This issue of the journal opens with an original study of a team from the Medical Faculty, Skopje, FYR Macedonia. Galina Severova et al have studied the impact of de novo HLA antibodies on graft function in 50 patients with kidney transplantation, 12 months after the transplant. The authors have found that de novo donor specific and non-donor specific antibodies produce graft injuries, so the regular follow up of HLA antibodies, together with systematic protocol graft biopsy, could be essential for further therapeutic interventions. In an article titled „Protective effect of probiotics on the healing of colon anastomosis after ischemia and reperfusion injury in rats“, Necdet Özçay et al (TRN Cyprus) investigated the effect of probiotics on the intestinal anastomosis healing process in rats. They concluded that probiotics have some beneficial effect to impaired anastomotic healing process, without any side effects on the colon, therefore they might be considered as a supportive treatment in patients with intestinal transplantation. Dan N. Paduraru et al, from the University of Medicine and Pharmacy „Carol Davila“, Romania, analyzed the physiological, psychological and oncological impact of surgical intervention in patients diagnosed with rectal cancer. The study took place in the University Emergency Hospital of Bucharest and included 92 patients. In these patients, the distance from the anastomosis level to the pectinate line, side-to-end anastomosis, the impossibility to identify the nerves, and the occurrence of anastomotic fistula have been identified as predictor factors for the occurrence of major low anterior resection syndrome during post-surgery evolution. Obstructive sleep apnea syndrome (OSAS) is a disease with increasing prevalence nowadays, being associated with multiple cardiovascular diseases, such as arterial hypertension. The study of Giorgiana Dediu et al (Romania) investigated the effect of continuous positive airway pressure (CPAP) on blood pressure values, in 52 patients with OSAS. The systolic blood pressure values decreased at 6 months in all OSAS patients who have used CPAP, including patients with normal values of blood pressure. The authors concluded that OSAS treatment can decrease the blood pressure values. A higher RDW may be considered a negative prognosis factor for these patients, reflecting the role of systemic inflammation in the appearance of cardiovascular disorders. In a mini-review titled „Balance disorders and diabetes mellitus“, Daniela Cîrpaciu and coauthors (Romania) summarized literature data regarding the relation between balance disorders and diabetes mellitus. „Because of decreased proprioception and vision, diabetic patients suffer more often from balance disorders than the rest of population and are at higher risk of falling. That seems to be the consequence of a combination between impaired proprioception, vision, and possible damage produced by long term hyperglycemia in the vestibular system“ said the authors. On the other hand, the presence and severity of diabetic peripheral neuropathy correlates to increased postural instability. The management of these patients may be facilitated by the knowledge of mechanisms involved in the equilibrium disorders encountered in diabetes mellitus. The Case Reports section of the journal contains interesting, rare and challenging cases. Gelu C. Rosianu et al (Romania) present the endoscopic management of a rare case of obstructive giant duodenal Brunner’s gland hamartoma. Brunner’s gland hamartomas are rare duodenal tumors occurring in middle-aged patients that present either with gastrointestinal hemorrhage, obstructive symptoms, or as an incidental finding. Surgical or endoscopic excision is uncomplicated, and the long-term outcome is favorable. Bogdan Socea et al (Romania) describe a rare case of a 43-year-old woman with small bowel obstruction due to phytobezoar. The patient has been admitted following a car accident, but 5 days after admission she developed bowel obstruction symptoms. The exploratory laparotomy discovered a phytobezoar, confirmed by the histopathological exam. In their article, Mehmet Inan and coauthors (TRN Cyprus) tried to answer to the question „Is manubrium limited mini-sternotomy an alternative for traditional full sternotomy in cases with massive mediastinal goiter?“. They presented the case of a 45-year-old male subject who was operated for a total mediastinal goiter. The nodular mass was successfully extracted from the mediastinum easily via manubrium limited mini-sternotomy, the patient being discharged from the hospital after 2 days. Bianca Hanganu et al (Romania) make considerations on umbilical cord resistance to traction. The authors present the case of a newborn found dead in a sink and discuss the circumstances when the umbilical cord may rupture. This issue is most important when there is a need to differentiate between a true accident and an intentional newborn homicide by the mother, set forth as an accident. We hope that the readers of this issue of the Archives of the Balkan Medical Union will find it of interest. I hope that the New Year 2018 will bring to all the members of the Balkan Medical Union everything that they have wished for! May this wonderful time of Christmas and New Year fill your life with happiness and wealth! Merry Christmas and a Happy New Year!

Introduction: Multiple sclerosis (MS) is a progressive demyelinating and degenerative neurological disease. The degree of disability increases along with pathological damage, especially in cases with comorbidity. Methodology: The objective of this study was to analyze the influence of MS alone and with comorbidity on some neuropsychological patterns. Individual quality of life of 80 MS patients at a mean age of 49 years, 56 females and 24 males, was examined by means of Multiple Sclerosis Quality of Life-54 Questionnaire (MSQOL-54) in 2002-2015. Forty patients presented with MS alone and 40 with MS and comorbidity. The frequency of troubles of mental concentration/thinking, fixation of attention, and memory as well as of difficulty at work and other activities were examined. Results: Statistically significant differences were observed between patients with MS alone and those with MS and comorbidity concerning troubles of mental concentration/thinking (t=4.822; p<0.0001), and of memory (t=4.020; p<0.0001). Gender correlated negatively with troubles of memory (R=-0.343; r<0.05), while EDSS scores did with troubles of memory (R=-0.346; p<0.05) and with troubles of attention (R=-0.330; p<0.05). The accompanying diseases additionally worsened the components of health-related quality of life. Conclusions: Common comorbidity in MS patients requires careful clinical examinations and proper management in order to reduce the neuropsychological burden and assure a better individual quality of life for the patient.

ntroduction. Osteoporosis is a disease characterized by decreased bone density and destruction of the microarchitectonics of the bone structure. This leads to increased bone fragility and risk of fracture particularly of the hip, spine, wrist and shoulder. Osteoporosis is known as „The Silent Epidemic of the Century“ because bone loss occurs without symptoms. Altered ovarian function is one of the most common causes of osteoporosis. Indicators for altered bone homeostasis are the changes in serum levels of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). Objective. The aim of current study was to determine the activity of alkaline phosphatase (ALP) and serum concentrations of MMP-9, MMP-13 and TIMP-1 in the ovariectomized rats. Materials and Methods. An experiment was performed on 35 female Wistar rats at reproductive age – 2 months divided into 2 groups: group 1 (G1)-20 animals were sham-operated (sham) and group 2 (G2)-15 were ovariectomized (ovx). Results. The concentrations of ALP, MMP-9, MMP-13 and TIMP-1 in G2 were significantly increased compared to G1 (p<0.05). Conclusion. Our study confirmed that the serum activity of ALP, which is a marker of bone formation, was elevated in rats with OVX-induced osteoporosis. Although the level of TIMP-1 is increased, the level of MMP 9 in G2 is also increased, that confirms the thesis that MMP-9 may be a marker for osteoclast activity.

Objectives: To analyze the inf luence of the CTLA-4(+49G/A)rs231775 gene polymorphism on the degree of thyroid gland enlargement in patients operated for nodular goiter secondary to autoimmune thyroiditis (NGAIT) and thyroid adenomas (TA). Also, to analyze the clinical course of the disease, depending on the genotype of this gene. Methods: The CTLA-4 (rs231775) genes’ polymorphism was studied by Real-Time Polymerase Chain Reaction in 95 patients with NGAIT, 30 patients with TA and 25 healthy individuals. Results: It has been found that, in patients with nodular goiter secondary to autoimmune thyroiditis, hyperplasia of the thyroid gland is associated with the wild A allele of the CTLA-4 gene (AA- and AG-genotypes): IB and III levels of hyperplasia are more likely to occur in carriers of the AA genotype by 30.13% and 26.35%, and the second degree of the thyroid gland enlargement- in patients with the AG-genotype by 33.52% and 34.04%, respectively. Conclusions: The incidence of hypertrophic form of autoimmune thyroiditis is associated with AA- and AG-genotypes of the CTLA-4 gene, characterized by a particular severity, with the rapid development of an “aggressive“ proliferative process in the thyroid tissue, according to sonographic findings. The carrier of the GG genotype is associated with atrophic origin of autoimmune thyroiditis; the tissue is characterized by a high content of cells in which there are atypical or follicular changes of an unclear genesis.

Background. Kidney transplantation (TR) is the best treatment of chronic kidney disease. Chronic cellular and humoral rejections have still major impact on graft survival. Single antigen bead technology enabled detection of donor specific (DSA) and non-donor specific (Non-DSA) anti HLA antibodies (HLA-Ab). Our study investigates the impact of de novo HLA-Ab on graft function (GF) 12 months after TR. Material and methods. Fifty pts with living (42) and deceased donor (8) transplantation were included in a 12-month prospective study. HLA-Ab were analyzed using LABScreen mixed kit in the 1st and 12th month after TR. According to the presence of HLA-Ab, pts were divided in group 1 (HLA+) and group 2 (HLA –). Both groups did not differ regarding gender, age, living or deceased donor, immunosuppression, underlying renal disease, rejection episodes, HLA mismatch, cold and warm ischemia time. Serum creatinine (SCr), GFR (Cockroft Gault) and proteinuria (Pr) were analyzed 1st and 12th month after TR. Results. HLA-Ab were detected in 17 pts (34%), 5 with DSA (10%) and 12 with Non-DSA (24%). Group 1 has a significant worsening of GFR (SCr increased from 112.1 to 141.5 ( p<0.002) compared with the group 2 where SCr decreased from 116.4 to 111.31 µol/L.( p<0.23). In the same time GFR decreased from 69.7 to 57.09 and increased from 67.8 to 69.3 while Pr increased from 0.42 to 0.58 ( p< 0.26) and decreased from 0.81 to 0.32 ( p<0.051) in the groups 1 and 2, respectively. Conclusion. De novo DSA and Non-DSA produce graft injuries in the first 12 months after TR. Regular follow- up of HLA-Ab together with systematic protocol graft biopsy could be essential for further therapeutic interventions.

Introduction. Osteoporosis is a disease characterized by decreased bone density and destruction of the microarchitectonics of the bone structure. This leads to increased bone fragility and risk of fracture particularly of the hip, spine, wrist and shoulder. Osteoporosis is known as „The Silent Epidemic of the Century“ because bone loss occurs without symptoms. Altered ovarian function is one of the most common causes of osteoporosis. Indicators for altered bone homeostasis are the changes in serum levels of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). Objective. The aim of current study was to determine the activity of alkaline phosphatase (ALP) and serum concentrations of MMP-9, MMP-13 and TIMP-1 in the ovariectomized rats. Materials and Methods. An experiment was performed on 35 female Wistar rats at reproductive age – 2 months divided into 2 groups: group 1 (G1)-20 animals were sham-operated (sham) and group 2 (G2)-15 were ovariectomized (ovx). Results. The concentrations of ALP, MMP-9, MMP-13 and TIMP-1 in G2 were significantly increased compared to G1 (p<0.05). Conclusion. Our study confirmed that the serum activity of ALP, which is a marker of bone formation, was elevated in rats with OVX-induced osteoporosis. Although the level of TIMP-1 is increased, the level of MMP 9 in G2 is also increased, that confirms the thesis that MMP-9 may be a marker for osteoclast activity.

ABSTRACT The objective of the study was to analyze the technology of electrophysiological identification of laryngeal nerves in goîter surgeries. Methods: The technology of electrophysiological identification of laryngeal nerves in goiter surgeries was developed. It is based on the recording of changes in the sound vibrations generated by the passage of air through the voice gap, the area of which changes in the event of a change in the tension of vocal cords from electrostimulation of the laryngeal nerves. The greatest changes in the frequency and amplitude of sound vibrations occur when electrostimulation of tissues near the nerve and the nerve itself. This phenomenon allows to determine the location of the nerve and prevent its injury. Results: The method was tested in 173 patients who had been operated for goiter. There were no cases of temporary or permanent disorders of phonation. Conclusions: The developed technology of electrophysiological identification of laryngeal nerves in goiter surgeries is reliable, easy to apply, and is not expensive. The influence of other factors on its results was not noted.

Introduction: Intestinal transplantation (IT) is one of the important cause of intestinal ischemia and reperfusion injury. It is well known that anastomotic problems seen after IT are mainly related to reperfusion injury. Probiotics are non-pathogenic live microorganisms that are used for various bowel diseases due to their beneficial effects on bowel functions. Wound healing is an important bowel function and impaired healing is a series trouble after IT and ischemic bowel. In this study, we aimed to investigate the effect of probiotics on the intestinal anastomosis healing process. Methods: Forty male SD rats were divided into four groups: Group I(n:10) colonic anastomosis only; Group II (n:10) colonic anastomosis after IR injury; Group III (n:10) probiotic and colonic anastomosis; Group IV (n:10) probiotic and colonic anastomosis after IR injury. Probiotics are given 250 million/day, po. The left colon was cut and anastomotised with continuous 6/0 nylon suture after 60 minutes of reperfusion. Animals were monitored for 7 days, then sacrificed. Macroscopic findings, anastomotic bursting pressures and histopathologic findings were evaluated. Results: Probiotics were well tolerated in the treatment groups (Groups III and IV). Macroscopically, there were no anastomotic leaks or abscess formation in either of the probiotic groups (Groups III and IV). Anastomotic bursting pressures of probiotics groups tended to be highly compared with the ischemic control group (Group II), although the difference was not statistically significant. The histologic scores of probiotic groups were very similar to the control groups. Conclusion: The probiotic groups had less adhesions according to the macroscopic findings; anastomotic bursting pressures tended to be high and histologically, they had equivalent healing scores compared with the control groups. We conclude that probiotics have some beneficial effect to impaired anastomotic healing processes , without any side effects on the colon in the colon. Therefore they might be considered as a supportive treatment in IT patients.

ABSTRACT The objective of the study Rectal cancer represents a public health issue, considering the increased incidence among the general population in Romania. At present, the ideal management of patients diagnosed with rectal neoplasms, leading to oncological healing while preserving all physiological functions, includes the low anterior resection of the rectum (LARS) with the partial or total excision of the mesorectum. The aim of the paper is to analyze the physiological, psychological and oncological impact of surgical intervention on patients diagnosed with rectal cancer. Material and methods Our study was retrospective, observative, descriptive, unicentric, and took place in the General Surgery and Emergency Clinic IIIrd of the Bucharest University Emergency Hospital, Romania, during 1 January, 2005 –31 December, 2016. The study included a total of 92 patients. Results The values of LARS score ranged from 0-42. The mean LARS scores in the study group were 12.46 with a median of 7 and a 13.06 standard deviation. Conclusions The distance from the anastomosis level to the pectinate line, side-to-end anastomosis, the imposibility to identify the nerves, the occurrence of anastomotic fistula are predictive factors for the occurrence of major LARS during post-surgery evolution.

Introduction. Obstructive sleep apnea syndrome (OSAS) is a disease with increasing prevalence nowadays, being associated with multiple cardiovascular diseases, such as arterial hypertension. The objective of the study was to evaluate the effect of continuous positive airway pressure (CPAP) on blood pressure values. Materials and methods. We performed a prospective interventional study on 52 patients with obstructive sleep apnea syndrome. The patients were divided into 2 groups: Group A (who received both pharmacological and CPAP treatment) and Group B (who received only pharmacological treatment), and were followed up at 3 and 6 months. The statistical analysis was made with SPSS and Microsoft Excel. At the same time, using the surrogate marker –RDW, we tried to evaluate the persistence of systemic inflammation, knowing that OSAS is associated with inflammation. Results. The systolic blood pressure values decreased at 6 months in all OSAS patients who have used CPAP, including patients with normal values of blood pressure. At the same time, the lack of OSAS treatment led to increased values of blood pressure by approximately 10 mmHg. We noticed a link between RDW, age and blood pressure values, respectively the increase of RDW and age may result in increasing of blood pressure. Conclusions. The OSAS treatment can decrease the blood pressure values. A higher RDW may be considered a negative prognosis factor for these patients, reflecting the role of systemic inflammation in the appearance of cardiovascular disorders.

