Pulmonary sequestration is a rare bronchopulmonary foregut malformation characterized by the abnormal development of non-functional lung tissue enclosed by visceral pulmonary pleura, supplied by a systemic arterial blood supply, and lacking communication with the bronchial tree. The blood supply commonly arises from the thoracic or abdominal aorta. We reported a 44-year-old female who presented with vomiting and recent weight loss of about 20 kilograms in the last 6 months. The physical and biochemical examination was unremarkable. A contrast-enhanced abdominal CT scan reveals signs of superior mesenteric artery syndrome (SMAS), including a decreased aortomesenteric angle and aortomesenteric distance. The lower chest sections show an irregular consolidative lesion in the posterior segment of the Left lower lobe supplied by an aberrant aneurysmal vessel from the celiac artery, consistent with intralobar pulmonary sequestration (ILS). To our knowledge, co-occurrence of SMAS and ILS with a celiac aneurysmal feeder has not been previously reported, as both conditions affect organs of different locations and embryological origins. A literature review was conducted to examine the presentation and vascular supply of ILS.
Background: Background: Metabolic syndrome (MetS) is a cluster of risk factors, including abdominal obesity, dyslipidemia, hyperglycemia and hypertension that markedly elevate the incidence of cardiovascular diseases and type 2 diabetes. Objective: This study aimed to evaluate the diagnostic value of serum angiopoietin-like protein 4 (ANGPTL4) and Caveolin-1 (Cav-1), as novel agents in diagnosing MetS in patients older than 50 years. Methods: A case-control study (January–April 2025) included 60 cases with MetS and 30 matched-healthy participants of the same gender and age (50 years) from hospitals in Diyala Governorate, Iraq. MetS was diagnosed by harmonized definition (3 features: elevated waist diameter, triglyceride 150 mg/dL, low HDL-C, BP 130/85 mmHg and fasting glucose 100 mg/dL). Results: Serum ANGPTL4 (142.78 22.53 vs. 69.29 30.80 ng/mL, p-value 0.001) and Cav-1 (16.12 2.87 vs. 8.51 1.59 ng/mL, p-value 0.001) were significantly elevated in the MetS group. Receiver Operating Characteristic (ROC) analysis demonstrated exceptional diagnostic performance, with an Area Under the Curve (AUC) of 0.97 for ANGPTL4 and 0.99 for Cav-1. Binary logistic regression analysis identified both biomarkers as significant independent predictors of MetS. Conclusion: Serum ANGPTL4 and Caveolin-1 levels exhibited outstanding diagnostic performance for MetS in Iraqi adults aged 50 years, reflecting underlying lipid dysregulation and endothelial dysfunction. These biomarkers showed significant potential for enhancing early detection and clinical management, warranting validation in a broader population
Objective : To evaluate the prognostic accuracy of the C-reactive protein (CRP)/albumin ratio in predicting severe acute pancreatitis (SAP) and its correlation with clinical complications. Methods : This retrospective observational study included 40 adult patients diagnosed with acute pancreatitis between January and August 2024. Patients were categorized by severity using the Revised Atlanta Classification into moderately severe or severe groups. Laboratory data, clinical characteristics, and imaging findings were compared. Receiver operating characteristic (ROC) analysis with Youden’s Index evaluated the CRP/albumin ratio predictive performance and logistic regression identified independent predictors of SAP. Results : The CRP/albumin ratio was significantly higher in SAP patients (median 5.0 [IQR 0.93–12.62]) compared to non-SAP (1.58 [IQR 0.28–8.6], p = 0.0187). ROC analysis showed an area under the curve (AUC) of 0.809 for the CRP/albumin ratio, superior to CRP alone (AUC 0.479) and comparable to the Ranson score (AUC 0.88). An optimal cut-off value of 4.22 provided 76.9% sensitivity and 85.2% specificity. Multivariable logistic regression identified absence of intestinal transit (p = 0.033) and splenic vein thrombosis (p = 0.026) as independent predictors of SAP. The CRP/albumin ratio correlated significantly with both these complications. Conclusions : The CRP/albumin ratio is a valuable, non-invasive, and readily available prognostic marker for early identification of severe acute pancreatitis. Its predictive accuracy is comparable to established scoring systems and may aid in triage and clinical decision-making.
