The evolution of medicine is strongly related to technological progresses and to vaccines that increased the life expectancy during the last century. The appearance of vaccines represented a true revolution in medicine. The principle of vaccination has been stated by Louis Pasteur in 1881 and is very simple: the exposure to an attenuated form of the disease to prevent a more severe form. Pasteur has discovered the first attenuated artificial vaccine, represented not by a microorganism similar to that causing the disease, but from the same strain having lost its virulence

Introduction. Since the onset of menopause, the incidence of cardiovascular pathology and changes in bone mineral density (BMD) in the female population significantly increase. The objective of the study. To determine the diagnostic and prognostic value of bone and cardiovascular remodeling biomarkers in terms of determining their interrelationship with coronary artery disease (CAD) progression on the background of postmenopausal osteoporosis (PMOS). Material and methods. The study involved 115 women in the postmenopausal period, with a diagnosis of CAD. Depending on the BMD state, patients were divided into three groups: (1) – with normal BMD, (2) – with osteopenia, (3)- with osteoporosis. The selected control group consisted of 12 relatively healthy women of the corresponding age. Daily monitoring of electrocardiogram by Holter, two-dimensional echocardiography, intima-media thickness (IMT) measurement, the ultrasound densitometry, and FRAX algorithm were performed. The levels of cardiovascular and bone remodeling biomarkers were assessed. Results. In women with CAD and PMOS, there was a significant increase in the level of bone (osteoprotegerin, oste??alcin) and cardiovascular remodeling biomarkers (VEGF-A, homocysteine). By means of the ROC analysis, the cut-off values of biomarkers for osteopenia and osteoporosis were determined. The results of the relative risk (RR) assessment showed a probable interrelationship between the course of CAD and PMOS. Conclusions. The levels of biomarkers, ?determined by the ROC analysis, can be used for early diagnosis of bone structure disorders, and also for predicting the course of CAD on the background of PMOS.

Introduction. The mortality rate from complications of acute lymphoblastic leukemia (ALL) in children is high and exceeds the mortality rate from relapse of leukaemia. Ultrahigh expression of HSP 70 is associated with treatment resistance and is an adverse clinical outcome in ALL in children. The objective of the study was to evaluate the dynamics of the level of HSP 70 in the blood serum of children with ALL. Material and methods. 46 children with ALL were studied. Before the start of treatment, the level of HSP 70 in the blood serum has been studied (n = 46). In case of appearance of complications during the conduction of the remission induction, the HSP 70 has been restudied in blood serum (n = 29). Results. HSP 70 is significantly increased in children with ALL. A significant decrease in HSP 70 in the blood serum of patients with induction therapy was revealed compared with the initial level of this protein (p <0.05). No correlation between the level of HSP 70 in the blood serum of children with ALL and the manifestations of chemotherapy complications has been found. In contrast to previous studies, we did not find a significant effect of HSP 70 on mortality. Conclusions. Induction therapy leads to a decrease in the level of HSP 70 in the blood serum of children with ALL. We did not find a direct correlation between the occurrence of complications during induction therapy and HSP 70 concentration in the blood serum.

Introduction. One of the pathogenic chains in neurodegenerative diseases, and the Alzheimer’s disease especially, is the disorder of cellular energy supply. Investigation of changes in the indices characterizing a functional state of the mitochondria in the cerebral cortex and hippocampus under the influence of carbacetam, a new modulator of GABA-system, is of a certain interest. The objective of the study was to evaluate the protective effect of carbacetam under conditions of mitochondrial dysfunction of the brain in rats with scopolamine-induced Alzheimer’s disease. Materials and methods. The experiments were conducted on laboratory nonlinear albino male rats with the body weight of 0.18-0.20 kg. To simulate Alzheimer’s disease, scopolamine hydrochloride (Sigma, USA) was injected in rats through the peritoneum, in the dose of 1 mg/kg for 27 days. Since the 28th day of the experiment, carbacetam was introduced through the peritoneum in the dose of 5 mg/kg, in 1 mL of 0.9 % NaCl solution, once a day for 14 days. Results. Under conditions of scopolamine-induced Alzheimer’s disease, light dispersion decreases and a relative rate of mitochondrial swelling increases in the mitochondrial fraction of the cerebral cortex and hippocampus of rats; free radical oxidation of lipids and proteins increases, and activity of Krebs cycle enzymes decreases – ?-ketoglutarate dehydrogenase and succinate dehydrogenase. After carbacetam administration for 14 days, a gradual decrease of light dispersion and relative rate of mitochondrial swelling are found in the mitochondrial fraction of the cerebral cortex and hippocampus. Moreover, the content of products reacting with 2-thiobarbituric acid and protein oxidation modification in the examined structures decreases; the activity of catalase, ?-ketoglutarate dehydrogenase, succinate dehydrogenase increases, and superoxide dismutase – only in the cerebral cortex Conclusions. Reduced intensity of mitochondrial swelling, improvement of the antioxidant system state and energy supply of mitochondria in the cerebral cortex and hippocampus of rats with scopolamine-induced Alzheimer’s disease are indicative of mitoprotective properties of carbacetam as a promising neuroprotector.

Introduction. One of the pathogenic chains in neurodegenerative diseases, and the Alzheimer’s disease especially, is the disorder of cellular energy supply. Investigation of changes in the indices characterizing a functional state of the mitochondria in the cerebral cortex and hippocampus under the influence of carbacetam, a new modulator of GABA-system, is of a certain interest. The objective of the study was to evaluate the protective effect of carbacetam under conditions of mitochondrial dysfunction of the brain in rats with scopolamine-induced Alzheimer’s disease. Materials and methods. The experiments were conducted on laboratory nonlinear albino male rats with the body weight of 0.18-0.20 kg. To simulate Alzheimer’s disease, scopolamine hydrochloride (Sigma, USA) was injected in rats through the peritoneum, in the dose of 1 mg/kg for 27 days. Since the 28th day of the experiment, carbacetam was introduced through the peritoneum in the dose of 5 mg/kg, in 1 mL of 0.9 % NaCl solution, once a day for 14 days. Results. Under conditions of scopolamine-induced Alzheimer’s disease, light dispersion decreases and a relative rate of mitochondrial swelling increases in the mitochondrial fraction of the cerebral cortex and hippocampus of rats; free radical oxidation of lipids and proteins increases, and activity of Krebs cycle enzymes decreases – ?-ketoglutarate dehydrogenase and succinate dehydrogenase. After carbacetam administration for 14 days, a gradual decrease of light dispersion and relative rate of mitochondrial swelling are found in the mitochondrial fraction of the cerebral cortex and hippocampus. Moreover, the content of products reacting with 2-thiobarbituric acid and protein oxidation modification in the examined structures decreases; the activity of catalase, ?-ketoglutarate dehydrogenase, succinate dehydrogenase increases, and superoxide dismutase – only in the cerebral cortex Conclusions. Reduced intensity of mitochondrial swelling, improvement of the antioxidant system state and energy supply of mitochondria in the cerebral cortex and hippocampus of rats with scopolamine-induced Alzheimer’s disease are indicative of mitoprotective properties of carbacetam as a promising neuroprotector.

Introduction. One of the pathogenic chains in neurodegenerative diseases, and the Alzheimer’s disease especially, is the disorder of cellular energy supply. Investigation of changes in the indices characterizing a functional state of the mitochondria in the cerebral cortex and hippocampus under the influence of carbacetam, a new modulator of GABA-system, is of a certain interest. The objective of the study was to evaluate the protective effect of carbacetam under conditions of mitochondrial dysfunction of the brain in rats with scopolamine-induced Alzheimer’s disease. Materials and methods. The experiments were conducted on laboratory nonlinear albino male rats with the body weight of 0.18-0.20 kg. To simulate Alzheimer’s disease, scopolamine hydrochloride (Sigma, USA) was injected in rats through the peritoneum, in the dose of 1 mg/kg for 27 days. Since the 28th day of the experiment, carbacetam was introduced through the peritoneum in the dose of 5 mg/kg, in 1 mL of 0.9 % NaCl solution, once a day for 14 days. Results. Under conditions of scopolamine-induced Alzheimer’s disease, light dispersion decreases and a relative rate of mitochondrial swelling increases in the mitochondrial fraction of the cerebral cortex and hippocampus of rats; free radical oxidation of lipids and proteins increases, and activity of Krebs cycle enzymes decreases – ?-ketoglutarate dehydrogenase and succinate dehydrogenase. After carbacetam administration for 14 days, a gradual decrease of light dispersion and relative rate of mitochondrial swelling are found in the mitochondrial fraction of the cerebral cortex and hippocampus. Moreover, the content of products reacting with 2-thiobarbituric acid and protein oxidation modification in the examined structures decreases; the activity of catalase, ?-ketoglutarate dehydrogenase, succinate dehydrogenase increases, and superoxide dismutase – only in the cerebral cortex Conclusions. Reduced intensity of mitochondrial swelling, improvement of the antioxidant system state and energy supply of mitochondria in the cerebral cortex and hippocampus of rats with scopolamine-induced Alzheimer’s disease are indicative of mitoprotective properties of carbacetam as a promising neuroprotector.

Introduction. Combinations of fibrous materials with therapeutic agents as a drug delivery system are currently studied. A new direction has appeared in reconstructive surgery – tissue engineering, which aims to restore biological functions, i.e. tissue regeneration, not only to replace it with synthetic material. The objective of the study was to evaluate the antibiotic-sorbing ability of the three-dimensional non-woven matrices we created for reconstructing bone defects, made of polycaprolactone, and the possibility of releasing the impregnated antibiotic from the matrix material. Materials and methods. The study was conducted in the Department of Surgical Dentistry of Ivano-Frankivsk National Medical University, Ukraine, between September 12, 2019 – October 3, 2019. We used samples of three-dimensional micro-fibrous non-woven matrix for the defects’ reconstruction of the bone tissue made of polycaprolactone according to the developed technique. Collagen fragments were used as control. Results. The evaluation of the preservation of antibiotics in samples of matrix materials was performed on the 1st, 3rd, 5th, 7th, 14th, 18th and 21st day of the experiment. The obtained experimental data indicate that both drugs (cefazolin and lincomycin) were stored in significant quantities both in the collagen and the polycaprolactone matrix, throughout the entire observation period. Lincomycin impregnated in the polymer matrix is less stable during storage than cefazolin. Antibiotics impregnated in the collagen matrix are stored slightly better than when impregnated into polycaprolactone, due to a smaller pore diameter in collagen and, accordingly, a better expressed capillary effect. Conclusions. The developed matrix materials are a mean of a one-time local delivery of the drug to tissues in the damaged zone. This is especially relevant in surgical dentistry, since even strict adherence to aseptic rules cannot ensure that individual microbial cells from the surface of the oral mucosa and saliva get into the surgery area.

Introduction. Electrotherapy is a non-pharmacologic, non-invasive and simple method of back pain treatment that is also applied using interferential (IF) therapy. The objective of the study was to investigate the effect of IF on pain, range of motion, and quality of life in patients with chronic non-specific low back pain (CNLBP). Materials and methods. 61 patients suffering from CNLBP were randomly assigned to IF group (n=30) and placebo IF (n=31). All patients received supervised exercises 3 times per week for 4 weeks. The outcome measures were visual analogue scale (VAS), lumbar range of motion (ROM) in terms of flexion& extension and the Short Form-36 (SF-36) health questionnaire to evaluate the quality of life (QOL). Results. There were no significant differences between groups in terms of baseline and demographic characteristics (p > 0.05). There were significant differences between pre and post intervention in IF group in all measured parameters (VAS at rest, VAS during activity, Flexion, extension range of motion and QOL in term of physical and mental components) (p<0.05), while there were nonsignificant difference in all measured outcome in placebo group except the quality of life and flexion range of motion which showed statistical significant difference. When comparing the 2 groups, the results revealed that there were highly significant differences in all measured parameters in favor of IF group. Conclusions. The study revealed that 4 weeks of IF treatment combined with exercise therapy is significantly effective in reducing pain, improving lumbar ROM and QOL in patients with CNLBP.

Introduction. Penetrating wounds of thorax are frequent and require specific cares. The target of this study is to describe the epidemiological, clinical, therapeutic and progressive aspects of penetrating wounds of thorax by stabbing. Material and methods. This is a retrospective study of 73 patients with thoracic wounds by stabbing hospitalized at the Thoracic Surgery Department of University Hospital Center Joseph Ravoahangy Andrianavalona, Madagascar, from January 01, 2015 to January 31, 2018. Results. The mean age was 31.5 years, with a male predominance (89.04%). Most of the patients were in the tertiary sector (56.16%). Most of the cases were criminal assaults (by an unknown person = 91.78%). The thoracic lesions seen were fluid effusion in 58.9%, mixed in 32.88% and air in 6.85%. The association with limb trauma was the most common (16.44%). Chest drainage was performed in 67.12% of cases, thoracotomy in 1.37%. Evolution was favourable for most of the cases (90.41%). We found complications in 9.59% of the patients. Conclusions. Penetrating thoracic wounds by stabbing are frequent and represent an emergency, but patients often arrive late due to remoteness, financial problems, and neglect of chest wounds.

Introduction. The surgical treatment of goiter with severe thyrotoxicosis may lead to an improvement of the general condition of the patient, and amelioration of the clinical manifestations of thyrotoxic cardiomyopathy. The aim of the study was to evaluate the long-term results of surgical treatment in patients with toxic goiter and severe thyrotoxicosis, including the study of changes in cardiac activity and the level of physical activity. Materials and methods. The study was conducted in 123 patients with toxic goiter and severe thyrotoxicosis treated surgically. The duration of thyrotoxicosis ranged from 18 to 74 months. Before the surgical treatment and one year after it, structural and functional changes of the heart were studied by echocardiography and electrocardiogram, and physical activity according to the six-minute walk test. The long-term effects of treatment were considered good, satisfactory, unsatisfactory and ineffective. Results. The results of surgical treatment depend on the severity of the manifestations of thyrotoxic cardiomyopathy. Good and satisfactory results were obtained in 44.7% cases, unsatisfactory results in 32.5% and ineffective treatment was found in 22.8% cases. Conclusions. The surgical treatment of patients with toxic goiter and severe thyrotoxicosis allows eliminating thyrotoxicosis and in some patients the rhythm disorders, reducing the intensity of clinical manifestations of thyrotoxic cardiomyopathy and improving the capacity of physical activity.

Introduction. Histological healing has become a therapeutic goal in patients with ulcerative colitis. However, a consensus on its precise definition has not been reached yet. A large number of complex histological scoring systems for ulcerative colitis are available in literature making standardization a complicated issue. The objective of the study was to identify a histological scoring system that is adequate for routine practice and thus contributes to standardization of histological reporting of inflammation activity in ulcerative colitis. Materials and methods. We retrospectively reviewed and scored 64 H&E stained slides using Nancy index (NI), Geboes score (GS) and Robarts Histopathology Index (RHI). The level of inter-rater and intra-rater agreement, time needed for scoring per slide, and correlation between the histological scores and Mayo endoscopic score were further analysed statistically. Results. The inter-rater agreement was very good for NI (kappa=0.861) and GS (kappa=0.820), and moderate for RHI (kappa=0.592), p<0.005. The intra-rater agreement was very good for NI (kappa=0.973), GS (kappa=0.942), and RHI (kappa=0.892), p<0.005. NI needed the least time to rate (average of 72.06s/slide), followed by GS (77.55s/slide) and RHI (92.67s/slide). The differences were statistically significant by Friedman’s test. All scoring systems correlated well with Mayo score. Conclusions. Nancy index and Geboes score appeared as most suitable for assessment of inflammation in ulcerative colitis in routine practice. NI is fast and has a simple approach. Geboes score is more complex Though simple scores are more likely to be accepted in routine practice, complex scoring systems could be more appropriate for evaluation of histological healing and for research purposes.

