Introduction. To date, there are virtually no data on pathomorphological changes in the mucous membrane of the small intestine in coinfection HIV/ Mycobacterium tuberculosis (HIV/TB), which could be the basis for the development of malabsorption. The objective of the study was to investigate the pathomorphological characteristics of the small intestine mucosa in patients with coinfection HIV/TB. Materials and methods. The prospective pathomorphological study included 24 patients with HIV/TB coinfection (main group), and 20 patients without HIV infection, gastrointestinal pathology or morphological signs of TB (control group). Results. The thickness of the small intestine mucosa, the average height and width of villi were significantly lower in the HIV/TB group compared with the control group (p<0.05). The relative area of connective tissue in the small intestine mucosa was increased in the main group (p<0.05). The coefficient of variation of the optical density of nuclear chromatin in the main group noticeably exceeded the coefficient in the control group: 42.7±6.47% vs. 6.7±0.34% (p<0.05). The red/blue (R/B) ratio in the main group almost doubled that of the control group, while the quantitative index of the optical density of the specific colour for free amino groups was 1.7 times higher than in the control group (p<0.05). Conclusions. Coinfection HIV/TB is accompanied by the development of atrophic and sclerotic changes in the small intestine, a decrease in the functional activity of enterocytes and increased intensity of free radical processes.

Introduction. The worldwide alarming rise in the incidence of metabolic syndrome (MS) in children has made the prevention and early treatment of obesity an important medical goal. The objective of the study was to assess the role of proinflammatory markers, such as tumour necrosis factor-alpha (TNF-?) and high-sensitivity C-reactive protein (hs-CRP), and adipokines (leptin, adiponectin) in the development of MS in children and the impact of treatment with gastrointestinal lipase inhibitors on the degree of obesity and blood pressure values. Material and methods. The study included 24 children with metabolic syndrome. The serum values of lepine, adiponectin, TNF-? and hs-CRP were determined in children with MS compared to a control group of 50 children of similar age. Results. The serum level of leptin, hs-CRP, and TNF-? was higher in children with MS as compared with the control group. The adiponectin level was lower in children with MS, compared to the control group. After eight weeks of drug treatment with gastrointestinal lipase inhibitors in all children, a decrease in body mass index, abdominal circumference and blood pressure values was found, but the most important decreases were found in children who received non-pharmacological treatment in combination with gastrointestinal lipase inhibitors and angiotensin-converting enzyme inhibitors. Conclusions. Hypoadiponectinemia, hyperleptinemia, increased serum hs-CRP and TNF-? suggest that these adipokines/cytokines contribute to subclinical inflammation in children with MS and may also serve as biomarkers of MS. In combination with a low-calorie diet, regular exercise and lifestyle changes, treatment with gastrointestinal lipase inhibitors may help to reduce the prevalence of obesity and hypertension in children.

Introduction. The main treatment of autoimmune thyroiditis (AIT) is conservative. However, there are patients with AIT in whom surgical treatment is mandatory. The growing experience and reports of surgical intervention with newer indications challenges this traditional view of AIT. The objective of the study was to determine the choice of surgery volume in patients with nodular goiter and AIT, taking into account the activity of apoptosis, index of proliferative activity and polymorphisms of cytotoxic T-lymphocyte antigen-4 (CTLA-4) gene. Material and methods. 95 patients with nodular goiter and autoimmune thyroiditis (NGAIT) were included in the study. We determined the activity of the apoptosis index of proliferative activity and gene polymorphism of CTLA-4. Results. The correlation analysis of markers used to optimize surgical treatment, namely the choice of the surgery volume in patients with NGAIT, showed that the studied tests are objective and reliable for the long-term results of surgical treatment: the volume of the thyroid gland not affected by the nodes less than 10 cm3, the level of antibodies to thyroid peroxidase (TPO Ab) <80.25 IU/mL, the level of antibodies to thyroglobulin (TG Ab) < 89.34 IU/mL, index of the immunoproliferative activity (IPA) Ki-67 <10.55%, index of immunoreactive cells (IIRC) Fas >43%, IIRC Bcl-2 <90%, IIRC p53 >50%; AA and AG-genotype of the CTLA-4 gene. Conclusions. The study allowed to determine new criteria for selecting the volume of surgery in patients with NGAIT.

