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Controlling pain after major orthopedic surgery may be challenging, and it is related to delayed recovery, the development of chronic pain, and analgesic dependence. It is well known that effective postoperative pain control can reduce hospital stays by ensuring a more rapid rehabilitation, thereby decreasing the overall costs. Despite the development of analgesics, the use of opioids and their derivates remains the cornerstone of treatment for patients with acute moderate-to-severe pain in association with general or regional anesthesia. To reduce the risk of side effects and opioid addiction, considering the alarming epidemiological reports in relation to opioid abuse, combined analgesic methods are used, in addition to lower dosages or different forms of administration, such as transdermal administration. Fentanyl transdermal patches appear to be effective in controlling postoperative pain as part of multimodal analgesic regimens in knee and hip surgery, shoulder arthroplasty, traumatic fractures, and one-day surgery; this treatment has fewer associated side effects and can be safely used even in patients with renal impairment. It is also recommended for postoperative pain management in combination with a femoral–sciatic nerve block during foot and ankle surgery. [ABSTRACT FROM AUTHOR]

Postoperative anaemia can affect more than 90% of patients undergoing major surgeries. Patients develop an absolute iron deficiency in the face of significant blood loss or preoperative anaemia and major surgery. Studies have shown the negative impact of these factors on transfusion requirements, infections, increased hospitalisation and long-term morbidities.

Nowadays, schizophrenia is treated with atypical antipsychotics that can determine neuroleptic malignant syndrome or rhabdomyolysis appearance. In addition to trauma and muscular hypoxia, there are some drugs and toxins associated with rhabdomyolysis development, among which olanzapine. A case of severe rhabdomyolysis syndrome, with extremely high levels of serum creatine kinase (CK), followed by acute kidney failure, secondary to olanzapine overdose and prolonged immobilization is outlined. Continuous renal replacement therapy was performed, with a slow clearance of serum CK levels. Under supportive therapy, systemic alkalinisation with volume resuscitation and corticotherapy, patient’s general condition was improved, as well as his lower limb paresis. He followed frequent psychiatric evaluations and psychotherapies, before and after being transferred to a medical service. Rhabdomyolysis diagnosis is difficult in mild cases due to non-specific signs and symptoms, but it also has some typical manifestation, generically called “the rhabdomyolysis syndrome triad”. The treatment is usually supportive; renal replacement therapy is required in the presence of acute kidney injury unresponsive to aggressive volume resuscitation. The systemic myoglobin release is responsible for renal injury. Olanzapine muscle toxicity can lead to severe rhabdomyolysis syndrome complicated with acute kidney injury and multiple organ dysfunction syndrome. Rapid identification and aggressive therapeutic management are essential for improving patients’ outcome and prevent the occurrence of irreversible injuries.

Chronic kidney disease (CKD) represents an increasingly common pathology that affects patients' quality of life, and it is frequently associated with a high mortality rate, especially in the final stages of the disease. At the same time, diabetes mellitus is a chronic disease that contributes to the increased number of patients with CKD through diabetic kidney disease (DKD). The alternation of hypoglycemia with hyperglycemia is a condition in the occurrence of microvascular complications of diabetes, including DKD, which involves structural and functional changes in the kidneys. The therapeutic management of diabetic nephropathy is a much-discussed topic, both from nutritional medical recommendations and a pharmacotherapy perspective. The diet starting point for patients with DKD is represented by a personalized and correct adjustment of macro- and micronutrients. The importance of nutritional status in DKD patients is given by the fact that it represents a modifiable factor, which contributes to the evolution and prognosis of the disease. Since, in most cases, it is necessary to restrict many types of food, malnutrition must be considered and avoided as much as possible. [ABSTRACT FROM AUTHOR]

High flow nasal cannula (HFNC) oxygen therapy devices are used on a daily-basis in many intensive care units and postoperative wards. Such a device deliver a mixture of air and oxygen, warmed, humidifi ed, with gas flow between 20-60 L/min, and inspired oxygen fraction between 0.21-1. Therefore, it improves oxygenation, decreases dead space, washes out the carbon dioxide (CO2) from patients’ airways, improves thoraco-abdominal synchrony and decreases the work of breathing. Studies have shown effi cacy of HFNC oxygen therapy use for acute hypoxemic respiratory failure, for patients with exacerbations of chronic pulmonary diseases, after extubation in order reduce the need for mechanical ventilation, in perioperative period to prevent atelectasis and in palliative care, in order to reduce breathlessness. It isn`t feasible for patients with severe altered neurological status, facial trauma, basal skull fracture, complete airway obstruction or epistaxis. There are no standardized recommendation for the use or contraindication of HFCN oxygen therapy. The weaning is realised according with patients’ tolerance, oxygen saturation, respiratory and heart rates.

