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Chronic kidney disease (CKD) stands as a prominent non-communicable ailment, significantly impacting life expectancy. Physiopathology stands mainly upon the triangle represented by parathormone–Vitamin D–Fibroblast Growth Factor-23. Parathormone (PTH), the key hormone in mineral homeostasis, is one of the less easily modifiable parameters in CKD; however, it stands as a significant marker for assessing the risk of complications. The updated “trade-off hypothesis” reveals that levels of PTH spike out of the normal range as early as stage G2 CKD, advancing it as a possible determinant of systemic damage. The present review aims to review the effects exhibited by PTH on several organs while linking the molecular mechanisms to the observed actions in the context of CKD. From a diagnostic perspective, PTH is the most reliable and accessible biochemical marker in CKD, but its trend bears a higher significance on a patient’s prognosis rather than the absolute value. Classically, PTH acts in a dichotomous manner on bone tissue, maintaining a balance between formation and resorption. Under the uremic conditions of advanced CKD, the altered intestinal microbiota majorly tips the balance towards bone lysis. Probiotic treatment has proven reliable in animal models, but in humans, data are limited. Regarding bone status, persistently high levels of PTH determine a reduction in mineral density and a concurrent increase in fracture risk. Pharmacological manipulation of serum PTH requires appropriate patient selection and monitoring since dangerously low levels of PTH may completely inhibit bone turnover. Moreover, the altered mineral balance extends to the cardiovascular system, promoting vascular calcifications. Lastly, the involvement of PTH in the Renin–Angiotensin–Aldosterone axis highlights the importance of opting for the appropriate pharmacological agent should hypertension develop.

Background: There are studies that have investigated the association of pro-inflammatory cytokines with depressive disorders, but they often present certain limitations. In this study, two substantial groups of patients were analyzed: 92 patients with major depressive disorder and 76 without depressive disorders. The strict inclusion and exclusion criteria for the analyzed groups significantly increased the value of the obtained results. The research question of this study was whether levels of inflammation, measured by the inflammatory markers IL-6, IL-1α, and TNF-α, could predict the severity of depressive symptoms. This could provide additional evidence supporting the hypothesis that inflammation plays a notable role in the pathogenesis of depression. The data analysis supports the hypothesis that the biological mechanisms of inflammation contribute to the clinical manifestations of depression. Elevated levels of inflammatory markers, especially interleukins (IL-6, IL-1α) and tumor necrosis factor-alpha (TNF α), have been identified in patients with major depressive disorder compared to the findings in healthy controls. Materials and Methods: Inflammatory markers (IL-6, IL-1α, and TNF-α) were measured in a sample of 92 patients hospitalized at the Socola Institute of Psychiatry in Iasi, Romania, and compared to a control group with no depression or inflammatory conditions (n = 76). Severity of depressive symptoms was assessed using HAM-D scores. Results: The study results indicated that values of plasma inflammatory markers were significantly higher in patients with major depressive disorder (MDD) compared to the control group (IL-1α: 1.16 ± 0.44 pg/mL vs. 0.89 ± 0.25 pg/mL, p = 0.0004; IL-6: 9.21 ± 4.82 pg/mL vs. 7.16 ± 4.32 pg/mL, p = 0.0149; and TNF-α: 2.02 ± 0.96 pg/mL vs. 1.67 ± 0.8 pg/mL, p = 0.0286). The differences remained significant after applying logarithmic transformation, which was necessary to adjust for outlier values. An analysis of demographic characteristics showed that the frequency of women (67.4% vs. 36.84%, p < 0.001), cohabiting individuals (28.26% vs. 10.53%, p = 0.0001), and alcohol consumers (67.39% vs. 47.37%, p = 0.0087) was significantly higher in patients with MDD. The level of education was significantly lower in patients with MDD (median (IQR): 12 (2.5) years vs. 14 (8) years, p = 0.0016). The evaluation of confounding variables, including patients’ gender, marital status, education level, and alcohol consumption, was performed using multiple linear regression models. The results indicated that these demographic variables did not significantly influence the correlation between the HAM-D score and the values of IL-6, IL-1α, and TNF-α. A significant correlation between the HAM-D score and the logarithmic values of inflammatory markers was observed for log IL-1α in men (r = 0.355, p = 0.0014), log IL-6 in women (r = 0.0313, p = 0.0027), and log TNF-α in women (r = 0.3922, p = 0.0001). The results of the multiple linear regression and predictive analysis indicated that IL-1α (AUC = 0.677, p = 0.0004), IL-6 (AUC = 0.724, p < 0.001), and TNF-α (AUC = 0.861, p < 0.001) demonstrate high accuracy in discriminating patients with MDD. Conclusions: The results highlighted that IL-6 (AUC = 0.724; 95% CI: 0.648–0.801) and TNF-α (AUC = 0.861; 95% CI: 0.797–0.925) are significant predictors for major depressive disorder. The study highlights the potential of cytokines (IL-1α, IL-6 and TNF-α) as diagnostic markers. These findings support the hypothesis that inflammation may play an important role in the development or exacerbation of depressive symptoms.

Dextro-transposition of the great arteries (D-TGA) is a critical congenital heart defect that can impact neurodevelopment due to cerebral perfusion and oxygenation disorders followed by alterations in synaptogenesis, gyrification, sulcation, and the microstructure. Brain injuries can occur both pre-operatively and postoperatively, especially white matter injuries, neuronal loss, and stroke. Materials and Methods: In a retrospective study conducted at a tertiary center between 2016 and 2023, we investigated the early effects of Prostaglandin E1 (PGE1) administration and balloon atrial septostomy (BAS) on cerebral blood flow and oxygenation in inborn neonates with D-TGA. Cerebral Doppler Ultrasound in the anterior cerebral artery (ACA) was performed to assess the resistive index (RI), Peak Systolic Velocity (PSV), and End-Diastolic Velocity (EVD) before PGE1, before the BAS procedure, and 24 h after birth. Cerebral regional saturations of oxygen (crSO2) and cerebral fractional tissue oxygen extraction (cFTOE) were evaluated. D-TGA patients were divided into the PGE1 group and the PGE1 + BAS group. Age-matched healthy controls were used for comparison. Results: All 83 D-TGA newborns received PGE1 within two hours after delivery, of whom 46 (55.42%) underwent BAS. In addition, 77 newborns composed the control group. PGE1 administration increased crSO2 from 47% to 50% in the PGE1 group, but lower than in controls at 24 h of life, while cFTOE remained elevated. The RI increased 24 h after delivery (0.718 vs. 0.769; p = 0.000002) due to decreased EDV (10.71 vs. 8.74; p < 0.0001) following PGE1 treatment. The BAS procedure resulted in a significant increase in crSO2 from 42% to 51% at 24 h of life in the PGE1 + BAS group. Doppler parameters exhibited a similar trend as observed in the PGE1 group. Conclusions: PGE1 treatment and BAS are lifesaving interventions that may improve cerebral perfusion and oxygenation in newborns with D-TGA during the transition period, as reflected by increasing SpO2 and crSO2.