Introduction. Cancer surgery often involves excisions that lead to important anatomical defects. The reconstruction methods following an ablative surgery for head skin cancer are unique and require special attention for both shape and function. Utilisation of split-thickness or full-thickness skin grafts is indicated for face regions with minimal motion. Case presentations. We present four cases of skin cancer, who required a flap for the reconstruction of post-excision defects. The first case is of a 90-year-old male with a right preauricular squamous cell carcinoma. The remaining defect after tumour ablation was reconstructed with a full-thickness skin graft harvested from the arm. The second case is of a 45-year-old male with a malignant melanoma of the scalp. The defect on the scalp was also covered with a skin graft. The third case is of a 51-year-old diabetic woman with left nasal skin cell carcinoma. The defect left after excision was reconstructed with a nasolabial flap and a free cartilage graft harvested from the concha. The fourth case is of a 65-year-old male with a basal cell carcinoma of the nose. The aesthetic result at a distance, after nasolabial flap reconstruction, was very good. Conclusions. The nasolabial flap is reliable, plastic and perfectly suited to the one-step reconstruction of fascio-cutaneous material losses. Age does not affect the graft viability, but control of comorbidities, such as diabetes, are extremely important when using cartilaginous grafts.

Introduction. Primary neuroendocrine tumours of the gallbladder represent 0.2% of all neuroendocrine tumours. The diagnosis is incidental in most cases. Case report. We present the case of a male patient, with no significant personal pathological history, who presented for pain in the right hypochondrium with posterior irradiation. The abdominal ultrasound examination performed at presentation in the emergency room described an acute lithiasis cholecystitis. Laparoscopic surgery proved difficult due to adhesions and difficulties in grasping the gallbladder. The results of the histopathological examination established the diagnosis of a small cell neuroendocrine carcinoma, confirmed by the immunohistochemical tests. Conclusions. In most cases of primary neuroendocrine tumours of the gallbladder the paraclinical examinations suggest a benign disease. The positive diagnosis is done after surgery, by histopathological examination, which can change the postoperative therapeutic management.

Introduction. Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease, considered to be caused by chronic, late-phase allergic reactions to various allergens, including food and environmental antigens. Case presentation. A 27-year-old woman presented for dysphagia, chest pain, vomiting, weight loss and painful aphtoid lesions in the oral cavity. An upper digestive endoscopy has been performed, that revealed attenuation of the subepithelial vascular pattern, exudate and edema in the cervical esophagus. In the lower thoracic esophagus, numerous ulcerative lesions and extremely fragile mucosa with numerous white papules have been observed. Multiple biopsies have been obtained from the distal esophagus, that showed a high number of eosinophils (>15 eosinophils per high power field). After seven days of treatment with omeprazole, topical glucocorticoids (Fluticasone) and allergen elimination diet, an upper endoscopy was repeated, revealing a significant improvement in the macroscopic aspect of the esophageal mucosa. Eight weeks later, the endoscopic reevaluation showed normal esophageal mucosa, biopsies containing less than 5 eosinophils per high power field. Conclusions. EoE should be suspected in adults with a history of food impaction, with persistent dysphagia for solids, or with gastroesophageal reflux disease that fails to respond to medical therapy. In patients suspected of having EoE, the first diagnostic test is the upper endoscopy with esophageal biopsies. The early diagnosis of EoE in young patients with suspicious symptoms can help prevent further complications, such as fibrotic esophageal strictures or even Boerhaave’s syndrome.

Coronavirus disease 2019 (COVID-19) is mainly a respiratory disease, that can lead also to cardiovascular complications such as myocarditis, acute coronary syndromes, arrhythmias, heart failure, stroke, venous and arterial thromboembolism etc. Furthermore, cardiovascular patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have worse outcomes and higher risk of death(1). Myocardial injury can be caused by myocardial ischemia or non-ischemic myocardial injury. Different mechanisms have been suggested: the affinity of SARS-CoV-2 to ACE2, widely expressed in the heart, the cytokine storm, activation of the sympathetic nervous system, myocardial damage induced by hypoxemia, anemia(2).

Introduction. Premenstrual syndrome (PMS) is a disorder characterized by physical, psychological and behavioural symptoms. These symptoms can affect the women’s quality of life on different aspects. The objective of the study was to investigate the relationship between PMS and sleep quality among women of reproductive age. Materials and methods. This is a cross sectional study on 768 women of reproductive age, who answered a self-reported questionnaire. This questionnaire consisted of three parts: demographic data sheet, premenstrual syndrome scale (PMSS) and Pittsburg Sleep Quality Index (PSQI). The primary outcome was the prevalence and severity of PMS and sleep quality, in addition to the correlation between PMS and PSQI. The demographic characteristics of participants and their impact on the PMS and PSQI were secondary outcomes. Results. PMS was reported in 90.5% of participants, with intensity ranging between moderate to very severe. There was a significant positive correlation between PMS and PSQI (p< 0.01). PMS did not show any correlation (P> 0.05) with the demographic characteristics, while the age and body weight only showed significant difference with reference to PSQI. Conclusion. The correlation between PMS and PSQI is significant and should be investigated in women with PMS, to develop a coping strategy regarding the sleep quality

