Acute myocardial infarction (AMI) is a multifactorial condition and a leading cause of morbidity and mortality worldwide. This study aimed to assess the distribution of clinical and demographic characteristics among AMI patients and compare these findings with data from the RO-STEMI program for the Romanian population. We performed a case-control analysis of 138 patients presenting with chest pain at the Emergency Department of “Dr. Carol Davila” Central Military Emergency University Hospital between November 2021 and April 2022. The AMI group (n = 69) included patients with STEMI-specific ECG changes and elevated cardiac biomarkers, while the control group (n = 69) was represented by patients with chest pain but normal ECG and biomarkers. Men with AMI were 8.66 years younger than women, exceeding the 6.51-year difference reported by RO-STEMI. Hypertension and dyslipidemia were strongly associated with AMI (OR = 8.20 and OR = 7.36, p < 0.0001). During the pandemic, early presentation (<6 h) decreased by 15%, while arrivals within 6–12 h increased by 19.02%. Primary percutaneous coronary intervention was performed in 81.16% of cases versus 12.94% previously. Killip class and reduced left ventricular ejection fraction correlated with mortality and hospitalization duration. These findings indicate significant changes in AMI onset age, treatment strategies, and presentation delays compared to pre-pandemic data.
Background: COVID-19, declared a Public Health Emergency of International Concern, affected hospital operations by increasing the number of patients presenting to hospitals, the necessity to control infections, and the shortage of staff. Through our study, we evaluated the quality and quantity of care and how these changes affected patient experience and outcomes, and we identified actionable methods in order to prepare for the future. Methods: We analyzed data between 2020 and the first half of 2023 from a Romanian tertiary military hospital using patient-reported experience surveys and operational indicators (readmissions, postoperative complications). Associations were assessed using Pearson and Spearman correlation coefficients. We then benchmarked against an ideal surge-ready hospital using a 0-1 Composite Risk Index (CRI) that integrates occupancy, adverse-event density, flow reliability, and readmissions. Results: Overall satisfaction was strongly influenced by satisfaction with medical care (p < 0.001). Higher overall satisfaction was associated with fewer readmissions. Benchmarking showed the highest risk in the ICU, intermediate in Surgery and Internal Medicine, moderate in the ED, and the lowest in the Ambulatory. Satisfaction was highest in the initial period of the COVID-19 pandemic, dropped in 2022, and showed partial recovery at the end of this period. Conclusions: Quality of care is a critical measure of hospital performance, especially in the context of the COVID-19 pandemic. Patient feedback revealed areas of good practice and also the limits of the system, influenced by the burden of multisystem disease and limited resources. Post-COVID-19 disability outcomes are strongly influenced by the quality and continuity of care. Systematic use of patient- reported outcomes, standardized evaluation, and adaptive rehabilitation is essential to preserve the quality of care and reduce long- term functional impairment.
Background and purpose: Colorectal cancer is one of the most prevalent cancers globally, representing a significant public health challenge. Treatment methods include surgery, chemotherapy, and targeted therapies, selected based on disease stage and patient status. Common cancer treatments, such as chemotherapy and radiation therapy, often induce considerable side effects, including fatigue, nausea, hair loss, and blood disorders, which can impact patients' quality of life. Consequently, researchers are focusing on developing novel drugs and targeted therapies aimed at reducing side effects while enhancing treatment efficacy. Innovative therapies, including bacterial and oncolytic viruses, can specifically target cancer cells while sparing healthy tissues. The present study aims to compare the cytotoxic effects of Lactobacillus casei extract with Newcastle disease virus on human colorectal cancer. Materials and methods: Human colorectal cancer cells were cultured and treated with various concentrations of Lactobacillus casei extract and Newcastle disease virus to determine the IC50. Cell viability and apoptosis rates were then assessed using MTT assay and acridine orange/propidium iodide staining. Statistical significance was set at P<0.05 for all evaluations. Results: The results demonstrated that both Lactobacillus casei extract and Newcastle disease virus significantly reduced cell viability and increased apoptosis in a concentration- and time-dependent manner. Caspase-8 and -9 activity measurements indicated that Newcastle disease virus and Lactobacillus casei extract activated both the mitochondrial and extrinsic apoptotic pathways. Conclusion: Based on the findings, it appears that bacterial and oncolytic viruses could be considered as complementary therapeutic options alongside chemotherapy and radiotherapy, following clinical trials.
Knee osteoarthritis (KOA) is a chronic, degenerative disease that affects not only the bone and cartilage but also all periarticular soft tissues. Transcriptomic investigations in osteoarthritis have recently advanced due to the introduction of RNA sequencing, which has been used to elucidate significant molecular differences between groups of patients with KOA. A total of 29 patients with knee pain were selected and divided into two groups. Group 1 comprised 26 patients, who were diagnosed with stage four KOA according to the Kellgren and Lawrence (KL) classification and were scheduled for total knee arthroplasty. Group 2 consisted of three patients who constituted the control group. The main objective of this study is to analyze gene expression in suprapatellar synovial tissue using the RT-PCR technique in patients with knee osteoarthritis. The promising results of gene expression analysis highlight the complex transcriptomic profile of synovial tissue in patients with stage IV KL KOA who required TKA after conservative treatments failed. The analysis of the expression of four genes indicates that compensatory mechanisms are either insufficient or exhausted due to the chronic proinflammatory status. Pro-inflammatory transcription factors (JUN, MYC) and feedback regulators (DUSP1, NFKBIA) require extensive clinical trials for the use of disease-modifying drugs.
