Chronic heart failure is a syndrome that appears in the evolution of a large majority of cardiovascular diseases. The main risk factors for chronic heart failure are arterial hypertension, coronary heart disease, diabetes mellitus, obesity, dyslipidemia etc. Over the years, researchers have been intensively studied new approaches and treatments to prevent the development of heart failure, to slow the evolution or to increase survival in patients with this syndrome. Dyslipidemia is a risk factor for chronic cardiovascular diseases, especially coronary heart disease. HMG-CoA reductase inhibitors (statins) are largely used for the treatment of hypercholesterolemia and coronary heart disease. Considering the beneficial effects of statins for the prevention and treatment of cardiovascular diseases, some studies suggested that these drugs can be beneficial in the context of chronic heart failure1-3. However, a “cholesterol paradox” has been recognized in patients with heart failure: although hypercholesterolemia is a risk factor for coronary artery disease, low cholesterol seems to be associated with a poor prognosis in patients with already installed heart failure, as compared with those without heart failure4-6. This is named “the cholesterol paradox”. There are multiple possible explanations for this paradox. Cholesterol is a marker of nutritional status in patients with mild to moderate heart failure. The congestive hepatopathy of patients with chronic heart failure may lead to decreased liver synthesis of cholesterol2. Also, the intestinal congestion in these patients may impair the absorption of cholesterol7. Studies have found that low serum cholesterol is secondary to the severity of the heart failure, as in other chronic diseases. However, it is not yet known if low cholesterol is the cause of a worse prognosis in heart failure or it is only a marker of more severe disease. On one hand, statins have pleiotropic effects that could be beneficial in heart failure, such as stabilization of atheromatous plaques, inhibition of proinflammatory cytokine activity and even antiarrhythmic effect8. On the other hand, statins may be harmful in patients with heart failure, raising their susceptibility to infections, because lipoproteins remove bacterial endotoxins from the circulation9. Treatment with statins reduces the level of coenzyme Q10, which plays a role in the mitochondrial respiration and influences the contractile activity of the myocardium10. The serum level of coenzyme Q10 is inversely correlated to mortality of patients with heart failure10. A meta-analysis of 15 studies including 45,110 patients with heart failure, from whom 22,471 were treated with statins, revealed that patients who received a statin had a lower all-cause mortality rate and rehospitalization for heart failure11. Two studies, CORONA and GISSI-HF, suggested that patients with systolic heart failure do not benefit from initiation of statin therapy12,13. CORONA trial suggested that rosuvastatin might be beneficial in patients with ischemic heart disease and systolic heart failure, with NT-proBNP value <868 pg/mL12. The negative results of these two studies are in contrast with numerous other small studies which have demonstrated the beneficial effects of statins in heart failure patients14. The clinical trials did not search if patients already taking a statin, who develop heart failure, benefit from continuation of statin treatment. Until further studies will clarify these issues, it seems reasonable that patients already on statin for another strong indication, developing heart failure, should continue the statin. Patients with systolic heart failure, with a left ventricle ejection fraction <35%, should receive a statin, according to CORONA trial results12. The decision to start a statin in patients with heart failure with preserved ejection fraction is usually based upon other indication, such as high LDL-cholesterol values or documented atherosclerotic vascular disease.

Oxidative stress is involved in the pathophysiology of many chronic diseases, including heart failure. Oxidative stress is an imbalance between the production of reactive oxygen species (ROS) and the antioxidant defense. The overproduction of ROS can lead to cellular damage and eventually cellular death. This applies also in patients with chronic heart failure, who present a dramatic increase of oxidative stress associated with a pronounced decrease of the antioxidant defense mechanisms. The components of the antioxidant defense mechanism of myocardial cells are superoxide dismutase (SOD), catalase, nicotinamide adenine dinucleotide (NAD+), glutathione peroxidase (GPx), and glutathione (GSH). Experimental animal studies have demonstrated the decrease of the activity of SOD, catalase and GPx in animal models with heart failure1,2. Furthermore, excessive ROS induce myocardial fibroblasts proliferation with cardiac remodeling. The promising results of experimental studies in animals with heart failure led to the hypothesis that oxidative stress may be a therapeutic target in patients with heart failure. Clinical trials have studied the effects of antioxidant treatments in humans with heart failure. Treatment of oxidative stress can have different approaches: inhibition of oxidative stress producers, increase of endogenous antioxidant capacity, and increase of antioxidant capacity by administration of exogenous antioxidants, such as vitamin C, vitamin A, vitamin E, folic acid. Inhibition of xanthine oxidase by the administration of allopurinol or oxypurinol in patients with chronic heart failure is the most studied treatment 3,4. Different trials have demonstrated that treatment with allopurinol or oxypurinol (inhibitors of oxidative stress) had beneficial effects on myocardial function, endothelial dysfunction, and led to the decreased levels of serum natriuretic peptides and improved left ventricle ejection fraction3,4. Other trials failed to demonstrate the beneficial effects of oxypurinol5. Other clinical studies focused on the effects of increasing the antioxidant capacity in patients with heart failure, by administration of vitamin A, vitamin C, vitamin E or folic acid. Despite the initial enthusiasm regarding the effects of these antioxidants, a recent meta-analysis of 50 randomized trials on their cardiovascular effects, including almost 300,000 patients, has demonstrated that supplementation with vitamins and other antioxidants failed to demonstrate a decrease of the cardiovascular risk. The third therapeutic approach, increase of endogenous antioxidant capacity, may be achieved by supplementation of cellular antioxidants GSH and NAD+6. This strategy has been studied only in a few trials, but their results until now seem to be promising. Supplementation with NAC, which is a precursor of GSH, in patients with chronic heart failure can be a potential approach in order to decrease the oxidative stress secondary to myocardial injury6. The improvement of the expression and activity of the gamma-glutamyl cycle and NAD+ producers is another option to increase the endogenous production of antioxidants in heart failure. Some studies have demonstrated that a few components of the gamma-glutamyl cycle (gamma-glutamyl-cysteine synthetase, GPx, OPLAH) are correlated with the risk of heart failure and its progression7. Therefore, the overexpression of these enzymes may have cardioprotective effects. OPLAH is a cytoplasmic enzyme of the GSH cycle, with a central function in the gamma-glutamyl cycle and also with an important antioxidant function; its expression is decreased in heart failure. Therefore, the stimulation of the expression and activity of OPLAH in patients with heart failure may play an important role for their prognosis. In conclusion, oxidative stress may play an important role in patients with chronic heart failure. Experimental studies have demonstrated the beneficial effects of therapies addressing the oxidative stress in animals. However, until now, these effects have not been fully demonstrated by clinical trials in humans. Further antioxidant strategies must be studied.

Introduction. Liver injury is an important cause of death in patients with traumatic injuries. The objective of the study. To study the dynamics of changes in histological parameters of injured liver tissues in case of mechanical trauma, depending on the time of damages in the absence of alcohol intoxication. Materials and methods. We examined liver tissue of 52 individuals (38 men and 14 women) aged 20-60 years, who died at known and unknown time in the absence of alcohol in the blood in the Lugansk region of Ukraine. The cause of death was a mechanical trauma. The study was conducted by means of histological, histochemical methods, statistical analysis. Results. Regular histological changes were observed in the area of injured liver tissue. These changes directly depend on the time elapsed since the caused damage. Usage of the histological method was proved to be expedient for determining the time of injury, both in the isolated liver injury and in combined injuries of the abdominal organs. This method allows to increase the objectivity of the results determining the time of injury. Conclusions. The study determined changes of histological parameters of liver tissue depending on the time of injury, time of death, presence of traumatic illness, which can help in solving the question on the injury duration.

Introduction. Non-Hodgkin’s lymphoma (NHL) shows clonal and uncontrolled proliferation of immature lymphoid precursors. The aim of the study. Dynamic analysis of immunobiological and immunophenotypic parameters in the treatment of patients with NHL, and recognition of immunological remissions. Material and methods. The retrospective study group consisted of 122 patients, admitted between 2012 and 2015 in the Hematology Clinic of the Republic of Moldova Oncology Institute, with a morphologically confirmed diagnosis of NHL. We assessed the predominant phenotypic line by indirect immunophenotyping and total concentration of immunoglobulin classes (A, M, G) according to treatment regimens applied to NHL patients. Results. 119 patients showed CD19 antigen and CD20 increased expression of cell line B phenotype (84.4%); only 3 patients in the study showed increased CD3, CD5, resulting in the predominant T-cell phenotype line. NHL patients with both aggressive and non-aggressive primary variants after 3 cycles and 6 cycles presented a significant decrease in immunoglobulin A, M, and G indices, on average of 7.3±0.2(mg/ml) (p?0.05), while the immunological indices of patients treated with the polychemotherapy (PTCH) scheme 2 reported statistically significant minimal decreases (p <0.05), setting an incomplete immunological remission. Conclusions. Due to the information obtained by periodic monitoring of patients with NHL following the termination of conventional clinical protocols, it was possible to reveal the immunological and immunophenotypic features of the disease, for the detection of early and late recurrences, late side effects, occurrence of the second malignancy, with the evaluation of the immunological and immunophenotypic remission and identification of specific molecular targets for subsequent targeted therapy.

Background. The burden of immunodeficiency and infectious diseases is rapidly increasing worldwide. Thus, it becomes necessary to find effective and affordable immunomodulatory drugs that may modify the response of the immune system. Objectives. To investigate ultramicroscopic changes that occur in parathyroid glands and thymus of male rats after administration of the immunomodulatory agent imunofan. Methods. Thirty-six WAG matured male rats were divided randomly into two groups. The first group received imunofan in a dosage of 0.7 mg/kg animal body weight by intramuscular injection. Rodents were sacrificed on the 3rd and 30th day after injection and specimens were dissected out and processed for electron microscopy. The second group served as control and was provided 0.9% soluble sodium chloride. Results. The results showed that imunofan exposure caused marked ultramicroscopic changes in parathyroid glands and thymus of rats. On the 3rd day after injection, the amount of the active chief cells significantly increases. A significantly increased number of secretory granules is recognized as the ultrastructural hallmark of chief cells change. Thymus in this term of imunofan administration showed no significant ultrastructural changes in comparison to control group. On the 30th day after the administration, the examination revealed that all the glands of the experimental rats have big amounts of active cells with well-developed secretory apparatus. Floccular ?r particulate material was observed in the enlarged intercellular spaces surrounded by three or more chief cells. A significant amount of the secretory granules as the material might be excreted by exocytosis into the intercellular spaces. Electron microscopy of thymus revealed that imunofan injection causes changes in organ as a result of the activation of cell-mediated and antibody-mediated immunity on 30th day. Apparently, it also causes temporary delay of age-related thymic involution. Conclusion. The dynamics of changes in the electronic microscopic structure of rats’ parathyroid glands and thymus indicates a high degree of organs reactivity in response to immunotropic drug administration.

The objective of the study was to research the dynamics of changes in oxidative and reducing systems in the blood and tissues of the pancreas, lungs and liver during the development of acute necrotizing pancreatitis. Material and methods. The experiment involved 63 sexually-mature rabbits “Gray giant”. The degree of oxidative modification of plasma proteins was assessed by the method of I.F. Meshchyshen. The content of malonic aldehyde in the erythrocytes was determined by the method of I. D. Stalna and T.G. Gorishvili. The content of ceruloplasmin in the serum was studied by M.I. Revina method. The level of medium mass molecules was determined by the method of N.I. Gabrielyan. The oxidative modification of proteins in the tissues of the pancreas, liver and lungs was carried out using the histochemical method and original techniques. Results. The development of acute necrotic pancreatitis in the experiment was characterized by an increase in the activity of lipids and proteins in the blood and the oxidative modification of proteins in pancreatocytes, hepatocytes and alveocytes, which is one of the leading mechanisms for their lesion. The growth of the oxidative modification of proteins in the endothelial cells of the pancreas, liver and lungs in the development of acute pancreatitis contributes to the occurrence of endothelial dysfunction, which is the leading factor in the secondary lesions of these organs. Conclusions. Considering the important role of lipoperoxidation and oxidative modification of proteins in the mechanisms of progression of acute necrotic pancreatitis, it is pathogenically grounded to develop new effective methods of systemic and local antioxidant and anti-proteolytic effects.

The aim of the study was to assess the state of receptor binding parameters under the action of sodium fluoride on the organism under model conditions for the intoxication formation. Material and methods. The experimental part of the work was performed on 16 white rats of the Wistar population. Internal organs and tissues were subjected to the study of the state of receptor binding parameters of labeled C1, C2 serotonin, a1, a2, ß-adreno, D2-dopamine and glucocorticoid type II receptor agonists and antagonists in various regions of the brain and liver. The functional activity of the receptors was assessed by affinity and the number of binding sites and ligands. Results. The study of the effect of sodium fluoride on the kinetic characteristics of the adrenoreceptors of the membrane fractions of liver cells and the cerebral cortex showed similar dynamic changes in the parameters of receptor binding of both a1-adreno- and ß1-adrenoreceptors. The effect of sodium fluoride was manifested in a decrease in the affinity of the radioligand for a2-adrenoreceptors and an increase in the number of binding sites for this type of receptors. Similar dynamics of the kinetic characteristics of a2-adrenoreceptors was found in the cerebellum. The number of binding sites for ß1-adrenoreceptors increased, while their affinity for ligands decreased. In the brainstem, there was a decrease in the affinity of the D2-receptors for ligands and the number of binding sites. Under conditions of subtoxic effect of sodium fluoride on white rats, a decrease in the affinity of radioligands for C2-receptors and the number of their binding sites in the cerebral cortex was observed. Conclusions. The results of the study show that under the conditions of the formation of fluoride intoxication, structural and functional disorders of the receptor apparatus occur, which confirms the leading role in the development of this pathology of the state of biological membranes. Changes in the kinetic characteristics of adrenaline (a1, a2, ß1), serotonin (C1, C2), dopamine (D2) and glucocorticoid receptors confirm the polytropic nature of the action of sodium fluoride on organs, systems and functions of the body.

Introduction. Melatonin, a potent antioxidant agent, is essential for glucose homeostasis. The objective of the study was to determine the influence of melatonin on basal levels of glucose in blood, activities of glucose-6-phosphatase in kidney and liver, pyruvate kinase in muscles and heart, content of glycogen in muscles and heart of rats with alloxan-induced diabetes. Materials and methods. Diabetes was induced in male Wistar rats by single intraperitoneal injection of alloxan monohydrates (170 mg/kg). Four days after diabetes induction, rats were divided into diabetic and melatonin-diabetic groups (10 mg/kg «Sigma» USA, daily and intraperitoneal for 14 days starting from the 5th day). Results. Melatonin injections caused normalization of the elevated serum glucose level in diabetic group of rats compared with basal glucose level before treatment. The activity of pyruvate kinase in muscle and heart tissue of diabetic animals was 45% and 63% less than in control groups, respectively. Regarding kidney and liver of diabetic rats, the activity of glucose-6-phosphatase was increased in average by 148% compared with control value. The glycogen content in the heart and skeleton muscles of diabetic animals was reduced in average by 20% compared with the control. Melatonin restored all these indexes back to normal level. Conclusions. These findings suggested that melatonin restored the events in Cori cycle by possible activation of glycolysis in skeletal and heart muscles and normalization of gluconeogenesis in liver and kidneys.

