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We present the case of a 51-year-old male with known congestive heart failure and acute myocarditis who presented to the emergency department (ED) with swollen testicles and urinary symptoms two weeks after the initiation of sodium glucose cotransporter 2 (SGLT2) inhibitor treatment. Abdominal and pelvic computed tomography (CT) scan was consistent with the diagnosis of Fournier's gangrene (FG). Intravenous antibiotics were administered and surgical exploratory intervention and excision of necrotic tissue were performed, stopping the evolution of necrotizing fasciitis. FG, a reported adverse event, may rarely occur when SGLT2 inhibitors are administered in patients with diabetes. To our knowledge, there have been no reported cases of FG in Romania since SLGT2 inhibitors were approved. The distinguishing feature of this case is that the patient was not diabetic, which emphasizes that patients without diabetes who are treated for heart failure with SGLT2 inhibitors may also be at risk of developing genitourinary infections. The association of predisposing factors may have contributed to the development of FG in this case and even though the benefits of SGLT2 inhibitors outweigh the risks, serious adverse events need to be voluntarily reported in order to intervene promptly, verify the relationship, and minimize the risk of bias. [ABSTRACT FROM AUTHOR]

Background: This article investigates the determinants of the intention to migrate of nursing students at a major medical university in Romania and relates them to major international developments, specifically the Brexit referendum and the COVID-19 pandemic. Methods: An online survey about the intention to migrate was made available to nursing students at the University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania, in 2016 (before Brexit) and again in 2016 (after Brexit), 2017, 2018, and 2021 and 2022 (during the pandemic). A total of 549 students responded (response rate: 84.6%). Results: Before the Brexit referendum, 62.6% of the respondents had a plan to seek employment abroad, whereas after the Brexit referendum, only 34.7% indicated that they had such a plan after graduation. Before the pandemic, 43.6% of the students expressed an intention to work abroad, while during the pandemic, only 19.8% had such plans. Conclusions: This study documented the effect of significant international developments—such as the Brexit referendum and the COVID-19 pandemic—on decreasing the intention to migrate. As expected, the change in preference for the UK as a destination country changed dramatically. Additionally, the study provides both theoretical and empirical insights into the types of and the consistency of preparation for migration of nursing students. [ABSTRACT FROM AUTHOR]

This study focuses on the legislative regulation of cosmetic products containing plant extracts in Romania and Europe. The classification of such products as medicinal products, cosmetics, or food supplements is explored within the context of European and Romanian laws. Cosmetic products with herbal extracts must meet the safety, quality, and efficacy requirements outlined in Regulation (EC) No 1223/2009 of the European Parliament and the Council. The distinction between cosmetic products and other categories like medicinal products, medical devices, or biocidal products is emphasized, with clear definitions provided to differentiate them. A "cosmetic product" is defined as any substance or mixture intended for external application on specific body parts or oral cavity areas, serving purposes like cleaning, perfuming, appearance alteration, protection, maintenance, or odor correction. A "cosmetic product" is defined as any substance or mixture intended for external application on specific body parts or oral cavity areas, serving purposes like cleaning, perfuming, appearance alteration, protection, maintenance, or odor correction. The study finds that there are numerous cosmetic preparations with herbal extracts available in the Romanian and European markets, all registered as cosmetic products in the Cosmetics Notification Portal. The assessment of whether a product falls under the cosmetic category depends on an evaluation of its characteristics on case-by-case basis. The paper also explores the diverse range of cosmetic products with herbal extracts, including skin creams, gels, makeup, hygiene, hair care, and sunbathing products among others. The study concludes that clear legislative regulations play a crucial role in ensuring the safety and quality of cosmetic products containing herbal extracts within the European and Romanian markets. [ABSTRACT FROM AUTHOR]

The mouthwashes in the Romanian legislation are not clearly included in the category of cosmetics, alimentary supplements or medicines. According to European legislation, the mouthwashes fall under Regulation (EC) No 1223/2009 of the European Parliament and of the Council of 30 November 2009 in the category of cosmetic products. Thus, on the Romanian and European market there are many cosmetic preparations in the form of mouthwashes that are notified as cosmetic products in the Cosmetics Notification Portal. Other products in the form of mouthwashes in general containing plant and animal extracts are approved and regulated as dietary supplements by the Institute of Food Bio resources, according to Order no. 244/2005, Order No. 1228/2005, Order No. 1946/2014, Law 491/2003, Annex to Order no. 244/2005 and Order 1069/2007. The ANMDMR (National Agency for Medicines and Medical Devices of Romania) has not approved on the Romanian market any medicine to be formulated in the form of a mouthwash to the EMA (European Medical Agency) which has regulated mouthwashes with active medicinal substances in the pharmaceutical form of mouthwashes. [ABSTRACT FROM AUTHOR]

Background and Objectives: The ongoing COVID-19 pandemic has posed an array of new challenges for medical students worldwide. Amidst academic rigors, students are confronted with unique stressors, potentially affecting their mental health and substance use. This study aimed to investigate the multifaceted effects of depression, alcohol use, and stress on medical students and discern how these factors have been amplified by the pandemic's circumstances, and to identify predictors of mental distress during the COVID-19 pandemic period. Materials and Methods: Two online anonymous and cross-sectional surveys were conducted at the University of Medicine and Pharmacy "Iuliu Hatieganu" in Romania among medical students in 2018 and in 2022. Data were gathered via online questionnaires distributed through closed student groups on social media platforms, with a total of 1061 participants, to investigate stress, depression, alcohol and drug use, and the impact of the pandemic and online education on mental health, maintaining anonymity and ethical approval. The Medical Student Stress Questionnaire (MSSQ) was employed to measure different aspects of stress, the Beck Depression Inventory (BDI) provided insights into the participants' depressive symptoms, and for the assessment of alcohol consumption habits, the Alcohol Use Disorders Identification Test (AUDIT) was utilized. Results: Our findings showed a significant decrease in mean depression scores (13.81 vs. 11.56, with p < 0.001) from 2018 to 2022. In 2018, students scored significantly higher in the overall stress-related domains. Additionally, being female, facing financial constraints, and being in pre-clinical years emerged as predictors of heightened academic-related stress and depressive symptoms. Students who had experienced the loss of a family member due to COVID-19 exhibited a statistically significant rise in their average BDI score and current anxiety levels. Conclusions: The pandemic, despite introducing new stressors, may have indirectly fostered an increased focus on students' mental health, leading to more refined support mechanisms. Specialized interventions, taking into account gender and financial problems, are needed to address the multifaceted challenges faced by medical students. Our study highlights the ongoing need to nurture both the academic and emotional strength of future medical practitioners. [ABSTRACT FROM AUTHOR]

Background: Sudden cardiac death (SCD) is a significant global public health issue and the leading cause of death worldwide. Its etiopathogenesis is complex and multilayered, involving dynamic factors interacting with a preexistent cardiovascular pathology, frequently unknown, and resulting in cardiac rhythm disorders and cardiac arrest; Methods: This study conducted a retrospective descriptive analysis over a one-year period, identifying 321 autopsy cases of sudden deaths from the Institute of Legal Medicine in Mures County, Romania, in 2019. From the 321 sudden death cases, 189 autopsy reports were selected for analysis based on inclusion and exclusion; Results: The autopsies had a mean age of 61.16 years and included 140 males and 49 females. No significant differences were found between the silent myocardial infarction (SMI) and no-SMI groups regarding demographic data. The SMI group exhibited higher thickness of LV (left ventricle), IV (interventricular septum), EAT LCx (epicardial adipose tissue at left circumflex artery), EAT LAD (epicardial adipose tissue at left anterior descending artery), heart weight, and BMI (body mass index). The left coronary artery showed a higher incidence of type V plaques, while the right coronary artery showed higher incidences of type V and type VI plaque. The SMI group also exhibited a higher incidence of moderate and severe valvular atherosclerosis, severe left ventricle dilatation, and a lower incidence of mild left ventricle dilatation. In addition, the SMI group showed a higher presence of contraction band necrosis on histological examination. Multivariate analysis revealed that type V and type VI plaques for the right and left coronary arteries, moderate and severe valvular atherosclerosis, severe left ventricle dilatation, heart weight, EAT LCx, EAT LAD, LV thickness, IV thickness, BMI, and the presence of contraction band necrosis are all independent predictors of SMI; Conclusions: The findings suggest that SCD is a complex condition, and its etiopathogenesis involves dynamic factors interacting with pre-existing cardiovascular pathology. The risk factors of SCD are similar to those of ischemic heart disease. The findings of this study could guide clinicians in identifying patients at risk of SCD and implementing preventive measures. [ABSTRACT FROM AUTHOR]

