Patients' rights in physicians' practice during Covid-19 pandemic: a cross-sectional study in Romania.

BACKGROUND: Although the Covid-19 epidemic challenged existing medical care norms and practices, it was no excuse for unlawful conduct. On the contrary, legal compliance proved essential in fighting the pandemic. Within the European legal framework for the pandemic, patients were still entitled to be treated equally, by a specialized physician, with the possibility of seeking a second medical opinion, in a confidential setting, following prior and informed consent. This study examines physicians' practices regarding patients' rights during the Covid-19 pandemic and the effects of age, experience, and specialty on physicians' behavior and preferences. Additionally, it explores the nexus of malpractice complaints, malpractice fear, and legal compliance. METHODS: A cross-sectional study was conducted on a convenience sample of attending physicians and general practitioners to assess compliance with patients' rights regulations. Respondents were physicians practicing in private and public settings in Southwestern Romania from July 2021 to May 2022. RESULTS: 396 attending physicians and 109 general practitioners participated in the research. Attending physicians acknowledged patients' rights in 55.7% of statements, while general practitioners showed a slightly higher level of compliance at 59.9%. Emergency and Anesthesia and Intensive Care physicians showed the lowest compliance. There were no significant behavioral differences based on physicians' age, years in practice, work sector, or location. However, when faced with the question of prioritizing treatment for patients with similar medical conditions, 46.2% of attending physicians reported favoring the younger patients. This preference was common among physicians under 39. Additionally, over half of the attending physicians reported working outside their area of expertise due to staff shortages. Malpractice fear was high among physicians, although unrelated to patients' claims, legal compliance, or working outside the scope of practice. It resulted in pressure and behavioral changes. CONCLUSION: Adherence to patients' rights was low during the Covid-19 pandemic. Physicians could benefit from educational and administrative support to ensure better legal compliance. Further research is needed to determine if this behavior persists beyond the pandemic context.

Validity and Reliability of Rule Orientation Scale among Romanian Physicians-A Pilot Study.

Background and Objectives: Legal compliance is influenced by several factors, including individuals' attitudes about when breaking the law may be acceptable or justifiable. The rule orientation scale provides a measurement capable of predicting an individual's offensive behavior, regardless of the legal punishment. The current research is the first that aims to evaluate the construct validity of the translated Romanian version of the rule orientation scale. Materials and Methods: A cross-sectional study was conducted online among Romanian physicians in Dolj County. A 12-item questionnaire previously validated in the United States was used for this study. Results: A total of 69 physicians responded to the survey with a mean age of 38.53 ± 8.28 and an average experience of 10.49 ± 8.27 years. Physicians were prone to adhere to the law and found only a few instances when legal breaches were acceptable. Nonetheless, they deemed it permissible to violate the law when they did not know its content. These attitudes were not affected by respondents' ages, genders, numbers of years in practice, industries, or specialties. The internal consistency of the questionnaire was high (Cronbach's α = 0.925). Conclusions: The rule orientation scale validated in the Romanian language can be used to determine conditions under which individuals find it acceptable to break the law.

Physicians' legal knowledge of informed consent and confidentiality. A cross-sectional study.

BACKGROUND: Only a few studies have been conducted to assess physicians' knowledge of legal standards. Nevertheless, prior research has demonstrated a dearth of medical law knowledge. Our study explored physicians' awareness of legal provisions concerning informed consent and confidentiality, which are essential components of the physician-patient relationship of trust. METHODS: A cross-sectional study assessed attending physicians' legal knowledge of informed consent and confidentiality regulations. The study was conducted in nine hospitals in Dolj County, Romania. Physicians were given a questionnaire with ten scenarios and instructed to select the response that best reflected their practice. We assessed the responses of physicians who claimed their practice to be entirely legal. Their legal knowledge was evaluated by comparing their answers to applicable laws. We also calculated a score for the physicians who admitted to committing a legal breach. RESULTS: Of the 305 respondents, 275 declared they never committed any law violation. However, their median correct answer score was 5.35 ± 1.66 out of 10. The specialty was the strongest predictor of legal knowledge, with emergency physicians rating the lowest and non-surgical physicians scoring the highest. Physicians who worked in both private and public sectors were better knowledgeable about legal issues than those who worked exclusively in the public sector. Results indicate that physicians are aware of the patient's right to informed consent but lack comprehensive understanding. While most physicians correctly answered simple questions, only a tiny minority identified the correct solution when confronted with ethical dilemmas. The physicians who acknowledged breaching the law, on the other hand, had a slightly higher knowledge score at 5.45 ± 2.18. CONCLUSION: Legal compliance remains relatively low due to insufficient legal awareness. Physicians display limited awareness of legal requirements governing patient autonomy, confidentiality, and access to health data. Law should be taught in all medical schools, including undergraduate programs, to increase physicians' legal knowledge and compliance.