Introduction. Carbapenems have been the ultimate antibiotics for the treatment of infections caused by multidrug-resistant bacteria. However, recently, carbapenems-resistant bacteria have emerged significantly. The objective of the study was the identification of ESKAPEEc bacteria and rapid detection of carbapenemase production. Materials and methods. We tried a novel rapid test methodology that detects some carbohydrates metabolization associated with bacterial growth in the presence of imipenem. The formation of acid metabolites is evidenced by a color change of a pH indicator. Results. Carbapenemase production is phenotypically demonstrated in carbapenem-resistant bacterial strains. In the study, carbapenemase production was detected within 3 hours, and identification of ESKAPEEc bacteria was completed within 4 hours by carbohydrate metabolism. Conclusions. In conclusion, our cost-effective technique may provide a practical solution for the determination of multi-drug resistance by using the fermentation metabolism in bacteria.

In ancient Greece, many textbooks were written in order to provide comprehensive, pioneering, and ingenious guides on the philosophy and medical aspects of sexual behaviour. Unfortunately, only fragments of these texts have survived among the treatises from Greek and Roman antiquity. The aim of this study is to examine these texts and understand the triad of the female prostitution-hygiene-medicine in ancient Greek populations. We conduct a thorough study of ancient texts, using PubMed, Google Scholar, and medical libraries of Athens, Greece. Prostitution in ancient Greece symbolized both lust and sexual freedom of women, while at the same time it could signal the relationship of female potency to control men. Most prostitutes served men in need of medical and psychological services. They also addressed issues like physical violence, sexually transmitted infections, post-traumatic stress, and unplanned pregnancies. The contribution of female prostitution in ancient Greece, demonstrates the polysemous development of terms such as «sexual pleasure», «lust», and «eroticism» in the medico-philosophical texts of that era.

Introduction. Recent research has demonstrated that the immunohistochemical nuclear ?-catenin expression is a valid surrogate for CTNNB1 exon 3 mutation in endometrial carcinomas (ECs). This mutation is an independent prognostic factor which identifies a subgroup of low-grade endometrial carcinomas that have a tendency for recurrence and worse prognosis. The objective of the study was to evaluate nuclear ?-catenin expression in different molecular subgroups of E Cs. Material and methods. We tested immunohistochemical nuclear ?-catenin expression in 50 cases of endometrial carcinomas diagnosed in two clinical institutions. Statistical analysis was performed between ?-catenin expression and various clinical, demographic, pathological and immunohistochemical parameters (age, myometrial invasion, FIGO grade, histopathological subtype, hormone receptors – ER, PR etc). Additionally, we analysed what molecular subgroup of ECs (MSS, MSI, p53wt, p53abn) revealed the most frequent cases with ?-catenin expression. Results. Our study indicated that ECs with nuclear ?-catenin positivity were observed in cases with higher FIGO grade (p=0.02), in endometrioid carcinomas (p=0.04) and in cases with lympho-vascular invasion (p=0.05). ER and PR were frequently expressed in the positive ?-catenin subgroup (p=0.03, p=0 .02). Our results show that ECs which express nuclear ?-catenin correlate with parameters that are already considered unfavourable. Conclusions. mmunohistochemical ?-catenin nuclear expression is an excellent replacement for the CTNNB1 exon 3 mutation in ECs and helps to stratify and predict prognosis in certain cases of ECs. We believe that future research will include this marker as part of the routine immunohistochemical panel for ECs.

ABSTRACT In troduction. Postoperative foreign body retention is a well-known and rare complication of all types of surgical interventions. The clinical presentation of a patient with an abdominal retained foreign body is generally as an infectious syndrome, such as intraabdominal sepsis, peritonitis, abscess formation, intestinal perforation or obstruction. However, these foreign bodies may remain dormant for years or may generate vague symptoms. Contained rupture and spontaneous passage through a hollow organ and subsequent rectal expulsion are very rare outcomes. Case presentation. We present the case of a 23 years-old female patient previously operated who had a spontaneous rectal expulsion about two months after the operation, with no need for any further operative intervention. Conclusions. The spontaneous expulsion of a postoperative foreign body is a very rare but possible situation. This is a very serious medicolegal problem and many safe operating room practices are implemented to minimize the occurrence of this complication, defined as gossypiboma or textiloma, as the most common foreign body retained is a surgical sponge.

