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Background: This study, aimed to evaluate the role of paraoxonase-1 (PON-1), in the pathogenesis of acute pancreatitis (AP). PON-1 plays a significant role in antioxidant, anti-inflammatory and antiatherogenic responses and may help predict the severity of AP.

Methods: A total of 50 patients with AP and 45 healthy volunteers were included in the study. AP was diagnosed when serum amylase and/or lipase values increased threefold and/or more than the upper limit of normal, together with a complaint of abdominal pain. Modified Atlanta and Ranson scoring were used for AP severity.

Results: AP causes were biliary for 35 (70%) patients and idiopathic for 8 (16%) patients, AP developed in 6 (12%) patients after endoscopic retrograde pancreatography, and AP in 1 (2%) patient was a consequence hypertriglyceridemia. No difference in PON-1 level was found between the groups (PON-1=197.06±164.6 and 192.1±111.78, respectively, p=0.86). On the other hand, patients were stratified according to the modified Atlanta (177.5±166.8 for mild to moderate vs. 268.5±64.2 for severe, p<0.018) or Ranson (163.2±133.06 for mild vs. 208.8±158.0 for severe, p<0.016). PON-1 level was significantly higher in patients with severe AP compared to patients with mild and/or moderate disease.

Conclusion: Although PON-1 level did not differ in patients with and without AP, PON-1 level increased significantly in parallel with the severity of AP. Thus, PON-1 can be a potential marker for the severity of the disease and can predict prognosis.

Cancer is the second important cause of death worldwide. Cancer is one of the top health priorities in Iran. We aimed to study the socio-economic inequality of cancer incidence in Iran provinces. We conducted this cross-sectional study using provincial data. We obtained the required data from the statistical yearbook report, the Statistics Center Report and the National Cancer Registration Program Report of Iran's Ministry of Health and Medical Education (MoHME) for 2018. Socio-economic inequality of cancer incidence was analyzed by estimating the concentration index and extracting the concentration curve. Statistical analyzes were performed using STATA 14. Our findings revealed that cancer incidence was unequally distributed in terms of the socio-economic status in Iranian provinces. Cancer incidence is slightly concentrated in the provinces with higher than average literacy, per capita income and insurance coverage and household size below average. The concentration of cancer incidence has been to the detriment of the provinces that have a slightly better ranking in terms of the socio-economic index. The employment rate did not significantly affect cancer's distribution burden. We recommend policymakers facilitate early cancer detection by providing insurance coverage for screening services, payment exemptions, and public awareness.

Background: Work-related musculoskeletal injuries and disorders (WMSD) are a significant cause of morbidity in the health care sector. Healthcare professionals are routinely exposed to various physical and psychosocial factors that increase the risk of developing a WMSD. Nurses are more susceptible to the manifestation of such disorders.

Methods: A cross-sectional study was conducted during the second semester of 2020. The Nordic Questionnaire (NMQ) was used to investigate the prevalence of musculoskeletal symptoms, the Short Anxiety Screening Test (SAST) for stress detection, and a data collection sheet was developed for the registration of clinical, demographic, and anthropometric characteristics of the nursing personnel of the tertiary hospital unit of Heraklion, Crete, Greece.

Results: A percentage of 82% of nurses had developed at least one musculoskeletal symptom in the last 12 months. The most common anatomical areas at which symptoms were present the last 12 months were the neck (53.9%), shoulders (50.8%), and the lower back (49.5%). The same areas were also the reported anatomical regions, most affected by musculoskeletal symptoms when stress levels were high. Absence from work was associated with the onset of musculoskeletal symptoms (p<0.001), while nurses' financial expenses (out-of-pocket payment) appeared to be associated with the onset of any symptom at 12 months, musculoskeletal symptoms limiting everyday activity at 12 months, and current musculoskeletal symptoms (p=0.001, p=0.002, and p=0.002 respectively).

Conclusions: Musculoskeletal disorders were common among the nursing personnel. Higher levels of stress were related with a higher prevalence of musculoskeletal symptoms.

