Dynamics of serum cross-neutralization capacity against SARS-CoV-2 Delta variant in convalescent COVID-19 patients.

The magnitude and breadth of the neutralizing antibody response against variants of concern following natural infection would provide valuable insights regarding the immune response induced by severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) infection. Herein, 25 patients were followed at 30 ±7 (Visit 1), 90± 15 (Visit 2), and 180 ± 15 (Visit 3) days post symptom onset (PSO). The neutralization titers against both Wuhan-Hu-1 (WT) and Delta variant were analyzed in parallel along with anti-Spike antibodies (anti-S1/S2 immunoglobulin G [IgG]). The median values of half-maximal neutralization titer (NT50 ) for the WT and Delta variants decreased by 75.8% and 82.2% at Visit 2 and by 85.4% and 81.4% at Visit 3, respectively. At Visit 1, the correlation between the anti-S1/S2 IgG and Nabs titers for the Delta variant was moderate for WT (r = 0.58) and weak for the Delta variant (r = 0.39). However, the correlation coefficient consistently remained above 0.7, with a very strong correlation at Visit 3 for both WT and Delta variants (r = 0.81). The dynamics of anti-S1/S2 IgG antibodies, NT50 , and cross-neutralization index correlated at different time points PSO. Longitudinal analysis of the cross-neutralization capacity of immune sera will inform upon the durability of the immune response against SARS CoV-2 variants.

Breast Cancer Prognosis: A Study on Mortality Indicators.

Background: The prognosis of breast cancer patients is critical for tailored treatment options. While previous observational studies have identified various prognostic markers, a consensus in their clinical application is lacking. This single-center retrospective study aimed to validate the most frequent risk factors associated with increased mortality in breast cancer patients. Methods: Our study spanned an 8-year interval (2014-2020) and included 213 female patients with stage IIA-IIIB breast cancer. Key variables such as age, disease stage, and type of treatment were analyzed in relation to one-year survival as the primary outcome measure. Results: Elevated preoperative levels of tumor markers ACE and CA 15-3, larger tumor size, and advanced lymph nodal invasion were significantly associated with increased mortality. Immunohistochemistry indicated that the presence of Estrogen and Progesterone Receptors (ER and PR) were protective factors, whereas Human Epidermal Growth Factor Receptor 2 (HER2) was a negative prognostic indicator. Among molecular subtypes, Luminal A demonstrated protective effects, whereas HER2-positive and Triple-negative subtypes were identified as risk factors. Conclusion: This study confirms the significant role of tumor size, lymph node stage, and specific molecular markers in predicting breast cancer mortality. These findings contribute to a nuanced understanding of disease prognosis and offer crucial insights for clinicians in managing treatment plans.

Gastro-Intestinal Bleeding in COVID-19 Patients - Is There Any Causal Relation?

The novel Severe Acute Respiratory Syndrome Coronavirus-2 has put an enormous pressure on health systems around the world. The large number of severe cases that had symptoms seemingly unrelated to the respiratory system, continues to create confusion. The digestive tract is not spared either. The most commonly reported digestive symptoms are nausea, vomiting, anorexia, diarrhea and, less frequently but with significant impact, gastrointestinal bleeding. The elderly population is the one more likely to develop severe anemia clinically expressed by hematemesis, melena or hematochezia. From our experience and as we concluded from literature, men confirmed with COVID-19 have a higher risk of developing digestive haemorrhage. The upper gastro-intestinal tract, defined as the digestive segment above the Treitz angle, is more often affected. The gastro-duodenal ulcers are the main cause found in COVID-19 patients with digestive bleeding. In addition, the patients with SARS-COV2 infection and gastro-intestinal bleeding most commonly associate with other comorbidities such as hypertension and diabetes.

Prognosis Evaluation for Patients with Abdominal Trauma Using Usual Biological Parameters.

