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Thrombocytopenia represents one of the most frequent causes of addressability for a hematological consultation. The purpose of the study is to establish a correlation between the degree of thrombocytopenia and the appearance of the mucocutaneous bleeding, with a therapeutic purpose. Materials and method: Our study is a retrospective observational study and was carried out on a group of 100 patients who were referred to the Hematology Clinic of Sp. St. Spiridon, Iași for a period of 12 months and who presented with isolated thrombocytopenia on admission. Other coagulopathy evolving with thrombocytopenia were excluded. To establish the correlation between the decrease in the number of platelets and the appearance of the hemorrhagic skin-mucosal syndrome, statistical methods were used – F Test – Two sample for Variance. Results and discussions: Thrombocytopenia was defined as the value of platelets below 150,000\mmc. 5 grades of thrombocytopenia were established: grade I (TR=150,000-100,000/mmc), grade II (TR= 100,000-50,000/mmc), grade III (TR=50,000-20,000/mmc), grade IV (TR= 20,000 -10,000/mmc), grade V (TR below 10,000/mmc)40% of the patients included in the study presented thrombocytopenia gr. I, 24% – grade II, 15% – grade III, 6% – grade IV and 15% presented severe thrombocytopenia (grade V). The mucocutaneous bleeding was manifested by: petechiae and ecchymosis, epistaxis, bleeding in the oral cavity (gingival bleeding, hemorrhagic bullae), menometrorrhagia, hematuria, melena. There is a statistical correlation between the number of platelets and the occurrence of mucocutaneous bleeding: p=0.000121 (p less than 0.001). The first clinical manifestations of the mucocutaneous bleeding appeared at the value of 70,000/mmc. No statistical correlation was obtained between the age of the patients and the number of platelets (p=0.0352). Conclusions: The occurrence of mucocutaneous bleeding is directly related to the decrease in the number of platelets. The oral cavity usually is involved in bleeding caused by the decrease in the number of platelets and requires a multidisciplinary approach.

Background: Emergency medicine in Romania has developed fast since inception. The need for faster diagnostic capabilities due to the high workload pre- and in-hospital made point-of-care ultrasound (POCUS) a logical next step. The advantages of POCUS are well known, but implementation presents challenges. Our goal was to study how a straightforward method of implementation would work locally. Methods: Two prospective observational studies were conducted at 6 months (prehospital) and 4 months (in-hospital). The protocol used was extended focused assessment sonography in trauma (eFAST), and the shock index (SI) was used to stratify patients. Voluntary sampling was conducted by emergency physicians. The primary outcomes were patient numbers, type of case use, results, and accuracy. Results: The prehospital study registered 34 patients: 41% traumas, 35% cardiac arrest, 18% shock, and 6% acute respiratory distress. The in-hospital study patients were 78: 36% traumas, 6% cardiac arrests, 41% shock, and 17% acute respiratory distress. A total of 88.5% of the cases were confirmed with definitive imagistic findings. Conclusion: The studies mark an increase in POCUS usage and use in complicated cases. Providing supervision and feedback into clinical practice resulted in a further increase in POCUS usage, the second study having an 88.5% accuracy when compared to the final diagnostic proving the increased efficiency of a longitudinal training approach.

Cardiovascular disease and periodontal disease are two distinct conditions that have been found to be linked through various research studies. Periodontal disease is a chronic inflammatory condition that affects the supporting structures of the teeth, including the gums, periodontal ligament, and jawbone. It is primarily caused by the accumulation of dental plaque, a sticky film of bacteria that forms on the teeth. If left untreated, periodontal disease can lead to gum inflammation, gum recession, tooth loss, and even systemic health problems. Several mechanisms have been proposed to explain the potential link between periodontal disease and cardiovascular disease. Maintaining good oral hygiene and preventing or treating periodontal disease is important for overall health