ABSTRACT Introduction. Osteoarthritis (OA) is a multifactorial disorder in which ageing, genetic, hormonal and mechanical factors are major contributors to its onset and progression. Objectives. To evaluate the genotypes frequencies of Matrilin-3 (MATN3, rs77245812) and Interleukin-10 (IL-10, rs1800872) genes polymorphism in OA patients combined with arterial hypertension (AH), abdominal obesity (AO) and type 2 diabetes mellitus (DM2). Methods. The polymorphic variants of genes MATN3 (C908T) and IL-10 (C-592A) were analyzed by PCR in 74 OA patients with AO, AH, DM2 and 25 healthy individuals. Results. Distribution of MATN3 gene polymorphic variants in observed groups was as follows: CC-genotype – in 94.59% OA patients, and in 96.0% of control (p>0.05); CC-genotype – in 5.41% and 4% respectively. The C-allele prevails over T-allele by 94.95% (p<0.001) with preservation of the population equilibrium: among the OA patients – 97.30% vs 2.70% (p<0.001), among the healthy – 98.0% vs 2.0% (p<0.001) accordingly. Distribution of IL-10 gene polymorphic variants in observed groups was as follows: CC-genotype – in 52.7% OA patients vs 68.0% in control (p>0.05); CA-genotype – in 37.84% vs 32.0% (p>0.05) respectively; CC-genotype was found in 9.46% OA patients and none of control. C-allele of IL-10 gene dominated over the A-allele: among patients – 2.52 times (p<0.001), among control group – 5.25 times (p<0.001). The wild C-allele of IL-10 gene dominated 2.96 times (p<0.001) generally in the observed population. Conclusions. Polymorphic variants of genes MATN3 and IL-10 are not additional risk factors of the OA occurrence in the observed population of Northern Bukovina.

Palliative care asserts the importance of life, considering that the human beings have the right to be cared and respected until the last moment of their lives. In oncologic patients, physical symptoms in general, and pain, in particular, are enhanced by psychological, social, cultural and spiritual issues. Along with progression of the disease, symptoms may become overwhelming and refractory to usual therapeutic approaches, despite the efforts, sometimes even aggressive, to identify a tolerable therapy which does not compromise the consciousness and relieves pain. One of the solutions may be palliative sedation, which means the voluntary administration of the opioids and non-opioids drugs in adequate doses and concentrations in order to lower the consciousness as much as necessary to ameliorate one or more symptoms which are refractory to other therapies. Palliative sedation, since the proposition of its practice in the healthcare of the terminal patient, with unbearable pain, generated numerous dilemmas and debates which are still ongoing. In this paper the authors approach the issue of the palliative sedation both from medical and ethical perspectives, highlighting the importance of placing the patient in the center of the decision-making process regarding the medical treatment and its guidance according to the risks and benefits for the patient.

The objective of this review is to summarize specialty literature data regarding the relation between balance disorders and diabetes mellitus, because balance disorders and vestibular dysfunctions are common complaints in ENT practice in Romania and these complaints seem to be more frequent in diabetic patients. We accessed electronic databases like PubMed, Scopus (Elsevier), Web of Science for research on this theme; clinical trials, specialty books and meta-analysis reports, pointing out plausible explanations for the association between balance disorders and diabetes mellitus. Because of decreased proprioception and vision, diabetic patients suffer more often from balance disorders than the rest of population and are at higher risk of falling. That seems to be the consequence of a combination between impaired proprioception, vision, and possible damage produced by long term hyperglycemia in the vestibular system according to some studies.

Endometriosis is a condition which affects women during their reproductive age. We present the case of a 42 years old Caucasian nulliparous woman accusing in the last three months a painful bulging mass in the right groin. The patient reported that the mass increases in size during prolonged standing and lifting of heavy weights. In addition, the inguinal pain was exacerbated during ovulation. The patient underwent surgery, during which wide excision of the nodule was performed. Furthermore, both direct and indirect hernia sacs were found and dissected, the content was reduced and the sacs were excised. Four months after the surgery, the patient was free of symptoms and had no signs of recurrence.

Although most mediastinal goiters (MG) are operable by a cervical approach, some cases require sternotomy. Manubrium limited mini-sternotomy (MLMS) is an alternative method for traditional full sternotomy in subjects with MG. We present the case of a 45 year-old male subject who was operated for a total MG. The nodular mass was conical in shape and extended beyond the aortic arch and tracheal bifurcation. Sternotomy was decided, because excision via cervical Kocher incision was not safe. The nodular mass was extracted from the mediastinum easily via MLMS. The postoperative period was uneventful, without any complication, and the patient was discharged from the hospital after two days. He returned to his normal life within one month. This case shows that MLMS is a convenient and easy alternative for traditional full sternotomy in subjects with MG.

Introduction Brunner’s gland hamartomas are very uncommon. They are small, benign lesions, frequently located in the bulb of duodenum. Usually found incidentally during routine esophago-gastro-duodenoscopies, these lesions are frequently asymptomatic, but some patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Surgical excision is required, especially if the lesion has large dimensions. Pathological examination is the most important in confirming the diagnosis. Case presentation We report a case of a 64-year-old female patient, who presented to the emergency room for vomiting partially digested food, without blood. Upper digestive endoscopy revealed a polypoid mass, with a 1 cm stalk, located in the duodenal bulb. The polyp was successfully endoscopically resected and the pathological diagnosis was of Brunner’s gland hamartoma. Histologically, this polyp consisted of the components of Brunner’s gland cells, as well as glandular, adipose and muscle cells. Conclusions Brunner’s gland hamartomas are rare duodenal tumors occurring in middle-aged patients that present either with gastrointestinal hemorrhage, obstructive symptoms, or as an incidental finding. Surgical or endoscopic excision is uncomplicated, and the long-term outcome is favorable. The particularity of our case is given by the fact that this lesion was very large, it caused symptoms such as vomiting and was managed solely by endoscopic resection.

ABSTRACT Phytobezoar is a rare cause of small bowel obstruction. This pathology represents 0.4%-4% of all mechanical bowel obstructions. Symptoms are similar to other small bowel obstructions. The most common localisation of the obstruction is represented by the terminal ileum. Phytobezoars are to be considered in patients who have had gastric surgery, a high fiber intake or psychiatric disorders. Also multiple sclerosis has shown to affect bowel motility, which is important to our case. Surgery is always indicated. A low fiber diet and prokinetics are indicated for the prevention of this pathology. We present the case of a 43-year-old female who was admitted to the ICU following a car accident. The patient presented bowel obstruction symptoms (nausea and vomiting, bloating, not passing gas and severe abdominal pain) the 5th day after admission and was transferred to the operating room for exploratory laparotomy. Intraoperatively, we discovered a phytobezoar which was confirmed by the histopathological exam.

ABSTRACT Neonaticide represents a particular issue both to society and forensic field, being admitted nowadays as a crime all over the world. Apart from common gross and microscopic examination of the newborn cadaver, thorough examination of the umbilical cord during autopsy proved many times its major utility in solving neonaticide cases. Although by its constituents, the umbilical cord is a quite resistant structure to bending and compression, mechanical properties vary along its surface, with gestational age or various pregnancy disorders, as well as genetic anomalies of the fetus, so that a rupture may occur. The authors present the case of a newborn found dead in a sink – about whom mother states that he accidentally fell in the feces, the moment of the birth being a surprise – and discuss on the circumstances when the umbilical cord may rupture. This issue is most important when is a need to differentiate between a true accident and an intentional newborn homicide by the mother set forth as an accident.

Cecum diverticulosis is a benign, rare and generally asymptomatic disease that can manifest with acute diverticulitis or bleeding, thus complicating the differential diagnosis of the right iliac fossa pathology. The optimal management of this disease does not have a well-established treatment plan, as it may vary in some centers from conservative treatment, consisting of only antibiotics, to segmental colectomy or even right hemicolectomy. We present the case of a 45-year-old patient, prior diagnosed with chronic pain in the right iliac fossa after appendectomy, who was diagnosed with a single cecum diverticulum.

Introduction. Studies report different incidence of acute pancreatitis (AP) during pregnancy, with a frequency rate between 1/1000 – 1/10 000 pregnancies. Case report. We present the case of a 26-year-old primipara, 35 weeks pregnant woman, who came to our hospital through transfer from a municipal hospital with the diagnosis of acute pancreatitis (AP). On admission she presented nausea, vomiting, epigastric pain and impaired general state, symptoms that started 3 days before and rapidly worsened. In the context of acute pancreatitis and uncertain fetal status, keeping in mind the possible negative outcome as a consequence of fetal and maternal complications in acute pancreatitis, we decided that the patient should undergo immediate caesarean section. Conclusions. There are no specific and well documented management protocols for acute pancreatitis in pregnancy.

Entre 6-8 octobre 2017, la Section Nationale Bulgare de l’Union Médicale Balkanique (UMB) a organisé à Sofia, en Bulgarie, „La 21-ème Session des Journées Médicales Balkaniques”, sous le patronage du Président de l’Académie des Sciences de la Bulgarie, Acad. Prof. Julian Revalski et du Recteur de l’Université de Médecine de Sofia, Prof. Dr. Victor Zlatkov. Le président du comité d’organisation a été le Prof. Dr. Latchezar Traykov, Président de la Section Nationale bulgare de l’UMB, secondé par le Prof. Dr. Valentina Petkova, secrétaire général de la section nationale bulgare de l’UMB et Prorecteur de l’Université de Médecine de Sofia. Le thème du congrès a été „Santé et Longévité des Peuples Balkaniques”. La séance officielle d’ouverture a eu lieu le 6 octobre, au siège de l’Académie des Sciences de la Bulgarie, en la présence du Président de l’Académie, du Recteur de l’Université de Médecine et Pharmacie de Sofia, des Prorecteurs de celle-ci, du Doyen de la Faculté de Pharmacie, de la direction de la Section Nationale Bulgare de l’UMB et de la direction des autres sections nationales membres, du Prof. Pierre- François Plouin (Académie Nationale de Médecine de France).

ntroduction Pancreatic cancer has the worst prognosis among gastrointestinal cancers. The high mortality is justified by the paucity of symptoms and by the lack of response to treatment. The lack of sensitive tumor markers specific to early diagnosis has a major contribution to the poor prognosis. The objective of the study was to evaluate whether tumor markers like mesothelin, circulating tumor cells, microRNA, can be used as early diagnosis and prognostic factors in pancreatic cancer. Secondary endpoints aimed to test these markers in chronic pancreatitis in order to create a panel of markers for high-risk population screening. Material and methods We measured the concentration of 3 markers (mesothelin, miR-10b and miR-155) using blood samples from the three groups: neoplasm, pancreatitis and control group (healthy) and tried to identify statistically significant correlations between them. Results Pancreatic cancer can be diagnosed using blood biomarkers such as mesothelin and certain types of miR with pancreatic neoplasia and chronic pancreatitis compared to healthy patients. Mesothelin could be used for differentiation between neoplasm patients and chronic pancreatitis (p=0.05). There was a direct correlation between tumor size and miR-10b (p=0.05), but none between mesothelin and miR-10b (p=0.53). Conclusions A better understanding of the principles and complex mechanisms of genes expression associated to miRNA may lead to new therapy and diagnosis opportunities for the pancreatic cancer and may become the premises of a screening strategy for the patient with high risk of developing pancreatic cancer.

Illicit drugs use is a real public health issue, especially among young people. The totality of the drugs harmful effects on the body is difficult to quantify, especially because of poor epidemiological data and ethical concerns about the inclusion of consumers in clinical trials. However, health professionals need to be alert to identify, report and fight drug-related pathology. This article aims to draw attention to the lung pathology induced by the consumption of some of the most commonly used illicit drugs: cocaine, heroin and cannabis.

Introduction. Systemic lupus erythematosus (SLE) is an autoimmune disease that affects various organs and systems. These patients develop disability in various stages of disease progression, which has a significant impact on individuals and society. The objectives of the study were to assess work disability in patients with SLE. Methods. We carried out a cross-sectional study including SLE patients (according to the Systemic Lupus International Collaborating Clinics – SLICC – classification criteria, 2012). The disability status was studied using American and Moldavian disability criteria. Validated questionnaires were applied: absenteeism and presenteeism at work, socio-economic status was calculated according to the Kuppuswamy scale and the quality of life using SF-8. Results. The study included 132 SLE patients. 20 patients (15.1%) with early disease (<24 months) had disability and the frequency of disability increased over the course of the disease. The duration of the disease, the activity and the PGA correlated significantly with the disability. Predictors of early disability in SLE group were high disease activity, poor education, exhausting physical work and residents of the rural area. Conclusions. Patients with SLE have disability in 81 (61.3%) cases. According to the criteria in list 14.02, it was found that 97 (73.4%) vs. 81 (61.3%) of the patients included in the study complied with the American and Moldavian disability criteria.

Background. As a result of the histological examination of the removed thyroid tissue, autoimmune thyroiditis has been diagnosed in 10.4% of patients. During the surgical treatment and while choosing the surgery volume, the pathogenetic mechanisms of the onset and progression of autoimmune processes in the thyroid tissue are not taken into account. Materials and methods. The immunohistochemical study was carried out using monoclonal antibodies against Ki67, Fas, FasL, Bcl-2, and P53 anti-genes on a puncture material of the thyroid glands obtained from 80 patients with a histologically verified diagnosis of nodular goiter combined with autoimmune thyroiditis. Results. The results of the study showed high proliferative activity of the lymphoid tissue, moderate proliferative activity of thyrocytes in the area of lymphoid infiltration which was low outside of it and which was taken into account when determining the volume of surgical intervention. Conclusions. The results of the study have shown that thyroidectomy is a pathogenetically grounded operation in the case of unilateral nodular goiter combined with autoimmune thyroiditis with pronounced proliferative activity of the thyroid tissue in contralateral lobe.

Background. Analysis of the results of clinical application of the developed method of laryngeal nerves electrophysiological identification. Material and methods. Electrophysiological identification of the recurrent and superior laryngeal nerves was performed intraoperatively in 200 patients operated on goiter. A total of 354 studies of laryngeal nerves were conducted to identify them. Among them, there were 45 unilateral researches and 308 bilateral. Results. In the first region, nerves were identified in 327 cases and unidentified – in 27 cases. In the second region, among the tissues of the surgical wound, nerves were identified in 337 studies and unidentified – in 17. Regarding unidentified nerves in 3 patients on both sides, there were two cases of thyroid cancer and one – multinodular recurrent goiter. In the third section among 354 patients, the external branch of the superior laryngeal nerve was identified in 329 (92.9 %) and unidentified in 25. Unidentified nerves are those cases where the nerves are not electrophysiologically isolated among the tissues of the surgical wound, but clearly defined their places of passing. There were no intraoperative injuries of the laryngeal nerves. Conclusions. The technology of intraoperative identification of the laryngeal nerves can identify both the recurrent and superior nerves of the larynx, or determine the probable areas of its passage and prevent their injuries during the surgery.

Introduction. Currently, numerous investigations have been conducted to study the role of various genes in the development of arterial hypertension, but still they do not contain data concerning patients with comorbid pathology. Objectives. To investigate the effect of Pro12Ala polymorphism of the PPAR?2 gene on metabolism rates in patients with essential arterial hypertension accompanied by stable ischemic heart disease and type 2 diabetes mellitus. Methods. Indices of carbohydrate, lipid metabolism and oxidative-antioxidant protective activity in blood were studied in 50 patients with essential arterial hypertension accompanied by stable coronary heart disease (group I) and in 62 patients with essential hypertension accompanied by stable coronary heart disease and type 2 diabetes (group II). Results. In the Ist group of patients Pro/Pro genotype (82%) predominated, and in the II-nd group of patients Pro/Pro genotype was found in 85.5%, Pro/ Ala – in 14.5% of the patients. Significant impairments (p<0.05) of carbohydrate, lipid metabolism and indices of oxidant-antioxidant homeostasis, with the exception of glutathione peroxidase and catalase in patients with Pro/Pro genotype, were detected in patients with essential hypertension accompanied by stable ischemic heart disease and type 2 diabetes with Pro/Pro and Pro/Ala genotypes of PPAR?2 gene compared to the controls. Conclusions. The most pronounced disorders of carbohydrate, lipid metabolism and oxidant-antioxidant homeostasis indices are observed in patients with essential hypertension accompanied by stable ischemic heart disease and type 2 diabetes with the Pro/Pro genotype compared with the control and Pro/Ala genotype.

