Background. Intravenous (i.v.) lidocaine exhibits multimodal analgesic, anti-inflammatory, and anticancer properties. However, concerns regarding systemic toxicity and impaired hepatic drug clearance during liver resection necessitate caution in perioperative dosing protocols. This study aimed to evaluate the clinical recovery parameters and systemic inflammatory markers following continuous perioperative i.v. lidocaine infusion in patients undergoing elective hepatectomy for hepatocellular carcinoma (HCC). Methods. In this prospective, randomized controlled trial, 60 patients undergoing elective surgical resection for HCC were assigned (1:1 ratio) to either a lidocaine group (n=30) or a control group (n=30). The lidocaine group received an intraoperative IV bolus (1.5 mg/kg) followed by a continuous infusion (1 mg/kg/h), maintained throughout surgery and for 24 hours postoperatively. Primary endpoints evaluated 24 hour opioid consumption, Numeric Rating Scale pain scores, return of bowel function, length of hospital stay, and perioperative inflammatory response. Results. No statistically significant differences were observed between the lidocaine and control groups across clinical recovery outcomes. Intraoperative fentanyl consumption was identical between groups 0.8±0.1 mg (vs. 0.8±0.2 mg; p=0.957). The lidocaine group demonstrated a non-significant trends toward reduced 24-hour postoperative morphine consumption (13.5±13.3 mg vs. 19.5±15.8 mg; p=0.224), lower mean 24-hour NRS pain scores (3.36±1.77 vs. 3.80±1.85; p=0.275), and faster recovery of bowel motility (3.0±0.9 vs. 3.4±1.5 days; p=0.215). Length of hospital stay was comparable (9.46±3.15 vs. 8.47±3.09 days; p=0.340). Both groups exhibited significant postoperative increases in CRP and leukocyte levels (p<0.05), with no significant between-group differences postoperatively. Conclusion. A modified, lower-dose perioperative i.v. lidocaine regimen tailored for toxicity safety in patients with liver resection is well-tolerated but does not yield statistically significant reductions in postoperative opioid consumption, pain scores, bowel recovery time, systemic inflammatory markers, or hospital stay following open hepatectomy. Further, adequately powered studies are needed.
Backgrounds:The fibrosis-4 index is a simple biomarker tool widely recommended to diagnose advanced hepatic fibrosis in patients with type 2 diabetes mellitus (T2DM). The primary aim of this study was to assess liver fibrosis risk among type 2 diabetes mellitus patients using the Fib-4 score, secondary to compare the prevalence of degenerative complications between patients according to Fib-4 index risk, and to evaluate the prevalence of metabolic dysfunction-associated-steatotic liver disease in our population. Methods:This is a descriptive-analytical cross-sectional study including 600 patients with type 2 diabetes mellitus who were followed at the Endocrinology-Diabetology and Nutrition Department of a university hospital center, for a period of 8 years and 10 months from January 2016 to October 2024. Results:The mean age in our population was 59±12.8 years. The median duration of diabetes was 6.4 years (1-15 years) with a median HbA1c value of 10.2±2.7%. Overweight and obesity were found in 39.2% and 34.5% of patients respectively, with a mean BMI of 28.2±5.9 kg/m2. The median of fibrosis-4 index was 1.09. Sixty-one percent of patients had a low risk of advanced liver fibrosis, 31% had an intermediate risk, and 8% had a high risk to develop an advanced liver fibrosis. Patients with a Fib-4 score ≥1.3 (indicating intermediate to high risk of liver fibrosis) had a statistically significantly higher prevalence of all microvascular complications and ischemic heart disease (p<0.001) compared to those with a Fib-4<1.3. There was no significant difference in HbA1c, arterial hypertension, metabolic syndrome, and dyslipidemia. However, the mean LDL-cholesterol was lower in the group with a Fib-4≥1.3 (p:0.024). Liver ultrasonography showed signs of metabolic dysfunction-associated steatotic liver disease in 47.7% of cases. Conclusion:Fibrosis-4 index should be considered for routine screening of liver fibrosis in patients with type 2 diabetes mellitus. This simple and cost-effective tool can help identify patients at high risk. The current study highlighted the benefits of using this score among patients with T2DM and supported the high prevalence of microvascular complications and ischemic heart disease among patients with Fib-4 index ≥1.3. Furthermore prospective studies are required to evaluate the incidence outcomes in this population.
