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.
Aseptic bone necrosis (ABN), also known as avascular necrosis (AVN), is a serious and often overlooked complication of systemic lupus erythematosus (SLE), a chronic autoimmune disease with diverse symptoms. AVN in SLE is caused by multiple factors, including blood supply disruption due to clotting disorders, chronic inflammation, and especially prolonged use of moderate to high- dose corticosteroids. This review analyzes 17 out of 62 peer-reviewed European studies (2015–2024) from the PubMed database, focusing on osteonecrosis in lupus. ABN affects between 0.8% and 33% of SLE patients, with a mean symptomatic rate of 9%, while up to 29% may be asymptomatic. The femoral head is most commonly involved. Besides corticosteroid use, other risk factors include antiphospholipid antibodies (especially anticardiolipin IgM), endogenous hypercortisolemia, hypercoagulability, dyslipidemia, and active disease. In Romania, where no national registry exists, a representative case of a 27-year-old woman with undiagnosed SLE and bilateral femoral head necrosis without steroid exposure highlights the role of autoimmune coagulopathy. Misdiagnosis of her facial rash as rosacea delayed proper identification, emphasizing the importance of clinical awareness in atypical cases.
Psoriasis is a chronic and complex disease that consists of characteristic cutaneous lesions and is frequently accompanied by systemic comorbidities caused by the chronic inflammatory state. The most common such comorbidities are hypertension, diabetes mellitus, dyslipidemia, inflammatory bowel diseases, depression, anxiety, neoplasia, and non-alcoholic fatty liver disease. Therefore, it is of utmost importance to simultaneously treat both psoriasis and the associated conditions with the best therapies available to improve patients’ life quality. Therefore, this review aims to evaluate the effects of biological therapies on both psoriasis and its comorbidities and also to highlight other future options.
Combat medics must deploy multiple cognitive, manual, and social skills to perform efficient life-saving interventions and ensure the safe transportation of casualties. In 2021, the Tactical Medical Training Cell of the Belgian Army introduced an immersive and integrative educational program for Advanced Emergency Medicine Technicians (EMTa) certification. This study aims to provide a correlational analysis of performance outcomes during the certification period. While conducting their assessment, candidates were evaluated in three different but complementary roles: Medical Leader (ML), Medical Practitioner (MP), and Tactical Leader (TL). The individual outcomes in theoretical and practical examinations of one hundred thirty-seven candidates were collected during 2021 and 2022. The mean success scores for the theoretical and total practical examinations were 90.6% and 80.1%, respectively. Candidates scored significantly better as TL. Theoretical results were significantly correlated with the ML function, and performances in all three positions were correlated with each other. This study showed that within the combat medic team, individual performances, even if initially well-defined, were associated with the success rates of the other positions. This finding should be considered in the further consolidation of combat medic education.
Effective communication is essential in healthcare, prompting the inclusion of communication courses in medical education. However, the effectiveness of such courses for Romanian medical students has not been evaluated. This pilot study investigates the impact of an ethical communication course on Romanian medical students' communication self-efficacy, communication skills, and the perceived importance of communication. Students attended a 3-month course on ethical communication, covering active listening, assertive communication, conflict management, non-verbal communication, patient- centered care, and ethical considerations in various medical fields. The course was developed based on the European Psychiatric Association guide regarding ethical aspects of communication with patients and their families. The data were analyzed on a sample of 24 students who completed the questionnaires at pretest and posttest. Students reported higher levels of medical communication self-efficacy and perceived importance of medical communication after the course. However, no statistically significant differences were found in health professionals’ communication skills. Future courses should include more patient interactions and varied teaching methods. Further research with larger samples and control groups is needed.
Ethnomedicine and ethnobotany have been at the forefront of current scientific focus. The focus of this review is Piper nigrum, for which there exists a wide host of traditional ethnomedical and ethnobotanical applications, recorded mostly from India and the surrounding regions where black pepper is native. These applications cover a wide range of pathologies, including cardiovascular, pulmonary, gastrointestinal, gynaecological, endocrine, integumentary and neurological, and viral diseases and colds. While some of these applications are confirmed by modern research, the majority have not been tested using modern scientific methods, and perhaps many more applications remain to be documented. Finally, it must be noted that some interesting non- medical applications comprise the application of black pepper, as an insecticide/larvicide, are worth further consideration, especially given the newer policies at a European and international level.
Gliosarcoma is a rare and aggressive variant of glioblastoma, characterized by both a malignant glial component and a mesenchymal sarcomatous component. Gliosarcomas have genetic alterations with glioblastomas, including TP53, PTEN mutations, and EGFR amplification, but may also exhibit additional changes related to epithelial-mesenchymal transition pathways. Management is similar to glioblastoma, involving safe, maximal surgical resection followed by radiotherapy and chemotherapy with temozolomide, but the prognosis remains poor, with a median survival of 6-14 months. Both Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) play crucial roles in the detection, characterization, and treatment planning of gliosarcoma. While MRI is the gold standard, CT remains valuable in certain situations. Light microscopy is essential for definitive diagnosis, allowing pathologists to examine cellular morphology and tissue architecture. It is essential for distinguishing gliosarcoma from other high- grade gliomas and for guiding treatment decisions. In addition, two-photon excited fluorescence (TPEF) microscopy is an advanced optical imaging technique that enables real-time, high-resolution visualization of tumor tissue without the need for staining or contrast agents and enhances visualization of collagen structure and vascularization, key factors in gliosarcoma assessment. The study of radiological and histopathological (light microscopy) features in primary gliosarcomas of the brain is a priority to achieve an early diagnosis that can be translated into better outcomes. Here, we describe the radiological and histopathological features observed in multiple cases of gliosarcoma in current practice.
This study analyzes the contribution of Computed Tomography (CT) in the detection and characterization of ovarian tumors, particularly malignant ones, to enhance the accuracy of preoperative diagnosis and postoperative follow-up, thereby optimizing therapeutic planning. This paper presents a retrospective study conducted on a group of 63 patients with ovarian tumors who were operated on at the Department of Gynecology of the Central University Emergency Military Hospital "Dr. Carol Davila" in Bucharest. The patients were investigated preoperatively using Computed Tomography to characterize the ovarian tumors and assess the sensitivity and specificity of the imaging diagnosis. Computed Tomography utilizing new multidetector technologies (MDCT) provides superior characterization of adnexal masses, with a sensitivity of at least 90% and a specificity of 80%. This imaging modality is recommended for the preoperative staging of ovarian cancer.
ISSN: 1222-5126 (print), 2501-2312 (online)
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