Introduction: Abdominal injuries are responsible for approximately 20% of all post-traumatic deaths, 45-50% of which occurring in the first 60 minutes. Currently there are several prediction scores for the evolution of these patients, which take into account degrees of anatomical lesion, clinical signs and imaging and paraclinical explorations. AIM: The aim of the study was to develop a scoring system to predict mortality in patients with abdominal trauma by using the usual biological parameters. METHOD: A retrospective, descriptive, correlational and non-interventional multicenter study was performed on a sample of 157 patients with abdominal traumata, hospitalized between 2015- 2021, in the General Surgery and the Emergency III clinics of the Emergency University Hospital Bucharest, respectively in the Surgery I Clinic of the Mures County Emergency Clinical Hospital. The following biochemical parameters were analyzed: hemoglobin, hematocrit, leukocyte and platelet counts, coagulogram, glycemia, urea, creatinine, AST, ALT with the intent to have the correlation with the ISS and NISS mortality and traumatic scores. Microsoft Excel and MedCalc applications were used for the statistical analysis of the data. Results: The studied sample presented a sex ratio M:F = 2.82:1, the mean age was 47.45 +- 17.37 years. The elements that presented a correlation with a value greater than 0.3 (and p 0.01) were: age, ALT, AST, urea, hemoglobin, platelet count and glycemia. The cut-off values for these parameters in reference to mortality were established by analyzing the ROC curves. This fact allowed the outline of a predictive score that correlates well with the value of ISS and NISS, the obtained ROC curve using as parameters the value of the proposed risk score and mortality highlighting a good predictive power of the mortality with an AUC of 0.930 (p 0.001). CONCLUSION: The results of our study showed that a number of biochemical parameters may contribute to shaping a score with predictive value in terms of the evolution of abdominal trauma patients.

Post-thyroidectomy Hypocalcemia - Risk Factors and Management.

The complications of thyroidectomy vary from hypocalcemia and recurrent laryngeal nerve lesions to injury of vocal folds, local hematoma, cysts, granuloma. Post-operative hypocalcemia has an incidence of 1.2-40%. Permanent hyoparathyroidism is registered in 3% of cases. This is a brief narrative review focusing on the levels of calcium after performing a thyroidectomy and the need of calcium supplements under these circumstances. This complication, even it seems rather harmless at first, in fact it represents an important contributor to hospitalization delay and, especially for severe forms, to poor quality of life, including the risk of life threatening episodes. Devascularisation of parathyroid glands in addition to injury or dissection causes hypoparathyroidism. Hypocalcemia risk differs with sex (females have a higher risk), lymph node dissection (it increases the risk), it differs with type of thyroidectomy (larger dissections have a higher risk; also the intervention for recurrent goitre and second intervention for post-operatory bleeding increase the risk of hypocalcemia; while Basedow disease is probably at higher risk than multinodular goitre among benign conditions) and the duration of procedure. Pre-operatory low calcium, parathormon (PTH), 25-hydroxivitamin D increases the risk. The calcium drop rate matters as well: a decrease of 1 mg/dL calcium over 12 hours after surgery is independently correlated with the risk of symptomatic hypocalcemia. Early post-operatory PTH and calcium are best predictors for the need of oral calcium supplements. Routine post-operatory calcium and vitamin D supplementation statistically significant decreases the risk of developing transitory hypocalcemia and acute complications compare to calcium alone supplements or no supplements. In cases of hypoparathyroidism calcitriol is preferred.

Predictive Factors for Intraabdominal Hypertension after Incisional Hernia Repair.

The purpose of our research is to synthesize the risk factors quoted in the literature which predispose to intra-abdominal hypertension occurrence following surgical repair of incisional hernias. We used for our research the Web of Science, Scopus and PubMed research platforms and we used the following search formula: (Intra-abdominal hypertension OR intra-abdominal pressure OR abdominal compartment syndrome) AND risk factors AND incisional hernia. The results were filtered according to the following criteria: language (English), publish year ( 2000) and access (in extenso). In this context, we chose to classify the risk factors for IAP increase in the following categories: (1) those related body habitus and anthropometry; (2) those associated with the presence of comorbidities; (3) those related to the defect of the abdominal wall; (4) those associated with the surgical management. Among the most important risk factors we mention: elevated BMI, chronic obstructive pulmonary disease, large incisional hernias with loss of domain, surgical technique used, prolonged surgeries and repeated attempts to close the defect.

Low Anterior Resection - Emergency Versus Elective Surgery in Rectal Cancer Treatement - Comparative Analysis.

Background: Rectal cancer is a public health problem, being one of the most prevalent neoplastic localizations. The current surgical management of this pathology includes low anterior resection with colorectal anastomosis. The presentation as an emergency of these patients and the need for immediate intervention make it impossible to follow the necessary multimodal management. The present study proposes a comparative assessment of a series of cases where the intervention was elective, respectively emergency. Methods: This is a retrospective, observational, descriptive, unicentric study, that took place between 1st of January 2010 and 31st of December 2018 in the 3rd Department of General Surgery of the University Emergency Hospital Bucharest. We included in the study patients with the discharge diagnosis of rectal neoplasm who underwent curative surgical treatment consisting of low anterior resection performed in compliance with oncological safety principles. Conclusion: The emergency nature of the surgery influences whether or not a R0 type resection is obtained due to lack of adequate preoperative assessment (stadialization) and the presence or absence of neoadjuvant treatment rather than a technical defect.