Acute kidney injury (AKI) is one of the main conditions responsible for chronic kidney disease (CKD), including end-stage renal disease (ESRD) as a long-term complication. Besides short-term complications, such as electrolyte and acid-base disorders, fluid overload, bleeding complications or immune dysfunctions, AKI can develop chronic injuries and subsequent CKD through renal fibrosis pathways. Kidney fibrosis is a pathological process defined by excessive extracellular matrix (ECM) deposition, evidenced in chronic kidney injuries with maladaptive architecture restoration. So far, cited maladaptive kidney processes responsible for AKI to CKD transition were epithelial, endothelial, pericyte, macrophage and fibroblast transition to myofibroblasts. These are responsible for smooth muscle actin (SMA) synthesis and abnormal renal architecture. Recently, AKI progress to CKD or ESRD gained a lot of interest, with impressive progression in discovering the mechanisms involved in renal fibrosis, including cellular and molecular pathways. Risk factors mentioned in AKI progression to CKD are frequency and severity of kidney injury, chronic diseases such as uncontrolled hypertension, diabetes mellitus, obesity and unmodifiable risk factors (i.e., genetics, older age or gender). To provide a better understanding of AKI transition to CKD, we have selected relevant and updated information regarding the risk factors responsible for AKIs unfavorable long-term evolution and mechanisms incriminated in the progression to a chronic state, along with possible therapeutic approaches in preventing or delaying CKD from AKI. [ABSTRACT FROM AUTHOR]

The limited antifungal drugs available and the rise of multidrug-resistant Candida species have made the efforts to improve antifungal therapies paramount. To this end, our research focused on the effect of a combined treatment between chemical and photodynamic therapy (PDT) towards a fluconazole-resistant clinical Candida albicans strain. The co-treatment of PDT and curcumin in various doses with fluconazole (FLC) had an inhibitory effect on the growth of the FLC-resistant hospital strain of C. albicans in both difusimetric and broth microdilution methods. The proliferation of the cells was inhibited in the presence of curcumin at 3.125 µM and FLC at 41 µM concentrations. The possible involvement of oxidative stress was analyzed by adding menadione and glutathione as a prooxidant and antioxidant, respectively. In addition, we examined the photoactivated curcumin effect on efflux pumps, a mechanism often linked to drug resistance. Nile Red accumulation assays were used to evaluate efflux pumps activity through fluorescence microscopy and spectrofluorometry. The results showed that photoactivated curcumin at 3.125 µM inhibited the transport of the fluorescent substrate that cells usually expel, indicating its potential in combating drug resistance. Overall, the findings suggest that curcumin, particularly when combined with PDT, can effectively inhibit the growth of FLC-resistant C. albicans, addressing the challenge of yeast resistance to azole antifungals through upregulating multidrug transporters. [ABSTRACT FROM AUTHOR]

Tenoxicam, a selective cyclooxygenase (COX)-2 inhibitor, has potent analgesic and anti-inflammatory effects and is frequently used for out-of-hospital pain control. Even though other non-steroidal anti-inflammatory drugs were incriminated in Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) appearance, the literature is scarce regarding this agent. We report a case of tenoxicam-induced toxic epidermal necrolysis, detailing the multidisciplinary approach in a patient presenting skin detachment of 90% of the total body surface area, with concomitant ocular, oral, nasal, and vaginal mucosae involvement. A skin biopsy confirmed the diagnosis. The immediate cessation of the incriminated drug and rapid initiation of systemic steroids, along with topical therapies, and isolation into a specific environmental condition to limit skin infection were the cornerstones of therapeutic management. The patient was discharged with skin hyperpigmentation area and mild anxiety as long-term sequels. This report emphasized that severe or complicated cases should be transferred to a specialized burn center to reduce mortality risk and long-term morbidity. [ABSTRACT FROM AUTHOR]

