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Objective: This study aimed to explore whether subclinical hypothyroidism (SCH) treated with levothyroxine in pregnancy complicated by gestational diabetes mellitus (GDM) is associated with an increased risk of gestational hypertensive disorders (GHDs) (gestational hypertension and preeclampsia). Methods: 96 pregnant women with GDM were enrolled in this study and grouped as per the European Thyroid Association criteria into the SCH (n = 21) and euthyroid groups (n = 75). All subjects were tested for anthropometric parameters, maternal glucose homeostasis parameters, lipid levels, thyroid function tests, and blood pressure. All GDM pregnant women received nutritional and insulin therapy where needed, and the SCH group received levothyroxine treatment. Then, the maternal and newborn outcomes were compared. Data were analyzed using Student’s t-test, Mann–Whitney U, and Chi-square tests wherever applicable. p values of p = 0.0004, p = 0.0009). There were no significant differences between groups regarding the incidence of GHD, preterm prelabor rupture of membranes (PPROMs), macrosomia, low birth weight, and fetal distress (p > 0.05). Patients with GDM and SCH treated with levothyroxine had more premature delivery than the euthyroid group (p = 0.03). Conclusions: Subclinical hypothyroidism treated with levothyroxine in women with GDM does not increase the risk of gestational hypertensive disorders, but is associated with increased risk for prematurity.

Background: The prevalence of overweight (OW), obesity (OB), and gestational diabetes mellitus (GDM) has been increasing worldwide in recent years. Adipolin is a new adipokine with reduced circulating levels in obesity and type 2 diabetes mellitus (T2DM). Objectives: Our prospective case-control study aimed to evaluate the maternal serum levels of adipolin and adiponectin, metabolic parameters, and anthropometric characteristics at the time of oral glucose tolerance test (OGTT) in pregnant women with a pre-pregnancy body mass index (BMI) ≥ 25 Kg/m2 and correlate them with newborn adipolin, adiponectin levels, and anthropometric characteristics of the newborns, and secondly to evaluate pregnancy outcomes. Material and Methods: After the OGTT results, we had 44 OW/OB pregnant women with GDM, 30 OW/OB pregnant women without GDM, and 92 lean healthy (LH) pregnant women. Data were analyzed by ANOVA and correlation tests, with a p-value < 0.05 considered significant. Results: We found no differences between adipolin values of the OW/OB pregnant women with GDM and the LH group (p > 0.99), OW/OB without GDM and the LH group (p = 0.56), and between OW/OB groups (p = 0.57). OW/OB pregnant women with GDM had a higher rate of gestational hypertension compared with the LH group (p < 0.0001). Newborns from OW/OB pregnant women with GDM were more frequently diagnosed with jaundice (p = 0.02), and they required more frequent admission to the neonatal intensive care unit (NICU) for treatment of respiratory distress (p = 0.01) compared with newborns from LH mothers. Conclusions: Our study revealed that the serum levels of adipolin in the second trimester among the group of OW/OB pregnant women with GDM, matched for age and BMI with OW/OB pregnant women without GDM, were not significantly different. This suggests that adipolin may not play an essential role in the occurrence of GDM in these patients. Despite good glycemic control during pregnancy, OW/OB pregnant women with GDM and their newborns tend to have more complications (gestational hypertension, jaundice, NICU admission) than LH pregnant women and their newborns, highlighting the importance of weight control before pregnancy.

Pilocytic astrocytoma is the most frequent type of brain tumor diagnosed during childhood. It originates from midline structures and is associated with good prognosis, with an estimated survival rate higher than 95%. We presented the case of a male patient diagnosed at the age of 6 with pilocytic astrocytoma located in the right optic nerve with associated chiasm infiltration. Incomplete resection of the tumoral process was performed, without any additional therapy, as association of chemotherapy or radiotherapy is still controversial among specialists. The patient had an unpredictable severe evolution of the disease, with associated leptomeningeal dissemination and extreme worsening of neurological and endocrinologic status. Six years after diagnosis, despite complex medical efforts the patient died. This article raises awareness of leptomeningeal dissemination risk, a rare evolution in cases of pilocytic astrocytoma. Early diagnosis, complete tumoral resection, tumor location and careful long-term follow up are key factors for long-term survival. [ABSTRACT FROM AUTHOR]

Granulosa cell tumors represent only 1% of the total number of ovarian tumors. "Coffee bean" nuclei represent an extremely rare feature of these tumors. We presented the case of a 66 year-old patient that was hospitalized for abdominopelvic pain, lately to be diagnosticated with an Adult Granulosa Cell Tumor. The histopathological analysis revealed Call- Exner corpuscles and Coffee Bean" nuclei. Positive S100 marker was a particular finding in the immunohistochemical profile. Treatment strategy for this kind of cases should include surgery and adjuvant treatment and a strict follow-up of the patient for at least 5-10 years. [ABSTRACT FROM AUTHOR]

