Predictive Value of Inflammatory Markers NLR, PLR, APRI, SII, and Liver Function Tests in Systemic Inflammatory Response Syndrome Detection in Full-Term Newborns

Systemic Inflammatory Response Syndrome (SIRS) is associated with significant morbidity and mortality in full-term newborns. This study aimed to evaluate the predictive value of the Neutrophil-to-Lymphocyte Ratio (NLR), Derived Neutrophil-to-Lymphocyte Ratio (dNLR), Platelet-to-Lymphocyte Ratio (PLR), Neutrophil, Lymphocyte, and Platelet Ratio (NLPR), AST-to-Platelet Ratio Index (APRI), and Systemic Immune-Inflammation Index (SII) in identifying the risk for SIRS development in full-term newborns. Conducted between January 2023 and January 2024, this observational cohort study compared full-term newborns diagnosed with SIRS with newborns without SIRS, measuring the inflammatory markers within the first day of life and three days post-birth. The study included 229 newborns, 81 with SIRS and 148 controls without SIRS. Statistically significant differences were observed in NLR (3.81 vs. 2.20, p < 0.0001), PLR (68.12 vs. 52.30, p < 0.0001), and liver enzymes (AST 40.96 U/L vs. 31.58 U/L, ALT 34.66 U/L vs. 22.46 U/L, both p < 0.0001) between the groups. The NLPR demonstrated substantial diagnostic value, with a sensitivity of 78.36% and specificity of 83.52% at 72 h (p < 0.0001). Regression analysis highlighted that the NLPR and SII were strongly predictive of SIRS, with the NLPR showing over three-times higher SIRS risk (HR 3.29, p < 0.0001) and SII indicating nearly 3.5 times the risk (HR 3.47, p < 0.0001). The NLPR, APRI, and SII showed similar prediction values to CRP levels measured on the first and third days of life (HR 3.16). Inflammatory markers like NLR, PLR, and systemic indices such as NLPR and SII, alongside liver function tests, are significant predictors of SIRS in full-term newborns. These findings support the integration of these markers into routine neonatal care, allowing for early identification and potentially improved management of newborns at risk for SIRS, thereby enhancing clinical outcomes.

A Three-Year Cross-Sectional Analysis of Depression, Anxiety, and Quality of Life in Patients with Post-COVID-19 Syndrome

Background

This study explores the longitudinal psychosocial impact of Long-COVID syndrome, also known as Post-COVID-19 syndrome, characterized by enduring symptoms after coronavirus disease (COVID-19) infection, over the years 2020, 2021, and 2022. It aimed to examine the variations in depression, anxiety, and quality of life among Post-COVID-19 patients during these years, hypothesizing significant inter-year differences reflecting the pandemic's evolving influence.

Methods

Conducted at Victor Babes Hospital for Infectious Diseases and Pulmonology, Romania, this cross-sectional research involved 324 patients diagnosed with mild to moderate COVID-19, assessed six months post-hospitalization. Standardized instruments, namely Short Form (SF-36) for quality of life, Generalised Anxiety Disorder Assessment (GAD-7) for anxiety, and Patient Health Questionnaire (PHQ-9) for depression, were utilized.

Results

The study observed a consistent average patient age of around 55 years across the years. A notable increase in COVID-19 vaccination rates was recorded, rising from 20.9% in 2020 to over 70% in 2022 (p<0.001). Trends in key post-COVID symptoms like fatigue and cognitive issues varied over the years. Importantly, there was a consistent decrease in feelings of sadness or depression, with scores declining from 7.3 in 2020 to 4.8 in 2022 (p<0.001). The SF-36 survey indicated a steady improvement in overall health, reaching 55.8±7.1 in 2022 (p=0.035). Both GAD-7 and PHQ-9 scores showed significant reductions in anxiety and depression over the years, with p-values of 0.030 and 0.031, respectively. Factors such as smoking status, substance use, and the initial severity of COVID-19 infection were significantly associated with depression levels.

Conclusion

The findings suggest that despite persistent physical symptoms, Long-COVID patients experienced enhancements in mental well-being and quality of life over the studied period. The increasing vaccination rates might have contributed to this improvement. Addressing modifiable risk factors like smoking and substance use could further optimize post-COVID care and mental health outcomes.