Appendiceal Mass - Dilemmas Regarding Extension of the Resection.

Starting from a typical case, we try to highlight the main critical elements, both in the diagnostic algorithm and in the therapeutic one. We hereby present a 54-year old patient, known with hepatic steatosis and renal microlithiasis, which undergoes an ultrasonography in ambulatory, on the background of unsystematised abdominal discomfort; the ultrasound reveals the presence of a tumoral mass in the right iliac fossa.

Tendencies on Traditional Metrics.

Technological evolution dynamics has led to the exponential increase of the quantity of information published in all the scientific domains. In this context, there has been necessary to develop an objective method of reviewing the journals, articles and respectively the researchers. This paper represents a review of the evolution of traditional metrics based on citations.

Particularities in the Evolution of Mortality by Traumatic Events in the Last 30 Years.

We present a retrospective descriptive study targeting the mortality in the European Union's countries during the past 30 years. Data was collected from the WHO (World Health Organization) database of global mortality. The aim of this study was the identification of particularities in the evolution of trauma-related mortality in before-mentioned countries. The results showed patterns of mortality related to socio-geographical conditions at different times in history and a general trend towards its decrease. Age was also an important factor to take into consideration. To conclude, we would like to point out the lack of studies and available research in trauma-related fields and also to underline their necessity and utility, especially in the pediatric department.

Haemobilia - A Rare Cause of Upper Gastro-Intestinal Bleeding.

Haemobilia is a rare cause of upper gastrointestinal bleeding that consists of haemorrhage within the biliary tree. Most cases of haemobilia are due to iatrogenic cause, laparoscopic or open cholecystectomy, abdominal trauma, gallstones, hepatic tumours, vascular aneurism. We present the case of a male patient admitted in the surgery department for epigastric and right hypochondria pain, nausea and vomiting. Open cholecystectomy was performed with a trans-cystic tube drainage. Postoperative outcome was favourable but with a continuous decrease in haemoglobin level. In the 13th day postoperatively biliary drainage was 800 ml - haemobilia. Patient health status altered and melena and hematemesis occurred. Endoscopy, cholangiography and abdominal computer tomography (CT) were performed. The episode repeated in day 27 after initial surgery. Duodenotomy and exploration of the biliary tree was performed. Angiography was performed next day that revealed biliary-arterial fistula within segment IV of the liver followed by embolization. Haemobilia reoccurred fifteen days later and colonoscopy and angiography were performed. Embolization with metallic coils was performed. Patient outcome was favourable and was discharged 13 days after second embolization. Interventional angiography remains the first treatment option of haemobilia. Selective arterial ligation or hepatectomy remain the options in case of lack of angiography or insufficient results after embolization.

Atrial Fibrillation and Mortality after Gastrointestinal Surgery: Insights from a Systematic Review and Meta-Analysis.

BACKGROUND: Heart failure, stroke and death are major dangers associated with atrial fibrillation (AF), a common abnormal heart rhythm. Having a gastrointestinal (GI) procedure puts patients at risk for developing AF, especially after large abdominal surgery. Although earlier research has shown a possible connection between postoperative AF and higher mortality, the exact nature of this interaction is yet uncertain. METHODS: To investigate the relationship between AF and death after GI procedures, this research carried out a thorough meta-analysis and systematic review of randomized controlled studies or clinical trials. Finding relevant randomized controlled trials (RCTs) required a comprehensive search across many databases. Studies involving GI surgery patients with postoperative AF and mortality outcomes were the main focus of the inclusion criteria. We followed PRISMA and Cochrane Collaboration protocols for data extraction and quality assessment, respectively. RESULTS: After GI surgery, there was no statistically significant difference in mortality between the AF and non-AF groups, according to an analysis of the available trials (p = 0.97). The mortality odds ratio (OR) was 1.03 (95% CI [0.24, 4.41]), suggesting that there was no significant correlation. Nevertheless, there was significant heterogeneity throughout the trials, which calls for careful interpretation. CONCLUSION: Despite the lack of a significant link between AF and death after GI surgery in our study, contradictory data from other research highlight the intricacy of this relationship. Discrepancies may arise from variations in patient demographics, research methodology and procedural problems. These results emphasize the necessity for additional extensive and varied studies to fully clarify the role of AF in postoperative mortality in relation to GI procedures. Comprehending the subtleties of this correlation might enhance future patient outcomes and contribute to evidence-based therapeutic decision making.