Bladder cancer is a significant health problem worldwide. The most important risk factor for bladder cancer is prolonged exposure to carcinogens, especially cigarette smoke. By understanding the risk factor represented by smoking for this disease we could improve early detection and prevention. The continuation of smoking after a cancer diagnosis is associated with worse outcomes. Bladder cancer management should also include individualized smoking cessation counseling. Despite smoking is a well-known risk factor in the development and recurrence of bladder cancer counseling and knowledge in the area are insufficient. Every healthcare specialist must raise awareness regarding the greatest preventable cause of the development and recurrence of bladder cancer. [ABSTRACT FROM AUTHOR]

Introduction: Melanoma, a type of tumor originating from melanocytes, can have different anatomic locations. Ocular melanoma represents about 5% of total melanomas and is a rare condition, with an overall incidence rate of 5.1 cases/million/year. The most frequent location of uveal melanoma is the choroid (90%), followed by the ciliary body (6%) and the iris (4%). The most frequent symptoms of choroidal melanoma are blurred vision and photopsia. The therapeutic approach of uveal melanoma can be classified into two main categories: globe preservation treatments and enucleation.

Background: Monoclonal antibody therapy is currently an additional treatment option to reduce exacerbations and improve symptom control in patients with severe eosinophilic asthma (SEA) that is uncontrolled despite treatment with high-dose inhaled corticosteroids and long-acting beta-2 agonists. Benralizumab, a monoclonal antibody that binds to the interleukin-5 receptor (IL-5), significantly reduces symptoms and annual exacerbations, as well as the use of systemic corticosteroids in patients with SEA. However, few studies are available on the effectiveness of this biological treatment in real life. The aim of this case series was to evaluate the efficacy of benralizumab by analyzing changes in clinical parameters and blood eosinophils in patients with SEA.

Background: Conflictual results regarding the relationship between plasmatic level of visfatin and obesity could be explained by the influence of the gene variants involved in the synthesis or action of these hormones.

Introduction: This study aims to suggest a new technique for the ultrasound assessment of fetal facial bones at the end of the first trimester and the beginning of the second gestational trimester. Material and method: The study was conducted over a period of 6 months, between October 2010 and March 2011, on a number of 52 acquired fetal 3D volumes, stocked by the same operator, on fetuses with normal echo structure, from unique pregnancies. The cohort of 52 fetuses had the gestational age between 12-14 weeks. Ultrasonographies were made at 16-17 weeks and 22-24 weeks. The methodology for the evidence of primary palate and maxillary alveolar used a 3D multiplanary ultrasonography technique "Face Reverse View" with Maxi IP and Skeletal Rendering. Results: Practically, in all volumes the presence of the jaw with alveolar ridge and primarly palate as single, uninterrupted structure has been documented. Conclusions: The usage of Skeletal Rendering can provide further information at the level of the cranial bone, especially in the first half of pregnancy. [ABSTRACT FROM AUTHOR]

The 3D multiplanar ultrasound is lately used for the study of the fetal face. The possibility of acquiring a volume which includes the whole fetal cephalic extremity, with further processing in various sections of nasal bone imaging, has opened new perspectives on the study of an ultrasound sign as a call for genetic syndromes. The aim of the paper is to assess the utility of acquiring of a single volume 3D, for the study of both nasal bones in the normal fetus. Material and method: A lot of 20 pregnant women, with a unique pregnancy and normal fetal echo structure, who had come at the screening of 12-14 gestational weeks, were scanned with an ultrasound machine, equipped with abdominal and vaginal 3D transducer, with a volume that included the acquisition of fetal head with the ultrasound beam direction directly to the fetus face, with an angle between the transducer and the long axis of the nose close to 45ş. Further analysis of the volume through multislice technique, to obtain an oblique transverse section of the skull along the nasal bones, could lead to simultaneous evidence of the two nasal bones, with their measurement. Results: All the fetuses had an acquire of 3D volume, satisfactory in terms of further processing of the image, obtaining optimal section comprising .top. sight of both, whole nasal bones. The average duration of volume processing, up to the oblique cross section described, was 20 minutes. Conclusions: The acquire of a single volume of the cephalic extremity, with the fetal face towards the ultrasound transducer, is a reliable method to obtain a section of the two nasal bones, at the time of the screening of 12-14 gestational weeks. [ABSTRACT FROM AUTHOR]

Pulmonary abscess or lung abscess is a lung infection which destroys the lung parenchyma leading to cavitations and central necrosis in localised areas formed by thick-walled purulent material. It can be primary or secondary. Lung abscesses can occur at any age, but it seems that paediatric pulmonary abscess morbidity is lower than in adults. We present the case of a one year and 5-month-old male child admitted to our clinic for fever, loss of appetite and an overall altered general status. Laboratory tests revealed elevated inflammatory biomarkers, leukocytosis with neutrophilia, anaemia, thrombocytosis, low serum iron concentration and increased lactate dehydrogenase level. Despite wide-spectrum antibiotic therapy, the patient’s progress remained poor after seven days of treatment and a CT scan established the diagnosis of a large lung abscess. Despite changing the antibiotic therapy, surgical intervention was eventually needed. There was a slow but steady improvment and eventually, the patient was discharged after approximately five weeks.

