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(1) Background: Does the variation in sequential development times of embryos, observed through time-lapse monitoring, between the two study groups play a role in predicting pregnancy success? (2) Methods: The prospective double-arm study was to identify the morphokinetic parameters specific to embryos that were capable of implanting and were conducted on 89 embryos cultured in the Esco Miri time-lapse incubator, divided into two groups: Lot A, consisting of 57 embryos that successfully implanted and resulted in life birth rate (LBR), and Lot B (NLB), comprising 32 embryos that did not implant, leading to a negative beta-hCG outcome. (3) Results: Baseline characteristics, including female age, were not found to be statistically significant ( p > 0.01). In contrast, there is a highly statistically significant difference concerning oocytes ( p = 0.0029). Morphokinetic variables represented by sequential culture times were not statistically significant ( p > 0.01) when comparing the two groups. However, the negative mean differences between these parameters suggest that the times for Lot A are better (shorter) than those for Lot B. While not statistically significant, these differences may still have practical significance. In the case of grading, the difference is considered to be extremely statistically significant ( p < 0.01). (4) Conclusions: Although there are no statistically significant differences in sequential timings ( p > 0.01) between the two groups, there are parameters indicating predictive potential for exploring pregnancy in embryo morphokinetics.

Maxillofacial trauma, as seen from a medico-legal point of view, is an integral part of medical practice in emergency departments. Therefore, general practitioners should have sufficient knowledge about their roles and responsibilities in managing these cases. This study aimed to assess general practitioners' knowledge, practices, and attitudes regarding managing medico-legal cases (MLCs)., Material and Method: This study included 113 general practitioners from St. Spiridon Hospital in Iasi, Romania. Participants completed a self-administered structured questionnaire assessing the knowledge, attitudes, and practices of general practitioners regarding the handling of medico-legal cases., Results: The scores obtained for the level of knowledge, attitudes, and practices indicate a good level of knowledge on the part of the responding doctors, with the average value being 38, in a range from 0 to 49 (min. value 28-max wave. 47). The score regarding the attitudes of doctors related to the management of medico-legal cases is modest, with the average value being 37 points out of a maximum of 60 points (min. 14-max. 51). The same situation is recorded in the case of practices regarding the management of medico-legal cases, with the average value being 68 out of a maximum value of 90 (min. 38-max. 84)., Conclusion: This study's results revealed the absence of a well-defined protocol for the recognition and handling of medico-legal cases among general practitioners from Iasi and the need to improve the level of attitudes and practices regarding the management of medico-legal cases. The limitations of this study included the relatively small sample from a single hospital and the use of a methodology based on self-administered questionnaires, which may be subjective. Accordingly, future studies should involve larger and more diverse samples to monitor changes in knowledge and practices over time and qualitative methodologies to gain deeper physician-related insights into medical case management.

Adolescents and young adults' active lifestyles make dental trauma a significant medical concern., Aim: This study aims to assess the etiology, frequency, and localization of dental and periodontal trauma in adolescents and young adults, along with these individuals' predisposition based on age, gender, and residence. Materials and Methods This retrospective study included 109 adolescents and young adults from a database of the Emergency and Oral and Maxillofacial Surgery department at "Sf. Spiridon" Hospital, Iasi, Romania. The collected data included demographic details, mechanisms of dental and periodontal trauma, treatment approaches, and clinical outcomes. Statistical analysis was performed using SPSS 26.0, with comparisons based on age, gender, and residence., Results: Enamel fractures (23.9%) and enamel-dentin fractures without pulp exposure (20.2%) were the most frequent dental injuries. Concussion (58.7%), subluxation (21.1%), luxation, avulsion (7.3%), and extrusion (5.5%) were common periodontal injuries. The anterior region of the dental arch accounted for the majority (60.6%) of injuries. Adolescents under 17 years were more prone to enamel-dentin fractures without pulp exposure (23.8%), enamel-dentin fractures with pulp exposure (20.6%), and root fractures (20.6%), while young adults over 18 years had a higher incidence of enamel fractures (32.6%) and crown-root fractures (30.4%). Falls (66.7%) were the predominant cause of trauma for female patients, whereas male patients were more often injured during sports activities (49.3%). The younger age group was 0.29 times more likely to sustain enamel-dentin fractures without pulp exposure ( p = 0.049, OR = 0.291) and root fractures ( p = 0.047, OR = 0.241)., Conclusions: Traumatic dental injuries are more prevalent in young adults compared to adolescents, with falls and sports activities being the most common causes, particularly among males. These findings emphasize the need for targeted preventive programs aimed at reducing the incidence of dento-periodontal trauma in these age groups.