Background:The digitalization of prosthetic dentistry - encompassing CAD/CAM fabrication, intraoral scanning, and digital prescription platforms - represents one of the most transformative biotechnological shifts in contemporary dental practice. Despite these advances, the transition from analog to digital communication workflows remains incomplete in many clinical settings, and the relationship between communication modality, error frequency, and professional satisfaction has not been quantified in a multicenter international sample. This study investigates whether the adoption of structured digital and standardized communication protocols translates into measurable improvements in interdisciplinary collaboration outcomes. Methods:An exploratory cross-sectional online survey was distributed via professional social media groups and institutional networks to dentists and dental technicians in five countries (Germany, Romania, France, Israel, United States). The questionnaire addressed communication modality, error frequency, satisfaction (1-10 scale), and turnaround time. Descriptive statistics and exploratory group comparisons (independent-samples t-test, chi-square) were applied; effect sizes (Cohen's d) are reported where applicable. Given the achieved sample (n=162), all analyses are exploratory and hypothesis-generating. Results:Verbal instructions were the most frequently used modality and were associated with the highest error rate (79% of technicians reported missing or incorrect information). Standardized work-authorization forms yielded the highest satisfaction scores (dentists 8.4/10, n=60; technicians 6.8/10, n=70) yet were incompletely filled in 76% of cases. Non-standard written requests generated the greatest frustration (44% of technicians cited poor communication). Turnaround time was shorter for in-house technicians (mean 5.17 days, SD=1.8) than external laboratories (mean 7.64 days, SD=2.3), though the difference did not reach statistical significance (p=0.08, d=0.24). Conclusions:Structured communication protocols - particularly standardized digital prescriptions - are associated with lower interdisciplinary error rates and higher professional satisfaction in prosthetic workflows. These pilot findings support accelerated adoption of digital workflow solutions as a pragmatic, low-cost innovation with measurable clinical and organizational impact. Integration of CAD/CAM-compatible communication standards into dental education and practice guidelines is recommended to bridge the persistent gap between technological capability and everyday clinical use.
Background and aims The creation of an ostomy constitutes a profound surgical intervention, invariably introducing a multitude of potential difficulties and challenges into a patient’s life. The aim of the study was to assess the effectiveness of a structured educational intervention, combined with nursing follow-up for self-care, in reducing anxiety, depression, and peristomal complications among patients who have undergone intestinal or urinary ostomy surgery, compared to those receiving standard care (control group). Methods A randomized, prospective comparative study was conducted from June 2023-April 2024, involving 100 adult patients with recently formed ostomies residing in the capital of Greece. Participants were randomly assigned to either an Intervention Group (IG) (n=48) or a Control Group (CG) (n=52). The IG received a structured, in-home educational intervention with printed materials and systematic nursing monitoring. Both groups had reinforcement sessions at 45 and 90 days. The study featured dual outcome assessments at baseline, 45 and 90 days. Peristomal complications were measured using the Ostomy Skin Tool (OST), while anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS). For the study purposes, a structured educational tool was developed in three versions, each adapted to the specific needs and characteristics of colostomy, ileostomy and urostomy. Results The analysis of HADS scores indicated a statistically significant difference in the IG versus the CG at both 45 days for anxiety (p=0.002) and depression (p<0.0005), and at 90 days for anxiety (p=0.001) and depression (p<0.0005). Furthermore, analysis of OST scores identified a statistically significant difference in the complication index at 90 days (p<0.0005) for the IG compared to the CG. Regarding the change in the severity index, a statistically significant difference was also recorded in the IG versus the CG at both 45 days (p=0.001) and 90 days (p<0.0005). Conclusions A structured, educational intervention significantly improves ostomy patients’ psychological well-being (anxiety and depression) and reduces clinical complications. The practical success of this intervention is largely attributed to its accessible printed tool and dedicated nursing follow-up.