The unpublished document - here, the third and last part of it - contains the transcript of the discussions, from June 28-30, 1982, between Nicolae Ceaușescu, the president of the Socialist Republic of Romania (SRR), and Richard M. Nixon, the former president of the United States, who, during the mentioned period, was for the third and last time in Bucharest, in a private visit. In Romania, Ceaușescu and Nixon had met, for the first time, in March 1967, also in the context of a private visit of the American politician (former, at that time, vice president - in two terms - of the USA), the second time, on the occasion of the historic visit official visit to SRR by President Nixon (August 2-3, 1969), the first visit of an American president not only to Romania, but also to a communist state. In 1982, the interlocutors addressed a wide range of issues discussed, from the Romanian-American relations at that time to the examination of the international political situation (for example, the relations between the great powers or the tense reality in the Middle East). [ABSTRACT FROM AUTHOR]

Pregnancy represents a psychologically and emotionally vulnerable period, and research indicates that pregnant women have a higher prevalence of symptoms of anxiety and depression, debunking the myth that hormonal changes associated with pregnancy protect the mother. In recent years, several researchers have focused on the study of prenatal anxiety/depression—emotional disorders manifested by mood lability and low interest in activities—with a high prevalence. The main objective of this research was to conduct an antenatal screening in a cohort of pregnant women hospitalized for delivery in order to assess the prevalence of anxiety and depression. The secondary objective was to identify the risk factors associated with depression and anxiety in women in the third trimester of pregnancy. We carried out a prospective study in which we evaluated 215 pregnant women in the third trimester of pregnancy hospitalized for childbirth at the Obstetrics and Gynecology Clinic of the Târgu-Mureș County Clinical Hospital. The research was carried out between December 2019 and December 2021. The results showed that age and the environment of origin are the strongest predictors of mental health during pregnancy (OR = 0.904, 95%CI: 0.826–0.991; p = 0.029). For women from urban areas, there is an increased probability of falling at a higher level on the dependent variable (moderate depression) (OR = 2.454, 95%CI: 1.086–5.545; p = 0.032). In terms of health behaviors, none of the variables were statistically significant predictors of the outcome variable. The study highlights the importance of monitoring mental health during pregnancy and identifying relevant risk factors to provide appropriate care to pregnant women and the need for interventions to support the mental health of pregnant women. Especially in Romania, where there is no antenatal or postnatal screening for depression or other mental health conditions, these results could be used to encourage the implementation of such screening programs and appropriate interventions. [ABSTRACT FROM AUTHOR]

(1) Background: Trauma is one of the leading causes of death worldwide, with the chest being the third most frequent body part injured after abdominal and head trauma. Identifying and predicting injuries related to the trauma mechanism is the initial step in managing significant thoracic trauma. The purpose of this study is to assess the predictive capabilities of blood count-derived inflammatory markers at admission. (2) Materials and Methods: The current study was designed as an observational, analytical, retrospective cohort study. It included all patients over the age of 18 diagnosed with thoracic trauma, confirmed with a CT scan, and admitted to the Clinical Emergency Hospital of Targu Mureş, Romania. (3) Results: The occurrence of posttraumatic pneumothorax is highly linked to age (p = 0.002), tobacco use (p = 0.01), and obesity (p = 0.01). Furthermore, high values of all hematological ratios, such as the NLR, MLR, PLR, SII, SIRI, and AISI, are directly associated with the occurrence of pneumothorax (p < 0.001). Furthermore, increased values of the NLR, SII, SIRI, and AISI at admission predict a lengthier hospitalization (p = 0.003). (4) Conclusions: Increased neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), aggregate inflammatory systemic index (AISI), and systemic inflammatory response index (SIRI) levels at admission highly predict the occurrence of pneumothorax, according to our data. [ABSTRACT FROM AUTHOR]

Background: It is currently considered that early initiation of nasal continuous positive airway pressure, using a less invasive exogenous surfactant administration and avoiding mechanical ventilation as much as possible to minimize lung damage, may reduce mortality and/or the risk of morbidities in preterm infants. The aim of our study was to quantify our experience and compare different strategies of surfactant administration, to investigate which method is associated with less morbidity. Materials and Methods: A total of 135 preterm infants with early rescue surfactant administration for respiratory distress syndrome were included in the study. The infants were treated in an academic, Level III Neonatal Intensive Care Unit over a 3-year period between 1 December 2018 and 1 December 2021. Patients were separated into three groups: those with standard surfactant administration; those with Less Invasive Surfactant Administration—LISA; and those with Intubation Surfactant Administration Extubation—INSURE. As a primary outcome, we followed the need for intubation and mechanical ventilation within 72 h, while the secondary outcomes were major neonatal morbidities and death before discharge. Results: The surfactant administration method was significantly associated with the need for mechanical ventilation within 72 h after the procedure (p < 0.001). LISA group infants needed less MV (OR = 0.538, p = 0.019) than INSURE group infants. We found less morbidities (OR = 0.492, p = 0.015) and deaths before discharge (OR = 0.640, p = 0.035) in the LISA group compared with the INSURE group. The analysis of morbidities found in infants who were given the surfactant by the LISA method compared with the INSURE method showed lower incidence of pneumothorax (3.9% vs. 8.8%), intraventricular hemorrhage (17.3% vs. 23.5%), intraventricular hemorrhage grade 3 and 4 (3.9% vs. 5.9%), sepsis/probable sepsis (11.5% vs. 17.7%) retinopathy of prematurity (16.7% vs. 26.7%) and deaths (3.9% vs. 5.9%). There were no significant differences between groups in frequencies of bronchopulmonary dysplasia, necrotizing enterocolitis and patent ductus arteriosus. Conclusions: Less invasive surfactant administration methods seem to have advantages regarding early need for mechanical ventilation, decreasing morbidities and death rate. In our opinion, the LISA procedure may be a good choice in spontaneously breathing infants regardless of gestational age. [ABSTRACT FROM AUTHOR]

The COVID-19 crisis, along with the other associated complex crises, has amplified the gap that exists in terms of the number of women reaching leadership positions, despite the quality of their work and their important contributions in various fields. This paper aims to explore women's leadership qualities, and perceptions regarding leadership, based on quantitative data originating from four studies. Concerning the research methodology it includes qualitative research and a comparative analysis of global studies. The paper focuses on women, looking mostly for the proportion of women within organizations, and the main characteristics of women's leadership. The analysis then turns to Romania, where we have identified the proportion of women leaders. The main goal of the paper is to investigate the representation of women leaders in EU countries and in particular in Romania. The results of the study illustrate that favorable work conditions have a greater impact on women's aspirations to become leaders. Extrinsic structural inequalities, such as bias against women in certain professions, and gender, racial and other discrimination, are barriers to women's access and advancement in leadership positions in the workplace. Intrinsic individual characteristics of successful women leaders, namely conscientiousness, respect, confidence, acceptance, and resilience have facilitated their success in obtaining and maintaining leadership positions. [ABSTRACT FROM AUTHOR]

The unpublished document - here, the second part of it - contains the transcript of the discussions, from June 28-30, 1982, between Nicolae Ceaușescu, the president of the Socialist Republic of Romania (SRR), and Richard M. Nixon, the former president of the United States, who, during the mentioned period, was for the third and last time in Bucharest, in a private visit. In Romania, Ceaușescu and Nixon had met, for the first time, in March 1967, also in the context of a private visit of the American politician (former, at that time, vice president - in two terms - of the USA), the second time, on the occasion of the historic visit official visit to SRR by President Nixon (August 2-3, 1969), the first visit of an American president not only to Romania, but also to a communist state. In 1982, the interlocutors addressed a wide range of issues discussed, from the Romanian-American relations at that time to the examination of the international political situation (for example, the relations between the great powers or the tense reality in the Middle East). [ABSTRACT FROM AUTHOR]