Differentiating Viral from Bacterial Pneumonia in Children: The Diagnostic Role of Lung Ultrasound-A Prospective Observational Study

This prospective observational study aimed to investigate the utility of lung ultrasound (LUS) in diagnosing and managing pediatric respiratory infections, specifically focusing on viral, bacterial, and SARS-CoV-2 infections. Conducted over a period of 1 year and 8 months, this research involved 85 pediatric patients (showcasing a median age of 14 months) recruited based on specific criteria, including age, confirmed infection through multiplex PCR tests, and willingness to undergo LUS imaging. This study employed a 12-area scoring system for LUS examinations, utilizing the lung ultrasound score (LUSS) to evaluate lung abnormalities. The PCR examination results reveal diverse respiratory pathogens, with SARS-CoV-2, influenza, and bacterial co-infections being prominent among the cases. As an observational study, this study was not registered in the registry. Distinct LUS patterns associated with different pathogens were identified, showcasing the discriminatory potential of LUS in differentiating between viral and bacterial etiologies. Bacterial infections demonstrated more severe lung involvement, evident in significantly higher LUSS values compared with viral cases (p < 0.0001). The specific abnormalities found in bacterial superinfection can be integrated into diagnostic and management protocols for pediatric respiratory infections. Overall, this research contributes valuable insights into optimizing LUS as a diagnostic tool in pediatric pneumonia, facilitating more informed and tailored healthcare decisions.

Analysis of Vaginal Microbiota Variations in the Third Trimester of Pregnancy and Their Correlation with Preterm Birth: A Case-Control Study

This study conducted a detailed analysis of the vaginal microbiota in pregnant women to explore its correlation with preterm birth (PTB) outcomes. The primary objective was to identify microbial variations associated with increased PTB risk. Secondary objectives included investigating how changes in microbial composition relate to the local immune environment and PTB. Utilizing a retrospective case-control design, the study involved pregnant women with liveborn infants between 2019 and 2023. In total, 89 women who delivered preterm and 106 term deliveries were included. Data collection focused on third-trimester vaginal cultures. Statistically significant differences were observed between the preterm and full-term groups in several areas. The median white blood cell count (10.2 × 103/mm3 vs. 7.6 × 103/mm3, p = 0.009) and neutrophil count (7.2 × 103/mm3 vs. 5.1 × 103/mm3, p < 0.001) were higher in the preterm group. Vaginal pH was also elevated in preterm births (5.6 vs. 4.4, p < 0.001), with a higher prevalence of bacterial vaginosis (29.2% vs. 12.3%, p = 0.001) as indicated by the Nugent Score. The study noted a significant association of PTB with the presence of Candida spp. (OR = 1.84, p = 0.018), Gardnerella vaginalis (OR = 2.29, p = 0.003), Mycoplasma hominis (OR = 1.97, p = 0.007), and Ureaplasma urealyticum (OR = 2.43, p = 0.001). Conversely, a reduction in Lactobacillus spp. correlated with a decreased PTB risk (OR = 0.46, p = 0.001). The study provides compelling evidence that specific vaginal microbiota components, particularly certain pathogenic bacteria and an altered Lactobacillus profile, are significantly associated with PTB risk. These findings highlight the potential of targeting microbial factors in strategies aimed at reducing PTB rates. Further research is necessary to fully understand the complex interplay between microbial dynamics, host immunity, and PTB outcomes.

Stratifying Disease Severity in Pediatric COVID-19: A Correlative Study of Serum Biomarkers and Lung Ultrasound-A Retrospective Observational Dual-Center Study