Helicobacter pylori și Giardia lamblia sunt răspândite în întreaga lume. Helicobacter pylori este un factor favorizant pentru prezența Giardia lamblia în stomac datorită neutralizării pH-ului gastric prin secreția de urează. Prezentăm cazul unui copil în vârstă de 5 ani, cu simptome gastro-intestinale intermitente în antecedentele personale patologice recente, care s-a internat în clinica Pediatrie 1 Târgu Mureș pentru dureri abdominale, grețuri, inapetență și hematemeză. Endoscopia digestivă superioară a evidențiat multiple sufuziuni hemoragice ale mucoasei gastrice, iar examenul histopatologic al mucoasei gastrice antrale a identificat coexistența infecției cu Helicobacter pylori și Giardia lamblia. Evoluția pacientului a fost favorabilă sub terapia de eradicare a infecției cu Helicobacter pylori și tratamentul antiparazitar administrat, endoscopia de control arătând o mucoasă fără modificări vizibile macroscopic, iar reevaluare histopatologică evidențiind modificări regenerative ale mucoasei gastrice. Particularitatea cazului este reprezentată de identificarea prezenței parazitozei cu Giardia lamblia în mucoasa gastrică, mediu fiziologic acid, alcalinizat de ureaza secretată de Helicobacter pylori, asigurând astfel condiții favorabile dezvoltării acestui parazit la un copil în vârstă de 5 ani, dintr-un mediu socio-economic favorabil, cu simptome gastro-intestinale intermitente în antecedentele personale patologice recente.

Parvovirusul B19 aparține familiei Parvoviridae, genul Erythrovirus și prezintă citotoxicitate asupra liniei eritroblastice umane ducând la anemie severă. Prezentăm cazul unei paciente în vârsta de 35 de ani, aflată la a 3-a sarcină, cu un avort spontan de prim trimestru în antecedente și o naștere fiziologică, care s-a prezentat la controlul de specialitate la 20 de săptămâni gestaționale, asociind semnele unei viroze respiratorii și fără alte patologii până la această vârstă gestațională. Analizele de laborator și ecografia fetală nu au evidențiat nimic patologic, astfel că pacienta a fost trimisă la domiciliu cu recomandarea de a reveni peste 2 săptămâni pentru reevaluare, moment în care ecografia fetală a evidențiat hidrops fetal și anemie severă, iar la 24 de ore asistolie fetală. Serologia maternă a pus în evidență infecția recentă cu Parvovirus B19. Particularitatea acestui caz constă în apariția unei infecții fetale relativ rare în trimestrul doi, în cazul unei sarcini fiziologice, monitorizate, cu prognostic nefavorabil și evoluție fulminantă spre moarte intrauterină.

Helicobacter pylori and Giardia lamblia are common worldwide. Helicobacter pylori is a favoring factor for the presence of Giardia lamblia in the stomach due to the neutralization of the gastric pH through the secretion of urease. We present the case of a 5-year-old child, with intermittent gastro-intestinal symptoms in the recent personal pathological history, admitted in the Pediatrics Clinic 1 Târgu Mureș for abdominal pain, nausea, loss of appetite and hematemesis. The superior digestive endoscopy revealed multiple hemorrhagic lesions of the gastric mucosa, and the pathological exam of the antral gastric mucosa identified the coexistence of Helicobacter pylori and Giardia lamblia. The evolution of the patient was favorable under the eradication therapy of the infection with Helicobacter pylori and the antiparasitic drugs, the control endoscopy revealing a gastric mucosa without macroscopically obvious modifications, and the pathological re-evaluation pointed out regenerative modifications of the gastric mucosa. The particularity of the case is represented by the identification of the parasite Giardia lamblia in the gastric mucosa, a physiologically acid environment, alkalinized by the urease secreted by Helicobacter pylori, therefore providing favorable conditions for the development of this parasite in a 5-year-old child, from a favorable socio-economic environment, with intermittent gastrointestinal symptoms in his recent personal pathological history.

Sepsis is a systemic inflammatory response (SIRS) characterized by two or more of the following: fever > 38.5 °C or

In 2007, Romania implemented a national program for smoking cessation, providing medication and counseling, entirely for free. The present study focuses on the results of the program among participating smokers treated in three smoking cessation centers from three main cities of Romania: Iasi, Targu Mures and Cluj.