In this study we investigated the relationship between vitamin D and markers of oxidative stress and apoptosis in patients with liver cirrhosis stratified according serum GGT activity. Forty-eight patients with liver cirrhosis of various aetiology were selected, among which 58% cases (n=28) diagnosed with alcoholic liver cirrhosis and 42% (n=20) with cirrhosis after hepatitis virus infection. Each group was divided into three quartiles according GGT activity. 25-hydroxyvitamin D [25-(HO) vit D], markers of oxidative stress (catalase, superoxide dismutase) and apoptosis (M30) were compared. Higher levels of GGT were correlated with elevated AST, ALT and ALP values in both groups. A statistically significant difference was observed when comparing 25-(OH) vit D levels of patients suffering from ethanol-induced liver cirrhosis versus control group for all the quartiles as well as for those from the first quartile of viral-induced liver cirrhosis. For SOD, statistically significant differences were noticed between all cirrhosis subgroups and the control group. CAT values in all cirrhosis subgroups were lower than in control, but significant differences were only between Q2.2 and Q1.3 quartiles and Q2.2 and control. Correlation of 25-(OH) vit D versus SOD yields statistically significant results in ethanol-induced cirrhosis patients. M30 activity was increased in patients with alcoholic cirrhosis compared to controls and those with virus-induced cirrhosis, being correlated with the degree of GGT activity. Our results emphasized that vitamin D deficiency is associated with enhanced liver dysfunction regardless of the trigger responsible for disease onset. Furthermore, vitamin D deficiency augments liver injury by promoting oxidative stress which influence the survival mechanisms of parenchymal liver cells.

Objective: Evaluation of Intraplacental Villous Artery Doppler (IPVA) as a predictive factor compared to umbilical artery (UA) Doppler in placenta-mediated disease (PMD).

Methods: This prospective study included a group of 106 pregnant women, of which 76 patients constituted the PMD group: preeclampsia (PE) and small for gestational age (SGA), and 30 pregnant women constituted the control group. IPVA and UA Doppler evaluation was performed in 2 pregnancy periods: 20.0-23.6 weeks, and 28.0-32.6 weeks of gestation.

Results: From the study of maternal characteristics and risk factors for the presented pathology, we found that no studied risk factor was statistically involved in the evolution toward PMD during pregnancy. In the control group, we noticed a decrease in IPVA PI and RI, along with an increase in gestational age, while in the PMD group, these indices increased. Both in the 2nd and the 3rd trimester, we had a significant statistical difference between the two groups (p<0.001). Regarding the degree of prediction of the changes that occurred at this level, we found a good statistical correlation. A higher degree of positive predictability is noted, for IPVA-PI, but also for UA-PI, but with better sensitivity (72.27%) for UA PI in the 2nd trimester.

Conclusions: We can conclude that both Doppler measurements, IPVA and UA can be used to evaluate and detect pregnancy complications that belong to PMD, preeclampsia, and/or fetal growth restriction.

Background: This study aimed to investigate the effects of MUVON PLUS, a dietary supplement containing hydrolized collagen, chondroitin sulfate, and vitamin C, on the biomechanical behavior of the knee joint in patients with second-degree osteoarthritis (OA).

Material and method: The study included 15 participants who underwent biomechanical testing before and after 3 and 6 months of supplement administration. Biometrics and SimiMotion software were used to process and analyze the data. Results showed significant improvements in biomechanical parameters such as joint range of motion, joint torque, and joint stiffness for all patients during the treatment. Improvements were observed across various tests, including horizontal walking, stairs climbing and descending, sitting/standing up from a chair, and knee squats. This improvement in biomechanical performance was also reflected in the patients' reported quality of life. For the stairs climbing test, the maximum flexion-extension angle increased by approximately 7% after 3 months and 12% after 6 months. In the stairs descending test, the maximum flexion-extension angle increased by approximately 8% after 3 months and 19% after 6 months. These results highlight an improvement in mobility for the study participants.