Background and Objectives: In the current literature, mandatory surgical exploration is a controversial topic, with some advocating for it and others against it, proposing a selective conservative management. This multidisciplinary therapeutic approach is based on clinical examination and serial paraclinical explorations associated with supportive drug treatment. Materials and Methods: The study group consisted of 103 patients with complex cervical trauma pathology produced by various mechanisms such as car or domestic accidents, aggression, ballistic trauma, self-inflicted attempts, hanging or strangulation hospitalized in the Ear, Nose and Throat (E.N.T.) Clinic, at "St. Spiridon" Iași Hospital, between 2012 and 2016. Results: The universal clinical indication for urgent surgical exploration of the patient with complex cervical trauma is the presence of the following symptoms: unstable vital signs, significant pulsatile bleeding, hematoma with a substantial increase in size, shock, airway obstruction, open airway wound, hematemesis, or hemoptysis. In this context, we considered it worthwhile to research the management of complex cervical trauma in a reference university medical center, alongside the analysis of the patient's characteristics under different aspects (demographic, pathological aspects, therapeutic). Conclusions: Complex cervical trauma has a variety of clinical aspects, with a variable evolution, which involves multidisciplinary therapeutic management. The increasing trauma rate is one of the main public health problems, requiring epidemiological studies, and the implementation of control strategies. [ABSTRACT FROM AUTHOR]

Burns represent one of the worldwide leading causes of injury. Burn wounds are associated with increased mortality and morbidity, especially the impaired quality of life due to hypertrophic scarring, scar pain and itching, paresthesia, and contractures. To properly influence the burn wound healing, it is important to establish a correct classification of the acute injury and to understand the main phase of burn wound healing process. There are various local and systemic factors that can be influenced to obtain proper healing. The most important factors include local necrosis and infection, increased local pressure and edema, anemia, hypoxia, hypotension, the presence of important chronic disease and medication, immunosuppression, nutritional status, age, and body constitution. After adequate fluid resuscitation and patient stabilization, the main step is represented by the detachment of the devitalized tissues and rapid coverage of the lesion. There are various methods to be used, like autologous or allogenic skin grafting, the use of skin substitutes, or tissue bioengineering. Knowing all these aspects, allows clinicians to properly define a therapeutic management for patients presenting severe burns. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE), essentially deep venous thrombosis and pulmonary embolism, urinary tract infection, and renal failure are the main unplanned hospital events with negative long-term impact on burn patients’ rehabilitation. Due to the hypercoagulable state induced by severe critical burns, either in the acute or recovery phase and the intimal vascular damage, the risk of VTE is increased, with an incidence varying from 0.4% to almost 60%. Other risk factors for VTE in burn patients are prolonged immobilization, long and multiple surgical interventions, central venous catheterization, wound infection and sepsis, extensive burns, and red blood cell transfusion. To avoid underdiagnosing VTE, in face of increased incidence of asymptomatic venous thromboembolism, high risk-patients should be routinely screened using Doppler ultrasound. Patients’ weight and burn size, as well as the high incidence of heparin resistance in the first weeks after injury, should be considered when establishing the optimal dose for venous thromboembolism prophylaxis, targeting an anti-Xa level of 0.2-0.5 IU/mL. [ABSTRACT FROM AUTHOR]

Severe burn injuries lead to acute kidney injury (AKI) development, increasing the mortality risk up to 28–100%. In addition, there is an increase in hospitalization days and complications appearance. Various factors are responsible for acute or late AKI debut, like hypovolemia, important inflammatory response, excessive load of denatured proteins, sepsis, and severe organic dysfunction. The main measure to improve the prognosis of these patients is rapidly recognizing this condition and reversing the underlying events. For this reason, different renal biomarkers have been studied over the years for early identification of burn-induced AKI, like neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinase-2 (TIMP-2), interleukin-18 (IL-18), and insulin-like growth factor-binding protein 7 (IGFBP7). The fundamental purpose of these studies is to find a way to recognize and prevent acute renal injury progression early in order to decrease the risk of mortality and chronic kidney disease (CKD) onset. [ABSTRACT FROM AUTHOR]