The objective of the study was to evaluate the dynamics of reorganization of connective tissue, aldosterone and glucose level as markers of favorable course of multidrug-resistant pulmonary tuberculosis. Materials and methods. The study was performed on 84 patients with firstly diagnosed multidrug-resistant pulmonary tuberculosis. Aldosterone, free and protein-bound hydroxyproline and glucose levels were measured in all patients. Results. It was found that in group I patients, free hydroxyproline levels are lower than in group II during the first two months of treatment for 60% at treatment onset and for 29.4% after 2 months of treatment. There was an increase in this index during the first 2 months of treatment in both groups. Protein-bound hydroxyproline level was higher in group I by 21.7%. The level of aldosterone at the treatment onset was almost identical in both groups. After 2 months of treatment, its level decreased in both groups. However, after 2 months of treatment in group I, its index was lower than in group II by 12.7%. Conclusions. Our results suggest that patients with a favorable course of multidrug-resistant tuberculosis have more pronounced decrease in aldosterone level, which may act as a pro-inflammatory agent and free hydroxyproline, which is a marker for the destruction of connective tissue. Inverse correlation between protein-bound hydroxyproline and glucose levels confirm the importance of normal glucose concentration for repair process.

Introduction. Reliable detection of papilledema is essential for establishing the diagnosis of idiopathic intracranial hypertension (IIH). The ophtalmoscopic fundus examination of the optic nerve head (ONH) is a subjective measurement, limited by the examiner’s experience, the patient’s degree of collaboration and the optics of the ophthalmoscope, making it often unreliable in detecting early edema and in assessing initial improvements or worsening. The objective of the study was to assess the role of optical coherence tomography (OCT) in diagnosing and monitoring papilledema in IIH. Materials and methods. The study period consisted of 3 years (October 2014- October 2017) in which we evaluated how OCT parameters correlated with the clinical grading of the optic nerve head (ONH) edema according to the Frisén’s scale. We included 11 patients (6 adults and 5 adolescents aged 15 years and above) with recently diagnosed IIH in the University Emergency Eye Hospital and ‘Prof. Dr. Al. Obregia Psychiatry Hospital, Bucharest, Romania. Patients underwent clinical evaluation and OCT examination in the Retina Clinic, Bucharest, Romania. The measurements were compared to a group of 13 subjects with demographic characteristics similar to the study lot, without IIH (7 adults and 6 adolescents over 15 years). Results. The average retinal nerve fiber layer (RNFL) thickness in the study lot was 165.8 µm, (95% CI ± 33 µm) compared to 116 µm (95% CI, ± 4.3 µm) in the control group, P= 0.001. We demonstrated a significant difference between the average RNFL thickness correlated to papilledema severity (r=0.967, N=22, p = 0.001), with an average value of 117 µm (95% CI, ± 16µm) in case of mild edema, 165 µm (95% CI, ± 89µm), in moderate cases and 269 µm (95% CI, ± 31 µm) in severe cases. Conclusions. Fundal photographs and optical coherence tomography can be used with clinical assessment and other visual tests for the diagnosis of papilledema. Frisén grade determined by direct fundus examination was significantly correlated with OCT parameters reflecting optic nerve head edema. Following the peripapillary RNFL thickness over different check-ups provides a quantitative and sensitive measurement of changes in the papilledema.

Introduction. The lung cancer has an increased incidence and is associated with the highest death by cancer worldwide. It represents a heterogenous disease with variability in trends and has a severe socio-economical impact. That is why it should be continuously monitored, especially in countries without national registries or screening programs. The objective of the study was to identify the epidemiological trend in patients with lung cancer addressed to a Romanian tertiary pneumology service. Material and methods. We performed a retrospective study on 660 patients diagnosed with lung cancer: the first group of 260 patients diagnosed between 2001-2004, and the second group of 400 patients diagnosed between 2009-2010. Results. Patients from the first group had a mean age of 61.20±11.14 years. 80.80% of them were men and 80.76% smokers. The main symptoms were cough (46.92%) and dyspnea (45%). The most frequent histological subtype was squamous cell carcinoma (44.13%). Only 35 patients from the first group underwent surgery. In 2004, from 260 patients enrolled, 20 were still alive. In the second group the mean age was 63.97±10.27 years. 79.05% were men and 84.29% smokers. The main symptoms were cough (58.12%) and dyspnea (40.10%). The most frequent histological subtype was the squamous cell carcinoma (47.13%). Surgery was performed in 65 patients (16.25%) and they had mean survival of 50 months. Conclusions. The incidence of lung cancer is increasing, especially in centers without screening programs. There is no change in male prevalence over the years. Despite the fact that, worldwide, adenocarcinoma has increased incidence, in our study squamous cell carcinoma was the main histological subtype. The delays in diagnosis remain similar. The majority of patients are still diagnosed in advanced stages, when curative treatment cannot be applied.

The objective of the study was to analyze a phenomenon that is more and more common in dental practice, i.e. the simultaneous presence on the arch of both the temporary tooth and the successor tooth. Material and method. The study has been conducted for over a year (1.01.2018-31.12.2018) by the authors practicing in Romania. From the total number of patients, we selected and studied those who had in the oral cavity both their temporary teeth and their successor teeth. In addition to their recording in the oral cavity, where appropriate, the temporary teeth extraction was used to place the definitive ones so that the functions of the dental-maxillary apparatus would not be altered. Results. 272 children with different pathologies at the oral cavity level were evaluated, of whom 102 children (37.5%) presented both temporary and definitive successor teeth. There were no significant differences between the two sexes. In the majority of cases, the temporary teeth and the definitive teeth were not in the same plane so that, on the arches line, the temporary ones and the permanent ones had an ectopic position; the temporary teeth had unreabsorbed roots and the final teeth had a defective position. Conclusions. Presence on the arches of both the definitive teeth and the temporal teeth leads to malocclusions that, if not corrected, the entire oral cavity will be damaged. If teeth with malposition do not return to their normal place on the arch, the patient will be directed to the orthodontic specialist.

Introduction. In the past years, the role of social workers in the oncological disease treatment processes has significantly increased. The role implies supporting patient’s psycho-social conditions. The objective of the study was to study the psycho-social challenges of oncological children and their families and to define a role of social work in this area. Material and methods. As part of a qualitative study, five interviews were conducted with pediatric oncologists, also 15 in-depth interviews with family members of oncological patients and a focus group with 8 members. For the quantitative study, 62 beneficiaries and 12 medical specialists were interviewed. Results. The children with oncology conditions and their families faced psycho-social challenges and were in need of social workers’ support in overcoming those challenges. The study demonstrated a low level of public awareness. There is a lack of information among both doctors and beneficiaries. Both psychologists and social workers are involved in re-socialization of oncological children and they care for the improvement of children’s quality of life and support their families. However, there are only a few of such organizations. Therefore, many people who need their support have no chance to take such services. Conclusions. Implementing the social work in the pediatric oncology will be a major step toward the medical quality standards.

Introduction. Recently, an increasing number of publications addressed the treatment of mild and moderate hallux valgus using corrective diaphyseal and distal osteotomies of the first metatarsal bone. Most of the diaphyseal and distal osteotomies of the first metatarsal bone are fixed with screws, which in combination with the shape of the bone saw cut provide, according to the authors, stability that is sufficient for early mobilization of patients, namely walking. The objective of the study is a comparative analysis of the results of surgical treatment of patients with mild and moderate hallux valgus with the use of corrective proximal sphenoid osteotomy of the first metatarsal bone and Scarf osteotomy. Materials and methods. The study is based on the surgical treatment of 100 patients with transverse-spread deformity of the forefoot and valgus deformation of the great toe of mild and moderate severity. Patients were divided into two groups, equal in number of people, gender (all women) and the average severity of the forefoot deformity. Patients of group 1 underwent corrective proximal sphenoid osteotomy (closing wedge) of the first metatarsal bone with fixation of “T”-shaped plate LCP of a single manufacturer. Patients of the group 2 underwent corrective Scarf osteotomy of the first metatarsal bone with fixation by two screws of a single manufacturer. Results. The average score of the treatment result according to the Groulier scale in group 1 is higher (76.40 ± 0.83 points) than in group 2 (70.88 ± 1.45 points) (t 3.3; p<0.001). Among the complications after surgical treatment of transverse-spread deformation of the feet, the most common was recurrence of hallux valgus, reaching 28 % of cases in group 2, which is 22% higher than in group 1. Conclusions. Displacement of the bone fragments of the first metatarsal bone in the osteotomy zone in the period of rehabilitation of the patients of group 2 resulted in 28% of cases of hallux valgus recurrence in the distant postoperative period, which is 22% higher than that in patients of group 1.

Introduction. A progressive increase of obesity prevalence, both among adults and children, is observed in many countries. Today, obesity is seen as a chronic systemic inflammation with low activity. Currently, new data are available about the biological and clinical significance of metal proteins in the inflammatory processes. The objective was to study the transferrin and ceruloplasmin indices in overweight and obese children. Material and methods. We have examined children with excess body weight (EBW, 30 children), obesity (40 children) and 30 healthy children aged 13-18 years. The evaluation included history, anthropometric data (height, body weight, body mass index, waist-to-thigh ratio – WTR), serum glucose, insulin, HOMA-IR calculation, transferrin (TF) and ceruloplasmin (CP). For statistical analysis of the results, statistic modules of Statistica v.6.0, MedStat and on-line SISA calculator were used. Results. In a total sample of 325 children, excess body weight was observed in 75 (23.1%) cases and obesity in 68 (13.6%) children. Boys prevailed, with 40 (53.3%) cases of EBW among those and 38 (55.8%) with obesity. The content of TF and CP in children aged 16-18 years was higher (28.1±0.8 mg/dL and 3.90±0.70 g/L, n = 22, p <0.05) than in children aged 13-15 years. The highest TF level (3.98±0.9 g/L, n = 16) and CP level (28.9±0.8 mg/dL, n = 16) were recorded in children with grade II obesity. There was no apparent difference either in the gender indices of TF and CP, nor in obese children combined with insulin resistance or obesity without insulin resistance. Less obvious changes in TF and CP were found in children with EBW. The weak relationships between the increase in BMI in children and the CP and TF (r = 0.28; p <0.001) level in the blood plasma of obese children (r = 0.23; p <0.0001) were detected, though they are highly statistically significant. Conclusions. Early identification of children with EBW and monitoring of their health, including the assessment of systemic inflammation markers, is an up-to-date and promising area for optimizing the obesity prophylaxis.

Introduction. Rapid development of perinatal medicine has led to an increase in the number of fetal surgical interventions performed intrauterine, on the trachea and principal bronchi. Therefore, topographic and anatomical peculiarities of the trachea and its morphometric parameters in the human fetuses of different ages cause interest of morphologists and surgeons. The objective of the study was to determine the skeleto-topic nature and the morphometric indices of the thoracic part of the trachea in the human fetuses aged 4-6 months. Materials and methods. Anatomical study of typical and variant anatomy of the thoracic part of the trachea involved 37 specimens of human fetuses, of 81.0-230.0 mm of crown-rump length, by means of macro-microscopic preparation and morphometry. Results. In the examined 4-6-month-old human fetuses, trachea within the superior mediastinum is predominantly placed in the median sagittal plane (25 cases, 67.6%), or is slightly replaced to the right (9 observations, 24.3%) or to the left (3 cases, 8.1%) from the median sagittal plane. In the fetuses aged 4-6 months the bifurcation of the trachea into the principal bronchi, is usually skeleton-topically determined at the level of the body of the II thoracic vertebra, and the pulmonary trunk bifurcates into the pulmonary arteries at the level of the body of the III thoracic vertebra. An intensive increase in the length and external diameter of the trachea within the superior mediastinum is noted in the fetuses aged 4 and 6 months. During the 4th-6th month of intrauterine development, these morphometric indices of the thoracic part of the trachea are 1.6 times higher.

Introduction. The continuous process of broadening the indications of laparoscopy has determined a reevaluation of its risks and benefits in extensive adhesiolysis. The objective of the study. The aim of the present study was to evaluate the efficacy and the associated risks of the laparoscopic adhesiolysis in the surgical management of the intestinal obstruction secondary to postoperative peritoneal adhesions. Material and methods. 17 patients with intestinal obstruction secondary to postoperative peritoneal adhesions admitted to the Surgical Department of the “Sf. Pantelimon” Emergency Hospital from Bucharest, Romania, between January 2014 and January 2018, were treated using laparoscopic surgery. The pneumoperitoneum was made using the open technique, far from the skin scars secondary to previous surgical interventions. After identifying the postoperative peritoneal adhesions as the cause of intestinal obstruction, the entire peritoneal cavity was rigorously inspected. Results. The laparoscopic exploration of the peritoneal cavity allowed for a clear identification of the cause and the level of the intestinal obstruction for all 17 patients included in the present study, 14 of them being treated by simple laparoscopic adhesiolysis, in 3 cases the conversion to laparotomy being necessary. The morbidity rate was low with no cases of death. The mean hospitalization stay was 5 days. Conclusions. The laparoscopic surgery represents an efficient therapeutic alternative to the classical methods for the treatment of the intestinal obstruction secondary to postoperative peritoneal adhesions,constituting a diagnostic and therapeutic tool that has the benefits of the minimally invasive techniques.

Introduction. Cognitive impairment is a key symptom of schizophrenia and is known to be due to neurodevelopment changes. The aim of our study was to compare verbal fluency of patients with paranoid schizophrenia (PSch), first grade relatives (FGR) and healthy control subjects (HC) and to find additional risk factors for poor verbal fluency test performances in cases with PSch. Material and methods. 108 PSch (66 males, 44 females, mean age 38.86±10.02 y), 58 FGR (30 males, 28 females, mean age 36.71±11.74 y) and 60 HC (37 males, 23 females, mean age 35.68±11.36 y) were studied during the period 2015-2017 at the Department of Psychiatry and Medical Psychology, University Hospital Pleven, Bulgaria. After giving informed consent, they underwent full somatic and neurological examinations and fulfilled Isaac’s Set Test (IST) and K, A, M, E literal fluency test (LF). Results. PSch obtained lower scores on both LF and IST than other two groups. FGR had poor performance only on LF. Ageing, level of formal education, severity and duration of schizophrenia were associated with LF and IST performances. Conclusions. PSch show significant LF and semantic fluency difficulties. FGR have only LF changes. Verbal fluency is related to ageing, formal education, duration and severity of schizophrenia.

Colorectal cancer represents one of the most common malignancies reported worldwide, associated with an increased risk of hepatic metastases development. Historically, the development of liver metastases from colorectal cancer has been associated with extremely poor rates in terms of survival. Improvement of the surgical techniques, as well as of the perioperative outcomes, in association with the development of new chemotherapeutic agents lead to a better survival; however, in certain cases with unresectable liver metastases, association of chemotherapy and resection can be no longer feasible due to the extent of the disease. In such cases liver transplantation has been proposed with promising results. However, this therapeutic strategy is only indicated when the absence of extrahepatic disease is documented. This is a literature review of the largest studies which focused on the topic of liver transplantation for unresectable liver metastases from colorectal cancer.