Intelligent Diagnosis of Thyroid Ultrasound Imaging Using an Ensemble of Deep Learning Methods.

Background and Objectives: At present, thyroid disorders have a great incidence in the worldwide population, so the development of alternative methods for improving the diagnosis process is necessary. Materials and Methods: For this purpose, we developed an ensemble method that fused two deep learning models, one based on convolutional neural network and the other based on transfer learning. For the first model, called 5-CNN, we developed an efficient end-to-end trained model with five convolutional layers, while for the second model, the pre-trained VGG-19 architecture was repurposed, optimized and trained. We trained and validated our models using a dataset of ultrasound images consisting of four types of thyroidal images: autoimmune, nodular, micro-nodular, and normal. Results: Excellent results were obtained by the ensemble CNN-VGG method, which outperformed the 5-CNN and VGG-19 models: 97.35% for the overall test accuracy with an overall specificity of 98.43%, sensitivity of 95.75%, positive and negative predictive value of 95.41%, and 98.05%. The micro average areas under each receiver operating characteristic curves was 0.96. The results were also validated by two physicians: an endocrinologist and a pediatrician. Conclusions: We proposed a new deep learning study for classifying ultrasound thyroidal images to assist physicians in the diagnosis process.

Sildenafil in Pulmonary Hypertension Associated with Bronchopulmonary Dysplasia: Friend or Foe?

INTRODUCTION: Sildenafil is a phosphodiesterase-5 inhibitor used to treat pulmonary hypertension, although its efficiency remains disputed in the neonatal population. We aimed to assess the clinical use of this drug in extremely premature infants diagnosed with pulmonary hypertension associated to bronchopulmonary dysplasia. STUDY DESIGN: This is a retrospective study of 18 patients born at ≤ 32 weeks gestational age with pulmonary hypertension complicating moderate to severe bronchopulmonary dysplasia, which was diagnosed on echocardiography at 36 weeks corrected gestational age. Median corrected gestational age at starting sildenafil was 48 weeks (range 32-60). In 4 cases there was a period of > 2 weeks between the evidence of moderate-severe pulmonary hypertension and starting sildenafil. In all other cases it was started as soon as the diagnosis was suspected or confirmed. RESULTS: All infants tolerated the use of sildenafil. However, 5 babies (26.31%) died despite ongoing intensive care, and 5 babies (26.31%) died after having care redirected due to severe chronic lung disease (1 due to co-existing neurological abnormality), with on overall mortality of this study of 52.62%. Eight babies (42.1%) survived: 5 continued on sildenafil until hospital discharge, 1 continued on transfer to the paediatric intensive care unit and 2 stopped while inpatients. Upon follow up to 2 years of age, out of the 5 patients who continued upon hospital discharge, 4 stopped at 6, 7, 12 and 18 months respectively, with 1 child being lost to follow up. Two patients (10.52%) restarted sildenafil use later in childhood. Echocardiographic evidence of improvement was noted in 58% (11 cases), with no improvement in 6 cases (32%) and incorrect original diagnosis in 1 case (5%). One infant died less than a week from the initiation of treatment. CONCLUSION: sildenafil use showed no clinical improvement of pulmonary hypertension complicating moderate to severe bronchopulmonary dysplasia in extremely premature infants.

Maternal Steroids on Fetal Doppler Indices, in Growth-Restricted Fetuses with Abnormal Umbilical Flow from Pregnancies Complicated with Early-Onset Severe Preeclampsia.

