Chronic liver disease is a late stage of progressive hepatic fibrosis. It consists of functional and structural disruptions in most chronic liver diseases. An accurate diagnosis allows us to establish the degree of fibrosis and the stage of the disease, the prognosis of the patient and to predict a treatment response. Despite the fact that liver biopsy is considered a gold standard, non- invasive methods for diagnosing liver fibrosis have gained more and more importance. Whether we talk about serum biomarkers or imagistic methods from transient elastography to 3-D magnetic resonance elastography, the question remains: are these useful or useless? Serum biomarkers represent blood components that can reflect liver histological changes, thus they can monitor the continuous process of fibrosis. These can be subcategorized in direct (that show extracellular matrix turnover) and indirect markers (that reflect disturbances in the hepatic function). However these markers alone are not as accurate in the staging of fibrosis, only help differentiate patients without or with low grade of fibrosis from those with significant fibrosis and cannot be considered alone in the diagnosis of liver fibrosis. Imagistic methods include: ultrasound-based transient elastography, magnetic resonance elastography (MRE), 2D-shear wave elastography, acoustic radiation impulse imaging (ARFI) and cross sectional imaging, the first being the most used. Using a combination of non-invasive tools allows us to diminish the number of patients in need of liver biopsy. However, the patient must always be informed of the advantages and disadvantages of each method and its limitations.
Background: Infection and sepsis represent major complications after abdominal surgery for secondary peritonitis. Finding new tools that can help identify patients at risk for developing postoperative complications is of the utmost importance for clinicians. We tried to evaluate the use of different biomarkers in evaluating the postoperative prognosis of patients with secondary peritonitis. Methods: We searched the available literature on the usefulness of serum biomarkers in evaluating prognosis in patients with secondary peritonitis. Results: Elevated postoperative lactate levels and high procalcitonin (PCT) levels were associated with negative outcomes. C-reactive protein values increase rapidly in response to the surgical insult but have no value in assessing the overall prognosis. Conclusion: Procalcitonin (PCT) is superior to other biomarkers in predicting severe septic complications and overall mortality in patients with secondary peritonitis.
Couvelaire syndrome is a rare complication of pregnancy involving the placenta and the uterine wall. It is caused by placental abruption, preeclampsia, or other disorders that compromise the blood supply to the placenta. Diagnosis is typically made through history, clinical evaluation, and ultrasound. This study aims to report a grave case of Couvelaire syndrome complemented by presenting a review of the relevant literature, to aid the meaning of a clinical path, as well as early and adequate diagnosis and treatment of Couvelaire syndrome, to prevent feto-maternal consequences. The treatment of Couvelaire syndrome depends on the severity of the condition and the well-being of both the mother and the fetus. If the condition is severe and poses a risk to the mother or fetus, immediate delivery may be recommended, mainly with urgent Cesarean section in general endotracheal anesthesia. If there is significant blood loss leading to a decrease in hemoglobin levels, blood transfusions may be necessary to restore normal blood volume and oxygen-carrying capacity. Part of the general treatment plan should also be the management of the underlying cause of placental abruption, for example, in cases of preeclampsia, medications are prescribed to control blood pressure and prevent seizures.
This paper focuses on the role of diffusion-weighted MRI of ovarian tumors as a potential biomarker to detect and characterize malignancy, and to improve the accuracy of preoperative diagnosis and postoperative follow-up to optimize therapeutic management. This is an original retrospective study of 76 patients with ovarian masses who underwent surgery between May 2014 and March 2016 at the "Dr Carol Davila" Central Military University Gynaecology Department. Patients underwent preoperative, 6-month, and 12-month postoperative evaluation of ovarian tumors using diffusion-weighted MRI. Due to the accuracy of this method using specific sequences in tissue characterization, magnetic resonance imaging can be used in the diagnostic work-up of complex adnexal masses.
Background/Objectives: Sepsis and septic shock are critical conditions associated with high mortality rates and substantial impacts on healthcare systems. Accurate and rapid diagnosis is essential for the management of these conditions. The objective of this study is to assess the accuracy of contemporary and traditional methods for diagnosing sepsis and to determine whether improvements have been made concerning the integration of novel diagnostic approaches, to facilitate a prompt diagnosis, taking into account the rapid progression of complications associated with this disease. For this purpose, studies published between 2014 and 2024 were examined to highlight the benefits and limitations of each approach. Methods: A systematic literature review was conducted, including randomized clinical trials, observational studies, and retrospective studies assessing both conventional diagnostic methods (blood cultures and clinical scoring systems) and modern methods (rapid molecular tests, specific biomarkers, and machine learning algorithms). The studies included were selected based on strict design and methodology criteria to ensure a rigorous comparative evaluation of the interventions and technologies used in diagnosing and monitoring patients with sepsis. Results: A total of 23,822 patients were reviewed across the studies included in this systematic analysis. Modern methods, such as continuous monitoring through integrated biosensors and the use of molecular panels for pathogen detection, demonstrated high potential for the early and accurate diagnosis of sepsis. The reviewed studies suggest that these methods can significantly reduce diagnostic time and improve the ability to stratify mortality risk compared to conventional methods. Conclusions: Integrating modern diagnostic technologies, such as rapid pathogen identification tests and specific biomarkers, may complement traditional methods and bring significant benefits in the management of sepsis.