The COVID-19 pandemic, caused by SARS-CoV-2, has manifested distinct impacts on infants and children. This study delves into the intricate connection between lung ultrasound (LUS) findings and serum biomarkers in neonates and infants with COVID-19. Exploring factors contributing to the mild symptoms in this demographic, including immune responses and pre-existing immunity, the study spans 3 years and 9 months, involving 42 patients. Respiratory and gastrointestinal symptoms predominate, and LUS emerges as a vital, non-irradiating tool for evaluating pulmonary abnormalities. Serum biomarkers like CRP, procalcitonin, and cytokines provide key insights into the pathophysiology. Correlations reveal nuanced links between LUS score and clinical parameters, unveiling associations with hospitalization duration (rho = 0.49), oxygen saturation (rho = -0.88), and inflammatory markers, like ferritin (rho = 0.62), LDH (rho = 0.73), and D-dimer (rho = 0.73) with significance level (p < 0.05). The absence of large consolidations in LUS suggests unique pulmonary characteristics. The novelty of these findings lies in the comprehensive integration of LUS with serum biomarkers to assess and monitor the severity of lung involvement in neonates and infants affected by SARS-CoV-2. This approach offers valuable insights into disease severity, biomarker levels, the duration of hospitalization, and oxygen saturation, providing a multifaceted understanding of COVID-19's impact on this vulnerable population.

Impact of Pre-Infection COVID-19 Vaccination on the Incidence and Severity of Post-COVID Syndrome: A Systematic Review and Meta-Analysis

This systematic review critically evaluated the impact of a pre-infection COVID-19 vaccination on the incidence and severity of post-COVID-19 syndrome and aimed to assess the potential protective effect across different vaccines and patient demographics. This study hypothesized that vaccination before infection substantially reduces the risk and severity of post-COVID-19 syndrome. In October 2023, a comprehensive literature search was conducted across three databases, PubMed, Embase, and Scopus, focusing on studies published up to that date. Utilizing a wide array of keywords, the search strategy adhered to the PRISMA guidelines and was registered in the Open Science Framework. The inclusion criteria comprised studies focusing on patients with a breakthrough SARS-CoV-2 infection who developed post-COVID-19 syndrome. We included a total of 13 articles that met the inclusion criteria, analyzing more than 10 million patients with a mean age of 50.6 years, showing that the incidence of intensive care unit (ICU) admissions post-vaccination was as low as 2.4%, with a significant reduction in mortality risk (OR 0.66, 95% CI 0.58-0.74). The prevalence of post-COVID-19 syndrome symptoms was lower in vaccinated individuals (9.5%) compared to unvaccinated (14.6%), with a notable decrease in activity-limiting symptoms (adjusted OR 0.59, 95% CI 0.48-0.73). Vaccinated patients also showed a quicker recovery and return to work (HR 1.37, 95% CI 1.04-1.79). The pooled odds ratio of 0.77 indicates that vaccination is associated with a 23% reduction in the risk of developing post-COVID-19 syndrome (95% CI 0.75-0.79). Despite the protective effects observed, a substantial heterogeneity among the studies was noted. In conclusion, a pre-infection COVID-19 vaccination is associated with a significant reduction in the risk and severity of post-COVID-19 syndrome. However, the observed heterogeneity across studies suggests a need for further research with standardized methods to fully comprehend vaccine efficacy against long COVID.

Assessing the Quality of Life, Coping Strategies, Anxiety and Depression Levels in Patients with Long-COVID-19 Syndrome: A Six-Month Follow-Up Study

This longitudinal study investigates the psychosocial effects of long-COVID Syndrome, a domain still not extensively researched. It specifically evaluates the quality of life, coping mechanisms, anxiety and depression levels in COVID-19 survivors, differentiating between those with and without long-COVID Syndrome. Conducted at the Victor Babes Hospital for Infectious Diseases and Pulmonology in Timisoara, Romania, the study utilized a cohort of patients diagnosed with mild to moderate COVID-19. The following standardized tools: WHOQOL-BREF for quality of life, COPE-60 for coping strategies, and the Hospital Anxiety and Depression Scale (HADS), were employed for the assessment. The sample consisted of 86 patients displaying persistent post-acute symptoms and 432 asymptomatic patients at the 6-month post-discharge mark. Patients with frequent post-acute symptoms reported significantly higher levels of fatigue (8.2 ± 1.4), cognitive difficulties (7.5 ± 1.6), and respiratory challenges (7.8 ± 1.3), along with a markedly lower overall quality of life (7.0 ± 1.5) compared to their asymptomatic counterparts. HADS scores revealed elevated depression (6.8 ± 1.9) and anxiety (7.1 ± 2.3) in the symptomatic group. Quality of life, as evaluated through the use of WHOQOL-BREF, showed lower scores in the symptomatic cohort across physical (58.8 ± 15.8), mental (56.3 ± 16.4), and social domains (50.2 ± 17.5). COPE-60 findings indicated a higher prevalence of disengagement (56.4%) and emotion-focused coping strategies (61.8%) in the symptomatic group, in contrast to 30.1% and 37.0%, respectively, in the asymptomatic group. The study highlights that long-COVID Syndrome significantly deteriorates the quality of life and is associated with increased depression and anxiety levels. The prevalent use of disengagement and emotion-focused coping strategies among patients with persistent symptoms suggests a need for enhanced psychosocial support tailored to this subgroup.