(1) Background: Despite some controversies between studies, chronic kidney disease (CKD) has a negative impact on COVID-19 outcomes, with patients presenting a higher mortality risk than in the general population. Studies have shown an association between COVID-19 severe cases and different inflammatory biomarkers. The aim of this study was to emphasize the epidemiological characteristics of CKD patients diagnosed with COVID-19 and to determine if the risk of mortality, and the severity of this infection might be influenced by different parameters. (2) Methods: Our retrospective study included CKD patients with COVID-19—362 in the non-dialysis group and 132 in the dialysis group. (3) Results: There were significant statistical differences between our groups regarding age (p < 0.001), hemoglobin (p < 0.001), interleukin-6 (p < 0.001), serum albumin (p = 0.016), procalcitonin (p = 0.002), ferritin (p < 0.001), and of course serum creatinine (p < 0.001). Even if the risk of death was higher in the dialysis group (Exp(b) = 1.839), the survival proportions were similar in both groups. (4) Conclusions: High values of hemoglobin, serum creatinine, and LDH at admission, age, length of hospital stay ≤ 10 days, and a pulmonary impairment > 25% are responsible for an adverse outcome in non-dialysis and dialysis patients diagnosed with COVID-19. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is associated with different complications, including chronic kidney disease–mineral and bone disorder (CKD–MBD), which represents a systemic disorder that involves the presence of different mineral or bone structure abnormalities (i.e., modification of bone turnover, strength, volume, etc.), including even vascular calcification development. Even if, over the years, different pathophysiological theories have been developed to explain the onset and progression of CKD–MBD, the influence and importance of serum magnesium level on the evolution of CKD have only recently been highlighted. So far, data are inconclusive and conflicting; therefore, further studies are necessary to validate these findings, which could be useful in developing a better, more adequate, and personalized management of CKD patients. [ABSTRACT FROM AUTHOR]

Background: The connection between uric acid (UA) and renal impairment is well known due to the urate capacity to precipitate within the tubules or extra-renal system. Emerging studies allege a new hypothesis concerning UA and renal impairment involving a pro-inflammatory status, endothelial dysfunction, and excessive activation of renin–angiotensin–aldosterone system (RAAS). Additionally, hyperuricemia associated with oxidative stress is incriminated in DNA damage, oxidations, inflammatory cytokine production, and even cell apoptosis. There is also increasing evidence regarding the association of hyperuricemia with chronic kidney disease (CKD), cardiovascular disease, and metabolic syndrome or diabetes mellitus. Conclusions: Important aspects need to be clarified regarding hyperuricemia predisposition to oxidative stress and its effects in order to initiate the proper treatment to determine the optimal maintenance of UA level, improving patients' long-term prognosis and their quality of life. [ABSTRACT FROM AUTHOR]

Thumb carpometacarpal (CMC) joint dislocation is rare, and the treatment options may vary from conservatives’ strategies to open reduction and fixation. In face of pain and joint instability persistence, surgical intervention is required. We present the case of a 67-year-old male that was referred to our hospital with pain and edema of the left hand, after the failure of a conservative treatment. After initial refusal of open surgery, due to the persistent joint instability, open reduction of the CMC joint dislocation was performed, and stabilized using two percutaneous Kirschner wires after repairing the joint capsule and dorsoradial ligament. Immobilization was required for 4 weeks. After that, the Kirschner wires were removed. Along with physiotherapy, the follow-up showed no pain persistence nor CMC joint luxation reoccurrence while the joint recovered its mobility. Further studies are required in order to determine the optimal therapy for such cases and to provide standardized recommendations, taking into account that the restoration of thumb CMC joint mobility is one of the most important goals in hand surgery. [ABSTRACT FROM AUTHOR]

Pain control is crucial in surgical patients, being an essential part of enhanced recovery after surgery protocols. Lidocaine, an amide local anesthetic, was primarily used as an antiarrhythmic. It has analgesic, antihyperalgesic and anti-inflammatory effects, with various actions on cardiovascular, respiratory, and digestive systems. Lidocaine has been shown to also have antithrombotic, antimicrobial, and antitumoral effects. Numerous studies have reported its safe profile and role in managing perioperative pain after breast cancer, abdominal, genitourinary, gynecologic, obstetric, orthopedic, cardiothoracic, spine, thyroid, and upper airway surgery. Lidocaine, as part of multimodal analgesia, also shows promising results in ambulatory surgery. Therefore, the use of intravenous lidocaine in the perioperative period is mainly associated with better pain control, reduced opioid use, diminished incidence of postoperative nausea, vomiting, and ileus, and exhibits antithrombotic effects. [ABSTRACT FROM AUTHOR]