Scop: evaluarea nivelelor serice de micronutrienţi la copii cu tulburări de nutriţie, şi aprecierea corelaţiei dintre acestea şi măsurătorile antropometrice. Material şi metode: Studiul a fost realizat pe 125 copii (0-18 ani); lotul de lucru a constat în copii cu scoruri Z < -2 deviaţii standard pentru cel puţin o măsurare antropometrică, copii fără tulburări de creştere fiind consideraţi lot de control. Astfel, pentru fiecare măsurare antropometrică am avut diferite loturi de lucru/control, folosite pentru evaluarea corelaţiei cu rezultatele de laborator. Am urmărit opt parametri antropometrici şi relaţia lor cu cinci micronutrienţi (Ca, Mg, Fe, Zn şi Cu). Rezultate: nu s-au găsit diferenţe semnificative între nivelurile serice de micronutrienţi nici în funcţie de sex, nici în funcţie de mediul de provenienţă. Cel mai frecvent, nivelurile serice medii de micronutrienţi au fost mici la copiii cu scoruri Z < -2 deviaţii standard (cu excepția Cu). Mg şi Ca s-au corelat pozitiv cu majoritatea măsurătorilor antropometrice. Pentru Fe, Zn şi Cu nu am găsit nici o corelaţie, cu niciuna dintre măsurile antropometrice. Diferenţe între nivelurile serice medii au fost găsite pentru Mg, cu valori mai scăzute la copii cu greutate scăzută pentru vârstă şi pliu tricipital redus, respectiv pentru Cu, cu niveluri mai ridicate la copii pliu tricipital redus. Indicii eritrocitari au fost corelaţi pozitiv cu nivelurile de Fe şi Zn. Concluzii: corelaţii între nivelul seric de micronutrienţi şi scorurile de evaluare antropometrică au fost găsite pentru Mg şi Ca, dar nu pentru Fe şi Zn, care în schimb s-au corelat direct cu indicii eritrocitari. Mg, Fe şi Zn tind să prezinte valori serice mici la copiii cu deficite de creştere. Având în vedere costurile, evaluarea de rutină a nivelurilor serice de Zn şi Cu la copii cu suspiciune de tulburări de creştere nu este justificată în zona noastră geografică.

Background: The incidence of obesity has dramatically increased in the last few years, and associated disorders such as non-alcoholic fatty liver disease (NAFLD) constitute a serious threat. The objective of our study was to assess the liver aspect of obese children and adolescents by real-time elastography, ARFI-technique, compared to the liver aspect of normal-weight children. Methods: Eighty-six children, aged 3-18 years, admitted to the County Emergency Clinical Hospital of Tîrgu Mureş between 15 September 2010 and 15 April 2012, were recruited for the study. They were included in two groups: 39 overweight/obese children and 47 normal-weight healthy controls. We evaluated the liver-tissue elasticity by measuring the Shear Wave Velocity (SWV), globally and separately for segments 1 and 8 in order to detect possible differences beetween them, knowing that the caudate-lobe has it's own vasculature; we also evaluated biochemical parameters (transaminases, etc). Correlations between SWV and laboratory tests were established using non-parametric Spearman correlation test. Results: In healty children in the 1st segment SWV was 1.012±0.31 m/s, smaller than in the 8th segment, 1.342±0.32 m/s (p = 0.0316). For obese children, SWV was higher in the 8th segment 1.982±0.85 m/s compared to the 1st segment 1.325±0.27 m/s (p <0.0001). Globally in obese children, the SWV was 1.746±0.49 m/s, significantly higher than in healthy children, 1.080±0.27 m/s (p = 0.0023). Positive statistical correlations have been established between SWV and aspartate-aminotransferase in obese (r = 0.61, Pearson correlation p = 0.025), with no statistically significant differences for other laboratory findings. Conclusion: Elastographic evaluation of liver alterations in obesity by ARFI-method shows higher SWV, which could be translated in fibrosis and necroinflammatory activity. According to our study, these alterations in liver tissue affect mainly the right lobe of the liver. [ABSTRACT FROM AUTHOR]

Objective: Pulmonary atresia is a relative rare critical congenital heart defect with ductal dependent pulmonary circulation. Echocardiography is the gold standard in diagnoses congenital heart defect in newborns, but also is the only diagnostic modality of congenital heart defect in the fetus. The purpose of this study is to demonstrate the impact of fetal echocardiography on outcome of patients with pulmonary atresia with ductal-dependent pulmonary flow. Methods: A single-institution observational study was made on 19 children diagnosed by echocardiography with ductal-dependent pulmonary atresia in Pediatric Cardiology Department from 1997 to 2010, from which four were diagnosed prenatally by fetal echocardiography. We compared a series of clinical data between the prenatally (group 1) and postnatally diagnosed group (group 2), respectivelly. Results: All of the infants diagnosed prenatally were delivered in a center for pediatric cardiology. The prostaglandine infusion, to maintain the patency of arterial duct, was initiated in the first 48 h after birth in every cases of the first group comparing to the second group (range3 h - 37 days) (26.66%) (p=0.03). Also, a significantly higher percent of group 1 managed to get in the cardiac unit in the first 48 h after birth comparing to the second group (range 1-37 days) (p=0.03). Conclusions: We suggest that fetal diagnosis might improve neonatal outcome because of earlier appropriate therapeutic intervention. [ABSTRACT FROM AUTHOR]