Corticoids are largely used for fetal interest in expected preterm deliveries. This study went further, evaluating the effect of maternal administration of dexamethasone (Dex) on the umbilical artery (UA), middle cerebral artery (MCA), and ductus venous (DV) spectrum, in growth-restricted fetuses, with the absent end-diastolic flow (AEDF) in UA, from singleton early-onset severe preeclamptic pregnancies. Supplementary, the impact on both uterine arteries (UTAs) flow was also evaluated. In 68.7% of cases, the EDF was transiently restored (trAEDF group), in the rest of 31.2% remained persistent absent (prAEDF group). UA-PI significantly decreased in the first day after Dex (day 1/0; p < 0.05), reaching its minimum during day 2 (day 2/1; p > 0.05), revealing a significant recovery to day 4 (day 4/2; p < 0.05), in both groups. The MCA-PI decreased from day 1 until day 3 in both groups, but significantly only in the trAEDF group (p = 0.030 vs. p = 0.227. The DV-PI's decrease (during day 1) and the CPR's increase (between days 0 and 2) were not significant in both groups. UTAs-PIs did not vary. The prAEDF group had a significantly increased rate of antenatal worsening Doppler and a poorer perinatal outcome compared with the trAEDF group. In conclusion, Dex transiently restored the AEDF in UA in the majority of cases, a "positive" effect being a useful marker for better perinatal prognosis. UA-PI significantly decreased in all cases. The improvement in umbilical circulation probably was responsible for the short but not significant DV-PI reduction. MCA-PI decreased only in sensitive cases, probably due to an already cerebral "full" vasodilation in the prAEDF group. Furthermore, the CPR's nonsignificant improvement was the result of a stronger effect of Dex on UA-PI than on MCA-PI. Finally, despite the same etiology, it was only a weak correlation between the severity of the umbilical and uterine abnormal spectrum.

Clinicopathological Analysis of Complicated Colorectal Cancer: A Five-Year Retrospective Study from a Single Surgery Unit.

Patients with primary colorectal cancer can present with obstructions, tumor bleeding, or perforations, which represent acute complications. This paper aimed to analyze and compare the clinical and pathological profiles of two patient groups: one with colorectal cancer and a related complication and another without any specific complication. We performed a five-year retrospective study on colorectal cancer patients admitted to a surgery unit and comparatively explored the main clinical and pathological features of the tumors belonging to the two groups. A total of 250 patients with colorectal cancer were included in the analysis. Of these, 117 (46.8%) had presented a type of complication. The comparative analysis that examined several clinical and pathological parameters showed a statistically significant difference for unfavorable prognosis factors in the group with complications. This was evident for features such as vascular and perineural invasion, lymph node involvement, pathological primary tumor stage, and TNM stage. Colorectal cancers with a related complication belonged to a group of tumors with a more aggressive histopathologic profile and more advanced stages. Furthermore, the comparable incidence of cases in the two groups of patients warrants further efforts to be made in terms of early detection and prognosis prediction of colorectal cancer.

The Role of Cognitive Coping Mechanisms in the Psychotherapeutic Approach of the Major Depressive Disorder.

The depressive disorder represents nowadays an important global health problem, with severe effects for the affected person and for the society as a whole. The psycho-social factors are a major risk element in the onset of depression, overlapping both on the individual vulnerabilities of the affected person, and on the coping mechanisms, especially the disadaptive one. Our study aims were the comparative evaluation of the cognitive coping mechanisms in the evolution of depression and in determining the quality of the therapeutic response in two samples of depressive patients benefiting from pharmacologic treatment, respectively pharmacologic therapy and cognitive-behavioral psychotherapy. The most frequently used cognitive coping strategies in the depressive patients from the two samples in the study were predominantly maladaptive, more precisely ruminating, catastrophizing, self-culpability, respectively putting into perspective. It was evident though that the adaptative coping mechanisms, such as accepting the current situation, positive refocus and positive re-evaluation, are protective factors contributing to reaching psycho-social rehabilitation and granting support to the combined therapeutic intervention. Consequently, the identification of coping mechanisms dominant in each individual with major depression is required in order to increase the efficiency of cognitive behavior therapy as enhancer for pharmaco-therapy.

The Influence of the Inflammatory Bowel Diseases on the Perceived Stress and Quality of Life in a Sample of the South-Western Romanian Population.