ABSTRACT Introduction. Recently, decrease in male reproductive function has become particularly relevant. Nowadays, 8 to 29% of married couples are infertile throughout the world. The purpose of our study was the ascertainment of the peculiarities of development of seminal vesicles, seminal and ejaculatory ducts. Material and methods. The study was carried out on 16 series of histological sections of pre-fetuses of 10-12 weeks and 4-month fetuses. Nine waxed reconstructions of pelvic organs of pre-fetuses of 65.0 mm parietococcygeal length (PCL) and fetuses of 82.0, 85.0, 95.0 and 130.0 mm PCL were made and studied. Results. In pre-fetuses of 46.0-52.0 mm PCL, the mesonephric duct (wolffian duct) is reduced in the cranial and middle sections. The diameter of the unreduced portion of the wolffian duct at the gonad level varies from 58 to 68 µm. At the beginning of the fetal period of ontogenesis, the length of the right seminal vesicle is 1.56 ± 0.12 mm, its width is 0.54 ± 0.05 mm, its thickness is 0.46 ± 0.06 mm. The dimensions of the left seminal vesicle are accordingly: 1.39 ± 0.11, 0.61 ± 0.05 and 0.57 ± 0.06 mm. In fetus of 130.0 mm PCL, the seminal vesicles are represented by the main tubule and its branches. The length of the right seminal vesicle is 2.3 mm, and the left is 2.2 mm. The length of the cavity of the main duct of the right seminal vesicle is 4.6 mm, and 6.4 mm including the branches. The length of the cavity of the main duct of the left seminal vesicle is 4.8 mm, and 5.6 mm including the branches. Conclusions. At the end of the 10th – the beginning of the 11th week of prenatal development, intensive upgrowth of the caudal parts of the mesonephric ducts was noted, resulting in the seminal ducts, seminal vesicles and prostate excretory ducts appearance. In the fetuses of 95.0 120.0 mm of PCL, formation of an ampulla of the seminal duct was observed. At the end of the 4th month of prenatal development, the external and internal structure of the seminal vesicles and ampullae of the seminal duct becomes more complicated.

Introduction Chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) is the most common cause of hypothyroidism which may associate weight increase and changes in serum lipid levels. There is still controversy over the link between obesity and autoimmune hypothyroidism. The paper aims to assess obesity and lipid metabolism in patients with Hashimoto’s thyroiditis, and to establish a correlation between TSH (thyroid-stimulating hormone), FT4 (free thyroxine) levels, and the titer of antithyroid antibodies. Material and Methods 100 female and male patients diagnosed with Hashimoto’s thyroiditis were included. According to BMI (body mass index), the patients were divided into three subgroups: normal BMI, overweight and obese group. Results 31% of patients had normal BMI, 37% were overweight and 32% had obesity. TSH mean value was higher in the overweight (10.76 µUI/mL) and obesity groups (7.58 µUI/mL), as compared to normal BMI group (2.67 µUI/mL). Similar results were obtained for anti-TPOAb (antithyroid-peroxidase antibodies) mean value. Antithyroglobulin antibodies (anti-TgAb) had higher values in patients with normal body weight: 431.23 U/mL compared to 212.37 U/mL in overweight and 368.64 U/mL in obese patients. FT4 average value was lower in obese patients (1.15 ng/ mL compared to 1.68 ng/mL in the normal weight and 1.53 ng/mL in overweight patients. There were no statistically significant correlations between BMI and TSH (p = 0.2753), FT4 (p = 0.6156, anti-TPOAb (p = 0.3347) and anti TgAb levels (p = 0.154). The correlation between TSH and total serum cholesterol was statistically significant (p <0.05). Conclusions The presence of obesity in patients with Hashimoto’s thyroiditis is directly related to hypothyroidism associated to autoimmunity.Thyroid autoimmunity may have some effects on hyperlipidaemia and obesity, independently of thyroid function.

In patients with myeloproliferative neoplasms (MPNs), including essential thrombocythemia, current studies have demonstrated a JAK2V617F-dependent reactive oxygen species (ROS) elevation partially mediated by a decrease in catalase expression associated with DNA damage. Oxidative stress plays a major role in carcinogenesis as well as in genomic instability, disease progression, myelofibrotic and leukemic transformation, and possibly in the development of vascular events in patients with essential thrombocythemia. Further comprehensive studies are needed to establish the role of oxidative stress in the pathogenesis of essential thrombocythemia, disease progression, vascular complications and whether targeting ROS as a therapeutic option could prevent disease progression and the development of vascular events MPNs patients.

Oesophageal cancer is the fourth most frequent cancer of the digestive tube, following gastric, \ colon and rectal cancer. The oesophageal cervical cancer has a growing incidence, and in 3-5% of cases it is associated with another cancer which is part of Ears-Nose-Throat (ENT) medicine. Generally, oesophageal cancer has a reserved prognosis. The cancer of the superior part of the oesophagus has a bad prognosis due to a late diagnosis. Therefore, an early, correct and complete diagnosis might improve its generally reserved prognosis.

Pregnancy rhinitis is defined as a nasal congestion in the last six or more weeks of pregnancy, without other signs of respiratory tract infection and without known allergic cause, disappearing completely within two weeks after delivery. Some authors say that there is clinical proof of a correlation between pregnancy rhinitis and preeclampsia, preeclampsia being the most frequent cause of maternal and fetal morbidity and mortality. The relationship between these two pathologies lies in snoring. Because of the pregnancy and its limitations for treatment options, most studies talk about the importance of educational measures as first choice of managing the symptoms of pregnancy rhinitis.

Cardiac hepatopathy is the term that describes liver damage due to cardiac diseases. The cardiac hepatopathy is divided into congestive hepatopathy, due to passive venohepatic congestion, and acute cardiogenic liver injury, due primarily to acute cardio-circulatory failure. Congestive hepatopathy can be determined by chronic heart failure, constrictive pericarditis, tricuspid regurgitation and right-sided heart failure. On the other hand, acute myocardial infarction, acute decompensated heart failure or myocarditis may cause acute cardiogenic liver injury. Monitoring of liver function tests, such as ?-glutamyltransferase, alkaline phosphatase and liver-derived metabolites, such as bilirubin, is an effective way to assess liver function. Also, the measurement of serum aminotransferases concentration is increasingly being studied, in order to identify the correlation between their values and the extent of the cardiac damage. Clinical examination, laboratory tests, and imaging tests are necessary for the diagnosis of cardiac cirrhosis in patients with heart failure. Patients with cardiac cirrhosis may be asymptomatic, but present abnormal liver biochemistry. Patients with congestive hepatopathy have elevated cholestasis markers, such as bilirubin, alkaline phosphatase, and ?-glutamyltransferase, while elevated levels of aminotransferases and lactate dehydrogenase are found in acute cardiogenic liver injury. There is no specific treatment for congestive hepatopathy, the treatment is that of the underlying cardiac disease. Restoration of the cardiac output and hemodynamics is the most important in the management of the acute cardiogenic liver injury.

Rheumatoid arthritis (RA) is a systemic autoimmune disorder that causes progressive, symmetric, erosive destruction of cartilage and bone, which is usually associated with autoantibodies production. It is common that articular signs and symptoms develop long before extraarticular signs, but sometimes lung involvement is the first manifestation of RA and the most aggressive feature of the disease. Respiratory symptoms can precede the articular symptoms in 10–20% of cases. However, they may be masked by the poor functional status from joint disease or chronic inflammation. The pulmonary involvement can be due to the chronic inflammation caused by the disease or it can be secondary to immune-modulating medication. The pulmonary disease due to the disease itself includes: interstitial lung diseases, airways involvement (large and small airways), pleural involvement, rheumatoid pulmonary nodules and vascular pathology. The most used medication in patients with RA, such as metotrexate, leflunomide, TNF alpha blockers, but also other used drugs, may cause pulmonary diseases.

Echoendoscopy, endoscopic ultrasound or endosonography is an examination that combines endoscopic and ultrasound images in order to evaluate the lesions found not only in the gastrointestinal tract wall but also around it. This investigation also allows staging patients with gastrointestinal cancer, tumors of the pancreas and lung. Therefore, the indications for endoscopic ultrasound are very broad (some more supported by the literature than others) and their utilities are multiple. The current trend is to move from diagnostic echoendoscopy to a therapeutic one, since it is being used for multiple purposes, such as guiding minimally invasive surgical procedures. A concise review of the literature was made to summarize the applications of endoscopic ultrasound, in order to familiarize gastroenterologists with their indications and possible therapeutic applications. Endoscopic ultrasound (EUS), also known as endosonography (ES) and endoscopic ultrasound (UE), is an examination that combines the endoscopic image with the ultrasound image to evaluate lesions located in and around the wall of the gastrointestinal tract. Although it was described more than 20 years ago, its indications, both diagnostic and therapeutic, remain unknown by the majority of medical specialists or general practitioners. Every day more and more publications about EUS are published, describing new indications of this interesting examination and ratifying those previously described, making it an indispensable tool within a gastroenterology service.

The posterior compartment of the vagina comprises the zone from the cervix until to the perineal body where different key structures, which contain connective tissue, can be deteriorated as a result of a trauma (e. g complicated vaginal birth), previous hysterectomy or an increased body mass index. These structures include the uterosacral and cardinal ligaments, the rectovaginal fascia (RVF) and the perineal body (PB), all of them playing also an important role in the pathophysiology of other vaginal wall disorders (anterior and/or median vaginal defects). However, the grade of connective tissue disruption seems not to be correlated with the severity of the dysfunction. A posterior vaginal defect exteriorizes itself in the form of a rectocele, enterocele or sigmoidocele and it generally requires surgical repair when symptomatic with impact on the patient’s daily activities. The role of this review is to make a review of the literature regarding the possible transvaginal approaches to the posterior compartment defects, and namely the posterior colporrhaphy and repair of the RVF with or without grafts, focusing on the technique, success and recurrence rates of the different methods as well as the reasons to choose between different therapeutic options.

Nowadays, the surgical success rate for stress urinary incontinence (SUI) is approximately 90 % the mid-urethral synthetic slings being currently the most effective surgical options in women with SUI. The initial treatment should consist of conservatory measures such as pelvic floor exercises, hormonal medication or vaginal pessary, the failure or refusal of these methods will then guide the surgeon towards a surgical decision with the use of a mid-urethral sling either of retropubic or transobturator type. The choice between the two slings should be done after a complete evaluation of the urinary function taking into consideration the coexistence of a mixed incontinence, a dysfunction of the intrinsic sphincter, a rigid urethra but also the age and the weight of the patient as well as the possible previous surgical interventions for SUI. The advantages of each type of mid urethral sling and their associated complications should be preoperatively explained to the patient, the decision to opt for one or another sling depending also on the professional experience of the surgeon. The aim of this review is to present the advantages and the disadvantages of two types of mid-urethral slings – the retropubic and the transobturator sling- as well as the possible intra-and postoperative complications and their management.

Acromegaly is a complex disorder caused by growth hormone excess mostly due to a pituitary adenoma. Surgery represents the first option but rate of long time success is almost 50% thus the patients need other therapies. Apart from radiation, medical therapy panel includes previously used long-acting formulas of first-generation somatostatin analogues like ocreotide or lanreotide and, moreover, pasireotide LAR which is a recently introduced second-generation analogue. Non responders to prior medication, proved a good response to this as pointed by C2305 extension trial or PAOLA study. The rate of overresponse to pasireotide may be explained by a different receptor target: mostly on somatostatin receptor type 5 opposite to type 2 as it acts first-generation compounds. The tolerance of pasireotide LAR is good; the safety profile includes the awareness of hyperglycaemia risk. The cross-road that follows the lack of acromegaly control after a patient was treated with somatostatin analogue of first generation is currently more complex since pasireotide LAR became a feasible option.

In our article we present the anatomical work of the distinguished Renaissance anatomist Realdo Colombo, as well as, his contribution to the discovery of pulmonary circulation. Colombo was not the first to describe the pulmonary circulation, but he backed up this hypothesis with evidence after extensive dissection and vivisection. He paved the way for his successors and particularly William Harvey (1578-1657) to the establishment of anatomy and physiology of blood circulation.

Breast cancer is the most frequent type of malignancy among female patients, while spine metastases represent the most frequent anatomic area for both-bone metastases and relapse lesions. The application of a fentanyl transdermal patch presents a significant variant for pain palliation. Although a complete remission of pain after a single application is rather rare, we present a female patient who reported it. GBPI, HADS and ECOG evaluation scales showed significant improvement. Practitioners who deal with oncology and palliative medicine should have a good working knowledge of this opioid.

Colonic intussusception in adults is extremely rare, accounting for about 5% of all cases of intussusception. The telescoping of a proximal segment in the lumen of the adjacent segment has a classic classical triad in the symptomatology of children: abdominal pain, bloody diarrhea and palpable abdominal mass. In the adult patient, the symptoms are almost absent, and rarely they consist of constipation, bloody stool, or a malignant pathology that accompanies intussusception, weight loss, and anemia. We present the case of a 86-year-old patient who underwent a surgical procedure for repairing a rectal prolapse; intraoperatively, we discovered a sigmoid intussusception for which we performed a segmentary sigmoidectomy, repairing the rectal prolapse by rectosacropexy with alloplastic mesh.

Spontaneous coronary artery dissection is a rare diagnosis in a postmenopausal woman. We report a case of a 55-year-old postmenopausal woman, who presented with acute myocardial infarction due to spontaneous long dissection of left anterior descending coronary artery, complicated with repetitive ventricular tachycardia, rapid formation of left ventricular aneurysm with thrombus, pulmonary edema and cardiogenic shock, with subsequent improvement after successful angioplasty and intensive care. We also present a short review of the literature.

Cushing’s disease is a rare pathology characterized by excess production of adrenocorticotropic hormone (ACTH) secondary to a pituitary adenoma which stimulates adrenal cortisol secretion. The main consequences are the metabolic and cardiovascular complications, as well as osteoporosis and infection predisposition, which increase mortality in untreated patients. The first case presentation is about a patient with Cushing’s disease, surgically treated and cured, without any need for substitution or signs of pituitary-adrenal axis failure. The second case is a patient diagnosed with Cushing’s disease, with multiple complications, with clinical and hormonal relapse after selective adenomectomy and resistant to medical therapy, who is scheduled for reintervention. The third presentation is about a patient known with osteoporosis, diagnosed with Cushing’s disease based on the clinical appearance with bilateral adrenal adenomas, with left suprarenalectomy and pituitary gamma knife radiotherapy. We aim to introduce a pictorial assay consisting of a series of three cases, different from detection, management and outcome.

Introduction. Esophageal dysphagia can be caused by functional or structural abnormalities of the esophagus like esophageal strictures due to acid reflux disease, eosinophilic esophagitis, tumors and extrinsic compression, or by neuromuscular disorders like achalasia and diffuse spasm. The true prevalence of esophageal dysphagia is unknown, although epidemiological studies estimate a prevalence rate of 16% to 22% among individuals over 50 years of age. Case presentation. We present the case of a 55-year-old man, admitted to our hospital with progressive dysphagia for solids and important weight loss over the last two months. The upper endoscopy revealed an extrinsic compression of the middle esophagus. At this point, a thorax and abdomen computed tomography scan was performed, that showed a retrohilar mass of 58/44/38 mm, which compressed the right inferior lobar bronchus at the origin and the thoracic esophagus in the middle part. Endoscopic ultrasound and fine needle aspiration were performed. The anatomopathological examination of the biopsy reveals elements of chronic inflammation with neutrophils and lymphocytes, and granulomas with areas of necrosis, highly suggestive for tuberculosis. Conclusions. Dysphagia is a rare manifestation of tuberculosis, most commonly caused by an extrinsic compression mechanism due to mediastinal adenopathies. The particularity of this case is related to the contradicting imaging studies, that suggested either an esophageal or a pulmonary tumor, with mediastinal adenopathies, and the importance of endoscopic ultrasound with fine needle aspiration in determining the benign or malignant nature of injuries that are hardly accessible to non-invasive diagnostic methods.

The Spieghelian hernia or ventro-lateral hernia is produced through the effect of rupture of the abdominal wall fibers, near the semi lunar line. The hernia sac is usually accompanied by extra peritoneal fatty tissue and is intra parietal, it passes through the aponeurosis of the transverse muscle and internal oblique muscle, and it grows under the aponeurosis of the external oblique muscle. The Spiegel hernia is rare and is difficult to diagnose clinically. In this article we present the case of a 43-year-old patient who presented at the emergency department for a pseudo-tumor mass in the left flank and was diagnosed with Spiegel hernia.

Introduction. Duodenal duplication cyst (DDC) is a rare congenital malformation that appears in the embryonic development of the digestive tract. It is a benign condition usually diagnosed in infancy and early childhood, being a rare and difficult diagnosis in adult population. DDC is a recognized cause of duodenal obstruction, acute pancreatitis, obstructive jaundice and even digestive hemorrhage. Case presentation. We report the case of a young adult male with abdominal pain history, who presents with recurrent episodes of acute severe necrotic pancreatitis. The abdominal computed tomography scan revealed a Balthazar C necrotic pancreatitis with partial thrombosis of the splenic vein and a cystic mass in the second part of the duodenum. The endoscopic ultrasonography (EUS) established that the duodenal cystic lesion came from the second layer, meaning the submucosa. We performed endoscopic cystotomy with complete evacuation of the fluid content into the duodenum, with favorable clinical outcome. Conclusions. The particularity of the case is represented by the low incidence of this pathology and the rare form of presentation, meaning acute pancreatitis probably from pancreatic ductular hypertension caused by the DDC.