It is well known that algogenic tissue substances (bradykinin, prostaglandins, histamine, serotonin, Substance P) are found in tissues under normal conditions in very small quantities. Cellular, vascular and nerve fiber aggression, especially inflammatory, but also mechanical -traumatic or ischemic of the oro-maxillary tissues causes the concentration of these algogenic factors to increase, inducing the stimulation of algo-conductive nerve pathways. Their presence in large quantities generates the appearance of violent pain sometimes, either through the irritating action they have on the peripheral endings, or through compression edema due to vasodilation and vascular hyperpermeabilization following tissue irritation or aggression. Current review whants to present the potential biomarkers involved in oro-facial pain by analyzing various biofluids different molecular markers who can used to identify the risk factors and predicting the progression and outcomes of painful oro-facial conditions.

Aplastic anemia is a non-oncological haematological disease, which is a challenge for specialists due to the severity of the clinical symptoms. It is characterized by hypocellularity of the bone marrow and its secondary pancytopenia. The aim of this paper is to characterize the symptoms of the oral cavity and the associated risks in the context of aplastic anemia. A brief review of the literature was conducted that highlighted pathological changes in the oral cavity in patients with aplastic anemia, to which were added data from current clinical experience. The clinical picture varies depending on the predominantly affected cell line. In aplastic anemia, symptoms of the oral cavity are always present. Thus, pallor can be found in the oral cavity as a sign of severe anemia, infections secondary to severe neutropenia and secondary immune deficiency syndrome, spontaneous bleeding due to severe thrombocytopenia. In addition to the signs of damage to the oral cavity in the context of the disease, there are symptoms caused by the side effects of treatment specific to this haematological pathology. Of these, gingival hyperplasia secondary to cyclosporine treatment is the most constant. Often these symptoms are the initial manifestation of the disease, which requires special attention from the dentist. The prevention, diagnosis, and specific treatment of oral pathology in the context of aplastic anemia improves the quality of life of these patients.

Dietary salt intake is a long-debated issue. Increased sodium intake is associated with high blood pressure, leading to salt-sensitive hypertension. Excessive salt intake leads to arterial stiffness in susceptible individuals via impaired nitric oxide action and increased endothelin-1 expression, overactivity of the renal sympathetic nervous system and also via aldosterone-independent activation of the mineralocorticoid receptor. Salt restriction in such individuals reduces blood pressure (BP) values. The optimal level of salt restriction that leads to improved cardiovascular outcomes is still under debate. Current BP and dietary guidelines recommend low sodium intake for the general population. However, a specific category of patients does not develop arterial hypertension in response to sodium loading. In addition, recent research demonstrates the deleterious effects of aggressive sodium restriction, even in heart failure patients. This mini review discusses current literature data regarding the advantages and disadvantages of salt restriction and how it impacts the overall health status.

Immune thrombocytopenic purpura (ITP) is a blood disorder characterized by a low platelet count of (less than 100 × 109/L). ITP is an organ-specific autoimmune disease in which the platelets and their precursors become targets of a dysfunctional immune system. This interaction leads to a decrease in platelet number and, subsequently, to a bleeding disorder that can become clinically significant with hemorrhages in skin, on the mucous membrane, or even intracranial hemorrhagic events. If ITP was initially considered a hemorrhagic disease, more recent studies suggest that ITP has an increased risk of thrombosis. In this review, we provide current insights into the primary ITP physiopathology and their consequences, with special consideration on hemorrhagic and thrombotic events. The autoimmune response in ITP involves both the innate and adaptive immune systems, comprising both humoral and cell-mediated immune responses. Thrombosis in ITP is related to the pathophysiology of the disease (young hyperactive platelets, platelets microparticles, rebalanced hemostasis, complement activation, endothelial activation, antiphospholipid antibodies, and inhibition of natural anticoagulants), ITP treatment, and other comorbidities that altogether contribute to the occurrence of thrombosis. Physicians need to be vigilant in the early diagnosis of thrombotic events and then institute proper treatment (antiaggregant, anticoagulant) along with ITP-targeted therapy. In this review, we provide current insights into the primary ITP physiopathology and their consequences, with special consideration on hemorrhagic and thrombotic events. The accumulated evidence has identified multiple pathophysiological mechanisms with specific genetic predispositions, particularly associated with environmental conditions.