Many patients, usually over 60 years old, presenting presenile dementia associated with marked gait disorders, impaired balance, urinary incontinence, have been shown to have enlarged ventricles associated with relatively small cortical atrophy. Intracranial pressure monitoring indicates normal values, or subject to only minor peaks, usually at night. Because some of these patients improve markedly after ventricular shunting procedures it has been suggested that their neurological dysfunction may be caused by a pressure effect on the brain from the increased internal surface of the ventricles. Many of these patients do benefit from surgery, and a lot of them have a history of subarachnoid hemorrhage, traumatic brain injury or meningitis which might have impaired the CSF absorption.
Chronic pancreatitis is characterised by progressive and irreversible damage of the pancreatic parenchyma and ductal system, which leads to chronic pain, loss of endocrine and exocrine functions. Clinically, pancreatic exocrine insufficiency becomes apparent only after 90% of the parenchima has been lost. Despite the simple definition, diagnosing chronic pancreatitis remains a challenge, especially for early stage disease. Because pancreatic function tests can be normal until late stages and have significant limitations, there is an incresing interest in the role of imaging techniques for the diagnosis of chronic pancreatitis. In this article we review the utility and accuracy of different imaging methods in the diagnosis of chronic pancreatitis, focusing on the role of advanced imaging (magnetic resonance imaging, endoscopic retrograde cholangiopancreatography and endoscopic ultrasound).
Autoimmune cholangitis defines a spectrum of cholestatic liver diseases that are characterized by inflammation of bile ducts and a reasonable response to immunosuppressive therapy. The two most common diseases associated with this term in the literature are: an overlap syndrome of primary biliary cirrhosis and autoimmune hepatitis and a form of hyper IgG4 syndrome (currently associated with autoimmune pancreatitis). Liver biopsy is mandatory for the diagnosis. There are, whatsoever, in clinical practice, many cases that do not meet current diagnostic criteria but that have a good response to corticosteroid treatment.
Introduction: The infection caused by H. pylori appears secondary after a bacterial colonization of the stomach and the initial portion of the small bowel. H. pylori –infected patients can develop gastritis, peptic ulcer, stomach cancer or MALT lymphoma. H. pylori infection is defined by WHO like a type I carcinogen, its role in gastric carcinogenesis being supported by the greatest researchers. Objectives: In this study our purpose was to determine the endoscopic appearances in H. pylori infection quoted in medical literature until now and the frequency of their appearance in our group of interest. Materials and methods: In this study it was made an analytic study in which it was realized a retrospective cohort investigation at the Emergency Central Military and University Hospital “Dr. Carol Davila” Bucharest, gastroenterology branch –endoscopic department between 18.12.2012- 21.08.2013 on 1694 patients between 18 and 92 years old, with the medium age of 55 years old. As a diagnostic method for H. pylori infection we used superior digestive endoscopy during which were taken biopsies and it was made a fast urease test. Results: Regarding the variation of the endoscopic aspects at the population of study, we have found gastritis with all its aspects (which was Sidney classified) in the biggest percentage meaning 59.3% of the cases, followed with a percentage of 18.8% by those without any endoscopic abnormality, and then in 10,33% of the cases we have found peptic ulcer. With a smaller percentage, under 10%, we have found duodenitis at 8.67% of this patients, and finally the most severe lesions represented by gastric cancer and lymphoma were found at 2,7% of the H.pylori infected patients.
Background: Neuroendocrine tumors of the pancreas (NTP) comprise a unique and relatively rare group of tumors, of which gastrinoma and insulinoma are the most common types. Insulinomas tend to be small, solitary and benign, with surgical resection curable in most cases. Introduction: Insulinomas are localized preoperatively using conventional imaging studies as transabdominal ultrasonography (US), computed tomography (CT), and/or magnetic resonance imaging (MRI). Purpose: Endoscopic ultrasound (EUS) is a valuable tool in the diagnosis of insulinomas. Goals & methods: We performed a retrospective study on 21 patients with insulinoma (6 male and 15 female, 25 to 73 years of age), who were hospitalized and operated on between 2003 and 2012 at “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest. Results: US view was positive in 10% of patients (2 of 20), that presented proximal location. The sensitivity of CT was unsatisfactory, 21.05% (4 positive results of 19). CT failed to detect liver metastases, but identified nodal metastasis in one patient. MRI was performed in 18 patients and was diagnostic in 11 of them, recording a detection sensitivity of 61.11%, including infra- centimetric tumor size. EUS has a high resolution which allows detection of lesions with very small diameter is safe and minimally invasive. EUS was performed in all patients, being able to identify formations in 17, was inconclusive in 3, showing a diagnosis sensitivity of 81%. Liver metastases were demonstrated in 3 patients, one by US and all 3 by MRI. Conclusions: - CT with intravenous iodinated contrast agent had a poor sensitivity in detecting the primary tumors, was insensitive in detecting liver metastases, but showed metastases in lymph nodes. - MRI has higher sensitivity than CT in detecting primary tumors, including insulinomas with infracentimetric size, and is the imaging test of choice for possible liver metastases. - EUS is the preoperative imaging test of choice.