Brown Adipose Tissue (BAT) is considered beneficial in diabetes and obesity, but it can also have negative effects such as its implication in tumours’ pathogenesis and the development of Cancer-induced Cachexia. Since 18F-FDG PET/CT is a common molecular imaging modality used in cancer assessment, we aim to study the 18F-FDG BAT biodistribution in oncological patients and look for possible correlations between BAT activity and different malignancies as well as the patient’s weight status. After analysing the total number of oncological 18F-FDG PET/CT scans between 2017 and 2021, we selected patients with active BAT. Based on their BMI, the selected patients were divided into nonobese (NO) vs. overweight and obese (OOB). OOB SUVmaxlean body mass(LBM) had the highest mean values in supraclavicular, latero-cervical, and paravertebral vs. mediastinal and latero-thoracic localisations in NO. BMI was positively correlated with latero-cervical and supraclavicular SUVmax(LBM) but negatively correlated with latero-thoracic and abdominal SUVmax(LBM). Considering the age of the patients, SUVmax(LBM) decreases in the latero-cervical, paravertebral, and abdominal regions. In addition, the males presented lower SUVmax(LBM) values. SUVmax(LBM) was not affected by the treatment strategy or the oncological diagnosis. To conclude, it is mandatory to take into consideration the BAT particularities and effects on weight status in order to optimise the clinical management of oncological patients.

Background and Objectives: The purpose of this study was to investigate whether early surfactant administration affects the status of ductus arteriosus (DA) in preterm infants ≤ 32 weeks of gestational age (GA) within 24 h of birth. Materials and Methods: It is a prospective study conducted from 1 March 2022 to 31 December 2023 in a tertiary academic center. In-born infants ≤ 32 weeks of gestation (n = 88) were enrolled. The study group was further divided into surfactant (n = 44) and non-surfactant (n = 44) subgroups. Results: A total of 76% of the preterm infants who received surfactant therapy (RRR = 0.839) recorded an increase in Kindler score at 24 h of life (1 − RR = 1 − 0.24 = 76%). Surfactant administration was significantly associated with decreased pre-ductal diastolic pressure (29.9 mmHg vs. 34.8 mmHg, p = 0.0231), post-ductal diastolic pressure (28.7 mmHg vs. 32.2 mmHg, p = 0.0178), pre-ductal MAP (41.6 mmHg vs. 46.5 mmHg, p = 0.0210), and post-ductal MAP (41.0 mmHg vs. 45.3 mmHg, p = 0.0336). There were no significant changes in ductus arteriosus parameters at 24 h of life. Conclusions: Early surfactant administration does not affect the status of ductus arteriosus in preterm infants ≤ 32 weeks of gestational age at 24 h of life.

Background and Objectives: The purpose of this study to investigate if the early variations in the hematological profile could be a useful tool in the prediction and evaluation of intraventricular hemorrhage. Materials and Methods: It is a retrospective study conducted between 1 January 2017 and 31 December 2022, in a tertiary academic center. In-born infants ≤ 28 weeks of gestation (n = 134) were enrolled. The study group of infants with all grades of IVH was further divided into mild IVH subgroups (grades 1 and 2) and severe IVH subgroups (grades 3 and 4); the control group included infants without IVH. Results: The prevalence of IVH was 35.8% (n = 48 of 134 infants—study group). We identified significantly lower median values of HGB (p = 0.0312) and HCT (p = 0.0172) in all grades of the IVH group at birth as compared with control, followed by a significantly higher drop in MCV (p = 0.0146) and MCH (p = 0.0002) in the fourth day of life. Conclusions: Extremely preterm infants with IVH may have lower HTC and HGB values at birth, together with a decrease in MCH and MCHC and increase in MPV. The predictive model based on logistic regression analysis could predict the probability of the occurrence of IVH according to their values.

Splenic cysts are rare benign lesions of the spleen, often asymptomatic and incidentally discovered during imaging studies. While many splenic cysts remain asymptomatic and do not require intervention, surgical management becomes essential in cases of symptomatic cysts, large cysts, or when malignancy cannot be ruled out. Laparoscopic surgery has emerged as a minimally invasive and effective approach for treating splenic cysts, offering advantages such as shorter hospital stays, reduced postoperative pain, and faster recovery. In this case report, we describe our experience with laparoscopic surgery for a symptomatic splenic cyst in a young patient.

Recent research has suggested that one novel mechanism of action for anti-obesity medications is to stimulate the activation of brown adipose tissue (BAT). 18FDG PET/CT remains the gold standard for defining and quantifying BAT. SUVmax is the most often used quantification tool in clinical practice. However, this parameter does not reflect the entire BAT volume. As a potential method for precisely evaluating BAT, we have utilised metabolic tumour volume (MTV) and total lesion glycolysis (TLG) to answer the question: Are MTV and TLG accurate in quantifying the intensity of BAT activation? After analysing the total number of oncological 18F-FDG PET/CT scans between 2021–2023, we selected patients with active BAT. Based on the BAT SUVmax, the patients were divided into BAT-moderate activation (MA) vs. BAT-high activation (HA). Furthermore, we statistically analysed the accuracy of TLG and MTV in assessing BAT activation intensity. The results showed that both parameters increased their predictive value regarding BAT activation, and presented a significantly high sensitivity and specificity for the correct classification of BAT activation intensity. To conclude, these parameters could be important indicators with increased accuracy for classifying BAT expression, and could bring additional information about the volume of BAT to complement the limitations of the SUVmax.

C-reactive protein (CRP) has been one of the most investigated inflammatory-biomarkers during the ongoing COVID-19 pandemics caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The severe outcome among patients with SARS-CoV-2 infection is closely related to the cytokine storm and the hyperinflammation responsible for the acute respiratory distress syndrome and multiple organ failure. It still remains a challenge to determine which of the hyperinflammatory biomarkers and cytokines are the best predictors for disease severity and mortality in COVID-19 patients. Therefore, we evaluated and compared the outcome prediction efficiencies between CRP, the recently reported inflammatory modulators (suPAR, sTREM-1, HGF), and the classical biomarkers (MCP-1, IL-1β, IL-6, NLR, PLR, ESR, ferritin, fibrinogen, and LDH) in patients confirmed with SARS-CoV-2 infection at hospital admission. Notably, patients with severe disease had higher serum levels of CRP, suPAR, sTREM-1, HGF and classical biomarkers compared to the mild and moderate cases. Our data also identified CRP, among all investigated analytes, to best discriminate between severe and non-severe forms of disease, while LDH, sTREM-1 and HGF proved to be excellent mortality predictors in COVID-19 patients. Importantly, suPAR emerged as a key molecule in characterizing the Delta variant infections.