Pancreatic adenocarcinoma remains one of the most aggressive malignancies worldwide which is unfortunately associated with very poor long-term survival. However, it seems that the only option in order to improve the outcomes of these patients remains radical surgery consisting of in block resection of the tumor and the surrounding tissues. When it comes to the extent of the lymph node dissection, a permanent debate still exists between the eastern and the western countries; while the Western countries consider that an extended lymph node dissection increases the postoperative complication worthwhile, the Eastern countries consider that this should be the treatment of choice as long as these tumors usually disseminate on the lymphatic route. In order to establish what patients could benefit most from an extended lymph node dissection, certain authors proposed performing the sentinel lymph node biopsy technique. This is a literature review of the largest studies conducted on this theme.

Budd-Chiari syndrome (BCS) is a rare disease characterized by obstruction of the hepatic veins, regardless of mechanism and degree, in the absence of heart disease, pericardial disease or sinusoidal obstructive syndrome. In relation to etiology, BCS is classified in primary BCS, when it is caused by an intravascular thrombosis, and secondary BCS, when the obstruction is due to extrinsic compression or tumor invasion. The positive diagnosis is based on patient’s medical history, clinical examination, and paraclinical investigations. The clinical picture is polymorphous. The most common signs and symptoms include fever, abdominal pain and abdominal tenderness on palpation, hepatomegaly, ascites, edema of the lower limbs, gastrointestinal bleeding and hepatic encephalopathy. Laboratory tests can detect the degree of liver injury, with decreased serum albumin, altered coagulation, hepatic cytolysis and cholestasis, while imaging investigations may reveal the venous obstruction. Regarding treatment, all patients with BCS are recommended systemic anticoagulation to reduce the risk of thrombus extension and prevention of further thrombotic episodes. Depending on patient’s individual characteristics, angiography with or without stent, thrombolysis, trans-jugular intrahepatic portosystemic shunt and liver transplant are to be considered. The syndrome’s severity and prognosis are dictated by the underlying disease, ranging from a possible curability to quick death.

Psoriasis is a chronic inflammatory disease that affects the patients’ quality of life. In psoriatic patients, the quality of life is generally low due to multiple co-morbidities, treatments, stigma and misperceptions about this condition. Sexual dysfunction, in both women and men, is a comorbidity that may impact the quality of life of these patients, in addition to those listed above. Because the recognition of sexual dysfunction by the patient can be difficult and considered shameful, it is necessary for the family doctor to intervene to improve the sexual health of these patients.

Introduction. Thalassemias are the most common monogenic diseases. They are divided in two major categories: alpha – thalassemias (minor thalassemia), that do not have a special symptomatology and beta-thalassemias, which are a form of hereditary disease of hemoglobin (hemoglobinopathy), a severe form of anemia that requires treatment for life. In the case of major thalassemias, ketogenic analysis, the genetic defect occurs through deletions and point mutations of the gene that controls the synthesis of alpha or beta chains in messenger RNA at chromosome 11 level. It is an autosomal recessive disease. Homozygous patients with two beta-mutant genes have severe forms of diseases; heterozygous patients with a single beta-mutant allele have mild disease forms, but it is very important that they should be properly evaluated and diagnosed for genetic counseling. The objective was to describe dental abnormalities that occur in case of thalassemias. Materials and method. Two clinical cases of two patients aged 2 years and 12 years, diagnosed with beta-thalassemia and alpha-thalassemia, respectively, are presented. Results. The disruptions that occurred, have resulted in physiognomic dysfunction, masticatory dysfunction, for which patients have requested dental care. The main problem is the optimization of the masticatory function, that can be solved at the age of the investigated patients, and will also solve the phonation disorder, followed by the supervision of the growth process and the intervention with other treatment solutions after the closure of the process. Conclusions. The clinical picture of the patients in the study reproduces the data from the specialized literature: structural abnormalities causing severe evolving dental cavities. Regular follow-ups at the dental office in this case are very important but beneficial at the same time. In a proper feeding and nutritional state – against the background of severe chronic anemia, we need to avoid the onset of hemolytic crises caused by outbreaks of dental infection.

Introduction. Skin and soft tissue defects in lower extremity are challenging clinical situations that have to be dealt with on an individual basis. Closure technique must be tailored to the wound size, location and etiology, and also to the patient’s characteristics (age, other comorbidities etc.). This paper aims at emphasizing the clinical particularities of lower extremity wound closure in children. Material and methods. We review the clinical data, surgical strategy and operative staging, and also the postoperative outcome of three cases of children (aged between 4 and 9 years old) with skin and soft tissue defect cause by trauma and infection, operated in our department in 2017. Results. The three patients presented with lower leg and anterior foot skin and soft tissue defects, ranging from 5 to 10 cm on the long axis, with deep involvement (including joint exposure in one of them). Etiology was traumatic in two cases, one complicated by infection due to inappropriate initial cure. In the third case, the skin defect was caused by foot cellulitis that was incised and debrided in another hospital, and was referred to us for closure of the remaining uncovered wound. The surgical approach was to use local flaps and skin grafts, alone or combined, after thorough debridement and removal of all infected and devitalized tissue, combined with systemic antibiotics. Postoperative assessment at 1-2 months showed very good graft take and convenient scar appearance, with no functional impairments and no other complications. Conclusions. Surgical protocol for closing lower extremity skin and soft tissue defects raises technical problems, even in the young patient. However, a careful planning of closure steps and preparation of good quality underlying tissues may ensure fast and satisfactory results for the patient and his/her family, as well as for the treating physician.

Introduction. We present different particular aspects of the thyroid ultrasound in patients who were first referred to an endocrinologist after a gynaecological check-up. Case series presentation. A 73-year-old woman was admitted for a routine gynaecological and general exam, after a thyroid nodule was incidentally detected. Ultrasonography showed a macronodule of 3.1 cm, that was treated by surgery. A 53-year-old woman presented for hot flashes in association with high blood pressure episodes. Hyperthyroidism was not confirmed, but a conglomerate of thyroid nodules of 2.2 cm was detected. The fine needle aspiration excluded a malignancy. A 66-year old woman, presenting for bone assessment, was incidentally detected with a large multinodular goitre. The left lobe has multiple nodules including TIRADS4 conglomerate. A 43-year-old woman, with bilateral mammary cysts, normal TSH, increased prolactin, presented at thyroid ultrasound a left lobe of 5.4 cm, with a conglomerate of 3.3 cm. The fine needle aspiration showed Hürthle cells and the patient was referred to surgery, which confirmed the diagnosis of follicular adenoma. A 41-year-old female, with a history of subtotal hysterectomy for uterine fibroma, presented for intermittent palpitations. TSH value was normal, but ultrasonography showed a mildly increased right lobe of 4.3 cm, with multiple bilateral micronodular masses. Conclusions. The thyroid ultrasound represents a very practical diagnostic method in daily gynaecological endocrinology. The detection of a nodule may be related to routine menopausal evaluation, may be associated with clinical examination for bone menopausal status or may be associated to thyroid function assessment if hot flushes mimic hyperthyroidism.

Introduction. The Kasabach-Merritt syndrome is a rare and severe disease that occurs in children in the presence of a large-sized hemangioma, accompanied by coagulation disorders. This disease complicates the course of many somatic diseases in children, including community-acquired pneumonia, due to the clotting disorder. Case presentation. A case of a 4.5-month-old child with a combination of capillary hemangioma of the dextral chest surface, complicated by Kasabach-Merritt syndrome, and community-acquired right-sided focal pneumonia is presented. The possible effect of the Kasabach-Merritt syndrome on the course of community-acquired pneumonia has been analyzed. Additionally, the drugs’ effect on the coagulation disorder, the state of hemangioma, and the course of community-acquired pneumonia in children have been investigated. Conclusions. Severe coagulation disorders may occur in patients with Kasabach-Merritt syndrome and community-acquired pneumonia. Constant monitoring is essential during hospitalization. Such combination of diseases should be treated considering the ability of the drugs to influence both the hemostasis system and the progression of hemangioma’s growth.

Introduction. The globulomaxillary cyst has been under controversy the last few years as an entity of its own. Nevertheless, there are cases of nonodontogenic cysts which cannot be categorized elsewhere. Case report. We describe such an entity, located in the region of the maxillary lateral incisor and the adjacent canine in a 17-year old patient discovered due to radiology examination. Excision of the mass was performed, a histological examination revealing a cyst lined with ciliated columnar and squamous epithelium followed to confirm the diagnosis of a nonodontogenic cyst. Conclusions. The scientific debate on the globulomaxillary cyst reveals a controversial or even inappropriate term, but one cannot deny that such kind of oral cysts exists and needs further attention.

Introduction. Scaphoid non-union associated with avascular proximal pole necrosis represent a really challenging problem for orthopedic surgeons and its treatment is still in debate. Case presentation. We present the case of a 33-year-old patient, with scaphoid non-union, who was treated according to Zeidenberg’s technique using a vascularized radial bone graft. The primary objectives of treatment were to obtain union of the scaphoid, to improve the functional recovery of the wrist and to allow professional reimplantation of the patient. We were able to obtain a functional graft and after 9 months the results were very good. Conclusions. Vascularized bone grafts represent the optimal method of treatment of scaphoid non-union associated to avascular proximal pole. It is mandatory to be associated to rigid osteosynthesis such as Herbert compression screw. The technique of Zeidenberg offers good results in these cases, but it should not be performed without magnifying lens and tourniquet uses.

A bifid rib is a congenital anomaly of the thoracic wall, being presented most commonly unilateral with a higher incidence among male individuals. We present a case of a 4th right rib, unearthed during an educational study of the donated cadavers in the Anatomy Department of the Democritus University of Thrace, Greece. We have studied 251 skeletons, resulting at an incidence of only 0.4%.

Introduction. Struma ovarii represents a rare tumor, only 1% of the ovarian tumors, with an incidence of 0.3-0.7%. The positive diagnosis is obtained by microscopic examination; sometimes elevated serum levels of thyroid hormone, CA 125 and ultrasound aspects can suggest the preoperative diagnosis. Case presentation. We report the case of a 56-year-old woman with unilateral struma ovarii and no clinical or paraclinical evidence of the diagnosis to come. Transvaginal ultrasound revealed polyfibromatous uterus and apparently normal adnexa. Partial hysterectomy with bilateral salpingo-oophorectomy (considering the patients’ age) through laparotomy was performed under spinal anaesthesia. The histopathological result showed an endometrial polyp, multiple intrauterine leiomyomas, left ovary with thyroid follicles, which looked like normal thyroid tissue. The evolution of the patient was favorable, with no complications at the 6 months’ follow-up. Conclusions. In the literature, there are only a few cases of benign struma ovarium, and even less cases of malignant struma ovarium or bilateral presentation of the tumor. The particularity of the case consists in the diagnosis of struma ovarii only after surgery, in a patient without clinical or paraclinical evidence of this diagnosis.

Introduction. The widely used antiarrhythmic amiodarone (AD) has been linked to many health problems, including pulmonary toxicity. The objective of the study. In the present study we assessed the protective effect of 21-aminosteroid U-74389 G due to its antioxidative and membrane-stabilizing potency on amiodarone-induced pneumotoxicity in rats. Material and methods. The study was carried out on 72 male Wistar rats, divided into four groups: (1) – control; (2) – treated with AD intratracheally; (3) – treated with AD and U-74389G; (4) – treated with U-74389G alone. AD was instilled twice on days 0 and 2 (6.25 mg/kg with a concentration 3.125 mg/mL). U-74389G was injected intraperitoneally on days 0, 1 and 2 in a dose of 5 mg/kg. The activity of super-oxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GP), malondialdehyde (MDA) content and hydroxyproline content were performed on days 3, 7, 14 and 28 in lung homogenate. Hydroperoxide concentrations were measured in the plasma. Results. AD administration affected antioxidant defense system in the lungs, promoted lipid peroxidation, and caused pulmonary fibrosis. Conclusions. The 21-aminosteroid U-74389G significantly inhibited lipid peroxidation and mitigated fibrous changes in rat lungs provoked by AD.

The objective of the study was to evaluate the intracellular cyclase cascade under the conditions of chronic fluoride intoxication in white rats of the Wistar population. Materials and methods. The study was conducted from 2009 to 2014 in the Department of Biochemistry and vivarium of Kharkiv National Medical University MOH, Kharkiv, Ukraine. The study was performed on white rats of the Wistar population. In these rats, we administered intragastric, in the morning, on an empty stomach, a solution of sodium fluoride at a rate of 20 mg/kg of body weight. In this way, the development of fluoride intoxication was simulated. The duration of oral administration of the drug was 1.5 months. The intracellular metabolism was assessed in plasma, liver, kidneys, spleen, and brain cortex. The energy components of the adenylate cyclase system, adenosine monophosphate (AMP), adenosine diphosphate (ADP), adenosine triphosphate (ATP), inorganic phosphorus and ions of Mg2+, guanylate cyclase, phosphodiesterase, were measured. The organs and tissues content of cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP) and absorption of ??2+ by the liver membranes microsomes and synaptosomes of the brain were also determined. Results. The increase in the content of cAMP and a decrease in the level of cGMP were observed in the blood plasma of animals, whereas a decrease in the concentration of cAMP and an increase in the amount of cGMP were observed in the liver, kidneys and spleen. In the cerebral cortex, a decrease in adenylate cyclase activity and cAMP content has been established. At the same time, the activity of guanylate cyclase, phosphodiesterase, and cGMP content increased. Conclusions. Analysis of the absorption of ??2+ membranes by macrosomes of the liver and brain synaptosomes revealed a decrease in basal and ?+– stimulated absorption of calcium ions by membrane preparations of nerve cells. In the liver, the ?+-stimulated and basal absorption of ??2+ ions was significantly less than in the brain.

Introduction. Certain regions in Europe and Ukraine have high concentration of fluorides in drinking waters. Highly developed agriculture can result in increased concentration of nitrates in ground and drinking waters. Therefore, their combined excessive intake with food and water is not excluded. The objective of the study was to determine the influence of combined nitrate-fluoride intoxication on concentration of different fractions of glycosaminoglycans (GAG) and L-hydroxyproline concentration in gastric mucosa of rats. Materials and methods. Chronic intoxications were induced by intragastric injection of sodium fluoride in a dose of 10 mg/kg, sodium nitrate in a dose of 500 mg/kg and their combination during 30 days. Concentration of GAG was determined by carbazole method. To evaluate concentrations of different fractions of GAG we used the method of differential precipitation with ethanol. For L-Hydroxyproline concentration estimation, we used Hydroxyproline Colorimetric Assay Kit (BioVision K555-100). Results. The total concentration of GAG decreases during chronic fluoride and nitrate intoxications, but increases during combined intoxication. Concentration of Heparin/Heparan GAG fraction and Keratan/Dermatan GAG fraction drops during nitrate and fluoride intoxications, but increases during combined intoxication. Chondroitin GAG fraction shows no statistically significant changes during fluoride intoxication, but increases during combined and nitrate intoxications. Concentration of L-hydroxyproline increases in all studied groups. Conclusions. We established that chronic excessive fluoride or nitrate intake can cause oxidative and nitrosative stress-depended collagen degradation, simultaneously decreasing the concentration of anti-inflammatory GAG. Combined intoxication leads to even more severe connective tissue degradation, but subsequently activates compensatory mechanisms through increase in concentration of anti-inflammatory GAG.