Branched-chain amino acids (BCAAs), comprising leucine (Leu), isoleucine (Ile), and valine (Val), are essential nutrients vital for protein synthesis and metabolic regulation via specialized signaling networks. Their association with cardiovascular diseases (CVDs) has become a focal point of scientific debate, with emerging evidence suggesting both beneficial and detrimental roles. This review aims to dissect the multifaceted relationship between BCAAs and cardiovascular health, exploring the molecular mechanisms and clinical implications. Elevated BCAA levels have also been linked to insulin resistance (IR), type 2 diabetes mellitus (T2DM), inflammation, and dyslipidemia, which are well-established risk factors for CVD. Central to these processes are key pathways such as mammalian target of rapamycin (mTOR) signaling, nuclear factor kappa-light-chain-enhancer of activate B cells (NF-κB)-mediated inflammation, and oxidative stress. Additionally, the interplay between BCAA metabolism and gut microbiota, particularly the production of metabolites like trimethylamine-N-oxide (TMAO), adds another layer of complexity. Contrarily, some studies propose that BCAAs may have cardioprotective effects under certain conditions, contributing to muscle maintenance and metabolic health. This review critically evaluates the evidence, addressing the biological basis and signal transduction mechanism, and also discusses the potential for BCAAs to act as biomarkers versus active mediators of cardiovascular pathology. By presenting a balanced analysis, this review seeks to clarify the contentious roles of BCAAs in CVD, providing a foundation for future research and therapeutic strategies required because of the rising prevalence, incidence, and total burden of CVDs.

Lung cancer remains a major public health problem both in terms of incidence and specific mortality despite recent developments in terms of prevention, such as smoking reduction policies and clinical management advances. Better lung cancer prognosis could be achieved by early and accurate diagnosis and improved therapeutic interventions. Nanotechnology is a dynamic and fast-developing field; various medical applications have been developed and deployed, and more exist as proofs of concepts or experimental models. We aim to summarize current knowledge relevant to the use of nanotechnology in lung cancer management. Starting from the chemical structure-based classification of nanoparticles, we identify and review various practical implementations roughly organized as diagnostic or therapeutic in scope, ranging from innovative contrast agents to targeted drug carriers. Available data are presented starting with standards of practice and moving to highly experimental methods and proofs of concept; particularities, advantages, limits and future directions are explored, focusing on the potential impact on lung cancer clinical prognosis.

The specialized literature emphasizes the fact that vitamin D has a potentially beneficial effect in the context of the current COVID-19 pandemic. The purpose of this article is to highlight the role of vitamin D, both prophylactic and curative, in the treatment of patients diagnosed with COVID-19. Even though its relevance is still unknown and causes various controversies, there is currently no specific treatment for patients diagnosed with COVID-19. There are various prevention strategies with new vaccination schedules, but additional randomized and clinical trials are still needed to combat this pandemic. In addition to the systemic manifestations of SARS-CoV-2 infection, oral manifestations of this disease have also been described in the literature. The etiology of oral manifestations associated with COVID-19 infection and vitamin D deficiency remains controversial. In the present studies, oral manifestations such as salivary gland infections, aphthae, erythema, gingivitis, ulcers, etc. have been reported. This is a new topic, and the prevalence of manifestations is described in only a few studies, which is inconsistent with the number of COVID-19 cases reported since the beginning of the pandemic. The clinical symptomatology in patients with current COVID-19 infection is polymorphic. Whether the oral manifestation is directly caused by SARS-CoV-2 or a secondary manifestation remains an important topic to analyze and discuss.