This econometric modeling emphasizes quantifying various economic phenomena, particularly that which is diverse and unpredictable, as it provides important support to managers. Our approach aims to achieve an econometric multiple regression model to analyze economic performance through a case study conducted on a sample of 107 entities in the clothing industry in Romania. We considered Net Profit as a dependent variable and Fixed Assets, Current Assets, Equity, and Number of Employees as independent variables. The 4 hypotheses proposed were measured, tested, and validated using EViews software with multiple linear regression. The results of the model have been validated as econometric, so we believe that they provide useful predictions regarding analysis of the economic performance in the clothing industry in Romania. [ABSTRACT FROM AUTHOR]

Background: Abdominal trauma is defined as a variety of injuries to the abdominal wall, solid or hollow intra-abdominal organs, and various intra-abdominal vessels. Recently, there has been a significant amount of interest in the establishment of a reliable biomarker that can predict the outcome in patients with an abdominal injury. The purpose of this study is to confirm the predictive role of inflammatory biomarkers and underlying risk factors and the risk of acute kidney insufficiency (AKI) developing and mortality in abdominal trauma patients; Materials and methods: The current study was intended as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with a diagnosis of abdominal trauma confirmed through a CT scan admitted to the County Emergency Clinical Hospital of Targu-Mureș, Romania between January 2017, and December 2021; Results: Non-survivor patients had a greater age (p = 0.02), as well as a higher prevalence of ischemic heart disease (IHD) (p = 0.007), history of myocardial infarction (MI) (p = 0.002), peripheral arterial disease (PAD) (p = 0.01), chronic kidney disease (CKD) (p = 0.01), and all risk factors (p = 0.0004 and p < 0.0001). In terms of injured organs, we have in the second group a higher incidence of kidney injury (p = 0.003) and hemoperitoneum (p = 0.008). Multivariate analysis showed a high baseline value for all inflammatory biomarkers that are independent predictors of adverse outcomes for all recruited patients. Furthermore, for all hospitalized patients, the history of MI (p = 0.03; p = 0.001; and p = 0.003), PAD (p = 0.01; p = 0.01; and p = 0.002), obesity (for all p < 0.0001), CKD (p < 0.001; p = 0.01; and p = 0.001), and kidney injury (p = 0.02; p = 0.004; and p = 0.01) were independent predictors of all outcomes. Moreover, IHD (p = 0.008 and p = 0.02), tobacco (p < 0.0001 and p = 0.02), and hemoperitoneum (p = 0.009 and p = 0.01) were predictors of mortality and composite endpoint, but not for AKI risk, as well as atrial fibrillation [AF] (p = 0.04) as predictors of the composite endpoint Conclusions: Higher monocyte to lymphocyte ratio (MLR), platelets to lymphocyte ratio (PLR), systemic inflammatory index (SII), neutrophil to lymphocyte ratios (NLR), aggregate inflammatory systemic index (AISI), and systemic inflammatory response index (SIRI) levels at admission, according to our data, highly predict AKI risk and death. [ABSTRACT FROM AUTHOR]

Essential oils were obtained from different parts of Agastache foeniculum (Lophanthus anisatus) plants by means of extraction: green extraction using hydro-distillation (HD) and bio-solvent distillation, BiAD, discontinuous distillation, and supercritical fluid extraction, in two stages: (1) with CO2, and (2) with CO2 and ethanol co-solvent. The extraction yields were determined. The yield values varied for different parts of the plant, as well as the method of extraction. Thus, they had the values of 0.62 ± 0.020 and 0.92 ± 0.015 g/100 g for the samples from the whole aerial plant, 0.75 ± 0.008 and 1.06 ± 0.005 g/100 g for the samples of leaves, and 1.22 ± 0.011 and 1.60 ± 0.049 g/100 g for the samples of flowers for HD and BiAD, respectively. The yield values for supercritical fluid extraction were of 0.94 ± 0.010 and 0.32 ± 0.007 g/100 g for the samples of whole aerial plant, 0.9 ± 0.010 and 1.14 ± 0.008 g/100 g for the samples of leaves, and 1.94 ± 0.030 and 0.57 ± 0.003 g/100 g for the samples of flowers, in the first and second stages, respectively. The main components of Lophanthus anisatus were identified as: estragon, limonene, eugenol, chavicol, benzaldehyde, and pentanol. The essential oil from Agatache foeniculum has antimicrobial effects against Staphylococcus aureus, the Escherichia coli and Pseudomonas aeruginosa. Acclimatization of Lophantus anisatus in Romania gives it special qualities by concentrating components such as: estragole over 93%, limonene over 8%, especially in flowers; and chavicol over 14%, estragole over 30%, eugenol and derivatives (methoxy eugenol, methyl eugenol, etc.) over 30% and phenyl ether alcohol over 20% in leaves. As a result of the research carried out, it was proven that Lophanthus anisatus can be used as a medicinal plant for many diseases, it can be used as a spice and preservative for various foods, etc. [ABSTRACT FROM AUTHOR]

Background: Numerous tools, including inflammatory biomarkers and lung injury severity scores, have been evaluated as predictors of thromboembolic events and the requirement for intensive therapy in COVID-19 patients. This study aims to verify the predictive role of inflammatory biomarkers [monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)] and the CT Severity Score in acute limb ischemia (ALI) risk, intensive unit care (ICU) admission, and mortality in COVID-19 patients.; Methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients older than 18 years of age with a diagnosis of COVID-19 infection, confirmed through real time-polymerase chain reaction (RT-PCR), and admitted to the County Emergency Clinical Hospital of Targu-Mureș, Romania, and Modular Intensive Care Unit of UMFST "George Emil Palade" of Targu Mures, Romania between January 2020 and December 2021. Results: Non-Survivors and "ALI" patients were associated with higher incidence of cardiovascular disease [atrial fibrillation (AF) p = 0.0006 and p = 0.0001; peripheral arterial disease (PAD) p = 0.006 and p < 0.0001], and higher pulmonary parenchyma involvement (p < 0.0001). Multivariate analysis showed a high baseline value for MLR, NLR, PLR, SII, SIRI, AISI, and the CT Severity Score independent predictor of adverse outcomes for all recruited patients (all p < 0.0001). Moreover, the presence of AF and PAD was an independent predictor of ALI risk and mortality. Conclusions: According to our findings, higher MLR, NLR, PLR, SII, SIRI, AISI, and CT Severity Score values at admission strongly predict ALI risk, ICU admission, and mortality. Moreover, patients with AF and PAD had highly predicted ALI risk and mortality but no ICU admission. [ABSTRACT FROM AUTHOR]

The global COVID-19 pandemic that is ongoing because of the Coronavirus II (SARS-CoV-2) has had until now a great impact on physical education and sports, especially due to the closure of training facilities and people's lack of motivation. In Romania, physical activity (PA) and physical education (PE) have also been highly affected, especially among university students. To our knowledge, this is the first study conducted in Romania regarding the influence of the lockdown on the physical health and well-being of university students. This study aims to determine if and how the pandemic affected the university students' mental and physical health in Romania, but also to highlight new strategies and approaches suggested by them through a questionnaire to enhance and motivate their participation in physical activities. Based on a cross-sectional design, a survey designed in two languages—Romanian and English—was completed by the students from the Technical University of Cluj-Napoca and foreign students that were on a mobility study visit through the Erasmus+ program in Romania. The questionnaire was filled out by 836 university students (age = 18–24 years; males: 57.73%). The findings showed that quarantine in Romania led to a significant increase in sedentarism among students and a reduction in energy for physical activity, which also affected their psychological well-being. The absence of social interactions and onsite classes led to a sedentary lifestyle among students and increased their fear and stress levels. The cancellation of all sports events and PA also led to fewer students remaining physically active. Time off training and leisure time activities caused by the ongoing restrictions might be used for new purposes, such as goal setting, overcoming injury, improving mobility, psychological development, and emphasizing strength sports for health. During the COVID-19 lockdown, sedentarism increased dramatically, especially among young people. [ABSTRACT FROM AUTHOR]