Aim of the study In the field of dentistry, emergencies can occur unexpectedly, requiring immediate attention and prompt action.The study aims to shed light on the experiences and knowledge of dental students in handling emergency situations and their understanding of the role of first aid in dental practice. Material and methods A cross-sectional study was conducted at the Faculty of Dental Medicine, Iasi. The questionnaire was updated on the Google Forms platform, and the link was distributed to dental students in their 3rd, 4th, and 5th years of study. Out of Approximately 420 students, 205 of them agreed to respond to the questionnaire. Statistical analysis was performed using SPSS 27.0. Initially, the group was characterized using descriptive statistics, and subsequently, the comparative responses of the students based on their years of study were analyzed using the Chi-square test. The collected data was then analyzed for frequency distributions. Results The findings indicate that dental students possess awareness regarding the risks associated with routine dental practice. While they exhibit a satisfactory level of theoretical knowledge, they lack the necessary confidence to administer first aid, thereby highlighting a disparity between their theoretical understanding and practical skills. Conclusions The findings underscore the need for comprehensive education and training in dental emergency management to equip dental students with the necessary skills and knowledge to handle emergency situations effectively. By incorporating these insights into dental curricula, educators can contribute to the development of competent dental professionals who prioritize patient safety.

Background. The worldwide COVID-19 pandemic has impacted the physical and psychosocial health of the population, with consequences that stretch beyond the initial outbreak. In this context, our aim was to evaluate the psychological effects of the pandemic on individuals in Romania. Methods. We conducted a cross-sectional survey to compare the severity of psychological distress, encompassing anxiety, stress, and depression, in the general population, using DASS-21 questionnaire. Results. Among the 521 valid responses, the experience of illness has broadened the perception of all DASS indicators compared to individuals who have not encountered the disease. Moderate cases of the illness have notably increased anxiety and stress levels, while severe cases of COVID-19 have led to elevated levels of depression. Women exhibit all the assessed variables in a more pronounced manner compared to men. Among the surveyed population, individuals aged over 65 have shown a significant increase in DASS values in response to the COVID-19 pandemic. Conclusion. As we have navigated through the pandemic, it has become clear that varying degrees of psychosocial scars remain in its wake. Within Romania’s sociocultural context, it is apparent that women and the elderly demonstrate unique psychological susceptibilities. Urgent action is required to proactively address and reduce the adverse effects of the pandemic on these vulnerable groups.

BackgroundContemporary scientific literature has emphasized two specific aspects of healthcare professionals: compassion satisfaction and compassion fatigue. In the context of the COVID-19 pandemic, which has placed significant strain on health systems and healthcare workers, the Russian-Ukrainian crisis appears to have a magnifying effect, particularly on mental health.MethodsThe aim of the present study was to investigate the relationship between threat perception, daily worries, and professional quality of life in a sample of Emergency Medicine Personnel during two major events mentioned above. The sample included 372 participants (56.7% nurses and 43.3% physicians) from emergency units in five county hospitals in the Eastern region of Romania.ResultsThe study revealed that threats related to the pandemic were positively linked to secondary traumatic stress, and daily worries were positively linked to both secondary traumatic stress and burnout. Threats generated by the war did not manifest a direct relation with any of the indicators of professional quality of life, but daily worries generated by war positively predicted both secondary traumatic stress and burnout.ConclusionBoth the pandemic, which involved cumulative exposure, and the war, which involved a lower and more distant level of exposure, had the potential to generate worries and predict a low quality of life. However, our results did not reveal any association between threats, worries, and compassion satisfaction. As a result, this positive indicator of quality of life remained stable despite the presence of threats and worries.