Background: The Roma are a socioeconomically disadvantaged, marginalized community with reduced access to education, social services, and healthcare. Despite the known health risks they are exposed to, we have limited data about a wide range of health outcomes in this population, including vitamin D deficiency. The aim of this study was to investigate prevalence of vitamin D deficiency and its impact on the anthropometric outcomes of newborns in a group of Roma mothers and their infants in Romania., Methods: In total, 131 Roma women and 131 newborns were included in the study. Vitamin D levels in both mothers and newborns, as well as the birth weight, length, and head circumference of newborns, were recorded at birth. We also assessed socioeconomic factors, including education, employment status, income, and living conditions, as well as factors that influence vitamin D status, including sun exposure, use of sunscreen, fish consumption, and skin type., Results: All mothers and almost all newborns had vitamin D insufficiency or deficiency, with 25-hydroxivitamin D levels below 30 ng/mL. Maternal vitamin D status was significantly correlated with neonatal vitamin D levels ( p < 0.01) but not with anthropometric outcomes such as birth weight ( p = 0.57), birth length ( p = 0.53), or head circumference ( p = 0.96). Most study participants had a low socioeconomic status, reporting severe deficiencies in education, employment status, household income, and living conditions., Conclusions: Vitamin D deficiency is a significant public health issue among Roma women and their newborns, which may be compounded by the socioeconomic challenges of this vulnerable population.

Introduction: Sternal metastases of serous ovarian carcinoma are extremely rare conditions, with less than 10 articles published in the medical literature on this subject. The aim of this article is to present a case of late-onset sternal metastasis of serous ovarian carcinoma in a patient who underwent surgery for serous ovarian carcinoma approximately 6 years before and to provide a review of the literature regarding the importance of multidisciplinary management in such cases. Material and Method: We aimed to conduct a review of the specialized literature concerning published articles on sternal metastases from ovarian serous carcinoma over a period of approximately 30 years, from January 1, 1994, to December 31, 2023. For this purpose, we utilized the following databases: PubMed and Web of Science (Clarivate Analytics), using the keywords: sternal metastases, ovarian cancer. Results: Following our review of the specialized literature, we identified only 10 articles that reported clinical cases of sternal metastases occurring after ovarian cancer surgery and chemotherapy. Additionally, we present the case of a 70-year-old female patient diagnosed with sternal metastasis from ovarian serous carcinoma, with an emphasis on the therapeutic management of the case. Conclusions: Sternal metastases of serous ovarian carcinoma represent extremely rare conditions. In such cases, if sternal metastases are solitary, and the patient does not present metastases at other sites nor signs of local recurrence, sternum resection may constitute a viable therapeutic option in the treatment of these patients., (Celsius.)

Introduction: This paper seeks to report and emphasize the most important aspects from the scientific literature about the diagnostic accuracy of the amniotic fluid "sludge" (AFS), its characterization, its treatment, and its association with premature birth. AFS is defined as a floating freely hyperechogenic material within the amniotic cavity in the proximity of the internal os. Materials and Methods: We conducted a search on Pubmed and Google Scholar for relevant articles on the subject of amniotic fluid "sludge" published until January 2024. Searches were focused on articles about diagnosis, treatment, maternal and neonatal outcomes, risk of preterm birth, and case reports. The full-text reading stage resulted in the inclusion of 51 studies. Results: AFS is independently associated with chorioamnionitis, preterm delivery, short cervix, increased risk of neonatal morbidity, and cervical insufficiency. This hyperechogenic free-floating material is linked with preterm birth before 32 weeks of gestation, especially when it is associated with short cervical length. Discussion: Present studies identify some controversial benefits of antibiotics in reducing the incidence of preterm birth in women with AFS. Nevertheless, in this review, we can conclude that the presence of AFS in pregnancy is a marker for the microbial invasion of the amniotic cavity, as it is associated with preterm birth. Further studies on a larger group of patients are necessary to clarify and exactly define the terms of managing these cases.