Background:Patient-reported outcome measures (PROMs) are becoming more popular in dental research for measuring various psychological aspects of patients' experiences. However, it is essential to validate these measures' properties based on the setting where they are applied. This study aims to validate the Romanian versions of the Kessler Psychological Distress Scale (K10) and the Rosenberg Self-Esteem Scale (RSES) for adult dental patients. Methods:This is a prospective study for psychometric validation of PROMs for adult dental patients conducted at the Department of Preventive Dentistry, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. Internal consistency, structural validity, and construct validity were assessed for these PROMs. Responsiveness was evaluated based on pre-post comparisons during routine dental visits. Results:The RSES showed high internal consistency reliability for adult dental patients (α = 0.77-0.80), whereas K10 showed excellent internal consistency reliability (α = 0.91). Furthermore, it was found that psychological distress was related to affective pain but not sensory pain, whereas self-esteem was not related to any of these measures. Both instruments showed responsiveness across clinical time points. Conclusions:The Romanian versions of K10 and RSES showed satisfactory psychometric properties for adult dental patients and could potentially be useful for psychosocial research in dentistry.
Background Oral hygiene is a primary determinant of the two most prevalent oral diseases — dental caries and periodontal disease. Despite privileged access to oral health education and clinical services, dental students represent an under-studied population regarding objective clinical oral hygiene status. Population-level data using standardized clinical indices remain scarce for young adults in Romania. Aim To determine the prevalence of acceptable oral hygiene and healthy gingival status in a cohort of Romanian dental students, assessed by the O’Leary Plaque Control Record Index (PCR, threshold ≤20%) and the Ainamo & Bay Gingival Bleeding Index (GBI, threshold ≤10%). Secondary aims included evaluating arch-level and gender-related differences. Methods This retrospective cross-sectional observational study extracted data from patient files of dental students attending the Periodontology Department of the Stomatology Ambulatory of Cluj County Clinical Emergency Hospital — the teaching clinic of Iuliu Hatieganu University of Medicine and Pharmacy, Cluj- Napoca — between April 2024 and December 2025. Statistical analysis was performed using IBM SPSS v.27 (Welch’s t-test; chi-square; α=0.05). Results 482 dental students were included (234F/248M; mean age 23.39 years). Mean PCR values were 29.43% (maxilla) and 32.83% (mandible); mean GBI values were 12.56% (maxilla) and 15.16% (mandible) — both exceeding acceptability thresholds. Only 21% met criteria for acceptable oral hygiene and gingival health across the full dentition. No gender-based differences were identified (p≥0.05). Conclusions A significant proportion of dental students fail to achieve acceptable plaque control and gingival health despite their educational background. These findings support the integration of structured, repeated oral hygiene self-monitoring into dental education curricula and provide baseline data for future interventional studies.
Five years ago, the COVID-19 coronavirus emerged as an invisible threat that profoundly disrupted the world, becoming a public health challenge. The COVID-19 pandemic has shown us how important it is to have health systems that can quickly find and track new viruses as they spread and has ushered in a new era of genomic surveillance, allowing scientists to track the evolution of the coronavirus, providing public health strategies. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), responsible for the COVID-19 pandemic, has been associated with very important global morbidity and mortality. The discovery of SARS-CoV-2 in bats and pangolins in South Asian countries indicates that SARS-CoV-2 likely originated from wildlife being the third highly pathogenic human coronavirus. The increased contagiousness of SARS-CoV-2 virus was due to the spike glycoprotein (S) that favors the attachment of the virus to the cell surface. SARS-CoV-2 infection triggers a damaging triad of oxidative stress, intense inflammation with cytokine storm, and endothelial dysfunction, leading to widespread cellular damage, blood clotting with thrombosis, and organ failure by overwhelming the body’s antioxidant defenses, damaging blood vessel linings, and promoting hyper-inflammation, all crucial factors in severe COVID disease. The purpose of the review is to make a synthesis of the data known so far about SARS-CoV-2 virus etiology, the complex interactions between the virus and the host, imbalanced immune response and cytokine storm, molecular mechanisms by which the spike protein drives endothelial dysfunction and, multisystemic pulmonary, cardiovascular, neurological, renal involvement.