Postsurgical Adhesions: Is There Any Prophylactic Strategy Really Working?

Postoperative adhesions are a frequent complication encountered after surgical procedures, mainly after intraperitoneal interventions. To this day, the pathophysiological mechanism behind the process of adhesions formation is not completely known. There are many strategies proposed as prophylaxis methods, involving surgical techniques, drugs or materials that prevent adhesions and even state of the art technologies such as nanoparticles or gene therapy. The aim of our review is to present these innovative approaches and techniques for postoperative adhesions prevention. After a thorough scientific database query, we selected 84 articles published in the past 15 years that were relevant to our topic. Despite all the recent groundbreaking discoveries, we are at an early stage of understanding the complexity of the adhesion formation mechanism. Further investigations should be made in order to create an ideal product for safe clinical use for prevention.

Endometriosis as an Uncommon Cause of Intestinal Obstruction-A Comprehensive Literature Review.

The prevalence of intestinal endometriosis has been estimated to be between 3% and 37% of all endometriosis cases. Cases of intestinal occlusion due to endometriosis foci on the small bowel and on the large bowel are even rarer, with a reported prevalence of 0.1-0.7%. The aim of this literature review was to summarize the available published evidence on the diagnosis, characteristics, and management of intestinal occlusion due to endometriosis. The search on PubMed retrieved 295 records, of which 158 were rejected following a review of the title and abstract. After reviewing the full text, 97 studies met the Population, Intervention, Comparator, Outcomes, and Study (PICOS) criteria and were included in the analysis. The total number of patients with bowel occlusion due to endometriosis included in the studies was 107. The occlusive endometrial foci were localized on the ileum in 38.3% of the cases, on the rectosigmoid in 34.5% of the cases, at the ileocecal junction and the appendix in 14.9% of the cases, and at the rectum in 10.2% of the cases. Only one case reported large bowel obstruction by endometriosis of the hepatic flexure of the colon extending to the transverse colon (0.9%), and in one case the obstruction was caused by an omental giant endometrioid cyst compressing the intestines. We identified six cases of postmenopausal females with acute bowel obstruction due to endometriosis. Malignant degeneration of endometriosis was also identified as a cause of intestinal occlusion. The mechanisms of obstruction include the presence of a mass in the lumen of the intestine or in the wall of the intestine, extrinsic compression, adhesions, or intussusception.

A Comprehensive Review of Inguinal Hernia Occurrence in Obese Individuals.

Inguinal hernia repair is one of the most commonly performed surgical activities worldwide. Given the circumstances, understanding and identifying the risk and the protective factors is an essential step in order to prevent, diagnose and treat such a common condition. For a long time, obesity was generally considered to be a risk factor in the occurrence of an inguinal hernia. Studies have provided some unexpected data, suggesting that it might actually be a protective factor. This review aims to provide an overview on this topic, taking into account systemic aspects such as collagen distribution and metabolism. In inguinal hernia patients, the ratio between type I collagen and type III collagen is decreased, with type III collagen being responsible for the weakness of the abdominal wall. In obese patients, the extracellular matrix becomes richer in collagen, especially type I collagen, which will generate strength and stiffness. Obesity seems to be a protective factor indeed, but in order to understand the underlying mechanism and to choose the optimal surgical approach, further research is needed.

Recent Developments in Metallic Nanomaterials for Cancer Therapy, Diagnosing and Imaging Applications.

Cancer continues to represent a global health concern, imposing an ongoing need to research for better treatment alternatives. In this context, nanomedicine seems to be the solution to existing problems, bringing unprecedented results in various biomedical applications, including cancer therapy, diagnosing, and imaging. As numerous studies have uncovered the advantageous properties of various nanoscale metals, this review aims to present metal-based nanoparticles that are most frequently employed for cancer applications. This paper follows the description of relevant nanoparticles made of metals, metal derivatives, hybrids, and alloys, further discussing in more detail their potential applications in cancer management, ranging from the delivery of chemotherapeutics, vaccines, and genes to ablative hyperthermia therapies and theranostic platforms.

A mesorectal incidentaloma: Rare localization of Castleman disease (Case report).