Profunda brachii artery (PBA), known also as the deep artery of the arm, constitutes the largest branch of the brachial artery (BA). Its anatomical variations are due to abnormalities during embryologic development and considered among anatomists as a rare finding, especially if they are found bilaterally. We present a case of a bilateral origin of the profunda brachii from the posterior circumflex humeral artery (PCHA). Awareness towards variations in the vascular branching pattern of the upper limbs is considered essential for plastic, vascular and general surgery and radiology as well.

ABSTRACT Background. The purpose of modern dental medicine is to restore the patient’s dental system in order to strengthen health, from a functional, comforting and aesthetic point of view. Methods. The study group consisted of 30 patients to whom we inserted dental implants, which were then rehabilitated by overloading, as follows: 18 patients with fixed metal-ceramic prosthetic (12 women, 6 men) and 12 patients with zirconium-ceramic (5 women, 7 men). Interleukin 1 beta (IL1-?) was quantified in all patients after implant insertion at 7, 30 and 90 days, and after overloading at 0, 30 and 90 days. Results. The IL1-? values correlate with the depth of the peri-implant pocket at all three moments of implant insertion (r>0.600), with a high statistical significance between the 30- and 90-day determinations (p<0.001). After overloading, it was demonstrated that there is a correlation between IL1-? values and the depth of the peri-implant pocket at all times of evaluation (metal-ceramic: r between 0.774-0.871, zirconium ceramic: r between 0.679-0.895). Conclusion. The existence of high correlations between peri-implant pocket depth and IL1-? supports the utility of IL1-? quantification as a parameter for monitoring patients after insertion of dental implants. For both types of dental materials, the value of IL1-? is the expression of gingival tissue remodeling after fixed denture prosthesis. Values of IL1-? quantified in the peri-implant fluid show the superiority of the zirconium-ceramic material compared to the metal-ceramic material.

ABSTRACT Introduction. Both calcium and iron significantly affect the level of free radical processes. The aim of the study was to determine the levels of protein oxidative modification in fibrinoid of placenta of different localization areas, depending on the variants of calcium deposits, based on histochemical methods of bromophenol blue staining of proteins into „acidic“ and „basic“ by Mikel Calvo with quantitative assessment of results by means of computed microspectrophotometry. Materials and methods. 164 cases of placental calcification, including 84 cases of iron deficiency anemia in pregnancy (IDAP) and 80 cases of pregnancy without anemia, were studied. Histochemical method of bromophenol blue into „acidic“ and „basic“ proteins by Mikel Calvo with the quantitative assessment of the staining results was performed by use of computed microspectrophotometry on the digital copy of the image with the fibrinoid areas in the computed program „ImageJ“. Results. The differences between the average indicator R/B, which is the measure of protein oxidative modification, were discovered both in fibrinoid as a part of the chorionic tree and in the basal plate of the placenta in particular types of calcium deposits. Conclusion. According to the histochemical study, pregnancies with iron deficiency anemia were characterized by fibrinoid with deposits of calcium type II and type IV (fine-granular deposits) both in chorial tree and in the basal plate of the placenta, where the protein oxidative modification processes increase compared to those without anemia.

Chronic heart failure continues to represent a major problem for the healthcare systems worldwide, because of high prevalence and impact on patients’ quality of life. Between May 25-28, 2018, in Vienna, Austria, took place the European Congress of Heart Failure and the World Congress on Acute Heart Failure, organized by the European Society of Cardiology. The congress was a forum of exchanging expertise in diagnosis and treatment of heart failure, and also an opportunity to present the latest progresses regarding the management of this pathology. It seems that an integrated, multidisciplinary team approach is the future for heart failure management. This team should include internists, cardiologists, general practitioners, and nurses. The new President of the Heart Failure Association of the European Society of Cardiology is from a Balkan country, Prof. Petar M. Seferovic, from the Belgrade University Medical Center, Serbia. In one of his presentations, Prof. Seferovic highlighted that the treatment of chronic heart failure should explore new frontiers. Recently, there is much interest in established antidiabetic drugs to treat cardiovascular complications of diabetes. Introduction of sodium-glucose transport protein 2 (SGLT2) inhibitors in the late 1990s was a major breakthrough in the treatment of diabetes complications. These drugs are the only antidiabetic drugs with good results in the treatment of cardiovascular diseases, demonstrated by several large randomized controlled trials, such as EMPA-REG (the first study to demonstrate a significant reduction in both cardiovascular mortality and heart failure-related hospitalization in patients treated with empaglifozin, a SGLT2 inhibitor). SGLT2 inhibitors are now recommended by some guidelines for the prevention of heart failure and associated mortality in patients with type 2 diabetes. The international registry REPORT HF, presented in Vienna, enrolled more than 18,000 patients from 44 countries across North America (NA), Central and South America (CSA), Western (WE) and Eastern Europe (EE), the Eastern Mediterranean and Africa (EMA), South East Asia (SEA) and the Western Pacific (WP), under the study co-chairs, Prof. Gerasimos Filippatos (Greece) and Prof. Mihai Gheorghiade (USA). Inter-regional differences in the hospital entry point, comorbidities and precipitants have been observed. Ischemia was a common precipitant in SEA, WP and EMA, whereas non-adherence to diet and medication was more common in NA. There have been also observed differences regarding the treatment, especially in time to initial intravenous therapy. Patients in NA have significantly longer time to first therapy, compared with other regions; this may impact the symptoms, because the sooner the IV therapies are delivered, the sooner symptoms will improve. There are differences regarding the implementation of international heart failure guidelines, which may influence the patients’ outcomes. Researchers from the Institute of Molecular Biotechnology at the Vienna BioCenter have studied the first systems for heart regeneration following complex heart attacks in mammals. In vivo neonatal models showed that, after a heart attack, mice underwent total repair of cardiac injury. This type of repair had been encountered previously in fish, but not in mammals. The researchers set up now genetic systems to identify the molecular signals that mediate this regeneration of the heart. Biotechnologies may become the future of the heart failure treatment.

ABSTRACT Purpose. This study aimed to quantify the deviation of an arterial pulse (pressure wave) from the „golden“ or „divine“ pulse, defined according to the golden ratio f (phi), and to investigate whether the extent of this deviation is related to the function of autonomic nervous system (ANS) as assessed by 24-hr heart rate variability (HRV). Methods. Seventy-two healthy subjects underwent 24-hr continuous monitoring of ECG. Applanation tonometry of the radial artery and pulse wave analysis of peripheral and central (mathematically derived) aortic pressure waveforms were performed in all subjects. Time- and frequency domain indices of HRV were computed together with nonlinear dynamic parameters. Two novel indices were computed primarily based on pressure (systolic and diastolic pressure; mmHg) and time (ejection and diastolic durations-intervals; msec) values extracted from the recorded pressure waves. Results. The new phenotypic, geometrical biomarkers based on the golden ratio (f) were associated with HRV indices and especially with those computed at the frequency domain. These associations were independent from age, gender, body mass index, mean arterial pressure, pulse pressure and mean 24-hr heart rate. Conclusion. The new proposed geometrical analysis of the arterial pulse reflects/characterizes specific 24-hr HRV features and is independently related with ANS function. Although the potential pathophysiological, underlying mechanisms of this association can be hardly explained by this study, the application of the golden ratio f for the analysis of the arterial pulse merits further investigation and may open a new window for the evaluation of cardiovascular risk. Keywords: arterial pressure, pulse wave analysis, brachial artery, hemodynamics, aorta, blood pressure.

ABSTRACT Introduction. The patients with cardiometabolic/ cardiovascular risk are commonly found in clinics and ambulatory clinics. The cardiovascular (CV) or cardiometabolic (CM) risk factors and biomarkers are certain characteristics of the person without CV disease, which are independently correlated with the subsequent occurrence of CV disease, without necessarily having a causal relationship between factor and disease. The visceral adiposity index (VAI) indicates the function of visceral adipose tissue and its growth is independently correlated with cardiovascular and cerebrovascular risk. The objective of the study was to evaluate the lifestyle and visceral adiposity index as possible cardiometabolic risk factors in patients with diabetes, prediabetes, and in the general population. Methods. The study was epidemiological, transversal, noninterventional, and was performed by analyzing 300 subjects, divided into three groups: group 1 (100 patients with type 2 diabetes), group 2 (100 pre-diabetic patients), and group 3 (control) consisting of 100 individuals randomly recruited without diabetes. Results. The accumulation of cardiovascular risk factors results is an increased risk of cardiovascular disease. We found statistically significant differences between the three groups in terms of BMI, CT, VAI, CT, HDL-c and LDL-c values, which were higher in patients with diabetes mellitus (DM) than in prediabetics or in the general population, which also coincided with higher cardiovascular risk in these patients. Conclusions. We emphasize the importance of both early cardiovascular risk assessment and the importance of controlling cardiovascular risk factors, both by non-pharmacological methods, and by associating early drug therapy when necessary. Keywords: obesity, sedentariness, cardiovascular risk, diabetes, prediabetes.

ABSTRACT Introduction. Infective endocarditis (IE) is a severe cardiovascular disorder involving native valves, ventricular or atrial endocardium, foreign intracardiac bodies (prosthetic valves, pacemaker or intracardiac defibrillator), and extracardiac (neurological, nephrological, musculoskeletal system etc.) complications with high mortality and poor prognosis. The objectives of the study were to evaluate clinical and laboratory features of infective endocarditis with musculoskeletal manifestations. Methods. The study was conducted on a sample of 235 patients, 185 being hospitalized in specialized Cardiology Departments, including four medical centers, between November 2014 and March 2016. All patients included in the study fulfilled the diagnostic criteria for infective endocarditis developed after Duke Endocarditis Service (Durham, North Carolina), revised in 1994 and 2007. Results. According to the presence or absence of musculoskeletal manifestations (MSM), patients were divided in 2 groups: 1st group – 90 patients with IE and MSM (38%) and 2nd group – 145 patients with IE without MSM (72%). In this way we found that women develop musculoskeletal symptoms more frequently than men – 44% vs. 36%, although MS symptoms were found in 38% of study patients. The highest incidence of IE in the general study group was seen in men – 70% vs. women – 30% respectively (p = 0.022). Conclusions. From all predisposing cardiac factors in IE patients with MSM the most prevalent ones were: rheumatic valvular heart disease (33%) and valvular prostheses (24%), the predominant bacteremia source being the respiratory infections (52%), poor dental hygiene (33%) and tonsillitis (24%) occurring in patients with diabetes mellitus (23%) and hepatitis (21%). Keywords: infective endocarditis, musculoskeletal manifestations, complications.ABSTRACT Introduction. Infective endocarditis (IE) is a severe cardiovascular disorder involving native valves, ventricular or atrial endocardium, foreign intracardiac bodies (prosthetic valves, pacemaker or intracardiac defibrillator), and extracardiac (neurological, nephrological, musculoskeletal system etc.) complications with high mortality and poor prognosis. The objectives of the study were to evaluate clinical and laboratory features of infective endocarditis with musculoskeletal manifestations. Methods. The study was conducted on a sample of 235 patients, 185 being hospitalized in specialized Cardiology Departments, including four medical centers, between November 2014 and March 2016. All patients included in the study fulfilled the diagnostic criteria for infective endocarditis developed after Duke Endocarditis Service (Durham, North Carolina), revised in 1994 and 2007. Results. According to the presence or absence of musculoskeletal manifestations (MSM), patients were divided in 2 groups: 1st group – 90 patients with IE and MSM (38%) and 2nd group – 145 patients with IE without MSM (72%). In this way we found that women develop musculoskeletal symptoms more frequently than men – 44% vs. 36%, although MS symptoms were found in 38% of study patients. The highest incidence of IE in the general study group was seen in men – 70% vs. women – 30% respectively (p = 0.022). Conclusions. From all predisposing cardiac factors in IE patients with MSM the most prevalent ones were: rheumatic valvular heart disease (33%) and valvular prostheses (24%), the predominant bacteremia source being the respiratory infections (52%), poor dental hygiene (33%) and tonsillitis (24%) occurring in patients with diabetes mellitus (23%) and hepatitis (21%).

ABSTRACT Introduction. Infective endocarditis (IE) is a severe cardiovascular disorder involving native valves, ventricular or atrial endocardium, foreign intracardiac bodies (prosthetic valves, pacemaker or intracardiac defibrillator), and extracardiac (neurological, nephrological, musculoskeletal system etc.) complications with high mortality and poor prognosis. The objectives of the study were to evaluate clinical and laboratory features of infective endocarditis with musculoskeletal manifestations. Methods. The study was conducted on a sample of 235 patients, 185 being hospitalized in specialized Cardiology Departments, including four medical centers, between November 2014 and March 2016. All patients included in the study fulfilled the diagnostic criteria for infective endocarditis developed after Duke Endocarditis Service (Durham, North Carolina), revised in 1994 and 2007. Results. According to the presence or absence of musculoskeletal manifestations (MSM), patients were divided in 2 groups: 1st group – 90 patients with IE and MSM (38%) and 2nd group – 145 patients with IE without MSM (72%). In this way we found that women develop musculoskeletal symptoms more frequently than men – 44% vs. 36%, although MS symptoms were found in 38% of study patients. The highest incidence of IE in the general study group was seen in men – 70% vs. women – 30% respectively (p = 0.022). Conclusions. From all predisposing cardiac factors in IE patients with MSM the most prevalent ones were: rheumatic valvular heart disease (33%) and valvular prostheses (24%), the predominant bacteremia source being the respiratory infections (52%), poor dental hygiene (33%) and tonsillitis (24%) occurring in patients with diabetes mellitus (23%) and hepatitis (21%). Keywords: infective endocarditis, musculoskeletal manifestations, complications.

Changes in the lipid profile in pregnant women, with and without obesity, have been studied depending on the angiotensin-converting enzyme (ACE) gene I/ D polymorphism and the 4G5G polymorphism of the plasminogen activator inhibitor type I (PAI-1). The combination of the D-allele of the ACE gene and the 5G allele of the PAI-1 gene is a risk factor of increasing total cholesterol in pregnant women, regardless of the obesity class, and of increasing triglycerides in pregnant women without obesity. The presence of the D-allele of the ACE gene in the haplotype, regardless of the combinations of the genotypes of the PAI-1 gene, is a risk factor of increasing triglycerides in pregnant women with obesity.

ABSTRACT Hepatorenal syndrome (HRS) is defined as a functional renal failure in patients with liver disease that features morphologically intact kidneys, where regulatory mechanisms have minimized glomerular filtration and maximized tubular resorption and urine concentration. The syndrome occurs almost exclusively in patients with ascites. Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output. Type 2 HRS is characterized by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure, but refractory ascites, and its impact on prognosis is less negative. Liver transplantation is the most appropriate therapeutic method, nevertheless, only a few patients can receive it. The first line treatment includes terlipressin plus albumin. Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term. Other therapies include transjugular intrahepatic portosystemic shunts (TIPS), dialysis and peritoneovenous shunts which are most commonly done when patients are awaiting a liver transplant or when there is the possibility of improvement in liver function.

Introduction. The role of individual cytokines in the development of various clinical forms of atopic dermatitis (AD) and the effect of cortisol on this process in children have not been sufficiently studied. Objective. To study the nature of cellular and humoral immunity disorders and the content of cytokines and cortisol in children with AD. Methods. The study involved 168 children, aged 1 to 18 years, with AD, in whom their immune status was determined. CD3, CD4, CD8 CD16 CD19 were determined by flow cytofluorometry, the concentration of IgA, IgM, IgG, IgE, IL-2, IL-4, IL-6, IL-10, INF-?, and cortisol by the ELISA method. The Excel program, Statistica 6.0 and the on-line SISA calculator were used. Average values are given in the form (M ± m), where M is the average value of the indicator, m is the standard error of the mean; n – the volume of the analyzed group. Results. The total number of leukocytes in children with AD did not exceed the norm, but it was likely to increase in case of a severe course. In all age groups and at varying severity of AD, there was a tendency to lymphocytosis, with severe course of the disease – to neutrophilia (p<0.05), an increase in the concentration of CD19 and CD16 (p<0.05). In severe forms of AD, higher IL-4, IL-6, IL-10 and lower IL-2 and INF-?? were reported. Proliferation to dysimmunoglobulinemia was revealed: reduction of serum IgA concentration, increase of serum IgE and IgG concentrations. Concentration of cortisol decreased in boys with AD and increased in girls. Conclusion. In the immunopathogenesis of AD there is an imbalance between individual subpopulations of T- and B-lymphocytes, changes in the differentiation of T-lymphocytes and their profile of cytokine secretion, dysimmunoglobulinemia, signs of adrenal cortex dysfunction. Keywords: atopic dermatitis, T- and B-lymphocytes, immunoglobulins, cortisol. Abbreviations: AD – atopic dermatitis, subpopulation of T- and B-lymphocytes –CD3, CD4, CD8 CD16 CD19, IRI – immunoregulatory index (CD4/CD8), IgA, IgM, IgG, IgE – immunoglobulins, IL-2, IL-4, IL-6, IL-10 – interleukins, INF-? – interferon-gamma.