BACKGROUND: Inflammatory bowel diseases (IBD) represent a category of chronic diseases of gastrointestinal tract with a long-term evolution which includes flares and periods of remission. The aim of the study is to identify and quantify the relationship between IBD status, perceived stress, coping mechanisms, and patients QOL. METHODS: Cross-sectional study on two samples consisting of 70 IBD patients monitored in the Gastroenterology Department of the Emergency Clinical County Hospital Craiova, Romania, respectively 70 healthy volunteers. Collected data include socio-demographic details, personal and familial medical history, clinical status, presumed risk factors, perceived stress (Perceived Stress Scale-PSS), coping strategies (COPE questionnaire) and Health-Related Quality of Life (HRQOL-SF-36 scale). RESULTS: Perceived stress was considerably higher on IBD subjects (p<0.0001). The assessment of HRQOL has shown that patients had the best perception over their physical and emotional domains of SF-36 (p<0.0001), while the most often coping mechanisms used are those from the problem-focused category. CONCLUSIONS: There is a significant relationship between increased activity of IBD and higher level of stress, that led to the development of problem-focused coping strategies. We did not find a strong correlation between lower HRQOL levels and the items considered as potential risk factors.

Liver damage in the context of SARS-CoV-2. Covid-19 treatment and its effects on the liver.

Since COVID-19 was declared a pandemic by the World Health Organization, the scientific community has tried to protect the population from the infection and its effects through multiple lines of evidence. Patients at high risk of developing severe disease were advised to protect themselves and practice effective physical distancing. Phenotypes specific to this infection need to be reviewed to understand COVID-19 and its clinical manifestations. When the pandemic began, the scientific community was concerned with the unfavorable outcome of cases with pre-existing liver disease. There have been speculations about risk factors for severe diseases such as liver disease, age, gender, and association with obesity or diabetes.

A Study Regarding Nursing Leadership.

PURPOSE: The research included the analysis and processing of questionnaires applied in county hospitals in Craiova. The purpose of this article is to highlight the qualities, skills and competencies of a leader, necessary in the development of leadership and professional development skills. MATERIAL AND METHOD: We performed a descriptive and cross-sectional study involving 166 medical staff from hospitals in Craiova. Between January 2020 and January 2021, we used a questionnaire as an investigative tool containing 26 questions on complex leadership issues. The results were stored in Microsoft Excel files (Microsoft Corp., Redmond, WA, USA) and were statistically analyzed using the Microsoft Excel XLST AT (Addinsoft) software suite. SARL, Paris,). Secondary data processing: calculation of fundamental statistical parameters, mean and standard deviation of their ratio, coefficient of variation, graphical representation and calculation of regression coefficients was performed with Excel, Pivot Tables using controls, Functions, Statistics, Diagram and Data Analysis module. In conclusion, a better organization of the management of the hospital units is required, taking into account the leadership in nursing.

Immunohistochemical expression of p53, Ki67, α-SMA, CD44 and CD31 in different histological subtypes of basal cell carcinoma.

Basal cell carcinoma (BCC) is a common, locally invasive tumor that arises within sun-damaged skin and rarely develops on the palms and soles or mucous membranes. Men generally have higher rates of BCC than women. Incidence also increases with age and the median age of diagnosis is 68 years old. Mortality from BCC is rare and cases of aggressive, local destructive, metastatic BCCs are more likely from tumors with aggressive histopathological (HP) patterns. The aim of this study was to investigate and correlate the immunohistochemical expression of p53, Ki67, alpha-smooth muscle actin (α-SMA), cluster of differentiation (CD)44 and CD31 with both aggressive and nonaggressive types of BCCs. In our study, we observed a varied staining pattern for p53, with the highest reactivity noticed in the peripheral palisading zone. The staining pattern for Ki67 was similar to p53, with a more pronounced reaction in the periphery of the tumor. We found different Ki67 and p53 expression among the various subtypes of BCC. The CD31 reactivity, mostly seen in the stroma, was positive in all BCCs and varied significantly between its different HP subtypes. Regarding stromal expression of α-SMA, the adenoid and basosquamous types had the most intense reaction in our study. The CD44 tumor expression was correlated in our study to the aggressive pattern of BCCs.

Mortality Rate in Upper Gastrointestinal Bleeding Associated with Anti-Thrombotic Therapy Before and During Covid-19 Pandemic.