Comparative Analysis of Microbial Species and Multidrug Resistance Patterns Associated with Lower Urinary Tract Infections in Preterm and Full-Term Births

The rise of multidrug-resistant organisms has significantly complicated the clinical management of urinary tract infections (UTIs), particularly in the context of pregnancy. This study aimed to identify and analyze the significant differences in microbial species and multidrug resistance patterns associated with UTIs in preterm versus full-term births, determine the bacterial species significantly associated with preterm birth, and describe the antibiotic resistance patterns affecting pregnant women with UTIs. This case-control study was conducted in western Romania and focused on pregnant women with UTIs admitted from 2019 to 2023. Data were retrospectively collected from 308 patients with positive cultures. Statistical analyses, including the Chi-square test, Fisher's exact test, and logistic regression models, were employed to compare the proportions of microbial species and resistance patterns between preterm (n = 126) and full-term (n = 182) birth groups and identify factors independently associated with preterm birth. The study found no significant differences in demographic or lifestyle factors between the groups. However, significant differences were observed in several infection and inflammation markers. The median white blood cell count was higher in the preterm group (12.3 vs. 9.1, p = 0.032), and the median C-reactive protein level was significantly higher in the preterm group (18 vs. 7, p < 0.001). The preterm group exhibited a higher incidence of multidrug-resistant organisms, notably ESBL-producing organisms (19.8% vs. 4.4%, p < 0.001) and carbapenem-resistant Enterobacteriaceae (4.8% with p = 0.003). Notably, the resistance to amoxicillin was significantly higher in the preterm group (20.6% vs. 6.6%, p < 0.001). Significant bacterial associations with preterm births included Group B Streptococcus (OR 2.5, p = 0.001) and Enterobacter spp. (OR 1.8, p = 0.022). The study confirmed significant differences in microbial species and multidrug resistance patterns between UTIs associated with preterm and full-term births. The higher prevalence of certain bacteria and increased resistance to commonly used antibiotics in the preterm group underscore the need for tailored antimicrobial therapies and robust microbial identification in managing UTIs during pregnancy.

Anatomical Changes in a Case with Asymmetrical Bilateral Maxillary Sinus Hypoplasia

Background and Objectives: The maxillary sinus hypoplasia (MSH) is an occasional variation of the maxilla, occurring either unilaterally or bilaterally. Previous studies dealing with MSH have not detailed the consequent anatomical changes of the maxilla and adjacent fossae. Materials and Methods: A 58-year-old female case was scanned in Cone Beam Computed Tomography and found to have asymmetrical bilateral MSH, who was then further evaluated anatomically. Results: The maxillary sinuses were hypoplastic and had mild mucosal thickenings. The orbital floors were curved. The uncinate process and the ethmoidal infundibulum were laterally displaced beneath the orbit floor. On each side, the lateral nasal wall protruded within the respective maxillary bone to reach above the vestibular cortical plate of the alveolar process. This expansion of the lateral nasal walls was limited to the premolar and first molar regions. The inferior turbinates were laterally curved. The perpendicular palatine plate was building a postero-lateral nasal wall in front of the pterygopalatine fossa. Conclusions: The classification systems of MSH should be detailed to indicate whether the normal uncinate process is medial or inferior to the orbit. The lateral expansion of the lateral nasal wall in MSH is limited to the anterior part of that wall. The laterally expanded nasal fossa could reach anterior to the pterygopalatine fossa in MSH. Seemingly, CBCT is a better tool than CT to evaluate the detailed anatomy of the modified anatomical structures in MSH; as such, it could be of help in a surgical approach.