Background: Numerous tools, including inflammatory biomarkers and lung injury severity scores, have been evaluated as predictors of disease progression and the requirement for intensive therapy in COVID-19 patients. This study aims to verify the predictive role of inflammatory biomarkers [monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), Aggregate Index of Systemic Inflammation (AISI), and interleukin-6 (IL-6)] and the total system score (TSS) in the need for invasive mechanical ventilation (IMV) and mortality in COVID-19 patients. Methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with a diagnosis of COVID-19 pneumonia, confirmed through real time-polymerase chain reaction (RT-PCR) and radiological chest CT findings admitted to County Emergency Clinical Hospital of Targu-Mureș, Romania, and Modular Intensive Care Unit of UMFST "George Emil Palade" of Targu Mures, Romania between January 2021 and December 2021. Results: Non-Survivors patients were associated with higher age (p = 0.01), higher incidence of cardiac disease [atrial fibrillation (AF) p = 0.0008; chronic heart failure (CHF) p = 0.01], chronic kidney disease (CKD; p = 0.02), unvaccinated status (p = 0.001), and higher pulmonary parenchyma involvement (p < 0.0001). Multivariate analysis showed a high baseline value for MLR, NLR, SII, SIRI, AISI, IL-6, and TSS independent predictor of adverse outcomes for all recruited patients. Moreover, the presence of AF, CHF, CKD, and dyslipidemia were independent predictors of mortality. Furthermore, AF and dyslipidemia were independent predictors of IMV need. Conclusions: According to our findings, higher MLR, NLR, SII, SIRI, AISI, IL-6, and TSS values at admission strongly predict IMV requirement and mortality. Moreover, patients above 70 with AF, dyslipidemia, and unvaccinated status highly predicted IMV need and fatality. Likewise, CHF and CKD were independent predictors of increased mortality. [ABSTRACT FROM AUTHOR]

Backgroundand Objectives: Gestational diabetes mellitus (GDM) is a pregnancy-associated pathology commonly resulting in macrosomic fetuses, a known culprit of obstetric complications. We aimed to evaluate the potential of umbilical cord biometry and fetal abdominal skinfold assessment as screening tools for fetal macrosomia in gestational diabetes mellitus pregnant women. Materials and methods: This was a prospective case–control study conducted on pregnant patients presenting at 24–28 weeks of gestation in a tertiary-level maternity hospital in Northern Romania. Fetal biometry, fetal weight estimation, umbilical cord area and circumference, areas of the umbilical vein and arteries, Wharton jelly (WJ) area and abdominal fold thickness measurements were performed. Results: A total of 51 patients were enrolled in the study, 26 patients in the GDM group and 25 patients in the non-GDM group. There was no evidence in favor of umbilical cord area and WJ amount assessments as predictors of fetal macrosomia (p > 0.05). However, there was a statistically significant difference in the abdominal skinfold measurement during the second trimester between macrosomic and normal-weight newborns in the GDM patient group (p = 0.016). The second-trimester abdominal circumference was statistically significantly correlated with fetal macrosomia at term in the GDM patient group with a p value of 0.003, as well as when considering the global prevalence of macrosomia in the studied populations, 0.001, when considering both populations. Conclusions: The measurements of cord and WJ could not be established as predictors of fetal macrosomia in our study populations, nor differentiate between pregnancies with and without GDM. Abdominal skinfold measurement and abdominal circumference measured during the second trimester may be important markers of fetal metabolic status in pregnancies complicated by GDM. [ABSTRACT FROM AUTHOR]

Background and Objectives: Extremely preterm infants were at increased risk of mortality and morbidity. The purpose of this study was to: (1) examine changes over time in perinatal management, mortality, and major neonatal morbidities among infants born at 250–286 weeks' gestational age and cared for at one Romanian tertiary care unit and (2) compare the differences with available international data. Material and Methods: This study consisted of infants born at 250–286 weeks in one tertiary neonatal academic center in Romania during two 4-year periods (2007–2010 and 2015–2018). Major morbidities were defined as any of the following: severe intraventricular hemorrhage (IVH), severe retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and bronchopulmonary dysplasia (BPD). Adjusted logistic regression models examined the association between the mortality and morbidity outcome and the study period. Results: The two cohorts differed with respect to antenatal antibiotics and rates of cesarean birth but had similar exposure to antenatal steroids and newborn referral to the tertiary care center. In logistic regression analyses, infants in the newer compared to the older cohort had a lower incidence of death (OR: 0.19; 95% CI: 0.11–0.35), a lower incidence of IVH (OR: 0.26; 95% CI: 0.15–0.46), and increased incidence of NEC (OR: 19.37; 95% CI: 2.41–155.11). Conclusions: Changes over time included higher use of antenatal antibiotics and cesarean delivery and no change in antenatal steroids administration. Overall mortality was lower in the newer cohort, especially for infants 250–266 weeks' gestation, NEC was higher while BPD and ROP were not different. [ABSTRACT FROM AUTHOR]

The article interprets Radu Jude’s 2018 film by referring to the political and historical present and having as a starting point the private life of the main heroine, the director Mariana Marin. This approach is camouflaged under the dominance of the directorial conception which insists on the analysis of the historical event (the Odessa massacre). Referring to the current dominant discourse of the film and the story it presents, the study highlights the need to mediate the meaning of the artistic act between the authority and the author of the work of art. Such an approach is necessary because the event presented, namely Romania's participation in the Holocaust, involves an infinite guilt that cannot be instrumentalized either by the authority or by the author of the work. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to illustrate the opportunities for adopting robotic applications, through a marketing mix perspective, as well as depicting the current state of industrial robot integration in Romanian enterprises and the labor market, in contrast to other economies of the European Union. In this research, we highlight the impact of industrial robots within enterprises, while also considering the perceived standard of living through GDP per capita. For this, we conducted exploratory research based on secondary data regarding the evolution of the robotics sector in Romania, in connection to the dynamics of the global and European Union robotics market. We also performed a principal components analysis, which revealed the main factors that contributed to the dynamics of nation-level enterprise statistics. Our analysis revealed that a higher integration of industrial robots contributed to the reduction of employment rates amongst all six EU countries considered, while also having positive correlations with the GDP per capita and apparent labor productivity. Mixed results were only observed for the impact of industrial robots on remuneration growth, suggesting the potential adverse effects automation could have on incomes. [ABSTRACT FROM AUTHOR]

Purpose: Romania has a high prevalence of hypertension (45.1% in 2016). Whether this is attributable to a low rate of treatment adherence—which can aggravate the pathology and reduce patients' quality of life (QoL)—is unknown. To address this point, the present study investigated the factors that influence short- and long-term adherence and QoL in patients with arterial hypertension using a specially designed questionnaire. Patients and Methods: The study enrolled 289 patients at different stages of hypertension with or without comorbidities. The diagnosis of hypertension was established by the cardiologist, and treatment regimens were communicated by patients to the clinical pharmacist who administered the questionnaire, which comprised 7 domains with variable numbers of items. Results: The majority of surveyed patients (57.43%) considered that their capacity for effort was decreased because of their hypertension, with 65.05% reporting that they were affected by symptoms associated with high blood pressure (eg, headache and dizziness). Most patients (71.28%) understood the consequences of discontinuing their medication and the severe complications of hypertension, and 69.55% indicated that they would not stop treatment if they experienced side effects. For 53.28% of patients, social activity was significantly affected by their condition. Only 47.05% of patients underwent regular mandatory medical examinations and 55.36% periodically monitored their blood pressure at home. A regression analysis revealed correlations between specific questionnaire items and patient characteristics. Conclusion: Nonpharmacologic factors that were shown to influence patients' adherence to treatment and QoL included the level of health education and knowledge of disease complications, self-monitoring of hypertension, and consultation with medical and pharmaceutical healthcare providers regarding hypertension and its treatment. [ABSTRACT FROM AUTHOR]