Diabetes mellitus (DM) is one of the most debilitating chronic diseases worldwide, with increased prevalence and incidence. In addition to its macrovascular damage, through its microvascular complications, such as Diabetic Kidney Disease (DKD), DM further compounds the quality of life of these patients. Considering DKD is the main cause of end-stage renal disease (ESRD) in developed countries, extensive research is currently investigating the matrix of DKD pathophysiology. Hyperglycemia, inflammation and oxidative stress (OS) are the main mechanisms behind this disease. By generating pro-inflammatory factors (e.g., IL-1,6,18, TNF-α, TGF-β, NF-κB, MCP-1, VCAM-1, ICAM-1) and the activation of diverse pathways (e.g., PKC, ROCK, AGE/RAGE, JAK-STAT), they promote a pro-oxidant state with impairment of the antioxidant system (NRF2/KEAP1/ARE pathway) and, finally, alterations in the renal filtration unit. Hitherto, a wide spectrum of pre-clinical and clinical studies shows the beneficial use of NRF2-inducing strategies, such as NRF2 activators (e.g., Bardoxolone methyl, Curcumin, Sulforaphane and their analogues), and other natural compounds with antioxidant properties in DKD treatment. However, limitations regarding the lack of larger clinical trials, solubility or delivery hamper their implementation for clinical use. Therefore, in this review, we will discuss DKD mechanisms, especially oxidative stress (OS) and NRF2/KEAP1/ARE involvement, while highlighting the potential of therapeutic approaches that target DKD via OS.

(1) Background: Myocardial infarction was, until recently, recognized as a major coronary event, often fatal, with major implications for survivors. According to some authors, diabetes mellitus is an important atherogenic risk factor with cardiac determinations underlying the definition of the so-called "diabetic heart". The present study aims to establish a correlation between the evolution of myocardial infarction in diabetic patients, by determining whether lactic acid levels, the activity of carbonic anhydrase isoenzymes, and the magnitude of ST-segment elevation are correlated with the subsequent evolution of myocardial infarction. (2) Methods: The study analyzed 2 groups of 30 patients each: group 1 consisted of diabetic patients with acute myocardial infarction, and group 2 consisted of non-diabetic patients with acute myocardial infarction. Patients were examined clinically and paraclinical, their heart markers, lactic acid, and the activity of carbonic anhydrase I and II isozymes were determined. All patients underwent electrocardiogram and echocardiography analyses. (3) Results: The results showed that diabetics develop acute myocardial infarction more frequently, regardless of how much time has passed since the diagnosis. The value of myocardial necrosis enzymes was higher in diabetics than in non-diabetics, and acute coronary syndrome occurs mainly in diabetics with poor metabolic balance. Lethality rates in non-diabetic patients with lactic acid values above normal are lower than in diabetics. (4) Conclusions: Lactic acid correlated with the activity of isozyme I of carbonic dioxide which could be early markers of the prognosis and evolution of diabetic patients with acute myocardial infarction.

(1) Background: The benefit of using inhibitors of carbonic anhydrase (CA), such as acetazolamide, in the treatment of epilepsy has previously been described. (2) Methods: In this paper, the effect on CA of the most well-known antiepileptic drugs was studied in vitro and in vivo. The effects, after chronic treatment, of carbamazepine, phenytoin, valproate, primidone, clonazepam, and ethosuximide were studied in vitro on purified CA, isozyme I (CA I) and CA, and isozyme II (CA II) activity and in vivo on epileptic erythrocyte CA I and CA II activity. (3) Results: In vitro results showed that all antiepileptic drugs reduced purified CA II activity according to dose-response relationships and slightly inhibited CA I activity. In vivo results showed that the chronic administration of antiseizure drugs induced a progressive reduction in erythrocyte CA II activity in all the groups studied. This study shows that CA II inhibition can be induced both in vitro and in vivo by major antiepileptic agents as it might be one of the effective mechanisms of these anticonvulsant drugs. (4) Conclusions: The decrease in CA II activity in epileptic patients after antiseizure treatment suggests the involvement of CA II in the pathogenesis of epilepsy.