Adenoidal bacterial biofilm in pediatric rhinosinusitis

The aim of the study was to observe, using scanning electron microscopy (SEM), the ratio of bacterial biofilm coverage of adenoidal tissue in children diagnosed with chronic rhinosinusitis (CR), compared to the ratio of adenoid bacterial biofilm coverage in children diagnosed with obstructive sleep apnea (OSA). We also performed histopathological and immunohistochemical tests to correlate the results with the images obtained from SEM. We estimated, using an image analysis program, the coverage ratio with bacterial biofilm on the surface of the lymphatic tissue. Adenoid vegetation extracted from children with CR had a higher percentage of bacterial biofilm coverage compared to the group diagnosed with OSA. In the nasopharynx of children with CR, the bacterial biofilm had a constant role of infection generator, and adenoidectomy was the only effective therapeutic procedure to relieve the symptoms. Allergy tests were performed in all children to establish a link between CR, OSA and allergic rhinitis.

Biological therapies targeting the type 2 inflammatory pathway in severe asthma (Review)

Asthma is a variable chronic respiratory disease characterized by airway inflammation and hyperresponsiveness, bronchoconstriction, and mucus hypersecretion. While most patients with asthma achieve good control of the disease, 5-10% experience severe symptoms and recurrent exacerbation despite the maximal offered therapy with inhaled corticosteroids and long acting bronchodilators. In previous years, novel biological therapies have become available, and various asthma phenotypes that are characterized by specific biomarkers have been identified. Currently approved biological agents target inflammatory molecules of the type 2 inflammatory pathway, and are effective at decreasing the frequency of asthma attacks, controlling symptoms and decreasing use of systemic steroids. The present study reviewed the effectiveness and safety profile of the currently approved biological drugs and provided an overview of the assessment of patients with severe asthma who are potentially suitable for biological therapy, in order to help clinicians to select the most appropriate biological agent.

Rare Intercondylar Distal Femoral Brodie's Abscess in a 21-Year-Old Man Who Refused Medical Care for Three Years after Initial Symptoms

Brodie's abscess is a rare form of sub-acute osteomyelitis that implies the collection of pus inside bone tissue. The present paper presents an extremely rare case of Brodie's abscess located in the distal femur in a young male patient who refused medical care for three years and presented directly with spontaneous fistula and septic complications. Laboratory tests also suggested chronic septic alterations. Complex imaging investigations including X-ray (RX), computer tomography (CT) and Magnetic Resonance imaging (MRI) confirmed the diagnosis with characteristic aspects, such as the penumbra sign on the T1 weighted MRI image. Management included aggressive debridement, defect reconstruction, and long-term specific antibiotics according to culture harvested intra-operatively. Evolution was positive with inflammatory blood tests returning to physiological values within four weeks and patient full recovery within six months, without any physical deficits. The novelty aspect found in this case presentation is represented by the long-term natural evolution of this pathology, and the fact that even in these conditions, the Brodie's abscess did not evolve into a 'malignant' septic condition, but remained rather benign until the spontaneous fistula prompted the patient to seek medical care.

Hexafurcated celiac trunks, trifurcated common hepatic artery, and a new variant of the arc of Bühler

The celiac trunk (CT) is well-known as trifurcated into the left gastric (LGA), common hepatic (CHA) and splenic (SA) arteries. Scarce reports indicate that the CT could appear cvadri-, penta-, hexa-, or even heptafurcated. Reports of CTs with six branches (hexafurcated CT) are few, less than ten. The hexafurcated CT variant was documented by a retrospective study of 93 computed tomography angiograms. Two hexafurcated CTs were found. In one case an arc of Bühler was added to the inferior phrenic arteries, LGA, CHA and SA. In the second case the dorsal pancreatic artery was added to the other five branches. That arc of Bühler descended in front of the aorta to connect with the origin of the third jejunal artery. The CHA in that second case was trifurcated into the left and right hepatic arteries, and the gastroduodenal artery; the proper hepatic artery was absent. Although the hexafurcated CT, as well as the trifurcated CHA, are rarely occurring and reported anatomic variants, this doesn't mean they could not be encountered during surgical or interventional procedures, which they would complicate if not recognized. Moreover, the arc of Bühler, the embryonic remnant, was not reported previously to insert into the CT as an additional branch of it.