Background. Pollution of the environment poses major risks for human health. Chronic exposure to some well-absorbed but slowly eliminated xenobiotics can lead to their bioaccumulation in living organisms. The objective of the study was to describe the organometric changes occurring in thymus of male rats under tryglycidyl ether of polyoxypropylenetriol exposure. Material and methods. 40 WAG matured male rats were divided randomly into two groups. The first group served as a control included 8 animals. The second group of 32 rats, 8 rodents in each, were treated via gavage by aqueous solutions of tryglycidyl ether of polyoxypropylenetriol (TEPPT) in a dose of 1/10 LD50 in conversion to 5.75 g/kg during 7, 15, 30, 45 days. All animals were sacrificed on the term defined by experimental design. Thymus specimens were dissected out and measurements of the linear dimensions (length, width, height) using digital caliper were taken. The mass and volume of the thymus were counted. Limits of the thymus morphometric indices’ variability in intact and experimental groups were calculated. Results. The research indicates that tryglycidyl ether of polyoxypropylenetriol exposure caused marked organometric changes in rats’ thymus. 100% effect on all morphometric indices of the thymus under impact of TEEPT in a dose of 1/10 LD50 on the 7th, 15th, 30th and 45th day was noted. However, more pronounced changes were observed on 7th and 30th days. The study revealed that IndT of the control group, which is related to the length and width of the thymus, has the greatest limits of the parameters’ fluctuations and their significant variability. IndHL of the control group, which is associated with the height and length of the thymus, has the lowest fluctuation limits of the parameters. In our opinion, this is connected, first of all, with the peculiarities of the structure and form of the rats’ thymus. Conclusions. Thymus shows active response on the induced xenobiotic and these data can be successfully extrapolated from experimental animals to humans.

Introduction. One of medical-social chronic consequences of diabetes mellitus is encephalopathy, with an advancing course and development of neurodegenerative disorders in the central nervous system. Objective: to examine carbacetam effect as a new modulator of gamma-aminobutyric acid activity on protein peroxide oxidation and morphological condition of the cerebral cortex and hippocampus in rats under conditions of experimental neurodegeneration in case of type 2 diabetes mellitus. Materials and methods. Changes in the content of protein peroxide oxidation in the cerebral cortex and hippocampus under effect of carbacetam (5 mg/kg) are examined in nonlinear laboratory albino male rats with neurodegeneration under conditions of type 2 diabetes mellitus simulated by streptozotocin and high-fat diet. Results. In rats with type 2 diabetes mellitus, the degree of protein peroxide oxidation in the cerebral cortex and hippocampus increases, which is associated with increased amount of cells with karyopyknosis, decreased relative density of staining of the neuron tigroid substance and partial denudation of vessels. After carbacetam administration during 14 days in rats with type 2 diabetes mellitus in the cerebral cortex and hippocampus the level of protein peroxide oxidation decreases, the amount of cells with karyopyknosis reduces, a relative density of staining of the neuron tigroid substance increases, and denudation of vessels is lacking. Conclusions. Decreased intensity of the protein peroxide oxidation processes, histological destruction of the cerebral cortex and hippocampus are indicative of a neuroprotective potential of carbacetam under conditions of neurodegeneration caused by type 2 diabetes mellitus.

Introduction. Kidney Disease Outcomes Quality Initiative (KDIGO) Group proposes the estimated glomerular filtration rate (eGFR) and albuminuria rate for a combined risk of clinical outcomes in patients with chronic kidney disease (CKD). However, the decline rate of eGFR can vary independently of the baseline eGFR. The objective of the study was to improve the prognostic efficacy in chronic kidney disease (CKD) stage 1-3 due to new significant factors of CKD progression detected by renal stress test via the water-salt loading with 0.5 % sodium chloride solution, at a rate of 0.5% of the body weight. Material and methods. In a single-centre prospective study, during 3-year follow-up period, from January 2016 to December 2018, 108 patients with CKD stage 1-3 (a, b) were examined. There were two groups: patients with rapidly progressive CKD whose eGFR throughout one-year follow-up decreased by 3 ml/min/1.73 m2 and more (59 patients), and the group with a stable CKD, whose eGFR throughout one-year follow-up did not decrease or has decreased by less than 3 ml/min/1.73 m2 (49 patients). Results. No relationship between the renal functional reserve, stimulated GFR and a decline in eGFR throughout the year was found. The change in urine creatinine on the background of the water-salt loading was positively correlated with changes in eGFR throughout the year. Spearman’s correlation coefficient was rs 0.4 (p-0.02). The OR of decline in eGFR by more than 3 ml/min/1.73 m2 throughout the year, with a decrease in urine creatinine level by more than 2 mmol/L, was 4.7 (95 % CI 1.9-12.0). Conclusions. Improving the functionality of the renal stress test via the water-salt loading by measuring urine creatinine can help to identify the high-risk group for disease progression.

Introduction. Surgical injury can stimulate tumor growth in metastatic colorectal cancer (mCRC), due to mitochondrial dysfunction. The objective of the study was to analyze the clinical significance of the molecular marker of 8-hydroxydeoxyguanosine and the oncological influence of the liver parenchyma warm ischemia on the prognosis of mCRC. Materials and methods. The study involved 89 CRC patients with metachronous metastatic liver disease treated in The National Cancer Institute of the Ministry of Health, Kyiv, Ukraine, from 2015 till 2018, and 19 conditionally healthy donors. 8-Hydroxy-deoxyguanosine (8-OHdG) level in the urine of patients with mCRC was determined. Urine sampling was done 24-hours before and on day 3 after surgery. Measurements of the marker of oxidative DNA damage were repeated three times. The state of the hepatocyte detoxification energy system, the levels of superoxide radicals (O2-) in the tumour tissue were determined by electron paramagnetic resonance (EPR) and Spin Trapping Technology. Results. The urinary 8-OHdG level of donors was within 0.24±0.063 nM/kg · day, whereas before the resection and on day 3 after the R0-resection of liver in mCRC patients it was 3.42±0.18 nM/kg·day and 2.12±0.08 nM/kg·day (p < 0.05), respectively. On day 1 after the liver resection with a total duration of warm ischemia period < 30 min and > 30 min have had marker at level 2.108 ± 0.13 nM/kg·day and 2.9883 ± 0.159 nM/kg·day (p < 0.0001), respectively. The volume of metastatic tissue (Vmts) significantly and directly increased the level of urine 8-OhdG. The duration of surgical intervention (resection t) and duration of warm liver ischemia (t ischemia) significantly increased urine level of 8-OhdG. Conclusions. R0-resection of liver metastases in mCRC patients decreases urine 8-OHdG level after surgery. Warm liver ischemia during the Pringle maneuver (= 40 min), surgical intervention duration (= 300 min) and metastatic tissue volume (= 12 cm3) in liver parenchyma in mCRC patients significantly increase urine 8-OHdG levels. The level of 8-OHdG correlates with the extent of organ resection, duration of ischemia, volume of post-resection liver tissue, volume of metastases and rate of superoxide radicals’ generation.

The objective of the study. To identify glutathione S-transferase M1 (GST?1) gene polymorphism in patients with tuberculosis depending on Mycobacterium tuberculosis (MBT) resistance. Material and methods. The study involved 100 patients with newly diagnosed pulmonary tuberculosis (TB), who had been hospitalized in Chernivtsi Regional TB Dispensary. The control group consisted of 50 healthy individuals. Genomic DNA was isolated from the whole venous blood. GSTM1 polymorphic areas were isolated by means of multicomplex polymerase chain reaction, according to the protocol for instantaneous analysis of polymorphism by Arana et al (1996). Deletion of gene corresponds to the lack of appropriate strips in the electropherogram. Results. An analysis of the occurrence of alleles and genotypes of GSTM1 gene in patients with pulmonary tuberculosis regarding the MBT resistance version allowed to establish that, under the conditions of pulmonary tuberculosis infection, GSTM1 gene deletion mutation can be found in one out of five (21.87% of cases), and the occurrence due to the MBT resistance version is: with newly diagnosed tuberculosis (NDTB) – 17.39%, with multidrug-resistant tuberculosis (MDR-TB) 35.0% and polyresistant pulmonary tuberculosis (PRTB) 20.0%, respectively. According to the nature of the distribution of allelic gene GSTM1, a favorable functional 1 allele prevails (73.29%) in the normal inbreeding among patients and deficiency of heterozygosity among healthy people, which generally forms a normal population distribution for the European race. Conclusions. According to the nature of allele distribution of GSTM1 gene, the favorable functional 1 allele prevails (73.29%) in case of normal inbreeding in patients (F=0,20, ?>0,05) and lack of heterozygote in healthy individuals (F=0.28 ?=0.033), which in general forms a normal population distribution [OR=14.06, ?=0.005].

The aim of the study was to determine the level of cytokeratin 18, adiponectin and leptin in plasma of the patients with nonalcoholic steatohepatitis (NASH) and coronary heart disease (CHD) and their association with the degree of cytolysis, disorders of carbohydrate and lipid metabolism. Materials and methods. We examined 60 patients with NASH, who were divided into 2 groups: group 1 – 30 patients with NASH on the background of obesity of 1st-2nd degree, group 2 – 30 patients with NASH and CHD (the 1st and 2nd functional classes of stable angina pectoris) and obesity of 1st-2nd degree. The mean age of patients was 55.13±6.34 years. The control group consisted of 20 practically healthy persons (PHP). Serum CK18, adiponectin and leptin levels were determined by the immunoassay analysis. Results. Our research showed that NASH is closely associated with disorders of adipocytokine homeostasis. In patients with NASH, comorbid CHD, and obesity of 1st-2nd degree, there is an increase level of CK 18, proinflammatory adipokine leptin and a decrease in the level of adiponectin. Conclusions. The significant increase of liver aminotransferases activity and the level of CK 18 in patients with NASH, their close positive correlation relationship suggest that the leading pathophysiological mechanism of progression of NAFLD is the necrosis and apoptosis of hepatocytes. The determination of serum fragments of CK 18 can be used as a non-invasive test for diagnosis of NASH and liver steatosis.

Introduction. Lichen planus (LP) is a chronic poly-etiologic dermatosis by the mechanism of its development, manifested by papular rash on the skin and mucous membranes, severe itching. The objective of the study was to determine and analyze the levels of endogenous intoxication markers in blood plasma of the patients with lichen planus depending on severity and duration of the disease. Materials and methods. 48 patients, 20 men and 28 women, participated in the study. 31 patients had suffered from dermatosis for about 2 years, and 17 patients for over 2 years. Mild LP was diagnosed in 17 patients and moderate LP in 31 patients. The blood levels of homocysteine (HC), carbonyl groups of oxidative modified proteins (CG-OMP) and medium molecular weight peptides (MMWP) were determined in all the patients. Results. Significantly increased blood plasma levels of HC, MMWP and CG were found in patients with lichen planus as compared to the control group. The patients with severe and prolonged course of dermatosis had more evident disturbances in the content of endogenous intoxication markers than those with short and mild course of the disease. Conclusions. A significant increase in the levels of homocysteine, MMWP and carbonyl groups of oxidative modified proteins was found in the patients with LP, being indicative of an essential role of endogenous intoxication processes in the pathogenesis of lichen planus.

The objective of the study was to determine the characteristics of bone mineral density in patients with osteoarthritis (OA), non-alcoholic steatohepatitis (NASH) and obesity. Material and methods. 90 patients were examined and distributed into three groups: group 1 (n = 30) consisted of patients suffering from OA of knee joints, grade 2-3 according to Kellgren and Lawrense classification,with normal body weight (mean BMI 22.88±0.39 Kg/m2); group 2 (n = 30) – patients with OA with NASH and obesity (mean BMI 34.38±0.69 Kg/m2). The control group consisted of 30 healthy subjects of the corresponding age. The average age of patients was 62.3±5.7 years.The bone mineral density (BMD) at the level of the proximal femoral bone was evaluated on a dual-energy X-ray densitometer using the STRATOS apparatus DMS-APELEM (France) under a densitometry cabinet based on the Swedish-Ukrainian Medical Center “Angelholm”, Chernivtsi, Ukraine. The diagnosis of osteoporosis and low BMD was done according to the criteria of the ISCD Official Positions, 2007 (revised in 2015). Statistical analysis was performed using SPSS Statistics 20 Multilingual. Results. Osteoporosis and low BMD were found to be significantly higher in patients with osteoarthritis compared with those from the group withosteoarthritis, NASH and obesity. Conclusions. In patients with isolated osteoarthritis, a significant decrease of bone mineral density was found, especially in the intertrochanteric region of the femur. In individuals suffering from OA, the risk of fractures was higher than in those with concomitant NASH and obesity. The difference was significant only in the case of osteoporotic and femur fracture, without considering BMD.

Introduction. One of the most specific areas in practical dentistry is the use of various biological matrix structures that serve as a backbone for osteogenic cells and a framework for vascular components that provide the gradual formation of a new bone tissue in the area of defect formed by the resultant enucleation. Objective. To establish the efficiency of using fibrous matrix and polymeric membrane in the process of restoration of defects of the bone structure after the procedure of the enucleation on the lower jaw and to analyze the results with those that were registered when performing bone defects with collagen sponge. Materials and methods. The study was conducted in the Department of Surgical Dentistry of Ivano-Frankivsk National Medical University, Ukraine, during 6 months, between September 10, 2018-March 10, 2019. The selected sample of patients randomly were divided into two groups: 1st group – the study group, which included 24 persons (filling the main bone defect in this group was carried out using the material developed by the authors, of fibrous matrix and polymer membranes); 2nd group – the comparison group, in which 25 people were included (the completion of the main part of the bone defect in this group was carried out using CollaTape Collage Spot (Integra Life Sciences). Results. The average index of reduction of the geometric radiological defect size in the research group was 89.4±2.5%, while in the comparison group, this indicator was equal to 90.2± 1.6%. The largest reduction in both the research group and the comparison group was noted in the horizontal (87.8-93.6%) and in the diagonal (88.4-91.5%) components of the defect. Six months after the intervention, the index of reduction increased and reached 1.74 (72.50%). Conclusions. The absence of registered statistical differences between the above described criteria for assessing surgical treatment of patients in both groups suggests that the use of fibrous matrix and polymeric membranes does not provoke significant violations in the process of physiological bone regeneration after the removal of cyst.