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Nowadays, IoT platforms have key-roles in almost all domains such as smart agriculture, health, cyber security, etc. The focus of this article is on water quality monitoring which can be improved by the use of wireless sensing networks and the implementation of the IoT technology. The aim of the article is to develop an efficient solution for farmers who irrigate crops with large amounts of water. The solution provided is based on multiple sensors (water quality, air quality, consumption, and climate) so that several parameters of the environment can be monitored simultaneously. The monitored parameters are conductivity, turbidity, salinity, precipitation levels, pH, dissolved oxygen and water temperature. The collected data will be filtered and translated into legible and meaningful data using intelligent algorithms for farmers. This paper is based on the experiments developed in the SWAM project, and the location where they were performed was chosen in Moara Domneasca. The location of the Moara Domnească Experimental Base, where the case study is implemented, is located 25 km from Bucharest, in the Commune of Afumați, Ilfov County in the Subunit of the Romanian Plain. Thus, the quality of the water used for irrigation purposes can be determined following the analysis and periodic monitoring of the parameters. [ABSTRACT FROM AUTHOR]

Digital transformation is essential for companies not only by adoption of new technologies but also by engaging in sustainable development of economies, of circular economies and by empowering people to adapt and embrace new challenges in order to face the new challenges. Collaborative economy, based on innovation, use of collaborative platforms may support responsible growth of economies. According to the Digital Economy and Society Index (DESI), Romania ranks 27th of 27 EU Member States in the 2021 edition of the Digital Economy and Society. Romania has to take action for identifying, implementing policies to support collaborative economy and digital trasnformation. [ABSTRACT FROM AUTHOR]

The main purpose of this paper is to investigate the current stage of implementation of telework in Romania and to determine potential positive and sustainable effects generated by its development on a large scale. The research methodology used is based on descriptive analysis, comparative analysis, but also on econometric analysis. The general results obtained show that Romania registers a very low level of telework employees, this being influenced, not only by the low share of those with tertiary education and high skilled professionals, but also by the fact that most Romanian employees do not want to practice this type of work. The results also showed that telework can generate significant economic and social benefits. The potential solutions we have identified for the sustainable development of the telework phenomenon in Romania include investments in tertiary education and awareness campaigns among both employees and companies, regarding the positive effects that can be obtained through telework and business development. [ABSTRACT FROM AUTHOR]

The unpublished document - here, the first part of our contribution - contains the transcript of the discussions, from June 28-30, 1982, between Nicolae Ceaușescu, the president of the Socialist Republic of Romania (SRR), and Richard M. Nixon, the former president of the United States, who, during the mentioned period, was for the third and last time in Bucharest, in a private visit. In Romania, Ceaușescu and Nixon had met, for the first time, in March 1967, also in the context of a private visit of the American politician (former, at that time, vice president - in two terms - of the USA), the second time, on the occasion of the historic visit official visit to SRR by President Nixon (August 2-3, 1969), the first visit of an American president not only to Romania, but also to a communist state. In 1982, the interlocutors addressed a wide range of issues discussed, from the Romanian-American relations at that time to the examination of the international political situation (for example, the relations between the great powers or the tense reality in the Middle East). [ABSTRACT FROM AUTHOR]

The objective of the present study was to explore what demographic and socioeconomic factors were associated with adolescent (younger than 20 years) and adult mothers living in Romania. In total, 274 adolescent and adult mothers were recruited from two maternity wards Romanian maternity wards. The mean age of the sample was 24.64 years (SD = 6.907, range: 13-44 years). Independent samples t-tests, Pearson's chi square, Cramer's V, and risk ratios were used to assess differences in continuous and categorical demographics variables between adolescent and adult mothers. This study has shown that maternity among adolescent mothers younger than 20 years has broad sociodemographic determinations, and, consequently, the socio-economic implications could be long-term as well as costly. [ABSTRACT FROM AUTHOR]

Introduction: Male breast carcinoma presents a rare and often overlooked aspect of oncology, accounting for only 1% of all breast cancer cases. The infrequency of pathology, combined with the common association of breast cancer primarily with females, leads to delayed diagnosis, management challenges and unfavorable prognosis. Case Report: We report the case of a 64-year-old male with no significant risk factors, diagnosed with invasive NST (no specific type) left breast carcinoma cT4bN0M0, stage IIIB, luminal B HER-2 negative subtype. The patient presented in 2019 with a palpable mass in the left nipple area, accompanied by skin retraction. The ultrasound revealed an ulcerated irregular mass measuring 2x3 cm, with adherence to the pectoral muscle. Ultrasound-guided tru-cut biopsy confirmed the diagnosis of invasive NST breast carcinoma cT4bN0M0, stage IIIB, HER-2 negative, estrogen receptor (ER = 100%) and progesterone receptor (PR = 55%) positive, with a low Ki-67 proliferation index(10%). Neoadjuvant chemotherapy was initiated, consisting of 4 cycles of Epirubicin plus Cyclophosphamide and 4 cycles of Paclitaxel. Following successful neoadjuvant chemotherapy, the patient underwent a left-sided mastectomy with sentinel lymph node biopsy. Histopathological examination established the presence of a residual invasive ductal breast carcinoma stage ypT2ypN0(3sn), with the same molecular profile. Surgical margins were clear and none of the three dissected lymph nodes showed evidence of metastasis. Adjuvant endocrine therapy with Letrozol 2.5 mg was initiated shortly after surgery. Since 2019, the patient has consistently adhered to Letrozole therapy, showing excellent tolerance to the treatment. Discussions : The patient's tumor, classified as invasive ductal NST, HR positive and HER-2 negative, represents a common subtype of male breast carcinoma (90%). Neoadjuvant chemotherapy plays an important role in the management of breast cancer, leading to downstaging and better results. Adjuvant endocrine therapy is a cornerstone in all patients diagnosed with HR positive breast cancer. Despite historically breast cancer in male patients has a poor outcome, the favorable prognostic indicators noted in this case, including clear surgical margins, negative lymph nodes, and a low Ki-67 proliferation index, seem to confer a survival advantage. Regular follow-up examinations, imaging studies and tumor marker monitoring will continue to be essential for tracking disease progression and detecting potential recurrence. Conclusions: This case highlights several key aspects of male breast carcinoma management and serves to raise awareness about breast cancer among males. Although rare, male breast carcinoma can exhibit similar clinical features to breast cancer in women, making early detection and patient adherence to therapy crucial for optimal outcomes. [ABSTRACT FROM AUTHOR]

Background: Recent years have seen significant advancements in dentistry, particularly with the integration of digital technologies. This has notably impacted the restoration of endodontically treated teeth (ETT). Digital technologies have revolutionized the approach to ETT restoration, offering enhanced precision, efficiency, and patient outcomes. This study dives into the diverse ways in which digital technologies contribute to restoring ETT. Objective: This study aims to assess the effectiveness of "one session dentistry" using chair-side CAD CAM systems in restoring endodontically treated teeth with significant substance loss. This approach offers medical and economic benefits such as preserving dental structures, eliminating intermediate appointments, enhancing precision, ensuring longevity, and saving time for both dentists and patients. The guided preparation technique ensures conservative treatment, removing only the affected tissues, determining preparation limits based on the lesion's extent, and adhering to bio-prophylactic cavity preparation principles. The study emphasizes the principles and advantages of contemporary tooth preparation methods. Material and methods: In our study 217 patients and 362 restorations were involved, from Dental Clinic Dr. Leahu - CORIDENT Sibiu. We used conservative methods in preparing the teeth and digital ways in restoring them. Following a vigorous protocol to achieve the best results. Results : Key findings include a higher prevalence of female patients, with treatments more common in those over 30 and less frequent in those over 60. Most patients received two restorations, with accidents causing partial or total crown fractures occurring less frequently. The distribution of restoration types was relatively even, with endo-crown and endoVcrown approaches being twice as common as classic crowns. Ceramic materials were predominantly used for coronal restorations compared to zirconia. Conclusions: In conclusion, the adoption of digital technologies, particularly CAD CAM technology, offers significant advancements in dental practice, enabling streamlined workflows and enhanced quality, predictability, and ergonomics in endodontic treatments. The ease of preparation for endocrown and endoVcrown restorations, coupled with the accuracy of design software and milling systems, further enhances dentist confidence and patient satisfaction. Overall, the study underscores the transformative potential of digital technologies in revolutionizing endodontic treatments and restoration practices while prioritizing functional and aesthetic outcomes and maintaining periodontal health. [ABSTRACT FROM AUTHOR]