Rare Anatomic Variation: The Hepatosplenomesentericophrenic Trunk

The rare anatomic variants of the celiac trunk and superior mesenteric artery include the hepatosplenic, hepatosplenomesenteric (HSMT), celiacomesenteric, hepatomesenteric and gastrosplenic trunks. We report a 72-year-old female patient whose computed tomography angiograms indicated a rare anatomic feature whereby the right inferior phrenic artery was inserted in the origin of an HSMT, thus modifying it into a hepatosplenomesentericophrenic trunk (HSMPT). Above the HSMPT, the insertion of the left inferior phrenic artery in the origin of the left gastric artery determined a left gastrophrenic trunk (GPT). Proper identification of this type of rare anatomic variant is of utmost importance prior to different surgical procedures. For example, an HSMT origin of the right inferior phrenic artery is surgically relevant if this artery is an extrinsic pedicle of a hepatocellular carcinoma and is used for embolization of the tumor.

Two cases of combined anatomical variations: maxillofacial trunk, vertebral, posterior communicating and anterior cerebral atresia, linguofacial and labiomental trunks

BACKGROUND

Commonly, arterial anatomic variants are reported as single entities. However, different such variants can occur in a single patient.

MATERIALS AND METHODS

During a retrospective study of computed tomography angiograms of 52 adult patients, two cases were found with unilateral maxillofacial trunks. In each case different other anatomic variants were documented.

RESULTS

The maxillofacial trunk in the first case was associated with bilateral posterior kinks of the internal carotid artery which passed beyond the transverse processes of the atlas vertebra and indented and displaced the internal jugular veins. Common carotid origins of the superior thyroid arteries were found, as well as a high origin of the contralateral facial artery. In the second case a plethora of variants were associated with a unilateral maxillofacial trunk: (1) direct occipital-vertebral arterial anastomosis; (2) ipsilateral atresia of the distal vertebral artery and of the A1 segment of the anterior cerebral artery; (3) bilateral atresia of posterior communicating arteries; (4) linguofacial and labiomental trunks; (5) terminal trifurcation of the external carotid artery.

CONCLUSIONS

The arterial anatomical variants of the head and neck should be carefully documented prior to specific surgical and interventional procedures, as well as for understanding the compensatory anatomical pathways of circulatory insufficiencies.

Influence of depression and self-esteem on oral health-related quality of life in students

Objective

We aimed to investigate the influence of depression and self-esteem on oral health-related quality of life (OHRQoL) in students.

Methods

Among the 67 included participants, we measured self-esteem using the Rosenberg Self-Esteem Scale, severity of depression using the Patient Health Questionnaire-9 (PHQ-9), personality dimensions with the Neuroticism–Extraversion–Openness Five-Factor Inventory, and OHRQoL using the Oral Health Impact Profile 49 (OHIP-49).

Results

Among all participants, 7.5% (n = 5) had the dominant personality trait openness to experience, 11.9% (n = 8) presented a neurotic personality type, and 64.% (n = 11) had an extraverted personality type. The most frequent was conscientious personality type, accounting for 64.2% (n = 43) of participants. Our results showed a significant correlation between increased PHQ-9 scores and OHIP scores (Spearman’s r = 0.280); thus, participants with poorer oral health tended to have more severe depression. An increase in depression severity was significantly and positively correlated with increased scores across the other two OHIP subcategories, physical pain (Spearman’s r = 0.314) and physical disability (Spearman’s r = 0.290).

Conclusion

The presence and severity of depression influences OHRQoL. An important factor in the presence of depression and level of self-esteem is the personality type, especially the neuroticism dimension.

Pro-inflammatory Cytokines (IL6, IL8 and TNF-a) in the Evaluation of Ovarian Endometriosis Cyst

Endometriosis is the abnormal growth of cells (endometrial cells) similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis is most commonly found on other organs of the pelvis. These lesions are most commonly found on the ovaries, the Fallopian tubes, the surface of the uterus, the bowel, and on the membrane lining of the pelvic cavity (i.e. the peritoneum). We corroborate TNF-a, IL-6 and IL-8 markers with intraoperative laparoscopic on 39 patients diagnosed with endometriosis in January 2016 - December 2017, aged 20-45 years. There has been a preoperative evaluation in the patients from this that included the anamnesis, clinical examination and laboratory tests. Anamnesis recorded demographic details, patient�s personal, physiological and pathological medical history. Evaluation of preoperative investigations consisted of general and local systems examination, a gynecological examination in order to identify the specific signs of endometriosis. Making matters worse is that endometriosis exhibits significant immunological dysfunction, including the over-expression of pro-inflammatory cytokines like interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF), all of which contribute to a chronic up-regulation of painful, tissue-damaging inflammatory processes. Because the cause of endometriosis is poorly understood, there are no known ways to prevent its development.

