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Liver involvement in Coronavirus Disease 2019 (COVID-19) has been widely documented. However, data regarding liver-related prognosis are scarce and heterogeneous. The current study aims to evaluate the role of abnormal liver tests and incidental elevations of non-invasive fibrosis estimators on the prognosis of hospitalized COVID-19 patients. We conducted a retrospective cohort study to investigate the impact of elevated liver tests, non-invasive fibrosis estimators (the Fibrosis-4 (FIB-4), Forns, APRI scores, and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio), and the presence of computed tomography (CT)-documented liver steatosis on mortality in patients with moderate and severe COVID-19, with no prior liver disease history. A total of 370 consecutive patients were included, of which 289 patients (72.9%) had abnormal liver biochemistry on admission. Non-survivors had significantly higher FIB-4, Forns, APRI scores, and a higher AST/ALT ratio. On multivariate analysis, severe FIB-4 (exceeding 3.25) and elevated AST were independently associated with mortality. Severe FIB-4 had an area under the receiver operating characteristic (AUROC) of 0.73 for predicting survival. The presence of steatosis was not associated with a worse outcome. Patients with abnormal liver biochemistry on arrival might be susceptible to a worse disease outcome. An FIB-4 score above the threshold of 3.25, suggestive of the presence of fibrosis, is associated with higher mortality in hospitalized COVID-19 patients.

Cardiovascular assessment of oncological patients suggests that cancer can lead to subclinical damage of the heart. The aim of the present study was to analyze the value of baseline cardiovascular biomarkers in patients with newly diagnosed colon cancer prior to treatment. Additionally, another aim was to establish baseline cut-off alert values for this low-intensity neoplastic damage. A total of 51 patients with newly diagnosed colon cancer, without history of cardiac disease, were enrolled in a prospective, cross-sectional study. All patients underwent clinical, biochemical and basic echocardiographic evaluation before starting treatment. Patients were assessed for myocardial damage using high-sensitivity troponin T (hs-TnT), creatine kinase-MB (CK-MB) and N-terminal-pro B-type natriuretic peptide (NT-proBNP). A group of 28 healthy controls was included for comparison. Cardiac ultrasound revealed similar left ventricular (LV) ejection fraction but enlarged LV chambers compared with the control group (LV at end systole, 29.50 vs. 26.00 mm; LV at end diastole, 44.50 vs. 38.00 mm; P0.001 in both cases). The levels of cardiovascular biomarkers of myocardial damage were higher in the patients than in the control group (CK-MB, 17.00 vs. 11.00 IU/l, P0.001; hs-TnT, 8.20 vs. 3.00 ng/l, P0.001; NT-proBNP, 155.40 vs. 48.50 pg/ml, P=0.001). In multivariate analysis, CK-MB and hs-TnT retained statistical significance (P=0.004 and P=0.045, respectively). Moreover, it was demonstrated that new cut-offs for hs-TnT (8.00 ng/l) and NT-proBNP (220.00 pg/ml) can identify cardiac damage in patients ≥65 years old. Thus, the present study confirmed the hypothesis that a basic cardiovascular assessment of treatment-naïve patients with colon cancer can identify important pre-treatment myocardial impact. Adapted cut-off values should be set for cardiovascular biomarkers in the cancer population, different from those currently accepted for acute coronary syndromes or heart failure.

Surface-enhanced Raman scattering (SERS) is emerging as a novel strategy for biofluid analysis. In this review, we delineate four experimental SERS protocols that are frequently used for the profiling of biofluids: 1) liquid SERS for the detection of purine metabolites; 2) iodide-modified liquid SERS for the detection of proteins; 3) dried SERS for the detection of both purine metabolites and proteins; 4) resonant Raman for the detection of carotenoids. To explain the selectivity of each experimental SERS protocol, we introduce a heuristic model for the chemisorption of analytes mediated by adsorbed ions (adions) onto the SERS substrate. Next, we show that the promising results of SERS liquid biopsy stem from the fact that the concentration levels of purine metabolites, proteins and carotenoids are informative of the cellular turnover rate, inflammation, and oxidative stress, respectively. These processes are perturbed in virtually every disease, from cancer to autoimmune maladies. Finally, we review recent SERS liquid biopsy studies and discuss future steps that are required for translating SERS in the clinical setting.

