Background and aim: Ombitasvir/Paritaprevir/Ritonavir+Dasabuvir in association with ribavirin was the only interferon-free regimen available in 2015 in Romania for compensated HCV cirrhosis. The aim of our study is to reveal our experience with interferon-free therapy in compensated HCV cirrhosis. Materials and methods: We conducted a multicenter prospective study including 90 patients with compensated (Child-Pugh A) HCV cirrhosis treated with Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir and Ribavirin regimen for twelve weeks. The HCV infection was diagnosed using clinical, biological, and FibroMax tests. Each patient had follow-up visits at four, eight, twelve and twenty-four weeks after the initiation of the treatment. Results: 44 (49% of) patients were female and 46 (51 % of) were male. The mean age of patients in the study was 61 years old. All the patients had HCV genotype 1b infection. 22 patients were naive and 68 had previous antiviral therapies based on pegylated IFN-α and ribavirin. At the initiation of treatment 64 (71%) of patients had cytolysis, 38 (42%) had thrombocytopenia, 19 (21%) patients had hyperbilirubinemia and 11 (12%) patients had anemia. It was noticed a decreasing of cytolysis, only 10% of 64 patients still having cytolysis after four weeks of treatment. One patient (1%) died after four weeks of treatment by complications of cirrhosis. 89 (99%) of patients had a virologic response (VR) at the end of treatment (EOT) and sustained virologic response (SVR) twelve weeks after the last dose administration. Conclusion: The most common side effect among the patients in the study group was anemia (47% cases). Cytolysis disappeared after four weeks of treatment in 61% of patients. The interferon-free combination treatment was safe and highly effective in compensated HCV cirrhosis.
Two major trials, EMPA-REG OUTCOME trial (with Empagliflozin) and CANVAS trial (with Canagliflozin) have demonstrated the beneficial effects of SGLT2 inhibitors in patients with type 2 diabetes at risk for heart failure. SGLT2 inhibitors possess a unique pharmacological profile and have shown a significant reduction of hospitalization for heart failure in diabetic patients, immediately after treatment commencement. It seems that their effects are beneficial both in heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. SGLT2 inhibitors reduce cardiovascular endpoints in patients with diabetes and high cardiovascular risk, most likely through a reduction of heart failure-related events. Empagliflozin treatment exerts beneficial effects on vascular function and central haemodynamics. Various mechanisms seem to contribute to the beneficial effects of SGLT2 inhibitors in heart failure. Taking into consideration their cardiovascular benefits and the number of ongoing trials with these drugs, there is a possibility to expand their indication to nondiabetic patients with heart failure. This review focuses on the newest insights into the beneficial effects of SGLT2 inhibitors on the cardiovascular system.
According to literature the primary retroperitoneal malignant pathology is rare, representing less than 0.5% of all malignancies. In spite of its low incidence, this pathology often proves challenging in terms of diagnosis and treatment. The most com¬mon retroperitoneal malignancy is represented by lymphoma that accounts for approximately 33 % of the retroperitoneal malignancies. Other frequent retroperitoneal tumors are sarcomas: leiomyosarcomas and malignant fibrous histiocytoma (in order of incidence). We have analyzed the existing data regarding the most common primary retroperitoneal tumors in order to realize a brief classification and their differential diagnosis considering their clinical, imagistic, histopathological and molecular characteristics. The technological developments that have been made over the years in terms of imaging investigations, as well as in biomelecular and cytogenetic studies have offered new possibilities for of assessing a retroperitoneal mass in order achieve more precise informations that can guide physicians to better distinguish between different types of retroperitoneal tumors and therefore their therapeutical protocol. liposarcomas,
As reported by literature, rheumatoid arthritis is a rheumatic disease with an increased risk of developing cardiovascular complications. Early detection of atherosclerosis by non-invasive techniques represent a current challenge of patient management. Current EULAR guidelines recommend careful monitoring of cardiovascular risk factors by stratification of patients and strict control of rheumatic disease activity to reduce it. The classic evaluation of intima- medium thickness (IMT) was completed by quantifying the degree of inflammation of the carotid plate using positron emission tomography or the degree of coronary calcifications by calculating Agatston score using Coronary Computer Tomography. These modern investigation techniques allow identification of several subclinical stages of atherosclerosis, the interest in their early detection resulting from the fact that, in this stage, through specific measures, the cardiovascular complications can be prevented.
Splenic injuries causedby traumatic events are common in the emergency departments, mostly because the spleen is frequently affected in trauma. The lesions of the spleen can be diagnosed using a contrast enhanced computed tomography and based on the results, the injury of the spleen is graded. The management of the patient can be operative or nonoperative. The choice of treatment is decided by the hemodynamic stability of the patient.
