The laboratory tests that should be performed and their frequency during isotretinoin treatment are controversial. We wanted to investigate muscle and joint pain and laboratory tests in acne patients who received isotretinoin. Between April 2019 and February 2023, serum CK, AST, ALT, and GGT levels were retrospectively evaluated in acne patients before and three months after systemic isotretinoin treatment. This study included 410 patients. The median serum AST, ALT, and GGT levels significantly increased, whereas serum CK levels were similar in all patients three months after treatment. 23 (5.6%) patients revealed muscle or joint pain after treatment. No significant difference was detected in patients with or without pain in the median serum CK, AST, ALT, and GGT levels after treatment. Isotretinoin treatment at a dose of 10 mg/day was more common in patients with pain than in those without pain, whereas none of the patients who received isotretinoin 40 mg/day developed muscle or joint pain. We suggest that routine evaluation of serum CK levels is unnecessary in acne patients treated with isotretinoin. However, muscle and joint pain may develop even at doses as low as 10 mg/day. Furthermore, monitoring AST, ALT, and GGT levels may be beneficial in acne patients treated with isotretinoin.
Background: Head and neck cancers, and particularly, oral cancers have a complex pathogenesis that includes genetic mutations and epigenetic alterations which interfere with cellular signaling and can trigger tumor development. The purpose of this study was to reveal whether low-frequency hotspot mutations may be detected in a study lot with histopathological evidence of squamous cell carcinoma (SCC) of the oral mucosa and skin of the head and neck. Methods: Tumor biopsies from treatment- naïve patients were tested for BRAF V600, NRAS G12/G13, NRAS Q61, KRAS Q61 mutations, and EGFR exon 19 deletions (Ex19Del) using droplet digital PCR (ddPCR). The tumors were also analyzed for EGFR T790M mutations by RT-PCR, using a CE-IVD validated kit, with a limit of detection of 0.05%. Results: None of the examined cases exhibited NRAS G12/G13, NRAS Q61, KRAS Q61, BRAF V600, or EGFR T790M mutations, indicating that these alterations are rare events in SCC pathogenesis. Interestingly, among the 12 specimens tested by ddPCR for EGFR Ex19Del, an HPV-negative cSCC tumor occurring in the parotid region tested positive for this drug-sensitizing mutation, offering unexplored therapeutic perspectives to the patient from whom it was collected. Conclusions: Our study highlights the important clinical implications of detecting low-frequency hotspot mutations in tumor biopsies by ddPCR. We believe that the ddPCR-assisted analysis of these mutations in larger SCC cohorts may provide us with mechanistic insights regarding their role in SCC pathogenesis and guide the development of novel therapeutic strategies for this problematic disease.
This study investigates the influence of experience on stress responses and fine motor skills among professional male military parachutists. We analyzed 132 paratroopers, divided into a non-experienced group (NEG; ≤6 parachute jumps) and an experienced group (EG; >50 jumps). Baseline samples were collected 2.5 hours before participants performed a 500 m jump, with post-jump evaluations conducted immediately after landing. Results indicated that experience significantly influences fine motor skills and stress responses. Non-experienced jumpers showed greater degradation in fine motor skills and higher cortical arousal pre-jump levels, suggesting an increased anticipatory state. In contrast, experienced parachutists maintained more consistent fine motor skills and exhibited a ceiling effect in stress response. Leg strength was higher in non-experienced jumpers, reflecting youth and greater muscle mass, with no significant difference in hand strength. These findings highlight the role of experience in managing stress and maintaining motor skills under pressure. The study suggests further exploration into psychological aspects like motivation and resilience, along with the long-term effects of stress exposure. The importance of experience in high-stress military operations emphasizes the need for targeted training interventions to enhance stress-coping mechanisms in less experienced individuals.
The rise of antimicrobial resistance poses a significant challenge to global health. This study investigates the antimicrobial properties of Taraxacum officinale and Chelidonium majus. Taraxacum officinale, commonly known as dandelion, has been utilized for centuries in traditional medicine for its various therapeutic benefits, including treating cholecystitis, enhancing hepatic function, regulating blood pressure and cholesterol levels, and exhibiting diuretic effects. Additionally, research has indicated that infusions derived from this plant offer favorable outcomes in managing renal diseases. This study aims to assess the antimicrobial activity of extracts from Taraxacum officinale and Chelidonium majus employing qualitative screening, quantitative determination, and in vitro evaluation of anti-biofilm properties. In vitro evaluation of the antibiofilm activity of plant products revealed their ability to inhibit the development of biofilms on inert substrate; plant extracts of C. majus were found to inhibit biofilm formation in all bacterial strains tested, while tincture of T. officinale showed very good activity on gram-negative and fungal strains. The results obtained are promising, supporting further research into the biochemical characteristics of these extracts in order to formulate strategies for the control of bacterial and fungal infections in humans.
Background: The deficit of medical staff in various health care systems points out the need for a more detailed strategic management toward sustainability in human resources. The purpose of this study is to explore the relationships linking self-esteem, self-efficacy, general attitudes, and career preferences among medical students, aiming to provide insights that could support sustainable career development. Methods: We performed a monocentric observational study that included 157 students. The participants completed four standardized questionnaires evaluating the self-efficacy, the self-esteem, the general attitudes and beliefs, and the perception of medical career specialty. We assessed the relationships between the psychological variables and career preferences. Results: Significant correlations emerged between the students' year of study and the need for achievement, the importance of mentorship, and career decision-making. Clinical students, in particular, placed greater emphasis on gaining practical experience in their chosen field. Conclusions: Our results reaffirm the impact of occupational psychology in the health care system, providing more sustainability in career decisions. Further research involving larger and more diverse samples is recommended to gain a more comprehensive understanding of how the study of various psychological factors could impact human resources management in the field.