The mainstay generic therapies of cancer including chemotherapy, are partly effective in a subset of the patient population due to the complexity and heterogenous nature of the disease. Nevertheless, the inherent variability of cancer has steered cancer therapy towards the concept of precision medicine. The approach focuses on matching effective and accurate treatment on the genetic profile of a patient and different unique characteristics that distinguishes one patient from another. Currently, precision oncology has been driven by various innovations including liquid biopsy, next generation sequencing (NGS) and multi-omics integration. Recent advances in next generation-based sequences have enabled the analysis of analytes including circulating DNA and genomic DNA. Liquid biopsy has enabled minimal invasion alternative and real-time monitoring of tumour dynamics and analysis of treatment responses. Moreover, emerging technologies including artificial intelligence and nanotechnology has enhanced the sensitivity of liquid biopsy. Similarly, multi-omics integration offers insights into the interactions between transcriptomic, proteomic, epigenomic and genomic enabling the unravelling the complex molecular mechanism driving carcinogenesis. These advances have resulted in the discovery of novel biomarkers and diverse therapeutic targets for different types of cancers. However, despite the promising advancements, challenges remain, such as concerns on data privacy, need for clinical validation and computational limitations. Ongoing research is, therefore, critical to embrace precision oncology in routine clinical care.
Objective : To synthesize current evidence on mechanisms, diagnostic evaluation, and treatment of infertility in PCOS, with emphasis on phenotype-specific implications and integrative management. Methods : A narrative review was conducted using PubMed, Scopus, and Web of Science from January 2015 to March 2024. Search terms included “PCOS,” “infertility,” “phenotype,” “letrozole,” “metformin,” “gonadotropins,” and “ART.” Eligible studies involved human females aged 18–45 years, written in English, and focused on PCOS-related infertility. Randomized trials, meta-analyses, and international guidelines were critically assessed for methodological rigor and clinical relevance. Results : PCOS accounts for 70–80% of anovulatory infertility, with marked variability across phenotypes. Phenotype A, combining hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology, carries the greatest reproductive and metabolic burden. Biomarkers such as AMH, testosterone, DHEAS, fasting insulin, and HOMA-IR improve risk stratification. Lifestyle modification restores ovulation in up to 60% of overweight patients. Letrozole is superior to clomiphene, while gonadotropins and ART are effective in resistant cases. Metformin enhances ovulatory and pregnancy outcomes in insulin-resistant women. IVF protocols using antagonists and agonist triggers improve safety by reducing ovarian hyperstimulation syndrome. Psychological comorbidities, particularly anxiety and depression, are frequent and negatively affect fertility outcomes. Conclusion : PCOS-related infertility requires a personalized, multidisciplinary approach. Integration of phenotype-based assessment, bio-marker evaluation, lifestyle intervention, and tailored reproductive strategies optimizes outcomes. Addressing metabolic and psychological dimensions further improves reproductive success and long-term health.
Objective : This study aimed to explore the feasibility and impact of implementing locum pharmacist models in Romanian community pharmacies, in the context of growing workforce shortages and operational challenges in the pharmaceutical sector. Methods : A cross-sectional survey was conducted using a 15-question structured questionnaire distributed via a national locum platform and professional forums. A total of 116 valid responses were collected. The questionnaire covered demographics, professional preferences, and financial expectations. Data were analysed using statistical software to identify correlations between variables such as professional experience, interest in locum work, and expected remuneration. Results : Respondents represented a diverse age and experience range, with the majority having between 10 and 20 years of professional experience. Community pharmacy was the dominant area of current employment (76%). Most pharmacists reported difficulty in finding replacements during leave, particularly in rural areas. Over half expressed willingness to work locum shifts if adequately compensated, preferring hourly rates 50% to 100% higher than standard wages. Data indicated a correlation between years of experience and higher salary expectations. The study highlighted distinct professional preferences between administrative and patient-facing roles and emphasised the stress associated with excessive workloads and reduced rest periods. Conclusions : Locum work presents a viable solution to mitigate staffing shortages in Romanian pharmacies, offering flexibility and increased earning potential for pharmacists. However, challenges such as professional isolation, inconsistency in pharmacy systems, and lack of formal support must be addressed to optimise implementation. Integration strategies and legislative clarity will be essential for the long-term success of locum models in the pharmaceutical sector.
