Article type: Original Research

Management of hepatitis C virus (HCV) infection: an update

Million people worldwide are affected by the hepatitis C virus (HCV). The highest incidence of illness was between 1945 and 1975. It was also estimated that 70% of those people were not tested for the disease. Most recent treatment concepts are safe, highly effective and have a vital public health influence by achieving a viral constant response in a significant proportion of treated patients. It helps reduce liver fibrosis, liver cancer risk and dissemination. With its increased population incidence, HCV becomes a serious public health problem. This review discusses the current literature in this field in terms of the importance of screening of HCV, follow-up, treatment and includes considerations in specific populations such as patients with cirrhosis, with HIV/HCV co-infection, patients with HBV/HCV co-infection and with renal damage.

Exploring of clinical decision making in care of patients with acute care in critical nurses: A qualitative content analysis

The appropriate clinical decision-making of the nurses can improve the patient outcome and reduce costs, otherwise delaying the recovery and preferably the death of the patient especially in acute care setting. The aim of this study was to describe the clinical decision making in care of patients with acute care in critical nurses. This study was a qualitative study conducted in 2020. Purposive sampling was used and continued until saturation. The study involved sixteen semi-structured interviews were conducted with critical nurses who had experience providing care for acute patients in critical care units. Interviews transcript and analyzed by qualitative content analysis. Two major themes were generated from the data included instantaneous decision-making and life-saving of the patient. This process was depended on the nurse’s ability to summarize in the moment, to consider everything, to focus on the patient, to combine experience and knowledge, to concern the patient's life, to prevent the deterioration of the patient's conditions and responsibility to their patients.

Ego-strength mediates the relationship between religious health behaviors and mental health symptoms during the COVID-19 pandemic in Iran

The present study aimed to examine the mediating role of ego-strength in the relationship between religious health behaviors and mental health symptoms during the COVID-19 pandemic in Iran. A total of 346 university students (301 women, 45 men) completed the Ego-Strength Scale, Religious Health Promoting Behaviors Inventory, and Mental Health Inventory from May 2021 to August 2021. The structural equation modeling and the Pearson correlation method were used. The results revealed that religious health behaviors have a positive and significant relationship with, psychological well- being, and ego-strength, as well as a negative significant relationship with psychological distress. The results also showed ego-strength has a negative relationship with psychological distress. Ego-strength mediated the relationship between religious health behaviors and symptoms of mental health. Ego-strength can be considered as a very important variable in religious health psychology; reinforcing ego-strength may have some implications for mental health during the Covid-19 pandemic.

Evaluation of muscle atrophy after sciatic nerve defect repair – experimental model

Peripheral nerve injuries are one of the most important causes for disability generating considerable costs around the world. Appropriate assessment of the extent of peripheral nerve lesions and the choice of the right therapeutic protocol remain some of the biggest challenges. Non-invasive neuroimaging approaches are suitable in managing peripheral nerve repairs, providing in the same time accuracy details in structural neural detection, with minimal discomfort at a low cost. Medical imaging technology development has led to progress in examination of peripheral nervous system, using a series of tools and methods, such as: ultrasonography (US), positron emission tomography (PET), magnetic resonance imaging (MRI) and magnetic diffusion tensor imaging (DTI). In this study, we evaluated the regeneration process in Wistar rats after sciatic nerve defects repair with 4 different techniques (i.e. nerve graft, rat aorta used as a nerve conduit, rat aorta filled with platelet rich plasma (PRP) and rat aorta filled with stem cells) by using MRI investigation alongside the clinical evaluation. Our results showed that among the 4 batches, the PRP batch had the best results in muscle atrophy condition (both on MRI scan and on gastrocnemius index); on the second place the stem cell batch, then the nerve graft batch and finally the aortic conduit batch. MRI proved to be a reliable non-invasive monitoring method and showed good result in correlation with the footprint test (sciatic functional index) and the gastrocnemius index.

Costs for a hospital stay: another lesson learned from the COVID-19 pandemic

Background and aim: After two years of pandemic, planning and budgeting for use of healthcare resources and services is very important. Inpatient COVID-19 hospitalizations costs, regardless of ICD-10 procedure codes, in a Covid-19 support military hospital were analyzed. Methods: The national protocol for the treatment of Covid-19 infection was applied. The costs for laboratory tests, drugs, protection equipment and radiological investigations (imaging techniques such as computed-tomography or radiography), hospitalization days and food were assessed. Results: In our hospital, from August 2020 through June 2021, 241 patients were hospitalized with COVID-19: mean age 59.92±7.8 years, 46% men, 26% military personnel, 11.57±3 days of hospitalization; two third of patients had moderate and severe forms of COVID-19. The main manifestations were: 69% respiratory (18% with severe pneumonia), 3.3% cardiac (2.9% with pulmonary embolism, diagnosed by computed tomography angiography), 28% digestive and 33% psychiatric (most commonly anxiety). The average estimated costs were about 3000€/patient, without significant differences based on disease severity. Equipment costs were 2 times higher than for drugs and 3 times than for laboratory tests. Conclusions: In a Covid-19 support military hospital that cared for patients with predominantly moderate forms of COVID-19, the costs for equipment were much higher than those for treatment. New criteria for hospitalization of these forms of COVID-19 deserve to be analyzed in order to avoid useless costs.