Introduction: During the last few years, a progressive higher proportion of patients have had upper gastrointestinal bleeding (UGIB) related to antithrombotic therapy. The introduction of direct oral anticoagulant (DOAC) and COVID-19 pandemic may change the incidence, mortality, and follow-up, especially in patients at high risk of bleeding. Patients and Methods: We studied the use of anti-thrombotic therapy (AT) in patients with upper gastrointestinal bleeding for 5 years (January 2017-December 2021) including Covid-19 pandemic period (March 2020-December 2021). We analyzed mortality rate, rebleeding rate and need for transfusion in patients with AT therapy compared with those without AT therapy and risk factors for mortality, and also the incidence of gastrointestinal bleeding in patients admitted for COVID-19 infection. Results: A total of 824 patients were admitted during Covid-19 pandemic period and 1631 before pandemic period; a total of 426 cases of bleeding were recorded in patients taking antithrombotic therapy and the frequency of antithrombotic therapy in patients with UGIB was higher in pandemic period (24.39% versus 13.8%). Unadjusted mortality was 12.21%, similar with patients with no antithrombotic treatment but age-adjusted mortality was 9.62% (28% lower). The rate of endoscopy was similar but fewer therapeutic procedures were required. Mean Hb level was 10% lower, and more than 60% of patients required blood transfusion. Conclusion: Mortality was similar compared with patients with no antithrombotic therapy, fewer therapeutic endoscopies were performed and similar rebleeding rate and emergency surgery were noted. Hb level was 10% lower and a higher proportion of patients required blood transfusions. Mortality was higher in DOAC treatment group compared with VKA patients but with no statistical significance. The rate of upper gastrointestinal bleeding in Covid-19 positive hospitalized cases was 0.58%. The mortality risk in multivariate analysis was associated with GB score, with no endoscopy performed, with obscure and variceal bleeding and with LMWH versus VKA therapy.

The Effect of Switching to Long-Acting Injection (LAI) Antipsychotic Therapy on Patients with Schizophrenia.

MATERIAL AND METHOD: We analyzed 362 patients with schizophrenia admitted during 2016 in an acute psychiatric ward and in a chronic psychiatric ward, diagnosed with paranoid or other schizophrenia, according to DSM-IV-TR, which, after remission of the symptoms of the acute episode, they benefited from antipsychotic therapy only in oral formulation. For some of these patients we instituted maintenance therapy with depot formulas. Patients were followed for up to two years. RESULTS: Comparing the level of adherence to therapy, we found a statistically significant improvement, from 42.96% to 76.30%. Although we estimate that adherence to LAI therapy is over 90%, almost a quarter of patients have given up this type of treatment at some point due to side effects. Carrying out the comparative analysis of the number of hospitalizations per year, from the past and from the follow-up period, as well as of the scores registered at the scales used (PANSS, CGI, GAS, WHOQOL), in dynamics, we demonstrated the appearance of statistically significant changes. CONCLUSIONS: the administration of antipsychotic therapy through LAI-type depot formulas can improve the therapeutic adherence of the patient with schizophrenia, thus improving the evolution of the disease and the quality of life.

A Cross-Sectional Study to Assess Thyroid Function in Infants and Children in a City from South-Western Romania.

Thyroid hormones are critical regulators of growth, myelination of the nervous system, metabolism, and organ function. The most prevalent endocrinopathies in childhood are related to thyroid disorders. Thyroid problems in children and adolescents have a significantly different etiology and clinical presentation than in adults. Thus, pediatric medical care involves an understanding of the unique features of thyroid function and dysfunction during childhood and adolescence. The etiology and clinical manifestations of thyroid disorders in children and adolescents are vastly different from those in adults. The particular aspects of thyroid function and malfunction in childhood and adolescence are hence part of pediatric medical therapy. To prevent persistent nervous system damage and developmental problems, it is vital to recognize and treat thyroid dysfunction in neonates as early as possible. The purpose of the research was to understand more how children's thyroid problems function, structure, and prevalence. The research examined 30 children under the age of 16 years who had symptoms that were linked to thyroid problems. In addition to demographic and family information, thyroid ultrasounds and blood samples for the detection of T3, T4, and TSH were obtained. Females surpassed males by a small majority (2.33:1 ratio).Out of the total children included in the study, 14(46.7%) cases for autoimmune thyroiditis, 2(6.67%) cases for congenital hypothyroidism, 1(3.33%) case for hyperthyroidism, 1(3.33%) case for hyperthyroidism-Graves disease, 8(26.7%) cases for hypothyroidism and 4(13.3%) cases for subclinical hypothyroidism.