Combat medics must deploy multiple cognitive, manual, and social skills to perform efficient life-saving interventions and ensure the safe transportation of casualties. In 2021, the Tactical Medical Training Cell of the Belgian Army introduced an immersive and integrative educational program for Advanced Emergency Medicine Technicians (EMTa) certification. This study aims to provide a correlational analysis of performance outcomes during the certification period. While conducting their assessment, candidates were evaluated in three different but complementary roles: Medical Leader (ML), Medical Practitioner (MP), and Tactical Leader (TL). The individual outcomes in theoretical and practical examinations of one hundred thirty-seven candidates were collected during 2021 and 2022. The mean success scores for the theoretical and total practical examinations were 90.6% and 80.1%, respectively. Candidates scored significantly better as TL. Theoretical results were significantly correlated with the ML function, and performances in all three positions were correlated with each other. This study showed that within the combat medic team, individual performances, even if initially well-defined, were associated with the success rates of the other positions. This finding should be considered in the further consolidation of combat medic education.
Effective communication is essential in healthcare, prompting the inclusion of communication courses in medical education. However, the effectiveness of such courses for Romanian medical students has not been evaluated. This pilot study investigates the impact of an ethical communication course on Romanian medical students' communication self-efficacy, communication skills, and the perceived importance of communication. Students attended a 3-month course on ethical communication, covering active listening, assertive communication, conflict management, non-verbal communication, patient- centered care, and ethical considerations in various medical fields. The course was developed based on the European Psychiatric Association guide regarding ethical aspects of communication with patients and their families. The data were analyzed on a sample of 24 students who completed the questionnaires at pretest and posttest. Students reported higher levels of medical communication self-efficacy and perceived importance of medical communication after the course. However, no statistically significant differences were found in health professionals’ communication skills. Future courses should include more patient interactions and varied teaching methods. Further research with larger samples and control groups is needed.
Gliosarcoma is a rare and aggressive variant of glioblastoma, characterized by both a malignant glial component and a mesenchymal sarcomatous component. Gliosarcomas have genetic alterations with glioblastomas, including TP53, PTEN mutations, and EGFR amplification, but may also exhibit additional changes related to epithelial-mesenchymal transition pathways. Management is similar to glioblastoma, involving safe, maximal surgical resection followed by radiotherapy and chemotherapy with temozolomide, but the prognosis remains poor, with a median survival of 6-14 months. Both Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) play crucial roles in the detection, characterization, and treatment planning of gliosarcoma. While MRI is the gold standard, CT remains valuable in certain situations. Light microscopy is essential for definitive diagnosis, allowing pathologists to examine cellular morphology and tissue architecture. It is essential for distinguishing gliosarcoma from other high- grade gliomas and for guiding treatment decisions. In addition, two-photon excited fluorescence (TPEF) microscopy is an advanced optical imaging technique that enables real-time, high-resolution visualization of tumor tissue without the need for staining or contrast agents and enhances visualization of collagen structure and vascularization, key factors in gliosarcoma assessment. The study of radiological and histopathological (light microscopy) features in primary gliosarcomas of the brain is a priority to achieve an early diagnosis that can be translated into better outcomes. Here, we describe the radiological and histopathological features observed in multiple cases of gliosarcoma in current practice.
This study analyzes the contribution of Computed Tomography (CT) in the detection and characterization of ovarian tumors, particularly malignant ones, to enhance the accuracy of preoperative diagnosis and postoperative follow-up, thereby optimizing therapeutic planning. This paper presents a retrospective study conducted on a group of 63 patients with ovarian tumors who were operated on at the Department of Gynecology of the Central University Emergency Military Hospital "Dr. Carol Davila" in Bucharest. The patients were investigated preoperatively using Computed Tomography to characterize the ovarian tumors and assess the sensitivity and specificity of the imaging diagnosis. Computed Tomography utilizing new multidetector technologies (MDCT) provides superior characterization of adnexal masses, with a sensitivity of at least 90% and a specificity of 80%. This imaging modality is recommended for the preoperative staging of ovarian cancer.
Multiple sclerosis (MS) is an autoimmune disease in which the myelin sheath is damaged by the body itself. Because of the symptoms and progressive forms, in most cases, patients experience recurrent depressive disorder or anxious depression disorders. Depression treatment for MS patients stands in two categories, one is psychotherapy and the other is pharmacological. This article presents the research results on customized pharmacological treatment schemes applied to a group of relapsing-remitting multiple sclerosis (RRMS) patients with moderate, or severe, depression. All of them are included in the national treatment program for multiple sclerosis and their health state is continuously monitored. The therapeutic scheme based on four different antidepressants had encouraging results, meaning that any of the antidepressants used is efficient and with the patient's good tolerance. There were no side effects that could determine interruption of the treatment. Further research development would focus on improved therapeutic plans for patients with depression disorders in relapsing-remitting multiple sclerosis.