Hospitalized COVID-19 patients often develop acute kidney injury (AKI), leading to increased mortality. In order to improve patients’ survival rate, it is important to understand the pathophysiology mechanism of AKI. In this brief review, we highlight the most important elements of the etiology and pathophysiology of COVID-19 associated AKI. Acute tubular injury seems to be more frequent than prerenal azotemia in COVID-19 patients and collapsing glomerulopathy is the most encountered form of glomerular disease. Another important role in acute kidney injury seems to play immune cell infiltration, inflammation, endothelial injury and microvascular thrombi. Renin-angiotensin-aldosterone system is also important in the pathophysiology of COVID-19 associated AKI. [ABSTRACT FROM AUTHOR]

Alcohol abuse is one of the leading health problems, with subsequent alcohol withdrawal syndrome (AWS) affecting around 50% of hospitalized patients, varying from mild to severe forms. Rapid recognition of AWS symptoms, along with prompt therapeutic management in the first 24 hours, can lead to better outcome. Improper treatment is correlated with seizure or delirium tremens, requiring specific intensive care management, and being the cause of with various complications, high mortality, and increased costs. Some studies reported possible predictive factors that may help clinicians identify patients at risk of developing severe or resistant forms. [ABSTRACT FROM AUTHOR]

As COVID-19 pandemic continues to test the medical world, due to rapid viral transmission and subsequent mutations, the old burning health crisis continues to surface, one of them being the blood shortage. The current situation has disrupted the fragile balance between blood donors and the real need of blood in hospitals, especially due to repetitive lock-downs, isolation, social-restrictions, and ongoing anxiety promoted by social media, threatening the quality of medical cares. [ABSTRACT FROM AUTHOR]

Purpose of review: The aim of this paper is to provide the clinician an overview about the link between iron homeostasis and erythropoiesis and how we can promote this relationship in order to improve surgical patients’ outcome. Key elements: Iron is essential for various cellular processes, like cell signalling, oxygen transport, erythrocyte and heme synthesis, mitochondrial respiration, host defence, nucleic acid replication. Erythropoietin and iron are the main erythropoiesis regulators. Under iron-restricted conditions, the erythrocytes production is impaired, leading to microcytic hypochromic anemia appearance. Iron-restricted condition enables patient capacity to recover from post-surgery anemia. Long-term consequences of chronic anemia affect patient’s quality of life. Therefore, parenteral iron supplementation, in patients with anemia secondary to blood loss, can lead to a fivefold increase in erythropoietic response, therefore enhancing recovery. Summary: Under normal circumstances, the link between iron and erythropoiesis is maintained especially through regulatory feedback mechanisms, with minimal external support. In face of important blood loss, with secondary acquired iron-restricted anemia, parenteral iron supplementation improves the bone marrow erythroid response and helps correcting haemoglobin levels. [ABSTRACT FROM AUTHOR]

Hydrotherapy represents the use of water for medical purpose, being involved in burn wound care since the 17th century. Burn wound cleansing, performed daily, twice a day, or as needed, as part of standard care, should be scheduled by a burn surgeon and supervised by proper specialists. It can be performed by various methods, like shower, immersion, bedside irrigation or wiping. Due to the high risk of cross-contamination, immersion is no longer recommended. Tap water seems to be superior to saline solution in burn wound care, and adjuvants can be added, especially chlorhexidine, povidone-iodine, or special detergents. Disposable plastic sheets use during showering and the following of cleaning protocols for washing areas have decreased the risk of infection. Apart from the wound-cleansing role, hydrotherapy reduces itching and pain, improves wound healing, favours early mobilization and increases patients’ comfort. Controversy persists around the optimal method and appropriate solutions for cleaning burn injuries and clinical studies are further required to solve this matter. In the absence of standardized recommendations, most burn centers are guided by experience. [ABSTRACT FROM AUTHOR]

The presence of inhalation injury has a negative impact on the evolution of burned patients, being associated with increased mortality. It occurs as a direct consequence of thermal action, or secondary to the presence of respiratory irritants or absorption of toxins, and actual therapeutic management is mainly supportive. Several clinical findings are relevant to raising suspicion and guiding further examinations, fiberoptic bronchoscopy being the gold standard of diagnosis and staging. In burned patients with inhalation injuries, various reports showed that nebulized heparin (5,000 or 10,000 units) with a 4-hour administration regimen leads to improved outcome, reduces the days of mechanical ventilation and consequently the length of hospital stay, reduces pulmonary complications and improves lung function, having a safe profile, with fewer side effects. [ABSTRACT FROM AUTHOR]

The article presents a case of a 31-year-old female who was rushed to a hospital due to occipital headache, paraesthesia of the lower limbs with progressive motor deficits, sensory loss and retention-like sphincter disorders to discuss neuromyelitis optica spectrum disorder.