Introduction. The increasing incidence of the breast cancer needs more comprehensive assessment approaches to ensure the best quality of the medical care before and after mastectomy and breast reconstruction, to minimize the negative consequences and to target maximum therapeutic compliance. The best results may be achieved in a multidisciplinary team. The objective of the study was to introduce the Multidisciplinary Management File for Breast Cancer Patients, for a more comprehensive management of the breast cancer case. Material and methods. Twenty patients of this prospective study, aged 32-65 years, divided into 2 groups: the study group (10 patients) in which the Multidisciplinary Management File for Breast Cancer Patients was used and the control group (10 patients), in which the classic approach was applied. Results. The openness for the multidisciplinary approach was increased in persons living in urban areas (80%) and with higher education (90% high school graduates or more). Unknown pathologies were detected: 3 thyroid diseases, 1 case of diabetes mellitus, 6 patients with postural changes, biomechanical alterations of the scapular belt, muscle compensations, anxiety (100%) and depression (3 patients). Six patients had breast reconstruction, compared to 3 patients in the control group. Conclusions. The data confirm the increased efficiency of the use of the Multidisciplinary Management File for Breast Cancer Patients, with a better objective and subjective evolution compared to the cases approached in a classical manner. Teamwork facilitates the communication between specialists, as well as between the specialists and the patients.

Introduction. Tobacco consumption is one of the global problems that creates serious health risks. The Georgian anti-tobacco law was accepted on 2017. The objective of the study. The research aims to evaluate the effectiveness of tobacco control legislation on tobacco consumption by students in Georgia. Material and methods. A focus group method was used within qualitative research. A nonprobability sampling method and its most convenient type – a snowball sampling was used for the respondent selection. Respondents were the students of Tbilisi State University (Georgia). The group was comprised of Ilia State University undergraduate and postgraduate students (Tbilisi, Georgia). A total of 14 respondents were interviewed: 6 women and 8 men male. The age of the participants ranged from 20 to 24 years. Results. Respondents began smoking between the ages of 14-16 years old. Regarding the reasons to begin smoking, the subjects attributed the decision to a mild curiosity spurned by a positive atmosphere of social encouragement. Respondents are aware of the amendments to the Tobacco Control Law, they being more or less aware of the prohibitions that followed, and what sanctions would be imposed in case of violations. Ten respondents positively evaluate these changes and believe that the positive results are noticeable in the short-term. Conclusions. It is advisable to facilitate the preventing measures of tobacco consumption. In this regard, it is welcome to introduce the Law on Tobacco Control in Georgia that prohibits tobacco consumption and advertising in public places, particularly in educational and other institutions, as well as selling tobacco products near schools.

Introduction. Cystic echinococcosis (CE) is a zoonotic parasitosis still encountered in Balkan countries. Bulgaria is a country with a high incidence of CE and ranks first among the countries of European Union. Objectives. The study aimed at analyzing the trends in CE incidence from 1998 to 2017 in the Pleven region of Bulgaria and of finding out if the implementation of the Bulgarian national program for control of cystic echinococcosis in humans and animals has resulted in the decrease of the disease rates. Methods. This study of echinococcosis in the Pleven region covers 20 years (1998–2017) and is divided into two parts: before and after the introduction of the 5-year program for control. Data were collected from epidemiological records and histories of 248 subjects with primary CE. Results. A high incidence was registered during the first studied period (1998 – 2007) – 5.27 o/oooo, which in 1999 reached 8.14 o/oooo. After implementation of the national program, the yearly incidence of hydatid disease showed a statistically significant decrease, reaching 2.42 o/oooo in 2017. The analysis of the data showed that the incidence was higher among working-age people and in the 5-19 years old age group. Conclusions. The persistence of a relatively high incidence in the young age group is a sign of continuing active transmission of the infection and demonstrates the necessity to continue active measures.

Biochemistry or biological chemistry is the science that studies all the chemical processes that take place in the living organism of humans, animals, protozoa and plants. In our article we reveal, the contribution of distinguished scientists to this field at the early 20th century tracing also the first steps of the scientific development of biochemistry.

The objective of the study was to assess the development of peripheral neuropathy in patients with newly diagnosed pulmonary tuberculosis during the treatment with first- and second-line antitubercular drugs, by studying the changes of plasma vitamin B1 and vitamin B12 levels. Materials and methods. The study involved 22 patients with drug-susceptible tuberculosis who received a standard four-component regimen that included isoniazid and 26 patients with drug-resistant tuberculosis whose treatment regimen included linezolid. Twenty matched control patients were included for baseline assessment comparison. Plasma vitamin B1 (thiamine) and plasma vitamin B12 (cyanocobalamin) levels were studied in all patients before treatment and after 30 days of antituberculosis therapy. To identify changes of the peripheral nervous system, we performed stimulation electroneuromyography (ENMG) on the lower limbs. The following factors were evaluated: motor nerve conduction velocity (MNCV), terminal motor latency (TML), sensory nerve conduction velocity (SNCV) and terminal sensory latency (TSL). Results. Patients with newly diagnosed pulmonary tuberculosis (??) had lower initial plasma levels of vitamins B1 and B12, compared to age- and sex-matched healthy persons. We did not find significant changes in vitamin B status and electroneuromyography during the treatment with combinations of isoniazid and first-line anti-TB drugs. During the treatment with combinations of linezolid and second-line anti-TB drugs, we identified significant decreases of plasma vitamin B1 and B12 levels and worsening of electroneuromyography indices by sensory and motor fibers. Conclusions. The deficiency of vitamins B1 and B12 during treatment with linezolid can be considered as one of the pathogenetic mechanisms of progressive damage of peripheral nervous system in pulmonary tuberculosis patients, which must be taken into account during the course of antitubercular therapy.

Neonates admitted for intensive care are a highly vulnerable population of patients, susceptible to infections. In newborns, the nosocomial infections have characteristics that are not seen in any other group of patients. The incidence rate of nosocomial infections in newborns is one of the highest and there are differences in this rate between developed and developing countries. The etiology of nosocomial infections in intensive care units is diverse and the causative agents might be bacteria, viruses or fungi. There are numerous risk factors associated with the characteristics of the patients, the hospital-stay and the level of care provided, that might increase the risk of nosocomial infections.

Introduction. Multiple sclerosis is a chronic disease, characterized by episodes of focal deficits of the optic nerves, brain and spinal cord. The neurological manifestations are versatile, being determined by the variability of the localization and the extension of the demyelination points. However, the lesions have a predilection for certain parts of the central nervous system, resulting in complex signs and symptoms, such as weakness, paraparesis, paresthesia, loss of vision, diplopia, tremor, ataxia, profound sensitivity and bladder dysfunction. The primary symptom in some of the patients consists of weakness or paresthesia, occasionally both, detected at the position of one or more limbs. Usually, there are associated symptoms of limb insensibility and restriction sensations in the trunk and limbs. Multiple sclerosis is often accompanied by depression, anxiety, insomnia. Cases presentation. A group of six patients aged between 16 years to 55 years, with multiple sclerosis, recurrent-remissive form, was divided into the control group and the yoga group. Each patient in both groups was evaluated neurologically, but also on the following scales: Hamilton Anxiety and Depression scales, Expanded Disability Status Scale, Modified Fatigue Impact Scale, The Bladder Control Scale and The Bowel Control Scale, Impact of Visual Impairment Scale, Mental Health Inventory and Perceived Deficits Questionnaire Conclusions. Practicing yoga, meditation and outdoor contemplation with landscapes, for a period of six months have beneficial effects in patients with multiple sclerosis, with relapsing-remittent form. These activities improve the patients’ quality of life and quality of cognition.

Diabetes mellitus (DM) and heart failure (HF) are often associated and each disease independently increases the risk for the other. It is well recognized that diabetes is a risk factor for mortality among individuals with heart failure. The risk of incident HF among patients with DM increases with older age, obesity, retinopathy, hypertension, coronary artery disease, peripheral arterial disease, nephropathy, longer duration of DM and higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) value. The treatment of each pathology in the presence of the other raise difficulties in the clinical practice. First-line treatment of DM in patients with HF should include metformin and SGLT2 inhibitors; conversely, saxagliptin, pioglitazone and rosiglitazone are not recommended in patients with DM and HF.

Neuropsychiatric diseases have a rising incidence and cause a significantly higher risk of morbidity and premature mortality in the general population. Also, cardiovascular diseases (CVDs) are characterized by the highest prevalence in the population and are a major cause of early morbidity, especially through the occurrence of coronary ischemic events. Recently, it has been demonstrated the involvement of neuropsychiatric diseases in the aetiology of CVDs. On the one hand, the treatment of these diseases can improve the prognosis of CVD, but on the other hand iatrogenesis may play a very important role in their determinism. Administrating neuropsychiatric medication (NPM) can be very challenging for patients with CVD because of their cardiovascular side effects (CVSEs). NPM and CVDs have a double edged-sword relationship. The purpose of this review is to present the link between the treatment with antidepressants and antipsychotics and the cardiovascular system, and to summarize the current information of the various CVSEs of NPM.

Introduction. Myofibroblastomas of the breast are rare mesenchymal lesions thought to be derived from a CD34-positive mammary stromal cell that shows a great capacity for multipotency. Cases presentation. We performed a retrospective analysis of 4 cases with confirmed mammary myofibroblastomas. Hematoxylin and eosin slides and immunohistochemical slides were reviewed. For next-generation sequencing studies we used a TruSight Tumor 15 panel which ran in a MiSeq sequencer and was analyzed with illumina VariantStudio 3.0 and IGV (Integrative Genomic Variation). The case series consisted of 4 patients (3 men, 1 woman). The anatomic location distribution was equal, with a 1:1 ratio between the left and right breast and a gross median size of the lesion of 34 mm. Gross features revealed a well circumscribed lesion with a vaguely lobular cut surface and the microscopical features were that of a classic-type MFB composed of benign, spindle-shaped cells interrupted by thick collagen fibers that show extensive hyalinization. CD34 and desmin immunohistochemical markers were diffusely positive in tumor cells, thus confirming the diagnosis. Next generation sequencing used a TruSight Panel 15 and revealed mutations in TP53, p.P72R gene in two cases and in ERBB2 p.1655V, KIT c.2484C>T, GUSB p.V270M genes in one case. No pathogenic mutations were identified. Conclusions. The diagnosis of these tumors is challenging based on the rareness of these lesions. Molecular analyses are important to confirm the diagnosis based on morphology and immunohistochemistry. Given the fact that these tumors are rare and benign, there is little data about the molecular signature of this tumor.

Open fractures are orthopedic emergencies that require immediate surgical intervention in order to provide fracture stabilization and to prevent development of osteitis. We present the case of a 33-years-old patient presented in our clinic for a type IIIB neglected open fracture of the distal tibia. We used external fixation for fracture stabilization and a distal based fasciocutaneous sural flap for covering the wound. The purpose was to obtain union of the tibia and reducing the risk of infection. The results at 6 months are good, but the patient needs to be closely followed in time.

Introduction. Ischemic colitis develops due to acute reduced blood flow through the colon and appearance of secondary reperfusion injuries. Patients dependent on renal replacement therapies are at highest risk because of frequent periods of hypotension and hypoperfusion, related to haemodialysis. Case presentation. A 66-year-old female patient, with history of stage 4 chronic kidney disease (CKD), presented for haemorrhagic shock following occult gastrointestinal bleeding and secondary acute posthaemorrhagic anaemia. Because of multiple systemic dysfunctions, she was admitted into the intensive care unit (ICU). Continuous renal replacement therapy with cytokine filter was performed, to reduce the level of circulating inflammatory markers. A computed tomography examination was performed, that established the diagnosis of ischemic colitis and she underwent subtotal colectomy with terminal ileostomy. The evolution was favourable, and after 10 days she was transferred from the ICU to the surgical ward. After another 5 days, she returned to the previous functional status and was discharged. Conclusions. Ischemic colitis can lead to lower gastrointestinal bleeding and even to haemorrhagic shock, especially in patients with chronic kidney disease, intermittent hemodialysis, atherosclerotic diseases, heart failure and diabetes mellitus.

Introduction. Exaggerated placental site reaction is a rare benign non-neoplastic lesion and presents with infiltration of the endometrium and myometrium by intermediate trophoblastic cells at the implantation site. This reaction may occur following healthy or ectopic pregnancy, aborts, or molar pregnancy. The diagnosis is only histopathological. Case report. We present a 44-year-old woman with prolonged menstrual bleeding, high levels of beta-hCG and ultrasound finding mimicking submucosal fibroid. Hysterectomy was performed because of the formation in the uterine cavity. The diagnosis made was exaggerated placental site reaction. Conclusions. Exaggerated placental site reaction is a benign condition, but this lesion has to be differentiated from placental site nodule, placental site trophoblastic tumor and choriocarcinoma because the latter require aggressive treatment.

Introduction. Tuberculosis is a common and treatable human immunodeficiency virus-related (HIV) disease. Intestinal tuberculosis is much more recurrent in immunocompromised patients and presents as a complication of pulmonary tuberculosis due to swallow of infected sputum, hematogenic dissemination or even ingestion of contaminated milk. There is a strong need for close collaboration between HIV programmes and tuberculosis programmes. Case presentation. A 48-year-old male patient presented for a three month history of frequent bowel movements (3-4 stools per day, without blood or mucus), a weight loss of eight kilograms, infrequent dry cough, fatigue, esophageal candidiasis, anorexia, persistent low-grade fever and intermittent pain in the right lower abdominal quadrant. Abdominal X-Ray revealed a marked dilatation of the small intestine. High resolution axial computed tomography described thickening of the terminal ileum and medial caecal wall, with slightly enlarged low density nodes. Histopathological examination of the intestinal mucosa revealed granulomatous design and caseous necrosis. The positive diagnosis was primary extrapulmonary multidrug-resistant tuberculosis with HIV infection. He received an individualized and second line antituberculous treatment combined with antiretroviral therapy. Later on, he developed pneumonia with Pneumocystis jirovecii. The patient had a good clinical response to all therapies. Conclusions. Physicians should be aware that intestinal tuberculosis must be considered in the differential diagnosis of patients with abdominal symptoms, especially in immunocompromised patients.

Introduction. Squamous cell carcinoma of the tongue is a very rare disease among children, with only a few cases reported in the literature. The tongue is the most common site for oral malignancy. The main contributing factors to pelvilingual cancer are constant irritants of the oral mucosa, such as tobacco, alcohol, and dentures. In children, however, the risk factors are immunosuppression induced by a hemopathy such as Fanconi anemia or by chemotherapy, Xeroderma Pigmentosum Syndrome or KID (keratitis, ichthyosis, deafness), Plummer-Vinson syndrome. Cases presentations. The authors present two cases of children, 12 and 15 years old, diagnosed with pelvilingual malignant neoplasia, for which review of the clinical manifestations, the methods of diagnosis and treatment used, but also the evolution will be described. Conclusions. Clinical symptoms of tongue cancer are similar to other types of neoplastic diseases developed in the oral cavity (for example oral floor neoplasm). Confirmation of the diagnosis is made by histopathological examination of the tissue specimen obtained from the tumor site. Therapy has a complex multimodal approach and includes, depending on staging, general condition, and the patient’s option, primary and adjuvant methods. Surgery followed by radio-, chemo-, immunotherapy are the preferred methods. Another possibility is tumor stage conversion by radio-, chemo- and immunotherapeutic treatment, followed by surgery. In some cases, surgery is an ultimate method of therapy, a salvage therapy.

Introduction. Hemolytic uremic syndrome (HUS) is a hemorrhagic systemic microangiopathy, which primarily affects the kidney and is defined by the triad: acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. We report two cases of HUS with neurological manifestations and different evolution. Cases presentation. We report the cases of two young children, without significant medical history, who were diagnosed with acute renal failure, hemolytic anemia and thrombocytopenia. The onset of the disease was a few days prior to admission, with fever and diarrhea, for which they received symptomatic treatment at home, with worsening of the general condition. The particularity of these cases is that even if the patients had the featured triad of HUS and they were both diagnosed with this disease, the neurological complications evolved differently, with a finally favorable outcome. Conclusions. Hemolytic uremic syndrome (HUS) is described as a multisystemic disease that affects mainly the kidney and is a major cause of morbidity and mortality in children less than 5 years old. The kidney and the brain are the main target organs in patients with HUS. In these two cases, the patients diagnosed with HUS and neurological complications, presented a favorable outcome with specific treatment.