Immune thrombocytopenic purpura (ITP) is a blood disorder characterized by a low platelet count of (less than 100 × 10 9 /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.

Background: Numerous studies indicate that most error sources in hemostasis laboratories occur during the pre preanalytical phase through biological product sampling., Objectives: The purpose of this study was documentation, monitoring, and reduction of preanalytical errors through operator training., Methods: For a period of 4 months in the "St. Spiridonˮ Hospital from Iaşi, 978 specimens were identified with non-conformities, due to the following causes: insufficiently-collected, hemolyzed- and coagulated samples. Data collection was conducted in two stages: before and after training of medical staff in clinical departments, upon improving the coagulation specimen sampling practices., Results: The study pointed out that subsequent to training, a reduction of the coagulated samples has been registered as follows: in medical departments from 33.33% to 16.78%, in surgery from 27.20% to 17.02%, ICU (intensive care units) from 10.63% to 8.74%, and slightly in EU (emergency) from 10.63% to 8.74%. Moreover, we noticed that the incidence of hemolyzed samples increased in clinical sections, as follows: EU from 4.50% to 14.89%, medical departments from 3.42% to 9.21%, surgery from 1.44% to 6.38%, and 4.50% to 14.89% for ICU. The insufficiently sampled volume persisted during the study in almost all sections: surgery from 1.80% to 4.96%, medical from 2.52% to 4.96%, EU from 1.80% to 3.78% with a slight decrease in ICU from 1.26% to 1.18%., Conclusions: Nurses traditionally represent the core of quality medical services. Peer education is effective and implementation and compliance of sample collection procedure rules ultimately providing patient safety.

Prolonged tourniquet stasis induced by venepuncture can lead to the release of the plasma of cell lysis products, as well as tissue factor (TF), impairing the quality of coagulation test results. The accidental presence of TF in vitro can trigger the coagulation mechanism, generating a false decrease in prothrombin time (PT). Background and Objectives: Identification of short PT tests below the normal reference value that could suggest a situation of hypercoagulability. The study aimed to compare the results of the shortened PT tests at their first determination with the eventual correction following duplication of the analysis from the same sample. Materials and methods: Identification of the shortened PT tests has been carried out for a period of 4 months, upon 544 coagulation samples referred to the Hematology department of Sf. Spiridon County Clinical Emergency Hospital from Iasi, Romania. Results: Out of the 544 samples of which the results indicated a state of hypercoagulability, by repeating the determination from the same sample, for 200 (36.76%) PT tests ( p = 0.001) the value was corrected, falling within the normal reference range. For 344 (63.24%) tests, the results suggested a situation of hypercoagulability. Conclusions: In order to guarantee the highest quality of the laboratory services, a proper interpretation and report of the patients' results must be congruent and harmoniously associated to the actual clinical condition of the patient. Duplication of the PT determination from the same sample would exclude situations of false hypercoagulability and would provide significant improvement for the patient's safety.

Type 2 diabetes mellitus (T2DM) remains one of the most problematic and economic consumer disorders worldwide, with growing prevalence and incidence. Over the last years, substantial research has highlighted the intricate relationship among gut microbiota, dysbiosis and metabolic syndromes development. Changes in the gut microbiome composition lead to an imbalanced gastrointestinal habitat which promotes abnormal production of metabolites, inflammatory status, glucose metabolism alteration and even insulin resistance (IR). Short-chain fatty acids (SCFAs), trimethylamine N-oxide (TMAO), lipopolysaccharide, aromatic amino acids and their affiliated metabolites, contribute to T2DM via different metabolic and immunologic pathways. In this narrative review, we discuss the immunopathogenic mechanism behind gut dysbiosis, T2DM development and the major known diabetic microvascular complications (retinopathy, neuropathy and nephropathy), the beneficial use of pre- and pro-biotics and fecal microbiota transplantation in T2DM management and new findings and future perspectives in this field.