Introduction. The face and its associated structures (cranial, oral, dental) form one of the most complex areas of the human body, hence the diversity of the anatomical and functional pathologies at this level. Sometimes, the approach from the perspective of only one medical specialization may lead to symptomatology improvement or even remittance, but there are many situations when relapse occurs over time; the effect was treated, but not the cause in its totality. Proper diagnosis, selection and implementation of the most appropriate therapeutic approach require the involvement and collaboration of a multidisciplinary team. The objective of the study was to highlight the advantage of combining manual therapy and myofunctional therapy, along with general relaxation, in patients with a mandible opening limitation in order to regain the harmony of the neuromuscular control and temporomandibular arthrokinematics. Material and methods. 46 patients were divided into 3 groups: group 1 benefited from manual therapy alone, group 2 only myofunctional therapy; group 3, manual therapy together with myofunctional therapy. Results. The data confirm the increased efficacy of the combined therapy used with group 3 compared to the groups where only one type of therapy was applied. Therefore, it is confirmed the importance of involving the multidisciplinary team in addressing the patient with temporomandibular joint dysfunctions. Conclusions. The short- and medium-term outcomes of combined therapy demonstrate the reduction of symptoms without recurrence, an improvement in dental functioning and, as a consequence, an increase in the quality of life of this patient population.

Introduction. Early childhood diet is of critical importance for the processes of tooth dentition, formation of organic matrix, mineralization and maturation of dental structures. The involvement of inorganic elements in the building up of bone and teeth tissue in childhood is an essential process, determining the achievement of their peak density. Considering the scientists’ interest in oral health, with emphasis on childhood and increasing of caries incidence at this age, it is necessary to investigate deeply the issue at national level as well. The objective of the study was to investigate the dietary intake of inorganic elements – calcium, phosphorus, magnesium, fluorine, sodium, and iron in children with early childhood caries. Material and methods. The dietary mineral intake of 53 children, aged 3-6 years, diagnosed with early childhood caries, was studied by the 24-hour dietary recall method. The data revealed by parents’ responses were processed statistically, compared to the referent values for inorganic elements intake in this age. Results. The results of investigated group of children revealed an average daily intake of calcium of 473.4±222.5 mg, phosphorus 745±177 mg, fluorine 0.8±0.37 mg, magnesium 139±43 mg, iron 6.7±4.64 mg, and of sodium 1159±529 mg. Conclusions. The detected lower intake of calcium, magnesium, fluorine could be considered as risk factor for caries development and the other elements are associated with children’s general health status. The specificity of the needs and health status requires complex caries treatment starting in early childhood together with adequate diet.

Introduction. The use of stem cells in dental practice has become possible due to the phenomenal discovery in biology and biotechnology regarding the ability of stem cells, after injecting them into the recipient’s body, to enter the places of damaged tissues and restore their cellular structure. Since bone healing occurs by replacing a defect with connective tissue, our task was to transplant multipotent stem cells, which will later differentiate into the actual bone tissue. The aim of the study was to determine the biocompatibility of mesenchymal stromal cells of adipose tissue (MMSC – AT) with osteoplastic materials. Material and methods. The research was conducted within the Bukovinian State Medical University, Chernivtsi, Ukraine, from May 2018 to February 2019. Samples of adipose tissue were obtained from the neck area of 60 experimental animals (white Wistar line rats). We conducted an analysis of phenotypic markers multipotent mesenchymal stromal cells of adipose tissue. It was determined the degree of remineralization of these samples, which was confirmed by Alamar Blue test (AB). Results. Analysis of the degree of mineralization of the extracellular matrix revealed that the investigated samples with the contents of multipotent mesenchymal stromal cells of adipose tissue (MMSC-AT) had osteogenic potential, which was more pronounced in the samples of MMSC-AT + platelet-rich plasma (PRP) and MMSC-AT + PRP + Kolapan. The cultured MMSC-AT tissues from experimental rats of the 2nd passage express the markers characteristic of MMSC, MMSC-AT capable of differentiation in the osteogenic direction, with the prevalence of this process in tissue samples containing Platelet-Enriched Plasma and Kolapan. Conclusions. Consequently, the tissue equivalent of bone tissue based on MMSC-AT can be used in regenerative medicine, and also can be used in different directions of dentistry.

Introduction. Vascular risk factors have been associated with cognitive decline, although their simultaneous effects on cognition are unclear. The aim of our study was to examine the additional impact of some of the most important risk factors (ageing, arterial hypertension (AH), chronic ischemic heart disease (CIHD), tobacco-usage and alcohol) on cognitive functions of patients with diabetes mellitus (DM). Material and methods. We examined 115 patients (average age 62.47±10.60 years; 49 males, 66 females) with DM (mean disease duration 9.28±6.88 years), admitted between 2016-2017 in the Neurology Clinic of the University Hospital „Sofiamed“, Sofia, Bulgaria. We used the following neuropsychological battery: Mini Mental State Examination (MMSE), Isaack Set Test, 10 words memory test, Digit Symbol Substitution Test, Trail Making Test A and B, Clock drawing test, Logic memory test (subscale of Wechsler memory scale IV ed.), Benton visual retention test (var. A, form E). The results were summarized in tables. All the results were analyzed in 95% confidence interval. Results. Ageing was associated with a poor cognitive performance in almost all examined cognitive domains, except MMSE. CIHD is associated with low Digit Symbol Substitution Test points and more omissions and size errors on Benton Visual Retention Test. Conclusions. Ageing is associated with decline in visual and verbal memory, executive functions and visual-spatial abilities in cases with DM. CIHD leads to additional alternating attention deficits in patients with DM. AH, tobacco-usage and mild and moderate alcohol drinking are not significantly associated with additional cognitive dysfunctions in cases with DM.

Introduction. Given the prevalence and burden of arterial hypertension, it is necessary to obtain an optimal control of blood pressure in order to improve the prognosis of these patients. Adherence to antihypertensive therapy is poor, leading to non-optimal disease control. The objective of the study was to investigate the adherence to therapy in hypertensive patients and to assess the impact of health education and self-action plan in improving the compliance to the therapy in primary care settings. Material and methods. A prospective study was conducted in 750 patients diagnosed with primary hypertension for 3 years. After inclusion in the study, patients were monitored for 24 weeks to evaluate treatment non-compliance. In patients without adherence to antihypertensive therapy, we used various health education strategies to improve compliance. Results. A total of 750 patients with essential hypertension who started therapy over duration of 3 years were included in the study. At the end of 24 weeks, it was observed that only 324 patients (43.2%) had regular compliance and 426 patients (56.8%) were noncompliant to antihypertensive treatment. The factors that were associated with poor compliance were: a low level of education, burdensome treatment, dislike of drugs, remote pharmacies, concerns about side effects, anger about the condition or its treatment, forgetfulness or complacency, as well as the patients’ poor attitude to health. After employing various strategies for improving the compliance in these patients, the compliance increased in 263 patients (61.7%) among the earlier defaulted patients, while the remaining 163 patients (38.3%) were found to be noncompliant even after various educational techniques. Conclusions. Failure to treat hypertension is a reality, and none of the strategies for improving compliance are likely to be as effective as a good doctor-patient relationship. Optimal self-management, which allows to optimize control of arterial hypertension by adjusting drugs, can be carried out by self-regulation using a written plan of action or by regular medical examination.

Introduction. During pregnancy, the uterus suffers a huge number of morphological changes. Placental changes lead to an adequate supply of the fetus and a normal process of childbirth. In particular, the uterine-placental area appears where the fertilized ovum attaches to the uterus. Myometrium increases in size and changes the spatial configuration. The objective of the study was to assess the relative immunohistochemical concentration of the von Willebrand’s factor in endothelial cells of different types of vessels of the uterine-placental area and myometrium in pregnancy. Material and methods. The biopsy material was obtained from pregnant women during the cesarean section. Three parts (central, pericentral, peripheral) of each biopsy were developed. Multiple paraffin sections were stained in three ways: 1) immunohistochemical von Willebrand’s factor staining with an antigen thermal exposure (DACO); 2) differentiated histochemical fibrin and collagen Slinchenko’s staining; 3) hematoxylin-eosin staining. Digital images were analyzed with a computer program ImageJ (1.48v, W. Rasband, National Institute of Health, USA, 2015). We also calculated the arithmetic mean and its average error for optical density (computer program PAST 3.19, Ø.Hammer, 2018). Results. The method was tested in 65 pregnant women during the cesarean section. The main results of the staining quantitative analysis in myometrium are: 1). Arterial type vessels 0.415±0.0029 units of optic density; 2). Venous type vessels 0.381±0.0024 units of optic density; 3). Microcirculatory system 0.375±0.0022 units of optic density. The main results of the staining quantitative analysis in uterine-placental area are 1). Arterial type vessels 0.404±0.0027 units of optic density; 2). Venous type vessels 0.380±0.0024 units of optic density; 3). Microcirculatory system 0.373±0.0021 units of optic density. Conclusions. Immunohistochemical study of von Willebrand’s factor allows investigation of the endothelial dysfunction in all types of vessels of both UPA and myometrium. This is very promising for the early detection of placental dysfunction and establishing of morphological preconditions for fetal insufficiency.

Introduction. Overweight and obesity is a global epidemic among children of all age groups. Obese children are at increased risk of insulin resistance, cardiovascular disease (including arterial hypertension), as well as bone fractures and psychological problems. In this regard, insulin resistance has become one of the most serious health concerns in overweight and obese children. The objective of the study was to investigate the specifics for carbohydrate metabolism in overweight and obese children, to identify the key factors for insulin resistance and to develop a regression analysis-based prognostic model to predict its occurrence. Material and methods. In 90 obese and 20 overweight children aged between 10-17 years, anthropometric measurements, history data collection and laboratory investigations were performed. Multiple regression analysis has been used to develop a mathematical model for prediction of insulin resistance. Results. Such variables as weight, body mass index, waist and hip circumferences, abdominal type obesity, family history, duration of breastfeeding (if any), birth weight, sedentary lifestyle, leptin and adiponectin levels and dyslipidemia were closely related to fasting glucose levels and insulin/insulin resistance indices. Conclusions. Abdominal obesity, male gender, family history of abnormal carbohydrate metabolism, insulin levels, duration of breastfeeding and plasma leptin levels have been defined as main predictors of insulin resistance in overweight and obese children and were included in regression equation for the index of insulin resistance using the method of multiple regression analysis.

Introduction. The most common diagnosis after a kidney biopsy in pediatric population is minimal change disease. When the prognosis is not favorable in spite of the minimal change disease diagnosis, there is a clinical suspicion of focal segmental glomerulosclerosis. The objective of this study was to identify the ultramicroscopic changes in minimal change disease and focal segmental glomerulosclerosis focused on podocyte foot process effacement. Moreover, to find if there is a correlation between podocyte foot process effacement and proteinuria level. Material and methods. 100 patients were included in the study: 50 in the control group, 25 in the minimal change disease group and 25 in the focal segmental glomerulosclerosis group. For each patient 5 images were taken, focused on different capillary loops to identify podocyte foot process effacement. We measured the foot process effacement related to glomerular basal membrane. Furthermore, we investigated the possible correlation with proteinuria using statistical analysis. Results. The mean value of podocyte foot process effacement (%) in the control group was 8.42 ±4.59%, in the focal segmental glomerulosclerosis group was 55.44±16.17, while in the minimal change disease group it was 74.35±13.01. Compared with the proteinuria level, we established a correlation with foot process effacement (p value < 0.001) in the affected groups: minimal change disease and focal segmental glomerulosclerosis groups. Conclusions. In this study, we demonstrated that there is a correlation between proteinuria level and podocyte foot process effacement in children.

Introduction. Giardiasis is the most frequently reported human intestinal parasitic infection. The objective of the study was to investigate the frequency of giardiasis, carry out the genotyping, estimate the growth and determine the level of fecal calprotectin in children. Material and methods. 688 children aged 6-18 years were examined for Giardia duodenalis by direct microscopy. Two groups were formed: group I – children with a positive test for Giardia duodenalis (n = 90); group II – children with a negative test (n = 110). Genetic examination, anthropometry and fecal calprotectin (FC) evaluation were carried out in these children. Results. Out of the 688 children examined, 90 had a positive result (G. duodenalis (+)). The leading clinical feature of G. duodenalis infection (+) was abdominal pain, followed by nausea and diarrhea. The FC content in the feces of the group I was significantly higher (p <0.05) compared to children of group II, and did not depend on sex. The analysis of the sequences characterizing the amplification of Glutamate dehydrogenase (GDH) revealed the presence of subgroups AII (54%, 13/24), BIII (8.3%, 2/24) and BIV (37.5%, 9/24). Annual body weight gain in children of group I is shifted by 1 year and 1 cm compared to the ones from group II. Conclusions. The socio-demographic factors can be considered as predictors of the development of giardiasis in children. In the clinical course of giardiasis, the digestive tract’s disease dominates. Direct and indirect methods of diagnosis are necessary to improve the diagnosis accuracy in children. Children with increased FC need further examination. Our study suggests that G. duodenalis infection is accompanied by the growth retardation and intestinal inflammation in children.

Introduction. This article presents a new mesh fixation technique for “onlay hernia repair”, based on a new principle – the “Equally-Distributed-Tension Principle”. Methods. The fixation technique is based on a continuous suture, different from any other continuous suture, with no stiffened points of attachment. It allows a slight glide of the thread, making possible the equally-distribution of tension. Based on this technique it is possible to realize a mesh fixation under tension. The „tension-free” concept is not suitable for ventral hernias. The mesh should be sutured under tension – the only way to remove the tension from the midline suture and offer the posibility for the aponeurotic layer to heal and regain its strenght. A new fixation system is necessary, a more efficient one, that will sustain this tension, without failure. In the same time, this system is the only one capable to realize an uniform distribution of tension. Results. Between February 2016 and November 2018, 49 patients were treated by this method in the Ilfov County Emergency Hospital, Bucharest, Romania, with only one recurrence until now (a bridging technique was used in this case). Conclusions. The new suture system is very easy to apply, very fast, extremely reliable and offers the posibility to manage a large variety of ventral hernias.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with unknown etiology and incompletely elucidated pathogenesis. It implies the loss of tolerance to the inner self, which leads to perturbations in the immune system, with production of autoantibodies. SLE is characterized by multisystem involvement, the evolution of these patients being directly influenced by the severity of organ complications. The most common pattern seen in patients with SLE is a combination of musculoskeletal, skin, renal, central nervous system, cardiovascular, hematologic and gastrointestinal manifestations. The gastrointestinal symptoms are commonly seen in patients with SLE, the main pathological mechanisms involved being mesenteric vasculitis, intestinal pseudo-obstruction and protein losing enteropathy. Neurological manifestations are also frequent among these patients and they correlate with a high rate of morbidity and mortality. This review aims to analyze the correlation between gastrointestinal and neurological manifestations in SLE and their impact on the quality of life.