Background Demographic changes - such as population ageing - pose great challenges to health systems around the world. For the Romanian health system, challenges might be particularly difficult to address. Facing a severe under-funding and significant workforce maldistribution, the health system in Romania is called to care about both the ageing population and the workforce taking care of the elderly. The aim of this paper is to apply the health labour market framework to the geriatric workforce in Romania. Methods The paper describes the composition and distribution of the geriatrics workforce in Romania based on data in the Healthcare Facility Activity report, policy documents and available reports. Results Geriatric care is provided in Romania mainly by geriatricians employed by public hospitals. The team around geriatricians is limited to nurses only, with other professions - such as psychologists, physiotherapists and social workers - almost absent. Even though the number of geriatricians has increased country-wide over recent years (from 149 to 242), there are significant differences in their distribution at a county level. Eleven counties out of the 41 reporting to have only 1 geriatrician for populations of hundreds of thousands. Training curricula for geriatrics residents fall short of addressing team work and inter-professional collaboration. Reports show growing concern over geriatrician burnout, caused in part by inadequate team work. Faced with burnout risk, many of them report considering changing specialties, which would further aggravate the lack of comprehensive elderly care. Conclusions The geriatrics workforce in Romania is poorly developed, and significant efforts are still needed to develop policies addressing geriatrics production, inflows and outflows, and maldistribution and inefficiencies. Moreover, addressing burnout by improving teamwork and collaboration is vital for maintaining and improving the workforce morale and motivation.

As colorectal cancer (CRC) is one of the forms of cancer with the highest prevalence globally and with a high mortality, screening and early detection remains a major issue. Colonoscopy is still the gold standard for detecting premalignant lesions, but it is burdened by some complications. For instance, it is laborious, with some difficulties of acceptance for some patients, and is ultimately an imperfect standard, given that some premalignant lesions or incipient malignancies can be missed by colonoscopic evaluation. In this context, new non-invasive approaches such as surface-enhanced Raman spectroscopy (SERS) based liquid biopsy have gained ground in recent years, showing promising results in oncological pathology diagnosis. These new methods have enabled the detection of subtle molecular profile alterations prior to any macroscopic morphological changes, thus providing a useful tool for early CRC detection. In the present review, we provide a summary of published studies applying SERS in CRC detection, along with our personal experience in using SERS in the diagnosis of different oncological pathologies, including CRC.

The "watch and wait" approach has recently been proposed as an alternative to surgery in locally-advanced rectal cancer patients that respond to neo-adjuvant chemoradiotherapy, in order to decrease its negative functional consequences upon the quality of life of these patients. Current methods show low accuracy for the identification of complete responders.A review of the literature was conducted for articles published up to March 31th, 2019. Relevant studies were identified using bibliographic searches of Pubmed database. The keywords that were used in various combinations were: "neoadjuvant chemoradiotherapy", "non-operative management", "complete pathological response", "rectal cancer", "biomarkers", "staging".Magnetic resonance imaging can identify complete responders with a high accuracy using new protocols like diffusion weighted imaging. Positron emission tomography with 18-fluoro-deoxy-glucose shows a sensitivity of 90.9% and specificity of 80.3% for the prediction of complete pathologic response using the change in standardized uptake value. A panel of 15 metabolites was identified and shows potential to discriminate patient resistance and sensitivity to neo-adjuvant therapy (Area Under the Curve 0.80). Furthermore, pre-treatment peripheral blood neutrophil to lymphocyte ratio below 2 and platelet to lymphocyte ratio below 133.4 are significantly correlated with good tumor response (OR 2.49). Analysis of the pattern of carcinoembryonic antigen (CEA) clearance after neoadjuvant treatment conclude that an exponential decrease of the CEA levels is associated with significant tumor down staging and complete pathologic response.New methods of assessing the response to neo-adjuvant therapy in locally-advanced rectal cancer have emerged, showing promising results. Further studies need to assess the best combination between imaging and these biomarkers in order to increase the accuracy and standardize the criteria for non-operative management.Biomarkers, Complete pathologic response, Non-Operative management, Rectal cancer, Staging.L’approccio “watch and wait” è stato recentemente proposto come alternativa alla chirurgia in pazienti con carcinoma del retto localmente avanzato che rispondono alla chemio-radioterapia neo-adiuvante, al fine di ridurre le sue conseguenze funzionali negative sulla qualità della vita di questi pazienti. I metodi attuali mostrano una bassa accuratezza per l’identificazione di responder completi. È stata condotta una revisione della letteratura per articoli pubblicati fino al 31 marzo 2019. Gli studi rilevanti sono stati identificati utilizzando le ricerche bibliografiche del database Pubmed. Le parole chiave utilizzate in varie combinazioni erano: “neoadjuvant chemoradiotherapy”, “non-operative management”, “complete pathological response”, “rectal cancer”, “biomarkers”, “staging”. Risultati: la risonanza magnetica può identificare i responders completi con un’accuratezza elevata utilizzando nuovi protocolli come l’imaging pesato in diffusione. La tomografia ad emissione di positroni con 18-fluorodeossi- glucosio mostra una sensibilità del 90,9% e una specificità dell’80,3% per la previsione della risposta patologica completa utilizzando il cambiamento nel valore di captazione standardizzato. Un gruppo di 15 metaboliti è stato identificato e mostra la possibilità di discriminare la resistenza e la sensibilità del paziente alla terapia neoadiuvante (Area Under the Curve 0,80). Inoltre, la neutrofilia periferica pre-trattamento il rapporto linfocitario inferiore a 2 e il rapporto piastrinico-linfocitario inferiore a 133,4 sono significativamente correlati con una buona risposta tumorale (OR 2,49). L’analisi del pattern di clearance dell’antigene carcinoembrionico (CEA) dopo il trattamento con neoadiuvante porta a concludere che una diminuzione esponenziale dei livelli di CEA è associata a un significativo decadimento del tumore e alla completa risposta patologica. In conclusione sono emersi nuovi metodi per valutare la risposta alla terapia neo-adiuvante nel carcinoma del retto localmente avanzato, mostrando risultati promettenti. Ulteriori studi devono valutare la migliore combinazione tra imaging e questi biomarcatori al fine di aumentare l’accuratezza e standardizzare i criteri per la gestione non operativa.