ABSTRACT The aim of the work – improvement of the evaluation method of remote results of surgical treatment in patients with toxic goiter, taking into account the changes in the severity of clinical manifestations of thyrotoxic cardiomyopathy Materials and methods. The research was conducted in 150 patients operated for toxic goiter of moderate severity (48) and severe (102). The method of estimation of remote results of surgical treatment, taking into account the regression of signs of thyrotoxic cardiomyopathy and gradation and division into good, satisfactory, unsatisfactory and ineffective treatment, was developed. Results and discussion. A good remote outcome of surgical treatment of thyrotoxicosis was achieved in 26 (54.2 %) patients with moderate thyrotoxicosis and in 9 (8.8%) patients with severe thyrotoxicosis, satisfactory in 21 (43.7 %) and 36 (35, 3%) cases respectively and unsatisfactory – in 1 (2.0 %) and 33 (32.4 %). Ineffective surgical treatment was recognized in 24 (23.5 %) patients. Unsuccessful results and ineffective surgical treatment of toxic goiter were found in patients with severe heart rate rhythm disorders, structural and functional changes in the cardiac muscle and functional classes II and III. Conclusions. Long-term results of surgical treatment of patients with toxic goiter are determined by the severity of thyrotoxic cardiomyopathy. In cases of severe thyrotoxicosis, the question of the need for surgical treatment should be put in the development of severe heart rhythm disorders and structural and functional changes in the heart muscle.

ABSTRACT Introduction. C-MYC is one of the essential transcription factors that play a role in various cellular functions. The MYC rearrangement is associated with low overall survival and low progression-free survival, increased risk of central nervous system disease relapse in patients diagnosed with diffuse large B cell lymphoma (DLBCL) and treated with R-CHOP. Also, c-MYC amplification is an unfavorable prognostic factor, amplified by BCL2 and BCL6 rearrangements, respectively, designating lymphomas as high grade according to the WHO 2016 revision. Objectives. We search the correlations of the double or triple expression of C-MYC and BCL2 and/or BCL6 markers, with clinical survival data. Methods. A cohort of 80 patients with DLBCL was examined for MYC, BCL2 and BCL6 immunohistochemical expression. Results. Six, respectively four, patients of the total cohort were MYC/BCL2 and MYC/BCL6 positive and only 3 were MYC/BCL2/BCL6 triple positive. The median overall survival was 6 months, 95% confidence interval (CI)) for triple expression and 13 months (CI 95%) for MYC/BCL2, respectively MYC/BCL6 dual expression. Complete therapeutical response was registered in 2 patients with triple expression and 4, respectively 2 patients, with MYC/BCL2 and BCL6 dual expression. Relapse was registered in 1 patient, either MYC/BCl2 dual positivity respectively triple positivity, and in 2 patients with MYC/BCL6 positivity. Conclusions. Our study has showed that the double and triple positivity expression in DLBCL have a low incidence (15%) and are correlated with poor survival, the prognosis being unfavorable.

ABSTRACT The importance of cardiovascular/cardiometabolic risk is a special one, because it may influence atherogenesis and its clinical consequences: ischemic heart disease, cerebrovascular disease, peripheral artery disease, but also diabetes mellitus (DM). To evaluate the cardiometabolic risk associated with visceral obesity, a useful indicator for the clinical practice was searched. The visceral adiposity index (VAI) could become an easy-to-use tool to evaluate the cardiometabolic risk in everyday practice. VAI indicates the function of visceral adipose tissue and its growth is independently correlated with cardiovascular and cerebrovascular risk. The medical world tried to identify an easy way to assess cardiovascular risk, so the visceral adiposity index was introduced, whose formula includes a number of cardiovascular risk factors.

ABSTRACT Introduction. Spinal muscular atrophy type 1 is an autosomal recessive neuromuscular disorder characterized by degeneration of the anterior horn cells in the spinal cord, leading to symmetric muscle weakness and atrophy. 95% of affected children die before 2 years of age. The annual incidence in the world has been estimated at around 1/11 000. The errors (mutations) in the SMN1 gene prevalence vary from 1: 38 to 1: 70 in the population. The disorder is primarily caused by the homozygous deletions of the gene (5q12.2-q13.3). The SMN gene mutation is primarily caused by a homozygous deletion in exons 7 or 8. Case presentations. 2 clinical cases of children with the Werdnig-Hoffmann disorder will be presented, and a literature review of this pathology. Two cases of spinal muscular atrophy diagnosed in Chernivtsi region, Ukraine, are presented. In both children, a molecular genetic analysis found the homozygous deletions of SMN1 gene in exons 7 and 8. Most affected children die within 2.3- 1.3 years of age. These two cases ended lethally due to subinfection. Material was collected in accordance with ethical standards of work person under Helsinki Declaration (World Medical Association Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects). Genealogical analysis of families, biochemical analysis of blood, ENMG were carried out. The molecular genetic method was used: DNA was extracted and the deletions of 7 and 8 exons of the telomeric SMN gene were tested by PCR method. The disorder usually manifests in young children, if mother has a history indicating a weak fetal movement during pregnancy. Hypotension and hypotrophy of muscles, absence of tendon reflexes on lower extremities, fibrillation of the muscles of the tongue and fingers are observed in the neonatal period. Children with this pathology can poise their heads, but never turn over and do not sit. They are characterized by a „frog“ position: the limbs are laid in the shoulder and femoral joints and bent in elbow and knee joints. Chest distortions are pathognomonic. The main cause of death is respiratory distress associated with intercurrent respiratory disorders. Conclusion. Based on the literature data and our experience of monitoring children with SMA type I, the disorder has a malignant rapidly progressing course.

ABSTRACT Acquired fetal position by patients in end stage Alzheimer’s disease is a quite common sign. The theory of retrogenesis was proposed to explain this anatomic remodelling of the human body.

The antibacterial therapy in children remains a complicated and an unsolved problem of medicine. Despite the fact that antibiotics are largely available, every year more and more bacteria become resistant to these drugs. Also, there is only a small number of new antibacterial agents introduced into practice, especially for respiratory system infections. This is due to the fact that systemic antibiotics poorly penetrate into the pulmonary tissue and do not create high concentrations at the site of inflammation. With increased doses of systemic antibacterial agents, their toxic effect on the body of the patient also increases. Therefore, the usage of inhalation route for the intake of these agents is a modern one and reduces the risk of systemic side effects. In the literature review conducted by us, the main advantages of inhalation intake of antibiotics have been examined, the analysis of the basic preparations usage has been carried out and the disadvantages and side effects of the inhalation route of the antibacterial agents intake have been identified. It is also worth noting that the inhaled antibiotics are practically not used as monotherapy, but only in combination with antibiotics with systemic action. They cannot be an alternative or a substitute for systemic drugs. The usage of this group of drugs makes it possible to improve the results of treatment of the respiratory diseases in children, especially with chronic inflammatory processes. The inhaled antibiotics can be one more important step in the fight against antibiotic resistance.

In the 8th century AD, when the West sank into the darkness of the Middle Ages, the bloom of the sciences came from the Arabs. The work of the most famous Arabo-Islamic physicians reflects their knowledge of heart function and heart disease. Rhazes (864-925), claims that heart has two ventricles while Hally Abbas (930-994), was one of the first to deny the existence of communication between the right and the left cavities. Avicenna (980-1037) observed that there are three valves in the aorta’s outflow, which open when the volume of blood is ejected from the heart during contraction and close during the expansion of the heart. He was also a pioneer in examining and studying pulse and its wave. Finally, Ibn Al-Nafis (1213-1288) was the first to describe pulmonary circulation and for this reason, he is considered as a true precursor of cardiology.

ABSTRACT Noisy breathing is a common presenting symptom among newborns to primary care and the clinician must be able to differentiate the different types of noisy breathing such as stridor, stretor, snoring and wheezing. Inspiratory stridor is one of the most important clinical findings in newborns and it requires fast and adequate evaluation of the newborn in order to determine the underlying etiology, because some of the pathologies that lead to stridor in newborns can be life threatening, depending on the severity of the airway obstruction and the presence or absence of associated symptoms as respiratory distress or feeding issues. It indicates the obstruction of the larynx, glottis or subglottic area. In the newborn period laryngomalacia is the most common cause of inspiratory stridor. This type of stridor worsens with agitation, after feeding and in supine positioning. A newborn that presents at the hospital with stridor can be managed conservatively or by surgery depending on the severity and the underlying pathology.

ABSTRACT Introduction. Iatrogenic injury of the urinary tract in women undergoing pelvic surgeries is one of the most feared complications and an important source of significant morbidity. Moreover, they cause a lot of anxiety to both patient and surgeon and they also create many legal concerns. The most commonly affected organs are the ureter, bladder and urethra. Urologic injury during obstetrics and gynecologic surgery should always be a matter of prevention, but there are situations in which prevention fails. With this article we intend to raise the awareness on potential situations leading to iatrogenic urinary tract lesions during obstetrics and gynecology surgery. CASE Cases presentation. Three different cases of iatrogenic injuries at various sites of the urinary tract during pelvic surgeries are presented and preventive and treatment measures are discussed. Conclusions. Most iatrogenic urinary tract lesions are prone to occur during difficult surgeries, but a significant number of iatrogenic injuries are made during routine interventions, even by the most trained surgeons. Therefore, preventing and recognizing iatrogenic urinary tract injuries is of highest importance for all surgeons performing interventions in the pelvic area.

ABSTRACT The statistical data show the continuosly increasing number of patients with chronic diseases and this fact has a significant impact on the workload of all clinicians, including maxillofacial surgeons. On the other hand, inflammatory processes in the maxillofacial region are an important problem for maxillofacial surgeons due to the high number of patients who present with this diagnosis, but also because of the life-threatening complications that may occur. Besides the usual complications, a maxillofacial surgeon has to be aware of other comorbidities of the patients diagnosed with inflammatory processes, falling into the category of medically complex patients. The preoperative assessment main purpose is to identify those patients for whom the perioperative period may present an increased risk of morbidity and mortality, aside from the known complications already associated with inflammatory processes. This article aims to emphasize the importance of performing a complete and meticulous preoperative assessment of every single patient, even the apparently healthy ones, since the patient himself may be unaware of a comorbidity he might have. In order to facilitate this process, the use of standardized questionnaires for different groups of patients is encouraged for the prompt assessment of the patient’s condition. Another suggestion is the use of standardized protocols for emergency situations that may occur with these patients, including the use of tables with possible drug interactions between the medication used for the management of their chronic disease with the medication administered in the maxillofacial surgery unit.

ABSTRACT Introduction. Ingestion of corrosive substances often causes serious damage to the upper gastrointestinal mucosa, occasionally perforation and, in rare cases, death. Most of these events are accidental, especially in children and the elderly, and voluntary (for suicidal purposes) in adults. If the patient survives the acute episode, the long-term complications are mainly esophageal and/or gastric stenosis and esophageal cancer after 1-2 decades of evolution. Endoscopic treatment of benign esophageal stenosis consists of dilation with Savary bougies and dilation balloon, esophageal stent assembly, with the purpose of restoring esophageal luminal patency. Superior digestive endoscopy plays an important role in the evaluation of benign esophageal stenosis in terms of the severity and the extent of stenosis. Case presentation. We present the case of a 47-yearold patient admitted to our clinic for dysphagia for solid and semi-solid foods. Endoscopy revealed an esophageal stricture due to the voluntary ingestion of caustic substance with suicidal purpose, 9 months before presentation. After multiple sessions of endoscopic dilatation with Savary bougies, an esophageal stent was placed, that solved patient’s dysphagia. Conclusions. Post-caustic esophageal stenosis is a common cause of dysphagia in patients with ingestion of corrosive substances. Patients can benefit from endoscopic esophageal stent placement treatment.

ABSTRACT Introduction. Bilateral recurrent paralysis treatment has changed in the last decades as various procedures have been developed in order to superiorly preserve the functions of the larynx. For life-threatening situations tracheotomy remains the treatment of choice. Case presentation. In this article we present the case of a 64 year-old patient, known with bilateral recurrent paralysis, who presented to our clinic with mild to moderate inspiratory dyspnea on effort. The endoscopic examination revealed the vocal folds in paramedian position, with a respiratory space reduced by 80%. We performed an endoscopic posterior cordotomy, also known as Kashima procedure. Conclusions. Kashima procedure or endoscopic laser posterior cordotomy is a preferred technique with better long term outcomes. It prevents the necessity of tracheotomy and improves the quality of life of the patient, by both widening the airway and preserving phonation.

ABSTRACT Introduction. Takayasu’s arteritis or pulseless disease is a systemic inflammatory disease of an unknown etiology, affecting medium and large arteries and their branches, leading to stenosis, occlusions, or aneurysmal degeneration. It is more frequent in young Asian women. Case presentation. We present a rare case of Takayasu’s disease in a young woman, who initially developed an acute ischemic cholecystitis. Ischemia is one of the mechanisms involved in the pathogenesis of acute acalculous cholecystitis. As this mechanism is most often involved in elderly people, such an uncommon finding at young age should be a reason to suspect a vasculitis with small vessel occlusion. Conclusions. Acute cholecystitis in this patient was the first onset sign of Takayasu’s arteritis. An acute acalculous cholecystitis at young age could be of ischemic origin and should also be considered as a possible epiphenomenon of a generalized vasculitis disease.

ABSTRACT Emergency endoscopy is a life-saving procedure of tremendous importance. It is a long-standing minimal invasive technique utilized for diagnosis and treatment of gastrointestinal tract diseases. Endoscopy is the most precise and practical method for diagnosing the source of upper gastrointestinal bleeding, grading the lesions induced by ingested caustic substances or removing foreign bodies from the esophagus or the stomach. Controversy exists regarding the timing of endoscopy, defined by the period of time between the patient presentation and performing the endoscopy. Hypothetically, an early endoscopy (generally defined as within 24 hours from presentation) compared with routine endoscopy may translate into an improved patient outcome, because early hemostasis should reduce the quantity of blood loss. Also, there are reasons for worse outcomes with urgent endoscopy: absence of back-up support available at the time of endoscopy (surgery or radiology), emergency endoscopy may be associated with insufficient resuscitation. Regarding caustic ingestions, most authors suggest a delay of only 12 hours and a total wait of no more than 24 hours after ingestion for early assessment and treatment. Endoscopy past 48 hours is discouraged because of progressive wall weakening and increased risk of perforation. Sharp esophageal foreign bodies or complete obstruction of the esophagus should prompt an endoscopy within 2 hours from patient’s presentation.

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. Gastrointestinal bleeding is a life-threatening condition, with a mortality depending on the cause and severity. The objective of this study was to retrospectively evaluate the epidemiological, clinical and evolutionary aspects of a series of patients diagnosed with gastrointestinal bleeding, admitted to the Intensive Care Unit of the Clinical Emergency Hospital of Bucharest, Romania. Material and methods. A retrospective, descriptive study was carried out, of patients diagnosed with upper and lower gastrointestinal bleeding, admitted to the Intensive Care Unit of the Clinical Emergency Hospital of Bucharest, Romania, between January 1st, 2013 – December 30th, 2018. The clinical variables were collected in a database designed exclusively for the study. Results. We observed that most of the cases were bleedings situated above the Treitz’s angle; the most frequent causes were peptic ulcer disease, followed by variceal hemorrhage and erosive gastroduodenitis. The three most frequent causes of upper gastrointestinal bleeding in our series were peptic ulcer disease, variceal hemorrhage and erosive gastroduodenitis. The global mortality due to gastrointestinal bleeding was 9.8%, with all cases occurring in the group of patients with upper gastrointestinal bleeding. Conclusions. It should be noted that in the group of patients who died, all had hemorrhagic shock at the time of admission, a fact that occurred only in 23% of the cases who survived. This highlights the prognostic value of the hemorrhagic shock on admission.