A novel coronavirus (nCoV) was first identified amid a recent outbreak of respiratory disease cases in China, Wuhan City. This infection was initially reported to the World Health Organization (WHO) on December 31, 2019. One month later, the WHO declared the 2019-nCoV outbreak a global health emergency(1). The WHO named the disease caused by 2019-nCoV as COVID-19, an acronym derived from “coronavirus disease 2019”. According to WHO, “Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain which has not been previously identified in humans”(2). The recent emergence of COVID-19 in China raised many questions regarding risk factors in the general population, transmission patterns, clinical characteristics, efficient protection methods for health workers or in household and other settings. The medical world is also concerned about the most appropriate means to predict the future evolution of the disease and to limit human-to-human transmission, preventing also further international spread from China. The rapid identification of the new cases and close follow up of their contacts, together with preventive health measures for travelers may be useful methods to prevent a possible pandemia of COVID-19. In mid-February 2020, COVID-19 has been confirmed in more than 64,000 individuals (the majority in China) and has resulted in more than 1300 deaths. The respiratory infection has been reported also in other countries from Middle East, Europe, United States etc. The disease seems to be transmitted by respiratory droplets from sneezing or cough and is usually limited to close contacts with the patients, such as family members and healthcare workers. A more severe evolution was encountered in elderly patients, with comorbidities(3). There are no validated diagnostic tests for COVID-19. In the USA, the Center for Disease Control has developed a diagnostic test and has requested special emergency authorization from the Food and Drug Administration for its use4. This test is a real-time reverse transcription–polymerase chain reaction (rRT-PCR) assay and can diagnose the virus in respiratory and serum samples from clinical specimens. There is no specific treatment until now for infections with COVID-19, the treatment is only supportive. Researchers have started to investigate possible drug treatments for COVID-19. In China there are more than 80 running or pending clinical trials on potential treatments for COVID-19, including old traditional Chinese therapies. Some of these studies were criticized because of their study protocol, lack of specific standards, such as methods of randomization, control groups and measures of clinical outcomes. Until now, there is no specific cure for the disease. The WHO initiated a clinical trial that will compare two or three therapies supported by initial scientific evidence, a HIV-drug combination (lopinavir and ritonavir) and an experimental antiviral (remdesivir). Up to now, the most important measure is the prevention of infection, by limiting the contact with potentially infected patients, travel restrictions for persons originating in the endemic areas of China, use of protection equipment (surgical masks, gloves, protection eyeglasses etc).

Introduction. Hypertension (HTN) is both a cause and effect of chronic kidney disease (CKD) and contributes to its progression. Visfatin and resistin, two of the key cytokines secreted by adipocytes, have been shown to be associated with HTN. The objective of our study was to investigate the association of plasma visfatin and resistin in HTN patients with CKD, after adjusting for multiple important risk factors of CKD. Materials and Methods. We investigated the association of plasma visfatin and resistin in 55 patients with HTN and CKD and in 55 HTN controls without CKD. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 or presence of albuminuria. Quantile regression and logistic regression models were used to examine the association between adipokines and CKD, adjusting for multiple confounding factors. Results. Compared to HTN patients without CKD, adjusted median visfatin value (48.0 vs. 22.1 ng/mL, p<0.0001) and adjusted mean resistin value (17.3 vs 9.8 ng/mL, p<0.0001) were significantly higher in HTN patients with CKD. The multiple-adjusted odds ratio (95% confidence interval) of CKD, comparing the highest tertile to the lower two tertiles, was 2.3. (1.1, 4.9) for visfatin and 13.8 (7.4, 25.2) for resistin. In addition, higher visfatin and resistin were independently associated with lower eGFR and higher urinary albumin levels. Conclusions. These findings suggest that adipocytokines are independently and significantly associated with the risk and severity of CKD in HTN patients. Longitudinal studies are warranted to evaluate the prospective relationship of adipocytokines to the development and progression of CKD.

Introduction. Due to the increase in the incidence of reno-ureteral lithiasis worldwide from 1% to 15%, varying according to age, sex, race, and geographical location, extracorporeal shock wave lithotripsy remains the method of choice in the treatment of reno-ureteral lithiasis. The need for antibacterial prophylaxis is required only in well-defined cases, uroculture with antibacterial sensitivity being crucial in order to reduce the infectious complications. The objective of the study was to evaluate the need for antibiotic administration and to detect risk factors for the development of post-ESWL bacteriuria. Material and methods. Between 05 Nov 2018 – 10 Dec 2019, a group of 120 patients with the diagnosis of reno-ureteral lithiasis was selected, who underwent ESWL treatment in Department of Urology and Surgical Nephrology from Republican Clinical Hospital „Timofei Mosneaga“. In all 120 patients, urine sample was taken before and after ESWL. In all patients included in the study, uroculture with antibiogram was performed. Results. The uroculture results obtained before ESWL were positive in 25 (20.84%) patients without any clinical symptoms and absence of leukocytes in the general urine analysis more than 10 per high power field. At the same time, the number of positive urine culture after ESWL increased significantly in 47 patients. Conclusions. Antibiotic prophylaxis is not justified in the absence of definite risk factors such as positive urine culture before ESWL, JJ stent or nephrostome and a history of infectious reno-ureteral lithiasis or recurrent urinary tract infections.

Living forever is a beautiful vision that human being has been pursuing. With the development of science and technology, an increasing number of approaches have been emerging for repairing and regenerating the damaged organs, such as cell therapy, gene therapy and transplant etc. However, the side effects of these methods limit their clinical use. For example, myoblast transplantation leads to an increase in number of early postoperative arrhythmic events(1). Therefore, it has a long way to use these approaches for clinical therapy in a short-term and it is urgent to look for secure effective strategies. Recently, extracellular vesicles (EVs) have attracted extensive interests as a potential therapeutic strategy of diseases such as cancer, cardiovascular diseases etc. A growing number of investigations demonstrate that various engineered EVs can repair the damaged tissue in vivo(2). This editorial highlights 6 selected papers dedicated to the engineered extracellular vesicles as well as nanoparticles, including: 1) classical strategies for modifying EVs; 2) the roles of engineered EVs in treatment. Besides, the outlook for engineered EVs has been briefly discussed. To improve the efficiency of EVs as well as targeted tissue retention, several investigations were performed. Kyle et al firstly used a cardiomyocytes specific peptide (CMP) to make the cardiac-targeted EVs(3). It was then verified that the modified EVS (CMP- EVs) can be specifically taken up by cardio-myocytes both in vitro and in vivo. This approach laid the foundation for cell and cardiac-specific EVs delivery, which gives a reference for studying targeted-EV. Interestingly, Tang et al came up with a novel idea based on the recruitment of platelets by injured endothelial cells(4). These authors decorated platelet-microvesicles (inside of platelet, similar with EVs) on the surface of cardiosphere-derived cardiac stem cells (CSCs), which significantly increased the retention in the heart. This manipulation approach is safe and straightforward, which opens novel insights into targeted-EVs for therapy. Recently, Liming et al used an adhesive hydrogel to enhance the retention of EVs(5). The EVs were immobilized in an adhesive hydrogel (Exo-pGel) and the encapsulated-EVs can stay at the injured area. The Exo-pGel presents a promising strategy for preclinical treatment. It has been well established that the engineered EVs have great potential for disease treatment in animal models. Vandergriff et al systemically investigated the role of CMP- EVs in cardiac dysfunction treatment. The authors found that EVs conjugated with cardiac homing peptide (CHP, similar with CMP) can protect heart from ischemia/reperfusion injury owing to their increased retention(6). This work demonstrates a novel approach for increasing delivery of myocardial infarction treatment. Liu et al reported that EVs loading with novel complex hydrogels can promote wounds healing, which provides another effective hydrogel strategy for engineering EVs(7). Li et al investigated the roles of Exo-pGel in treatment of spinal cord injury. The Exo-pGel significantly promoted nerve recovery via inhibiting oxidative stress and inflammation5. Besides, Chuanjiang He et al give an insight into how EVs engineered as powerful tools in translational medicine(8). In conclusion, there are strategies for engineering EVs/nanoparticles, with potential roles in disease treatment. Notably, more preclinical investigations and clinical trials are still needed to elucidate the possibility of engineered EVs and nanoparticles in human diseases treatment.

Introduction. The accumulated factual material about the topography of the great saphenous vein is extremely contradictory. Therefore, an individual approach is necessary to study the age-related anatomical variability of the large saphenous vein in human fetuses. The objective of the study was to determine the peculiarities of the saphenous vein topography in human fetuses of 4-10 months. Materials and methods. Studies of the variant anatomy of the great saphenous vein (GSV) were carried out on specimens of the lower limbs of 80 human fetuses of 81.0-375.0 mm parietal-coccygeal length using macro-microscopic dissection, vascular injection, surface staining of prepared vessels and nerves, radiography and morphometry. Results. GSV is a continuation of the medial marginal vein, which is directed upwards in the subcutaneous tissue along the anterior edge of the inner ankle in the studied human fetuses. On the lower leg, the GSV runs along the medial edge of the tibia and receives superficial veins from the anterior medial surface of the lower leg. The GSV bends around the back of the medial epicondyle of the femur in the knee area, is located outside the sartorial muscle, and passes to the anteromedial surface of the thigh. The GSV returns inward through the perforated fascia. In the saphenous opening area, it bends around the lower corner of the falciform margin of the saphenous opening, and it flows into the femoral vein (FV) from the anteromedial side. The anterior accessory saphenous vein flows into the femoral part of the GSV in 45% of cases. The posterior accessory saphenous vein is formed from the saphenous veins of the medial and posterior surfaces of the thigh. Conclusions. The anatomical variability of the great saphenous vein has been determined in human fetuses. The anterior accessory saphenous vein was detected in 71.3% of the studied fetuses, while the posterior accessory saphenous vein was found in 38.1% of cases. The great saphenous vein is characterized by the predominance of the transitional vein type (55.6% of cases) over the main (33.8% of cases) and loose (10.6%o cases) ones. The main type prevails over the loose type in the ratio of 3.2:1. The coincidence of the type of formation of a great saphenous vein on the right and left lower extremities was observed in 61.3% of fetuses. Significant gender differences in the typology of the great saphenous vein in human fetuses were not found.

Introduction. Conflicting findings have been published regarding the pressure wave reflection and the arterial stiffness in young women with polycystic ovary syndrome (PCOS) as opposed to the overt ab initio presence of endothelial dysfunction, which can be reversed six months after metformin administration. The aim of this study was to investigate wave reflections in women with PCOS and to evaluate the effect of metformin treatment. Material and methods. Sixty-four young women, 35 with PCOS (P) (20 lean(L), PL; 15 overweight/ obese (OWB), POWB) and 29 controls (18 CL;11 COWB) were studied. Wave reflection was assessed by the Augmentation Index (AIx) as central augmentation pressure-to-pulse height ratio corrected for heart rate (HR) 75 bpm (AIX@75) or without HR correction AIx and the central augmentation time index (Tr). The endothelial function was evaluated biochemically by plasma endothelin 1(ET-1) levels. The metabolic and hormonal profile and a dvanced glycated end-products (AGEs) levels were also assessed. Metformin (1700 mg/daily) was administered for six months in 20 (9 lean, 11 obese) women with PCOS and the measurements were repeated. Results. All subgroups had comparable age. Wave reflection indices did not differ between PCOS and controls. AIx@75 significantly improved post-metformin treatment in POWB (p=0.046). AGE levels differed between PCOS women groups and controls (p<0.001), but their values became normal after metformin treatment. ET-1 levels did not differ between PCOS and controls, but they were significantly improved post-metformin treatment in both lean and obese PCOS groups (p=0.01, p=0.04, respectively). Conclusions. Wave reflection markers seem to be a covert negative predictor in PCOS, which ameliorates after treatment with metformin, particularly in the overweight/obese subgroup of PCOS women.

Introduction. Matrix metalloproteinases (MMPs) are important target genes for angiotensin II (AII), which subsequently alters MMP expression in extracellular matrix (ECM) and lead to remodeling process. Objective. To investigate whether an association between serum levels of MMP-12, AII and left ventricular hypertrophy exists in patients with heart failure with mid-range ejection fraction (HFmrEF) and arterial hypertension (AH). Material and methods. 56 patients with HFmrEF and AH were examined, mean age 65.62±9.69 years, and 22 age and sex-matched healthy subjects, mean age 56.4±5.53 years. 41 patients had hypertension-mediated organ damage and 15 did not. Patients were divided in two subgroups: subjects with left ventricular hypertrophy (n=32), (HFmrEF+LVH), and subjects without left ventricular hypertrophy (n=24), (HFmrEF-LVH). ELISA was used for measuring AII and MMP-12. Results: Serum MMP-12 levels were statistically significant lower in patients, than in controls: 0.0033 ng/mL (0.0022 ÷ 0.0071) vs. 0.0075 ng/mL (0.0068 ÷ 0.016) (KW=7.37; p=0.006). MMP-12 showed correlation with grade of AH (r=0.28; p=0.03). Patients with HFmrEF+LVH showed statistically significant higher levels of AII: 8.533 pg/mL (1.477÷13.009) than HFmrEF-LVH 1.333 pg/mL (0.477÷6.932) and healthy controls 1.539 pg/mL (0.274÷5.218); (KW=3.48; p=0.04). AII correlated with stage of AH (r=0.47; p=0.001). MMP-12/AII ratio was significantly higher in patients with HFmrEF+LVH than in HFmrEF-LVH 3.867 vs. 0.0025 (p<0.001). Conclusions. Our data suggest an association between serum MMP-12 levels, AII and grade and stage of AH. Determination of serum MMP-12/Angiotensin II profile may be a useful method for monitoring of development and progression of left ventricular hypertrophy.

Introduction. Urinary lithiasis is an important health issue, with an estimated prevalence of 2-3% in the general population and about 70% of recurrence rate. The objective of the study. To evaluate the efficacy of combined medication (potassium and magnesium tribasic citrate and pyridoxine) versus traditional general recommendations, in removing the remaining stone fragments after extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. Material and methods. The study enrolled 60 patients after kidney or ureteral stones treatment performed by extracorporeal shock wave lithotripsy (ESWL), with signs of calculus disintegration, ureteroscopy (URS) with contact lithotripsy, and after percutaneous nephrolithotomy (PNL). The patients were randomly divided into 2 groups. Patients from Group I (n=30) were administered potassium citrate tribasic 2.7 gr, magnesium citrate tribasic 376 mg, pyridoxine 25 mg in sachet, twice daily for two months. The control group (Group II), initially consisting of 30 patients, was prescribed only general recommendations. Results. The increase in daily diuresis was statistically significant compared to the control group (2275±257 mL vs 1580 ± 321 mL, p <0.05). The urine pH in the study group was statistically significant higher (7.1±0.3) compared to the control group (6.2±0.9), p <0.01. The renal colic during the expulsion period of disintegrated calculus fragments was present in 1.8±0.3 cases (study group) compared with 6.7±0.8 (control group), p> 0.001. The „stone-free“ rate was the basic index of the study. The rate of spontaneous removal of disintegrated stone fragments was 90.0% in the study group compared with 71.4% in the control group (p <0.05). The visual analogue scale (VAS) score was 4 points in the study group and 7 points in the control group. Conclusions. The addition of combined therapy in the postoperative treatment of urinary calculi reduces the expulsion time of disintegrated calculus fragments, the number of attacks of renal colic and possibly the need for analgesic administration.

Introduction. Transurethral resection of the bladder tumours (TURBT) is the standard approach to bladder tumour removal; however, it has several disadvantages. The objective of the study was to evaluate the safety and efficacy of „en bloc“ resection of non-muscle invasive bladder tumours (ERBT) by using the conventional monopolar „Hook“ resection electrode. Material and methods. ERBT and TURBT procedures were conducted in 67 and in 85 patients respectively, diagnosed with superficial bladder tumours. In the ERBT group, the tumours were removed retrograde en bloc, under direct vision, via a conventional monopolar „Hook“ electrode. Clinical pathological, intra-operative and post-operative patients’ data were compared retrospectively between both groups (ERBT and TURBT). Results. Of the 152 patients, 67 underwent ERBT and 85 were treated with TURBT. Both groups were comparable in clinical characteristics. ERBT has been performed as safely and effectively as TURBT. There were no significant differences in the operative time and intraoperative or postoperative surgical complications. The comparative recurrence rates were similar for both groups during up to 24-month follow-up. The detrusor muscle fibers were histologically identified in 100% of ERBT tumour samples and marginal tumour bases, and only in 80% of post-TURBT samples. Conclusions. ERBT is a feasible and safe technique for removing superficial bladder tumours using a monopolar „Hook“ resection, with the same advantages of a proper tumour resection, as well as possibility to collect good quality tumour samples and bladder tumour base specimen for pathological diagnosis and staging compared to standard TURBT.