Anatomical remodeling of the aortic wall in relation with the cause of death.

AIM: The authors set out to evaluate the correlations between three of the main morphological aortic parameters (aortic diameter, intima, and media thickness) and the cause of death. MATERIALS AND METHODS: Study group included 28 people died of a cardiovascular (CV) disease and 62 people died of a noncardiovascular (NCV) disease. Four aortic cross-sections (base, cross, thoracic, abdominal) were collected during autopsy from the selected cases, fixed in 10% buffered formalin and photographed together with a calibrating ruler. Then, they were processed using the classical histopathological (HP) technique (formalin fixation and paraffin embedding), stained with Hematoxylin-Eosin (HE) and Orcein, and the obtained histological slides were transformed into virtual slides. Aortic diameters were determined on calibrated photos using a custom-made software, developed in MATLAB (MathWorks, USA). Intima and media thicknesses were determined on virtual slides using a dedicated image analysis software. RESULTS AND DISCUSSIONS: The most frequent CV causes of death were the ischemic heart diseases and the most frequent NCV causes of death were the inflammatory diseases. Aortic diameter decreased from the aortic origin till the aortic end, with larger values in women than in men and in CV diseases than in NCV diseases. The difference in the remodeling of the aortic diameter between the two groups is smaller towards the abdominal region. Intima thickness increased from the aortic origin till the aortic end and was larger especially in women died of CV diseases, whereas in men there were some shifts at the extremities of the aorta. The difference in the remodeling of the intimal thickness between the two groups is extremely variable. Media was thicker in almost all of its segments in CV group than in NCV. It was a divergent evolution of the correlation degree trends in the two groups. CONCLUSIONS: The three morphological parameters of the aorta (diameter, intima, and media thicknesses) are more or less influenced by the pathological status that caused patient's death by the patient's sex and by the topographic region where the measurement was made.

Dexamethasone on absent end-diastolic flow in umbilical artery, in growth restricted fetuses from early-onset preeclamptic pregnancies and the perinatal outcome.

BACKGROUND: Absent end-diastolic flow (AEDF) in the umbilical artery (UA) worsens the already poor prognosis of growth-restricted fetuses (GRFs) in pregnancies complicated by early-onset preeclampsia with severe features (ESP). METHOD: We assessed the correlation between the effect of maternal dexamethasone (Dex) on AEDF in the UA and perinatal outcomes, in 59 GRFs from EPS-complicated pregnancies. The maternal outcome was also evaluated. RESULTS: The mean maternal age at inclusion was 22.4 ± 5.9 years. Dex transiently restored EDF in the UA in 38 (64.4%) cases (trAEDF group), but in 21 (35.6%) patients, the flow was persistently absent (prAEDF group). The effect lasted up to the 4th day.The gestational age at diagnosis, number of days from admission until delivery, and fetal weight were significantly lower in the prAEDF group than in the trAEDF group (p < .05). The same group had a significantly increased rate of fetal proximal deterioration, low APGAR scores, neonatal hypoxia, assisted ventilation, mild intraventricular haemorrhage (I/II), and respiratory distress syndrome, as well as maternal deterioration, especially in cases of resistant hypertension (p < .05). Although the rates of fetal acidemia and perinatal mortality in the prAEDF group were respectively three times and two times higher, the differences were not significant (p > .05). CONCLUSIONS: The Dex no-effect on UA Doppler in GRFs with AEDF in the UA, in EPS-complicated pregnancies, can be a useful marker for a higher risk of proximal fetal deterioration, poor state at delivery, neonatal hypoxic complications, and worsening maternal condition, but not for perinatal mortality. The findings also highlight the alarmingly younger age of patients with EPS. Finally, all these pregnancies should be monitored in a complex multidisciplinary manner in tertiary referral units.Key messageThe effect of dexamethasone on absent end-diastolic flow in the umbilical artery in growth-restricted fetuses from pregnancies complicated by early-onset preeclampsia with severe features can be a useful prognostic factor for perinatal outcomes.