Background and aims. Condyle fractures are one of the most common traumas of the mandibular bone, but the treatment of these lesions lacks a standardized protocol. This study aimed to investigate the outcomes of orthopedic treatment by comparison with surgical treatment in a 10-year retrospective study. Methods. We included condyle fracture patients treated in the Department of Oral and Maxillofacial Surgery of Cluj-Napoca County Hospital between 2015 and 2024. Results. Young men were prone to suffer from mandibular condyle fractures, aggression being the most frequent cause. Usually, minor or moderate painkillers and amoxicillin are enough as medical treatment. There were no statistically significant differences between outcomes of orthopedic and. surgical treatment in patients with condylar trauma without displacement. Conclusion. The condylar fractures with no displacement or changes in the functionality of the mandible can be successfully treated by orthopedic reduction and intermaxillary fixation. The results of this study may help in choosing the optimal treatment based on the characteristics of the clinical cases.
Aim:To establish a real-world benchmark for treatment with the immune checkpoint inhibitors (ICI) and clinical outcomes for patients with metastatic urothelial carcinoma (mUC) by analyzing two distinct, standard-of-care therapeutic sequences at a single Romanian tertiary care center. Methods:We conducted a retrospective analysis of 30 patients with mUC treated between January 1, 2020, and April 30, 2025. Patients were analyzed in two clinically distinct cohorts: the Avelumab Maintenance Cohort (N=12), which included platinum-eligible patients who responded to first-line platinum-based chemotherapy (PBC) followed by avelumab maintenance, and the Pembrolizumab Cohort (N=18), consisting of patients who received pembrolizumab therapy following disease progression after PBC. The primary endpoint was time to treatment failure (TTF). Secondary endpoints included overall survival (OS) and the incidence of grade ≥3 treatment-related adverse events (TRAEs). Results:The two cohorts displayed different baseline characteristics and clinical trajectories. The Avelumab Maintenance cohort, selected for chemotherapy-sensitive disease, demonstrated a higher disease control rate (DCR) of 91.7%. The Pembrolizumab cohort, representing a more clinically diverse and challenging population, had a DCR of 55.6%. In the Avelumab cohort, median TTF and median OS were not reached. In the Pembrolizumab cohort, the median TTF was 10.2 months and median OS was 21.8 months. Grade ≥3 TRAEs were infrequent, occurring in 1 of 12 patients (8.3%) in the Avelumab cohort and 2 of 18 patients (11.1%) in the Pembrolizumab cohort, with no new safety signals identified. Conclusion:This single-center study provides a context-specific presentation of mUC treated with ICIs effectiveness and safety in the Romanian healthcare context and highlights the impact of systemic factors, such as national healthcare reimbursement policies, on clinical practice.
Background and aims. Skin cancers are among the most common malignancies worldwide, and improved non-invasive diagnostic tools are needed to support clinical decision making. Metabolomics offers a promising approach by capturing systemic biochemical alterations associated with tumor presence. Methods. In this study, we performed untargeted serum metabolomic profiling based on high-performance liquid chromatography coupled with mass spectrometry in 85 individuals, including 49 with basal cell carcinoma, 19 with squamous cell carcinoma, 8 with melanoma and 9 with benign lesions. Results. The analysis yielded 98 polar metabolites and 53 lipophilic metabolites that passed quality filtering. Thirteen metabolites showed significant differences between the cancer and benign groups, including lysophosphatidylcholine (20:3), N-palmitoyl tryptophan, serotonin, and fumaric acid. Principal component analysis demonstrated clear separation between malignant and benign groups, while cancer samples displayed wider metabolic variability consistent with tumor heterogeneity. Integrating principal component scores into a linear discriminant model yielded an area under the ROC curve of 0.98 corresponding to a sensitivity of 96% and a specificity of 67%. Pathway enrichment analysis revealed consistent alterations in mitochondrial electron transport, amino acid metabolism, the urea cycle, and the Warburg effect, indicating that common metabolic pathways are perturbed across cutaneous malignancies. Conclusions. These findings show that serum metabolomics can distinguish cancer from benign skin lesions and highlight metabolic signatures that may serve as potential biomarkers for non-invasive assessment of skin cancer.
