On February 24, 2022, the Russian-Ukrainian war began, in which hundreds of thousands of military personnel are participating. Almost all military personnel experience combat stress. In our opinion, the most fully reflecting the occurrence of stress in humans, including combat stress in military personnel, is the conservation of resource theory proposed by S. Hobfoll. According to this theory, stress occurs when: central or key resources (health, well-being, family, self-esteem, and a sense of purpose and meaning in life) are threatened with loss, are lost, or cannot be retrieved following significant effort. Combat stress in military personnel can manifest itself in the form of negative manifestations of the psychological, physical, psychophysiological, and behavioral register. The most effective system for the prevention and control of combat stress among military personnel was developed in the US Army. Such a program should contain medical and psychological work activities carried out in three stages: preparatory (before performing combat missions), the stage of direct performance of tasks in the combat zone, and the final stage (after completing tasks upon returning to permanent deployment points).
Colorectal cancer is the third most common cancer worldwide and represents a significant major public health issue. Therefore, the interest in detecting the multiple factors implied in the development of cancer has increased recently. One of the factors could be the Helicobacter pylori infection, but a direct causal connection is missing. This gram-negative bacterium infects approximately 4 billion individuals globally and various conditions such as gastroduodenal ulcers or gastric adenocarcinomas can be induced by it. Some of the reported carcinogenic effects of Helicobacter pylori bacterium are hypergastrinemia, chronic inflammation, dysbiosis, and toxin production. Each of these elements involved in the pathogenesis has various mechanisms of action. Dysbiosis can occur due to various treatments for the eradication of the Helicobacter pylori infection. This bacterium also has a proinflammatory effect at the gastric level which can predispose to the development of dysplasia or even neoplasia. The toxins produced by this bacterium, such as the vacuolating cytotoxin A, promote inflammation. In this review, we discuss the possible connections between the Helicobacter pylori infection, through its diverse pathogenic mechanisms, and colorectal neoplasm. Prospective studies are necessary to determine whether there certainly is a direct link between the two conditions.
Bariatric surgery represents one of the most efficient treatments addressing obesity and its associated complications with an increasing trend. Even if the medical benefits for patients are huge, due to weight loss and despite technical improvements in bariatric procedures, it is still associated with diverse types of complications. Most of the complications appear due to nutrient deficiency, as absorption is compromised after surgical anatomy modification. Neurological complications after bariatric surgery are very diverse with an occurrence within days to years after surgery, most frequently in patients with gastrointestinal or surgical complications. Any segment of the nervous system can be affected with distinct types of manifestations ranging from peripheral axonal neuropathy, nerve palsy secondary to compartment syndrome, encephalopathy, and myelopathy, to psychiatric and demyelinating central nervous system diseases. Identifying patients at risk and systematic screening for nutrient deficiency with proper supplementation is essential for preventing neurological complications and lifelong sequelae. In this paper, we present the spectrum of neurological complications reported after bariatric surgery.
Background. Primary headaches are comprised of three big categories: migraines (with or without aura), the third most common and the 6th most disabling disease worldwide, tension-headaches, and trigeminal autonomic cephalalgias, each with different, complex, and not completely understood pathophysiological, clinical, and neuroimagistic characteristics. Structures like the brain stem, hippocampus, or hypothalamus have been depicted as being the main triggers of these types of headaches, which have a significant impact on the quality of life. Methods. We performed a broad literature review on primary headaches from January 2016 to June 2023, analyzing the latest scientific updates and emphasizing the pathophysiological and neuroimagistic characteristics. Results. We provide a concise review of the main neuroimaging studies that help in differential diagnosis between several types of primary headaches. Conclusions. It is difficult to approach the pathophysiology of these three primary headache categories. Keeping in mind that neuroimagistic methods are rapidly developing (especially in the MRI sphere), the most important endpoint of future studies will be to establish a reliable distinction system for all these types of cephalalgias, thus updating the protocols and guidelines. Currently, imaging studies are indicated only in certain circumstances.
The Human Immunodeficiency Virus (HIV) and the Acquired Immunodeficiency Syndrome (AIDS) remain significant public health concerns worldwide. This review seeks to present an updated perspective on the spread, consequences, and control measures of HIV/AIDS, focusing on military personnel as a particular at-risk group. It starts by outlining general information about the transmission of the virus and summarizing recent global epidemiological trends. This review further explores the difficulties that HIV/AIDS presents in military settings, including policies regarding the management of service members living with the virus. Additionally, it examines several prevention strategies implemented by militaries around the world, such as educational programs, provision of condoms, and efforts to reduce the stigma associated with the infection.
Acupuncture is one of the main components of Traditional Chinese Medicine and has been applied as a therapeutical method for centuries. As a therapeutical system, it is based on the use of specific lines in the human body, called meridians, and specific acupuncture points, for choosing the locations where the needles will be applied, depending on the specific problem. In the last few decades, there have been increasing efforts to detect and document the existence of such meridians and points based on at least some of their electrical properties being different when compared to the surrounding skin. A number of researchers have designed experiments, which have had varying degrees of success. Since different researchers have used different experimental setups, and the sample size is usually low, there are issues of validity and comparison between different research results. On the other hand, the majority of available evidence is in favor of there being points and lines characterised by distinct electrical properties, corresponding to acupuncture points and meridians respectively. At the same time, several other theories have been proposed to explain the biological basis of acupuncture points and meridians, while their connection to specific cellular components or neural sequences is an intriguing possibility. While comprehensive research is required to fully document the electrical properties of acupuncture points and meridians, a connection between such properties and their biological basis must also be established.