Objectives : This study aimed to investigate the serum level of adipolin and adiponectin in healthy pregnant women and pregnant women with gestational diabetes mellitus (GDM) during the second trimester, the prepartum period, and in the newborns of these patients. Methods : A total of 55 women diagnosed with GDM and 110 healthy pregnant women were included in this study. Pearson's and Spearman's correlation coefficients were calculated to determine the association of adipolin and adiponectin with anthropometric markers of obesity (body mass index (BMI), mid-upper arm circumference (MUAC), tricipital skinfold thickness (TST)), inflammation markers (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)), and maternal glucose homeostasis parameters (fasting glucose, insulin, C peptide, glycosylated hemoglobin A1c (HbA1c), Insulin Resistance-Homeostatic Model Assessment (IR HOMA)). Results : There were no statistical differences between the adipolin value in patients with GDM compared to healthy patients ( p = 0.65 at diagnosis and p = 0.50 prepartum) and in newborns from mothers with GDM compared to healthy mothers ( p = 0.24). Adipolin levels are significantly higher in patients with GDM who gave birth via cesarean section ( p = 0.01). In patients with GDM, the adipolin level correlates positively with HgA1c in the prepartum period. We found a positive correlation between the maternal adipolin values at diagnosis and prepartum and neonatal adipolin (respectively: r = 0.556, p = 0.001; r = 0.332, p = 0.013). Adiponectin levels were significantly lower in patients with GDM at diagnosis and prepartum ( p = 0.0009 and p = 0.02), but their levels increased prepartum (5267 ± 2114 ng/mL vs. 6312 ± 3150 ng/mL p = 0.0006). Newborns of mothers with GDM had lower adiponectin levels than newborns of healthy mothers ( p < 0.0001). The maternal adiponectin value correlates negatively with maternal BMI, MUAC, and IR HOMA in both groups at diagnosis and prepartum. There were no differences between the groups in terms of cesarean rate ( p > 0.99). The relative risk of occurrence of adverse events in patients with GDM compared to healthy ones was 2.15 (95% CI 1.416 to 3.182), and the odds ratio for macrosomia was 4.66 (95% CI 1.591 to 12.69). Conclusions : There was no difference in adipolin levels between mothers with GDM and healthy mothers during the second trimester and the prepartum period. Adipolin is known to enhance insulin sensitivity and reduce inflammation, but unlike adiponectin, it does not appear to contribute to the development of GDM.

Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of

Vitamin D is an essential nutrient that plays a vital role in bone health and musculoskeletal development. The aim of this narrative review is to present up-to-date information about the impact of vitamin D deficiency (VDD) on the health status of infants in their first year of life. Vitamin D is indispensable for skeletal growth and bone health, and emerging research suggests that it may also have significant roles in maternal and fetal health. VDD affects a large proportion of infants according to current guidelines. However, its prevalence varies depending on geographic location, skin pigmentation, and the time of year. Based on current guidelines for normal vitamin D levels and recommended daily intake, studies suggest that VDD is a global health issue with potentially significant implications for those at risk, especially infants. Our understanding of the role of vitamin D has improved significantly in the last few decades. Systematic reviews and meta-analyses investigating the effect of vitamin D on preterm birth, low birth weight, anthropometric parameters, and health outcomes such as infectious diseases in infants, have found conflicting or inconsistent results. It is important to encourage further research to fill in these knowledge gaps and develop national or global strategies that ease the burden of VDD, especially in groups at risk.

Regarding the hypertensive disorders of pregnancy, pre-eclampsia (PE) remains one of the leading causes of severe and life-threatening maternal and fetal complications. Screening of early-onset PE (<34 weeks of pregnancy), as well as late-onset PE (≥34 weeks), shows poor performance if based solely on clinical features. In recent years, biochemical markers from maternal blood-the pro-angiogenic protein placental growth factor (PlGF) and the antiangiogenic protein soluble FMS-like tyrosine kinase 1 (sFlt-1)-and Doppler velocimetry indices-primarily the mean uterine pulsatility index (PI), but also the uterine resistivity index (RI), the uterine systolic/diastolic ratio (S/D), uterine and umbilical peak systolic velocity (PSV), end-diastolic velocity (EDV), and uterine notching-have all shown improved screening performance. In this review, we summarize the current status of knowledge regarding the role of biochemical markers and Doppler velocimetry indices in early prediction of the onset and severity of PE and other placenta-related disorders, as well as their role in monitoring established PE and facilitating improved obstetrical surveillance of patients categorized as high-risk in order to prevent adverse outcomes. A sFlt-1/PlGF ratio ≤ 33 ruled out early-onset PE with 95% sensitivity and 94% specificity, whereas a sFlt-1/PlGF ≥88 predicted early-onset PE with 88.0% sensitivity and 99.5% specificity. Concerning the condition's late-onset form, sFlt-1/PlGF ≤ 33 displayed 89.6% sensitivity and 73.1% specificity in ruling out the condition, whereas sFlt-1/PlGF ≥ 110 predicted the condition with 58.2% sensitivity and 95.5% specificity. The cut-off values of the sFlt-1/PlGF ratio for the screening of PE were established in the PROGNOSIS study: a sFlt-1/PlGF ratio equal to or lower than 38 ruled out the onset of PE within one week, regardless of the pregnancy's gestational age. The negative predictive value in this study was 99.3%. In addition, sFlt-1/PlGF > 38 showed 66.2% sensitivity and 83.1% specificity in predicting the occurrence of PE within 4 weeks. Furthermore, 2018 ISUOG Practice Guidelines stated that a second-trimester mean uterine artery PI ≥ 1.44 increases the risk of later PE development. The implementation of a standard screening procedure based on the sFlt-1/PlGF ratio and uterine Doppler velocimetry may improve early detection of pre-eclampsia and other placenta-related disorders.