Background and aims: Primary hyperparathyroidism (PHPT) is a common endocrine disorder; one of its common complications is renal calcifications. Our study aimed to determine the prevalence of renal calcifications (nephrolithiasis and nephrocalcinosis) in patients with primary hyperparathyroidism, to elucidate potential demographic, biochemical, radiological, and histological differences between patients with and without renal calcifications, and to assess potential risk factors associated with its occurrence. Methods: This was a retrospective, single-center, descriptive, and analytical study involving 62 patients with primary hyperparathyroidism (PHPT). Participants were assessed through serum and urinary parameters, kidney-urinary tract ultrasonography, and abdominal computed tomography (CT) scans to evaluate the presence or absence of renal calcifications. Results: We found 30 patients (48.4%) with renal calcifications, all of them nephrolithiasis, and only 2 cases (6.7%) had nephrocalcinosis associated with nephrolithiasis; and they were all detected by abdominal CT scan. Compared to patients without renal calcifications, those who had renal calcifications had a significantly higher prevalence of diabetes, BMI, waist circumference, PTH 1- 84, alkaline phosphatase, and lower 25-hydroxy vitamin D (25-(OH)-D). No significant difference was found between the two groups in other studied parameters. Higher BMI and lower 25-(OH)-D were potential risk factors for renal calcifications in multivariate regression analysis. Conclusion: The combination of PHPT and renal calcifications is still common and often asymptomatic.
Introduction:While tooth whitening is widely used to manage dental discoloration, results can vary substantially across teeth and protocols. In this in vitro study, we assessed whether enamel thickness across tooth regions influences whitening efficacy under different peroxide-based protocols. Methods:Ninety extracted human premolars were stained and allocated to three protocols (n=30 each): 10% (10 h), 20% (4 h), and 35% (1 h). Enamel thickness was measured on CBCT at the cervical, middle, and occlusal thirds. Color was recorded with a spectrophotometer using one acquisition before whitening and one after whitening; three regional L*a*b* values were extracted from each image. Color change was expressed as CIEDE2000 (ΔE00). Because three regions were analyzed per tooth, the primary analysis used a linear mixed-effects model (LMM) with a random intercept for tooth (ΔE00 ~ Group×Region + (1|Tooth)). Enamel thickness was added as a covariate in a secondary LMM. Robustness was assessed by GEE with robust standard errors and a tooth-level sensitivity analysis (mean ΔE00 per tooth). Results:ΔE00 differed significantly across protocols in the LMM: compared with 35%, ΔE00 was higher for 20% (p=0.003) and 10% (p<0.001). Region was not significant (p>0.05) and the interaction was not supported overall; a localized 10%×occlusal effect was borderline in LMM (p≈0.055) and significant in GEE (p≈0.024). Baseline color differed between groups and was therefore included a priori as a covariate; adjustment for baseline L* did not alter the main conclusions. After adjustment, enamel thickness was not associated with ΔE00 (p≈0.933). Exposure-dose (concentration × time, % h) showed a positive trend with ΔE00 (r=0.401, p<0.001; R2=0.161). Only 0.37% of measurements showed ΔE00 ≤ 1.8. Conclusion:Whitening efficacy was primarily governed by the protocol (cumulative exposure) rather than enamel thickness. Regional modulation was modest, and enamel thickness alone was not predictive.
Background and aims:Abu al-Qasim Al-Zahrawi (936-1013), known in Western literature as Albucasis, is recognized as one of the founders of modern surgery. Practicing in medieval Andalusia, he played a decisive role in transforming surgery into a systematized medical discipline. His major work, Kitāb al-Taṣrīf, a 30-volume medical encyclopedia, synthesized the surgical knowledge of his era and profoundly influenced European medicine for several centuries. The aim of this article is to examine Albucasis' contributions to the development of medieval surgery, focusing on instrumentation, and the educational influence of Kitāb al-Taṣrīf on European medical practice. Methods:A narrative and historical analysis of open-access secondary sources was conducted, including the text of Kitāb al-Taṣrīf in medieval Latin translations, and modern academic literature indexed in international databases. Results:Albucasis described advanced surgical procedures in pediatric, abdominal, orthopedic, and urological surgery and introduced more than 200 original surgical instruments, many of which became prototypes of modern tools. He emphasized the need to adapt operative techniques to the physiological particularities of children and highlighted the importance of clinical experience. The Latin translation of Al-Taṣrīf in the 12th century facilitated the integration of his principles into European universities. Conclusions:Kitāb al-Taṣrīf remains a fundamental work in the history of surgery, and the principles formulated by Albucasis continue to influence medical education and modern surgical practice.