The ultrastructural anatomy of the nuclear envelope in the masseter muscle indicates its role in the metabolism of the intracellular Ca+

Specific ultrastructural anatomy of masticatory muscles is commonly referred to a general pattern assigned to striated muscles. Junctional feet consisting of calcium channels of the sarcoplasmic reticulum (i.e. the ryanodine receptors, RyRs) physically connected to the calcium channels of the t-tubules build triads within striated muscles. Functional RyRs were demonstrated in the nuclear envelopes of pancreas and of a skeletal muscle derived cell line, but not in muscle in situ. It was hypothesized that ryanodine receptors (RyRs) could also exist in the nuclear envelope in the masseter muscle, thus aiming at studying this by transmission electron microscopy. There were identified paired and consistent subsarcolemmal clusters of mitochondria, appearing as outpockets of the muscle fibers, usually flanking an endomysial microvessel. It was observed on grazing longitudinal cuts that the I-band-limited mitochondria were not strictly located in a single intermyofibrillar space but continued transversally over the I-band to the next intermyofibrillar space. It appeared that the I-band-limited transverse mitochondria participate with the column-forming mitochondria in building a rather incomplete mitochondrial reticulum of the masseter muscle. Subsarcolemmal nuclei presented nuclear envelope-associated RyRs. Moreover, t-tubules were contacting the nuclear envelope and they were seemingly filled from the perinuclear space. This could suggest that nucleoplasmic calcium could contribute to balance the cytosolic concentration via pre-built anatomical routes: (i) indirectly, via the RyRs of the nuclear envelope and (ii) directly via the communication of t-tubules and sarcoplasmic reticulum through the perinuclear space.

The Role of C-reactive Protein and Interleukin 6 in the Cases of Preeclampsia Associated with Obesity

In the management of preeclampsia/eclampsia, it would be useful at least at European level, to have clear protocols for early detection and approach of cases with hypertension, as well as to create an algorithm to identify the predisposition to hypertensive pregnancy pathology. The aim has been to identify the favorable factors and the evolution of the pregnancy in the 100 patients admitted to the obstetrics clinic between January 2014 and December 2018, aged between 15-44 years, who have been diagnosed with preeclampsia. In recent years, the management of pregnant women with preeclampsia has improved a lot due to a better understanding of the pathogenesis and a refinement of adequate pregnancy monitoring. Obesity has been shown to be a risk factor in preeclampsia. Several studies have identified preeclampsia as an inflammatory condition. A large number of inflammatory markers, such as C-reactive protein (PCR) and Interleukin 6 (IL-6), have been shown to be elevated in pregnant women with preeclampsia.

Essential Oil of Hypericum perforatum. The chemical composition and antimicrobial activity

The chemical composition and antimicrobial activity of the essential oil isolated by steam distillation from Hypericum perforatum L. (St John�s wort) growing wild in western Romania have been studied. The extraction yield was 0.41% (v/w) based on the dry plant material. The essential oil was analyzed by GC�MS, and a total of twenty-two components were identified. The major components were alpha-pinene (30.92%), beta-pinene (18.32%) and caryophyllene (15.26%). The antimicrobial activity of the H. perforatum essential oil was screened using the disk diffusion method against 7 common food-related bacteria and fungus. The analyzed EO possesses strong antimicrobial activity. Klebsiella pneumoniae and Pseudomonas aeruginosa were the most resistant species. The analyzed oil can represent an inexpensive natural source of antiseptic compounds, an alternative to synthetic preservatives.