We thank Campbell et al. for their comment [...]

Background and Objectives: The aim of this study was to evaluate choroidal structure and vascularity indices in patients with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: Sixty-three eyes from sixty-three patients were evaluated: 21 from healthy subjects, 20 with diabetes mellitus (DM) and no diabetic retinopathy (DR), and 22 with DM and non-proliferative diabetic retinopathy without diabetic macular edema (DME). Each patient underwent ocular examination, macular swept-source ocular coherence tomography (SS-OCT) imaging, glycemic control, and systemic high blood pressure (HBP) evaluation. Subfoveal choroidal thickness (SF-CT) was manually assessed on a line scan. Line scan OCT images were exported to ImageJ program. The areas under a 1.5, 3 and 6 mm horizontal line centered on the fovea were assessed by converting the OCT images to binary images, and total choroidal area (TCA), luminal area (LA), stromal area (SA), LA:SA ratio, and choroidal vascularity index (CVI) were evaluated. SF-CT and choroidal parameters were compared between groups, and correlations with ocular and systemic factors were analyzed. Results: SF-CT, TCA, LA, and SA were similar between groups. CVIs were significantly different between groups for all three studied areas (CVI-1.5: 66.21% vs. 66.06% vs. 63.74%, p = 0.003; CVI-3: 65.88% vs. 66.46% vs. 63.79%, p = 0.008; CVI-6: 64.79% vs. 65.40% vs. 63.61%, p = 0.032). NPDR patients had significantly lower CVIs compared to DM patients (p < 0.05). No association of choroidal parameters with glycemic control, DM duration and HBP was found significant (p < 0.05). Conclusions: Choroidal assessment by SS-OCT and image binarization in healthy subjects, subjects with DM without DR, and subjects with DM and NPDR indicated that CVI changes were identifiable and significant in early DR. The lack of association with ocular and systemic factors suggest that CVIs are reliable assessment parameters of choroidal vascular structure.

Background and Objectives: Cytokines are cell-signaling proteins whose identification may serve as inflammatory markers or early indicators for progressive disease. The aim of our study was to quantify several cytokines in aqueous humor (AH) and their correlations with biochemical parameters in diabetic eyes with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: A total of 62 eyes from 62 patients were included in the study: 37 eyes from nondiabetic patients (group 1), 13 diabetic eyes with no retinopathy changes (group 2) and 12 diabetic eyes with early and moderate NPDR (group 3). AH samples were collected during uneventful cataract surgery. The cytokines IL-1β, IL-6, IL-8, IL-10, IL-12, IP-10, MCP-1, TNF-α and VEGF were quantified using multiplex bead-based immunoassay. Due to unreliable results, IL-1β, TNF-α, IL-10 and IL-12 were excluded. Concentrations were compared between groups. Biochemical parameters (fasting blood sugar, glycated hemoglobin, C-reactive protein) and the duration of diabetes were recorded. Results: VEGF levels were significantly different between groups (p = 0.001), while levels of IL-6, IL-8, IP-10 and MCP-1 were comparable across all groups (p > 0.05). IL-6 concentration correlated with VEGF in group 1 (rho = 0.651, p = 0.003) and group 3 (rho = 0.857, p = 0.007); no correlation could be proved between IL-6, IL-8, IP-10, MCP-1 or VEGF and biochemical parameters. Duration of diabetes was not correlated with the cytokine levels in groups 2 and 3. The receiver operating characteristic (ROC) curve revealed that VEGF concentrations could discriminate early and moderate NPDR from diabetes, with an area under the curve (AUC) of 0.897 (p = 0.001, 95% CI = 0.74–1.0). Conclusions: Diabetes mellitus induces significant intraocular changes in the VEGF expression in diabetic patients vs. normal subjects, even before proliferative complications appear. VEGF was increasingly expressed once the diabetes progressed from no retinopathy to early or moderate retinopathy.