Background and aim:Family caregivers of individuals with schizophrenia frequently experience substantial emotional and functional strain, yet little is known about the subtle stress-related cognitive-perceptual tendencies that may emerge during long-term caregiving. Such tendencies, measurable with the Eppendorf Schizophrenia Inventory (ESI), have only recently begun to be examined in Romania, and their potential associations with caregiver well-being remain insufficiently explored.The objectives of this study: to compare cognitive-perceptual tendencies between schizophrenia caregivers and matched hybrid controls; to examine associations between ESI subscales and quality of life (QoL), depressive symptoms, and cognitive performance among caregivers; and to interpret these findings within a stress-adaptation and response-shift framework. Methods:In this cross-sectional study, 52 non-professional family caregivers of individuals with schizophrenia were compared with 52 matched hybrid controls comprising individuals with chronic somatic illnesses and their caregiving relatives. Participants completed the Romanian-adapted ESI, WHOQOL-BREF, Beck Depression Inventory (BDI), and Montreal Cognitive Assessment (MoCA). Group comparisons, Pearson correlations, and stratified exploratory comparisons based on Ideas of Reference were conducted. Results:Caregivers showed moderately elevated ESI subscale scores, particularly Ideas of Reference, relative to controls. Higher Ideas of Reference scores were modestly associated with lower psychological QoL and higher depressive symptoms, whereas associations with cognitive performance were minimal. Correlation patterns indicated small-to-moderate associations across cognitive-perceptual tendencies and caregiver well-being domains. Conclusions:In this exploratory, cross-sectional analysis, stress-related cognitive-perceptual tendencies were more pronounced in schizophrenia caregivers than in matched controls and showed modest associations with psychological QoL and depressive symptoms. These findings underscore the relevance of considering cognitive-perceptual stress responses in caregiver research while highlighting the need for longitudinal designs and formal psychometric validation of the Romanian ESI.
Background and aims:Type 1 diabetes mellitus is a chronic metabolic disease of autoimmune origin with early manifestations, which appear predominantly in childhood. Its incidence has increased in most European countries mainly due to refined diets and increased consumption of sweets. Diabetes is known as a predisposing factor for the development of oral diseases; therefore, prevention at an early age is essential. Genetic factors and environmental factors contribute to the risk of disease, indicating a multifactorial etiology. Along with chronic periodontitis and other oral manifestations, such as increased incidence of tooth decay, aphthous ulcers, salivary qualitative and quantitative changes represent an important segment of diabetes complications. It has been observed that people with diabetes are more prone to oral changes compared to healthy people.In recent years, many studies have been published in the literature that have examined the relationship between type 1 diabetes and oral health. The purpose of this review is to investigate oral health indices in children with type 1 diabetes and how diabetes influences these indices. Methods:An electronic search of the following databases was conducted to identify the literature assessing the effect of type 1 diabetes on oral health in children and adolescents aged 6-17 years: MEDLINE, Europe PMC, Google Scholar and PubMed. In total, 121 studies were identified. After removing duplicates, a total of 90 articles were included in this systematic review. Results:This study describes the relationship between oral health in children with type 1 diabetes mellitus and presents the relationship between diabetes mellitus and the incidence of dental caries, periodontal diseases, microbial infections, as well as the influence of diabetes on orthodontic treatment and the measures that are required during the management of treatment in these patients. Conclusions:The analysis of scientific evidence supports the fact that diabetes has a negative effect on oral health, and changes in the oral cavity will influence glycemic control, with the onset of multiple systemic complications. The association between diabetes and oral health is sometimes ignored and for this reason, instead of the early diagnosis and treatment of certain oral conditions, it leads to late diagnosis, resulting in tooth loss and sometimes even severe complications. Monitoring diabetic and dental patients can reduce diabetes-related complications.