Aims: Measurement of myocardial strain using 2D speckle-tracking echocardiography can successfully quantify ventricular function, being considered superior to conventional echocardiography. This study aimed to establish reference intervals, interobserver agreements and reliability of two fetal echocardiographic parameters which reflect left ventricular myocardial function, left ventricular apical 4 chamber endo peak strain (AP4pLS) and ejection fraction (EF)., Material and Methods: We conducted a prospective study on 103 healthy fetuses. In each case, cardiac ultrasound images obtained were stored and afterwards were subject to offline 2D speckle-tracking echocardiographic analyses. In 15 randomly chosen subjects a second examiner also carried out an offline analysis of the 4-chamber view and the archived images, in order to assess inter-observer reproducibility and agreement level. Our study group was sub-divided into four different gestational age groups., Results: Reference ranges were established for the two measured parameters, AP4pLS and EF, which did not differ significantly between four different gestational age groups (p=0.98 and p=0.64) and neither correlated with gestational age progression (p=0.37 and p=0.08). An excellent level of agreement between the two examiners was found for the echocardiographic measurements, expressed through an intra-class correlation coefficient (ICC) value of 0.85 (0.62-0.94 for 95%CI) for AP4pLS and 0.78 (0.47- 0.92 for 95% CI) for EF., Conclusions: Speckle tracking AP4pLS and EF parameters are useful for assessment of ventricular myocardial function in healthy fetuses and can be reliably reproduced by two different skilled examiners. Further studies conducted on larger populations are required to standardize reference values of fetal speckle-tracking measurements.

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.

Primary neuroendocrine tumors (NETs) of the breast are considered a rare and undervalued subtype of breast carcinoma that occur mainly in postmenopausal women and are graded as G1 or G2 NETs or an invasive neuroendocrine carcinoma (NEC) (small cell or large cell). To establish a final diagnosis of breast carcinoma with neuroendocrine differentiation, it is essential to perform an immunohistochemical profile of the tumor, using antibodies against synaptophysin or chromogranin, as well as the MIB-1 proliferation index, one of the most controversial markers in breast pathology regarding its methodology in current clinical practice. A standardization error between institutions and pathologists regarding the evaluation of the MIB-1 proliferation index is present. Another challenge refers to the counting process of MIB-1's expressiveness, which is known as a time-consuming process. The involvement of AI (artificial intelligence) automated systems could be a solution for diagnosing early stages, as well. We present the case of a post-menopausal 79-year-old woman diagnosed with primary neuroendocrine carcinoma of the breast (NECB). The purpose of this paper is to expose the interpretation of MIB-1 expression in our patient' s case of breast neuroendocrine carcinoma, assisted by artificial intelligence (AI) software (HALO-IndicaLabs), and to analyze the associations between MIB-1 and common histopathological parameters.

Background and Objectives: Cortisol, the stress hormone, is an important factor in initiating and maintaining lactation. Maternal suffering during pregnancy is predictive for the initiation and shorter duration of breastfeeding and can also lead to its termination. The aim of this study is to evaluate the relationship between the level of salivary cortisol in the third trimester of pregnancy and the initiation of breastfeeding in the postpartum period in a cohort of young pregnant women who wanted to exclusively breastfeed their newborns during hospitalization. Materials and Methods: For the study, full-term pregnant women were recruited between January and May 2022 in the Obstetrics and Gynecology Clinic of the Mureș County Clinical Hospital. Socio-demographic, clinical obstetric and neonatal variables were collected. Breastfeeding efficiency was assessed using the LATCH Breastfeeding Assessment Tool at 24 and 48 h after birth. The mean value of the LATCH score assessed at 24 and 48 h of age was higher among mothers who had a higher mean value of salivary cortisol measured in the third trimester of pregnancy ( p < 0.05). A multivariate logistic regression model was used to detect risk factors for the success of early breastfeeding initiation. Results: A quarter of pregnant women had a salivary cortisol level above normal limits during the third trimester of pregnancy. There is a statistically significant association between maternal smoking, alcohol consumption during pregnancy and the level of anxiety or depression. Conclusions: The most important finding of this study was that increased salivary cortisol in the last trimester of pregnancy was not associated with delayed initiation/absence of breastfeeding.