Early diagnosis based on screening is recognized as one of the most efficient ways of mitigating cancer-associated morbidity and mortality. Therefore, reliable but cost-effective methodologies are needed. By using a portable Raman spectrometer, a small and easily transportable instrument, the needs of modern diagnosis in terms of rapidity, ease of use and flexibility are met. In this study, we analyzed the diagnostic accuracy yielded by the surface-enhanced Raman scattering (SERS)-based profiling of serum, performed with a portable Raman device operating in a real-life hospital environment, in the case of 53 patients with gastrointestinal tumors and 25 control subjects. The SERS spectra of serum displayed intense bands attributed to carotenoids and purine metabolites such as uric acid, xanthine and hypoxanthine, with different intensities between the cancer and control groups. Based on principal component analysis-quadratic discriminant analysis (PCA-QDA), the cancer and control groups were classified with an accuracy of 76.92%. By combining SERS spectra with general inflammatory markers such as C-reactive protein levels, neutrophil counts, platelet counts and hemoglobin levels, the discrimination accuracy was increased to 83.33%. This study highlights the potential of SERS-based liquid biopsy for the point-of-care diagnosis of gastrointestinal tumors using a portable Raman device operating in a clinical setting.

Hepatitis C infection (HCV) and menopause are associated with insulin resistance (IR), and IR accelerates HCV-induced liver disease. The relationship between menopause and IR has not been studied in this population. This study aimed to assess the impact of menopause on IR and metabolic syndrome in HCV. One hundred and three (69 men, 16 premenopausal, 18 postmenopausal women) noncirrhotic, nondiabetic HCV-infected adults underwent IR measurement via steady-state plasma glucose during a 240-min insulin suppression test. Metabolic syndrome was defined by at least three of five standard laboratory/clinical criteria. The patient characteristics were as follows: mean age 48 years, waist circumference 94.4 ± 12.4 cm and 37.9% Caucasian. SSPG was higher in postmenopausal than premenopausal women or men (mean difference 18, 95% CI −41 to 76 and 35, 95% CI −3 to 72 mg/dL; respectively). After adjusting for waist circumference, female gender, nonwhite race and triglycerides were positively associated and high-density lipoprotein negatively associated with steady-state plasma glucose. Compared to men, both pre-(Coef 48, 95% CI 12–84) and postmenopausal women (Coef 49, 95% CI 17–82) had higher steady-state plasma glucose. Compared to premenopausal women, men (OR 2.0, 95% CI 0.38–10.2) and postmenopausal women (OR 2.9, 95% CI 0.46–18.8) had higher odds of metabolic syndrome, but this was statistically nonsignificant. Both liver inflammation (OR 7.9) and nonwhite race (OR 6.9) were associated with metabolic syndrome. We conclude that women are at increased risk for IR in HCV. There may also be an increased risk of metabolic syndrome postmenopause. Along with lifestyle modification and weight loss, women with metabolic abnormalities represent an especially at-risk group warranting HCV treatment to prevent adverse metabolic outcomes.