A patient with pontocerebellar pathology has complaints in the ENT field, like hearing loss, tinnitus, vertigo or facial pain The vestibular and non-vestibular schwannoma are the most frequent pathologies of this anatomical region, and because of their “mild” clinical manifestations, the diagnosis can be delayed during a regular follow-up. Improvement of differential diagnosis between vestibular schwannoma and non-vestibular schwannoma requires a detailed anamnesis as well as radiological and electrophysiological exams. Nevertheless, the non-vestibular tumors are often misdiagnosed as vestibular tumors. The surgeon must have all the knowledge and skills in order to provide, case by case, the right diagnosis and the best care for his patient. The aim of this publication is to overview the most recent data related to pontocerebellar non-vestibular schwannoma.

Anal cancer is a rare digestive malignancy with high propensity to spread via lymphatic route, leading to the apparition of metastases at the level of superficial inguinal and perirectal stations. However, prophylactic irradiation of all these fields is not recommended due to the inacceptable high risks of complications when compared to the rates of metastases. Therefore, sentinel lymph node biopsy has been routinely associated in order to determine which cases present lymphatic metastases and could benefit most after irradiation. This is a literature review of the largest studies conducted on the subject of sentinel lymph node biopsy in anal cancer patients.

The ENT practitioner has a principal role for diagnosis, treatment and clinical recovery of vestibular schwannoma patients. These tumors require a special attention, concerning the treatment and the follow-up, because of their location in a deep anatomical region, very rich in vascular and neurological elements. If surgery is chosen as the best treatment modality, the vascular related complications, during surgery or immediately after surgery, can be disastrous for the patient. The surgeon must have the anatomical knowledge and appropriate skills. The anatomy of the venous system has an individual variability, with an impact to the procedure’s surgical risks. The objective of this publication is to synthetize the local venous anatomy and surgical practices in case of venous bleeding at the level of the pontocerebellar angle.

Gastric cancer has been for a long period of time one of the most aggressive malignancies due to the fact that it was usually diagnosed in advanced stages of the disease. However, in the last decades, introduction of upper digestive endoscopy on a wider scale led to a higher detection of this malignancy in earlier stages. Therefore, surgery with curative intent and, in consequence, better long-term outcomes, has been reported. In order to maximize the effect of surgery and to minimize the postoperative complication rates, in the Eastern studies the concept of sentinel lymph node biopsy has been implemented with satisfactory results. This is a literature review of the studies conducted so far on the theme of sentinel lymph node detection in gastric cancer patients.

Introduction. Mesh reinforcement is generally considered the standard of care in hernia repair. Infection is a common complication following hernia repair. Infection of the mesh is a complex problem. Knowledge of new treatment strategies is necessary for surgeons performing abdominal wall reconstruction. Case presentation. We present the case of a 68-year-old woman, who presented with a non-traumatic entero-atmospheric fistula at the site of the hernia repair, which had been done 2 years previously through the implantation of a dual mesh. The fistula has appeared one year previously. The treatment consisted in a complete removal of the infected mesh and segmentary enterectomy. The abdominal wall was repaired through a tissular procedure and the skin was left to close per secundam. The postoperative outcome was favorable. Conclusions. Following excision of infected mesh, multi-staged abdominal wall reconstruction can be considered. Biologic or biosynthetic mesh is recommended when repairing incisional hernias following excision of infected mesh and likely represent the patient’s best chance for a definitive hernia repair. Negative pressure wound therapy closure should be considered in higher-risk patients. Mesh infection is a complex complication that is commonly encountered by surgeons performing hernia repair. Prevention through patient optimization should be performed whenever appropriate. However, when patients develop a mesh infection, most of them will require a complete mesh excision and recurrent hernia repair.

Introduction. Skin burns are one of the most common traumatic injuries in human society. Most of them are small in area and not life-threatening, due to which people hardly look for specialized medical care for their treatment. This is not the case with large burns, which even of a low grade may result in serious complications and even death. According to the injury depth the burns are divided into 1st, 2nd, 3rd and 4th degree, while the most frequently used method to define their area relative to the total body surface is that of the nines. The treatment of burns is a difficult and slow process and is directly depending on their depth, area and injuring agent. Surgical and non-surgical method are used, their goal being the following: pain reduction, prevention of infection, removal of avital tissues, preventing the formation of coarse scars, keloids and contractures of the joints or if the patient has them, they to be as minimal as possible and finally overcoming the consequences. Cases presentation. We present here two clinical cases of 3rd degree limited burns, initially treated with necrectomy and antiseptic silver dressings, and subsequently alternatively with ?heresienöl. Conclusions. ?heresienöl is a good alternative to the free skin graft plastics, when it refers to 3rd degree, small size burns.

Nowadays, more and more evidence points out to the interrelationship between intestinal microbiota and cardiovascular diseases. Gut microbiota is composed of a large number of microorganisms that live in the human gut and are involved in many physiological processes. Changes in the composition and activity of intestinal microbiota may lead or may accelerate the evolution of some cardiovascular diseases. Alterations in the composition of gut microbiota will induce dysbiosis, causing inflammation and initiating the development of cardiovascular diseases. These alterations may be secondary to intestinal infections, exposure to some environmental factors, changes in dietary habits, high stress, use of antibiotics. Studies have shown that gut microbiota is composed of six families, the Firmicutes, Bacteroidetes, Proteobacteria, Actino-bacteria, Fusobacteria, and Verrucomicrobia phyla1. These microorganisms are involved in the immune processes of the host, the fight against the pathogenic microorganisms and also in maintaining the integrity of intestinal barriers. Coronary heart disease and arterial hypertension are chronic diseases with a high prevalence. Some studies have demonstrated a link between the composition of gut microbiota and the increased risk of atherosclerosis, which is the main cause of coronary heart disease2,3. These studies have identified different species of bacteria, both in the gut and in the atheromatous plaques, suggesting that gut is a source of atherogenic bacteria2,3. The mechanisms by which these bacteria can initiate the atherosclerotic process (or in some cases protect against it) are still unknown. Trimethylamine N-oxide (TMAO) is a microbial metabolite that was studied for its effects on cardiovascular diseases after the discovery of a positive correlation between the serum level of TMAO and the atherosclerotic plaque area. This correlation was partially explained by the role that TMAO plays in the inhibition of reverse cholesterol transport and the accumulation of macrophage cholesterol4,5. One study has found that the TMAO level in patients with an acute coronary syndrome is an independent predictor of short-term and long-term major adverse cardiac events6. The implication of gut microbiota in arterial hypertension has been demonstrated by animal studies7,8. Adnan et al have shown that the blood pressure can be influenced by the exchange of gut microbiota between spontaneously hypertensive rats and Wistar-Kyoto rats7. The ratio of Firmicutes and Bacteroidetes is considered specific for intestinal dysbiosis9. In animal studies, the alteration of this ratio correlated with arterial hypertension, suggesting that gut microbiota could be a potential target of future antihypertensive therapies9. Heart failure is the final stage of evolution of the majority of cardiovascular diseases, with high mortality rates. One study has comparatively analyzed the bacteria and fungi in the feces of patients with heart failure with those of healthy controls and demonstrated that patients with chronic heart failure have more pathogenic bacteria10. Moreover, some species, like Candida, Shigella, and Campylobacter, were positively correlated with the severity of the heart failure10. Patients with heart failure, with decreased cardiac output, have gastrointestinal mucosa congestion and ischemia, with subsequent alterations in the composition of gut microflora and also intestinal functions. These alterations will lead to bacterial translocation, the release of endotoxins in the circulation, promoting a systemic inflammatory response. Some authors suggested that TMAO can be used as a biomarker for prognosis stratification in patients with heart failure11, although the exact mechanisms of increased levels of TMAO in patients with heart failure are still unknown. Other gut microbiota metabolites, p-cresyl sulfate and phenylacetylglutamine, have been suggested by some studies to be involved in the appearance of cardiovascular diseases12,13. Based on the above findings, the future cardiovascular therapies may include gut microbiota and their metabolites as potential targets. These therapies could be represented not only by drugs but also by diet changes and supplementation with prebiotics and/or probiotics.

Nowadays, more and more evidence points out to the interrelationship between intestinal microbiota and cardiovascular diseases. Gut microbiota is composed of a large number of microorganisms that live in the human gut and are involved in many physiological processes. Changes in the composition and activity of intestinal microbiota may lead or may accelerate the evolution of some cardiovascular diseases. Alterations in the composition of gut microbiota will induce dysbiosis, causing inflammation and initiating the development of cardiovascular diseases. These alterations may be secondary to intestinal infections, exposure to some environmental factors, changes in dietary habits, high stress, use of antibiotics. Studies have shown that gut microbiota is composed of six families, the Firmicutes, Bacteroidetes, Proteobacteria, Actino-bacteria, Fusobacteria, and Verrucomicrobia phyla1. These microorganisms are involved in the immune processes of the host, the fight against the pathogenic microorganisms and also in maintaining the integrity of intestinal barriers. Coronary heart disease and arterial hypertension are chronic diseases with a high prevalence. Some studies have demonstrated a link between the composition of gut microbiota and the increased risk of atherosclerosis, which is the main cause of coronary heart disease2,3. These studies have identified different species of bacteria, both in the gut and in the atheromatous plaques, suggesting that gut is a source of atherogenic bacteria2,3. The mechanisms by which these bacteria can initiate the atherosclerotic process (or in some cases protect against it) are still unknown. Trimethylamine N-oxide (TMAO) is a microbial metabolite that was studied for its effects on cardiovascular diseases after the discovery of a positive correlation between the serum level of TMAO and the atherosclerotic plaque area. This correlation was partially explained by the role that TMAO plays in the inhibition of reverse cholesterol transport and the accumulation of macrophage cholesterol4,5. One study has found that the TMAO level in patients with an acute coronary syndrome is an independent predictor of short-term and long-term major adverse cardiac events6. The implication of gut microbiota in arterial hypertension has been demonstrated by animal studies7,8. Adnan et al have shown that the blood pressure can be influenced by the exchange of gut microbiota between spontaneously hypertensive rats and Wistar-Kyoto rats7. The ratio of Firmicutes and Bacteroidetes is considered specific for intestinal dysbiosis9. In animal studies, the alteration of this ratio correlated with arterial hypertension, suggesting that gut microbiota could be a potential target of future antihypertensive therapies9. Heart failure is the final stage of evolution of the majority of cardiovascular diseases, with high mortality rates. One study has comparatively analyzed the bacteria and fungi in the feces of patients with heart failure with those of healthy controls and demonstrated that patients with chronic heart failure have more pathogenic bacteria10. Moreover, some species, like Candida, Shigella, and Campylobacter, were positively correlated with the severity of the heart failure10. Patients with heart failure, with decreased cardiac output, have gastrointestinal mucosa congestion and ischemia, with subsequent alterations in the composition of gut microflora and also intestinal functions. These alterations will lead to bacterial translocation, the release of endotoxins in the circulation, promoting a systemic inflammatory response. Some authors suggested that TMAO can be used as a biomarker for prognosis stratification in patients with heart failure11, although the exact mechanisms of increased levels of TMAO in patients with heart failure are still unknown. Other gut microbiota metabolites, p-cresyl sulfate and phenylacetylglutamine, have been suggested by some studies to be involved in the appearance of cardiovascular diseases12,13. Based on the above findings, the future cardiovascular therapies may include gut microbiota and their metabolites as potential targets. These therapies could be represented not only by drugs but also by diet changes and supplementation with prebiotics and/or probiotics.

Introduction. Rubella is a worldwide contagious disease with self-limited symptoms and a generalized rash. Epidemiology of rubella changed after licensing the vaccine in 1969. Children’s rubella is a self-limited infection, but when it occurs during pregnancy, there is a risk of severe damage to the fetus. Objectives. The aim of this study was to determine the immunity against rubella virus in pregnant women in Pleven Region, Bulgaria. Methods. A cross-sectional study was carried out on pregnant women hospitalized in a Clinic of obstetrics and gynecology, University Hospital-Pleven, Bulgaria. Quantitative determination of specific Immunoglobulin G (IgG) antibodies against rubella virus was performed by Enzyme-Like Immunosorbent Assay (ELISA). Data were analyzed using the Microsoft Office Excel 2007 software. Results. Between January 2018 and December 2018 there were collected and tested to Rubella virus IgG antibody 242 serum samples. Two hundred and four (84.30%) of them were positive, 29 (11.98%) were negative and 9 (3.72%) – equivocal. The age of examined women was between 14 and 45 years, average 27, sd±6.429. We found high seropositivity within age group 21-30 years of age. The immunization status of the investigated women shows – unimmunized – 79, selectively immunized with one dose of monovaxin – 58, immunized with combined (measles, mumps, rubella) vaccine one dose – 82, with a double immunization schedule – 23. In each group there were seropositive women. Conclusions. Data analysis shows that pregnant women have high immunity and a tendency for lower morbidity rates of acute rubella infection.

Although a common condition, acne is a complex condition that involves chronic inflammation and hyperkeratosis of the hair follicles, increased sebum secretion, and colonization of Propionibacterium acnes. Metformin has been found to play a role in acne, particularly hormonal acne. Our goal is to review the relevant studies and their results following metformin administration in patients with acne.

Introduction. The digestive tract is invariably affected in HIV-infected patients and should be investigated especially in patients with longer disease duration. The significance of decreasing CD4+ cell counts as a predictive factor for the existence and severity of upper gastrointestinal lesions has been previously evaluated in some studies, that demonstrated a link between this parameter and the frequency or extent of esophageal or gastric lesions. The objective of the study was to investigate the upper digestive tract infections in HIV-infected patients and to establish the link between endoscopic changes (type and location) and the peripheral CD4+ cell counts. Material and methods. This is a retrospective cohort study. 88 HIV-infected patients, hospitalized for clinical and biological evaluation between November 2015 and July 2018 in the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, Romania, were investigated by upper digestive endoscopy. In all patients, CD4+ T-lymphocyte values were determined. Results. Our study emphasizes a greater probability of developing lesions of the upper digestive tract and a greater frequency of esophagitis in HIV-infected patients with low CD4+ T-lymphocyte values compared to patients with normal values. The most commonly involved segment is the esophagus. The most common gastric lesion is gastritis, which in patients with lymphocytic depletion affects the entire gastric mucosa. Conclusions. The results of the study support the necessity of routine evaluation by upper digestive endoscopy of HIV-infected patients with low CD4+ T-lymphocyte values, irrespective of the presence or absence of symptoms specific for upper digestive tract lesions, both for diagnostic and epidemiological purposes.

Introduction. Wound regeneration is an important process in surgical interventions. Failure of an intestinal anastomosis is an important intestinal surgery problem. The objective of the study. To evaluate the effect of platelet-rich plasma (PRP) and compare the effectiveness of various application methods in intestinal anastomosis regeneration in rabbits. Methods. Platelet-rich auto-plasma was obtained from 81 rabbits, which was used to study two methods of applying PRP (injection into the muscle layer / soaking in the intestinal wall) in comparison with the control group, on the end-to-end small-intestinal anastomosis. Results. The analysis of the histological and morphometric data showed that the regeneration between the samples of intestinal anastomosis treated with PRP soaking and injections into the intestinal wall is more favorable in comparison with the control group, which, in turn, was determined by the quantitative ratio of inflammatory infiltrate, fibroblast proliferation, neo-angiogenesis, and collagen deposition. PRP soaking in the intestinal wall significantly increased the number of adhesions battles. The analysis of the deformation and strength characteristics of the formed anastomoses also showed significantly high values ??of the rupture strength of the anastomoses treated with PRP, in contrast with the control group. Conclusion. PRP injection into the muscular layer of the intestinal wall significantly reduces the development of adhesions in comparison with the PRP-saturated group of intestinal anastomoses. Further research is needed to clarify the optimal method of PRP application, which will improve the regeneration of the intestinal anastomosis.