Introduction. Several studies have shown that neuroendocrine cells (NECs) are increased in the colorectal mucosa of patients with ulcerative colitis (UC) compared to normal, mainly in the left colon. A threshold of 3.2 NECs/crypt has been proposed by some authors for defining NEC hyperplasia in these patients. However, correlations of NEC changes with clinical parameters have not been described. The objective of this study was to analyze NEC histological changes, described by several descriptors, in UC patients and identify relevant clinicopathological correlations. Material and methods. We analyzed colonic biopsies from 42 UC patients by highlighting the neuroendocrine cells with Chromogranin A immunohistochemical stain. Positive cells were detected and quantified by computerized image analysis, and their morphology and distribution were assessed. The data obtained were described as mean and maximum number of cells per crypt, and number of crypts showing linear hyperplasia. Results. Increased numbers of cryptic NECs were identified (mean 3.62/crypt). A rising trend was observed for Nancy grades 2 and 3 and a small decrease for grade 4 at the site of most severely active inflammation. However, linear hyperplasia negatively correlated with increase of Nancy and Geboes grades of histological inflammation (rho=-0.326, p=0.013; respectively rho=-0.368, p=0.005) and with age (rp=-0.328, p=0.039). The maximum counts per crypt correlated positively with corticosteroid treatment (rp=0,332, p=0.012). The mean count per crypt negatively correlated with disease duration ( rp=-0.388, p=0.013). Conclusion. NEC hyperplastic changes correlate with important clinical and histological parameters and could impact on the management of UC patients.

Introduction. The high medical and social significance of type 2 diabetes mellitus (T2DM) is not only due to its prevalence, but also to serious complications that lead to a decrease in the quality of patients’ life, early disability, and high mortality. The objective of the study was to evaluate the histological and morphometric features of the oesophagus mucous membrane in patients with gastroesophageal reflux disease (GERD) and T2DM compared to patients with GERD without T2DM. Material and methods. 67 patients with GERD and T2DM and 50 patients with GERD without T2DM, matched for age and sex, were examined. Comparative morphometry of histological changes of the oesophageal mucosa was performed. Results. The histological investigation showed that in patients of the main study group (with GERD and T2DM), almost all the studied parameters had a significantly more severe course and exceeded similar indicators of the group with isolated GERD: the thickness of the basal layer (1.86±0.04 points against 0.97±0.02 points), papillae height (1.71±0.06 points versus 0.72±0.07 points), inflammatory epithelial infiltration (1.88±0.03 points against 1.27±0.07 points), width of intercellular spaces (2.04±0.08 against 1.10±0.07 points) (p<0.01 in all cases). Conclusions. The inflammatory process in the oesophageal mucosae in patients with GERD without T2DM has a more superficial character and is limited mainly to the epithelial layer, whereas hyperplastic changes in the mucous membrane of the oesophagus are more pronounced in patients with GERD and T2DM.

Despite the remarkable technological advances of recent decades, there is not a general consensus or universal standard in the diagnosis and therapeutic management of malignant tumours of the neck. Beginning by defining the neck as the anatomical-surgical region with many organs and a series of very important vascular and nervous structures, the multitude and complexity of pathology elements that could be encountered at this level make cancers of the neck often difficult to diagnose and treat. The authors describe and synthesize the main types of cervical malignancies that the ENT surgeon may encounter in current medical practice, emphasizing the particularities of each individual pathological entity, as well as the diagnostic and therapeutic problems it may pose.

Introduction. Canonical Wnt signaling pathway regulates stromal stem cells (SSCs) differentiation and controls the balance between adipogenesis and osteogenesis. Estrogen deficiency affects Wnt signaling by altering the expression of sclerostin (SCL) and the peroxisome proliferator-activated receptor-? coactivator 1-?(PGC-1?) in the bone tissue. The objective of the study was to monitor whether there is a feedback mechanism between SCL and PGC-1? and to determine the extent of the immunohistochemical staining of PGC-1? and SCL in bone tissue of estrogen deficiency-induced osteoporosis in female Wistar rats. Materials and methods. An experiment was performed on 20 female Wistar rats at reproductive age (2 months), divided into 2 groups: in group 1 (G1) 10 animals were ovariectomized (ovx) and in group 2 (G2) 10 of the remaining were sham-operated (sham). Results. We found that the PGC-1? in the bone marrow stromal cells was reduced in the group with osteoporosis (G1 – ovariectomized rats), compared to sham-operated control group G2 (p<0.05). The SCL in osteocytes was increased in the group with osteoporosis – G1, compared to control group G2 (p<0.05). Histomorphological analysis of femur from G1 animals indicated reduced areas of mineralized tissue and bone marrow fatty degeneration. Conclusions. Estrogen deficiency in G1 ovx rats increased the expression of SCL in the osteocytes by activating osteoclastic bone resorption and reduced PGC-1? expression in SSCs cells, which stimulated adipogenic differentiation that led to significant fatty degeneration in the bone marrow. We confirmed the exceptional role of PGC-1a and SCL in the pathogenesis of osteoporosis and that there is a mechanism of feedback loop between SCL and PGC-1?.

Introduction. The most important histologic prognostic factors for melanoma remain depth of invasion and mitotic rate. In a digital era, precision (in terms of reproducibility and inter laboratories repeatability), as well as image evidence, are new qualitative parameters. The objective of the study was to evaluate in a retrospective analysis any significant difference among the Breslow digital assessments performed using two different immunohistochemical stains and the gold standard, hematoxylin eosin stain. Material and methods. We evaluated 130 primary cutaneous melanomas diagnosed in a two-year period (2016-2017) with known Breslow scale. Immunohistochemistry staining (SOX10 and Melan A) was perform followed by slide scanning. Aperio Imagescope and StataCorp software were used for data acquisition and statics. Results. No significantly statistic differences were recorded between groups in terms of Breslow values (p=0.98, Kruskal-Wallis test). Conclusions. All three stains perform similar in evaluating depth of invasion regardless of the method used to quantify it. The pathologist should consider using an accurate and precise method like a digital measurement technique for daily reports.

Introduction. Ovarian cancer is characterized by a high capacity of relapse, even in cases in whom cytoreductive surgery with curative intent followed by platinum and taxanes-based chemotherapy were performed. In such cases, attention was focused on determining if iterative cytoreduction might improve the long-term outcomes and how far these boundaries can be pushed. While for secondary cytoreduction multiple studies have been conducted, for tertiary and quaternary cytoreduction data are significantly scarcer. The objective of the study. This paper aims to realize a systematic review of the studies published so far on the theme of quaternary cytoreduction. Methodology. We searched medical journals in English language published from January 2010 to December 2019. Results. Six studies involving 110 patients submitted to quaternary cytoreduction met the inclusion criteria. Data reported in the above mentioned studies demonstrate that quaternary cytoreduction can be safely performed both at the level of the lower and the upper abdomen, in order to maximize the debulking effort. However, a significantly lower number of cases will be considered candidates for this type of procedure, when compared to secondary or even tertiary cytoreduction, an adequate selection process being mandatory in order to minimize the postoperative risks. Conclusions. Although it is less frequently feasible when compared to secondary or tertiary cytoreduction, quaternary cytoreduction might be beneficial in selected cases.

The use of alloplastic materials in different surgical urogynecological interventions has been subject to limitations during the past years by the international societies, because of late onset mesh-related complications. Xenograft-based biomaterials obtained from extracellular matrix offer a proper acellular foundation for tissue repair in urogynecology, with improved tissue-graft rejection. We have searched PubMed database to identify all publications regarding the use of extracellular matrix in gynecological reconstructive surgery. The use of these matrices in organ prolapse surgery has shown efficient integration and favorable outcomes. Biomaterials are used for vaginoplasties in patients with vaginal congenital agenesis, patients who underwent vaginal radical resection for cervical cancer or patients diagnosed with profound endometriosis, who had partial vaginal resection. Biomaterials may also have a future in vaginoplasties performed for aesthetic reasons. It is foreseen that in the future these biomaterials might be used in the treatment of certain fetal structural anomalies, like neural tube defects. Although nowadays the use of biological grafts is quite limited, due to the lack of prospective randomized trials to compare them with classical surgical techniques, with the emerging technologies, in the near future we foresee its significant role in urogynecology, plastic surgery repair and possibly fetal congenital malformation correction.

Introduction. Paragangliomas are benign tumours that arise from the paraganglionic system. The most frequently encountered symptoms of tympanojugular paragangliomas are pulsatile tinnitus and conductive hearing loss. High resolution computed tomography, with reconstruction in axial and coronal planes, is mandatory in every suspected case of tympanojugular paraganglioma. The treatment is guided by the classification of Fish. Cases presentation. We present two cases in whom the clinical manifestations and paraclinical investigations established the diagnosis of tympanojugular paraganglioma. Both surgery and postoperative evolution are described for each case. In most of these tumours, surgery remains the mainstay treatment. According to the preoperative plan of the first case, it was decided that the tumour can be resected safely, without compromising the cranial nerves. In the second case, the entire tumour was removed, but with the sacrifice of the inferior cranial nerve, caught in the tumour mass. Conclusions. These tumours have the tendency to involve multiple vital structures of the skull base. A detailed preoperative plan of treatment is required to maximize tumour resection, while minimizing morbidity of the great vessels and lower cranial nerves.

Krukenberg tumors are ovarian metastases from different malignancies, most often originating from the gastrointestinal tract. However, in rare cases, other primary tumors, even with extra-abdominal location, might lead to the development of such lesions. Neither the mechanism of development, prognostic significance or therapeutic strategy are not clearly defined so far. It seems that these lesions are more frequently encountered in patients with BRCA1/2 mutations. Most often, Krukenberg tumors are bilateral lesions associated with ascites and with firm areas at the level of the ovarian surface. This paper aims to review existing data regarding Krukenberg tumors from breast cancer.

Introduction. Meningiomas are benign tumours of the arachnoid layer and although relatively frequent they have an intracranial development, implications of the visceral cranium or the neck are rare. Case presentation. We present the case of a 67-year-old male with an intracranial meningioma, with recurrences in the extra cranial area. We focused on clinical presentation, imaging studies and treatment options in this kind of tumour. Extra cranial meningiomas, primary or secondary, are rare and a sinonasal type should always be considered that it may be an extension of an intracranial tumour. The recurrence rate is moderate and outcome is good, but a missed follow-up may lead to unfavourable consequences. Treatment options may vary from „watch and wait“ to surgery – transcranial and endoscopic approaches, combined techniques – and even radiotherapy, depending on the site and extension. Conclusions. Endoscopic endonasal surgery may be a safe and effective way of treatment for skull base tumours, although it requires advanced techniques and a good knowledge of reconstruction of dura and skull base defects. There are also limitations, that can be surpassed with a combined approach.

Introduction. Although squamous cell carcinoma (SCC) is the most common oral cancer with distribution worldwide, the giant form of the disease is extremely rare, due to its easy detection and early diagnosis. The primary goal in tumor surgery is excision with borders clear of neoplasia. The second goal is aesthetics and function retention. The specific surgical approach is chosen according to the length, the thickness and the location of the lip defect. Case presentation. We present the case of a patient with squamous cell carcinoma of the lower lip. In the reported case, the full thickness defect resulting from SCC excision, which affects more than one third of the length of the lower lip, had been reconstructed with the Bernard-Webster lid. Conclusions. Although the etiologic factors for squamous cell carcinoma are well-known, new prognostic factors for tumor differentiation, such as ?-catenin abnormal expression, and the negative impact on patient’s demographic characteristics are considered. Poor social conditions are to be considered as a potential risk factor for the development of giant forms of SCC in addition. Improving the quality of life of these patients would be essential to minimize risk factors for the development of the disease and to improve prognosis overall.

Introduction. Paragangliomas are benign tumours that arise from the paraganglionic system. The most frequently encountered symptoms of tympanojugular paragangliomas are pulsatile tinnitus and conductive hearing loss. High resolution computed tomography, with reconstruction in axial and coronal planes, is mandatory in every suspected case of tympanojugular paraganglioma. The treatment is guided by the classification of Fish. Cases presentation. We present two cases in whom the clinical manifestations and paraclinical investigations established the diagnosis of tympanojugular paraganglioma. Both surgery and postoperative evolution are described for each case. In most of these tumours, surgery remains the mainstay treatment. According to the preoperative plan of the first case, it was decided that the tumour can be resected safely, without compromising the cranial nerves. In the second case, the entire tumour was removed, but with the sacrifice of the inferior cranial nerve, caught in the tumour mass. Conclusions. These tumours have the tendency to involve multiple vital structures of the skull base. A detailed preoperative plan of treatment is required to maximize tumour resection, while minimizing morbidity of the great vessels and lower cranial nerves.

Introduction. Scalp tumours raise multiple problems regarding the radical excision of the neoplasm followed by reconstructive surgery. Prolonged sun exposure and administration of immunosuppressive medication are the main risk factors for the onset of this neoplasm. The paper presents the advantages and disadvantages of scalp reconstruction using rhomboid flaps, after surgical excision of the skin cancer. Case presentation. The paper presents the case of a 83-year-old patient admitted for the treatment of squamous cell carcinoma located on the scalp. The pathological history of the patient showed that there were multiple hospitalizations for the treatment of chronic heart failure and hypertension. The therapeutic protocol included excision of a squamous cell carcinoma located in the scalp, followed by immediate reconstruction with three rhomboid flaps advanced towards the midline. The local evolution of the patient was favorable, the flaps integrating without complications, obtaining in this context a very good result from an aesthetic point of view. Conclusions. The use of the reconstructive technique involving the transposition of three rhomboid flaps to cover the soft tissue defects located in the scalp region is a feasible solution that offers very good aesthetic results.

Introduction. Non-steroidal anti-inflammatory drugs (NSAID) use for adequate pain control and antipyretic effect is common worldwide. Multiple side effects (gastrointestinal, cardiovascular, renal) are well known and despite preventive measures for the upper digestive tract, less is known and can be done on the lower gastrointestinal tract. Several risk factors have been identified, especially age over 65 years, pre-existing mucosal lesions, concomitant aggressive factors (corticotherapy, antithrombotic medication, radiotherapy). Case presentation. We present the case of a 76-year-old male, who developed a deep hemorrhagic solitary rectal ulcer following NSAID administration, on a pre-existing minor post-radiation erosion and chronic radiation proctitis. Conclusions. The case is a reminder of NSAID gastrointestinal complications; though well documented on the upper GI tract, they should not be neglected on the lower tract, especially in elderly patients with pre-existing lesions or concomitant aggressive factors. Limited time exposure doesn’t seem to be a guarantee of avoiding more serious complications, such as bleeding or deeper lesions.

Introduction. Stevens-Johnson syndrome is a rare, severe and life-threatening condition that develops mostly in response to drug use. Case presentation. We present a case of Stevens-Johnson syndrome in a boy of 11 years old, most probably developed in response to a combination of etiologic factors, such as virus infection, use of ibuprofen, and topical use of sulfanilamide agents. The clinical picture of the child was suggestive, involving tunica mucosa of mouth, genitals, conjunctiva, and skin. Parenteral administration of glucocorticoids, detoxification, antibiotic prophylaxis, and topical treatment led to rapid regression of clinical symptoms and prevented the development of complications. Conclusions. The treatment of Stevens-Johnson syndrome involves systemic glucocorticoids in combination with topical therapy. In our patient, the treatment avoided serious complications and led to rapid regression of cutaneous manifestations. The etiology of Stevens-Johnson syndrome is sometimes difficult to establish. Physicians should avoid polypragmasia and unreasonable prescription of drugs and be aware of the risk of Stevens-Johnson syndrome, especially in pediatric patients.