Introduction: The prevalence of hypokalemia in psychiatric population is very high with eating disorders and laxative abuse being the main incriminated factors. Case presentation: We report a case of a 34-year-old woman with history of sleeve gastrectomy and breast implant, who presented for fatigue, severe myalgia, generalized hypotonia and palpitations. Laboratory exams revealed severe hypokalemia and rhabdomyolysis. The electrocardiography showed prolonged QT interval and ST segment depression with second-degree atrioventricular block. She received intravenous potassium supplementation with consecutive hydration. When potassium level was within safety limits, the patients received loop diuretics in order to decrease rhabdomyolysis and avoid kidney injury. The underlying cause was a pathological behavior, with frequent self-provoked episodes of nausea and vomiting after eating and chronic consumption of laxatives. She started psychotherapy. Conclusion: Psychiatric behaviour can lead to life-threatening conditions, therefore it should be discovered and managed promptly. [ABSTRACT FROM AUTHOR]

Introduction: Acute hypoxemic respiratory failure may have different causes. Case presentation: We present the case of a 42-year-old woman, with history of recent thyroidectomy and a late history of sleeve gastrectomy, who presented for acute dyspnoea. The chest X-ray revealed hydropneumothorax, and, therefore, an intercostals chest tube drainage was inserted. The evolution was unfavourable, with further respiratory status deterioration. A computed tomography of the thorax and abdomen was performed, that revealed a dilated thoracic oesophagus and stenosis of the esophagogastric junction, with lack of substance in the oesophageal wall and extravasation of oesophageal content in the posterior mediastinum, due to an oesophageal pleural fi stula. An oesophageal stent was inserted under endoscopic guidance and the patient underwent minim-invasive surgical interventions for evacuation of the mediastinal and pleural collections, with a favourable evolution. Conclusions: Acute respiratory failure can be the face of multiple conditions, some of these can be life threatening and in need for rapid detection and treatment. [ABSTRACT FROM AUTHOR]

We present a case of a 40 years old female who was admitted in our hospital after a road accident with thoracolombar, right fibula and tibia trauma injuries. Physical examination relevant for kidney injury was only represented by macroscopic hematuria. Findings on computed tomography (CT) imaging were defining to put the diagnosis of posttraumatic right renal artery thrombosis. She underwent classical total nephrectomy do to the prolonged renal ischemia time (>48 hours after the accident). [ABSTRACT FROM AUTHOR]

Work-related accidents have a great spread worldwide. The incidence of crush syndrome is 2-15% in all trauma patients and in many cases may lead to trauma related amputation. This type of patients are at risk of developing cardio-vascular instability, renal failure, other organ failure and metabolic abnormalities. The treatment is complex and should prevent and treat all the complications. In the present paper we reported a case of work related injury which lead to the above-knee amputation, followed by severe complication and difficult social rehabilitation. In this particularly cases, when you think that the fight is almost over, a new organ failure may occur and threaten the life of the patient. [ABSTRACT FROM AUTHOR]

The nose represents one of the most common sites for skin cancer, therefore, treatment usually leads to defects of this aesthetic unit that needs reconstruction procedures. Even if there are many surgical methods described in the literature, repairing this complex structure is a challenge for every surgeon. In this paper we described our method in order to cover a medium defect of the distal third of the dorsum nasi after tumor removal. A long and narrow nasolabial flap was used in a single-stage reconstruction procedure. Some minor complications were encountered due to the pushing of the flap measurement limits and the defatted choice of flap, therefore with a thin blood supply. This method lead to good outcomes with tumor recurrence-free after a 2 years follow-up and to a very good cosmetic result according to the patient's appreciation. [ABSTRACT FROM AUTHOR]

Work-related accidents have a great spread worldwide. The incidence of crush syndrome is 2-15% in all trauma patients and in many cases may lead to trauma related amputation. This type of patients are at risk of developing cardio-vascular instability, renal failure, other organ failure and metabolic abnormalities. The treatment is complex and should prevent and treat all the complications. In the present paper we reported a case of work related injury which lead to the above-knee amputation, followed by severe complication and diffi cult social rehabilitation. In this particularly cases, when you think that the fi ght is almost over, a new organ failure may occur and threaten the life of the patient. [ABSTRACT FROM AUTHOR]

