Melanoma is one of the most common types of malignancy in the world, and one known to carry a very poor prognosis until recent years. This review aims to outline the events in the history of the disease and the impact made by the discoveries along the way, as well as the modern-day consensus by referencing the updated literature regarding the present approach and future directions. In the last two decades, several studies and research have brought significant improvement in the diagnosis and clinical management of melanomas. The development of sentinel lymph node biopsy has brought major changes to the surgical approach to the disease, and modern therapies based on recently developed knowledge changed the death sentence this diagnosis once meant to a manageable condition despite its aggressiveness, keeping in mind that early diagnosis and safe margin excision remain the best and most optimistic course of treatment.
Psoriasis is a chronic inflammatory skin condition with genetic determinism characterized by the presence of well- defined, erythematous plaques, covered by white, pearly, stratified scales, located on the extension areas, the skin of the scalp, intertriginous regions. The origin of psoriasis is multifactorial, involving hereditary and environmental pathogenic mechanisms. It is triggered by various risk factors involving a variety of processes, such as inflammation, antigen presentation, cell signaling, and transcriptional regulation.
Pulmonary hypertension (PH) has gained more and more attention in the last years given the increased mortality and morbidity rate and in particular pulmonary arterial hypertension associated with autoimmune diseases (a specific subgroup of PH), entities with an increasing incidence and prevalence globally. Among these, systemic sclerosis is of particular interest, being the most common among connective tissue diseases (CTDs) with PH as a major complication. Other CTDs such as mixed connective tissue disease (MCTD), systemic lupus erythematosus (SLE), primary Sjogren's syndrome, and dermatomyositis may also develop PH as a complication of these severe and complex conditions, which can have a major impact on prognosis and quality of life. PH has also been reported in rheumatoid arthritis and ankylosing spondylitis but further studies are necessary. Several studies have shown that the 3-year survival rate for patients with systemic sclerosis-associated with pulmonary hypertension (SSc-PH) is between 31% and 52%, while the 5-year survival rate is below <50%. Therefore, an early and accurate diagnosis as well as subsequent management of PH in these conditions is mandatory, since survival remains suboptimal despite treatment advances. The aim of this article is to provide an overview of different autoimmune diseases associated with PH and to provide an easy reference source on current best practices.
Lynch syndrome, also known as hereditary non-polyposis cancer syndrome, represents the most common autosomal dominant genetic predisposition for the early onset development of several malignancies. Nearly three decades ago, the discovery of microsatellite instability, a distinctive feature of pathogenic variants within genes encoding mismatch repair proteins, marked a significant leap forward in understanding cancer biology and the underlying spectrum of cancers triggered by these mutations – typical of Lynch syndrome. In recent years, a new treatment paradigm, using immune checkpoint inhibitors, as well as preventive measures has drastically improved the survival rates. Identifying individuals with an inherent predisposition to cancer, through diagnostic protocols followed by personalized screening and treatment algorithms, holds the potential to mitigate premature cancer-related fatalities as well as preventable mortality. It is estimated that only a limited number of patients have been diagnosed, underscoring the importance of implementing specific screening programs for early detection of malignancies to which these patients are susceptible. This article aims to underline the importance of a national protocol tailored to guide a Western-inspired practice for Lynch syndrome patient management, the main aim of the Romanian Society for Lynch Syndrome, by providing an overview of similar initiatives throughout the world.
Colorectal cancer is one of the main causes of death by cancer in the European Union and in Romania. Lynch Syndrome is an autosomal dominant inherited disease that affects around 3% of all colorectal cancer patients, defined by mutations in the mismatch repair genes (MLH1, MSH2, MSH6, PMS2). Aside from the high risk for colorectal cancer (CRC), they exhibit a high risk for endometrial cancer, ovarian cancer, gastric cancer, pancreatic cancer, brain cancer, small bowel cancer, and sebaceous gland cancer. Diagnosis is often made by the gastroenterologist, usually when he meets a young patient with symptoms suggesting the presence of a colonic tumor and a family history of CRC. The role of the gastroenterologist is to investigate the best practices in order to have an early diagnosis and to prevent interval cancers according to the newest guidelines or other gastrointestinal tract tumors associated with Lynch Syndrome. Registries play an important role in the optimal surveillance of these particular categories of patients and should be put into place in every country. They will allow clinicians to have a better understanding of the disease and a more standardized quality of care for them.
The purpose of this article is to investigate the role of emotional regulation (ER) as a process underlying a variety of symptoms associated with Lynch syndrome (depression, anxiety, fear of cancer recurrence (FCR), insomnia, fatigue, pain, and subjective cognitive difficulties in patients with Lynch syndrome. Firstly, we provided an overview of the main psychopathological symptoms found in cancer patients and their impact, and then an overview of emotional regulation strategies and discussed the main impact ER strategies have on cancer patients, especially emotional suppression and experiential avoidance, as found in evidence-based studies. Recent research has shown that two ER strategies generally considered maladaptive, emotional suppression and experiential avoidance were significantly associated with higher levels of anxiety, depression, FCR, fatigue, and cognitive difficulties. We propose that experiential avoidance and emotional suppression may be common transdiagnostic mechanisms for a common set of psychological symptoms in Lynch syndrome patients, a hypothesis to be tested in a future study.
Chemotherapy is an important treatment in oncological disease, with a vast number of side effects. The cardiotoxicity of several chemotherapeutic agents and appropriate risk stratification and patient follow-up must be ensured by a multidisciplinary team which must include an oncologist and a cardiologist. Lynch syndrome is associated with younger-onset malignant tumors of various localizations, requiring aggressive chemotherapy. FOLFOX chemotherapy which is frequently used in Lynch syndrome-associated colorectal cancer has several cardiotoxic effects with mechanisms ranging from increased reactive oxidative species to Krebs cycle blockade or coronary vasospasm. These complex effects on the cardiovascular system have varied clinical effects, such as heart failure, arrhythmias, or acute ischemic events.
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.