Introduction. Pure white cell aplasia (PWCA) is a rare hematologic disorder characterized by the absence of neutrophil lineages in the bone marrow, with intact megakaryopoiesis and erythropoiesis. PWCA is commonly associated with several immune pathologies. Cytopenia in patients with thymoma is a paraneoplastic syndrome, along with other manifestations. The two major clinical issues in PWCA are various infectious complications and ulcerative-necrotic lesions of the skin and mucosa membranes. Case presentation. We present a rare case of a patient with thymoma and PWCA, as paraneoplastic syndrome. On the background of agranulocytosis, the patient developed sepsis and infective endocarditis (IE) caused by a rare agent, carbapenem-resistant Klebsiella pneumoniae. Conclusions. The rarity of endocarditis caused by Klebsiella species limits its recognition and awareness of its often severe course. Most cases of endocarditis with Klebsiella pneumoniae are associated with prosthetic heart valves. In patients with immunosuppression, such as PWCA associated with thymoma, and endocarditis, rare microorganisms must be considered.

Introduction. Common hepatic artery is one of the three branches of Haller tripod and gives rise to the left and right hepatic arteries. We describe the case of a 62-year-old woman with the right hepatic artery rising from abdominal aorta, diagnosed incidentally during an abdominal computed tomography angiography. Case report. The common hepatic artery was absent. In its place, the left hepatic artery originated from the celiac trunk, while the right replaced hepatic artery was observed arising directly from the abdominal aorta. Conclusions. The uncommon abnormal vascular pattern presented has not been yet classified as an anatomic variation. Such arterial aberrations should be considered by surgeons during cholecystectomy, liver transplantation and pancreatectomy, to avoid complications.

Introduction. Ganglioglioma represents a rare neuroglial tumour, affecting most frequently the pediatric population and arising in the temporal lobe. Based on the Ki67 proliferation index, gangliogliomas can be divided into benign and anaplastic. The aim of our study was to assess the interobserver variability regarding the estimation of the Ki67 index, in order to establish if such a system could have a high reproducibility. Material and methods. The proliferative activity of 25 cases including benign and anaplastic ganglioglioma has been revised through the Ki67 marker (clone SP6). The cases have been evaluated by five different pathologists with different degrees of experience, in order to test the reproducibility. Additionally, all the cases were evaluated for immunoreactivity for CD34 (clone QBEnd/10). Results. Out of the 25 cases included in this study, 44% of them were diagnosed as anaplastic gangliogliomas. Best interobserver agreement was noted in cases with a low Ki67 index (<5%), namely in 85.71% of all benign gangliogliomas. Cases of anaplastic ganglioglioma which had a fatal outcome featured Ki67 values ranging from 2% to 45%. In anaplastic ganglioglioma, the difference between the lowest and the highest assigned Ki67 value per case ranged from 4 to 25, with a mean value of the differences of 11. Conclusions. Most cases of benign gangliogliomas can easily be identified through Ki67, with little interobserver variability. Similar results can be obtained for anaplastic gangliogliomas with high Ki67 values. Nonetheless, there is a small percentage of cases with relatively high Ki67 values and little reproducibility among pathologists.

Introduction. Nerve stimulation tests are crucial in the early diagnosis and monitoring of neuromuscular disease. The objective of the study was to clinically characterize and validate repetitive nerve stimulation (RNS) testing in patients with the chronic autoimmune neuromuscular disease, myasthenia gravis (MG). Material and methods. Clinical assessment and RNS testing were performed in 30 myasthenic patients. Clinical assessments were classified using the Myasthenia Gravis Foundation of America (MGFA) clinical classification. Results. 30 myasthenic patients were recruited, with a mean age of 48.57±2.4 years and a female/male ratio of 2/1. MGFA classification placed 7 patients in group I (23.3%), 7 in group IIa (23.3%), 7 in group IIb (23.3%), 6 in group IIIa (20%), 2 in group IIIb (6.7%), and 1 in group IVa (3.3%). Additionally, 73.3% of patients had positive acetylcholine receptor (AChR) antibodies, and 20% had been diagnosed with thymoma. The RNS test was positive in 21 patients (70%). Patients with involvement limited to the orbicularis oculi muscles (group I) had a positive RNS test rate of 42.9%, whereas this rate increased to 64.2% in patients where the limbs and truncal muscles were affected (“a” groups: IIa, IIIa, IVa). Where respiratory and pharyngeal muscles were affected (“b” groups: IIb, IIIb), patients had a 100% positive RNS test rate. A statistically significant association was found between RNS test results and AChR antibody levels (p = 0.0041). Conclusions. These findings are of interest for physicians treating MG patients and administering RNS testing and suggest an alternative method for the diagnosis and monitoring of MG, in cases where AChR antibody quantitation is not appropriate.