Background: The selection and rejection of non-conforming coagulation specimens is essential in safeguarding quality management in hemostasis laboratories that provide routine testing for bleeding and thrombotic disorders. In order to increase quality, it is important to reduce pre-analytical errors that generally account for 60 - 70% of total laboratory failure. The accidental presence of clots in vitro, in the pre-analytical phase of the coagulation, is a reason for coagulation specimen rejection, given that the reliability of test results can be adversely compromised. This study aimed to ascertain the effect of clots identified in the post-analytical phase within the blood sample sediments upon standard laboratory tests such as PT (prothrombin time) and APTT (activated partial thromboplastin time)., Methods: From a total of 24,670 coagulation specimens gathered and prospectively collected and analyzed at the Haematology Laboratory of the ˮSf. Spiridonˮ Emergency County Hospital Iasi, Romania, during four months, 671 were identified with clot. Of the coagulated samples, 153 (22.80%) were considered for this study, including those specimens pinpointed with sediment clot through a post-analytical new reverification procedure., Results: The comparative study of the PT and APTT results obtained based on the samples identified with sediment clots in relation to the actual results recorded after the repetition of the sampling, pointed out 43.93% false results for PT1 test, with a significant difference between the variances of the values at the two evaluated moments (t = 2.961, p = 0.0037). The pattern was congruent in the case of the APTT test as well, exhibiting 69.04% false results, for which the variances of values at the two evaluated moments displayed significant differences (t = 2.208, p = 0.0306). In both of the cases significantly lower mean values were noted in the second determination of PT (PT1: 33.1 ± 39.6 vs. PT2: 25.8 ± 30.5) and APTT (APTT1: 42.8 ± 42.7 vs. APTT2: 38.1 ± 26.1. Results are important as they highlight the actual interference between the clot in the erythrocyte sediment and the evaluation of the patient's hemostasis., Conclusions: Our results confirm that the presence of clots in the erythrocyte sediment, with no identification prior to centrifugation, significantly affect the PT and APTT analysis, their accurate results being critical for the proper diagnosis and monitoring of anticoagulant therapy.

Nonalcoholic fatty liver disease (NAFLD) is an emerging worldwide problem and its association with other metabolic pathologies has been one of the main research topics in the last decade. The aim of this review article is to provide an up-to-date correlation between hypothyroidism and NAFLD. We followed evidence regarding epidemiological impact, immunopathogenesis, thyroid hormone-liver axis, lipid and cholesterol metabolism, insulin resistance, oxidative stress, and inflammation. After evaluating the influence of thyroid hormone imbalance on liver structure and function, the latest studies have focused on developing new therapeutic strategies. Thyroid hormones (THs) along with their metabolites and thyroid hormone receptor β (THR-β) agonist are the main therapeutic targets. Other liver specific analogs and alternative treatments have been tested in the last few years as potential NAFLD therapy. Finally, we concluded that further research is necessary as well as the need for an extensive evaluation of thyroid function in NAFLD/NASH patients, aiming for better management and outcome.

The adrenal gland serve important roles in the modulation of the immune response, the adjustment of blood pressure, the stress reaction via glucocorticoids and the hydroelectrolytic balance via mineralocorticoids. Primary adrenal insufficiency, known as Addison disease, is characterized by a decrease in glucocorticoid secretion (cortisol) and, more rarely, by a hyposecretion of mineralocorticoids (aldosterone). The production of cortisol, which is a hormone that helps the body respond to stress, is regulated in the brain, the hypothalamus and the pituitary gland. The hypothalamus stimulates the pituitary gland to produce adrenocorticotropic hormone, which stimulates cortisol production from the adrenal gland. If left untreated, Addison disease has a high mortality rate. Corticotherapy used in the treatment of Addison disease is associated with a certain cardiovascular risk. The proatherogenic effect of corticoids is based on the chronic inflammatory response of the vascular wall to a series of events. The aim of the current case report was to review the pathophysiological mechanisms and interactions that may lead to the onset of acute coronary syndrome with ST elevation in a patient with Addison disease., (Copyright: © Aida Maranduca et al.)