Objectives: To study changes in heart function and hemodynamics during the transitional period in small for gestational (SGA) infants and appropriate (AGA) healthier counterparts., Design: A hospital based prospective observational study was performed at a perinatal center. Echocardiograms were performed on the first postnatal day and again at 48 h age. Term SGA infants were compared with those AGA newborns matched for the GA and mode of delivery., Results: Eighteen SGA infants were compared with 18 AGA infants [gestation 38 ± 1.5 vs. 38 ± 1.2 weeks, p  > 0.05 and birthweight 2331 ± 345 vs. 3332 ± 405 grams, p  < 0.05, respectively]. Maternal weight and body mass index was higher among non-affected pregnancies, 61% infants were born vaginally, and no differences in cord blood pH at birth were noted. SGA infants had higher systolic and mean blood pressure at both time points, lower indices of right ventricular (RV) performance [TAPSE (tricuspid annular peak systolic excursion) 7.4 ± 2.8 vs. 9.3 ± 0.7 on day 1, 7.2 ± 2.8 vs. 9.2 ± 0.5 on day 2, p  = 0.001], lower pulmonary acceleration time (PAAT) suggestive of elevated pulmonary vascular resistance [56.4 ± 10.5 vs. 65.7 ± 13.2 on day 1, 61.4 ± 12.5 vs. 71.5 ± 15.7 on day 2, p  = 0.01] and higher left ventricular (LV) ejection fraction [62.1 ± 7.8 vs. 54.9 ± 5.5 on day 1, 61.9 ± 7.6 vs. 55.8 ± 4.9 on day 2, p  = 0.003]., Conclusions: SGA infants had evidence of higher pulmonary vascular resistance, and lower RV performance during the postnatal transition. The relevance and impact of these changes to hemodynamic disease states during the postnatal transition requires prospective investigation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Suciu, Giesinger, Mărginean, Muntean, Cucerea, Făgărășan and McNamara.)

The transposition of great arteries (TGA) is one of the most frequent and severe congenital heart diseases. After newborn stabilization and while pending surgical correction, echocardiographic monitoring with a careful evaluation of left ventricle (LV) performance is warranted. In this study, our objectives were (i) to compare myocardial function, assessed via speckle-tracking echocardiography, between neonates with TGA and neonates without TGA and (ii) to identify a strain parameter with a good discriminatory ability for TGA. We conducted a retrospective, single-center study. A total of 90 neonates were examined, of whom 66 were included (16 comprised the TGA group and 50 comprised the control group). The results of a bivariate analysis showed that classic echocardiography parameters displayed no significant differences between the two studied groups ( p = 0.785 for EF, p = 0.286 for MAPSE and p = 0.315 for TAPSE). We found a statistically significant difference between the two groups for the mean values of the LVpGLS parameter (adjusted p = 0.0047), with impaired LV myocardium function being observed in the TGA group after adjusting for other covariates. Regarding segmental strain, the mean medial and apical inter-ventricular septum strain values were found to be significantly lower in the neonates with TGA than in the controls (95% CI for difference in means: [-6.45, -0.65], [-8.56, -1.97]). The results of an ROC analysis showed that LVpGLS had a significant ability to differentiate between neonates with TGA and controls (AUC = 0.712, 95% CI: [0.52, 0.903], p = 0.011). In conclusion, LVpGLS is a parameter with a significant discriminatory ability for LV dysfunction, and it is useful in the evaluation of ventricular myocardial function in newborns with TGA.

Dysgerminoma represents a rare malignant tumor composed of germ cells, originally from the embryonic gonads. Regarding its incidence, we do not have precise data due to its rarity. Dysgerminoma occurs at a fertile age. The preferred treatment is the surgical removal of the tumor succeeded by the preservation of fertility. Even if a multidisciplinary team, founded in 2009 by a gynecologist, an oncologist, a pediatric oncologist and a pediatric surgeon, under the guidance of the Malignant Germ Cell International Consortium (MaGIC), studies this type of tumor, issues still remain related to the lack of a randomized study and to both the management and understanding of the concept of OMGCTs (ovarian malignant germ cell tumors). The aim of this review is to present from the literature the various approaches for this type of tumor, and, regarding innovative therapies or possible prevention, which can be applied in clinical practice. Multidisciplinarity and treatment in reference centers have proven their usefulness as well.

Intrauterine devices (IUDs) are very common as a method of birth control. By adding progesterone (levonorgestrel), a decrease in the risk of complications has been documented, including the risk of perforation. Even though only a few complications have been described, adjacent organs may be involved in the case of migration-a life-threatening situation. A 45-year-old G4P2 woman was seen in our clinic for LNg-IUD removal, according to the medical instructions. Her main complaints were abdominal discomfort, low back pain, and recurrent menorrhagia. A "lost" IUD was initially suspected; the patient confirmed the detection and removal of the control strings, and a subsequent discussion related to delayed transmural migration of the IUD being followed. The ultrasonography revealed the migration of the IUD to the uterine cervix and size-decreased uterine fibroids, confirming the effectiveness of the LNg-IUD. The MRI and ultrasonography being useless, a subsequent X-ray and CT scan were requested, both confirming a myometrium-positioned IUD, adjacent to the serosa and lumbosacral plexus. Even though the IUD is considered a safe device with reversible effect, it can be associated with severe morbidity, with an ultrasound follow-up being required. For more precise detection of the IUD, we strongly recommend an X-ray or CT scan examination, followed by safe removal.