Background: We report the case of a 42-year-old patient presenting with acute symptoms of fever and severe abdominal pain to our hospital. Despite having an intrauterine device (IUD) but lacking regular gynecologic followups, clinical examination revealed signs of peritonitis. Ultrasound diagnostics identified bilateral pyosalpinx and free fluid in the peritoneal cavity. The patient's history included two vaginal deliveries and a cesarean section performed in 2015. Objective: The primary objective was the immediate treatment of this life-threatening condition. The therapeutic regimen included broad-spectrum antibiotics (ceftriaxone, gentamicin, and metronidazole administered intravenously thrice daily), along with anticoagulant, anti-inflammatory, and analgesic medications. Material and methods: This case study is based on an analysis of medical records and a direct interview with the patient. Results : Within 24 hours, surgical intervention was necessary, conducted via Pfannenstiel laparotomy. The surgery revealed purulent fluid in the peritoneal cavity, and the pelvis was obstructed by extensive adhesions involving the small bowel, caecum, appendix, omentum, and sigma. These adhesions had encapsulated the pelvic space, where an inflamed uterus of enlarged, soft consistency and both annexes, transformed into tubo-ovarian abscesses, were found. The surgical procedure included adhesiolysis, removal of both annexes, and the uterus due to evident endometritis, and the appendix due to signs of inflammation and necrosis. Approximately 500ml of purulent fluid was evacuated for bacteriological examination. The operation emphasized meticulous removal of infected tissues, ensuring hemostasis, and was followed by thorough lavage and drainage. Postoperatively, the continuation of the antibiotic regimen and supportive medications facilitated early mobilization. Drainage was removed after 48 hours, and the patient's recovery was closely monitored through laboratory tests, which showed a steady return to normal inflammatory markers, underscoring the intervention's success in eliminating infection and promoting healing. Conclusions: This case highlights the critical need for a multidisciplinary approach in managing complex gynecological conditions, particularly those involving extensive pelvic adhesions and infections. It underscores the utility of combining general surgical and gynecological expertise in treatment. Importantly, this case serves as a reminder of the complications that can arise from neglected IUDs, including endometritis, bilateral pyosalpinx, peritonitis, and secondary appendiceal involvement. It underlines the vital importance of routine gynecologic consultations, especially for individuals with IUDs, to prevent such severe outcomes. [ABSTRACT FROM AUTHOR]

This scientific article represents an empirical research on the smart and sustainable development of Romania after the accession to the European Union. The main objective is to determine the current state of smart development of the four macro-regions of our country and to identify possible solutions for improving the performance and reducing the gaps. The research methodology applied in this case is based on critical comparative analysis, and statistical data. The results from the first part of the research shows, on the one hand, that between the macro-regions of the country there are gaps in terms of smart and sustainable development, and the highest performances are registered at the level of Macroregion three. On the other hand, the results show large gaps with Austria (performer in the smart development) with most of the dimensions characteristic of the smart regions / cities considered by us in this research. The results of the second part of the research demonstrates that the level of competitiveness has a decisive role in supporting the process of smart development and reducing gaps at national and international level, and stimulating innovation is essential for achieving the goal of smart, sustainable and inclusive long-term development. [ABSTRACT FROM AUTHOR]

Background and objectives: this study assessed variations in the blood parameters of patients with hematological disorders infected with HCV throughout a 12-week interferon-free treatment regimen. Materials and methods: We followed a total of 344 patients suffering from chronic hepatitis C, infected with the 1b genotype and concomitant hematological disorders, who benefited from the direct-acting antiviral (DAA) therapy in our clinic. Seven of the most routinely checked blood parameters were analyzed, namely, hemoglobin, leucocyte count, neutrophils, erythrocyte count, platelet count, ALT, and total bilirubin level. In total, 129 patients received a treatment scheme comprising ombitasvir, paritaprevir, ritonavir, and dasabuvir, while the 215 other patients received a sofosbuvir and ledipasvir regimen. Results: Patients enrolled in the study showed remarkably increased ALT levels in the first four weeks of DAA treatment, normalizing to levels below 40 U/L by the end of regimen. There were no other blood parameters that worsened throughout the 12-week regimen to levels below our laboratory’s normal range. After 12 weeks of DAA therapy, 309 patients (90%) achieved SVR. Conclusions: Our findings are consistent in evaluating the efficacy and tolerability of direct-acting antivirals for 1b genotype HCV infected patients with associated hematological malignancies under remission, and other hematological disturbances, that were previously unsuccessfully treated with a pegylated interferon regimen. Thus, paving a pathway for government-funded programs being implemented in this direction. [ABSTRACT FROM AUTHOR]

The interest in the topic of peripheral location (of Eastern Europe, of Romania, of thinking in this cultural space, etc.) has increased in recent years, a proof being the publication of several reference works that address this topic. It competes more and more vigorously the interest in the issue of Europeanisation and it is a reaction, a questioning of European normativism. The article aims to place the periphery issue in the current context, starting from attempts to define and understand authors located in distinct places and adopting distinct perspectives. They aim, for example, to forge a certain outlook on the periphery by appealing to Western theories on neo-colonialism or to Romanian critical theories of the nineteenth century (the theory of forms without substance). Their historical landmarks may be different, such as the fall of the Iron Curtain in 1989 or the process of westernization of the Romanians in the nineteenth century. They may also have different intentions, from the restructuring of the Euro-centered paradigm to the acceleration of social movements. Undoubtedly, what unites all these attempts is a desire of disenchantment which normative Europeanization postponed indefinitely. But, without a doubt, they also build a complex set of reports and positions necessary to ensure the effect of disenchantment. [ABSTRACT FROM AUTHOR]

Three sections from the upper Miocene (Pannonian) of the Guşteriţa quarry - Sibiu (the southern border of the Transylvanian Basin) were investigated in detail. The main part of the research was based on calcareous nannofossil analysis to which some aspects on molluscs and ostracods fauna, together with sedimentological remarks were added. The calcareous nannofossil assemblages from Guşteriţa quarry were compared with seven other previously analyzed sections from the western border of the Transylvanian Basin: Aiud area (Geoagiu, Gârbova, Gârboviţa, Lopadea exposures and Decea quarry) and Sibiu area (Vurpăr and Apoldu exposures). The Pannonian calcareous nannofossil assemblages are abundant at some levels and contain mostly species of the genera Isolithus and Noelaerhabdus. [ABSTRACT FROM AUTHOR]

The giant European catfish, Silurus glanis (total length = 200 cm; total weight ≈ 80 kg) was caught downstream of Iron Gate II hydropower dam (Danube River, 863 rkm) and tagged with an ultrasonic transmitter (V16TP; Vemco Ltd.) equipped with depth and temperature sensors. Changes in catfish diving behavior and temperature exposure were monitored over a period of roughly 2 years. Transmitter detections were recorded by nine autonomous receivers (VR2W, installed in 2015 between Serbia and Romania, as well as near Romanian shiplock and upstream Romanian turbines). The first signals were recorded on April 28, 2015 and the last on February 13, 2017. Altogether 59,355 and 59,175 detections of the catfish depth and water temperature were recorded, respectively. The greatest number of signals were recorded by the two receivers closest to the location where the catfish was caught, 72.3% and 27.1%, while only 0.6% of signals were recorded by other receivers. The mean catfish depth was 8.4 m, while minimum and maximum depths were 1.2 and 16.2 m. Results obtained showed that this catfish exhibited high site fidelity, while changes in depth at certain periods are possibly related to its search for prey and upstream migration during the spawning period. Hydropower dam and shiplock were obstacles on its migration upstream and telemetry studies could ensure habitat requirements and meet the development of restoration and conservation strategies for the fish resources in the future. [ABSTRACT FROM AUTHOR]

2021/7 The termination of employment by mutual agreement or by resignation occurring on the employer's initiative to be considered when establishing the actual number of employees collectively dismissed (RO): The Vaslui Tribunal has recently annulled an individual dismissal decision issued during the state of alert in Romania due to formalities which had not been observed by the employer. While the judge invested with determining the matter limited their analysis to the elements contained in the individual dismissal decision, the judicial assistant ascertained, within a competing opinion, that the dismissal decision should have been annulled for other reasons, namely for the fact that, in reality, the employer had implemented a collective redundancy process without observing the procedure and employees' rights in the event of such dismissal. Relying on the provisions of Directive 98/59/EC of 20 July 1998 on the approximation of the laws of the Member States relating to collective redundancies, the judicial assistant has made an exhaustive analysis of the conditions required for the existence of a collective dismissal. While the competing opinion does not have the same effect as a court ruling, it is part of the judicial procedure and, from this perspective, the independence and impartiality of all the members of the court and their obedience solely to the law is maintained. [ABSTRACT FROM AUTHOR]