Introduction. Wound regeneration is an important process in surgical interventions. Failure of an intestinal anastomosis is an important intestinal surgery problem. The objective of the study. To evaluate the effect of platelet-rich plasma (PRP) and compare the effectiveness of various application methods in intestinal anastomosis regeneration in rabbits. Methods. Platelet-rich auto-plasma was obtained from 81 rabbits, which was used to study two methods of applying PRP (injection into the muscle layer / soaking in the intestinal wall) in comparison with the control group, on the end-to-end small-intestinal anastomosis. Results. The analysis of the histological and morphometric data showed that the regeneration between the samples of intestinal anastomosis treated with PRP soaking and injections into the intestinal wall is more favorable in comparison with the control group, which, in turn, was determined by the quantitative ratio of inflammatory infiltrate, fibroblast proliferation, neo-angiogenesis, and collagen deposition. PRP soaking in the intestinal wall significantly increased the number of adhesions battles. The analysis of the deformation and strength characteristics of the formed anastomoses also showed significantly high values ??of the rupture strength of the anastomoses treated with PRP, in contrast with the control group. Conclusion. PRP injection into the muscular layer of the intestinal wall significantly reduces the development of adhesions in comparison with the PRP-saturated group of intestinal anastomoses. Further research is needed to clarify the optimal method of PRP application, which will improve the regeneration of the intestinal anastomosis.

Introduction. Wound regeneration is an important process in surgical interventions. Failure of an intestinal anastomosis is an important intestinal surgery problem. The objective of the study. To evaluate the effect of platelet-rich plasma (PRP) and compare the effectiveness of various application methods in intestinal anastomosis regeneration in rabbits. Methods. Platelet-rich auto-plasma was obtained from 81 rabbits, which was used to study two methods of applying PRP (injection into the muscle layer / soaking in the intestinal wall) in comparison with the control group, on the end-to-end small-intestinal anastomosis. Results. The analysis of the histological and morphometric data showed that the regeneration between the samples of intestinal anastomosis treated with PRP soaking and injections into the intestinal wall is more favorable in comparison with the control group, which, in turn, was determined by the quantitative ratio of inflammatory infiltrate, fibroblast proliferation, neo-angiogenesis, and collagen deposition. PRP soaking in the intestinal wall significantly increased the number of adhesions battles. The analysis of the deformation and strength characteristics of the formed anastomoses also showed significantly high values ??of the rupture strength of the anastomoses treated with PRP, in contrast with the control group. Conclusion. PRP injection into the muscular layer of the intestinal wall significantly reduces the development of adhesions in comparison with the PRP-saturated group of intestinal anastomoses. Further research is needed to clarify the optimal method of PRP application, which will improve the regeneration of the intestinal anastomosis.

Introduction. The brachial plexus injury represents 3-5% of all injuries and is considered to be one of the most serious types of injuries to the musculoskeletal system, due to the development of severe and often irreversible changes. The objective of the study was to establish the features of blood supply and innervation of the shoulder girdle muscles in 4-10-month-old human fetuses. Materials and methods. Using methods of macromicroscopic preparation, vascular injection and morphometry, the fetal topography of the arteries and nerves of the shoulder girdle muscles was studied in 37 human fetuses, 4-10-month-old. Results. The quadrangular space in the experimental fetuses is a narrow axillary canal in which three permanent walls, anterior and posterior foramina can be distinguished. The surgical neck of the humerus is the fourth non-permanent wall of the axillary canal. At the same time, the branching of the axillary nerve into secondary trunks for the most part occurs before entering the canal or in the canal itself. The triangular space looks like an axillary fissure. It has been established that the nature of the intramuscular distribution of blood vessels and nerves in each muscle of the shoulder girdle is peculiar and differs in the topography of muscle fiber bundles. In all the muscles of the shoulder girdle, intra-and intramuscular anastomoses between arteries of different orders and diameters were clearly detected. Conclusions. The axillary nerve is involved in the innervation of the posterior artery, enveloping the humerus and of its branches. In each muscle, one can meet both a loose and a main pattern of branching of the arteries regardless of their shape. When the direction of the vessels and muscle bundles is in line, the main form of branching (infraspinous and subscapularis muscles) is usually formed, and if they do not conform, it is mainly loose (deltoid, supraspinous, teres minor and major muscles).

Introduction. A clear knowledge on the variations of blood supply and innervation of muscles in different areas of the body allows the surgeon to select the neurovascular pedicle, when performing muscle transposition operations using microsurgical techniques, to correctly choose the muscle flap, the method of replacing the defect and the localization of the donor area. The objective of the study: to clarify the information about the sources of innervation and blood supply to the gracilis muscle, adductor muscles and pectineus muscles, as well as to investigate the intramuscular distribution of nerves and arteries in the muscles of the medial group of the thigh in human fetuses aged 4-10 months. Materials and methods. The peculiarities of the fetal topography of the arteries and nerves of the medial femoral group muscles were studied in 42 human fetuses aged 4-10 months using the methods of macro microscopic preparation, vascular injection, surface staining of the prepared vessels and nerves, and morphometry. Results. It has been established that the distribution of nerves and arteries is uneven in the thickness of the muscles of the medial group of the thigh, at the same time the middle third of all adductor muscles is supplied with blood and innervated more intensively. The places where nerves penetrate into the thickness of the muscles of the medial femoral group, do not coincide with the places where the arteries enter, pectineus muscle is an exception. The nature of the intramuscular distribution of nerves and arteries depends on the structure and function of the muscle. The intramuscular nerve trunks are interconnected in the gracilis and adductor magnus muscles, forming loops and arcades. Nerve connections between the obturator and sciatic nerves are found in the thickness of the adductor magnus muscle. Conclusions. In the picture of the intramuscular distribution of nerves and arteries in the muscles of the medial group of the thigh in human fetuses, three forms can be distinguished: loose, trunk, and mixed. In the thickness of the muscles of the medial femoral group, the distribution of nerves and arteries is uneven. Segmentation is preserved in the intramuscular distribution of arteries in the muscle gracilis, adductor longus and magnus muscles, while in the distribution of nerves in these muscles segmentation is absent.

Introduction. Chronic pancreatitis (CP) is a variable part of cystic fibrosis (CF) syndrome caused by mutations in CFTR gene. The objective of the study was to assess the frequency of CFTR gene mutations in patients with chronic relapsing pancreatitis (CRP). Material and methods. The study enrolled 41 patients with CRP and control group (CG), which consisted of 100 healthy people. The R117H mutation of the CFTR gene was confirmed in the Molecular Genetics Laboratory of the Institute of Genetics, Physiology and Plant Protection of the Academy of Sciences of Moldova. As a biological specimen, venous blood was used. The genetic polymorphism was identified through the polymerase chain reaction and analysis of enlarged fragment length and restriction fragment length polymorphism (RFLP), with the use of the respective primers. Results. The study detected the presence of the R117H/CFTR mutation in 31 (75.61%) of CRP patients and in 53 (53%) healthy persons from CG. A more significant difference was demonstrated when evaluating the ratio between homozygous and heterozygous variant of R117H mutation. In the group of the CRP patients, detected with the respective mutation, 11 (35.48%) had homozygous variant and 20 (64.52%) – heterozygous variant; in CG – in 11 (20.75%) persons the homozygous variant and in 42 (79.25%) – the heterozygous variant of the mutation have been confirmed. According to literature data, a high frequency of R117H mutation in heterozygous variant represents a higher risk of developing pancreatic pathology. The predominant CRP installation was confirmed at a young age of 25-34 years (48.8%). Conclusions. The high frequency of R117H/CFTR mutation in the heterogeneous population of the Republic of Moldova, in combination with other genetic and nongenetic risk factors, represents a high degree of risk for the development of pancreatic disorders.

Introduction: in our multicultural society the global pandemia of obesity consists in the severest form of overweight, affecting young children, with individual and parental dietary and lifestyle factors being associated with OW/OB among preschoolers. The objective of the study was to assess the parental dietary and lifestyle trajectories that predict and determine native Greek and immigrant preschoolers’ BMI and KIDMED score. Material and methods: 578 guardian parents and 578 preschoolers (5-6 year-old), both native Greeks (n=451) and other nationalities (n=127) participated in this cross-sectional study. The Food Frequency Questionnaire and KIDMED scores were utilized. Results: Significantly high level of concordance of guardian parents’ and preschoolers’ dietary habits (Spearman’s rho= 0.94, R2=0.91, p <0.001) was revealed. The strongest predictors significantly increasing BMI in preschoolers (p <0.05) were: low levels of KIDMED score, low frequency of removing fat from meat prior eating, low parental frequency of following Mediterranean Diet. Contrariwise, regular family’s breakfast and brunch consumption, high frequency of consuming vegetables or fruits and physically active parents who control preschoolers’ diet, were predictors of diminishing the risk of high BMI in children. Child’s increased physical activity and parents’ frequency of following the Mediterranean Diet were found to decrease the risk of low KIDMED score in preschoolers. Conclusions: Both Greek and other nationalities’ guardian parents’ lifestyle characteristics, dietary habits and choices act as determinants either reinforcing or aggravating preschoolers’ health outcomes. Families should promote optimal dietary habits for better health outcomes.

Introduction. The identification of the type and site of origin in undifferentiated tumours of unknown primary site using immunohistochemistry is a frequent requirement in pathology practice. There are many histologic lesions that display similar morphologic aspects, with misdiagnosis potentially resulting in over- or undertreatment. This makes the diagnostic accuracy extremely important in the era of targeted therapies. The objective of the study was to evaluate the process of diagnosis in 50 melanoma cases presenting as poorly differentiated or undifferentiated tumours with unknown primary origin, with emphasis on the immunohistochemical algorithm. Methods. 50 cases were selected to analyse the utility of IHC testing in diagnosing poorly differentiated malignancies. The immunohistochemical evaluation was based on the staining percentage of cells: focal positive <50%, diffuse positive >50%, negative (-) 0%. Results. After applying the Fan Lin algorithm, for most of the cases (45), the cytokeratin and CD45 proved negative, while S100 and vimentin were positive in diffuse or zonal patterns. For the 3 cases analysed by applying the Turin algorithm, the first antibody panel consisted in testing CK7/CK20, that showed no expression for all 3 cases. Conclusions. In this study, we demonstrated that the immunohistochemical examination of poorly differentiated malignant tumours is a reliable and valuable test and is recommended as a standard method in diagnosis along with the correlations with clinical and histological data.

Introduction. Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare type of squamous cell carcinoma (SSC). It differs from the usual SSC of the cervix in its morphology and clinical behavior and shows a better prognosis than the more common SSC of the cervix. It is considered that LELC is associated with Epstein–Barr virus (EBV) infection in Asian and with human papilloma virus (HPV) or no infection in Caucasian patients. The aim of the study was to confirm whether or not LELC is more common in Caucasian patients with EBV/HPV infection or whether there is no correlation to the previous viral exposure. Material and methods. A retrospective research has been done on 775 female patients for a period of 8 years, who have been operated for cervical cancer in the Onco-gynecological Department of UMHAT “Doctor Georgi Stranski”-Pleven, Bulgaria. A group of 16 women with LELC has been identified by clinical data. Morphologically, 13 of them have been examined by routine histological and immunohistochemical tests, for assessment of the viral status, with monoclonal antibodies against EBV/HPV by DAKO protocol. Results. Two of the women have been proven to have EBV, tree-HPV infection and two – both viruses. In the other six cases no viral infections have been identified. Conclusion. Our results show a stronger correlation between LELC in Caucasian women and a previous HPV infection or no viral infection, rather than association with EBV infection.

Introduction. The risk of inappropriate prescribing and inadequate drug use in the elderly population is growing with ageing associated physiological changes and polypharmacy due to increased number of chronic diseases. In order to optimize the therapy, numerous criteria have been developed which can help pharmacists and physicians to implement rational pharmacotherapy. The objectives of the study were to survey the practice of medication use in patients older than 65 years with different stages of renal failure and to identify potentially inappropriate prescribing, as well as to justify the role of pharmacists in pharmacotherapy optimization. Material and methods. This retrospective study included 100 patients with average age of 72.30±5.00 years. Demographic, clinical and pharmacotherapy data were collected from hospital discharge summary after one day hospital examination at the Clinic of Nephrology of Clinical Center Niš, Serbia. Potentially inadequate drugs were identified by STOPP criteria (Screening Tool of Older Persons’ Prescriptions), while START criteria (Screening Tool to Alert doctors to Right Treatment) pointed out the lack of potentially helpful drugs in therapy. Results. 63 STOPP and 60 START criteria were identified. The most common STOPP criteria were the use of benzodiazepines (14%) and duplication of therapy (11%). The greatest influence on the occurrence of STOPP criteria was the total number of medications in therapy. START criteria identified the lack of statins in therapy in 19% of patients with cardiovascular disease and in 13% with diabetes mellitus type 2. The occurrence of START criteria was mostly influenced by the number of comorbidities. Conclusions. The presence of potentially inadequate prescribed and the lack of potentially useful drugs in the complex pharmacotherapy of elderly patients is the reason for including pharmacists in a team which creates optimal pharmacotherapy for elderly.

The aim of the study was to evaluate the condition of cytoplasmic membranes of leukocytes and to study their viability, to determine the varieties and stages of cell death of leukocytes in patients with pulmonary tuberculosis treated by different schemes of antimycobacterial treatment. Materials and methods. The study was performed on 30 patients with pulmonary tuberculosis: the 1st group – 12 patients treated by standard regimen with 1st line drugs; the 2nd group treated by individual regimen with 1st and 2nd line drugs. Results. The analysis of cytoplasmic membranes of leukocytes in the blood of patients from the 1st and the 2nd group showed that the proportion of live intact cells was 71.05±3.66%, that is lower by 20.75 % from the results of control group. In the 2nd group, the proportion of alive cells was lower by 12.9% than in the 1st group (?<0.05). In the same time, the proportion of leukocytes on the late of apoptosis/necrosis, that have deep damages of cell structure, was more than 10% higher than in the 1st group (?<0.05). Conclusions. A significant difference between the groups of patients in the proportion of absolutely alive leukocytes and cells on the late stage of apoptosis/necrosis can be a proof of higher activation of apoptosis process by individual treatment regimen that included 1st and 2nd line-drugs, compared with standard 1st line regimen. The obtained data allow us to recommend the study of influence of different anti-tuberculous drugs and regimens on apoptosis process of immune-competent cells, to evaluate the efficacy of pulmonary tuberculosis treatment.