Background : Ameloblastic fibro-odontosarcoma (AFOS) is a rare malignant odontogenic tumor with benign epithelial and malignant mesenchymal components. It typically affects younger individuals, with a predilection for the posterior mandible. With fewer than 25 cases reported globally, it remains a diagnostic challenge due to overlapping features with other odontogenic lesions and limited documented information. Case presentation : This is a case of a 21-year-old male who presented with a progressively enlarging swelling on the right side of his face, painful growth in the posterior mandible, and numbness in the right lower lip. Clinical examination revealed a bony hard swelling with an ulcerative lesion in the mandibular alveolar mucosa. Cone-beam computed tomography showed a heterogeneously hypodense, expansile lesion with bicortical expansion, cortical erosion, and hyperdense masses resembling enamel and dentin. Histopathological analysis confirmed AFOS, showing benign odontogenic epithelial islands within a malignant mesenchymal stroma. The patient underwent surgical resection with wide margins, followed by radiotherapy and chemotherapy to address metastatic lymph node involvement. Conclusion : This case highlights the diagnostic complexities and aggressive behavior of AFOS. A multidisciplinary approach integrating clinical, radiographic, and histopathological findings is critical for accurate diagnosis and effective management.
Objective : Antimicrobial resistance has become a worldwide health challenge due to antibiotic misuse; thus, there is a rising interest in repurposing non-antibiotic substances, such as vitamin C. Whether these compounds can alter antibiotic efficacy remains insufficiently investigated, especially alongside commonly used antibiotics like ciprofloxacin. This study aims to evaluate the impact of vitamin C on ciprofloxacin activity in standard bacterial strains. Methods : Ciprofloxacin and vitamin C were assessed by checkerboard assay on six ATCC strains: methicillin-susceptible Staphylococcus aureus , methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, Escherichia coli , and Klebsiella pneumoniae . The research was conducted in triplicate to ascertain minimum inhibitory concentrations and calculate the fractional inhibitory concentration index (FICI). Data were summarized with means and standard deviations, classified by outcome, and analyzed with Fisher’s exact test. Figures were created using R software. Results : For both methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Enterococcus faecalis , and Klebsiella pneumoniae , all combinations showed indifference (FICI range 0.83-4), while Pseudomonas aeruginosa showed one antagonistic outcome (FICI=5). In Escherichia coli , antagonism was predominant (n=9, FICI range 4.001-6), with a statistically significant reduction in complete inhibition compared to ciprofloxacin alone (p=0.037), suggesting that vitamin C reduces ciprofloxacin efficacy at higher concentrations, while synergy occurred at lower concentrations (n=4, FICI range 0.064-0.281). Conclusions : To our knowledge, this is the first systematic checkerboard analysis of ciprofloxacin-vitamin C on multiple ATCC strains, underscoring the impact of non-antibiotic compounds. These findings are significant because they support the need for further studies on how non-antibiotic compounds may influence antibiotic therapy in patients.
Introduction: Thyrotoxic crisis is a rare, but potentially fatal endocrine emergency resulting from a sudden surge in thyroid hormone activity. Early recognition is critical, however atypical or multisystem presentations can delay diagnosis and treatment.
Worldwide, chronic hepatitis B and C infections remain a significant public health challenge, causing millions of cases of liver disease globally.
Sodium-glucose transporter 2 inhibitors have been identified as pleiotropic pharmacological agents with demonstrated efficacy in a wide range of pathologies. Given the strong association between arrhythmias and significant comorbidities, exploring the potential antiarrhythmic effects of sodium-glucose transporter 2 inhibitors represents a critical therapeutic opportunity, particularly considering the limited efficacy and adverse profile of current antiarrhythmic drugs. The antiarrhythmic mechanisms of sodium-glucose transporter 2 inhibitors operate through direct cardiac ion channel modulation. Along with the ion channel effects, sodium-glucose transporter 2 inhibitors improve gap junction coupling by modulating connexin-43, lower sympathetic tone, maximize mitochondrial function, and induce metabolic reprogramming through adenosine monophosphate-activated protein kinase/sirtuin 1 activation and autophagy enhancement. Translating these encouraging mechanisms into focused antiarrhythmic strategies still requires establishing clear cause-and-effect links between sodium-glucose transporter 2 inhibitor therapy and arrhythmia prevention. Nevertheless, the current evidence regarding these effects remains inconsistent, underscoring the necessity for further research to elucidate the underlying mechanisms and resolve existing controversies.