Incidentalomas are defined as tumors or pseudo-tumoral masses accidentally discovered during clinical and imaging investigations. We present a 51-year-old female patient who presented at the gynecology service for genital bleeding caused by uterine fibromatosis. Computerized pelvic tomography showed an engorged uterus completely deformed by numerous intramural and submucosal nodular structures suggestive of multiple fibroids. Behind the uterus, a well-defined, iodophilic, 49/51 mm diameter, tissue-shaped, nodular mass was identified, with pushing borders into the adjacent fat and showing a mass effect on the rectum against which it retained a demarcation zone. A conclusion of the histopathological examination was made. Histopathological aspects and immunohistochemical tests supported the diagnosis of Castleman disease (CD) variant vascular hyaline variant. The mesorectum is a particularly and extremely rare localization for CD, and preoperative diagnosis is difficult to achieve. The correct surgical attitude in the case of an incidental finding in this localization is the extensive resection that satisfies the presumption of a neoplastic formation.

Liquid biopsy in lung cancer management.

Liquid biopsy is a promising tool for a better cancer management and currently opens perspectives for several clinical applications, such as detection of mutations when the analysis from tissue is not available, monitoring tumor mutational burden and prediction of targeted therapy response. These characteristics validate liquid biopsy analysis as a strong cancer biomarkers source with high potential for improving cancer patient's evolution. Compared to classical biopsy, liquid biopsy is a minimal invasive procedure, and it allows the real-time monitoring of treatment response. Considering that lung cancer is the most common cause of cancer-associated death worldwide and that only 15-19% of the lung cancer patients survive five years after diagnosis, there is an important interest in improving its management. Like in other types of solid cancers, lung cancer could benefit from liquid biopsy through a simple peripheral blood sample as tumor-related biomarkers, such as circulating tumor cells (CTCs), cell-free nucleic acids (cfNA) [cell-free ribonucleic acid (cfRNA) and cell-free deoxyribonucleic acid (cfDNA)], exosomes and tumor-educated platelets (TEPs) may shed into circulation because of necrosis or in an active manner. More, the detection and analysis of these biomarkers could lead to a better understanding of oncological diseases like lung cancer. The better the tumor profile is established; the better management is possible. However, this approach has currently some limitations, such as low cfNA concentration or low count of CTCs that might be overcome by improving the actual methods and technologies.

Abdominal Compartment Syndrome-When Is Surgical Decompression Needed?

Compartment syndrome occurs when increased pressure inside a closed anatomical space compromises tissue perfusion. The sudden increase in pressure inside these spaces requires rapid decompression by means of surgical intervention. In the case of abdominal compartment syndrome (ACS), surgical decompression consists of a laparostomy. The aim of this review is to identify the landmarks and indications for the appropriate moment to perform decompression laparotomy in patients with ACS based on available published data. A targeted literature review was conducted on indications for decompression laparotomy in ACS. The search was focused on three conditions characterized by a high ACS prevalence, namely acute pancreatitis, ruptured abdominal aortic aneurysm and severe burns. There is still a debate around the clinical characteristics which require surgical intervention in ACS. According to the limited data published from observational studies, laparotomy is usually performed when intra-abdominal pressure reaches values ranging from 25 to 36 mmHg on average in the case of acute pancreatitis. In cases of a ruptured abdominal aortic aneurysm, there is a higher urgency to perform decompression laparotomy for ACS due to the possibility of continuous hemorrhage. The most conflicting recommendations on whether surgical treatment should be delayed in favor of other non-surgical interventions come from studies involving patients with severe burns. The results of the review must be interpreted in the context of the limited available robust data from observational studies and clinical trials.

An Up-to-Date Review of Natural Nanoparticles for Cancer Management.

Cancer represents one of the leading causes of morbidity and mortality worldwide, imposing an urgent need to develop more efficient treatment alternatives. In this respect, much attention has been drawn from conventional cancer treatments to more modern approaches, such as the use of nanotechnology. Extensive research has been done for designing innovative nanoparticles able to specifically target tumor cells and ensure the controlled release of anticancer agents. To avoid the potential toxicity of synthetic materials, natural nanoparticles started to attract increasing scientific interest. In this context, this paper aims to review the most important natural nanoparticles used as active ingredients (e.g., polyphenols, polysaccharides, proteins, and sterol-like compounds) or as carriers (e.g., proteins, polysaccharides, viral nanoparticles, and exosomes) of various anticancer moieties, focusing on their recent applications in treating diverse malignancies.