2020/18 Prohibition of dismissal of pregnant employee (RO): Analysing the national legal framework in relation to the protection of pregnant employees and employees who have recently given birth or are breastfeeding, provisions which transposed the regulations of Directive 92/85/EEC and of the conclusions in case C-103/16, Jessica Porras Guisado – v – Bankia S.A. and Others , the Constitutional Court of Romania ascertained that the dismissal prohibition of a pregnant employee is strictly restricted to reasons that have a direct connection with the employee's pregnancy status. As for other cases where the termination of the employment contract is the result of disciplinary misconduct, unexcused absence from work, non-observance of labour discipline, or termination of employment for economic reasons or collective redundancies, the employer must submit in writing well-reasoned grounds for dismissal. [ABSTRACT FROM AUTHOR]

Background: Rational use of medications and monitoring of prescriptions in elderly patients is important to decrease the number and duration of hospitalizations, emergency medical consultations, mortality, as well as medical costs. Purpose: To identify potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), and determine their prevalence based on the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) v2 criteria and Screening Tool to Alert doctors to Right Treatment (START) v2 criteria for patients aged > 65 years. Methods: This cross-sectional study was conducted in two rural counties in Romania based on electronic prescriptions for chronic conditions (EPCCs) issued from 30 days to 90 days by a specialist or general practitioner. Collected EPCCs were evaluated by an interdisciplinary team of specialists based on 26 STOPP v2 criteria and 10 START v2 criteria. Results: PIM prevalence was 25.80% and PPO prevalence was 41.72% for 646 EPCCs. The mean age of patients was 75 years and the mean number of drugs per EPCC was four. The most frequently identified PIMs were treatment duration (6.65%), theophylline administration (5.72%), drug indication (4.64%), cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs (1.39%), and zopiclone prescription (0.77%). Statins (24.76%), beta-blockers (8.04%), and beta-2 agonist/antimuscarinic bronchodilators (5.88%) were the most frequently identified PPOs. Conclusion: PPOs were more prevalent than PIMs for elderly populations living in the two rural counties in Romania we studied. Health practitioners (family physicians, specialists, and pharmacists) should focus on prophylactic and curative considerations when prescribing agents to decrease the morbidity and mortality of elderly rural Romanian patients. [ABSTRACT FROM AUTHOR]

In this paper we will present the linguistic perspective about learning foreign languages, and will be structured in two parts: the first part will explain the distinction made by E. Coşeriu between two important aspects of languages, and the second part will approach the linguistic theories in teaching foreign languages. In teaching the Romanian language as a foreign language, it is important to take account, firstly, of the distinction between the sistem and normă by Eugeniu Coşeriu. This is an essential element for understanding and exemplifying the learning/teaching process of Romania as a foreign language. The language has multiple possibilities to form plural, for example, but the grammar only accepts one of those possibilities. The confusions between the right form and the wrong one are explained by this distinction made by E. Coşeriu. In the second part of this article, we will discuss the theories offered by Coşeriu in teaching languages that are directed towards a teaching using a language that both student and teacher speak, avoiding the direct method. We will discuss E. Cassirer's theory, because both theoretical visions develop and capitalizes in different ways the Humboldt's understanding of language as creative activity, not just an instrument that humans use to communicate. [ABSTRACT FROM AUTHOR]

Civil servant forms a distinct category within the staff working in the public sector. They have a reserve obligation that imposes several limitations on them in the exercise of fundamental civil rights. The right to freedom of expression is a right whose limitation is justified by both the public and private interests. The public interest mainly concerns the image of the public authority or institution as well as of the entire body of civil servants. The private interest concerns the right of persons interacting with civil servants to dignity, image and protection of personal data. The limitations imposed by the special law must be consistent with the standards imposed by the Constitution and the international acts that Romania has signed. These limitations must be regulated only by law; they must be justified by defending values more important than free expression; they must be necessary in a democratic society, proportionate to the situation that led to the establishment of the fence and not harm the very existence of law. [ABSTRACT FROM AUTHOR]

Introduction: Transjugular intrahepatic portosystemic shunt (TIPS) is used to treat the complications of portal hypertension. This procedure reduces the blood pressure in the portal vein by creating a shunt between the portal vein and the hepatic vein. Endotipsitis is the infection or inflammation of the shunt, defined by continuous clinically significant bacteremia with or without vegetation/thrombi inside TIPS. Case Report: A 66-year-old male patient presented to our health care center with altered mental status, jaundice, distended abdomen, and bilateral edema of the lower limbs. Relevant information from the patient's history was: etanolic liver cirrhosis and refractory ascites for which he underwent a TIPS insertion 6 months before. Laboratory examinations displayed leukocytosis, elevated plasma protein C level, Child-Pugh score of 11 points, and Meld-Na 32 points. The infection assessment confirmed bacterial peritonitis and Escherichia-coli in both admission blood cultures. An antibiotic course with Cefotaxime was started for 10 days. Given the ascites recurrence, a TIPS dysfunction is suspected, ultrasound showed signs of dysfunction (low TIPS velocity, return of antegrade intrahepatic portal flow), and CT examination demonstrated thrombosis of the shunt. Later, he underwent a TIPS revision and the dysfunction was solved by balloon angioplasty. The patient initially improved (blood cultures were), but 7 days after discontinuing the antimicrobials, the patient developed a fever, and blood cultures were again positive with Escherichia-coli. In the absence of any other sites of infection, he was diagnosed with endotipsitis and continued antimicrobial therapy with Cefotaxime and afterward with Ciprofloxacin for 1 month, with a favorable outcome. Discussions : There are only a few cases of endotipsitis recorded in literature, a diagnosis of exclusion that must be suspected in case of recurrent bacteremia in a patient with TIPS insertion. The symptoms usually include fever, malaise, jaundice, recurrent ascites, and persistent bacteremia. A diagnosis of definite endotipsitis needs the presence of vegetations or thrombi of the TIPS on CT or ultrasound examinations. In most cases, the bacteremia is composed of multiple Gram-positive bacteria or even fungi; in our case, the source of the infection is just one pathogen. There is no data to support the prophylactic use of antibiotics before the initial TIPS unless the patient has joint, valve, and other endoprostheses. Conclusions: Endotipsitis is a serious complication after TIPS insertion that can lead to death but often goes underdiagnosed due to a lack of knowledge about it. [ABSTRACT FROM AUTHOR]

Introduction: Multiple endocrine neoplasia 2A (MEN 2A) is an inherited dominant syndrome due to specific RET proto-oncogene mutations characterised by medullary thyroid carcinoma (MTC), adrenal pheochromocytoma and hyperparathyroidism. Molecular genetic diagnostics are currently allowing familial types of MTC to be detected at an asymptomatic stage and surgery thus to be performed at a time when the prognosis is good. The current report aims to highlight the importance of appropriate monitoring of patients with hereditary MEN 2A syndrome as well as the importance of reasonable timing for prophylactic thyroidectomy in a paediatric patient with MTC. Case Report: We present the case of a 5-year-old male patient with a family history of MEN2A syndrome and metabolic syndrome who was admitted to our department for excessive weight gain and hypertension. Physical examination revealed an overweight patient (96.4th BMI percentile), cervical and axillary acanthosis nigricans and arterial hypertension (BP>95th percentile). Biochemical investigations revealed elevated basal and post-calcium stimulation test calcitonin levels, normal serum, and 24h-urine metanephrines levels and normal PTH levels. Thyroid ultrasound described a marked hypoechogenic area with an ill-defined margin and slightly visible intranodular vascularisation but no calcifications. 18F-FDOPA PET/CT did not describe local or distant metastases. Findings were overall consistent with MTC and the patient underwent total thyroidectomy. Histopathological examination confirmed the diagnosis of in situ MTC. Postoperatively the patient received long-term thyroid replacement therapy and the follow-up included thyroid ultrasound evaluation of residual disease, calcitonin and thyroglobulin levels, fractionated metanephrines and PTH every 6 months. DNA analysis of our patient and his brother, who had no endocrinopathies, confirmed the diagnosis of MEN2A by a mutation at codon 634 of the RET proto-oncogene. Discussions : Nearly all patients with MEN2A have either C-cell hyperplasia (CCH) or MTC, but the incidence of these manifestations depends on the underlying RET mutation. Even though our patient was not tested for RET gene mutations preoperatively, the MEN2A family history, high calcitonin levels and imaging findings were considered sufficient for the surgical indication. Even though thyroidectomy is associated with a higher morbidity rate in pediatric patients, in this case, it was necessary to prevent macro-invasive MTC, lymph node involvement and distance metastases. Conclusions: MTC is the most common cause of death in MEN2A patients, its early diagnosis through regular screenings and the optimal timing for prophylactic thyroidectomy are crucial. Genotype-phenotype correlation in MEN2A familial syndromes has a strong variability even in patients with the same mutation. [ABSTRACT FROM AUTHOR]