Objective : This research foucuses on the development of a liquid chromatographic method for the rapid and reliable separation and identification of major nitrosamine impurities, ensuring both short analysis time and adequate resolution. Given the toxicological relevance of nitrosamines, their occurrence in pharmaceutical formulations has raised substantial concerns, leading to the reassessment of multiple drug products. In response, reverse-phase HPLC with UV detection and LC-MS techniques have been widely applied as powerful analytical tools for their detection and control. Methods : The following impurities of the N-nitrosamine class are separated and identified by the LC-MS technique: NDMA (N-nitrosodimethylamine), NDEA (N-nitrosodiethylamine), NMEA (N-nitrosomethylethylamine) NDIPA (N-nitrosodiisopropylamine), NDBA (N-nitrosodibutylamine) NPIP (N-nitrosopiperidine). A standard solution of nitrosamines mix was prepared and subsequently diluted in methanol to achieve a final concentration of 20 µg/mL for each compound. The analysis was performed using a UHPLC chromatography system Flexar FX10 (Perkin Elmer) with MS QTOF (AB Sciex TripleTOF4600), Phenomenex Luna Omega 3 C18 (150x4.6mm, 3μm) column, column temperature 450C, mobile phase methanol and formic acid 0.1% in ultrapure water, gradient elution, flow 0.45 mL/min., injected volume 5 µl. The proposed LC-MS conditions are significantly improved compared to the European Pharmacopoeia recommendations for N-Nitrosamines impurities in active substances analysis. Results : Based on the mass fragmentation profiles of the six investigated nitrosamines, chromatographic separation was successfully accomplished in less than 25 minutes, with the elution sequence established as follows: NDMA, NMEA, NDEA, NPIP, NDIP, NDBA. Conclusions : The development of optimal chromatographic conditions allows further separation and identification of nitrosamines impurities in pharmaceutical products.
Introduction : Pneumothorax is a potentially life-threatening complication in preterm neonates, frequently associated with respiratory distress syndrome (RDS). Prompt diagnosis and individualized respiratory support are essential to avoid invasive interventions. Objective : To describe the successful conservative management of a preterm neonate with respiratory distress syndrome complicated by pneumothorax and congenital infection, emphasizing the role of early respiratory support and infection control. Methods : A male infant was born prematurely with clinical signs of systemic inflammation and respiratory distress. Initial management in the delivery room included thermal stabilization, tactile stimulation, and continuous positive airway support. Blood gas analysis revealed mild mixed acidosis. Chest radiography confirmed pneumothorax and respiratory distress syndrome. The patient was managed conservatively with intratracheal surfactant (100 mg per kilogram per dose), right lateral positioning and high-frequency oscillatory ventilation, without pleural drainage. Results : The patient responded favorably to supportive management. Respiratory status improved progressively. Oxygen requirements decreased rapidly, and the pneumothorax resolved without invasive intervention. Extubation was achieved on the second day of life, and oxygen therapy was stopped by day six. The patient remained hemodynamically stable, tolerated enteral feeding, and showed appropriate weight gain. On day seven, he was transferred to the neonatal prematurity unit for continued monitoring of growth and jaundice. Conclusions : This case supports the safety and effectiveness of conservative management in selected preterm neonates with pneumothorax. Early surfactant administration combined with high-frequency oscillatory ventilation (HFOV) can facilitate recovery while avoiding the risks associated with pleural drainage [2]. Tailored respiratory strategies and early control of systemic infection are essential for optimizing outcomes in vulnerable neonates.