In vitro fertilization represents a risk factor for vasa praevia

Vasa praevia is a rare but very dangerous obstetrical condition. The purpose of our article is to evaluate data available in literature that indicate in vitro fertilization as a risk factor for vasa praevia. PubMed Library and Cochrane Database were searched using the keywords vasa praevia, in vitro fertilization, velamentous cord insertion, placenta praevia. The conditions related to in vitro fertilization that increase the risk of vasa praevia formation were identified and discussed. Also, the diagnosis and management options were reviewed. In vitro fertilization represents a risk factor for vasa praevia and all such pregnancies should be screened by transvaginal ultrasound for vasa praevia.

Histopathological and imaging modifications in chronic ethanolic encephalopathy

Chronic abuse of alcohol triggers different types of brain damage. The Wernicke-Korsakoff syndrome gets together Wernicke's encephalopathy and Korsakoff's syndrome. Another type of encephalopathy associated with chronic ethanol consumption is represented by the Marchiafava-Bignami malady or syndrome, an extremely rare neurological disorder, which is characterized by a demielinization of corpus callosum, extending as far as a necrosis. Because the frequency of ethanolic encephalopathy is increased and plays a major role in the sudden death of ethanolic patients, we have studied the chronic ethanolic encephalopathy both in deceased and in living patients, presenting different pathologies related to the chronic ethanol consumption. The present study investigated the effects of chronic ethanolic encephalopathy on the central nervous system based both on the histopathological exam of the tissular samples and the imaging investigation, such as MRI and CT.

Anatomical and histological considerations of placenta vascular diseases with implications in forensic medicine

Placenta, as a highly specialized organ in connecting the maternal and fetal organism, is frequently affected by a specific vascular pathology. The correlation between the macroscopic and the microscopic aspects of the fetal placenta vascularization together with the appearance of fibrin deposits is used to determine the pathological cause of death. Different studies suggest the hypothesis of precocious development of fibrin deposits during pregnancy, due to some immune-like reactions or due to the circulatory variations in the villous territory. The present research was realized on 467 placentas - out of 467 placentas collected in the past 10 years, 287 were from term births, 98 from premature births and 82 from abortions. The fibrin deposits in the placenta resulting from abortion can also be interpreted as alterations caused by the same circulatory variable conditions. In the therapeutic abortion, the placental fragments do not contain fibrin deposits. The correct approach of the macroscopic exam in the vascular pathology, accompanied by the recognition of the microscopic changes in the placenta, contributes to determine the cause of abortion, the premature birth or the term birth, followed by the death of the fetus and/or the mother. The study assesses the macroscopic and microscopic aspects of the vascular pathology at the placental level in cases with medical and legal implications. Our study also reported these placental aspects in aborted fetuses or in cases of intrauterine deaths, for various reasons considered forensic cases.

Preoperative ultrasonography as a mean of predicting the conversion of mini cholecystectomy into classic cholecystectomy

Cholecystectomy is considered to be the treatment of choice in symptomatic biliary lithiasis. Lately, due to medical progress, classic cholecystectomy has been gradually replaced by laparoscopic cholecystectomy and by mini cholecystectomy. Therefore, it is very important to determine certain preoperative factors which might predict the conversion of mini cholecystectomy (MC) into classic cholecystectomy (CC).

MATERIAL AND METHOD

The possibility of selecting high-risk conversion patients has important clinical implications, both for the surgeon and for the patient. Differentiating preoperative risk allows the surgeon to inform the patient about a high conversion risk to CC, and about the ensuing consequences: longer hospitalization period, longer postoperative recovery, greater costs. All the patients were examined by ultrasonography. The tests recorded six parameters: the diameter of the biliary duct (mm), the number of calculi, the diameter of the largest calculus (mm), the contracted aspect of the gallbladder, the distance between the tegument and the gallbladder fundus (cm), the distance between the tegument and the cystic duct (cm). All the variables were introduced into an initial model, which was checked using the colinearity method and significant observations, and subsequently reduced by eliminating insignificant predictive factors, revealed by Wald tests.

RESULTS

The significant predictive conversion factors to CC, quantified on the basis of regression analysis, are: age > 70, calculus with a diameter > 20 mm, biliary duct with a diameter > 6 mm, contracted gallbladder, distance between the tegument and gallbladder fundus > 7.2 cm, distance between the tegument and cystic duct > 17.1 cm.

CONCLUSION

Being a procedure that can be carried out on an outpatient basis and with rather low costs, ultrasonography plays a very important role in the preoperative prediction of converting MC to CC.