Introduction. Psoriasis is an immune-mediated inflammatory skin disease. Since the use of therapeutic agents is often hampered by low efficacy and/or adverse effect profile, the presence of comorbid pathology, it is necessary to develop new therapeutic approaches for psoriasis. The objective of the study was to evaluate the clinical and laboratory efficacy of rosuvastatin in the treatment of patients with chronic plaque psoriasis. Material and methods. The study involved 52 patients with mild and moderate psoriasis, aged 45-64 years. The blood serum level of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP) and vascular endothelial growth factor (VEGF) were determined by immunoassay analysis. The serum lipid profile was also determined. Patients were divided into two groups, depending on the method of therapy. Patients of the 1st group received a combination therapy – rosuvastatin, topical corticosteroids (TCS) or phototherapy, patients of the 2nd group were prescribed only TCS or phototherapy. Results. The clinical improvement of psoriasis is noted under the influence of combination therapy. The PASI (Psoriatic Area and Severity Index) score decreased in 3 months by 68.2%. A marked decrease in the level of IL-6, hs-CRP after 1 month was noted, less significant V?GF relative to the results before therapy. Lipid metabolism indices changed reliably only at the end of the 3rd month – the levels of TC and LDL-C were reduced. Conclusions. The use of rosuvastatin in the combination therapy of patients with psoriasis increases the effectiveness of treatment, helps to reduce the level of inflammatory markers, proangiogenic growth factor and normalize blood lipid spectrum.

Introduction. The pathogenesis of hepatopulmonary syndrome (HPS) has not been clarified, but since the basis of HPS development is the dilation of inner lung capillaries, researchers suggest that HPS is caused by the prolonged action of biologically active compounds on the blood vessels of pulmonary circuit and a syndrome of systemic inflammatory response has also been implicated in its development. The objective of the study was to evaluate the indices of endogenous intoxication and inflammation in blood serum and lung tissue of animals with different models of hepatopulmonary syndrome. Material and methods. The first experimental model of HPS was made by imposing a double ligature on common bile duct and its further dissection with a scalpel. The animals of second experimental group were fed with a mixture of maize flour, lard, cholesterol, and alcohol plus subcutaneously injection with carbon tetrachloride oil solution for 8 weeks. Determination of the middle mass molecules contents, TNF-a and CRP was carried out in blood serum and lung tissue. Results. The modelling of HPS resulted in a statistically significant increase in endogenous intoxication, manifested by an increase in the content of MMM and inflammation indices in blood serum and supernatant of lung tissue homogenate. An increasing of middle mass molecules was more significant for a pool of ?M?2. Conclusions. Comparing the indices of endogenous intoxication and inflammation in blood serum and lung tissue in both models of hepatopulmonary syndrome, we have found the synchronous development of destructive processes on systemic and local levels with predominance in lungs.

Introduction. Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of disorders, characterized by chronic muscle weakness, low muscle endurance and by the presence of inflammatory cell infiltrates in muscle tissue, with organ damage and disability. The objective of the study was to determine the degree of disability in a Moldavian cohort of patients with idiopathic inflammatory myopathies, by Rankin’s scale. Methods. We performed a cross-sectional study, from December 2015 to December 2018, in which were included patients with IIMs. Demographic and clinical data were collected using a special questionnaire, including employment status, upholding dose of corticosteroids. In order to estimate the degree of functional disability at the time of the research, we applied the modified Rankin’s scale, with possible scores from 0-no disability to 5-totally dependent. Results. 65 IIMs patients were enrolled in the study. Male to female ratio was 1:3.3, the patients’ mean age was 50.2±11.7 years, the mean disease duration 95.2±6.89 months. According to modified Rankin’s scale, the 1st degree was found in 20 cases (30.77%), the 2nd degree in 24 patients (36.92%), 11 patients (16.92%) had 3rd degree, 8 patients (12.31%) 4th degree, and 5th degree was determined in 2 patients (3.08%). Many variables were analyzed and we determined that the dose of prednisolone-equivalent <10 mg (RR 2.2; 95% CI 1.34 to 3.6, p<0.01) and disease duration less than 2 years are protective factors (RR 0.4; 95% CI 0.2 to 0.9, p<0.05) for severe degree of disability (= 3). Conclusion. Our study has shown that patients with idiopathic inflammatory myopathies have a mild disability in 67.69% of the cases, moderate in 16.92% and severe disability was found in 15.39% of the cases. The dose of prednisolone-equivalent <10 mg and disease duration less than 2 years were determined as protective factors against the severe degree of disability.

The objective of the study was to investigate the features of free-radical oxidation and apoptotic leukocyte death in the dynamics of mechanical non-penetrating corneal injury in rabbits. Material and methods. The peculiar features of free-radical oxidation (the content of TBA-reactants and Schiff bases) in blood and aqueous humor were determined using biochemical methods. The analysis of blood leukocytes samples to determine reactive oxygen species was evaluated by the flow laser cytometry method, using 2.7-dichlorodihydrofluorescein diacetate. The percentage of apoptotic blood leukocytes was evaluated by the flow laser cytometry method, using specific kit. Results. In case of experimental non-penetrating mechanical corneal injury, the percentages of reactive oxygen species and spontaneous apoptosis of blood leukocytes increased significantly from the 3rd day of the experiment, with the highest values within 14th and 21st days of observation. Also, the intensification of lipid peroxidation (increased content of TBA- reactants and the Schiff bases) in blood and aqueous humor, with a maximal increase on the 14th day of observation (p<0.05), has been observed. The strongest correlations between the percentage of apoptotic blood leukocytes, the content of TBA-reactants and the percentage of ROS were observed within the 7th-14th days of the experiment. Conclusions. One of the important signaling pathway of blood leukocytes apoptosis triggering in case of mechanical non-penetrating corneal injury in rabbits is reactive oxygen species overproduction and possible disruption of the mitochondrial inner membrane (direct relationship between the increase of TBA-reactants, reactive oxygen species and percentage of annexin-positive blood leukocytes (r=0.99; p<0.05)).

The objective of the study was to compare the NADPH/ H2O2 system and the expression of enzymes in the culture of thyroid gland cells, depending on the sex. Material and methods. The thyroid gland was collected from adult female donors (n=20) and men (n=15). The cells were washed twice with HBSS and centrifuged at 1000 × g for 5 minutes, and then cultured to 106 cells in 0.5 ml culture medium per well in 24-well plates (Thermo Fisher Scientific, USA). H2O2 levels in the cells were determined quantitatively using a hydrogen peroxide sensor Premo™ Orp1-roGFP (Life Technologies, USA) according to manufacturer’s instructions. Statistical analysis of the results was carried out using Statistica 6.1 (StatSoft, Inc., USA). Results. We found that the expression of DUOX1 and NOX4 in the thyroid gland was significantly higher in women than in men (1.5 times, p<0.05). Expression of DUOX2 in female cells was 1.5 times higher than in men, but statistically significant (p=0.06). We have found that the thyroid gland of women produces a significantly higher H2O2 content than the male gland cells (p<0.05). The expression of DUOX1 and NOX4 is significantly higher in cells derived from the female thyroid gland than in cells derived from males. H2O2 levels were also higher in cells derived from female thyroid gland than in male cells. Conclusion. As a result of our experiment, the expression of DUOX1 and NOX4 is significantly higher in cells derived from the female thyroid gland than in cells derived from males. We have shown during the experiment that NOX4 is regulated both at the transcription level and at the level after transcription, and the level of sustained-release NOX4 mRNA does not accurately reflect the content and function of the NOX4 protein. Chronic effects on the female thyroid gland at higher concentrations of H2O2 can potentially cause many adverse effects.

Introduction. The actual prevalence of toxic nephropathies in children is not fully known, because renal functional and structural changes caused by nephrotoxins are nonspecific. The objective of the study was to evaluate the aetiology and renal involvement in severe poisoning with lethal potential in children. Methods. We retrospectively analyzed a group of patients, aged between 0-18 years, with deaths due to acute intoxication, who were investigated at the National Institute of Legal Medicine “Dr. Mina Minovici” Bucharest, Romania, during a 9 years period. We analyzed the aetiology of deaths by poisoning in children, the aetiology and the frequency of nephrotoxic injury and the pathological aspects of nephrotoxic poisonings. Results. From a total of 69 children deaths due to acute intoxication, the most common cause of death was acute poisoning with carbon monoxide (23 cases). The other etiologies were represented by multidrug poisoning – 9 cases, organophosphorus intoxications – 9 cases, and intoxications with illicit drugs – 8 cases. Acute renal injury was present in 20 patients, mainly in acute multidrug poisoning. The most common aspect was tubular nephrosis in 15 cases, followed by the appearance of acute tubular necrosis in 10 cases, tubulo-interstitial nephritis in 1 case, and non-specific aspects with renal stasis in the remaining 6 cases. Conclusions. Kidney involvement in pediatric poisoning is rare, but when acute kidney injury occurs, the prognosis of the intoxication becomes severe. Renal injury was present in 30% of cases, either by direct kidney damage with acute tubular necrosis, or by association of haemodynamic, cardiogenic, or septic shock.

Introduction. Skin metastases are rare metastases of internal or cutaneous tumors, commonly diagnosed after the primary cancer. Sometimes, they can be the first manifestation of a malignancy. Cutaneous metastases associate a poor prognosis for the patient and the survival rate decreases considerably. The objective of the study was to analyze the clinico-epidemiological and histological characteristics of skin metastases, in order to better understand different types of malignancies and their prognosis, as well as to highlight the particularities of this rare localization of the metastases. Material and methods. We conducted a retrospective study, in which we included 50 cases of skin metastases diagnosed in the Pathology Department of the University Emergency Hospital Bucharest, Romania, over a period of three years. We analyzed the cases from all epidemiological, clinical, gross and histological data, based on the records of the hospital. Results. The patients’ ages ranged from 16 to 92 years old, with a mean age of 60.1 years. Almost half of the patients were females (26 cases). Most of the patients were diagnosed with primary melanoma (17 cases), followed by primary tumors of the gastrointestinal tract (9 cases) and breast carcinomas (8 cases). 29 cases presented with complications, such as ulceration, infection or necrosis. Conclusions. Most of the skin metastases were of malignant melanoma, but any kind of primary tumor can, eventually, disseminate to the skin, conferring a poor prognosis on the patient. Also, any site can be involved, but some malignancies do have preferred areas for dissemination.

Introduction. Administration of antibiotics in case of acute tonsillopharyngitis (ATP) is reasonable only when the disease is caused by ß-hemolytic streptococcus of A (BHSA) group, although clinical confirmation of its etiology is rather complicated. Objective. Improvement of the diagnosis and treatment of acute tonsillopharyngitis in children, considering the etiological factor and the clinical characteristics of the course of this disease. Materials and methods. 102 children with acute tonsillopharyngitis were included in the study. The patients were divided in 2 groups. The first group included 68 patients with non-streptococcal acute tonsillopharyngitis (nATP), the second one – 34 children with streptococcal acute tonsillopharyngitis (sATP) with BHSA. The study was performed in the Children Regional Hospital, Chernivtsi, Ukraine, during the period 2014-2016. General clinical examination was performed in all the children, using MacIsaac, Centor and Breeze probabilistic-orientation clinical systems. Constellation pattern of ATP was simulated by successive Waald’s method in Kulbak’s modification. Results. MacIsaac and Centor clinical systems, with the total sum less than 3, with a specificity of 93.9% and a sensitivity of 12.5%, were indicative of non-streptococcal acute tonsillitis in children. The prospective 1-year observation of children who had ATP determined that every third child from the 1st group and half of the representatives from the 2nd group presented different complaints associated with vegetative-vascular dystonia syndrome. In case of impossible microbiological examination in patients with ATP, we have suggested the algorithm of a rational administration of antibiotics for its treatment. Conclusions. MacIsaac and Centor probabilistic-orientation clinical systems with the total sum of less than 3 are indicative of non-streptococcal acute tonsillitis in children, with a high specificity, but low sensitivity. Therefore, according to our research, to reduce the risk of insufficient diagnosis of acute tonsillopharyngitis caused by ß-hemolytic streptococcus when microbiological examination is not possible, a multilevel algorithm for its treatment should be used.

Introduction. Lipid metabolism disorder is recognized as one of the risk factors for vitamin D deficiency, and the amount of adipose tissue is crucial in its metabolism and biological role. Childhood obesity is an important public health problem in Ukraine, especially among adolescents. The objective of the study was to determine peculiarities of the prevalence and risk factors for vitamin D deficiency in overweight and obese adolescents in Ukraine. Material and methods. 146 children, aged 12 to 17 years, with excessive weight and obesity, and 63 healthy children with normal body weight were examined. The vitamin D status was determined by the level of 25(OH) D in blood serum. The multiple logistic regression analysis was used to determine the risk factor affecting the development of vitamin D deficiency. Results. The study has established that the average level of 25(OH) D in adolescents with normal body weight was 19.76±4.28 ng/mL, in adolescents with excess body weight 15.24±3.47 ng/mL, and in obese children 13.87±2.71 ng/mL. The prevalence of vitamin D deficiency in overweight adolescents was 70.62%, and in adolescents with obesity 77.19%. Conclusions. The study has established the main risk factors and prevalence features for vitamin D deficiency in overweight and obese adolescents.

The objective of the study. This study aims to investigate the role of mitochondria in blood neutrophils’ apoptosis in case of periodontitis combined with hyper- and hypothyroidism in rats. Material and methods. Experimental studies were conducted on male, nonlinear, white rats of around 4 months of age. Analysis of cell samples to determine reactive oxygen species was evaluated by the flow laser cytometry method, using 2.7-dichlorodihydrofluorescein diacetate. The percentage of neutrophils with low transmembrane mitochondrial potential and percentage of apoptotic neutrophils were evaluated by the flow laser cytometry method, using specific kits. Results. We have found a statistically significant higher percentage of blood neutrophils with increased reactive oxygen species generation, low transmembrane mitochondrial potential and the percentage of FITC Annexin V- positive cells in rats with periodontitis and in rats with periodontitis combined with thyroid dysfunction. At the same time, the changes were more pronounced in animals with hyperthyroidism. Conclusion. One of the important signaling pathways of apoptosis triggering, in case of experimental periodontitis combined with thyroid dysfunction, is reactive oxygen species overproduction and disruption of the mitochondrial inner membrane, due to the decreased transmembrane potential, which is more pronounced in case of hyperthyroidism.

Introduction. The close relationship of the osteoporosis with the periodontal tissue disease is of great importance in dentistry, because of the development of inflammatory-destructive processes of tooth holding tissues. A database to individualize the basics of metabolism in terms of bone remodeling in patients with generalized periodontitis (GP) in connection with AB0-belonging will reveal the fundamental basis of the influence of group-specific features of blood flow and treatment of generalized periodontitis. The aim of the study was to assess the dynamics of bone remodeling markers in blood and oral liquid of patients with generalized periodontitis, with different blood groups. Material and methods. The clinical and laboratory studies were conducted in 175 patients with generalized periodontitis (main group) and in 120 persons without somatic and dental diseases (comparison group), who were divided into groups in connection with AB0-belonging. It was determined the activity of acid and alkaline phosphatase in blood and oral liquid of patients, by conventional biochemical methods, and levels of osteocalcin and C-end telopeptide by ELISA. Results. Patients with generalized periodontitis presented a significant increase of the markers of bone resorption (acid phosphatase and C-end telopeptides), while healthy persons presented a reduction of these parameters of bone formation (osteocalcin and alkaline phosphatase) in blood and oral liquid, regardless of blood group affiliation. Further, processes of bone resorption in blood and oral liquid were examined in patients with GP, carriers of O(I) and A(II) blood groups. It was noted that the process of bone formation for these levels of osteocalcin and alkaline phosphatase were significantly lower in patients with GP, in O(I) and B(III) blood groups. Conclusions. The results of the study showed that in patients with GP there is an imbalance in the processes of bone remodeling, regardless of AB0-belonging. The study of the composition and functions, not only of blood, but also of saliva, can find high regulatory and trophic potential of this biological environment and the diversity of its protective and compensatory features.