Conclusions: Significant improvements of the biomechanical parameters of the knee joint were found in all patients during the treatment with the MUVON PLUS in all tests, which indicates the clear clinical benefit, revealed by improving the quality of life reported by patients. Overall, the study demonstrated the effectiveness of MUVON PLUS in enhancing the biomechanical behavior of the knee joint in patients with OA, providing valuable insights for future research and treatment.

Surfactant deficiency is a rare genetic disease. Clinical presentation is manifested with a large specter that varies from severe form to lethal in neonatal age and to progressive, chronic form of the interstitial lung disease in older child. In this manuscript we want to present the case of a two years and 7-month-old child, which was diagnosed with Pediatric Acute Respiratory Distress Syndrome (PARDS) as consequence of bilateral interstitial pneumonia. The child was treated in a supportive way, placed in mechanical ventilation, antibiotic therapy and corticosteroid. After the complete examination, the child resulted with surfactant metabolism dysfunction of type ABCA3. In this case we want to emphasize the attention for rare genetic disease like surfactant deficiency as a cause of recurrent pneumonia cases with unclear focus.

Melanomas originating from the dura-mater are extremely rare tumors. The diagnosis is complex, and usually only made after excluding other entities. The prognosis is poor, with average free-disease survival of 20 months, after treatment with complete surgical excision and adjuvant therapy. We report the case of a 41-year-old asymptomatic patient, presenting with a subcutaneous mass in the left parieto-occipital region, later diagnosed as a primary dura mater melanoma. Treatment included complete microsurgical excision, radiotherapy and adjuvant immunotherapy. Therefore, due to the rare nature of the disease and its high lethality, correct diagnosis and treatment are medical challenges.

Background: Increased uteroplacental resistance is associated with high uterine artery pulsatility and resistance indices and early diastolic notching. Evolution toward reversed diastolic uterine flow in the third trimester was scarcely reported previously. The feature was related to severe complications for both mother and fetus.

Material and methods: Data were collected from 3638 pregnancies undergoing prenatal care in our hospital. In this study, we aimed to identify those pregnancies with development of a reversed diastolic flow at the spectral Doppler interrogation of uterine arteries later than 24 weeks of gestation. A secondary aim was to follow up and actively manage these pregnancies.

Results: Previously, reversed uterine diastolic flow was reported during the third trimester in four cases only. In our study three pregnancies only developed reversed uterine arteries diastolic flow, none being associated with preeclampsia. All cases evolved with complications at birth.

Conclusions: Progressive deterioration of uterine arteries flow is possible during pregnancy. Reversed diastolic flow is a rare occurrence in the third trimester of pregnancy. Based on current knowledge, it may be considered an ominous sign and should trigger a close follow-up. Future studies using routine investigation of uterine arteries flow late in pregnancy may prove informative.

The association of sedation with analgesia in endoscopic procedures represents the ideal combination of anesthetic drugs, which allows these exploratory procedures to be carried out safely, in an outpatient setting. The aim of this study is to compare the results of the use of simple Propofol or Propofol associated with Fentanyl in order to ensure optimal sedation necessary for the detection of benign or malignant lesions of the digestive tract. In this study, 80 patients aged between 18 and 80 years were included, 40 in Group 1 who were administered Propofol alone and 40 in Group 2 in which Propofol was administered associated with Fentanyl. The onset of anesthetic sleep was 19.3±5.1 seconds in Lot 2 versus 29.6±9.1 seconds in Lot 1. The average dose of Propofol used was 203.6±82.8 mg in Lot 1 and in Lot 2 it was lower, 166.3±8.3mg. Cardio respiratory changes were more frequent in Lot 2. The wake-up time was 3.2±1.2 minutes in Lot 1 as a result of the administration of Propofol alone and 7±1.4 minutes in Lot 2. The discharge time was equal for patients in both groups. The degree of postanesthesia safisfaction was 10 for all patients from Lot 2, due to the analgesia provided by the administration of Fentanyl. The use of Propofol associated with Fentanyl in gastrointestinal endoscopic procedures is associated with a rapid recovery of cognitive function at the time of discharge and minimal adverse events, ensuring optimal conditions of analgesia and stability of vital functions.