Introduction. In the surgery of esophagogastric junction tumours, obtaining a tumour-free proximal surgical margin and determining the right approach to reach this goal may be challenging. The objective of the study was to make a technical contribution to the performance of high esophago-jejunal anastomoses via transabdominal approach alone, following resection of esophagogastric junction tumours. We named this technique as the „cut and sew“ technique. Material and methods. Between January 2015 and December 2017, 113 patients were operated with curative intent for gastric cancer in our surgical unit. Distal gastrectomy was performed in 41 patients, while 51 patients underwent total gastrectomy. The remaining 21 patients, who constitute the subjects of this study, presented with a Siewert type II (8 patients) or a Siewert type III (13 patients) esophagogastric junction tumour. Results. One patient in the neoadjuvant chemoradiotherapy group, with additional thoracotomy, died because of pulmonary complications and respiratory failure. No mortality or any significant morbidity was seen in the group operated transabdominally alone. Conclusions. The „cut and sew“ technique is efficient and safe in performing high esophago-jejunal anastomosis following resection of Siewert type 2 and 3 esophagogastric junction tumours, through abdominal approach alone. The omission of an additional thoracic route decreases the morbidity and eventually the mortality.

On 18th of April 2020, a 49-year-old woman developed a fever of 38.40C, with no other symptoms. After taking oral nonsteroidal anti-inflammatory agents for 2 days, the temperature returned to normal. On 20th of April 2020, she complained of persistent dry cough, sore throat, ageusia, anosmia and chest distress. The next day, she presented to the Emergency Department of Arges County Hospital, Pitesti, Romania. She divulged that she had been in close contact with a friend, who had been recently confirmed with the diagnosis of COVID-19. A high-resolution computed tomography (CT) of the chest was performed, that revealed multiple images of patchy ground-glass opacities in bilateral lower lobes (Figure 1). Given the close contact history and imaging findings, she was admitted as a suspected case of SARS-CoV-2 infection. On admission, physical examination unveiled normal vital signs, with oxygen saturation of 96% while breathing ambient air, lung auscultation normal. The antigen test for influenza was negative. Arterial blood gas analysis pointed out a pO2 of 103 mmHg, potassium 3.3 mEq/L, calcium 1.09 mmol/L and glucose 113 mg/dL. The blood routine tests revealed: white blood cell count 3.99 10^9/Liter, red blood cell count 6.41 10^12/Liter, hemoglobin 13.4 g/dL, hematocrit 40.1%, neutrophils 1.99 10^9/Liter, lymphocytes 39.9%, D-dimers 0.526 ug/mL, troponin T 7.22 ng/L, ferritin 192 ng/mL, procalcitonin 15 ug/L, creatine kinase-MB 27 U/L, lactic acid dehydrogenase (LDH) 481 U/L, fibrinogen 455 mg/dL, normal liver and renal function, normal prothrombin time. The electrocardiogram was normal. On 22th of April, the lab confirmed that the oropharyngeal swab test of SARS-CoV-2 by qualitative real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay was positive. After seven days of symptomatic treatment and hydroxychloroquine therapy, the patient’s respiratory symptoms significantly improved. The dynamics of high-resolution CT of the chest revealed systematic absorption of lung lesions (Figure 2). After two consecutive (24 hours apart) oropharyngeal swab tests of SARS-CoV-2 RNA negative, the patient was discharged on 30th of April, with the indication for home quarantine for at least 14 days. SARS-CoV-2 RNA by oropharyngeal swab remained negative in the follow-up visit on 13th of May 2020. Take home messages: The accuracy of chest CT in symptomatic patients with COVID-19 is high, but used as a single diagnostic test, CT can not accurately diagnose or exclude coronavirus infection and should not be relied upon as a screening or diagnostic tool for COVID-19 pneumonia. Chest CT is rather helpful in evaluating the complications of COVID-19 and is indicated in patients with COVID-19 and worsening respiratory symptoms. The most common imaging findings are of an atypical or organising pneumonia, with bilateral involvement, especially of the lower lobes. Point of care lung ultrasound may be useful for the diagnosis and can detect abnormalities even in asymptomatic patients. The definitive diagnostic test for SARS-CoV-2 infection is the RT-PCR test.

COVID-19 is an ongoing pandemic infectious disease determined by a new coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV-2). The severity spectrum of the clinical manifestations of the disease is variable, from almost asymptomatic cases to critical, fatal cases. The clinical manifestations usually include fever, dry cough, dyspnea, muscular symptoms, headache, sore throat, diarrhea, nausea/vomiting, abdominal pain, fatigue, loss of smell or taste. The laboratory tests in patients with COVID-19 may reveal lymphopenia, increased aminotransferases, high lactate dehydrogenase, inflammatory syndrome (high C-reactive protein, erythrocyte sedimentation rate, fibrinogen), coagulation tests abnormalities. There are recent reports and small studies that reported an association between COVID-19 and hyponatremia (serum natrium < 135 mEq/L) (1). A few case reports described patients with COVID-19 with only symptoms of hyponatremia(2). The etiology of hyponatremia in patients with COVID-19 is likely to be multifactorial and its early etiologic diagnosis may be extremely important for the evolution of the disease. For a correct diagnosis and treatment, measurement of plasma and urine osmolality is always necessary. An appropriate treatment of hyponatremia may be even more important in hospitalized patients with COVID-19, in whom an inadequate fluid and electrolyte management may increase the risk for respiratory and/or cardiac complications. What could be the causes of hyponatremia in COVID-19 patients? Hyponatremia may be due to the increased release of antidiuretic hormone (ADH) because of gastrointestinal fluid losses (diarrhea, vomiting) or low oral fluid intake, but also to the syndrome of inappropriate ADH secretion (SIADH) induced by pneumonia, respiratory insufficiency or other comorbidities. SIADH is characterized by euvolemic hyponatremia (natrium <135 mEq/L), low serum osmolality (<280 mosmol/Kg H2O), high urine osmolality (>100 mosmol/Kg H2O), increased urine natrium (>40 mmol/L), hypouricemia, in the absence of other causes of hyponatremia. Apart from pneumonia, that is frequent in patients with COVID-19, other causes of SIADH may be psychological and physical distress induced by the disease (with activation of the cortical neurons and increased hypothalamic secretion of ADH), and also the cytokine storm (with lesions of the pulmonary tissue that can induce SIADH and/or the non-osmotic release of ADH stimulated by interleukin-6)(3). The measurement of serum and urine osmolality will help the differential etiological diagnosis and will ensure a proper fluid and electrolyte management, to prevent further deterioration of these patients(4). The association of COVID-19 with hyponatremia needs to be further identified and explored. Until then, a careful approach may be that febrile patients presenting with hyponatremia should be isolated and tested for SARS-CoV-2 infection.

Background. Computed tomography (CT) and magnetic resonance imaging (MRI) are used for the identification of an adrenal neoplasm. Traditionally, the adrenal gland radiological size (RS) is underestimated by any preoperative imaging compared to the actual histological size (HS). The objective of the study was to investigate whether recent and more sophisticated imaging techniques can more accurately predict adrenal tumors’ size. Material and methods. We retrospectively analyzed 129 patients (86 females, 67%) with mean age 54.2 years (median: 56; range: 6 – 82), who underwent adrenalectomy (1 bilateral adrenalectomy) during the period 11/2016 to 2/2019. The 130 adrenal tumors were divided according to their RS in: A, = 3 cm, B, > 3 cm and = 6 cm, C, > 6 cm. Agreement between RS and HS was evaluated by the intraclass correlation coefficient (ICC). Results. In the total population, RS underestimated HS by 34% using CT or either imaging with good agreement; 28% using MRI with fair agreement. Only for RS 3 – 6cm CT, MRI or either method underestimated HS by 35% with fair agreement; for RS > 6 cm underestimation was 15% using CT, or 6% using either imaging with fair agrement. Conclusions. In defiance of the technological progress in imaging modalities, the present study confirmed previous findings that adrenal imaging by CT or MRI, cannot predict accurately the real size of adrenal tumors. In case of an adrenal incidentaloma this disagreement has a major impact not only on achieving an effective decision- making process favoring a conservative treatment or a surgical excision, but also on deciding when surgery is the option of the appropriate approach by open or laparoscopic adrenalectomy.

Introduction. Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare, unusual lesions, that most commonly appear in the right lobe of the liver. Clinical and radiological findings are very similar with liver hydatid cysts. Therefore, the differential diagnosis with liver hydatid cyst (LHC) is usually made by pathological examination, postoperatively. The objective of the study was to detect the prevalence of BCA and BCAC in patients who were treated for hydatid cysts. Material and methods. Data of 720 cases with operated liver hydatid cysts (LHC) at the General Surgery Clinics of Seyhan State Hospital Adana, Turkey, and Near East University Nicosia, Cyprus, were retrospectively reviewed. The study included 10 patients with BCA and two patients with BCAC, who were operated with a preliminary diagnosis of liver hydatid cyst. Results. Of the 12 patients included in the study, 5 were male and 7 were female. The mean age of the patients was 43.58 years. All patients were pre-diagnosed with liver hydatid cyst after preoperative laboratory and radiological evaluations and all underwent partial cystectomy. The results of histopathological examination showed that 10 of these patients had BCA and two had BCAC. The mean follow–up was 28.4 months. During this period, recurrence was seen in 3 out of 10 patients with BCA and total cystectomy was performed in these 3 patients. Two patients with BCAC underwent right hepatectomy. Conclusions. The follow-up and evaluation of the histopathological results are very important in patients operated with the diagnosis of liver hydatid cyst. Cases with biliary cystadenoma and cystadenocarcinoma, which are difficult to detect, especially in the preoperative period, should be re-evaluated and complementary operations should be performed.

Introduction. Much of the research in obesity has explored the role of social networks in promoting health through social influence and selection. However, little research has examined how social networks themselves could condition health behaviours. Research began to address more detailed questions regarding peer socialization process and network properties. One of the key questions is whether behaviour association (either peer socialization or selection) is dependent on the local network structure. Examining social network position, structure, and how they interact with behaviour provide valuable insight on how to modify these behaviours. The objective of the study was to examine the moderating role of friendship network properties on the association between individual’s and friends’ weight-related behaviours among adolescents. Materials and methods. Methods are drawn from a set of analytical tools known as ‘Social Network Analysis’, which uses friendship nomination data from a complete network (socio-metric), along with reported data on diet, physical activity, sedentary behaviour, and sleep deprivation. Results. A total of 673 adolescents aged between 11-15 years, from four schools in Kingdom of Bahrain, participated in this study. Findings from binary logistic regression models suggest that there are associations between adolescents and their friends’ in multiple weight-related behaviours. There is also evidence for the moderating role of some network properties on these associations. Conclusion. Properties of friendship network are critical in conditioning associations between individuals and their friends’ weight-related behaviours. However, findings are gender specific, which has implications for gender-tailored interventions.

Introduction. Burnout is one of the major unresolved problems of healthcare professionals. Considering the recent situation with COVID-19 and associated psychological stress, this issue becomes high- critical over the world. Objective. The study aimed at validating the effectiveness of Asimov’s coping strategy among a group of primary care physicians in reducing emotional burnout. Material and methods. The study was conducted in Almaty (Kazakhstan). The volunteers (N = 243) were randomly divided into intervention group (IG) and control group (CG). In the IG, short-term psychotherapy based on the coping strategy (Asimov method) was implemented. Methods of measurement of emotional burnout included the use of emotional burnout (‘Maslach’) and Lazarus questionnaires. In addition, factors related to demography, work, and lifestyle were assessed as well. Results. The assessment of the emotional burnout showed a high level of emotional burnout in both groups (p>0.05). After 6 months, emotional exhaustion (EE) (p=0.019) and depersonalization (DP) (p=0.028) indicators in the IG group were reduced, in contrast to the CG group, except for the lack of personal achievement (PA) (p=0.067). However, after 12months, indicators of EE and DP were decreased, at the same time the PA indicator was elevated in the IG group (p <0.05). The data of the study based on the Lazarus questionnaire (12 months) showed the effectiveness of this method (p <0.05). Conclusions. The use of Asimov’s coping strategy showed a positive effect on the emotional status of primary care physicians. Such a strategy possesses the potential for the management of the psychological stability of doctors who underwent emotional burnout.

Introduction. In the wake of the current situation of the COVID-19 pandemic, it is important to strictly follow all the standard infection prevention and control measures (SICPs) of the World Health Organization (WHO). SICPs is a scientific approach and practical solution designed to prevent harm caused by infection to patients and health workers. Objective. This study aimed to evaluate the knowledge and practice of standard measures of IPCs among the staff of the radiology departments in Sudan. Material and methods. A qualitative survey was conducted using a questionnaire distributed via email among radiology staff in thirty-three different hospitals in Sudan. The questionnaire was developed by the authors, with help from scientific literature to cover key areas of knowledge, awareness and attitude regarding infection prevention and control guidelines of COVID-19. Results. A total of 68.3% of the study group knew the guidelines established by WHO to deal with COVID-19 patients or suspected cases. 65% of the respondents had previous training in hand hygiene and about 75% of them had sufficient knowledge in hand hygiene, observed during their routine clinical practices. 69.2% of respondents used portable imaging equipment to limit the transportation of COVID-19 patients and 69.2% were aware that the patients were wearing a surgical mask when entering and leaving the radiology department. Conclusions. The radiology departments staff in Sudan is fairly aware of SICPs. They are strictly following standard guidelines for infection, prevention and management of COVID-19 issued by WHO.

Introduction. The Free Radical Theory initiates a research of antioxidants as preventive factors against degenerative age-related diseases. The importance of antioxidants in diet for strengthening the body antioxidant defense is confirmed by numerous studies, arising the need to determine their content in foods. The objective of the study was to obtain data about the composition of antioxidant micronutrients and biologically active compounds in foods typical for Bulgarian diet, due to their active role in prevention of age-related diseases, thus providing healthy and available food choices of the elderly for antioxidants density diet. Materials and methods. The vitamins E, C, and bio-actives ß-carotene and flavonoids – quercetin, catechins and flavones in 13 fruits and 13 vegetables were studied. The compounds were analyzed with high performance liquid chromatography methods. Results. The richest source of vitamin E is apricot (4.04 mg/100 g), of vitamin C – red pepper (142.8 mg/100 g), of ß-carotene – carrot (6.3 mg/100 g). Quercetin has the highest value in onion (20.41 mg/100 g); catechins are found only in fruits with maximal content in black grapes (19.53 mg/100 g), while flavones are detected only in the vegetables: carrot, peppers, lettuce, and especially in parsley (79.74 mg/ 100g). Conclusions. The current study provides information of antioxidants density of fruits and vegetables typical for Bulgarian diet. The present data are a basis for establishment of healthy diet for prevention of age-related diseases and can be used for forming the European database of foods antioxidants, building the variety of diets in the European Union.

Introduction. Non-Hodgkin’s lymphoma (NHL) is a malignant cancer of the lymphatic system. Modern treatment of NHL allows patients to extend their lifespan, but at the same time somatic and psychological complications reduce the patients’ quality of life. The objective of the study was to assess the quality of life in patients with NHL. Material and methods. The study included patients with aggressive and indolent NHL. The quality of life was assessed using the standard assessment tools Eastern Cooperative Oncology Group (ECOG), Global Well-Being (GWB) and European Organization for the Research and Treatment of Cancer (EORTC) QLQ-C30. Results. The study included 56 NHL patients: 36 women, 20 men, with a mean age of 58.1±1.3 years. The ECOG Scale of Performance Status, the EORTC functional scales, global health status and GWB were according to the primary tumour. Higher values ??of functional scales were recorded in patients with aggressive NHL (70%). The symptom scales assessment did not clearly vary in both types of lymphomas (70% aggressive, 63% indolent), and the “better” global health status predominated in indolent NHL (36.8%). In 64.3% of cases there is severe suffering, with the predominance in women (72.2%). Conclusions. Patients with indolent NHL had a higher degree of independence. The ECOG scale of NHL patients, regardless of morphological type, does not correspond to the stage of the disease, but to the location of the primary tumour and its size.