The high energy of α emitters, and the strong linear energy transfer that goes along with it, lead to very efficient cell killing through DNA damage. Moreover, the degree of oxygenation and the cell cycle state have no impact on these effects. Therefore, α radioisotopes can offer a treatment choice to individuals who are not responding to β− or gamma-radiation therapy or chemotherapy drugs. Only a few α-particle emitters are suitable for targeted alpha therapy (TAT) and clinical applications. The majority of available clinical research involves 225Ac and its daughter nuclide 213Bi. Additionally, the 225Ac disintegration cascade generates γ decays that can be used in single-photon emission computed tomography (SPECT) imaging, expanding the potential theranostic applications in nuclear medicine. Despite the growing interest in applying 225Ac, the restricted global accessibility of this radioisotope makes it difficult to conduct extensive clinical trials for many radiopharmaceutical candidates. To boost the availability of 225Ac, along with its clinical and potential theranostic applications, this review attempts to highlight the fundamental physical properties of this α-particle-emitting isotope, as well as its existing and possible production methods.

Background: In STEMIs, the evaluation of the relationship between biomarkers of myocardial injury and patients’ prognoses has not been completely explored. Increased levels of CK-MB in patients with a STEMI undergoing primary angioplasty are known to be associated with higher mortality rates, yet the correlation of these values with short-term evolution remains unknown. Material and Methods: The research encompassed a sample of 80 patients diagnosed with STEMIs, and its methodology entailed a retrospective analysis of the data collected during their hospital stays. The study population was then categorized into three distinct analysis groups based on the occurrence or absence of acute complications and fatalities. Results: The findings indicated that there is a notable correlation between rising levels of CK-MB upon admission and peak CK-MB levels with a reduction in left ventricular ejection fraction. Moreover, the CK-MB variation established a point of reference for anticipating complications at 388 U/L, and a cut-off value for predicting death at 354 U/L. Conclusion: CK-MB values are reliable indicators of the progress of patients with STEMIs. Furthermore, the difference between the peak and admission CK-MB levels demonstrates a high accuracy of predicting complications and has a significant predictive power to estimate mortality risk.

In modern clinical practice, digital pathology has an essential role, being a technological necessity for the activity in the pathological anatomy laboratories. The development of information technology has majorly facilitated the management of digital images and their sharing for clinical use; the methods to analyze digital histopathological images, based on artificial intelligence techniques and specific models, quantify the required information with significantly higher consistency and precision compared to that provided by optical microscopy. In parallel, the unprecedented advances in machine learning facilitate, through the synergy of artificial intelligence and digital pathology, the possibility of diagnosis based on image analysis, previously limited only to certain specialties. Therefore, the integration of digital images into the study of pathology, combined with advanced algorithms and computer-assisted diagnostic techniques, extends the boundaries of the pathologist’s vision beyond the microscopic image and allows the specialist to use and integrate his knowledge and experience adequately. We conducted a search in PubMed on the topic of digital pathology and its applications, to quantify the current state of knowledge. We found that computer-aided image analysis has a superior potential to identify, extract and quantify features in more detail compared to the human pathologist’s evaluating possibilities; it performs tasks that exceed its manual capacity, and can produce new diagnostic algorithms and prediction models applicable in translational research that are able to identify new characteristics of diseases based on changes at the cellular and molecular level.

Background: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) has shown constant incidence throughout time, despite advances in endoscopic technology, devices, or personal skills of the operating endoscopists, with prevention and prediction of severity in PEP being constant concerns. Several prospective studies have investigated the role of systemic inflammatory response syndrome (SIRS) criteria or the quick Sequential Organ Failure Assessment (qSOFA) score in the PEP severity assessment. However, there are no clearly defined tools for the prediction of PEP severity. Methods: A total of 403 patients were prospectively monitored 60 days after ERCP for the detection of PEP development. Consequently, we evaluated the lengths of stay, incidence of organic dysfunction, and mortality rates of these patients. The predictive power of the univariate model was evaluated by using the receiver operating characteristic curve and analyzing the area under the curve (AUC). Results: Incidence of PEP was similar to that reported in the majority of trials. The 60-day survival rate of PEP patients reached 82.8%. A qSOFA score ≥ 1 is a very good predictor for organ dysfunction (AUC 0.993, p < 0.0001). SIRS can also be considered a significant predictor for organic dysfunctions in PEP patients (AUC 0.926, p < 0.0001). However, only qSOFA was found to significantly predict mortality in PEP patients (AUC 0.885, p = 0.003), with SIRS criteria showing a much lower predictive power. Neither SIRS nor qSOFA showed any predictive value for the length of stay of PEP patients. Conclusion: Our study offers novel information about severity prediction in PEP patients. Both SIRS criteria and qSOFA showed good predictive value for organic dysfunction, mortality, and hospitalization.

Omphalocele is the most common ventral abdominal wall defect. Omphalocele is associated with other significant anomalies in up to 80% of cases, among which the cardiac ones are the most frequent. The aim of our paper is to highlight, through a review of the literature, the importance and frequency of association between the two malformations and what impact this association has on the management and evolution of patients with these pathologies. We reviewed the titles, the available abstracts, and the full texts of 244 papers from the last 23 years, from three medical databases, to extract data for our review. Due to the frequent association of the two malformations and the unfavorable effect of the major cardiac anomaly on the prognosis of the newborn, the electrocardiogram and echocardiography must be included in the first postnatal investigations. The timing of surgery for abdominal wall defect closure is mostly dictated by the cardiac defect severity, and usually the cardiac defect takes priority. After the cardiac defect is medically stabilized or surgically repaired, the omphalocele reduction and closure of the abdominal defect are performed in a more controlled setting, with improved outcomes. Compared to omphalocele patients without cardiac defects, children with this association are more likely to experience prolonged hospitalizations, neurologic, and cognitive impairments. Major cardiac abnormalities such as structural defects that require surgical treatment or result in developmental delay will significantly increase the death rate of patients with omphalocele. In conclusion, the prenatal diagnosis of omphalocele and early detection of other associated structural or chromosomal anomalies are of overwhelming importance, contributing to the establishment of antenatal and postnatal prognosis.

Neurofibromatosis type 1 (NF1) is a genetic disease, with autosomal dominant transmission, related to pathogenic variant of the tumor suppressor gene NF1 (17q11.2), predisposing affected subjects to a variety of benign (neurofibromas and plexiform neurofibromas) and malignant tumors. The lack of the NF1-neurofibromin gene product can cause uncontrolled cell proliferation in the central or peripheral nervous system and multisystemic involvement, and so the disease includes a heterogeneous group of clinical manifestations. Ganglioneuromas are benign tumors developing from the neural crest cells of the autonomic nervous system, considered to be part of neuroblastic tumors. Bladder localization is extremely rare in adults, and only three such cases were reported in children so far. The aim of our study, in addition to a brief review of the literature of these pathologies, is to bring to your attention the case of a sixteen year old patient with a very rare association of NF1 and bladder ganglioneuroma, who presented at the hospital with gross hematuria. Since bladder ganglioneuroma is a rare pathological condition, the differential diagnosis is difficult and imaging investigations and pathological investigations are the ones that elucidate this disease. The clinical approach of the medical multidisciplinary team involved should help the patient in managing her medical and surgical situation.