Background and objective : Mixed polymeric nanomicelles are nanoscale structures produced by the self-assembly of two or more amphiphilic polymers in an aqueous solution. These nanomicelles are of great interest in a variety of fields, including medication delivery, due to their capacity to encapsulate both hydrophobic and hydrophilic drugs, as well as their stability and capacity to enhance the solubility and bioavailability of poorly water-soluble medications. Our study focuses on preparing and evaluating mixed polymeric self-nanomicellizing solid dispersions (MP-SNMSD) of Canagliflozin (CFZ), a sodium-glucose co-transporter-2 inhibitor used in managing Type 2 Diabetes Mellitus (T2DM). Its poor aqueous solubility and bioavailability remain significant challenges. Materials and methods : The solvent evaporation technique was employed to create CFZ-MP-SNMSDs using Soluplus® as a main carrier and Solutol® HS15 or D-α-tocopherol polyethylene glycol succinate (TPGS) as the second carrier. Results : Ten formulations with high drug loading and stability are prepared. Optimized CFZ-MP-SNMSD formula, consisting of 1:1:4 of CFZ: Solutol® HS15: Soluplus®, exhibited reduced particle size (68.44 nm) and improved dissolution rates under non-sink conditions in phosphate buffer pH 6.8, with a 58% release in 60 minutes compared to 18% for the pure drug. X-ray diffraction revealed a transition of CFZ to an amorphous state in an optimized CFZ-MP-SNMSD formula, enhancing solubility. The MP-SNMSD formulations demonstrated significant enhancements in solubility and dissolution efficiency, which will improve the oral bioavailability of CFZ. Conclusion : These findings suggest that MP-SNMSD formulations represent a promising approach to overcoming the limitations of CFZ, providing a foundation for more effective oral drug delivery systems of hydrophobic drugs and improving therapeutic outcomes.
Objective : To evaluate the prevalence and clinical impact of psychiatric comorbidities—specifically depression, anxiety, bipolar disorder, and schizophrenia—among patients hospitalized with chronic obstructive pulmonary disease (COPD), and to examine their influence on disease progression and outcomes. Methods : A cross-sectional study was conducted from September 2024 to May 2025 at the Pneumology Department of Mureș County Clinical Hospital. Hospitalized COPD patients were assessed using standardized psychiatric screening tools and clinical evaluations. Mixed methods were used: quantitative (PHQ-9 - Patient Health Questionnaire and SGRQ-C questionnaires - SGRQ-C - COPD-adapted Saint George Questionnaire) and qualitative (semi-structured interviews). Results : Psychiatric comorbidities were common among the study population, with depression and anxiety being the most frequently diagnosed disorders. The PHQ-9 scores showed that the percentage of people experiencing depression is much higher than the declared prevalence. The median SGRQ-C score was 62, reflecting a major impairment in quality of life. Qualitative assessment through semi-structured interviews allowed a deepening of the doctor-patient relationship. Conclusions : Psychiatric disorders are prevalent and clinically significant in patients with COPD yet often remain underdiagnosed and undertreated. These findings highlight the importance of routine mental health screening and the implementation of integrated care strategies that address both respiratory and psychiatric needs. Such approaches have the potential to improve overall health outcomes and quality of life in this vulnerable patient population.
Objective : The primary aim of this study was to analyze the temporal trend and the histopathological and demographic characteristics of tumoral and non-tumoral bladder lesions diagnosed at the Pathology Department of the Bistrița-Năsăud County Emergency Clinical Hospital, Romania between 2018 and 2023. A secondary objective was to assess the impact of the COVID-19 pandemic on tumor diagnosis. Methods : We conducted a retrospective observational study including 279 cases diagnosed via bladder biopsy, transurethral resection of bladder tumor, and cystectomy. Variables such as age, sex, environment, intervention type, histopathological diagnosis, and TNM staging were collected. Statistical analysis was performed using Epi Info and Microsoft Excel, with a significance threshold set at p<0.05. Results : Invasive urothelial tumors were the most common (n=144 cases, 51.61%), followed by non-invasive urothelial tumors (n=95, 34.05%), non-tumoral lesions (n=31, 11.11%), and non-urothelial tumors (n=9, 3.22%). Most cases occurred in men (n=226, 81%), particularly in the 61–70 and 71–80 age groups. Non-muscle invasive bladder cancers (pTa, T1) were triple as frequent as muscle-invasive bladder cancers. Comparing the pre-pandemic/pandemic (2018–2020) and post-pandemic (2021–2023) periods, we observed a 88% increase in total diagnosed cases (p<0.0001) along with a significant rise in both non-muscle invasive bladder cancers (+70%, p=0.002) and muscle invasive bladder cancers (+106%, p=0.017), the latter showing a more pronounced increase. Conclusions : Our study provides a comprehensive overview on the impact that COVID-19 pandemic has had on the diagnosis of bladder lesions within Bistrița County area. The post-pandemic group exhibited a marked rise in both tumoral and non-tumoral lesions, as well as in the number of MIBCs, highlighting the effect of pandemic related restriction on patients care. Nevertheless, our results need further confirmation through future larger scale studies.