Basosquamous carcinoma: an overview of actual protocol and the importance of basal and squamoid components

Due to its scarcity, the basosquamous carcinoma represents a challenging pathology both as a result of its aggressiveness and potential of relapse and metastases, and also due to unclear management guides. Encountered under the name of basal cell carcinoma or metatypical carcinoma, the pathophysiology of such tumors is still unclear and it is not known yet if it either derives from a basal cell carcinoma or it could be a variant of transition to a squamous cell carcinoma. Due to low incidence, unclear treatment protocols and not enough research regarding squamous component in the aggressivity of basosquamous carcinoma, the aim of this paper is to analyze histopathological features of 5 cases of basosquamous carcinoma from Plastic Surgery Department of Emergency University Hospital, Bucharest, and correlate them with current literature.

Analysis of COVID-19-related psychiatric disorders – clinical manifestations and therapeutic considerations

During the COVID-19 pandemic, neuropsychiatric disorders have been diagnosed both in the acute phase, and in the aftermath of this disease. Inpatients, as well as outpatients recently diagnosed with mild, moderate or severe forms of Coronavirus infection have reported neuropsychiatric manifestations with variable duration, symptoms that could be directly or indirectly related to the viral pathogenic agent. Patients who are recovering from the acute phase of COVID-19 also may exhibit various psychopathological manifestations, during the so-called “post-COVID-19 syndrome” or “long COVID-19 syndrome”. Explanations regarding the onset of this type of clinical manifestations and the SARS-CoV-2 infection are extremely diverse, ranging from biological factors (e.g., direct central nervous system viral activity, cerebral hypo- oxygenation, high level of inflammatory response) to psycho-social stressors (e.g., isolation, fear of death, anxiety related to possible somatic complications or sequelae). Objectives: The primary objective of this article was to analyze psychiatric manifestations in patients with acute COVID-19 disease and in patients during post-COVID-19 phase. The secondary objective was to propose a conceptual framework for the evaluation and treatment of these patients. Methods: Patients included in this analysis were screened positive for COVID-19 infection in the last 6 months before their first psychiatric examination. These patients were further evaluated to detect any personal history of psychiatric disorders, somatic comorbidities, or significant concomitant pharmacological treatments. Specific scales for the measurement of symptoms severity and functional impairment were administered in all patients. Results: Five patients were included in this analysis, one during the acute phase of COVID-19 infection, and four patients were evaluated after the complete remission of this disease. Hyperactive delirium, mild neurocognitive disorder, major depressive episode, panic disorder with agoraphobia, or acute psychotic disorder were the main diagnoses in these patients. All patients received adequate treatment and they were monitored using psychological scales until symptoms remission or stabilisation. Conclusions: Psychosocial stressors, neurobiological changes, systemic inflammatory reaction, and individual vulnerability factors may contribute to a diathesis- stress model for psychiatric disorders onset within the acute phase or after the remission of acute manifestations in COVID- 19-diagnosed patients.

A brief overview of the Epstein Barr virus and its association with Burkitt’s lymphoma

Epstein Barr virus (EBV) is known as an oncovirus and associates with several human malignancies such as Burkitt's lymphoma, other non-Hodgkin lymphomas, nasopharyngeal carcinoma, Hodgkin's disease, gastric adenocarcinoma, etc. in Burkitt's lymphoma, and the key event is the translocation of MYC gene, that increase of cell survival and aberrant expression of MYC gene. The biology of EBV and its function in the development of Burkitt's lymphoma are discussed in this review.

Succinct review on biological and clinical aspects of Coronavirus disease 2019 (COVID-19)

The prevalence of coronavirus disease 2019 (COVID-19) is the third registered spillover of an animal coronavirus to humans from the early 21st century. Coronaviruses are important human and animal pathogens. The 2019 novel coronavirus (2019-nCoV) rapidly spreads, resulting in an epidemic throughout China, followed by an increasing number of cases in other countries throughout the world. Recently, a wide range of inhibitors have been introduced for treatment of COVID-19, and also promising vaccines are in late phase of development. Here, we aim to present an overview of recent findings of the biological and clinical aspects of SARS-CoV-2 infection, along with possible treatments and future vaccines.

Cannabinoids – a new therapeutic strategy in neurology

Cannabinoids' usefulness in the treatment of neurological disorders (epilepsy, and various neurodegenerative diseases, such as Multiple Sclerosis and Alzheimer's Disease) has been demonstrated in a growing number of studies. Of the 11 known general types of natural cannabinoids, the focus has been mainly directed at cannabidiol (CBD) due to its specificity in stimulating cannabinoid receptors and the low rate of side effects, as well as on Δ (9)-tetrahydrocannabinol (Δ9-THC). The natural and synthetic analogs of CBD have been described as a potential treatment in neurological diseases, as they showed their therapeutic benefits in reducing the seizures from epilepsy and their neuroprotectivity in neurodegenerative diseases. First and foremost, CBD's neuroprotective properties are due to its capacity to act as an endogenous cannabinoid receptor agonist. Second, CBD enhances neuroprotection by interacting with many signal transduction pathways mediated indirectly through cannabinoid receptors. CBD also reduces the hyperphosphorylation of glycogen synthetase kinase 3 (GSK-3) induced by the buildup of Amyloid β in the physiopathology of Alzheimer's disease.