The nose represents one of the most common sites for skin cancer, therefore, treatment usually leads to defects of this aesthetic unit that needs reconstruction procedures. Even if there are many surgical methods described in the literature, repairing this complex structure is a challenge for every surgeon. In this paper we described our method in order to cover a medium defect of the distal third of the dorsum nasi after tumor removal. A long and narrow nasolabial flap was used in a single-stage reconstruction procedure. Some minor complications were encountered due to the pushing of the flap measurement limits and the defatted choice of flap, therefore with a thin blood supply. This method lead to good outcomes with tumor recurrence-free after a 2 years follow-up and to a very good cosmetic result according to the patient's appreciation. [ABSTRACT FROM AUTHOR]

Background: Anemia and iron deficiency are two of the main public health problems worldwide, associated with negative outcomes in surgical patients. This experimental study aimed to create a model of acute iron deficiency with anemia through blood loss and extensive surgery. Afterwards, intravenous iron was administered to correct the iron deficiency and to improve the hematological parameters in distinct moments regarding the surgical time. To assess the optimum time for therapeutic intervention, experimental subjects were compared, performing clinical, paraclinical, and histological examinations, as well. Methods: Male rats (n = 35), aged 11–13 months, were randomly designated into six groups. Anemia and iron deficiency were obtained through a 15% blood volume loss, followed by major surgical intervention (femur fracture and osteosynthesis using Kirschner wire). Therapeutic intervention was obtained with an intravenous ferric carboxymaltose infusion, as follows: group II: intraoperative (n = 7), group III: 48 h after surgery (n = 7), group IV: 48 h before surgery (n = 5), and group V: seven days before surgery (n = 6). Group I (n = 5) was left anemic, while group 0 (n = 5) was nonanemic without therapeutic intervention. Results and Discussion: In group I, serum iron lower than in group 0 (27.04 ± 6.92 μg/dL versus 60.5 ± 2.34 μg/dL), as well as hemoglobin (10.4 ± 0.54 g/dL versus 14.32 ± 2.01 g/dL) and ferritin values (22.52 ± 0.53 ng/mL versus 29.86 ± 3.97 ng/mL), validated the experimental model. Regarding wound healing after surgical trauma, we observed that neovascularization was more significant in group III, followed by group V, with fewer neutrophils, a well-represented and rich in lymphomonocytes inflammatory infiltrate associated with the biggest collagen fiber dimensions. The periosteal reaction and callus area presented thicker trabeculae in groups II and III compared to the anemic group. Conclusions: This original experimental study assessed the effect of perioperative intravenous iron administration at a specific time by comparing the weight, hematological, and iron status-defining parameters, as well as histological characteristics of the included subjects. The present findings highlight that correcting the iron deficiency in emergency settings through intravenous iron administration intraoperatively or 48 h postoperatively could determine the improved bioumoral parameters, as well as a better evolution of the postoperative wound and bone healing compared to the anemic group or subjects that received therapeutic intervention 48 h before surgery. [ABSTRACT FROM AUTHOR]

Upper extremities are frequently involved in fire burns due to the natural protective reflexes. The presence of bilateral Dupuytrenʼs disease and COVID-19 disease in patients with circumferential upper extremity burns can negatively impact the outcome, through severe contracture and a tendency to hypoxia or infections, which affects normal wound healing. Enzymatic debridement with a concentrate of proteolytic enzymes enriched in bromelain prevents compartment syndrome development in such patients, reduces blood loss, surgery duration, and appears to favor a more rapid recovery. [ABSTRACT FROM AUTHOR]

The latest treatment guidelines for patients with arterial hypertension continues to indicate as the first line therapy a minimal association between renin-angiotensin system (RAS) blockers and a thiazide-type or a thiazide-like diuretic. In addition, according to 2018 ESC/ESH (European Society of Cardiology/European Society of Hypertension) guidelines for the management of arterial hypertension, a mineralocorticoid receptor antagonist may be added in resistant hypertension cases (uncontrolled hypertension under at least 3 classes of antihypertensive drugs including a RAS blocker, thiazide diuretic and a calcium channel blocker) for general population. For chronic kidney disease (CKD) patients, achieving the optimal blood pressure (BP) level can be difficult because high complication rates can be encountered in any antihypertensive class mentioned, especially for RAS blockers and mineralocorticoid receptor inhibitors. This brief review aims to highlight the importance of diuretics use in CKD patients and the boundaries of their usage. [ABSTRACT FROM AUTHOR]