Brown adipose tissue (BAT) participates in the regulation of whole-body metabolism by producing a variety of adipokines. This study investigates into the BAT pattern and the clinical aspects of overweight and obese (OOB) vs. non-obese (NO) hyperparathyroidism (HPT) patients with the aim of assessing the impact of BAT and obesity on HPT. Parathyroid scans performed on 441 HPT patients between 2015 and 2020 were retrospectively analyzed in order to select the images with active BAT. Based on their BMI, the patients with active BAT were divided into OOB vs. NO. The results showed that BAT was present in cervical and supraclavicular regions, with a single localization especially among NO vs. multiple sites among OOB. The (total counts/pixels)BAT/(total counts/pixels)non-BAT ratio in the right cervical localization showed a significant difference between the groups with higher values in OOB. BMI, PTH, FT4, vitamin D, magnesium, creatinine, and urea had significant correlations with BAT ratios. The predictive values showed that right cervical ratios higher than 1.52 and right supraclavicular ratios lower than 1.15 indicated an increased probability of being OOB. The significant correlations between BAT activation in OOB vs. NO and HPT clinical parameters could be useful for developing potential treatments based on this tissue.

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.

Background and Objectives: The post-mortem diagnosis of hypothermia is challenging in forensics. The aim of our study was to detect the kidney and heart histopathological changes that occurred in a group of hypothermia-related fatalities. Materials and Methods: The cohort included 107 cases identified in the database of our department between 2007 and 2021, which have been associated with extreme cold stress. Demographic and clinicopathological data were collected from the medico-legal reports. Archived tissue samples were evaluated to identify the histopathological features, in routine haematoxylin-eosin (H&E), Periodic acid-Schiff (PAS), and Masson’s trichrome stainings, while cardiac sirtuin1 (SIRT1) and renal ubiquitin (Ub) immunostaining have been performed. Results: The majority of cases exposed to low temperatures were males (76%) from rural regions (68.2%) during the cold season. Paradoxical undressing was documented in 9.3% of cases. The common comorbidities included alcoholism (50.5%), neuropsychiatric diseases (10.3%), diabetes mellitus (3.7%), and lung tuberculosis (4.7%). The microscopic heart exam revealed areas of myocardial degeneration (100%), contraction bands (95.3%), fatty change (13.1%) and focal wavy contractile myocardial cells. Basal vacuolisation of renal tubular epithelial cells (Armanni-Ebstein lesions) (21.5%), focal tubular necrosis (7.5%), tubular renal cysts (7.5%), interstitial haemorrhages (5.6%), diabetic kidney disease (3.7%), background benign nephroangiosclerosis (42.1%), variable thickening of tubules and corpuscles basement membranes, capsular space amorphous material, and intratubular casts were identified in kidney tissue samples. Myocardial cells displayed SIRT1 weak expression, with a loss of immunopositivity correlated with areas with contraction bands, while a variable Ub expression was observed in renal corpuscles capsules, proximal, distal, and collecting renal tubules, Henle’s loops, urothelium, and intratubular casts. Conclusions: In the context of the current concept that death associated with hypothermia is still a diagnosis of exclusion, our findings suggest that the microscopic exam provides relevant data that support the diagnosis of hypothermia-related fatalities in appropriate circumstances of death. A deeper insight into the histopathologic findings in hypothermic patients may lead to new therapeutic approaches in these cases.

Introduction. FEM is a reliable tool for researching the impact of orthodontic therapy on the affected periodontal tissues. Material and methods. Using Catia V5R16 and Abaqus software we analysed various clinical scenarios for intruding the lateral mandibular incisor in different situations of horizontal bone loss (HBL). Results and Discussions. When intruding the lateral mandibular incisors we noticed that the equivalent tensions are increasing together with the extent of HBL and the magnitude of the applied force. Conclusions. When optimal intrusive forces are applied at the level of the mandibular lateral incisor, the periodontal status of the patient will not represent a restriction for the interdisciplinary treatment.

Urachal cancer is very rare, accounting for only 0.5–2% of bladder-associated malignancies and 0.01% of all cancers in adults. It has an insidious appearance, an aggressive behavior and a poor prognosis. The most common symptoms are hematuria and the presence of a palpable hypogastric mass. The scarcity of cases and the low number of studies carried out explains the lack of an evidence-based management strategy, but it seems that surgical treatment (open, laparoscopy or robot-assisted) represents the gold standard, while neoadjuvant and adjuvant chemotherapy or radiotherapy has a limited impact on overall survival. Since mucinous cystadenocarcinoma of urachal origin is a very uncommon pathological condition the differential diagnosis may be difficult and pathological investigations have to elucidate this disorder. It is worth mentioning the psychological impact on the patient in addition to the medical aspects. A rare condition is associated with heightened risk for mental health and psychosocial difficulties and this must be taken into account in the subsequent follow-up of the patient. In order to increase awareness of this rare entity we report a case of a 40-year-old male with a urachal adenocarcinoma who was treated surgically, with a favorable outcome. We also perform a brief literature review about this type of tumor.

In the case of SARS-CoV-2 infection, children seem to be less affected than adults, but data regarding epidemiologic characteristics and biochemical values are poor and essentially based on limited case series. The aim of our study is to highlight the predictive value of some biochemical markers at hospitalization, for the correct classification of the patient in the form of disease. Methods: We performed an analytical retrospective study on 82 pediatric patients diagnosed with COVID-19 in the emergency department, with moderate or severe form of disease, and treated in our tertiary hospital. We analyzed the epidemiologic characteristics, symptomatology and biochemical values and compare the data according to the form of disease. Results: The mean age at admission was 4.5 years (median 1 year) and the masculine/feminine ratio was 1.5. Comparing the data between the two groups of patients (42 severe/40 moderate), we observed that the severe form presented with a lower pH at admission (p = 0.02), hyperglycemia (p = 0.01), increased values of transaminases (p = 0.01 and 0.02) and hypoproteinemia (p = 0.01). Also, the severe form was statistically significantly associated with comorbidities, acute respiratory distress, rising of the inflammatory markers during hospitalization. Hyperlactatemia (Lactate > 1.5 mmol/L) was significantly associated with the age under one year (p < 0.001). Mortality rate was 9.75% and the median age at death was 3 months. Univariate logistic regression model shows that the presence of anemia increased the probability of death 88 times, comorbidities 23.3 times and ketoacidosis 16.4 times. Conclusions: Metabolic acidosis, hyperlactatemia, hyperglycemia, modified hepatic values and hypoproteinemia are biochemical markers associated with the severe form of disease in SARS-CoV-2 infection in children. Presence of anemia, comorbidities and ketoacidosis are important risk factors for death of pediatric patients with SARS-CoV-2 infection.