Background and aims. Male prolactinoma remains a singular entity. Our study represents the first reported experience of male prolactinoma in Northern Africa. Our work aimed to characterize prolactinomas in the male population, an entity known for its aggressive features, and also to highlight the specific challenges encountered in a North African clinical context. Methods. This is a retrospective descriptive study of male patients presenting with prolactinoma at the endocrinology, diabetology and nutrition department of a university hospital center over a 10-year period. Results. The mean age at diagnosis was 37 ± 11 years. Mass effect related symptoms were present in 83% of cases. Decreased visual acuity was found in 60% of cases. Galactorrhea was found in 13% of cases, decreased libido in 60% of cases, and gynecomastia in 20% of cases. At the time of diagnosis, the mean prolactin level was 4,685 ng/ml (79-33,000). All patients had hypogonadotropic hypogonadism. Among our patients, 66% had undergone dopaminergic agonists as monotherapy, and pituitary surgery was performed in 33% of cases in conjunction with dopaminergic agonists. After a 30-month average follow-up, medical treatment achieved prolactin control in 83% of cases and tumor shrinkage in 70%, while surgery achieved prolactin control in 85% and tumor shrinkage in 70% of cases. Conclusion. Prolactinoma in men is usually invasive and of considerable volume, putting patients at risk of mass effect related symptoms, especially ophthalmologic complications. Hence the importance of early, multidisciplinary and personalized management.
Background:This study aims to assess the impact of COVID-19 infection on both mental well-being and biological parameters of patients with type 2 diabetes, highlighting the potential long-term effects. Methods:A longitudinal observational study was conducted on a total of 62 patients diagnosed with type 2 diabetes. We used two validated questionnaires: the WHO-5 Well-Being Index (WHO-5) and the Diabetes Distress Scale (DDS). Biological data were extracted from medical records. We had two-point evaluations, in 2023 and 2024. Patients were divided into three groups based on the year of COVID-19 diagnosis: 2020, 2021, 2022. Descriptive and inferential statistics were performed, with results presented as percentages and associations. The Wilcoxon signed-rank test, the Kruskal-Wali's test, and Spearman's rank correlation coefficient (ρ) were applied for non-normally distributed variables. Analyses were performed using Jamovi 3.2.28. A p value < 0.05 was considered statistically significant. Results:There were 24 (38.7%) females, and 38 (61.3%) males. The mean age was 66.5 years. From the medical history, regarding COVID-19 severity, 7 (11.3%) of cases were classified as mild 29 (46.8%) as moderate, and 26 (41.9%) as severe. WHO-5 scores increased from a mean of 42.5 from 2023 to 51.2 in 2024, indicating improved psychological well-being over time. A significant reduction in diabetes-related emotional distress was observed (p < 0.001). Regimen-related distress scores showed a small but significant decrease from 2023 to 2024 (p = 0.004). A statistically significant correlation was observed between WHO-5 score (2023) and LDL cholesterol (2024) (ρ = 0.629, p = 0.02). Descriptive statistics showed that mean HDL cholesterol values vary with COVID-19 severity levels. Conclusion:Psychological well-being showed an improvement over time. Emotional distress related to diabetes, including emotional burden and regimen-related distress decreased with time. Serum LDL- and HDL cholesterol levels may play a potential role in supporting psychological well-being. This study reinforces the importance of holistic approaches in managing post-COVID-19 effects, especially in patients with pre-existing metabolic disorders.
Background and aim:Basal cell carcinoma (BCC) is the most common skin cancer, yet reliable non-invasive markers for distinguishing low-risk (LR) from high-risk (HR) lesions are still lacking. Serum metabolomics provides a promising approach for capturing systemic biochemical changes associated with tumor behavior. In this study, we conducted untargeted serum metabolomic profiling using high-performance liquid chromatography coupled with mass spectrometry in 48 patients with histologically confirmed BCC. Methods:The cohort included 38 HR and 10 LR lesions. After quality filtering, 99 polar and 54 lipophilic metabolites were retained for analysis. Using a significance threshold of P < 0.01 and absolute fold change > 1.2, 10 metabolites differed between HR and LR BCC. Results:Principal component analysis showed partial separation between the two groups driven by metabolites including dihydroxybutyric acid, glucosylsphingosine, androsterone, and several lysophosphatidylcholines. A linear discriminant model based on the first 4 principal components achieved an AUC of 0.88, corresponding to a sensitivity of 89% and a specificity of 40% for identifying HR lesions. Enrichment analysis revealed representation of multiple chemical classes, including carboxylic acids, steroids, glycerophospholipids, indoles, diazines, and organooxygen compounds. Several metabolites varied significantly by anatomical location and tumor size, while histologic subtype showed no meaningful influence. Conclusions:These findings provide initial evidence that serum metabolomics can detect metabolic differences between LR and HR BCC and may serve as a basis for developing non-invasive biomarkers to improve BCC risk stratification.