A strong association between functional mitral regurgitation severity and all-cause mortality and hospitalization was found in patients with dilated cardiomyopathy and left ventricular systolic dysfunction, with or without an implanted device. Many studies revealed a bidirectional link between the decrease in functional mitral regurgitation severity and the response to cardiac resynchronization therapy. This emphasizes the importance to find methods for mitral regurgitation evaluation in heart failure patients after device implantation. In this complex pathology, adequate measurement remains a challenge for clinicians. Echocardiography is the key technique used to confirm the diagnosis and to assess the severity and prognosis. In this review, we discuss the echocardiographic challenges in the evaluation of functional mitral regurgitation after cardiac resynchronization therapy. An integrated approach including various criteria is strongly recommended. The assessment includes the integration of data from 2D/3D echocardiography imaging, as well as Doppler measures of severity. For quantifying the regurgitation degree, the vena contracta width and the parameters derived from the PISA method, effective regurgitant orifice area and regurgitant volume, are the most useful. There is also important to provide information about the left ventricle and right ventricle dimensions and ejection fraction, as well as the left atrium, right atrium dimensions and the pulmonary arterial systolic pressure.

Introduction. Blastocystis sp. is a common protozoan parasite that colonizes the intestinal tract of humans and animals and in humans nine subtypes have been described so far. Gastrointestinal symptoms and/or allergic reactions are the most common reported symptoms. It is considered that there could be a link between symptoms and the subtype of Blastocystis sp. The objective of the study was to determine the subtype of Blastocystis sp. isolates from a cohort of patients hospitalized in the University Hospital – Pleven, Bulgaria. Material and methods. Blastocystis sp. isolates were collected from hospitalized patients who were clinically referred for parasitological testing and genomic DNA was extracted from cultivated Blastocystis sp. samples. The isolated DNA was then used to perform subtype classification using known sequence-tagged site (STS) primers and RFLP analysis of small subunit (SSU) rRNA gene. Results. Blastocystis sp. was isolated from 42 out of the 261 tested patients – a prevalence of 16.09%. Out of the 42 Blastocystis sp. positive fecal samples, DNA was successfully extracted from 33. The isolated DNA belonged only to two subtypes – ST1 and ST3. No mixed subtypes were detected. Conclusions. We found that ST3 was more prevalent among patients with clinically presenting allergic diseases – 17 of the tested patients (65.38%). ST1 was isolated from patients with allergic and with gastro-intestinal symptoms.

Transarterial chemoembolization is a standard locoregional therapy for intermediate stage hepatocellular carcinoma. The tumour is typically supplied by the hepatic arteries, however, extrahepatic collateral arteries may significantly contribute parasitic blood supply to the tumour. Large and exophytic tumour, subcapsular location, direct invasion and adhesion to adjacent organs, hepatic artery dissection, stenosis and occlusion resulting from multiple embolizations are risk factors of extrahepatic collateral arteries. Understanding the prevalence and prediction of these parasitic supplies on pre-procedural imaging is of utmost importance for optimizing technical and clinical outcomes.

Introduction. Although many patients recover functionally, breast cancer and mastectomy have physical and psycho-emotional impact on the quality of life. To avoid errors and biases, reduce emotional distress and help postoperative recovery, physiotherapeutic and psychological assessments before and after mastectomy are needed. The objective of the study was to demonstrate that physiotherapy and psychological counseling enhance the rehabilitation process, by assessing and treating the postural alterations and lymphedema and reducing the level of distress and anxiety. Material and methods. We performed a prospective study on 20 patients with breast cancer, aged 32-65 years, divided into two equal groups. The study group undergone physiotherapeutic and psychological assessment and intervention, before mastectomy (for postural alterations, emotional status) and after mastectomy (for lymphedema, limited arm movements, anxiety, depression, hopelessness, acceptance). None of the patients in the control group presented to physiotherapeutic and psychological assessment before mastectomy. After surgery, all were assessed by a physiotherapist, 2 patients completed the therapy; 70% went to psychological evaluation, but had poor attendance to counseling sessions. Results. Six patients had postural and biomechanical changes and variable degrees of psychological distress, prior to mastectomy. The compliance to physiotherapeutic rehabilitation was greater in the study group than in the control group. The levels of distress were lower in the study group, due to pre-surgery counseling sessions. Conclusions. The data confirmed the utility of preoperative assessments and counseling, the need for post mastectomy interventions and support the efficiency of the multidisciplinary approach of breast cancer cases.

Introduction. Pulmonary embolism is an important public health problem in both developing and industrially developed countries. Diagnosis and management of pulmonary embolism remain a challenge for the current obstetrics practice, due to pregnancy-associated symptoms, which are sometimes similar to those of venous thromboembolism. The gold standard for diagnosis is computed tomography (CT) pulmonary angiography/ ventilation perfusion scanning, which imply radiation exposure for mother and fetus. Administration of “blind” anticoagulant therapy in pregnant women may increase the risk of hemorrhagic complications. The major challenge in these cases is to decide when angiography is really needed. Several algorithms and scores are proposed to avoid imaging techniques in these patients. The objective of the study was to evaluate local practices regarding the diagnosis of venous thromboembolism in the department of Obstetrics and gynecology of Louis Dommergues Hospital, Trinity, Martinique, and to compare them with the existing international guidelines. Material and methods. Presentation of series of cases with suspicion of venous thromboembolism investigated in the Department of Obstetrics and Gynecology of “Louis Dommergues” Hospital, Trinity, Martinique. Results. Initial diagnostic testing (electrocardiogram, blood gases, D-dimers, troponine, NT-proBNP) was performed for all pregnant patients presenting clinical suspicion of PE. According to the original Geneva score, the majority of patients had a high risk of PE (> 8 points) – 4 (44.44%) and 3 (33.33%) – intermediate (5 – 8 points) and 2 (22.22%) – low-risk of PE (0 – 5 points). PE was confirmed by angio-TC in 2 patients (22.22%). Conclusions. Clinical suspicion of pulmonary thromboembolism should lead to imaging techniques as CT angiography or ventilation/perfusion scanning. Abnormal blood gases, D-dimers, NT-pro BNP or electrocardiogram are not sufficient to confirm nor to invalidate the diagnosis.

Introduction. Hyperuricemia is a strong predictor of an altered metabolic status. There are complex interrelationships between hyperuricemia, type 2 diabetes mellitus (T2DM), metabolic syndrome (MS) and chronic kidney disease (CKD). The objective of the study was to investigate the impact of hyperuricemia on the prevalence of MS and glomerular function in patients with T2DM. Materials and methods. This retrospective study included 300 patients with T2DM, hospitalized for one day in the diabetes clinic, between 01.01.2016-31.12.2018; all the data used for the analysis were obtained from the medical records. Results. The prevalence of hyperuricemia was 46%. MS was identified in 88.41% patients with hyperuricemia compared to 61.73% in patients with normo-uricemia (p<0.01); also, all the components of MS were better represented among hyperuricemia patients. The prevalence of CKD (defined as glomerular filtration rate <60mL/min/1.73m2) was 49.28% in patients with hyperuricemia, while in patients with normo-uricemia it was 25.31% (p<0.01). Other metabolic conditions were statistically significantly represented for hyperuricemia patients: obesity (88.4% vs. 61.72%, p<0.01), hepatic steatosis (81.11% vs. 57.41%). The impact of the aggregation of metabolic risk factors in hyperuricemia patients was visible in this study, the prevalence of ischemic heart disease being 83.33% in patients with hyperuricemia and 72.4% in patients with normo-uricemia (p=0.02). Conclusions. Hyperuricemia is associated with increased MS prevalence and increased prevalence of CKD in T2DM patients.

Introduction. Intestinal malrotation and hypertrophic pyloric stenosis (HPS) are both rare diseases, usually diagnosed during infancy. In the medical literature there are only a few reports about infants who suffer from a combination of these diseases. The simultaneous occurrence of both diseases in adult patients is extremely rare. However, in this case, the surgical approach has to be a combination of different techniques, aiming at treating each one of the diseases separately. Case presentation. A 37-years-old female patient who presented for upper gastrointestinal symptoms was diagnosed with adult hypertrophic pyloric stenosis (AHPS), intestinal malrotation and consequent dilated stomach. The diagnosis was based on the history, clinical findings, imaging examinations (X-ray, abdominal computed tomography), and gastroscopy. The surgical approach included division of Ladd’s band and Jaboulay pyloroplasty. Conclusions. The simultaneous occurrence of intestinal malrotation associated with AHPS is an extremely rare condition. Applying a combined surgical approach may have good postoperative results.

Introduction. In 2018, the number of newly diagnosed breast carcinomas in the 28 countries of the European Union was 404 920, with an estimated annual incidence of 144.9/100 000. Figures have increased since the introduction of mammography screening and continue to rise with population aging. Mammograms may convey clinically occult breast cancer, which is associated in some cases with the presence of clustered microcalcifications. Case presentation. We present the case of a 64-year-old patient with multifocal invasive ductal left breast cancer and lobular carcinoma in situ, diagnosed after biopsy of a mammogram-marked area with clustered microcalcifications. The patient underwent subsequent radical surgical treatment. Conclusions. Clustered microcalcifications on mammograms may indicate clinically occult breast cancer. These lesions cause clinical and diagnostic difficulties due to the inability of ultrasound visualisation and the option to perform punch biopsy, as recommended by European Society for Medical Oncology. Excision biopsy by mammography-guided wire marking and pathological-anatomical examination of the entire resectate can detect tumour heterogeneity, which is important for the subsequent therapeutic strategy and prognosis of the disease.

Introduction. Ataxia-telangiectasia (A-T) or Louis-Bar’s syndrome and Nijmegen breakage syndrome (NBS) belong to primary immunodeficiencies associated with impaired DNA repair, because of the damage to genes involved in the repair system. The peculiarity of these orphan diseases is that the onset and development of clinical manifestations depend on the severity of genome instability, the rate of accumulation of mutations determining the severity of the course for each individual patient. Cases presentation. The clinical cases of the syndrome A-T in a 4-year-old child and NBS in an 8-year-old child are presented in this article. The dynamics of clinical symptoms and their evolution were analyzed. The authors identified common clinical and immunological features of A-T and NBS in the examined children. The features of clinical cases were compared with data from the scientific literature. Conclusions. The complexities of the A-T and NBS diagnosis, due to the peculiarities of the course in different patients and the variability of the onset of the first clinical manifestations, are highlighted. The analyzed clinical cases will contribute to better physicians’ awareness and vigilance regarding the early diagnosis of primary immunodeficiency, that will prevent serious complications.

Introduction. Dirofilariosis is caused by the filarial nematodes Dirofilaria (Nochtiella) repens and Dirofilaria immitis. The vectors are mosquitoes of the Culicidae family of the genus Anopheles, Aedes and Culex. Case presentation. We present the case of a 47-year-old woman, under treatment for suspected atheroma of the facial skin of the eye and nose. The patient presented to medical check-up without symptoms of pain or discomfort. After histological examination of the lesions, the diagnosis of “dirofilariosis repens” was established, a disease extremely rare in Bulgaria. Conclusions. Dirofilariasis repens is a parasitosis, with few cases reported in Bulgaria. It is believed to be a consequence of being bitten by insects from the Mediterranean region. Due to the nature of the disease and the small number of cases in Bulgaria, the diagnosis is difficult. The primary diagnoses are: neoplasms, lymphadenitis of unknown etiology, hydrocele, lipoma, dermoid cyst, fibroadenoma, neurofibroma, allergic conjunctivitis. In this case, the removal of the tumour and histological examination of the removed parasites were made, which guarantees diagnosis and treatment.

Introduction. Malignant skin melanoma accounts for 1% of all human malignancies. Vulvar melanoma constitutes less than 1% of all melanomas and it is the second most common malignant tumour of the vulva, accounting for 10% of all vulvar malignancies. Usually, it is detected in a later stage compared to other skin melanomas because of its anatomical location and represents a real diagnostic and treatment challenge for dermatologists and gynaecologists. Case presentation. We present a rare clinical case of a 27-year-old woman with pigmented malignant melanoma affecting the left labium majora. Conclusions. Malignant vulvar melanoma in women under the age of 45 years is rare. It is more aggressive than other types of malignant skin melanomas because of its relatively late diagnosis. Knowledge of the disease will improve the medical care provided and patients’ prognosis.

Introduction. The presence of mosquitoes and the abundance of microfilariae in dogs are considered of great risk for invading humans with dirofilariasis. We present an extremely rare case of Dirofilaria repens in the periorbital subcutaneous area, diagnosed for the first time in Bulgaria by magnetic resonance imaging (MRI). Case presentation. A 39-year-old woman presented for swelling of the eyelid and eye redness, sensation of movement, irritation and pain. MRI was performed in the axial, coronary and sagittal planes, with pulse sequences T1 W, T2 tse_dix, T2 vibe_fs. On the base of the anamnestic data and pathologic changes identified by MRI, which indicated the presence of Dirofilaria, the patient was referred to an eye surgeon. After the parasitological studies, two immature female parasites of the species Dirofilaria repens (larvae; Onchocercidae; Nematoda) were identified. Conclusions. MRI is a non-invasive and effective diagnostic method for assessing changes in the proximity and the affected areas of Dirofilaria repens, to determine the exact location, for subsequent surgical access and rapid removal of the parasite.

Introduction. Rhabdomyolysis (RM) is a clinical and laboratory syndrome resulting from skeletal muscle damage, with the release of a big number of intracellular substances of myocytes into the systemic circulation and endotoxemia. The entry of the muscle destruction products into the systemic circulation leads to the development of systemic manifestations, serious disorders in homeostasis, multiple organ failure syndrome, including acute renal failure, often threatening the patient’s life. Case report. A rare case of RM in a patient with staphylococcal sepsis (SS) and development of multiple organ failure is described. The diagnosis of RM was confirmed by the results of pathological and anatomical studies. Possible causes of RM in staphylococcal sepsis are discussed here. Conclusions. Only a few cases of RM upon SS were found in the literature. The development of RM in combination with the systemic inflammatory reaction syndrome in SS exacerbates the course of the disease and worsens its prognosis. Therefore, the timely diagnosis of RM and appropriate treatment are extremely important. The mechanism of RM development upon SS is complex. After staphylococcus was isolated from the affected muscles in a patient with SS, one of the first descriptions of RM upon SS suggested the role of direct invasion of the infectious agent into the muscles, followed by the development of “pyomyositis.” Another mechanism for RM occurrence of PM may be the presence of toxin upon the staphylococcal toxic shock syndrome in patients with SS.

Introduction. The development of obstructive jaundice caused by hepatobiliary ascariasis is quite rare. The main factors contributing to the occurrence of mechanical obstruction of bile leakage are the death of helminth in the lumen of the duct, the massive invasion of the biliary tract by ascarids, or the accompanying stenotic papillitis. Case presentation. We describe a case of obstructive jaundice in a woman with massive ascariasis of the biliary tract and stenotic papillitis. The treatment strategy consisted in endoscopic retrograde cholangiopancreatography (ERCP) with mechanical removal of helminths from the bile ducts, papillosphincterotomy, antihelmintic drugs and symptomatic therapy. Conclusions. Biliary ascariasis must enter into the differential diagnosis of biliary duct pathologies, especially in endemic regions for this parasitosis. ERCP may be an important therapeutic method for this disease.

Introduction. The aim of this article is to present the advantages of tracheoesophageal puncture using secondary placement of the voice prosthesis, at present the “gold standard” for voice rehabilitation in the laryngectomized patient with advanced cancer following total laryngectomy. Absence of voice and, therefore, inability to verbally communicate, constitutes one of the greatest challenges for laryngeal cancer patients, having a major impact on their quality of life. Case report. The authors illustrate the case of a 61-year-old patient diagnosed with advanced laryngeal cancer, who underwent total laryngectomy. After approximately one year, a voice prosthesis is installed. Phonation was immediate and close to natural laryngeal speech. Conclusions. From a functional, as well as psychological and social point of view, a laryngeal cancer diagnosis can have devastating consequences on all aspects of a patient’s life. Phonation recovery is thus essential for psychological well-being, labour and social reintegration. Correct understanding and management of this pathology and treatment options is of utmost importance in obtaining the best possible medium and long-term outcomes. Secondary placement of the voice prosthesis provides greater oncological safety as well as avoids common post-radiotherapy side effects.