Introduction : Vaginal melanomas account for less than 3% of vaginal neoplasms and are characterized by poor prognosis. Case report : We present the case of a 65-year-old patient with a history of invasive breast carcinoma and BRAF-negative vaginal melanoma, showing positive immunostaining for S100, SOX-10, PRAME, and vimentin, who was referred to the Dermatology Clinic of Mureș County Clinical Hospital for an erysipelas-like skin reaction on the upper limb affected by chronic lymphedema secondary to axillary lymph-adenectomy. Clinical examination revealed diffuse melanosis cutis, acanthosis nigricans, and tripe palms. The patient also exhibited stigmata of Cushing syndrome, with a recent history of systemic corticosteroid therapy. Dermoscopy was performed and revealed dark brown, well defined, round macules on the genital mucosa, while the vaginal mass exhibited dermoscopic signs suggestive of melanoma. Conclusions : Clinical examination and dermoscopy are essential for patients with mucosal melanomas, as they can uncover details that are critical for creating a comprehensive picture.
Objective: This study investigates trust in health-related content sources on social media among Mureș County, Romania residents.
Renal cell carcinoma (RCC) represents the most common solid malignancy of the kidney, comprising a broad spectrum of histopathological entities. Advances in diagnostic imaging, histopathological classification, and minimally invasive surgical techniques have improved early detection and treatment options. However, renal cell carcinoma with sarcomatoid dedifferentiation remains a challenge due to its aggressive nature and resistance to systemic therapies. We report the case management of a 69-year-old male with a history of significant comorbidities diagnosed with an advanced right renal cell carcinoma cT3aN1M0 who underwent a laparoscopic radical nephrectomy (LRN) and lymph node dissection with minimal blood loss in 110 minutes of surgery. The patient’s postoperative recovery went well, with no significant complications. Histopathological results revealed a renal carcinoma with sarcomatoid and rhabdoid dedifferentiation staged as pT3aN1, with metastases identified in two out of four retrocaval lymph nodes. This case underscores the feasibility of minimally invasive surgery in advanced renal cancer and the prognostic implications of aggressive histological subtypes.
Recent evidence establishes robust causal relationships between autonomic nervous system dysfunction and ventricular arrhythmias through multiple converging mechanisms. Direct neural recording studies demonstrate that sympathetic discharge from the left stellate ganglion immediately precedes ventricular fibrillation. At the same time, mechanistic investigations reveal that nerve growth factor-mediated sympathetic sprouting creates heterogeneous innervation patterns, directly triggering arrhythmogenesis. Although genetic syndromes like Brugada syndrome show opposing patterns with parasympathetic dominance driving arrhythmic events, disease-specific autonomic patterns have emerged, with heart failure and post-myocardial infarction displaying sympathetic overactivation and parasympathetic withdrawal. Current predictive tools show significant advances, but implementation challenges persist. The most clinically validated method is meta-iodobenzylguanidine imaging, and when using standardized protocols, heart rate variability analysis shows dependable prognostic value. Therapeutic interventions reveal mixed clinical outcomes. While beta-blockers remain effective in reduced ejection fraction populations, questions regarding benefits in preserved ejection fraction patients persist. Stellate ganglion blocks show promise for managing electrical storms, achieving a 62% reduction in ventricular arrhythmias. However, major clinical trials have yielded disappointing results for spinal cord stimulation and cardiac sympathetic denervation. Future directions emphasize personalized medicine approaches integrating genetic data, advanced imaging, and artificial intelligence for biomarker-guided therapy selection, representing the next frontier in precision cardiology for arrhythmia management.