Background: The management of endometrial polyps and other uterine conditions such as adenomyosis, pelvic inflammatory disease, and suspected external endometriosis presents a clinical challenge, particularly in perimenopausal women experiencing abnormal uterine bleeding. Objective: This case report aims to illustrate a comprehensive approach to diagnosing and treating complex gynecological conditions in a 49-year-old female patient, highlighting the effectiveness of hysteroscopic polypectomy combined with uterine curettage. Material and methods: A 49-year-old patient was admitted to the hospital from January 21, 2024, to January 23, 2024, for scheduled surgery due to complaints of menorrhagia, a history of regular menstrual cycles with heavy flow lasting 5 days, and a medical history including nasal polypectomy and uterine curettage in 2017. Pre-admission medication history included contraceptive use and a noted allergy to Ibuprofen. The diagnostic process involved clinical examination and ultrasound imaging. The operative procedure performed on January 22, 2024, included hysteroscopic polypectomy and uterine curettage under spinal anesthesia. Results : The surgical intervention led to the resection of two endometrial polyps and systematic curettage of the uterine cavity. Histopathological examination confirmed the presence of hyperplastic endometrial polyp fragments without atypia. The postoperative period was uneventful, with the patient receiving antibioprophylaxis, anticoagulant, anti-inflammatory, and analgesic treatment, demonstrating good recovery without complications. Conclusions: Hysteroscopic polypectomy combined with uterine curettage offers an effective treatment option for women with abnormal uterine bleeding due to endometrial polyps. This case highlights the significance of personalized patient care, incorporating surgical intervention, histopathological examination, and postoperative management to achieve optimal outcomes. [ABSTRACT FROM AUTHOR]

Background: Hospitalized individuals with acute myocardial infarction (AMI) who show altered nutritional status are likely to have a worse clinical prognosis. However, the prognostic significance of malnutrition in patients with critical stage of AMI has not received adequate attention. Objective: Discovering factors associated with damaged nutritional status in hospitalized patients with resvascularized AMI. Material and methods: Retrospective observational study by collecting information from the observation sheets of AMI patients admitted to the Cardiology Department, SCJU Tg Mures between September and December 2020. Depending on the nutritional status calculated with the GNRI score, the patients were divided into 2 study groups, those with impaired nutritional status (GNRI<98) and those with normal nutritional status (GNRI≥ 98) Results : A group of 99 patients was investigated, and according to the GNRI score, almost thirty-three percent of them (30.3%) presented an impaired nutritional status. Out of the total of 99 patients, 7 patients died in the hospital, all of them having impaired nutritional status, p=0.0001. Of the total number of patients with poor nutritional status, during hospitalization, 23.3% experienced cardio-respiratory failure (p=0.0001), 30% displayed supraventricular arrhythmias (p=0.001), and 46.7% necessitated inotropic support (p=0.0001). Malnourished patients had considerably extended hospitalizations in CCU, p=0.02, and hsCRP values were significantly higher both at the initial moment and 5 days after AMI. In the logistic regression analysis, variables significantly associated with malnutrition risk (GNRI<98) were inotropic support (OR: 4.68), cardio-respirator failure in the hospital (OR: 11.85), and supraventricular arrhythmias (OR=11.81). Conclusions: This study established a connection between a nutritional deficiency and a higher risk of complications, an increased inflamatory status, death inside the hospital, and longer hospitalization days in cardiac care units in patients with acute myocardial infarction who experienced revascularization. [ABSTRACT FROM AUTHOR]

Background: Ebstein's anomaly (EA) is a rare congenital cardiac malformation characterized by apical displacement of the tricuspid valve (TRv) and reduced volume of the true functional right ventricle (RV). Despite its low rate of occurrence, neonatal presentation of EA represents the most severe clinical form of this condition, associated with high mortality. The pathophysiology and clinical presentation vary depending on the anatomical severity of the disorder. Symptomatic neonates with EA presented with cyanosis and severe congestive cardiac failure. Objective: The identification of risk factors for hemodynamic instability is extremely important in therapeutic management. These factors include lack of effective antegrade pulmonary flow in anatomic or functional pulmonary atresia, severe TRv regurgitation creating a large right-to-left shunt through an atrial septal defect, RV dysfunction, inadequate left ventricle filling owing to ventricular septal bowing, arrhythmias, and the extrinsic compression of lungs by the space-occupying mass of the dilated right heart. In the neonate, these factors are amplified by the elevated pulmonary resistances (PVR). Material and methods: The classic radiographic appearance of EA is massive "wall-to-wall" cardiomegaly. The echocardiography is the most useful in the diagnosis of EA providing sufficient anatomic and hemodynamic information: the degree of apical displacement of the septal leaflet, the degree of atrialization of the RV, size of TRv annulus, severity of TRv regurgitation. It may be difficult to differentiate physiological from anatomical pulmonary atresia. Following a confirmation of diagnosis by echocardiography, the clinical evolution should be monitored closely. Results : Most neonates born with EA do not require surgical intervention. Neonates who are reasonably stable are treated with supplemental oxygen, Prostaglandin E1 as require, and closely observed for adequate cardiac output. The immediate therapy of unstable patients may involve intubation, deep sedation, inotropic support, inhaled nitric oxide to reduce PVR, and Prostaglandin E1 if deemed ductal-dependent. Many neonates tend to stabilize and improve over a few days as PVR decreased. Neonates who continue to decline despite standard resuscitative measures need surgical intervention. Surgical options depend on the hemodynamical anatomical features and ranging from a complete biventricular repair to single-ventricle palliation. Conclusions: Symptomatic neonates with EA represent the most severe form of the disease and can be effectively managed with good outcomes. Echocardiography is generally the key test for diagnosis. The choice of management pathway based on anatomy and physiology can help reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Romania has drastically improved an array of health indicators in recent years, including maternal mortality rates, which decreased from 1990 to 2015, but the mortality rates are still high, ranking among the first in Europe. Preeclampsia and eclampsia constitute one of the primary causes of maternal death in the country. The study was conducted from early January to the end of February 2019 to assess the current state of resident physicians' and midwives' knowledge of preeclampsia and eclampsia reflected in their practice at a clinical hospital in southern Romania. Self-administered questionnaires were used for data collection. Most of the investigated resident physicians and midwives (87.5%) answered correctly regarding the correct definition of preeclampsia. The first choice of procedure for the patient with preeclampsia (vaginal delivery or C-section) was chosen correctly by only 37.5% of the participants. Regarding the correct identification of the necessary paraclinical tests used for women with suspected preeclampsia, 58.3% of the participants answered correctly. As far as the correct identification of the possible risks of dexamethasone administration to mothers is concerned, only 29.2% of the participants answered correctly. Also, 58.3% of the participants answered correctly regarding the correct identification of contraindicated uterotonic drugs for women with diagnosed hypertension. Resident physicians and midwives are aware of pregnancy complications, but they hold limited knowledge specific to pregnancy complications as preeclampsia and eclampsia. It is imperative to promote studies to evaluate the impact of enhancing their training to include additional content related to the early detection and management of preeclampsia and eclampsia. [ABSTRACT FROM AUTHOR]