Introduction. The closure of schools and the transition to online teaching, results of the restrictions imposed by COVID-19 pandemic, have led to major changes in the work environment, as well as the emergence of various negative manifestations on teacher’s health, such as burnout. The objective of the study was the assessment of burnout among teachers during the COVID-19 pandemic in the Republic of Moldova. Material and methods. A two-stage research questionnaire was applied on a sample of 375 teachers. As a result of the influence of pandemic restrictions, the occurrence of burnout was investigated using Maslach Burnout Inventory. Results. We found significant relationships between some demographic variables and the burnout. It has also been shown that women are more susceptible to burnout than men. Occupational stress and poor working conditions, as well as the absence of physical contact with students, are strong predictors of burnout, work experience being the only protective factor. Conclusions. The sudden change in physical working conditions, as well as the need to quickly change the teaching methods because of the COVID-19 pandemic, have a negative impact, increasing the incidence of burnout in teachers.

Introduction. Probiotics are well-known adjuvants, used as complementary therapeutic agents in health (e.g. metabolic or gastrointestinal) disorders, considering their beneficial role on gut microbiota, and their support in immunity. The objective of the study. This research followed the impact of probiotic supplementation on some clinical parameters related to metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) (weight status, body mass index, carbohydrate/ lipid profiles). Materials and methods. The comparative monitoring of the parameters was conducted over a 3- month period, on 41 subjects diagnosed with both MS and T2DM, who were separated into two groups, as follows: the study group (probiotics associated with allopathic treatment) and the control group (without probiotics). Results. Administration of dietary probiotics had a major impact on body weight, weight loss being significantly enhanced in the probiotic group than in the diet-only group (p=0.01). The effect of dietary probiotic administration on glucidic and lipidic profile was small (effect size (ES) 0.26 and 0.33, respectively), but better than in the control group, in whom the evolution was insignificant (ES 0.10 and 0.10, respectively). From a statistical point of view, the differences were insignificant (p>0.05). Conclusions. In the metabolic profile management of patients suffering from both MS and T2DM, probiotics administration had beneficial results, as highlighted by the results of the present study.

Introduction. Juvenile idiopathic arthritis (JIA) is a persistent type of arthritis with no defined cause that starts before the age of 16 years and lasts for at least 6 weeks. The objective of the study was to determine the clinical and laboratory efficacy of tocilizumab treatment in patients with systemic and polyarticular seropositive forms of JIA. Material and methods. The study took place in the Division of Rheumatology, Public Healthcare Institution – Mother and Child Institute, Chisinau, Republic of Moldova. The parents of the patients signed the written consent to participate in the study. The study was approved by the Ethics Committee of the institute. The inclusion criteria for enrolling the patients who underwent the biological treatment were both the systemic and polyarticular JIA forms (seronegative or positive) and active sacroiliitis. The exclusion criteria were the patients with active infections, tuberculosis, sepsis, malignancies, and immunodeficiency disorders. This study included 20 children with JIA, in whom tocilizumab was administered every two weeks. The number of painful joints, the number of swollen joints, and the global evaluation of the disease by the doctor (GEDD) and by the patient (GEDP), as well as via the Childhood Health Assessment Questionnaire (CHAQ), were determined. Furthermore, paraclinical tests, that included complete blood count and C-reactive protein (CRP), were determined. Results. Children treated with tocilizumab exhibited a decreased number of painful and swollen joints, as well as the GEDD, GEDP, and CHAQ scores. Moreover, a decrease of the erythrocyte sedimentation rate (ESR) and CRP was observed. Conclusions. Children with JIA treated with tocilizumab showed a considerable clinical improvement and the paraclinical indices revealed a lower active inflammatory response.

Introduction. Ophthalmologists worldwide are reporting various ophthalmic manifestations of coronavirus disease 2019 (COVID-19). The most common ocular manifestation is conjunctivitis. Even a rarer complication, retinal vein occlusion may appear in patients with COVID-19. Case presentation. A 52-year-old man was admitted for retinal vein occlusion of the right eye. He had been complaining of blurred vision for several days. A complete clinical and paraclinical evaluation of the patient was performed, in search of associated diseases. The patient tested positive for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Conclusions. Retinal circulation is a potential site for thromboembolic complications in patients with COVID-19. Ophthalmologists should be aware of this possible association and maintain a high level of suspicion of COVID-19 in patients with vascular occlusive diseases of the eye.