Pheochromocytomas are rare neuroendocrine tumors that frequently have genetic involvement and can present a particular risk in terms of the anesthetic-surgical procedure. Current worldwide medical recommendations state that laparoscopic adrenalectomy is the conventional treatment for pheochromocytoma, however, the ideal surgical strategy is still being developed as specialized surgeons gain experience with these rare tumors. The study's purpose was to thoroughly evaluate our film library and identify the best surgical steps that represent our standardized procedure. We developed a comprehensive set of surgical critical strategies for either a left or right adrenalectomy, providing helpful advice on patient positioning, port placement, the adrenal gland approach, as well as other surgical methods specifically designed for tumor mobilization and dissection. The current paper aims to synthesize our clinical experience in terms of preoperative preparation, patient positioning, intraoperative complications, causes of conversion, and specimen extraction. The main conclusions concern both the best surgical approach and the importance of surgical experience in the clinical management of these rare tumor types.
Angiosarcoma is a malignant tumor derived from the endothelium of the blood and lymphatic vessels. Its aggressive behavior results in a poor prognosis for the patients. Radiation-associated angiosarcoma is a rare recently described particular subtype of angiosarcoma best shown in patients after treatment of breast cancer. The latency period of development is approximately 8 years, thus the 5-year standard follow-up after mammary neoplasm therapy needs to be extended up to 10 years. Radiotherapy is an independent risk factor for angiosarcoma development. Rapid diagnosis is essential for prompt therapeutical intervention to improve the patient’s prognosis. The importance of early diagnosis is emphasized by a case of a 54 years old woman, with a diagnosis of breast cancer treated by sectorectomy and radiotherapy 7 years prior, presenting to our Dermatology Department for the recent occurence of erythemato-violaceous cutaneous patches on the area subjected to radiotherapy.
Gastric mesenchymal tumors are a pathology that is increasing in incidence in recent years but the treatment is not yet standardized. The laparoscopic approach to these lesions is a modern option, with the patient benefiting from the advantages of minimally invasive surgery. Methods: We included in the study 4 patients operated laparoscopically for suspicion of gastric GISTs between Mars 2019 and May 2022. From a prospectively kept database, we extracted the following characteristics: age, sex, length of postoperative hospital admission, operation time, tumor location, tumor size, histopathological assessment of resection margins, intraoperative blood loss, and incidence of postoperative complications. Results: Average tumor size was 4.3 cm, ranging from 4 to 6 cm. Laparoscopic wedge resection was possible in all cases. There was no conversion, no episode of tumor rupture or spillage, and no major intraoperative complications. Histology confirmed a GIST in 3 of 4 cases. In one case histological workup showed gastric schwannoma. Conclusion: Laparoscopic wedge resection for gastric stromal tumors, even larger than 5 cm, appears to be safe and feasible in selected patients, with acceptable operative time and oncological outcome after an intermediate follow-up. More important than the size of tumors that are approached laparoscopically is their location and the possibility of a stenosis-free resection.
Background: The prevalence of smoking among students is a growing concern, particularly among medical students. Being associated with stress, competitiveness, and various social influences, smoking can have detrimental effects on self-esteem and self-efficacy and may create a vicious cycle that may contribute to student’s well-being and academic performance outcomes. We aimed to investigate the relationship between self-esteem, self-efficacy, and smoking habits among medical students and their sociodemographic correlates. Methods: A cross-sectional study on 456 medical students was conducted via an online survey using structured questionnaires on socio-demographic characteristics, smoking habits, nicotine dependence, self-esteem, and self-efficacy. Results: The prevalence of smoking was 31.1% The scores of self-esteem and self-efficacy were positively correlated with smoking habits (W1=0.957, W2=0.975, P<0.05). Students presented rather low smoking addiction with male students having slightly higher scores than female students on self-esteem and self-efficacy, military students had higher self-esteem scores than civilians with physical activity having a positive correlation with non-smoking behavior. Conclusion: According to our results, self- esteem and self-efficacy were slightly positively correlated with smoking habits. Furthermore, there was no statistically significant association between other social factors and smoking. Our results may develop a theoretical basis for medical students’ psychological variables studying for further implementation of university educational programs and preventive interventions empowering students towards an overall better quality of life, addressing, among others, smoking behaviors.
Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections and an important cause of morbidity and mortality worldwide. The objective of the study was to identify the predictive factors for unfavorable evolution and deaths among patients with CDI. Materials and methods: We conducted a retrospective, observational, non-randomized study on 202 patients diagnosed with CDI in the Clinical Emergency Hospital of Bucharest, Romania, for a period of two years. For the statistical analysis, the R program was used, with p-values <0.05 being considered statistically significant. Results: The average age of the patients included in the study was 70.8 years, the average duration of hospitalization was 18.4 days, and the mortality rate was 25.7%. During the follow-up period, only 5% of the patients presented a recurrence of CDI. Multiple binomial logistic regression defined as independent risk factors for death among CDI patients: advanced age, comorbidities such as chronic obstructive pulmonary disease (p=0.008), chronic kidney disease (p=0.007), or COVID-19 (p=0.036), leukocytes ≥ 16,755/mm3 (p=0.009) and serum albumin < 2.83 g/dL (p<0.001). Conclusions: The identification of certain negative prognostic factors in patients with CDI requires a careful follow-up of the patients, for an early identification of complications and adaptation of therapeutic management.