Cardiac amyloidosis (CA) represents the accumulation and deposition of misfolded protein fibrils in the myocardium, resulting in progressive restrictive cardiomyopathy. Light chain (AL) and transthyretin (TTR) amyloidosis are the most common types of CA. While endomyocardial biopsy remains the gold standard for diagnosing cardiac amyloidosis, its invasive nature and associated risk of complications have led to increased reliance on clinical suspicion and noninvasive imaging modalities as alternative diagnostic tools. Over the last decade, radionuclide imaging studies have become a widely accepted tool in diagnosing ATTR CA, whereas its diagnostic utility in AL CA detection remains limited. Recent advances in PET-CT radiopharmaceuticals have further expanded the potential of nuclear imaging as a comprehensive tool for diagnosis, prognostication, and therapy monitoring. This literature review appraises the current applications of nuclear imaging in the clinical management of cardiac amyloidosis.
Malignant melanoma and urological cancers originate from different tissues and organs, yet several studies highlight connections between these malignancies, including common risk factors, genetic predispositions, and immunological pathways. Evidence from recent studies suggests that a prior diagnosis of melanoma may increase the likelihood of subsequently developing renal cell carcinoma (RCC), and, conversely, patients with RCC appear to face a heightened risk of being diagnosed with melanoma. Shared factors such as a personal or family history of cancer, UV radiation exposure, smoking, and obesity have all been linked to an increased incidence of various cancer types. A major link between malignant melanoma and urological cancers is the presence of shared genetic mutations and familial cancer syndromes. Key mutations, including germline mutations in BRCA1, MITF, CDKN2A, TP53, and alterations in the PI3K/AKT pathway, significantly contribute to the risk of both types of malignancies. Personalized medicine, which tailors prevention and treatment strategies to an individual’s genetic, environmental, and lifestyle factors, has significantly improved cancer care. The primary aim is to select the most effective treatment for each patient, maximizing therapeutic outcomes, reducing side effects, and minimizing the risk of drug resistance. Advances in genomics and immunology are driving the development of personalized therapies that target specific molecular pathways and immune responses common to both melanoma and urological cancers. Angiogenesis inhibitors and checkpoint inhibitors have demonstrated notable success in treating these cancers, with tumor mutational burden serving as a valuable biomarker for predicting the efficacy of immune checkpoint inhibitors.
Neuroendocrine tumors (NETs) are a group of rare malignancies characterized by heterogeneous clinical and biological presentations. Their estimated annual incidence ranges from 3 to 6 cases per million inhabitants, with a notable rise in prevalence due to improved diagnostic capabilities and medical awareness. Gastrointestinal NETs predominantly affect the small intestine (~45%), followed by the rectum, appendix, colon, and stomach. Despite advancements in imaging modalities such as CT, MRI, and somatostatin receptor-based PET-CT scans, the diagnosis of small intestinal NETs remains challenging due to nonspecific symptoms, frequently leading to delayed recognition until advanced disease stages. Surgical resection with comprehensive lymphadenectomy remains the cornerstone of curative management for localized disease, offering improved survival outcomes when R0 resection is achieved. Nevertheless, recurrence rates remain high, underscoring the critical importance of postoperative surveillance. This review provides a comprehensive synthesis of recent literature regarding the epidemiology, clinical manifestations, diagnostic methods— including imaging and immunohistochemical markers—and therapeutic approaches, particularly emphasizing surgical management strategies. A clinical case example is integrated into the review to illustrate the real-world complexity and challenges in the diagnosis, treatment, and follow-up of patients with small intestinal NETs.
Colorectal cancer (CRC) ranks third worldwide in terms of morbidity and second in mortality. In Romania, CRC represents the second leading cause of malignancy, accounting for 13.3% of all diagnosed cancers and associated with a five-year survival rate close to 50%. Despite the availability of effective CRC screening programs proven to reduce incidence and mortality, low participation rates contribute to a high occurrence of advanced disease complications. As a result, bowel obstruction develops in approximately 25% of colorectal cancer cases, significantly worsening patient outcomes. This review aims to highlight the role of screening in reducing the incidence of such complications and to assess the outcomes associated with surgical management of malignant bowel obstruction. A comprehensive review of current literature was conducted, focusing on the incidence, clinical presentation, and management of intestinal obstructions in CRC patients. Emphasis was placed on studies evaluating screening programs, risk factors, and surgical interventions. Data indicate a continuous rise in emergency presentations due to obstructive CRC, correlating with low screening uptake. Early detection through organized screening significantly lowers the risk of obstruction and improves outcomes. Enhanced screening programs and early identification of high-risk individuals are crucial in preventing advanced CRC complications. Timely diagnosis not only reduces emergency surgical interventions but also improves prognosis and overall survival rates.