Evidenced-based medicine drives best practices. The Lessons Learned (LL) process in clinical medicine for deployed and military support services drive the NATO Military Medical Center of Excellence (MILMED COE). This review article focuses on the Lessons Learned process and its use in NATO and partner countries medical services. Organizational learning drives development and progress; capturing lessons from mistakes, colleagues’ interactions and institutional experience can be lost without an organized lesson learned process. Therefore, in 2014, NATO institutions and Centers of Excellence across disciplines began to focus on the quality management, information sharing and evidence-based practices to maximize outcomes. Since this inception, NATO has implemented the Lessons Learned process and expanded the impact across the alliance in order to save life and prevent illness. The Lessons Learned process and sharing of experience is also a way to improve the quality of care in the military medicine, from preventive, epidemiological, trauma related, casualty evacuation and forward surgical care, among many others, to the medical standardization and organization of military medical services. The Lessons Learned process is an undertaking and an instrument that can also be used to achieve better international and civil-military cooperation. Finally, we deal with the current situation and use of the information obtained from the areas of military health care.
A unique approach to the treatment of posttraumatic stress disorder (PTSD) is difficult to support, because of the complexity and heterogeneity of this pathology. Multiple evidence-based guidelines for PTSD treatment exist, elaborated by prestigious institutions around the world, but a certain level of the inconsistency of their recommendations appears when these sources are compared with each other. Therefore, a review of current guidelines and extraction of the most supported by evidence recommendations is considered important for clinical practice, due to the need to approach such complex cases as PTSD-diagnosed patients in a stepwise manner. Structured monitoring of the clinical status during the treatment is also an important and rather neglected aspect of the case management in PTSD, and the necessity of follow-up visits for efficacy and tolerability should be taken into consideration. Psychotherapy (especially cognitive- behavioral oriented therapies and eye movement desensitization and reprocessing therapy) is supported by evidence as a first-line approach, as well as certain antidepressants, like the selective serotonin reuptake inhibitors and venlafaxine. Many second-line pharmacological agents and psychotherapies are also available, but there is an obvious need for more pragmatic trials with PTSD patients.
Cardiovascular-kidney-metabolic (CKM) syndrome describes the complex, bidirectional interplay among cardiovascular, renal, and metabolic dysfunctions, where impairment in one system accelerates decline in the others. This interconnected pathophysiology significantly elevates the risk and progression of heart disease, particularly heart failure, through mechanisms involving insulin resistance, systemic inflammation, neurohormonal activation, and endothelial dysfunction. In this context, therapeutic strategies targeting heart disease must address the multifaceted drivers of CKM. Recent advances highlight the need for an integrated, patient-centered approach that combines lifestyle interventions with pharmacological treatments tailored to individual cardiovascular risk. While foundational therapies such as RAAS inhibitors and statins remain essential, novel agents now offer additional prognostic and quality-of-life benefits. SGLT2 inhibitors have emerged as a cornerstone therapy, improving outcomes in heart failure with both preserved and reduced ejection fraction, independent of glycemic control. GLP-1 receptor agonists and dual GLP-1/GIP agonists like tirzepatide demonstrate cardiometabolic and renal protection, while finerenone shows promise in diabetic kidney disease and several heart failure phenotypes. These therapies not only target glycemic control but also reduce cardiovascular mortality, hospitalizations, and renal decline. Optimizing cardiovascular outcomes in CKM syndrome requires early, multifactorial therapeutic intervention, informed by evolving evidence and a deeper understanding of the heart–kidney–metabolism axis.
Recent advances in technology and artificial intelligence have transformed radiology. Artificial intelligence, which uses machine learning, deep learning algorithms, and cellular neural networks, is now applicable to image analysis, enabling the analysis of large volumes of data and the early identification of lesion features, such as tumors. Integrating artificial intelligence into clinical workflows increases the efficiency of medical report generation and enables efficient prioritization of complex or urgent cases. Predictive analytics based on artificial intelligence uses extensive patient data, including demographics, medical history, tests, and imaging, to build more accurate predictive models. Among the areas where artificial intelligence is successfully implemented in radiology is the automated detection of lung nodules. In the field of neurology, artificial intelligence helps track progressive lesions through volumetric analysis of the brain and surveillance of demyelinating diseases. In oncologic radiology, artificial intelligence is used for automated image segmentation, lesion review, and standardized report generation. Therefore, in this ever-evolving landscape, radiologists must embrace emerging technological advances in order to occupy a unique position at the intersection of different diagnostic fields.
Diabetes mellitus refers to metabolic disorders whose main characteristic is chronic hyperglycaemia. The cause is either disturbed insulin secretion, insulin resistance, or usually both. MicroRNAs represent a subclass of non-coding RNA molecules that are short in length, about 17-26 nucleotides. Since they are circulant and can be tissue-specific, their use as diagnostic biomarkers or screening for different diseases is currently undergoing deeper studies. It was found that 22 miRNAs were associated with the pathophysiology of T1DM, 34 with T2DM, and 16 miRNAs were identified to be common amongst T1DM and T2DM. All of them were reconfirmed in at least two separate studies.