Background: The effect of stress on sympathetic modulation measured by HRV has been studied in various population groups exposed to different stressors. HRV measurement tools are based on the electrocardiogram (ECG), portable tools such as POLAR V800, and recently photoplethysmography (PPG). The aim of this study was to analyze the validity of a PPG mobile app to measure HRV with a validated V800 system in a tactical athlete population. Methods HRV of 53 professional militaries were analyzed by POLAR V800 and an HRV Camera app with a smartphone during 5 min and 30 s protocol respectively. Results: The HRV values obtained by the PPG presented a significant negative significant correlation in the HRVI index, LF, HF, LF (n.u.), HF (n.u.), and a positive significant correlation in TINN index by the Polar V800 system with the application of a regression equation over the data obtained. Conclusions: HRV Camera PPG App 30s record analysis protocol could be applied using a regression formula depending on the HRV variables after the comparison with a standard 5-minute test conducted with a validated Polar V800. In future research, it is suggested to validate PPG protocols with longer durations.
A multipurpose hall designed for CBRN (Chemical, Biological, Radiological, and Nuclear) purposes plays a vital role in enhancing preparedness, response, and recovery capabilities in the face of CBRN incidents. A multipurpose hall for CBRN purposes provides a dedicated and specialized environment to support CBRN preparedness, response, and recovery efforts. It enhances coordination, facilitates training and exercises, ensures proper equipment storage, and fosters collaboration, ultimately strengthening the ability to protect personnel, mitigate risks, and minimize the impact of CBRN incidents. This study is qualitative research based on the content analysis method. To design and build multipurpose halls for CBRN events, this study can be used as a checklist. The purpose of this study is to collect important factors and sub-factors in the design, construction, and equipping of buildings and multi-purpose CBRN structures.
Background: As total hip replacement cases increase year after year, registry-wide data becomes increasingly important in order to assess pathology distribution, reimbursement efficiency as well as physician performance. In order to assess all these factors patient evolution needs to be documented after surgery as well, but the main impediment to doing this is losing patients to follow-up. For this reason, the present study aims to perform a descriptive analysis of the hospital’s internal registry data as well as to determine what percentage of patients can be expected to return to follow-up after total hip replacement. Methods: A query of the hospital’s internal registry data in the last years was performed. Patient demographics, county distribution as well as ICD-10 code usage were documented. Data standardization was performed to determine the probability and cumulative distribution of the patient’s age. The chi2 test of independence was used to assess whether there is a correlation between the patient’s gender and ICD-10 codes. Pot hoc power analysis was performed to assess the accuracy of correlation analysis. Results: Only 29.6% of the patients undergoing total hip replacement are from the county within which the hospital is located. 25% of the patients were under 60 years old. Conclusions: Current registry data reveals that most patients undergoing total hip replacement are around 67.5 ± 11 years old, suffer from unilateral or bilateral primary or secondary hip osteoarthritis and only 29.6% of them are likely to return to follow-up.
Background and Objectives: Chronic Kidney Disease (CKD) affects 6,7% of the adult population in Romania and is associated with high morbidity. About one out of three adults with diabetes has kidney disease. According to current literature data, the prevalence of diabetes is very high, up to 11,6%, of whom 2,4% had undiagnosed diabetes, and is the leading cause of kidney damage and the need for renal replacement therapy (RRT). COVID-19 has brought with it a lot of unanswered questions, regarding the risk factors, the disease evolution, and the treatment possibilities. It became clear that diabetic kidney disease (DKD) is among the independent risk factors that predict unfavorable outcomes upon SARS-CoV-2 infection, so we aimed to evaluate the characteristics of diabetic and non-diabetic dialyzed patients, COVID-19 positive. Materials and Methods: It is an observational, single-center study that analyzed type 2 diabetes mellitus and non–diabetic patients in maintenance hemodialysis hospitalized for SARS CoV-2 infection. Results: A total of 101 adult dialyzed patients were admitted with a SARS-CoV-2 RT-PCR positive test, out of which 42 had a long history of diabetes mellitus type 2 and 59 of them have been known with other etiologies of CKD. Hypertension and heart disease were the most commonly associated comorbidities. Inflammatory markers and anemia were significantly increased in diabetic patients compared to non-diabetic. Conclusions: We found that anemia was more severe in patients COVID-19-positive MHD T2DM patients.
Chronic inflammation and immunosuppressive treatment may play a role in the etiopathogenesis of cancer in psoriasis patients. We wanted to evaluate the Papanicolaou smear (Pap smear) results of female patients with psoriasis which were performed for cervical cancer screening before the initiation of biological agent treatment. Between April 2019 and November 2021, Pap smear results of female patients with psoriasis were reviewed retrospectively. This study included 70 female psoriasis patients with a mean age of 48.41±11.62 years. 49 (70%) patients were biologically naive, whereas 21 (30%) patients previously received biological agents. Obscuring inflammation was reported in 33 (47.1%) patients. Atrophy, intermediate cell predominance, reactive cellular changes due to inflammation, and both atrophy and reactive cellular changes were detected in 15 (21.4%), 7 (10%), 3 (4.3%) patients, and 1 (1.4%) patient, respectively. No malignancy or intraepithelial lesion was observed in 69 (98.6%) patients, whereas atypical squamous cells of undetermined significance were reported in 1 (1.4%) patient. Infections such as bacterial vaginosis, candidiasis, and actinomycosis were detected in 13 (18.6%) patients. Pap smear tests should be performed in female psoriasis patients to detect premalignant lesions of the cervix before the initiation of biological agent treatment. Moreover, psoriasis treatment guidelines should be updated accordingly.