The negative impact of an elevated serum uric acid on the onset and/or progression of different diseases is well known. During the last decade, new forms of therapies were developed, with beneficial results on correcting hyperuricemia, but also with potential side effects that should not be overlooked as most of the hyperuricemic patients are presenting concomitant comorbidities that could influence the decision in prescribing a specific lowering serum uric acid drug. The review will describe recent treatment options, part of them available also in our country. [ABSTRACT FROM AUTHOR]

Rhinophyma is a benign tumor characterized by a progressive hypertrophy of the nasal soft tissue and it is believed to be the end stage of severe acne rosacea. It is more common in Caucasian men. The main differential diagnosis is the basal cell carcinoma. Non-surgical treatment proved insufficient in reversing this disease, while surgery remains the golden standard, even if a spontaneous regression may be observed in extremely rare cases. We presented a case of a severe rhinophyma associated with a giant nodule successfully treated with surgical removal of the suspicious tissues with safety margin and grafting of the excised area. The postoperative outcome was satisfactory for the patient. [ABSTRACT FROM AUTHOR]

The hand is both a motor and sensory organ, and in terms of society, it is an organ of defense, of creation and an organ of expression. This is why hand surgery is very important and studies regarding the functional results of different treatments in order to treat injuries are necessary. In this paper, we presented the results of a retrospective clinical study in order to compare osteosynthesis using plates and screws (n=36) versus fixation using Kirschner wires (n=32) in order to treat metacarpal fractures of 68 patients. The functional outcomes where assessed using the DASH and the TAM score measured at two and twelve months from surgery.The DASH scores were lower (showing better results) in the PS group compared to the KW group, with a mean difference of 20.53 after two months and 6.41 after twelve months, while the TAM scores were higher (235° at two and 261° at twelve months in the PS group compared with 218° at two and 257° at twelve months in the KW group). Therefore, we concluded that osteosynthesis using plates and screws leads to better functional recovery than osteoynthesis using Kirschner wire. [ABSTRACT FROM AUTHOR]

The hand is both a motor and sensory organ, and in terms of society, it is an organ of defense, of creation and an organ of expression. This is why hand surgery is very important and studies regarding the functional results of different treatments in order to treat injuries are necessary. In this paper, we presented the results of a retrospective clinical study in order to compare osteosynthesis using plates and screws (n=36) versus fi xation using Kirschner wires (n=32) in order to treat metacarpal fractures of 68 patients. The functional outcomes where assessed using the DASH and the TAM score measured at two and twelve months from surgery.The DASH scores were lower (showing better results) in the PS group compared to the KW group, with a mean difference of 20.53 after two months and 6.41 after twelve months, while the TAM scores were higher (235° at two and 261° at twelve months in the PS group compared with 218° at two and 257° at twelve months in the KW group). Therefore, we concluded that osteosynthesis using plates and screws leads to better functional recovery than osteoynthesis using Kirschner wire. [ABSTRACT FROM AUTHOR]

Immunoglobulin A (IgA) nephropathy is one of the most common glomerulonephritis. Its clinical manifestations vary from asymptomatic forms to cases with nephritic syndrome or nephrotic-range proteinuria. The prognosis depends on the level of proteinuria, decline of glomerular filtration rate and control of blood pressure. The pathognomonic histological changes are represented by the granular IgA deposits in the mesangium. The treatment consists of comprehensive support care and immunosuppressive therapy. We discuss the case of a 50-year-old man who presented microscopic hematuria, nephrotic-range proteinuria and decreased renal function, exacerbated in the last 6 months prior the admission. We performed a renal biopsy and granular deposits were present in the glomerular mesangium that were highly suggestive for IgA nephropathy. Immunosuppressive therapy was instituted immediately, but the decline of the renal function continued and renal replacement therapy was needed. Patients with poor prognosis have an unsatisfactory response to the immunosuppressants, especially those with a delayed diagnosis. [ABSTRACT FROM AUTHOR]

The combination of posterior femoral head dislocation with ipsilateral intertrochanteric fracture is an extremely rare occurrence, therefore, few reports exist. In this paper, we describe a particular case of a middle-aged patient who sustained a high energy trauma which led amongst other to this lesion. We performed the reduction and fixation of the fracture-dislocation on a traction table with a Dynamic Hip Screw-plate (DHS-plate). Primary objectives of the treatment were to obtain a stable limb, to reduce blood loss in a polytraumatized patient and allow early mobilization. Follow-up after three months was good. [ABSTRACT FROM AUTHOR]