Background: Oral squamous cell carcinoma (OSCC) registered an alarming fall in the average age of individuals diagnosed in the last decade. Objectives: The aim of our study is to assess the main risk factors for OSCC specific to Romania and to identify patients at risk for this pathology. The purpose is to implement in the future a screening and early diagnosis program for OSCC in our country. Materials and Methods: A ten-year case-control study was conducted on patients selected from “St. Spiridon” Hospital-Iaşi, Romania. The study contained 1780 individuals diagnosed with oral squamous cell carcinoma. Results: For the patients under 46 years old: APC = −2.8 percent (95% CI: −24.4 to −7.1; p = 0.0012), with the observed rate of 30.18 percent. The incidence increased in patients aged 46 to 49 years (APC = 9.6%; 95% CI: 6.7 to −10.4; p = 0.0081). For the age group 49 to 64 years old: APC = −2.4 percent (95% CI: −5.3 to −1.6, p = 0.1239). For the age group 64–74: APC = −4.6, (95% CI: 1.4 to 6.9, p = 0.0108). The incidence of incidents was lower in the age group 74–80 (p = 0.0025). For the age group 80–91: APC = 8.1 (95% CI: 6.4 to 14.2, p = 0.0024), with the incidence of cases: APC = 8.1 (95% CI: 6.4 to 14.2, p = 0.0024). Univariate analysis revealed a substantially higher risk of developing oral carcinoma in males (OR = 4.43; CI: 3.84 to 5.80). Age above 60, cigarette usage and alcohol abuse are significant risk factors for OSCC. Patients with lymph node dissemination, ulcero-vegetant form, stages II and IV, whose therapeutic approach consisted of radiotherapy and chemotherapy or radiotherapy only had a worse rate of survival at 24 months post-therapy. Conclusions: Our study highlights the increase in the incidence of OSCC in Romania during the research period, the decrease in the average age of diagnosed patients, as well as the degree to which the studied population is exposed to the main risk factors specific to this geographical area.

Background: Monitoring surgical quality has been shown to reduce locoregional recurrence (LRR). We previously showed that the arterial stump length (ASL) after complete mesocolic excision (CME) is a reproducible quality instrument and correlates with the lymph-node (LN) yield. We hypothesized that generating an LRR prediction score by integrating the ASL would predict the risk of LRR after suboptimal surgery. Methods: 502 patients with curative resections for stage I–III colon cancer were divided in two groups (CME vs. non-CME) and compared in terms of surgical data, ASL-derived parameters, pathological parameters, LRR and LRR-free survival. A prediction score was generated to stratify patients at high risk for LRR. Results: The ASL showed significantly higher values (50.77 mm ± 28.5 mm) with LRR vs. (45.59 mm ± 28.1 mm) without LRR (p < 0.001). Kaplan–Meier survival analysis showed a significant increase in LRR-free survival at 5.58 years when CME was performed (Group A: 81%), in contrast to non-CME surgery (Group B: 67.2%). Conclusions: The prediction score placed 76.6% of patients with LRR in the high-risk category, with a strong predictive value. Patients with long vascular stumps and positive nodes could benefit from second surgery to complete the mesocolic excision.

Background: Antioxidant defense of the body is assured by both endogenous and exogenous factors comprising several enzymes, vitamins, protein components and derivates and oligoelements. Breast milk has been proven to have important and essential antioxidant composition to prevent and protect against diseases in infancy. The objective of this study was to determine the total antioxidant status (TAS) of human milk and to evaluate the differences between premature milk and term milk at different moments of lactation (colostrum, transitional milk and mature milk). A second objective was to evaluate how TAS varies whether the human milk is refrigerated or frozen. Methods: Pumped human milk samples of the third, seven and 30th day were collected from women who had term deliveries (30 cases) and preterm deliveries (60 cases). Samples were refrigerated (+4 °C) or frozen in domestic conditions (−20 °C) for various durations and TAS was determined using the ABTS® technique with Randox® reagents and compared for the two groups. Results: Higher values were found in term versus preterm fresh milk at 30 days of lactation. A slight reduction in TAS was found after 72 h of refrigeration, while 1 week freezing produced significant decrease of total antioxidants. Freezing for 12 weeks reduced more than 50% of TAS in fresh milk. Conclusion: Breastfeeding provides the optimal antioxidant for neonates, regardless of gestational age. Fresh milk has the higher antioxidant power. When it is not available, refrigerated milk for 24 h is better than for 72 h and preferable than frozen milk. Freezing human milk for 3 months in household conditions markedly diminishes TAS. Key Words: early lactation, human milk, preterm, term, total antioxidant status

Introducere. Greutatea la naştere rămâne cel mai important indice antropometric al nou-născutului. Restricţia de creştere intrauterină (RCIU) stă la baza mortinatalităţii, dar şi la baza afecţiunilor metabolice şi cardiovasculare la adult. În acest studiu este evaluată relaţia între restricţia de creştere intrauterină, dezvoltarea antropometrică şi dinamica unor parametri ai sindromului metabolic până la vârsta de cinci ani. Material şi metodă. Studiul s-a desfăşurat pe o perioadă de 4 ani (2010-2013) pe un lot de 622 de nou-născuţi cu RCIU fără patologie în perioada neonatală. Starea de nutriţie s-a evaluat prin determinarea greutăţii, taliei, indicelui de masă corporală (IMC) cu încadrarea valorilor obţinute pe curbele de creştere în funcţie de vârstă şi sex propuse de Organizaţia Mondială a Sănătăţii şi a fost comparată cu statusul nutriţional al unui lot de 627 nou-născuţi cu RCIU internaţi în Terapie Intensivă Neonatală. Valorile trigliceridelor şi glicemiei preprandiale au fost evaluate şi comparate cu valorile normale pentru vârstă. Rezultate. Incidenţa obezităţii (16.1%) este semnificativ crescută (χ2=32,23, p<

Introduction. Birth weight is the most significant anthropometric indicator of the clinical status of neonates. Intrauterine growth restriction (IUGR) is the cause of increasing death rate in neonates and is associated with adult cardiovascular disease and metabolic syndrome. The purpose of our study is to evaluate the relationship between IUGR, the development of children and metabolic complications in children up to the age of five. Material and methods. We performed a prospective study over a period of 4 years (2010-2013) on a group of 622 newborns with IUGR without any reported conditions during the neonatal period. The nutritional status assessment was performed by determining the weight, length, body mass index and their integration according to age and sex, on the growth curves proposed by the World Health Organization and was compared to that of 627 IUGR infants admitted to the Neonatal Intensive Care Unit. The triglyceride, cholesterol and glucose levels were evaluated and compared with normal values for age. Results. The obesity incidence (16.1%) is significant higher (χ2=32.23, p<