The Frequency of Dental Materials Use for Fixed Prostheses in a General Dental Practice.

This retrospective study aimed to evaluate the frequency of dental materials use for fixed prosthesis depending on the location of the teeth, the restorative prosthetic type, the age and sex of the patients from a dental practice in Essen, Germany. The analysis of the collected data showed that zirconia is currently the most common material for making dental fixed prostheses, a larger number of prosthetic elements for women and a significant increase for these restorations at ages over 40 years. Most of the prosthetic elements were made in the mandibular molar area, with an increased frequency of zirconia bridges in the mandible, while for the upper jaw the number of crowns was higher. Zirconia was more frequent used in female patients and in the age group 60-69.

Managing Low Back Pain in Primary Care.

Low back pain (LBP) is one of the most common pathologies for which patients present for consultation in primary medical practice. The objective of the study was to determine the number of patients with LBP who presented to the general practitioner 's (GP) office between October 2019 and March 2020, to determine risk factors, favoring factors and their correlation with clinical data obtained after performing the clinical examination, with paraclinical data obtained by imaging investigation. 347 patients, aged between 17 and 82 years, were included in the study, presenting a sex ratio of men: women of approximately 2: 1. The main pain symptoms of the patients were: localized pain in the lumbar spine, radicular pain, referred to the lower limbs, subjective sensitivity disorders felt in the lower limbs, distal motor deficit in the lower limbs, paravertebral muscle contractions and the feeling of instability in the low back. The main risk factors were smoking, the existence of a trauma to the lumbar spine, sedentary lifestyle, maintaining a prolonged fixed position and intense physical exercise, either occasionally or daily. Among the patients included in the study, a number of 93 patients required the granting of medical leave both by the attending GP and by other specialists. Regardless of the etiology and pathophysiological mechanisms involved in the occurrence of LBP, therapeutic management should aim to stop pain symptoms and prevent recurrences.

Predictors of early and sustained virological response of viral hepatitis C.

Due to complex interplay between host and viral factors, pathogenesis of chronic hepatitis C (CHC) is considered a challenging issue. Infection with hepatitis C virus (HCV) is not confined only to liver but can induce disturbances in many other organs and systems. Our primary aim for this study was to evaluate biological response rates and sustained virological response (SVR) in patients diagnosed with CHC, treated with Interferon-alpha (IFN-α), Pegylated (PEG)-IFN-α2a or -α2b plus Ribavirin. The second aim of the study was the identification of predictive factors for a favorable response to antiviral therapy in patients diagnosed with CHC. We enrolled in this study 210 patients diagnosed with CHC who have accomplished all inclusion and exclusion criteria, treated with PEG-IFN plus Ribavirin. Patients' recovery progress has been evaluated by determining: age, gender; biochemical tests: alanine aminotransferase (ALT), aspartate aminotransferase (AST); serological assays - detect anti-HCV antibody and molecular assays - detect, quantify and/or characterize hepatitis C viral load (ribonucleic acid) (HCV-RNA); liver histopathological (HP) examination. According to their response to treatment, they were classified into responders (n=145) and non-responders (n=65). Liver biopsies were histopathologically evaluated for necroinflammatory grade and fibrosis stage according to the modified Ishak and Metavir scoring systems for chronic hepatitis. Demographic, laboratory, and HP results were introduced in statistical analysis. These parameters were included in area under curve (AUC) analysis in order to estimate their degree of influence on getting early virological response (EVR) and SVR. Our study demonstrates that factors connected to treatment failure in CHC are linked to older age, high hepatitis C viral load, and impaired glucose tolerance at beginning of treatment [high fasting glucose and insulin, high homeostatic model assessment of insulin resistance (HOMA-IR) index] and also to liver histology features (high fibrosis score, liver steatosis, iron infiltration, and more or less high necroinflammatory activity). Analyzing results of our study shows that HOMA-IR index, serum insulin levels, baseline HCV-RNA, baseline mean blood glucose and HP score like Ishak fibrosis score, steatosis score and liver iron score may have a predictive value for obtaining an EVR in patients diagnosed with CHC.