Introduction. Iron homeostasis has been extensively studied in the recent years. The factors regulating hepcidin secretion and the significance of hepcidin during pregnancy have not been fully clarified. The objective of the study was to investigate the serum concentrations of hepcidin and interleukin-6 (IL-6) and their relationships to parameters of iron metabolism in women with low-risk and high-risk pregnancies. Material and methods. The study involved 40 pregnant women distributed in two groups: high-risk pregnancies (HRP, n=20) and low-risk pregnancies (LRP, n=20). The HRP were associated with chronic inflammatory disorders and reproductive failures. We evaluated the red blood cell count, hemoglobin (Hb) concentration, hematocrit (Hct), erythrocyte indices, serum concentrations of hepcidin, IL-6, ferritin (Ferr) and iron (Fe), the total iron binding capacity (TIBC)

Introduction. Ischemic stroke (IS) is a rare, but underestimated disease in children. The incidence of IS is 2–13:100000 children or 1:4000 in neonatal period. The objective of the study was the evaluation of the expressivity of immune parameters in children with IS, to improve understanding of pathogenesis, early diagnosis and predictive factors of the disease. Materials and methods. We performed a prospective study between 2017–2019 in the Republic of Moldova, on a sample of 53 children with IS (study sample, SS), investigated by ELISA in the acute phase, determining the serum levels of S100B protein, vascular endothelial growth factor (VEGF) and ciliary neurotrophic factor (CNTF). These markers were also appreciated in 53 “practically healthy“ children (control sample, CS). Six months after IS, serum levels of VEGF and S100B were re-assessed. Results. The mean values of markers in the acute phase were as follows: (1) S100B 0.524±0.0850 ng/mL (Fisher’s test 9.330, p<0.01); (2) VEGF 613.41±39.299 pg/mL (Fisher’s test 60.701, p<0.001); (3) CNTF 7.84±0.322 pg/mL (Fisher’s test 32.550, p<0.001), which were significantly different from the levels in CS. Conclusions. In the acute period of IS we observed a significant increase of values of certain markers (S100B, VEGF and CNTF), which determine their role as biomarkers involved in ischemic brain processes. It is necessary to carry out new longitudinal studies in children with IS to improve the diagnosis and treatment.

Introduction. Ischemic stroke (IS) is a rare, but underestimated disease in children. The incidence of IS is 2–13:100000 children or 1:4000 in neonatal period. The objective of the study was the evaluation of the expressivity of immune parameters in children with IS, to improve understanding of pathogenesis, early diagnosis and predictive factors of the disease. Materials and methods. We performed a prospective study between 2017–2019 in the Republic of Moldova, on a sample of 53 children with IS (study sample, SS), investigated by ELISA in the acute phase, determining the serum levels of S100B protein, vascular endothelial growth factor (VEGF) and ciliary neurotrophic factor (CNTF). These markers were also appreciated in 53 “practically healthy“ children (control sample, CS). Six months after IS, serum levels of VEGF and S100B were re-assessed. Results. The mean values of markers in the acute phase were as follows: (1) S100B 0.524±0.0850 ng/mL (Fisher’s test 9.330, p<0.01); (2) VEGF 613.41±39.299 pg/mL (Fisher’s test 60.701, p<0.001); (3) CNTF 7.84±0.322 pg/mL (Fisher’s test 32.550, p<0.001), which were significantly different from the levels in CS. Conclusions. In the acute period of IS we observed a significant increase of values of certain markers (S100B, VEGF and CNTF), which determine their role as biomarkers involved in ischemic brain processes. It is necessary to carry out new longitudinal studies in children with IS to improve the diagnosis and treatment.

Introduction. Alveolar hemorrhage syndrome is a severe condition, with a high-risk of death. A timely diagnosis and therapy may be life-saving. The “gold-standard” method for diagnosing alveolar hemorrhage is bronchoscopy with bronchiolo-alveolar lavage. Pulmonary function tests are useful to appreciate the severity of alveolar hemorrhage. The objective of the study was to measure the impact of alveolar hemorrhage on lung function tests and to detect useful associations between Golde score value and the type of alveolitis with spirometry tests, lung diffusing capacity for carbon monoxide (DLCO) and carbon monoxide transfer coef?cient (KCOc), and six minutes walking test (6MWT). Material and methods. We conducted a retrospective study on a sample of 60 patients diagnosed with alveolar hemorrhage syndrome, hospitalized in The National Institute of Pneumology “Marius Nasta” Bucharest, Romania, between June 2010 and February 2019. Results. The results of bronchiolo-alveolar lavage show that macrophage alveolitis is associated with moderate-severe alveolar hemorrhage syndrome, while neutrophilic and lymphocytic alveolitis are associated with mild to moderate alveolar hemorrhage syndrome. Pulmonary function tests (spirometry and complex respiratory tests) showed that only Tiffeneau index, maximal expiratory flow at 50% of vital flow capacity and DLCOc were influenced by the presence of moderate to severe alveolar hemorrhage. The degree of desaturation measured at the end of 6MWT did not correlate with the degree of alveolar hemorrhage severity. Conclusions. An abnormal gas transfer is common in alveolar hemorrhage, an increase of DLCOc value being a sensitive marker for the disease.

Introduction. Iron homeostasis has been extensively studied in the recent years. The factors regulating hepcidin secretion and the significance of hepcidin during pregnancy have not been fully clarified. The objective of the study was to investigate the serum concentrations of hepcidin and interleukin-6 (IL-6) and their relationships to parameters of iron metabolism in women with low-risk and high-risk pregnancies. Material and methods. The study involved 40 pregnant women distributed in two groups: high-risk pregnancies (HRP, n=20) and low-risk pregnancies (LRP, n=20). The HRP were associated with chronic inflammatory disorders and reproductive failures. We evaluated the red blood cell count, hemoglobin (Hb) concentration, hematocrit (Hct), erythrocyte indices, serum concentrations of hepcidin, IL-6, ferritin (Ferr) and iron (Fe), the total iron binding capacity (TIBC) and transferrin saturation (SatTf) twice, at the beginning of the second and third trimester of pregnancy. Results. We found significantly higher serum Ferr and lower TIBC in HRP than in the controls at the beginning of the second trimester (p<0.05). Significant decline in serum Ferr and rise in TIBC were observed during pregnancy in both groups, whereas decrease in SatTf was found only in LRP (p<0.05). In HRP, serum concentrations of IL-6 were negatively related to serum Fe and SatTf, and positively – to Hb concentration, while serum hepcidin was negatively related to Hb concentration and Hct (p<0.05). A significant positive relationship between serum hepcidin and IL-6 was found in LRP (p=0.038). Conclusions. There are significant relationships between IL-6 and hepcidin production and parameters of iron metabolism in pregnancy.

Introduction. Ataxia-telangiectasia (A-T) is a neurodegenerative disorder characterised by progressive ataxia, telangiectasia, immunodeficiency, increased susceptibility to malignancies and radiation sensitivity. The objective of the study was to determine the clinical and immunological features, as well as the consequences of A-T in the Ukrainian population. Material and methods. Sixty-four patients with A-T, registered at the Ukrainian National Registry of primary immunodeficiencies, were first included in the study. The evaluation of clinical signs and investigations were possible in 53/64 patients with A-T. Results. Neurological signs and telangiectasies were evidenced in all patients, and were followed by recurrent infections (81.1%), lymphoid hypoplasia (66.0%), and malignancies (15.1%). Poor weight gain was observed in 73.6% of patients, orthopaedic disorders in 52.8%, and bronchiectasis in 30.8%. High alpha-fetoprotein levels were seen in 93.5% of patients, mean level- 150.3 IU/mL. Among immunoglobulin changes, the most significant was a decreased IgA level (83.0%), followed by a high IgM level (50.9%), low IgG (18.9%) and IgE levels (49.1%). Reduced CD3, CD4 and CD8 T-lymphocytes were observed in 85.7% of patients. Infections and cancer were the most often causes of mortality. The mean age at death was 14.1 years, ranging from 6 to 21 years. Conclusions. Ataxia in combination with recurrent infections is the key to A-T diagnosis. In addition to syno-pulmonary infections, pyoderma and stomatitis are also frequent presentations. Children with ataxia should be referred to an immunologist, as well as genetic testing should be recommended for all patients with ataxia for timely diagnosis.

Introduction. Prostate cancer is the second leading cause of cancer death worldwide, including developed countries. There are epidemiological studies on the prevalence of this disease in Central Asia. However, a study about the prevalence of prostate cancer depending on ethnicity in Kazakhstan was not conducted yet. Objective. To assess the incidence rates of prostate cancer in relation to ethnicity, age and morphological type of tumour (in Kazakhstan). Methods. This is a retrospective study of morphologically verified cases of prostate cancer, performed on 7082 patients during the period 2015-2019. According to ethnicity, the patients were subdivided into the following groups: Central Asians, Slavs, and other nationalities. Four categories were identified by age: <60 yo, 60-69 yo, 70-79 yo and 80+ yo. The information on the age difference, social status, stages of the malignant process, morphological type of cancer was collected and analysed. The age-standardized incidence rate of prostate cancer was calculated depending on ethnicity. All statistical calculations were performed using SPSS software (version 22.0, IBM SPSS Inc., Chicago, Illinois, USA). A p value < 0.05 was considered statistically significant. Results. The mean age of the patients was 69.04±8.5 years. Among 7082 patients, 61.6% were Slavs, 35.01% Central Asians and 3.37% other ethnic groups. Prostate cancer prevailed in the age group 60-69 yo in 41.9% cases, which was higher among Slavs compared to the Central Asians (p=0.05). The average annual increase in the disease incidence was 2.1%. There was no significant increase in the incidence of prostate cancer in the age groups: <40 yo (r = 0.41), 40–49 y0 (r = 0.31), +80 yo (r = 0.32). Stage II of the tumour process was the most diagnosed in the total number of cases (N = 2856), the highest prevalence being found among Slavs (40.66%) (p = 0.05). Adenocarcinoma was the most frequently detected type of tumour (97.37%) in all ethnic groups. Conclusions. The results of the study showed there was a relatively low increase in the incidence of prostate cancer in the Kazakhstan population between 2015-2019. A high incidence of prostate cancer among men of Slavic nationality than among Central Asians was determined. These findings indicate the importance of the early diagnosis of prostate cancer, especially in ethnic groups with a higher incidence of the disease.

Introduction. Patients with metabolic syndrome (MS) frequently present alterations of paraclinical tests. The effectiveness of dietary intervention has been intensively studied in the last decade. The objective of the study. This research studied the correlation of uric acid with the evolution of paraclinical parameters (HOMA index, cholesterol, triglycerides and C-reactive protein) in patients with MS, following the evolution of specific imbalances in MS, after an anti-inflammatory diet, associated or not with sport. Materials and methods. The monitoring of the parameters was performed over a period of 12 months, on a number of 110 patients, aged> 18 years, with HOMA index> 2, divided into three groups: control group, diet therapy group, and diet therapy and sports group, respectively. Results. Following the statistical processing, the correlation of the paraclinical parameters indicates the following: uric acid and cholesterol – Pearson coefficient r=0.192, p <0.05; uric acid and triglycerides – r=0.544, p <0.001; uric acid and C-reactive protein – r=0.443, p <0.001; HOMA index and uric acid – r=0.223, p <0.05. Conclusions. The results of this study indicate that after dietary interventions combined with physical activity, the metabolic imbalances were reduced in patients with MS. At the same time, the evolution of paraclinical parameters, in the control group, indicates an evolution of the disease in the absence of nutritional intervention. The correlation of paraclinical parameters indicated a strongly positive and directly proportional link.

Introduction. Diabetes mellitus is associated with overweight and pancreatitis. To date, the results of routine laboratory tests are not being utilized as reliable markers for comorbidities associated with type 2 diabetes mellitus (T2DM). The objective of the study. The aim of this study was to analyze complete blood count parameters in order to determine significant predictors of T2DM comorbid course. Material and methods. The study involved 579 T2DM patients with comorbid overweight/obesity and chronic pancreatitis (CP). Complete blood count (CBC) was performed using a Yumizen H500 CT automatic hematology analyzer. Insulin levels were determined using a standard kit with a Thermo Scientific Multiskan FC enzyme-linked immunoassay analyzer. Glucose levels were determined using a standard kit with a COBAS INTEGRA® Diagnostics automatic biochemical analyzer. The neutrophil-to-lymphocyte ratio (NLR) was calculated based on CBC. Results. In T2DM patients, glucose levels significantly correlated with the fraction of neutrophilic granulocytes, including segmental neutrophils, lymphocytes, and NLR, while glycated hemoglobin (HbA1c) levels were significantly correlated with the lymphocyte and NLR fractions. Notably, no correlations between leukocyte profile and carbohydrate metabolism variables were found in T2DM patients. We found a negative correlation between glucose levels and the rod-shaped neutrophilic granulocyte fraction, as well as between HbA1c and NLR levels in overweight T2DM patients without CP. In overweight T2DM patients with comorbid CP, glucose levels correlated with the lymphocyte and NLR fractions. Conclusion. T2DM in overweight/obese patients with CP is characterized by an abnormal and uncontrolled leukocyte response, therefore a complete blood count is not an adequate marker of the comorbid course of diabetes in such patients.

Introduction. The infection with Mycobacterium tuberculosis represents a common cause of pleural effusions, and its diagnosis poses difficulties for clinicians. In the attempt to facilitate a quick, accurate and inexpensive diagnosis, the research is focused on evaluating useful biomarkers in the pleural fluid. Adenosine deaminase (ADA) level in the pleural fluid is a biomarker with high specificity and sensitivity for the diagnosis. The objective of the study was to assess the association between ADA levels in the pleural fluid, other pleural fluid characteristics, and clinical aspects in tuberculous pleurisy. Material and methods. We performed a retrospective study on 77 patients diagnosed with tuberculous pleurisy (positive Mycobacterium tuberculosis cultures in the pleural fluid or biopsy specimens and/or specific histological aspect: epithelioid granuloma with caseous necrosis in pleural biopsy), between 2011-2018, in The National Institute of Pneumology “Marius Nasta” Bucharest, Romania. Results. The ADA values were positively and statistically significant correlated with lactate dehydrogenase (LDH) and protein levels in the pleural fluid. Also, the mean ADA value was increased in febrile patients as compared with the afebrile ones, statistically significant (p <0.05). Conclusions. Probability scores (developed on the ground of biochemical and cytological characteristics of the pleural fluid, clinical and demographic parameters), together with the local epidemiological context, may contribute to a faster, reliable, accessible and non-invasive diagnosis of tuberculous pleurisy.

Introduction. Depression in patients with advanced breast cancer is a serious comorbidity that affects the quality of life of these patients, and their survival rates. Objective. This study aims at systematically reviewing the current literature with data on the prevalence of depression symptoms in metastatic and recurrent breast cancer patients, examining the pooled mean prevalence of depression symptoms and potential sources of heterogeneity. Methods. An extensive systematic review of PubMed, Web of Science, Scopus, ScienceDirect, Google Scholar, American Doctoral Dissertations and Open Grey databases, and the following reference list hand-search was performed to retrieve studies from January 2005. Results. We identified 11 eligible studies that assessed 1223 patients on the presence of depression symptoms, and 465 patients met the criteria. According to the random-effects model, the pooled mean prevalence of depression was 38.23% (95% CI [30.92; 45.83]; I2= 87%; Q (df =10)=77.89, p-value < 0.01). Patients with metastatic stage had a slightly higher prevalence of depression symptoms compared to recurrent breast cancer patients. Conclusion. Prevalence of depression symptoms among advanced breast cancer patients is high. It is important to improve psychological prevention methods to decrease the occurrence of depression, as breast cancer patients start receiving care from primary diagnosis and offer continuous support and treatment to meet their psychological needs.