The SARS-Cov2 pandemic is a major challenge for the nowadays medicine and raises major issues, through the severity of symptoms, the high degree of contagion and the speed of spread. Since the onset of the pandemic, several mathematical models have been proposed to make epidemiological predictions and projections - SEIR / SIR, Agent-based and Curve fitting / Extrapolation models, but their practical utility has proved to be relatively limited due to the high complexity of the analyzed phenomenon. We aimed in this paper to make a short review of such models, with their advantages and drawbacks, and also to present the current situation of cases evolution in Europe, in order to highlight similarities and dissimilarities between countries. Our analysis uses the data reported by www.worldometers.info – the diagrams with the daily number of new cases, recorded by countries. An empirical comparison between these diagrams reveals certain facts: the situation in Italy is similar with those from Spain, France and Germany; other similarities can be observed between UK and Portugal; Belgium and Switzerland; Poland, Czech Republic, Slovakia and Rep. of Moldavia; Romania, Bulgaria, Hungary and Greece. From a general point of view, a few conclusions can be noted: regardless the strategies applied at the country level, the successes reported in the pandemic control were only temporary; in the Nordic countries, the evolution of the pandemic has been milder and the general evolution of the disease rate was equally unfavorable in all European countries, the differences being given only by the time gaps; therefore, the local policies and restrictions for pandemic control had a limited efficiency.

Background: The rate of preterm births in Romania is one of the highest among European countries. However, there is little information regarding the ways in which premature birth affects the outcome in Romanian preterm infants. Aims: To investigate the effects of early developmental intervention after discharge from the hospital on motor and cognitive development in preterm infants. Study Design: Longitudinal observational study Methods: We performed the Amiel-Tison neurologic evaluation at discharge and the Bayley Scales of Infant Development from 3 to 24 months. Based on these evaluations, an outcome score was formulated. Results: Between 2007 and 2010, 1157 of 2793 premature infants were included into the study. There was a negative correlation between the number of evaluations and the risk of developing neurologic sequelae (p

Background: The increased prevalence of obesity among children determined the rising number of its comorbidities in children and adults, too. This study aimed to evaluate certain markers of inflammation and insulin resistance in obese pediatric patients, identifying those who are more likely to develop further complications. Methods: We included 115 obese pediatric patients: 85 overweight and obese patients in the study group and 30 normal-weight patients in the control group. We calculated the body mass index (BMI) and we evaluated markers (biological, inflammatory) and the hormones profile. Results: Low-threshold inflammation was assessed by measuring interleukin 6 IL-6 and Intercellular Adhesion Molecules (ICAM). The analysis showed that IL-6 is significantly correlated with glucose (p = 0.001) and BMI value (p = 0.031). ICAM correlates significantly with triglycerides (p = 0.001), glucose (p = 0.044) and BMI percentile (p = 0.037). For pediatric obese patients, endotoxemia has been significantly correlated only with BMI percentile (p = 0.001). Plasma cortisol did not show significant correlations with total cholesterol, triglycerides, glucose or BMI percentile. The results indicated a significant predictive power of BMI percentile on inflammatory markers: IL-6 (AUC = 0.803, p < 0.001), ICAM (AUC = 0.806, p < 0.001) and endotoxemia (AUC = 0.762, p = 0.019). Additionally, BMI percentile has a significant predictive power for metabolic markers of insulin resistance (insulin value: AUC = 0.72, p < 0.001 and HOMA index: AUC = 0.68, p = 0.003). Conclusions: The study highlighted the importance of early markers of cardiovascular risk in obese pediatric patients represented by IL-6, ICAM, endotoxemia and their correlation with metabolic markers of insulin resistance represented by insulinemia, HOMA index and plasma cortisol. It can clearly be considered that the BMI percentile has significant predictive power for metabolic markers of insulin resistance.

Preoperative cognitive impairment (PCI) in cancer patients includes a broad spectrum of neurocognitive changes produced by complex interplay of patient, tumoural and treatment-related factors. Reduced preoperative cognitive reserve can favour the emergence of postoperative delirium (POD). The study aims to document PCI prevalence and to assess the relationship with POD in elderly cancer patients. The prospective observational study included consecutive patients scheduled for elective surgery; PCI was assessed with Mini-Cog test and defined at a score ≤ 3, POD was screened using Nursing Delirium Screening Scale (Nu-DESC) and defined at a score ≥ 2. Data on education, American Society of Anesthesiologists (ASA) score, preoperative medications, substance use, comorbidities, sensorial deficits, surgery and anaesthesia type, anaesthetic drugs, Mini-Cog score, postoperative pain, Nu-DESC were collected. In total, 131 patients were enrolled, mean age 72.1 ± 5.9 years. PCI prevalence was 51.9% (n = 68). POD prevalence was 19.8% (n = 26), with significantly higher value in PCI patients (27.9% vs. 11.1%, p = 0.016). In multivariate analysis, Mini-Cog score ≤ 3 (OR = 2.6, p = 0.027), clock draw (OR: 2.9, p = 0.013), preoperative renal dysfunction (OR = 2.6, p = 0.012), morphine (OR = 2.7, p = 0.007), metoclopramide (OR = 6.6, p = 0.006), and high pain score (OR = 1.8, p = 0.018) had a significant association with POD development. In this sample of elderly patients, PCI had a high prevalence and predicted the emergence of POD. Incorporating Mini-Cog test into the preoperative evaluation of onco-geriatric patients seems valuable and feasible.

In children’s first year of life it is mandatory to make a difference between physiological gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD), in order to avoid an aggressive pharmacologic therapy. All ages of childhood benefit from modern criteria of clinical evaluation, by corroborating the digestive or extradigestive symptoms with the results of modern investigations. The dietary measures (sufficient in GER but mandatory in all cases) together with proton pump inhibitors administration after one year of age induce remission in majority of GER cases. The chronic and recurrent evolution of the disease or failure of the common treatment require surgical intervention, recently enriched in children with peroral endoscopic myotomy (POEM).

Departajarea refluxului gastro-esofagian (RGE) fiziologic (cel mai frecvent) de boala de reflux gastro-esofagian (BRGE) în primul an de viaţă este obligatorie pentru a evita farmacoterapia agresivă. La toate vârstele copilăriei se aplică criterii moderne de evaluare clinică, sumând simptome digestive şi/sau extradigestive şi rezultatele unor investigaţii moderne. Tratamentul igieno-dietetic (suficient in RGE fiziologic), obligatoriu în toate cazurile, şi inhibitorii de pompă protonică dupa vârsta de un an induc remisiune în majoritatea cazurilor de RGE. Evoluţia cronică/recidivantă şi rezistenţa la tratamentul comun impun intervenţia chirurgicală, domeniu îmbogaţit recent la copil cu miotomia perorală endoscopică (POEM).