Background. Craniofacial anomalies, particularly cleft lip and palate affecting 1 in 500 to 1 in 2,500 live births globally, exert profound influences on physical function, psychological well-being, and social integration throughout the entire life. While surgical advances have improved outcomes, the long-term impact on the quality of life remains incompletely understood, necessitating comprehensive evaluation of psychosocial outcomes following primary surgical repair. Methods. We conducted a cross-sectional comparative study evaluating 85 pediatric patients aged 4-7 years with surgically repaired non-syndromic cleft lip and/or palate and their caregivers, compared to 90 age-matched healthy controls. All patients underwent standardized surgical repair with minimum 24-month postoperative follow-up. Quality of life was assessed using the validated KINDL questionnaire administered to both children and parents, measuring physical well-being, emotional well-being, self-esteem, family relationships, friendships, and school functioning. Statistical analysis employed independent-samples t-tests and chi-square tests with significance set at p < 0.05. Results. Children with cleft conditions demonstrated overall quality of life scores comparable to healthy controls (82.15 ± 14.72 vs 83.78 ± 16.72, respectively; 1.9% difference, not statistically significant). However, self-esteem scores were significantly lower in the cleft group (78.17 ± 24.79 vs 83.49 ± 22.17, p = 0.036). Parental assessments yielded high overall scores (80.38 ± 12.41) but identified significant concerns in self-esteem (72.41 ± 16.82) and infirmity perception (72.15 ± 17.67) (both p < 0.01). Age-stratified analysis revealed that children requiring reinterventions and older children (6-7 years) demonstrated greater family-related quality of life concerns. Conclusions. While children with surgically repaired cleft lip and/or palate achieve overall quality of life outcomes comparable to healthy peers, persistent self-esteem deficits indicate ongoing psychosocial challenges requiring comprehensive multidisciplinary intervention. These findings emphasize the need for holistic care approaches that integrate psychological support, targeted therapies, and family counseling to optimize both functional and psychosocial outcomes beyond primary surgical repair.
Background:Insulin resistance (IR) drives early cardiometabolic risk in populations with high adiposity. Simple fasting markers, such as the triglyceride-glucose (TyG) index and the triglyceride-to-HDL cholesterol ratio (TG/HDL-C), may be helpful. Still, their performance against the updated, non-linear Homeostatic Model Assessment 2 (HOMA2) model in Middle Eastern adults remains unclear. Objectives:Compare TyG versus TG/HDL-C for HOMA2-defined IR; test modification by Body Mass Index (BMI) (overweight vs. obesity); and evaluate discrimination, calibration, and clinical utility. Methods:Cross-sectional study of 140 adults without diabetes with overweight/obesity. Fasting triglycerides, HDL-C, glucose, and insulin were assayed under quality control; HOMA2-IR, %S, and %B were derived. Multivariable linear models (per-SD predictors) adjusted for age, sex, and BMI; multiplicative interactions probed effect modification. Higher IR was defined as the sex-specific top quartile of HOMA2-IR. Discrimination (Area Under the Curve AUC; DeLong test), calibration (intercept, slope, Brier), decision-curve analysis (DCA), multiple imputation (20 datasets), and prespecified sensitivity checks were performed. Results:TyG independently tracked higher HOMA2-IR (β=0.127 per SD; 95% CI 0.033-0.220; p=0.0078), whereas TG/HDL-C was null. TyG×BMI interaction was significant (p=0.0011): negligible in overweight (β≈0.01; p=0.85) but strong in obesity (β=0.29; p<0.001). Discrimination was similar (AUC TyG 0.714 vs TG/HDL-C 0.707; ΔAUC=0.007; p=0.801). DCA showed a higher net benefit for TyG, especially TyG+BMI, across thresholds of 0.20-0.60. Calibration was acceptable; bootstrap-validated metrics and extensive sensitivity analyses were consistent. Conclusions:In adults without diabetes with excess adiposity, TyG captures HOMA2-defined IR more consistently than TG/HDL-C, with the greatest incremental value in obesity. As a low-cost fasting metric, TyG, particularly when combined with BMI, may refine triage for further evaluation; external validation in regional cohorts is warranted.