Introduction. Percutaneous core biopsy (PCB) is a minimally invasive, widely available and relatively safe procedure enabling pathological diagnosis in oncological patients. The objective of our study was to analyse the complication rates of PCBs between the lungs and other organs, for a better preprocedural evaluation. Material and methods. We performed a retrospective observational study of 558 PCBs, divided into: lung PCBs (n=355) and other PCBs (n=203). Descriptive statistics, the independent sample t-test, and Pearson correlation coefficient were used to analyse the statistical differences and relationships with the rate of complications. Results. The largest number of procedures was performed on the lungs (n=355), followed by breast (n=70) and liver (n=45) biopsies. The complication rate was 7.7% (n=43). The lung had a higher rate of complications (11.3%; n= 40), compared to 1.5% (n=3) from other PCBs. Lung PCBs correlate with complications (r(556) =.18, p < .001). The independent samples t-test was statistically significant, t(501) =5.2, p < 001. The lung PCBs were associated with a statistically significantly larger mean complication occurrence than the other PCBs. Cohen’s d was estimated at .37, which is a medium effect. The most common complication was pneumothorax (n=31), rate of 8.1% (n=29) from lung biopsies. CT-guidance (r(487) =.15, p =.001), repeated biopsies (r(538) =.17, p < .001), and INR (r(524) =-.10, p =.019) are correlated with complications. Conclusions. Lung biopsy is riskier than other biopsies and should be avoided if another biopsy, in the same pathological context, is available, to avoid unnecessary complications.

Introduction. Adequate utilization of primary health care directly reflects the health status of a population. In the Republic of Georgia, many patients seek care without a referral of a primary-care provider; as a result, patient’s referral rate to the family physician is low. The tendency of patient’s self-referral behaviour may reduce the effectiveness of the health care system. The objective of the study was to assess the cause of the low referral rate to a family physician in Georgia. Material and methods. An analytic cross-sectional study was conducted. Within the quantitative survey 300 patients and within the qualitative research 20 family physicians from different cities and regions of Georgia were interviewed. Results. Patient’s referral rate to a family physician was low. 55% of family physicians revealed that patients have often addressed them only for the referral to specialists. 42% of patients visited the family physician once or did not visit at all and 57% did not consult with a family physician for preventive purpose. Conclusions. The results suggest that the patient’s low referral rate was due to distrust towards family physicians, which was related to the lack of qualification of physicians and the low public awareness of the family doctor’s competence. Due to an inadequate reimbursement, family physicians do not have enough motivation to provide adequate service and the lack of continuous education negatively affects their professional development. It is recommended to raise public awareness about the primary care, to introduce effective methods for payment of family doctors, to increase the role and affordability of continuous professional education.

Introduction. Rheumatoid arthritis (RA) is a systemic, chronic condition that belongs to autoimmune diseases, characterized by synovial membrane damage with the involvement of connective tissue, which leads to important functional limitations. The objective of the study was to estimate the functional and psycho-emotional status in people with rheumatic damage in relation to the degree of activity and differentiated programs of medical rehabilitation. Material and methods. The data were collected from 67 patients diagnosed with moderate activity RA, aged 29-73 years, of both sexes, randomized in 2 groups (test group L(T) – 31 patients, and control group L(C) – 36 patients). Patients in the test group were involved in medical rehabilitation programs with active-assisted kinetic techniques, individualized for each patient. All persons included in the study were clinically-functionally examined with the application of a set of identical functional tests at admission and again, more than one month after treatment. The functional capacity of the hand was assessed by testing bi-digital, poly-digital and palm-based forceps (dots). The severity of the pain was assessed by visual analogue scale. The SF-11 (Medical Outcomes Study Short-Form Health Survey) scale was applied to assess the quality of life. The results obtained were analyzed using the Student test (p<0.05 value considered statistically significant). Results. One month after initiation of physiotherapeutic rehabilitation treatment in the L(T) test group, the average pain value decreased from 78.531±1.36 to 51.231±1.38 (?<0.001) points. The testing of the hand function in the L(T) test group showed an increase in scores from 4.27±1.25 to 7.31±1.03 (?<0.01) points. Application of the SF11 scale one month after treatment revealed in the L(T) test group the increase in psycho-emotional parameters: mental state (MS) from 40.12±2.13 to 72.14±7.1 (?<0.01) points; functioning of the emotional role (ER) from 27.24±1.23 to 68.43±3.12 (?<0.01) points, vitality (VT) from 22.37±4.32 to 35.28±3.14 (?<0.01) points. Conclusions. Medical rehabilitation programs with kinetic techniques have considerably improved clinical-functional manifestations, by reducing pain and improving hand function, mental state, emotional role, and general perception of health in people with rheumatic damage.

Obesity and malnutrition are subjected to comprehensive studies as risk factors in the pathogenesis of colorectal cancer (CRC). Nevertheless, the most recent scientific evidence revealed that a number of issues associated with risk impact processes remain to be clarified. The aim of the current review is to discuss the action mechanisms of obesity and malnutrition, their effect in the prediagnosis and later phases of CRC, with emphasis on concomitant oxidative stress. The relationship obesity-CRC is considered in three aspects: low-grade inflammation and role of adipocytokines, development of metabolic syndrome, lipid peroxidation and oxidative stress. Malnutrition effect is discussed in two aspects – metabolic dysregulation and oxidative stress. Data are presented on the specificity of action of the two risk factors referring to the periods of disease course. Oxidative stress is a characteristic indicator of obesity, malnutrition and CRC. This fact enables us to recommend its inclusion together with nutritional status indicators in CRC screening.

Arterial hypertension (HTN) is one of the most prevalent diseases all over the word. There are many studies and reviews about the coexistence of HTN with coronary, cerebrovascular and renal diseases. However, sometimes clinicians do not search for aortic disease in hypertensive patients. The coexistence of HTN and various aortic diseases raises peculiar issues regarding monitoring and managing of these patients. This review presents data about HTN and aortic aneurism, aortic coarctation and aortic valve disease, emphasizing the particularities of the diagnosis and management of HTN in these patients. Also, a part of the review will focus on the evaluation of arterial stiffness and its clinical implications.

Palaeopathology is a scientific tool which provides an integrated vision of diseases and lifestyle habits of ancient populations. This review paper aims to present an overview of the most common diseases of the Stone Age, their correlation with human habits and lifestyle, as well as their impact to health status of the prehistoric populations. Although the paleopathology of the Stone Age period is not well studied, we provide some indicative results of research works from Greek Neolithic archaeological sites. More paleopathological investigations are needed to have a satisfactory approach of the health status of prehistoric populations.

Global burden of diseases studies collected and analysed data from more than 195 countries, reflecting premature death and disability related to more than 350 diseases and injuries, by age and sex, since 1990 to the present. The national profile of each country in the studies contains comparative data for 2007 and 2019. The purpose of this paper was to analyse the differences in leading risk factors and causes of global burden of diseases between Balkan countries. The leading causes of years of life lost due to disability are mainly chronic non-communicable diseases, with the leading positions being low back pain, falls, headaches, diabetes, etc. The summary indicator for lost years of life due to premature death and disability-adjusted life years (DALYs) for 2017 again shows the leading role of ischemic heart disease and stroke. Preventable mortality in Bulgaria remains very high. Much of the overall burden of disease in Bulgaria can be attributed to behavioural risk factors, including smoking, alcohol consumption, dietary risks and low physical activity.

Introduction. In 1706, Raymond de Vieussens described a proximal inter-coronary pathway connecting the conus branch of the right coronary artery (RCA) with an infundibular branch of the left anterior descending artery (LAD) or directly with the proximal LAD. Later, in the 19th century, this anatomical structure would be named in his honour “Vieussens’ arterial ring” (VAR). VAR serves as a collateral pathway in case of coronary artery disease. Case presentation. We present the case of a 58-year-old male with a concurrent ostial chronic total occlusion of the LAD and an acute thrombotic occlusion of the proximal RCA, that survived via a Vieussens’ arterial ring. Conclusions. The existence of collateral circulation holds a crucial role in the manifested symptoms and the prognosis of patients with ischaemic heart disease. The connection between the conus branch and the LAD (VAR) may provide adequate circulation to either the left or right coronary arterial system, preserving the left ventricular ejection fraction and allowing patients to survive even the most severe myocardial infarctions.

Introduction. Invasive apocrine carcinoma of the breast is a rare special subtype of mammary carcinoma and accounts for 0.3-1% of all breast malignancies. It has specific histological, immunohistochemical, and molecular genetic characteristics. The tumour cells have a unique immunohistochemical profile, which is to show Gross Cystic Disease Fluid Protein 15 (GCDFP-15) and androgen receptor (AR) positivity, as well as estrogen (ER), progesterone (PR), and Human Epidermal Growth Factor Receptor 2 (HER2) negativity. Case presentation. We report a case of invasive apocrine carcinoma in a 55-year-old female with a lump in the right breast and no axillary lymphadenopathy. Lumpectomy and sentinel node biopsy were performed. The histological examination and the immunohistochemical profile confirmed the diagnosis of invasive apocrine carcinoma with micro metastasis in sentinel lymph node which, to our knowledge, is the first published case. Due to the involvement of one of the resection lines from high grade apocrine ductal carcinoma in situ (DCIS), the patient underwent right modified radical mastectomy with axillary dissection. Conclusions. This report is a rare specific morphological type of invasive apocrine carcinoma with micro metastasis in sentinel lymph node. The unique immunohistochemical profile, the possibility of an anti-AR therapy, and the favorable prognosis separate it from basal-like triple-negative breast cancers.

Introduction. Approaching the pediatric patient with joint pain is often a challenge, even for the most experienced clinicians. The diagnosis of inflammatory bowel disease in children may be difficult because of atypical symptoms and/or extraintestinal manifestations such as arthritis, weight loss, chronic anemia, unexplained fever. Case presentation. We present the case of a 13-year-old girl, presented initially with musculoskeletal complains, feverish, weight loss. After an extensive clinical and paraclinical examination and a proper differential diagnosis, the diagnosis of inflammatory bowel disease was established, confirmed by immunological investigations, colonoscopy with biopsy. The peculiarity of the clinical case translates into the onset of ulcerative colitis through extraintestinal manifestations, the main clinical manifestations being related to articular involvement. Conclusions. Overlap syndromes are a main challenge for clinicians. Inflammatory polyarticular syndrome in a child can often result in a benign self-limiting disease, but sometimes may reveal a serious chronic disease with significant morbidity. Ulcerative colitis diagnosed in children presenting with an amalgam of extraintestinal manifestations requires a multidisciplinary approach.

Introduction. Cholesteryl ester storage disease or lysosomal acid lipase deficiency is a rare severe congenital enzyme pathology of lysosomal storage disorders. This pathology is linked with LIPA gene impairing mutations on chromosome 10 in locus 10q24-q25, coding lysosomal acid lipase enzyme (cholesterol ester hydrolase). The lysosomal acid lipase enzyme is involved in cellular fat metabolism, thus causing hepatic, vascular, nervous system, and adrenal glands damage. Case presentation. We report the case of a six-year-old boy with cholesteryl ester storage disease, who was admitted to the hospital with physical retardation, hepatosplenomegaly, impaired lipid profile, revealing an increased very-low-density lipoprotein cholesterol level and decreased high-density lipoprotein cholesterol level, dyslipidaemia, and hypercholesterolemia with highly increased atherogenic index, elevated bilirubin and aminotransferases. Conclusions. Severe hepatic impairment may occur in patients with cholesteryl ester storage disease in the absence of replacement therapy with acid lipase fermentation. The possibility of a timely diagnosis raises the likelihood of a quality treatment and prolongation of life in patients with lysosomal storage diseases.

Introduction. Pyogenic granuloma (PG) is a vascular inflammatory hyperplasia involving the skin and oral mucosa, often associated with local irritation or trauma, or with pregnancy. Intraoral location usually affects the gingiva, but tumoral aspect can be misleading, especially in extra-gingival locations. A thorough assessment and diagnosis are therefore important for ensuring the proper treatment. Case presentation. We report the case of a 12-year-old boy who presented for a growing and bleeding tumour of his lower lip mucosa. The tumour was labeled as “hemangioma”. It was growing for several weeks and associated with minor, but repeated mucosal trauma. Although the anatomic location was not common, the patient history suggested a diagnosis of PG. After a dermatologic assessment, which proposed a differential diagnosis with oral papilloma, a soft tissue ultrasound sustained the clinical diagnosis. The tumour was surgically excised and the defect was closed directly with absorbable sutures. Three weeks later the mucosa had a healthy appearance, without signs of impaired healing or tumour recurrence. The histopathological exam confirmed the clinical diagnosis. Conclusions. There are several types of soft tissue solid or vascular tumours that can be mislabeled and the diagnosis of hemangioma is commonly used for various vascular anomalies. In our case, the clinical aspect, together with the tumoral growing pattern and the history of repeated trauma, led us to the correct diagnosis and treatment. Surgical excision completely removes the PG and ensures rapid and esthetically convenient healing, without complication or tumour regrowth.

A 30-year-old male presented to the Emergency Department for a 3 day history of photophobia, redness and watery discharge from both of his eyes. The patient had no symptoms of fever, cough or dyspnea. His medical history was unremarkable and physical examination was normal. The patient mentioned that he is a dentist and that he wore personal protective equipment when having close contact with patients suffering from stomatological diseases, but on some particular events, he had to take off his protective eye-wear during certain interventions. In this instance, he can’t deny a possible contact with an asymptomatic case of COVID-19. The ophthalmology eye exam (Figure 1) with slit lamp examination described bilateral moderate conjunctival injection, inferior palpebral conjunctival follicles and bilateral watery discharge. Fundus examination disclosed unremarkable results. No subconjunctival haemorrhage or pseudomembranes. Macular ultrastructure or thickness assessed on optical coherence tomography were normal. No lesions on the corneal or anterior chamber. Routine fungal and bacterial cultures were also carried out and provided negative results. Oral and nasopharyngeal swab tests for SARS-CoV-2 were recommended, and came back negative. Nasal swab for influenza was also negative. Considering acute conjunctivitis, it was recommended to him to frequently clean the eyes by washing them with normal saline, to use cold compressions, topical anti-histaminics and frequent application of preservative free artificial tears. Also, a topical antibiotic was prescribed for 8 days. The patient was then discharged and recommended home isolation. After 36 hours, he was admitted to the hospital because of added complaints of cough and fever. Routine blood examination: glucose 113 mg/dL, C-reactive protein 13 mg/L, AST 43 U/L, ALT 73 U/L, LDH 313 U/L, monocytes% 14.3%, total cholesterol 223 mg/dL, triglycerides 234 mg/dL, a white blood cell count of 8.11 10^9/ Liter, neutrophils 5.76 10^9/Liter, lymphocytes 42.29%, D-dimers 487 ng/mL, creatine kinase-MB 17 U/L, fibrinogen 443 mg/dL, troponin T 7.11 ng/L, ferritin 179 ng/mL, erythrocyte sedimentation rate of 73 mm/hr, normal thrombin clotting time, creatinine clearance rate normal. Normal electrocardiogram. The computed tomography of the chest showed no signs of viral pneumonia (Figure 2). Samples for testing for SARS-CoV-2 were collected by conjunctival swab technique. The patient had positive RT-PCR results for both eye samples. Routine adenovirus tests returned negative results. To stop the evolution of COVID-19 infection, based on national protocol, the patient received the combination of lopinavir/ ritonavir (7 days), Heparin Sodium 5000 IU injection daily (7 days), cough syrup, hepatoprotectors, antacids, dexamethasone 20 mg tab daily (7 days), Azithromycin 500 mg tab daily (7 days). Other treatment was largely supportive. On day 8 of hospitalisation (day 12 of illness), the patient stated that all ocular symptoms had resolved. After hospital discharge, constant negative oropharyngeal swab tests for SARS-CoV-2 but serial conjunctival swab testing have shown that SARS-CoV-2 RNA may persist for up to 16 days, indicating a persistent replication of the 2019-nCoV.

Aristotle (384-322 BC), the founder of the peripatetic sect of philosophers was a polymath and his work covers almost every major area of human inquiry such as physics, biology, metaphysics, ethics, rhetoric and politics. However, it seems that he had an inclination for the investigation of nature and human being. The heart is considered by Aristotle as the source of life, the part wherein the “psychical fire” is kept burning, the place of passions where all the feelings end and the true seat of the soul. His notions on anatomy were revised by the physicians of the Alexandrian school of medicine, but they prevailed over centuries till the leading discovery of William Harvey (1578-1657) on blood circulation.