Scop. Evaluarea eficienţei cafeinei comparativ cu aminofilina în tratamentul apneei de prematuritate. Material şi metodă. Am realizat un studiu retrospectiv comparativ pe două loturi de nou-născuţi prematuri admişi în Centrul Regional de Terapie Intensivă Neonatală din cadrul Spitalului Clinic de Obstetrică şi Ginecologie „Cuza-Vodă“, Iaşi, în perioada iunie 2012 – iunie 2015. Rezultate. La nou-născuţii care au primit cafeină s-a înregistrat o reducere semnificativă statistic a numărului crizelor de apnee în ziua a 3-a, respectiv a 14-a de tratament comparativ cu cei care au fost trataţi cu aminofilină. Tratamentul cu cafeină s-a asociat o uşoară scădere a necesităţii instituirii CPAP şi a ventilaţiei mecanice comparativ cu aminofilina, dar diferenţele nu au fost semnificative statistic. Anemia, hemoragia intraventriculară, persistenţa de canal arterial şi boala pulmonară cronică s-au corelat cu creşterea duratei tratamentului pentru apnee de prematuritate. Nou-născuţii din lotul cu cafeină au prezentat mai multe episoade de agitaţie, tahicardie şi intoleranţă digestivă, însă o incidenţă mai mică a enterocolitei ulcero-necrotice, a scăderii ponderale şi a HTA, faţă de cei care au primit aminofilină. Durata de spitalizare a fost mai redusă la nou-născuţii trataţi cu cafeină, comparativ cu cei din lotul cu aminofilină. Concluzii. Avantajele terapeutice ale cafeinei sunt remarcabile prin incidenţa scăzută a efectelor adverse semnificative şi raportul cost/beneficiu pe termen lung, pledând pentru recomandarea acesteia ca tratament de elecţie pentru apneea de prematuritate. Aceste aspecte justifică iniţierea unui studiu multicentric la nivel naţional care să includă un număr mult mai semnificativ de nou-născuţi prematuri pentru evaluarea eficienţei tratamentului cu cafeină la toate categoriile de vârstă gestaţională.

Purpose. Comparison of the efficiency of caffeine and aminophylline for the treatment of apnoea in premature neonates. Material and method. We conducted a retrospective study on two lots of premature infants admitted in the Regional Centre of Neonatal Intensive Care Unit of the “Cuza-Vodă” Clinical Hospital of Obstetrics and Gynaecology of Iasi during June 2012 – June 2015. Results. Neonates treated with caffeine had significantly less apnoea on day 3 and 14 of treatment comparing with those who received aminophylline. Caffeine treatment was associated with less need for CPAP and mechanical ventilation comparing with aminophylline, but there was no statistical significance. Anemia, intraventricular hemorrhage, persistent ductus arteriosus and chronic lung disease were correlated with an increased duration of the treatment for apnoea of prematurity. Neonates from the caffeine group had more episodes of agitation, tachycardia and digestive intolerance, but at the same time a reduced incidence of necrotizing enterocolitis, weight loss and hypertension, compared to those from the aminophylline group. The hospital stay duration was reduced in the infants that received caffeine treatment compared to those that received aminophylline. Conclusion. The therapeutic advantages of caffeine are remarkable due to low incidence of significant adverse effects and its long-term cost/efficiency ratio, which recommend it as the best treatment for apnoea of prematurity. These facts justify the initiation of a multicentre national study including a higher number of premature neonates for the evaluation of the efficiency of caffeine therapy in all gestational age groups.

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.

Background and objectives: Knowledge of the interactions and influences of infectious, genetic, and environmental factors on the evolution and treatment response of malignant tumors is essential for improving the management of the disease and increasing patient survival. The objective of this study was to establish the contribution of human papillomavirus (HPV), as well as p53 and p16 tumor markers, alongside associated factors (smoking and alcohol consumption), in the progression of malignancies located in the oropharynx and at the retromolar trigone–oropharyngeal junction. Materials and Methods: We performed a prospective study including 50 patients with malignant tumors of the oropharynx and retromolar trigone–oropharyngeal junction. In all patients, the presence and type of HPV were determined, as well as the status of the tumor markers p53 and p16. The associated risk factors, biopsy results, treatment method, and post-treatment evolution were all documented. Statistical analyses were performed to evaluate the correlations between the determining factors and their influence on the post-treatment evolution. An overall increased survival rate was found in HPV(+) patients. Results: Our study outlined the prevalence of different high-risk subtypes of HPV from the ones presented by other studies, suggesting a possible geographic variation. Correlations between the p53 and p16 statuses and patient survival could be established. The association of smoking and alcohol consumption strongly correlated with an unfavorable evolution. Conclusions: Awareness of the differences in the post-treatment evolution of the patients in relation to the presence of the factors determined in our study could change the future management of such cases for ensuring improved treatment outcomes.

Objectives. The aim of this paper is to identify the correlations between the clinical evolution of the neonates with necrotizing enterocolitis (NEC) and the stage of disease, associated risk factors and the type of treatment used. Material and methods. A 6 years retrospective study was performed based on reviewing the casuistry of the Regional Centre of Neonatal Intensive Care Unit (NICU) „Cuza Voda” and 205 cases of necrotizing enterocolitis were identifi ed from a total number of 6183 neonates admitted there. Patients were divided in to study groups based on the gestational age (GA) and birth weight (BW). The analysis protocol was realized based on a working sheet that included the epidemiological data of the patients, the risk factors, type of nutrition, age at diagnosis, stage of disease according to Bell classifi cation, type of treatment (medical, surgical or combined), complications and the general evolution. The statistical data processing was performed in SPSS Statistics 20 program. Results. NEC had a frequency of 3.3% is the study group and was diagnosed in premature newborns in 75.6% of cases. The mean GA for the study group was 33 weeks. The mean BW was 1896 g with 43% of the cases in very low birth weight (VLBW) group and 31.2% in low birth weight (LBW) group. The percentage incidence of the risk factors was as follows: persistence of ductusarteriossus 19.5%, perinatal asphyxia 13.7% and respiratory distress 100% of cases. 75.5% were treated and discharged from NICU, 16.6% were transferred to Pediatric Surgery Department „Sf. Maria” and 3.9% died in NICU. From the 34 cases transferred19 cases were surgically treated: 8 cases with peritoneal drainage (PD), 8 cases with primary laparotomy (LAP) and 3 cases with PD and LAP. The survival rate in this group was 2.4% and for the medically treated group was 4.9%. Conclusions. Prematurity is statistically correlated with encountering advanced stages of enterocolitis at the time of diagnosis. The option for surgical treatment (peritoneal drainage or laparotomy) does not infl uence the results and early enteral feeding with formula is the most important risk factor for NEC followed by age of gestation and very low birth weight.