Introduction. The anatomy of the gluteal and anterior femoral regions is characterized by considerable age and individual variability of the muscles and neurovascular formations, which is a rather common cause of complications during surgical interventions. Objective. The study aimed at determining the age and individual anatomical variability of the parietal branches of the internal iliac artery and the branches of the external iliac and femoral arteries during the fetal period of human ontogenesis. Materials and methods. The study included 80 specimens of fetuses, aged 4-10 months, of 81.0-375.0 mm of crown-rump length (CRL), without external signs of anatomical impairments or developmental malformations. Results. The branches of the iliolumbar artery anastomosis with the deep circumflex iliac artery and obturator artery; the lateral sacral arteries anastomosis with the branches of the median sacral artery. The branches of the right and left superior gluteal arteries (SGA) anastomosis at different frequencies with the internal pudendal artery, the inferior gluteal artery (IGA), the deep circumflex iliac artery, the lateral femoral circumflex artery (LFCA), the fourth lumbar artery and the obturator artery. The inferior epigastric artery anastomoses with the inferior posterior intercostal arteries, the lumbar arteries, and the superior epigastric artery. The latter also anastomoses with the branches of the superficial epigastric artery. The branches of the right and left medial femoral circumflex artery (MFCA) with different frequency form anastomoses with the obturator artery, IGA and SGA, the internal pudendal artery, LFCA and the first perforating artery. Also. the variants of the topography of the accompanying artery of the sciatic nerve in human fetuses were indicated. Conclusions. 4-10-month-old fetuses are characterized by the age and individual anatomical variability of the arteries of the pelvic and femoral walls.

Background. Escherichia coli enteritis is one of the most common causes of diarrhea in developed countries and is caused usually by pathogenic strains of Escherichia coli. Objectives. To investigate the role of reactive response of polymorphonuclear neutrophilic granulocytes (NG) of peripheral blood in the systemic inflammatory response mechanisms of acute Escherichia enterocolitis (AEC), depending on genes polymorphism of heat shock proteins (HSP) family 70-2 (HSP70-2, 1267A®G) and interleukin 10 (IL-10, C-592A). Material and methods. The genes polymorphism was analysed by PCR based method in 95 patients with AEC and 30 healthy individuals. Clinical markers of immune disorders were evaluated after hematological indices, based upon an extended general clinical blood analysis, using verified formulas. Results. The endogenous intoxication severity did not depend reliably on genotypes of IL-10 gene (rs1800872), however it was significantly 23.68% (?=0.043) higher in GG-genotype carriers of HSP70-2 gene (rs1061581). The reduction of cellular reactivity by 14.71-19.08% (?<0.01) did not depend on the analyzed genes genotypes. But general non-specific immune reactivity decreases 3.49-4.24 times (?<0.001) was deeper in GG-genotype carriers of HSP70-2 gene and AA-genotype carriers of IL-10 gene by 17.78% (?=0.009) and 12.37% (?=0.023) respectively. The immunologic resistance index was lower by 18.75% (?=0.024) in GG-genotype carriers than in patients with ? allele. Conclusions. Hematological indices, based upon an extended general clinical blood analysis, are indicative and reliable non-specific clinical markers of immune disorders in case of AEC.

Introduction. The results of the surgical treatment of ventral and incision hernias in the obese patients are poor, because of the high incidence of complications and relapses. The objective of the study was to analyse the outcomes of patients with hernias, obesity and non-specific connective tissue dysplasia (NSCTD), and to define the main predictors of complications development. Methods. We analysed the outcomes of treatment in 1133 patients, who underwent surgery for primary and incision ventral hernia between 2006-2017. Results. Pulmonary embolism was diagnosed in 0.62% of the patients, abdominal compartment syndrome (ACS) in 3.0% of the individuals, after stretching hernioplasty. The highest incidence of wound complications was evidenced in patients with stage 3 obesity – 35.14%. The signs of NSCTD were present in 53.45% of the patients with recurrent hernia, and in 18.61% of the patients with no recurrence of hernia. In patients with obesity stage 1 and 2, the development of ACS depended only on the chosen method of surgical intervention. In patients with no recurrent hernia, the division of patients according to their blood groups did not significantly differ from the general population. Conclusions. The non-stretching methods of hernioplasty should be a priority, especially for patients with morbid obesity, stage 2-3, and significant comorbidity. The risk group for relapses also includes the patients with NSCTD and A(2) blood group, since the incidence of NSCTD in these individuals is statistically significantly higher.

Background. Wrist arthrosis is a painful disease that is responsible for a reduced wrist function and upper limb dysfunction. Proposed by Watson in 1984, scaphoidectomy and four-corner arthrodesis has good results in scapho-lunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) treatment. Objectives. The purpose of this study was to analyze the results of four-corner arthrodesis using Kirschner wire and shape-memory staples. Methods. 12 patients (12 wrists) were operated by scaphoidectomy and four-corner arthrodesis according to Watson technique, using Kirschner wires fixation for capito-luno-hamato fusion and shape-memory staples for hamato-triquetral fusion. The mean age of the patients was 64.7 years, and the period of follow-up was 2.1 years. Results. The results were evaluated using preoperative data, surgery protocols and clinical postoperative data obtained at follow-up: pain, patient’s satisfaction, force, range of motion, X-ray imaging. The fusion was achieved in all cases in a mean time of 2.4 months for all involved articulations. The mean postoperative range of motion was 26.25° of extension, 24.16° of flexion, 16.11° of radial inclination and 18.89° of cubital inclination. After surgery, compared to the unaffected contralateral side, grip strength was 62.8%. Conclusions. Combination of K-wires and shape-memory staple for four-corner arthrodesis is very efficient in treating SLAC and SNAC lesions.

Introduction. Liver cirrhosis (LC) is a chronic disease characterized by destruction of liver cells, changes in its lobular structure and vascular system, enlargement of connective tissue and irreversible dysfunction of the organ, with severe mental and psychological complications. Not only the treatment and prevention of complications, but also the psychological support of the patients with liver cirrhosis and their families are important. The objectives of the study. To explore empirically the individual psychological features of patients with LC, as well as to identify the gender peculiarities of the personality of the patient with LC. Material and methods. The study was conducted in the gastroenterology department of Chernivtsi Regional Clinical Hospital, Ukraine, from September 2017 to April 2018. The research involved 24 patients (9 women and 15 men). The average age of patients was 64 years. Methods as observation, conversation, R. Cattell’s Multi-Factor Questionnaire were used to diagnose individual psychological peculiarities. Results. As indicated by the results of the study of the communicative qualities of patients with LC, high levels were detected in such factors as Dominance (54%) and Vigilance (83%). As for the group of intellectual qualities, the average level prevails. Concerning the group of emotional qualities, the average level of internal stress, emotional sensitivity, anxiety, self-control, courage and organization in social contacts prevails among the patients with LC disease. According to the results of the study of the regulatory qualities of patients with LC, the vast majority of respondents demonstrated a high level of self-discipline (79%). Conclusions. A comparative analysis of gender peculiarities has shown that women with LC tend to demonstrate sociability, internal stress; they are more self-disciplined than men, whereas men with LC are more open to the perception of new things. It is worth paying attention to the fact that both men and women of this sample were found to have a low level of emotional sensitivity.

Introduction. Considering the inadequate results of the actual treatment, the search for new means of pathogenic therapy of Alzheimer’s disease is important. The objective of the study. To assess the efficacy of new original modulator of gamma-aminobutyric acid (GABA)-ERGIC carbacetam system by the dynamics of parameters of the cognitive ability of rats with Alzheimer’s disease. Materials and methods. Alzheimer’s disease was simulated by intraperitoneal introduction of scopolamine hydrochloride (Sigma, USA) during 27 days, in the dose of 1 mg/kg. Beginning with the 28th day of the experiment, carbacetam was introduced intraperitoneal, in the dose of 5 mg/kg in 1 ml of physiological solution (saline) – once a day during 14 days. Results. Behavioral reactions of rats with Alzheimer’s disease after carbacetam introduction in the “open field” test, were characterized by reduced period of “immobility”, increase motor, orientation-learning activity; in “conditioned passive avoidance reflex” test – increased latent period of entering rats into a dark chamber connected to electric current. Conclusions. Behavior of rats with Alzheimer’s disease in “open field” test after carbacetam introduction during 14 days was characterized by reduced latent period of “immobility”, improvement of motor and orientation-learning activity. It was indicative of decreased anxiety level, improvement of adaptation and cognitive reactions. Increased latent period in conditioned passive avoidance reflex (CPAR) test on the 1st and 14th day of carbacetam introduction reflected more effective retention of the conditioned reflex to electric painful stimulation, and improvement of cognitive ability of rats with Alzheimer’s disease respectively, under the influence of the new endogenous modulator of GABA-ERGIC system.

Introduction. An early diagnosis of primary immunodeficiencies (PID) prevents the development of complications and improves the quality of life of children with PID. A large number of PID are undiagnosed or misdiagnosed. An important challenge is improving the awareness of physicians about these diseases. The objective of the study was to evaluate the knowledge about primary immunodeficiencies among postgraduate medical students of different specialties. Methods. A survey among postgraduate medical students of different specialties on awareness of PID was conducted. The study involved postgraduate medical students (interns) of I. Horbachevsky Ternopil State Medical University, Ukraine. There were 93 participants: 17 pediatricians, 27 general practitioners / family (GP/F) physicians, 39 internists, 10 surgeons. The survey consisted of a questionnaire containing 25 questions. Results. The average percentage of correct answers given by the surveyed postgraduate medical students was 63.6%, and ranged from 24.7% to 91.4%. The highest level of knowledge was demonstrated among pediatricians (76.9%). The lowest knowledge was revealed concerning the specific signs of PID, in particular verification of ataxia-telangiectasia and management of Nijmegen breakage syndrome. The percentage of correct answers about warning signs of PID in children was 88.2% among pediatricians and 63.5% among internists. Conclusions. The study has shown insufficient knowledge about PID among postgraduate medical students of different specialties. Identified weaknesses in educating and training of postgraduate medical students about PID will help to enhance the educational programs that may benefit of early diagnosis, patient’s management and improve quality of life of children with PID.

Introduction. The association between cognitive functions and personal traits is a question of interest and debate. Diabetes mellitus is associated with cognitive changes. The aim of our study was to find if any relations exist between cognitive functions and personal traits in persons with diabetes. Material and methods. We examined 115 patients (average age 62.47±10.60 years; 49 males, 66 females) with diabetes (13 with diabetes type 1 and 102 with type 2 diabetes; mean duration of disease 9.28±6.8 8years), admitted during 2016-2017 in the Neurology Clinic of the University Hospital “Sofiamed”, Sofia, Bulgaria. After having signed the informed consent, all patients underwent full somatic and neurological examination, and fulfilled specific neuropsychological tests and personal questionnaire (Minnesota Multiphasic Personality Inventory 2, MMPI). Results. We found statistically significant associations between MMPI subscales and cognitive domains. Conclusions. Our data analysis shows significant associations between cognitive functions and personal traits. We suggest that cognitive-focused therapy can improve some negative personal traits and vice versa.

Hernia was a common problem in Hellenic antiquity as we may infer by a plethora of references in ancient Greek and especially in Byzantine medical literature. However, in ancient Greek art there discovered only two examples representing this rather common surgical entity. Hernia is depicted in two Hellenistic terracotta figurines, one male and one female. They were part of a course in an ancient school or votive offerings in a sacred ancient temple. Although surgery was an existent medical branch at the era, it seems that only a radical ablation, probably fatal, was performed by medico-philosophers and surgeons.

Introduction. Multiple studies have assessed the role of the stress, as well as of the quality of life, in patients with heart failure. However, specific data about the quality of life in patients with cardiorenal syndrome (CRS) are limited. The objective of the study. To assess the quality of life and the level of psychosocial stress in patients with type 2 cardiorenal syndrome. Materials and methods. We performed a case-control study for the comparative analysis of two groups of heart failure (HF) patients, with mid-range or reduced ejection fraction: 78 cardiorenal syndrome patients and 64 patients with no renal impairment. Results. The quality of life parameters were diminished in most of the patients with HF, being more noticeable in the cardiorenal group, 23.6 vs. 28.62 points (p <0.001). HF patients with renal impairment have a more altered psychological state compared to patients without renal impairment, due to depression, anxiety and reduced vitality related to heart disorders, as well as renal dysfunction (32.67 vs. 36.06 points, p <0.05). The stress level was lower in subjects with CRS compared to those with no CRS – 315.57 vs. 329.97 points (p?0.05). Factors enhancing stress resistance were more common in the CRS group. Conclusions. CRS influences patients’ status significantly, mostly by diminishing the quality of life.

The proportion of older people continues to grow worldwide. This, along with an increase in the prevalence of oral diseases, will significantly challenge health and social policy planners. Oral health is often neglected in the elderly and oral diseases associated with aging are complex, adversely affecting the quality of life. Identifying the psychopathology or the type of deviation from normality in the elderly, involves the assessment of psychological health and the operation with the psychological health major symptomatology. One of the dentist’s difficulties may be the recognition of a particular disorder in the case of an individual who is accusing a suffering state. The communication between the doctor and the elderly patient, which is the key in geriatric practice, is not optional, because it helps to achieve an efficient medical act in an appropriate, relevant and satisfactory manner for the care of the elderly patient. Discussion with the patient should be appropriate to the level of understanding of the individual elderly person. The patient’s cooperation is essential for any type of dental treatment. The biopsychosocial concept is fundamental to find an optimal treatment for oral diseases. The oral health influences the mental health of patients, changing their self-esteem, mood and satisfaction, even influencing their social life and quality of life. This is an important factor that has a direct influence on the general health and quality of life of older people, fundamental factors for “healthy aging”.

Vitiligo is a chronic, asymptomatic, disease that affects the patient from a cosmetic point of view. It is characterized by the appearance of depigmented areas on the skin or mucous membranes. Depending on the morphology of the lesions, vitiligo can be classified into: segmental, non-segmented or mixed. Vitiligo is associated with a range of autoimmune disorders, most commonly autoimmune thyroid diseases, alopecia areata, halo nevi, psoriasis, diabetes, etc. Etiology is not entirely elucidated, autoimmune theory related to specific genetic mutations being the most studied.

Rare diseases are a special category of pathology recognized as such relatively recently, starting about 30 years ago in the USA and around the year 2000 in Europe. Rare diseases are clinically and therapeutically heterogeneous, being characterized by a number of common aspects that have a negative impact on patients’ evolution and quality of life, such as: delayed diagnosis, limited scientific knowledge about some of them, lack of treatment or limited availability of treatment. At the same time, information campaigns on rare diseases are limited, and the number of association of patients that promote their interests and rights is also reduced. The quality of physician- patient relationship is particularly important in the management of rare diseases, non-medical aspects, especially the ethical and moral aspects, being often more relevant to patients than the medical aspects. The ethical framework for the analysis of rare diseases encompasses a number of particular aspects, generated on the one hand by the need to properly approach patients suffering from rare diseases in the context of rising expectations for the medical system, and on the other hand, the pro-profit behavior of the pharma companies. This paper analyzes the particular ethical issues identified in the clinical approach on rare diseases, with a focus on the particularities of the physician-patient relationship in this context.

Pétrequin was a French surgeon born in the town of Villeurbanne, near the city of Lyon. He lived in an era when surgery was evolving towards a more complex and modern specialty. His magnificent career was shared between surgical pathology and history of surgery. His two most significant works were “Traité d’anatomie médico-chirurgicale et topographique” (An Assay of Medical and Surgical Anatomy and Topography) and “La chirurgie d’Hippocrate” (The Surgery of Hippocrates). Having realized the need for surgery to be combined with anatomy, he was the scholar who introduced the concept of surgical anatomy. His innovations, travels and publications won him a series of nominations and a place among th greatest European surgeons and philosophers of all times.

Introduction. Considered by many authors a vestigial structure, the appendix is a small dimensions organ with mostly unknown functions. Acute appendicitis is the most common condition of the ileocecal appendix, having multifaceted clinical manifestations, often masquerading as various unrelated syndromes, but causing increased morbidity, especially when diagnosed late. Although the disease could manifest at any age, there is a progressive increase of its incidence from birth, with a maximum between 10 to 40 years. Case presentation. We report the case of an 84 years-old female patient, who presented with significant abdominal pain in the lower quadrants, mainly in the right iliac fossa and in whom the CT examination was suggestive of a utero-appendicular fistula, a very rare complication in daily practice and even more seldomly encountered in the elderly. Conclusions. Acute appendicitis remains a condition for which surgery is still the optimum treatment, especially in the case of an elderly patient having a radiologically suspected fistula with the uterus that could easily lead to septic gynecological complications and possibly progression to multiple organ failure.