Introduction. In the last years, the non-invasive methods of evaluating liver fibrosis were imposed in the current medical practice. The objective of the study was to evaluate the role of 2D Shear Wave elastography in the dynamic monitoring of liver fibrosis compared to a validated method – Fibromax. Materials and methods. 37 patients with chronic hepatitis C infection and advanced fibrosis (F3/F4) who received treatment with Paritaprevir/Ritonavir + Ombitasvir + Dasabuvir were included. The evaluation was done at baseline, 12 weeks after the end of treatment and 48 weeks after therapy. Results. There was a significant and positive correlation of high degree, according to the Spearman’s rho correlation coefficient, between 2D Shear Wave elastography and Fibromax, showing very similar results both at the beginning of therapy (p<0.001, R=0.726) and one year after its completion (p<0.001, R=0.961). The correlation between platelet count and the non-invasively estimated liver fibrosis degree is statistically significant, being moderately negative (p=0.009, R=0.426) – patients with low platelet count at baseline did not present an improvement of fibrosis or it was not statistically significant one year after stopping the treatment. Direct antiviral therapy with Paritaprevir/Ritonavir + Ombitasvir + Dasabuvir, besides the chronic hepatitis C eradication rate of 99-100%, also determines a statistically significant improvement (p<0.001) of the degree of liver fibrosis. Conclusions. There is a strong correlation between the two non-invasive methods analyzed, which recommends routine use of 2D Shear Wave elastography alone or in combination with other tests. In addition to the remarkable effectiveness of the therapeutic regimen used (SVR rates >95%), there is also a significant improvement of fibrosis, which prevents progression to cirrhosis and hepatocellular carcinoma.

Introduction. Ambrosia artemisiifolia (common ragweed) is an invasive weed with capacity for rapid growth in many disturbed environments, whose highly allergenic pollen appears to be a significant public health problem. Ambrosia is now recognized to have a significant contribution to increased risk of air pollution and of respiratory diseases in urban environment. The aim of our study was to evaluate clinical aspects and risk factors of patients diagnosed with respiratory allergies due to Ambrosia pollen, addressed to our Allergy center from Bucharest, Romania. Material and methods. We performed a retrospective study of patients confirmed with allergy to Ambrosia pollen for a period of 33 months, between January 2017 – October 2019. Results. From a total number of 760 patients addressed for respiratory symptoms, 184 patients (24.21%) were diagnosed with clinical allergy due to Ambrosia pollen, based on clinical picture and specific serologic or skin tests. The clinical forms were seasonal allergic rhinitis in 42 cases, seasonal rhino-conjunctivitis in 65 cases, rhino-sinusitis in 49 cases and rhinitis complicated with allergic asthma in 28 cases. Moderate and severe clinical forms, according to symptoms scores, were recorded in 147 cases (79.89%). History of atopy was found in 22 patients (11.95%). Almost all patients have admitted environmental exposure to the plant Ambrosia, either at home or at the working place. The mean duration from symptoms onset until presentation to allergist consultation was 3.2 years.

Introduction. The infections of the deep neck spaces, are often a clinical challenge, being a medico-surgical emergency with a bad prognosis and lethal potential in the absence of early diagnosis and well applied treatment. Case report 1. The first case presented is a woman, 72-year-old, known with anaemia due to myelodysplastic syndrome, admitted in the haematology department. The symptoms were dysphagia with odynophagia and right submandibular tumefaction, on an afebrile background. In this case the infection started with the peritonsillar abscess which then developed into a parapharyngeal abscess. The main medical difficulties appeared after the surgery, the general condition of the patient worsening despite the favourable evolution of the surgical wound. A total recovery, including deglutition, was possible two months after discharge. Case report 2. The second patient is a young female, aged 26, with a good social and material status, without associated comorbidities. The triggering factor is the extraction of the 3.7 molar prior to the appearance of the symptoms. The condition of the patient was critical during the first seven days after surgery due to the severity of the cervical and mediastinal lesions. Conclusions The management of deep neck infections is a diagnostic and therapeutic challenge, and must be based on the multidisciplinary aid. The prevalence of deep neck infections is decreasing, due to antibiotics, but still remains an ENT emergency.

Inflammation of the salivary glands manifest differently, depending on the etiologic agent and patient population. Inflammatory and infectious pathology of the salivary glands is multifactorial and has a multimodal therapy. Bacterial infections are the result of ductal blockage or decreased salivary production. On this background, retrograde contamination of glandular parenchyma occurs. Some systemic viral infections produce salivary pathology such as mumps or AIDS. Many granulomatous infections can affect salivary glands such as tuberculosis (TB), syphilis, tularemia, toxoplasmosis, actinomycosis, and bartonellosis. Salivary inflammation occurs either in the secretory canal or in the whole gland. Suppuration of the salivary glands in immunosuppressed individuals can extend to cervicofacial regions and the mediastinum and require immediate treatment. Interdisciplinary collaboration with the infectionist, parasitologist and radiologist is the golden standard towards the benefit of the patient. Authors describe the clinical features and treatment of inflammatory diseases of the salivary glands.

Ioannis Kardamatis was born in Athens in 1859. He studied medicine at the National University of Athens (in 1932, it was renamed to National and Kapodistrian University of Athens) and specialized in internal medicine and pediatrics in Paris and Brussels. He pioneered the anti-malaria battle in Greece in 1905. In 1909, he was elected lecturer at the Chair of Tropical Diseases and Parasitology at the Medical School of Athens. Moreover, he debated on the erroneous theory of Sir Ronald Ross (1857–1932) and William Henry Samuel Jones (1876–1963) proving that malaria did not provoke the fall of ancient Greece. His original work on malaria comprised more than 150 scientific papers, including monographs. The French Government and Paris Medical Academy awarded his work and research on malaria. In 1915, the Medical School of Athens abolished the chair of Tropical Diseases and Parasitology but Kardamatis continued to contribute to the field of the disease.

Primary extragonadal germ-cell tumors (EGCTs) are a rare group of neoplasms, that can exist anywere along the midline of the body, without the evidence of a primary gonadal tumor. Their morphology varies widely and includes teratoma, seminoma, yolk sac tumor, embryonal carcinoma, choriocarcinoma, and mixed GCTs. The ethiopathogenesis of EGCT is poorly understood, existing multiple theories. Diagnosis is often difficult, but an accurate one should be made in order to apply a correct management.

Ureteral endometriosis is characterized by the development of deep infiltrating islets of endometrial tissue affecting the ureter, the optimal management in such cases being still poorly defined. Once the techniques of laparoscopic surgery improved, this minimally invasive approach has been proposed with encouraging results in treating such cases. When it comes to the types of surgical procedure which are needed in such cases, they are chosen accordingly to the degree, extent and localization of the endometrial tissue. This is a literature review of the largest studies which were conducted on the theme of the laparoscopic management of ureteral endometriosis; the main analyzed parameters refer to the efficacy and safety of the procedure.

Ureteral endometriosis is characterized by the development of deep infiltrating islets of endometrial tissue affecting the ureter, the optimal management in such cases being still poorly defined. Once the techniques of laparoscopic surgery improved, this minimally invasive approach has been proposed with encouraging results in treating such cases. When it comes to the types of surgical procedure which are needed in such cases, they are chosen accordingly to the degree, extent and localization of the endometrial tissue. This is a literature review of the largest studies which were conducted on the theme of the laparoscopic management of ureteral endometriosis; the main analyzed parameters refer to the efficacy and safety of the procedure.

Deep infiltrating endometriosis is a debilitating disease which usually affects young women and significantly impacts on the quality of life. Due to the fact that it remains a benign condition which usually affects patients at the reproductive age, an aggressive, radical surgical procedure might be considered as a too mutilating one by certain cases. In consequence, attention was focused on treating these patients in a less invasive manner, procedures like rectal shaving or full thickness local excision being proposed. In the meantime, once the minimally invasive techniques evolved, laparoscopic surgery has been widely proposed in the last decade in order to treat this pathology. The current paper is a literature review of the largest studies which investigated and compared the outcomes after minimally invasive approach for deep infiltrating colorectal endometriosis.

Human Papilloma Virus (HPV) is the virus responsible for the most common and widespread sexually-transmitted infection. Most sexually active people will acquire at least one type of HPV in their lifetime and some may be repeatedly infected. In most cases, HPV infection is transient and asymptomatic, but when the infection persists it can cause benign diseases, precancerous lesions and malignancies of various locations. Low risk HPV types can produce proliferative lesions either in the skin or mucosa, whereas high risk types possess carcinogenic potential. This paper is a review of the latest data in the literature regarding the clinical manifestations of HPV infections, current prevention and therapeutic possibilities.

Despite considerable improvements in medical care over the past 25 years, cardiovascular disease (CVD) remains a major public health challenge. Dyslipidemias are one of the topics of greatest interest in cardiology. Decreasing serum cholesterol level is a central objective for preventing cardiovascular events. The current European Society of Cardiology guidelines recommend evaluation of the cardiovascular risk, treatment decisions being based on this risk, and clinician–patient discussion about the risk (shared decision making).

Introduction. Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare type of squamous cell carcinoma (SSC). It differs from the usual SSC of the cervix in its morphology and clinical behavior and shows a better prognosis than the more common SSC of the cervix. It is considered that LELC is associated with Epstein–Barr virus (EBV) infection in Asian and with human papilloma virus (HPV) or no infection in Caucasian patients. The aim of the study was to confirm whether or not LELC is more common in Caucasian patients with EBV/HPV infection or whether there is no correlation to the previous viral exposure. Material and methods. A retrospective research has been done on 775 female patients for a period of 8 years, who have been operated for cervical cancer in the Onco-gynecological Department of UMHAT “Doctor Georgi Stranski”-Pleven, Bulgaria. A group of 16 women with LELC has been identified by clinical data. Morphologically, 13 of them have been examined by routine histological and immunohistochemical tests, for assessment of the viral status, with monoclonal antibodies against EBV/HPV by DAKO protocol. Results. Two of the women have been proven to have EBV, tree-HPV infection and two – both viruses. In the other six cases no viral infections have been identified. Conclusion. Our results show a stronger correlation between LELC in Caucasian women and a previous HPV infection or no viral infection, rather than association with EBV infection.

Introduction. Sialolithiasis is one of the most common pathologies of the salivary glands. When calculi are present in the distal excretory duct, in the hilum or in the parenchyma, complete removal of the submandibular gland is recommended. Case report. We present the case of a 43-year-old male patient, suffering from left chronic submandibular sialadenitis. The patient accused recurring colic and intermittent swelling of the left submandibular gland experienced for about 10 years, with a progressive evolution. CT scan revealed a lower volume of the left submandibular gland compared to the right submandibular gland, the presence of a microcalcification in the parenchyma and an oval calcification corresponding to the projection area of the left submandibular gland’s duct. A left sub mandibulectomy was performed. Conclusion. Complete removal of the submandibular gland is the most effective therapy for sialolithiasis, being associated with better long-term outcomes and low operative morbidity.

Introduction. Precocious puberty is a common endocrine disorder in pediatric patients, leading to important changes in growth patterns. Case presentation. We present the case of a patient with precocious puberty and accelerated bone maturation, evaluated in several medical centers. A 9-year-and-11-month-old female patient was evaluated for premature thelarche, adrenarche and menarche starting at the age of 7. On clinical examination, height was 143 cm, 0.9 SD above the age and sex median, with 37.91% excess weight. She also presented with acne, cervical posterior acanthosis nigricans, hirsutism and Tanner puberty development stage B3/P4. The endocrine profile showed pubertal values for FSH (Follicle-Stimulating Hormone), LH (Luteinizing Hormone) and estradiol, before and after the Diphereline test, hyperprolactinemia (of 38.6 ng/mL, normal: 2-18.9 ng/mL) and high levels of 17-OH Progesterone (of 2.60 ng/mL, normal: 0.2-0.9 ng/mL). The Synactene® test excluded 21-hydroxylase deficiency. Knee X-rays showed a tendency for premature growth plate fusion and bone age advancement of 3.1 years. Gynecological examination and pelvic ultrasound showed normal ovarian morphology and volume, according to chronological age and a 17-mm endometrium. Hypothalamic-pituitary MRI (Magnetic Resonance Imaging) excluded the presence of a local lesion. Conclusions. In the absence of therapeutic intervention, accelerated skeletal development due to precocious puberty initially leads to high stature compared to the patient’s age group, followed by premature closure of the growth plates and low final height.

Introduction. Pineal tumors are an inhomogeneous group of lesions with pineal origin, characterized by various degrees of hypothalamic-pituitary dysfunction. Case presentation. We present the case of a patient with pineal germinoma and hypogonadotropic hypogonadism who was evaluated in several medical centers. A 31-year-old male patient with a history of primary hypothyroidism and pineal germinoma, for which he underwent surgery, radiation and chemotherapy, was admitted for frontal-temporal headache, nausea and moderate intensity asthenia. Clinical examination revealed normal weight, normal blood pressure, left eye strabismus, pale skin, diminished facial and body hair, bilateral gynecomastia. The endocrine profile showed adequate thyroid hormone replacement, low normal basal cortisol levels (5.88 µg/dL, normal 5-25 µg/dL), low IGF-1 (Insulin-like Growth Factor) (93.2 pg/mL, normal 115-307 pg/mL), low gonadotrophins, testosterone (0.57 ng/mL, normal 1.3-8.53 ng/mL) and estradiol (<10 pg/mL, normal 15-60 pg/mL). Breast ultrasound showed bilateral asymmetric gynecomastia, BIRADS-2. No tumors or surgery complications were found on MRI (Magnetic Resonance Imaging) exam. A diagnosis of hypogonadotropic hypogonadism was established and surgical cure of gynecomastias, as well as testosterone replacement therapy were recommended. Conclusions. Pineal germinomas are rare tumors associated with increased risk of endocrine dysfunctions, including hypogonadotropic hypogonadism, as a consequence of germinoma-specific therapy. Frequent biochemical assessment as well as follow-up imaging are needed, in order to prevent tumor recurrence and long-term complications related to the germinoma itself or the chosen therapy.

Introduction. Evans’ syndrome (autoimmune hemolytic anemia combined with thrombocytopenia) is a rare hematological syndrome in the elderly. Case report. A 94-year-old patient was diagnosed with Evans’ syndrome with the secretion of monoclonal protein. The disease manifested initially by a periodic decrease in hemoglobin and platelet counts, accompanied by a deterioration of the clinical condition, and the development of a hemorrhagic syndrome. Long-term glucocorticoid therapy led to the development of osteoporosis, complicated by compression fracture of the lumbar vertebra. The main clinical manifestations of the disease (pain, limited mobility) were associated with the development of this complication. Conclusions. Diagnosis of Evans’ syndrome in elderly patients requires the exclusion of other similar diseases. Long-term glucocorticoid treatment can cause complications, such as osteoporosis with a risk of vertebral fracture. The resulting complications can disrupt the quality of life to a much greater extent than the underlying disease. When choosing a treatment for elderly patients with Evans’ syndrome, it is necessary to consider the possible benefits and the risk of complications.