Obiective. Identifi carea corelaţiilor între evoluţia clinică a nou-născuţilor cu enterocolita ulceronecrotică (EUN) şi stadiul de boală, factorii de risc asociaţi, respectiv tipul de tratament utilizat. Material şi metodă. S-a realizat un studiu retrospectiv pe o perioadă de 6 ani pe baza cazuisticii Centrului Regional de Terapie Intensivă Neonatală „Cuza Voda“ şi s-au identifi cat 205 cazuri de enterocolită ulceronecrotică dintr-un total de 6.183 de nou-născuţi îngrijiţi aici. Bolnavii au fost împărţiţi în loturi de studiu în funcţie de vârsta de gestaţie (VG), respectiv greutatea la naştere (GN). Protocolul de analiză s-a realizat pe baza unei fişe de lucru care a cuprins datele epidemiologice ale pacienţilor, factorii de risc, tipul alimentaţiei, vârstă în momentul diagnosticului, stadiul de boală conform clasifi cării Bell, modalitatea de tratament (medical, chirurgical sau mixt), complicaţiile înregistrate şi evoluţia pacienţilor. Prelucrarea statistică a datelor s-a făcut utilizând programul SPSS Statistics 20. Rezultate. Enterocolita ulceronecrotică a avut o frecvenţă de 3,3% în lotul studiat şi a fost diagnosticată la nounăscuţii prematuri în 75,6% dintre cazuri. VG medie în grupul de studiu a fost de 33 săptămâni. GN medie a fost de 1.896 g, cu 43% dintre cazuri în grupul cu greutate foarte mică la naştere (VLBW) şi 31,2% în grupul cu greutate mică la naştere (LBW). Incidenţa procentuală a factorilor de risc a fost următoarea în ordinea frecvenţei: persistenţa canalului arterial 19,5%, asfi xia perinatală 13,7%, detresa respiratorie 100% dintre cazuri. 75,5% dintre cazuri au fost tratate şi externate din CRTIN, 16,6% dintre cazuri au fost transferate în Clinica de Chirurgie Pediatrică a Spitalului „Sf. Maria“ şi 3,9% au decedat la CRTIN. Din cele 34 de cazuri transferate, 19 cazuri au fost tratate chirurgical: 8 cazuri cu drenaj peritoneal (DP), 8 cazuri cu laparotomie primara (LAP) şi 3 cazuri cu LAP şi DP. Rata supravieţuirii în acest grup a fost 2,4%, iar pentru grupul cu tratament medical a fost 4,9%. Concluzii. Prematuritatea se corelează statistic cu stadii avansate de enterocolită în momentul diagnosticului. Modalitatea de tratament chirurgical aleasă (drenaj peritoneal sau laparotomie) nu infl uenţează rezultatele, iar alimentaţia enterală precoce cu formula de lapte este cel mai important factor de risc pentru apariţia EUN, urmat de vârsta de gestaţie şi greutatea foarte mică la naştere.

Introducere. Infecţiile bacteriene cronice şi, adesea, exacerbările infecţioase acute sunt caracteristice bolii pulmonare din fi broza chistică (FC). Obiectivul studiului a fost reprezentat de identifi carea copiilor cu FC, depistarea infecţiei cu Staphylococcus aureus la aceşti bolnavi şi cuantifi carea impactului infecţiei asupra statusului clinic. Material şi metodă. S-a realizat un studiu prospectiv pe o perioadă de 3 ani pe un lot de 37 de copii cu FC afl aţi în evidenţa Centrului Regional din Clinica III Pediatrie Iaşi, România. La aceşti bolnavi s-a urmărit prezenţa S. aureus, prevalenţa tulpinilor de S.aureus meticilino-rezistente (SAMR), impactul infecţiei cronice cu SAMR asupra funcţiei pulmonare concomitent cu prezenţa unor elemente de severitate în FC. Rezultate. 22 de pacienţi dintre cei 37 cu FC au prezentat culturi pozitive pentru S. aureus; la 9 dintre aceştia s-a izolat SAMR, 5 având infecţie cronicǎ. Grupul SAMR pozitiv a prezentat valori semnifi cativ mai mici ale volumului de gaz expirat în prima secundǎ a expirului forţat (FEV1), status nutriţional mai precar, bronşiectazii severe, un număr mai mare de exacerbări pulmonare şi implicit de spitalizări, insufi cienţă pancreatică în majoritatea cazurilor şi o asociere mai mare cu genotipul F508del. Concluzii. S. aureus rămâne un patogen important în FC. Din cauza patogenicităţii sale crescute, S. aureus şi în special tulpinile SAMR pot contribui la evoluţie clinică nefavorabilă.

Introduction. Chronic bacterial infections and – often – acute infectious exacerbations are characteristic to the lung disease of the cystic fi brosis (CF). The objective of this study was to identify children with CF and Staphylococcus aureus infection and quantify the impact of this infection on their clinical status. Material and methods. A prospective study was carried out during 3 years on a batch of 37 children with CF registered in the records of the Regional Monitoring Centre of the 3rd Clinic of Pediatrics of Iasi, Romania. In these patients, we searched for the presence of S. aureus, the prevalence of methicillin-resistant S. aureus (MRSA) strains, the impact of the chronic infection with MRSA on the lung function concomitant with the presence of severity elements in CF. Results. 22 of the 37 patients with CF had positive culture for S. Aureus; at 9 of them was isolated MRSA and 5 had chronic infection. The MRSA positive group of patients presented signifi cantly lower values of the FEV1, a more poor nutritional status, severe bronchiectases, a larger number of pulmonary exacerbations and implicitly hospitalizations, pancreatic insuffi ciency in most cases and a higher degree of association with the F508del genotype. Conclusions. S. aureus remains an important pathogen in CF. Due to its high pathogeny, S. aureus and especially the MRSA strains can contribute to an unfavourable clinical evolution.

Given the complexity of etiological factors of periodontal disease, it is required a detailed analysis of the clinical issues encountered, depending on age, gender and periodontal indices. The results can guide the dentist practitioner to choose the most appropriate and effective therapeutic methods. Material and methods: 126 patients were selected, of both genders and aged between 20-70 years, with periodontal pockets, and a control group of 40 patients without periodontal pockets. Results: Various categories of periodontal pockets were detected by us, with a significant association between groups of patients examined, correlations that can provide very important evidence about methods of treatment that needs to be applied. Size of periodontal pocket was analyzed in correlation with gender, age, plaque index (PI) and papillary bleeding index (PBI). Results of correlation test for periodontal pocket depth and age, gender, PI, PBI and CPITN indicates a significant increase of periodontal pocket depth in patients with increased PBI (r = 0.67, p = 0.0001). Conclusions: This study may guide the dentists’ practitioners in choosing of the appropriate treatment technique, avoiding some failures that may occur in time.