Introduction. The glucose-6-phosphate-dehydrogenase (G6PD) deficiency is probably one of the most frequent genetic alterations and represents a public health issue, affecting more than 400 million people worldwide. Due to migration, G6PD deficiency cannot any longer be determined in a specific geographical location, but it can occur anywhere, including Romania. Case presentation. We present the case of a newborn hospitalized for prolonged neonatal jaundice because of a combination of risk factors (preterm birth, breastfeeding and G6PD deficiency) and medication – paracetamol and hepatoprotective syrup from Ayurvedic traditional medicine, that triggered the hemolytic crisis. After the diagnosis was established, the intake of drugs received at home was stopped and the hemoglobin and hemoglobinuria values were monitored; the iso-group iso-Rh erythrocyte mass was administered and the posttransfusion hemoglobin was determined. At discharge, the family was trained to know the factors that delineate the hemolytic crisis, as well as the recognition of the occurrence of a hemolytic crisis, in order to address the emergency specialized service. Berberine, the hemolysis trigger factor, is found in green pharmacy preparations and as such in the present context – of mixed races population and of the globalization – we can expect an increase in hemolysis incidence associated with G6PD deficiency. Conclusions. The identification of high-risk populations – through well conducted family medical history and screening – reduces the possibility of irreversible neurological damage. Educating the parents and the medical staff involved in the care of these newborns plays an extremely important role, avoiding the exposure to the chemical, medication and alimentary triggers being a very efficient way of preventing the hemolytic crisis.

Introduction. Eosinophilic esophagitis (EoE) is a rare pathology characterized by chronic inflammation with mucosal eosinophilic infiltrate of the esophagus. The clinical symptoms vary according to the age group, from recurrent abdominal and thoracic pain, vomiting, dysphagia, food impaction and gastroesophageal reflux symptoms refractory to treatment with proton pump inhibitors. In the recent years, different studies suggest that EoE is now the leading cause of food impaction in the adult population. Case presentation. A 30-year-old female, without a pathological personal history, was admitted with symptoms of esophageal food impaction. Upper endoscopy revealed esophageal rings and the bolus impacted in the lower esophagus. Biopsy samples were obtained from several different locations, including areas away from the site of food impaction. Histopathologic examination revealed esophageal mucosal eosinophilic infiltrate >15 eosinophils per high-power field. Proton pump inhibitor (PPI) therapy, twice-daily dosing for 8 weeks was administered, as the first line treatment. Conclusions. Consensus guidelines for the diagnosis of EoE require symptoms of esophageal dysfunction, 15 or more eosinophils per high-power field on microscopic examination of esophageal biopsy after 8 weeks on a high-dose proton pump inhibitor (PPI), and the absence of alternative causes of eosinophilia.

Introduction. The parotid gland, the largest salivary gland, can be the site of various pathology. Any swelling located in the parotid gland requires thorough investigations. Symptoms usually include a painless, unilateral tumor, with a slow evolution. Histology establishes the therapeutic plan. Case presentation. We present the case of a 60 years-old patient, known with a tumoral mass in the parotid region for 3 years, who came to our clinic for a history of 3 months persistent dysphonia. Endoscopic laryngoscopy revealed a tumoral mass occupying two thirds of the right vocal cord, covered in keratin plates, with normal mobility of both vocal cords. From the patient’s record, we note an ultrasound fine needle aspiration biopsy, performed at the onset of the parotid tumoral mass, which did not reveal any malignancy criteria. Conclusions. Differential diagnosis for parotid gland pathology must include inflammatory, infectious and tumoral conditions. A complete set of investigations must be performed in order to establish the therapeutic approach. Treatment, depending on the histological type of the tumor, is commonly surgical and can be followed by radiotherapy and in some cases, chemotherapy.

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. 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.

Introduction. Immunotherapy has emerged as a potent strategy for treating advanced cancer. This generated new and exciting research, especially regarding tumour microenvironment (TME), including the immune checkpoint system, to further stratify endometrial carcinoma (EC) patients and improve targeted therapy. The objective of the study was to evaluate the TME and PD-L1 impact on various molecular groups. Material and methods. 50 cases of formerly diagnosed ECs were tested for CD4, CD8, CD68 and PD-L1. Results. PD-L1 testing in our group revealed 60% of cases showing <1% cell positivity, 34% of cases showing 1-49% cell positivity, and 6% of cases showing =50% cell positivity. The statistical analysis revealed the following significant correlations with clinical and pathological parameters: pT (p=0.012), FIGO stage (p=0.028), myometrial invasion (p=0.037) and ESMO risk stratification (p=0.017). PD-L1 expression in the three different molecular subgroups showed significant correlation with the MSI-H subgroup (p=0.014). The analysis between TME and PD-L1 expression revealed significance with stromal CD4+ cells (p=0.037), tumour and stromal CD8+ cells (p=0.011, p=0.028), and stromal CD68+ cells (p=0.012). Conclusions. Molecular classification, TME evaluation and PD-L1 expression are key ancillary tools in elaborating comprehensive EC pathology reports. Combined evaluation of these features allows a more precise prognostic stratification of EC patients and provides significant implications for incorporating immunotherapy in current therapeutic strategies for EC.

Introduction. Lymphocyte subsets are important in regulating immunity and specific killing of tumour cells and appear to be strongly associated with the development of solid tumours. However, their prognostic value in cancer patients remains unclear. The objective of the study was to determine whether peripheral blood lymphocytes subsets might be prognostic markers for patients with solid cancers. Material and methods. A databases search was conducted to identify publications from 2010 to 2020 exploring the association of different lymphocyte subsets with overall survival and disease-free survival among cancer patients. Results. Twenty-nine articles referring to 14 different malignancies were included: 21 evaluated the immune parameters before surgery and 8 after surgery. Sixteen studies reported lymphopenia associated with poor prognosis, other 3 reported increased lymphocytes associated with better prognosis, while 10 studies reported different data: 6 showed correlations between high lymphocyte count and poor prognosis, one study reported low lymphocyte subsets with better prognosis and three reported no impact on prognosis. Conclusions. Lymphocyte depletion, before and after surgery, tends to be associated with reduced survival rate. Post-surgery, lymphocyte subsets could have higher predictive value compared to their preoperative levels and regulatory T cells (Tregs) may be a better prognostic indicator of survival.

Introduction. A growing number of studies indicates the increased susceptibility of patients with hematologic malignancies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as compared to the apparently healthy population. The objective of our study was to identify and evaluate the contemporary epidemiological and diagnosis patterns of chronic myeloid leukemia (CML) in the context of coronavirus disease 2019 (COVID-19) pandemic, to optimize the management of this hematologic malignancy. Material and methods. This analytical, descriptive and prospective study included 15 patients with CML and COVID-19, who were treated and followed up in the Institute of Oncology Chisinau, Republic of Moldova, between 2005–2021. SARS-CoV-2 infection was diagnosed in these patients between April 2020– September 2021. Results. These 15 cases represented 10.6% out of 142 patients diagnosed with CML and followed up under the treatment with tyrosine kinase inhibitors. There were 9 (60.0%) males and 6 (40.0%) females, with the male/female ratio 1.5/1. The patients’ age at diagnosis of COVID-19 ranged between 38-74 years (average age 54.2 years). According to the World Health Organization classification of COVID-19 severity, mild forms were registered in 4 (26.7%) cases, moderate in 6 (40.0%) and severe in 5 (33.3%) cases. Eight (53.3%) patients were hospitalized for treatment of COVID-19: 5 patients with severe forms and 3 patients with moderate forms. Viral pneumonia was diagnosed in 6 patients: 5 with severe and one with moderate form of COVID-19. Non-infectious comorbidities were registered in 4 of 5 patients with severe COVID-19 forms. Conclusions. COVID-19 commonly affects CML patients of male gender and older than the average age of patients with CML. Patients without hematologic response presented an unfavorable evolution of both diseases, CML and COVID-19.

Background. Hematologic markers ratios have been proposed as indicators to assist in the diagnosis and risk stratification of infectious diseases. The objective of the study was to explore the predictive value of neutrophils and monocytes to lymphocytes ratios (NLR and MLR, respectively) and to determine their cut-off values for the early severity stratification in mechanically ventilated critically ill SARS-CoV-2 infected patients. Material and methods. This study was retrospectively conducted on 193 patients admitted with COVID-19 in a specialized center in Jordan. Data were retrieved from the electronic medical record system over 9 months, between April – December 2020. Patients aged below 18 years, with a hospital length of stay less than 7 days, and whose studied variables were totally or partially missed were excluded from our study. An Independent and One-Sample T-Tests were used for parametric comparative data while non-parametric comparative variables were analysed using Chi Square Test. A receiver operating characteristic (ROC) was plotted to investigate the area under each curve (AUROC) of the tested prognosticator. Results. The mean age of the entire study group was 58.37 9.96 years, and the survivor group was insignificantly older than the non-survivor group (58.55 9.95 years versus 58.09 10.05 years, respectively). The 28-day intensive care unit mortality was detected in 94 patients (48.70%) during a mean of 12.40 4.79 days. NLR and MLR were significantly lower in the survivor group compared to the non-survivor cohort (2.22 0.99 and 0.25 0.10 versus 5.16 2.08 and 0.89 0.19, respectively, p <0.05). Conclusions. In this study, the higher values of MLR and NLR in patients with COVID-19, particularly in those with mechanical ventilation, could be used as predictors for risk stratification of patients with COVID-19.

Introduction. The development of angiosurgery requires the morphologists to clarify in more details the topographic anatomical peculiarities of arterial vessels, considering their morphogenesis, peculiarities of innervation, age and individual anatomical variability in different periods of human ontogenesis. The objective of the study was to clarify the sources and peculiarities of innervation of the aortic arch and thoracic aorta in human fetuses. Materials and methods. The study was performed on 36 preparations of human fetuses of 81.0-375.0 mm of parietal-coccygeal length using a combination of methods, such as macro-microscopic preparation, vascular injection, application staining, making of 3D reconstruction models, morphometry. Results. The sources of innervation of the aortic arch in human fetuses are the cervical cardiac branches of the vagus nerve, the cervical cardiac nerve and the single branches of the upper three or four thoracic ganglia of the sympathetic trunks. The innervation of the thoracic aorta is performed by the branches of the thoracic aortic plexus, collateral trunk and also the branches of the paraaortic plexus, which is located between the sympathetic trunk and the thoracic aorta on both sides. From each thoracic ganglion and internodal branch of the sympathetic trunks depart 2-6 branches, some of which go to the thoracic aorta along the posterior intercostal arteries, and the other branches are connected by connecting branches forming the collateral trunk. The vagus nerve throughout the thoracic region gives branches to the thoracic aorta with the formation of the thoracic aortic plexus. Conclusions. In human fetuses, the paraaortic plexus is found between the right and left sympathetic trunks and the thoracic aorta, in addition to the intermediate plexus or collateral trunk. In the dynamics of the fetal period of ontogenesis, a bilateral asymmetry in the structure and formation of plexuses of the thoracic aorta is observed. At the end of the human fetal period, the number of connecting branches between the nerve branches of the paraaortic plexus increases.

Introduction. Inulin has high potential as a supplement for food, pharmaceutical and medical use and raised an increased interest in obtaining high-quality products. The objective of the study was to evaluate the physiological impact of the administration of inulin obtained by microwave hydrodiffusion and gravity (MHG). Materials and methods. Helianthus tuberosus was used as a raw material from commercial sources. The inulin was extracted using MHG, followed by separation. The extraction method has been optimized by surface response methodology (SRM). The obtained inulin was administered to laboratory animals. The influence of the administration of standard inulin (INS), inulin obtained by MHG (INE) and inulin obtained by MHG in combination with quercetin (INE+Q) was evaluated, for 12 days, on the variation of weight and blood parameters such as blood sugar, cholesterol and triglycerides. Results. Inulin was obtained at optimal values (74.74 C and 15.55 min); the yield was 72.98%. The statistical analysis revealed that on the first day of treatment there are statistically significant differences only between the groups treated with INS and INE. On the third day of treatment, significant differences occur only when comparing the weights recorded in the batches treated with INS and INE+Q. In the following days of treatment (5th, 7th, and 9th) there were statistically significant differences only between the groups treated with INS and INE. Even though there are significant differences between the two groups, all data fall within the normal range. On the 12th day of treatment, the results obtained were considered statistically insignificant. Conclusions. The use of inulin obtained by innovative MHG proved to have positive effects on laboratory animals.

Bilio-pancreatic malignant neoplastic diseases are characterized by aggressive evolution and low 5-year survival rates. The only therapeutic method with curative potential remains surgical treatment. Unfortunately, a very high percentage of patients are diagnosed in advanced stages, no longer suitable for surgical resection. Studies in recent years have focused on identifying new therapeutic techniques to improve the quality of life and survival of these patients. One of these techniques is endoscopic radiofrequency ablation, that showed good results in terms of morbidity and mortality, with an acceptable rate of complications.

Introduction. Pseudoaneurysms of superior mesenteric artery and its branches are extremely rare but life threatening when complications occur. However, the diagnosis is often missed or delayed because of its non-specific signs and symptoms. Treatments depend on patient’s characteristics. In contrast to conventional open surgery, endovascular therapy has been reported as an effective option with minimally invasion, low complication, short recovery time and good outcome, especially in high-risk patients. Case presentation. We describe a case of ruptured pseudoaneurysm of ileal artery, a branch of superior mesenteric artery, presenting with gastrointestinal bleeding signs while on anticoagulant therapy. Both upper and lower gastrointestinal endoscopy were inconclusive. The diagnosis was confirmed by angiography and the patient was successfully treated by coil embolization. Conclusions. Ruptured pseudoaneurysm of superior mesenteric artery and its branches should be suspected in patients with unexplained gastrointestinal hemorrhage. Endovascular intervention is a feasible approach, especially in patients with multiple comorbidities and high bleeding risk.

Introduction. Acetaminophen (paracetamol) is a widely used drug and known as a safe analgesic and antipyretic. Hepatotoxicity is usually the first complication of acetaminophen overdose. Nephrotoxicity usually appears after liver toxicity. Most studies on this topic focused on cases of acute over dosage of acetaminophen, with fewer studies on the effects of chronic overdose. Case presentation. We present the case of 74-year-old woman with acute kidney failure because of chronic overdose of acetaminophen and a minireview of the literature. The patient presented to the emergency unit for confusion, with altered vital parameters. She had regularly used 5-6 g/ day of paracetamol over the previous 4 weeks because of articular pain. Acute kidney and hepatic failure were diagnosed. After specific treatment, the patient was discharged in a good condition. Conclusions. An appropriate history of administered drugs (including those without prescription by the physician) allows the accurate diagnosis and enables a faster therapeutic management. In the case presented, hyperkalemia accompanied by syncope from bradycardia raised the suspicion of the diagnosis of acute kidney injury.

Introduction. The introduction of COVID-19 screening through rapid antigen tests has become a key mechanism to ensure the continuity of the learning process and safety of school environment during pandemic. The objective of the study was to investigate and analyse the attitudes and beliefs of students, teachers, and parents regarding the rapid antigen test as a method to limit COVID-19 spreading in school environment. Material and methods. An online anonymous survey was conducted among 228 participants, 11th and 12th grade high school students (n=114), teachers (n=44) and parents (n=70) in November 2021. Results. 43.9% of students and 52.9% of parents agree with rapid antigen testing for COVID-19, while over 63.3% of teachers disagree with it. Students (45.6%) and parents (48.6%) shared optimistic expectations that testing for COVID-19 would reduce the spread of the virus in schools, while 59.1% of the teachers surveyed remained sceptical about this prevention measure. The interruption of school classes does not find support among students and parents, as well as among members of the teaching staff. Conclusions. According to students and parents, rapid antigen testing for COVID-19 seems a more acceptable solution than closing school completely. Given the concern of teachers to conduct antigen tests in the school environment, it is necessary to adequately plan the participation of medical professionals in this process, instead of delegating these activities to teachers.

Introduction. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) belongs to a family of ribonucleic acid (RNA) viruses, causing novel coronavirus disease 2019 (COVID-19). Because of a global inflammatory response and endothelial damage, COVID-19 may predispose to coagulation disorders and severe thrombotic events. Case presentation. A 62-year-old man patient was admitted for COVID-19 pneumonia and abdominal pain for 10 days. Because of the rapid deterioration of the clinical status, shock and evidence of peritoneal irritation, the patient was consulted by a surgeon. The native spiral computed tomography (CT) of the abdomen detected enlarged colon filled with air collections and hydro-aeric levels. The surgical intervention revealed diffuse peritonitis with necrosis of the distal ileum secondary to mesenteric thrombosis. A partial resection of the ileum was done. The histological examination showed an infarcted small bowel, with hemorrhage, vascular thrombosis, and signs of necrotizing endovasculitis. Conclusions. SARS-CoV-2 binds to ACE2 receptor, which results in increased signalling by thrombin receptors on platelet and endothelial cells, leading to coagulopathy. In older patients presenting with abdominal pain, shock and peritonitis, the most common underlying cause is mesenteric thrombosis which could be a complication of COVID-19.