Background: Monitoring of anticoagulation therapy is based on screening tests: prothrombin time (PT) and activated partial thromboplastin time (APTT). The accidental presence of a clot in the coagulation samples determines a false prolongation of PT by fibrinogen (FI) consumption and the false or delayed prolongation of APTT, depending on FI consumption or activation. The purpose of this study is to document from the present data re-garding procedures used to exclude the accidental presence of clot in the sample., Methods: For a more efficient approach, we conducted a study based on research from the main databases that included original and peer-reviewed studies., Results: We have reported studies in which pre-analytical procedures have been recommended and studies that have also presented post-analytical protocols. A correlation between the efficiency of the procedures in terms of additional laboratory costs has been performed, as well., Conclusions: Focusing on patient safety, it remains a continuous challenge for each laboratory to be able to establish its own pre-analytical and post-analytical procedure for highlighting accidental clot presence, thus ensuring provision of results with maximum confidence to the clinicians.

Background: Human papillomaviruses (HPVs) are associated with a wide variety of cutaneous and mucosal infections and with malignancies in humans. More than 100 HPV types have been identified, some of which have affinity for skin and others for mucosal sites., Aim: The purpose of this study came from our desire to support the "Stop Cervical Cancer" campaign, adopted as "Cervical Cancer Removed as a Public Health Problem", following the World Health Organization (WHO) initiative in 2019-2020. At European level, cervical cancer mortality has fallen by more than 30% over the past 30 years, through coherent, consistent and comprehensive prevention programs based on accurate and consistent public information. Romania is in an unfavorable situation with regard to incidence (32.8 new cases∕100 000 women) and cervical cancer mortality (10.9 deaths∕100 000 women). Free Babeş-Papanicolau (Pap) testing for early detection of cervical cancer was valid this year until March., Patients, Materials and Methods: The study runs over a period of three years, between 2016-2018, in the "Elena Doamna" Hospital of Obstetrics and Gynecology, Iaşi, Romania. Of the 8500 patients hospitalized for various diseases (ovarian cysts, uterine fibroids, endometriosis, abnormal vaginal bleeding, dysmenorrhea, ectopic pregnancies, placenta praevia, spontaneous abortions and on demand, benign, malignant tumors), only 382 were present in the ambulatory for Pap test. For the other conditions, Pap test denied because the patients did not want this but to solve the condition for which they presented themselves., Results: We retrospectively review 382 Pap tests of patients who presented themselves in the Ambulatory Service of the Hospital both at the advice of the gynecologist and due to the program initiated by the WHO and supported by the Department of Public Health, Iaşi: "Cervical cancer can be eliminated as a problem of public health". Lesions equal to or worse than high-grade squamous intraepithelial lesion (HSIL) equivalate with high-grade lesions including HSIL (cervical intraepithelial neoplasia - CIN1, CIN2). Endometrial lesions were excluded from the study. As seen of this campaign, the number of patients has increased in 2018 (242 cases), compared to 46 cases in 2017 and 94 cases in 2016., Conclusions: Our study demonstrated that 35% (7/20) of HSIL-confirmed biopsies previously had negative HPV assays. Despite the previous negative HPV tests, a wide variety of HPV genotypes has been detected in most biopsies. In our case, we frequently identified the HPV 59 and 45 strains, 51 cases with HSIL lesions presented a first positive HPV test, 13 cases with low-grade squamous intraepithelial lesion (LSIL) showed three negative HPV tests. Prevention plays an important role in reducing the incidence of cervical cancer cases. The Pap test is now considered the primary prevention method, but consecutive vaccination significantly increases protection against high-risk HPV strains. Education plays an important role in the prophylaxis of HPV infection and cancer. It should be instituted in schools, from puberty age through partnerships or government programs with public health directorates and university hospitals or using European funds.