Dynamics of tumor evolution after Gammaknife radiosurgery for sporadic vestibular schwannoma: defining volumetric patterns characterizing individual trajectory.

BACKGROUND: Definition of tumor control and treatment failure after Gammaknife radiosurgery (GKRS) for vestibular schwannoma (VS) is still debated. The lack of knowledge on the dynamics of tumor evolution can lead to misinterpretation and subsequent inappropriate second treatment. The aim of this study was to evaluate the post-GKRS dynamics of evolution of tumor volume, and characterize volumetric patterns. METHODS: We included patients with sporadic VS treated by GKRS with an MRI follow-up of minimum 3 years. A clustering in 2 steps was performed: definition of the patterns of evolution based on a subset of patients with the most comprehensive follow-up, then assignment of the remaining patients on a best fit basis. The minimum length of follow-up was assessed by measuring the consistency of the clusters over time (Adjusted Rand Index and Normalized Mutual Information). An analysis of the discriminant variables was finally performed. RESULTS: 1,607 patients were included (median follow-up: 67 months). Five patterns were defined with one pattern gathering almost all cases of treatment failure. The clustering at 5 years afforded the highest consistency with long-term follow-up. Discriminant variables for clusters were: sex, initial symptoms, delay of diagnosis, Koos grading, fundus invasion, and number of isocenters. CONCLUSIONS: The definition of these robust distinct patterns is likely to help tremendously the physicians to distinguish tumor control from potential failure. We advocate for no retreatment decision before 5 years post-GKRS. Further investigations are required to decide if the dynamics of evolution can be predicted at GKRS on an individual basis.

Interactions between Cognitive, Affective, and Respiratory Profiles in Chronic Respiratory Disorders: A Cluster Analysis Approach.

This study conducted at Leamna Pulmonology Hospital investigated the interrelations among cognitive, affective, and respiratory variables within a cohort of 100 patients diagnosed with chronic respiratory conditions, utilizing sophisticated machine learning-based clustering techniques. Spanning from October 2022 to February 2023, hospitalized individuals confirmed to have asthma or COPD underwent extensive evaluations using standardized instruments such as the mMRC scale, the CAT test, and spirometry. Complementary cognitive and affective assessments were performed employing the MMSE, MoCA, and the Hamilton Anxiety and Depression Scale, furnishing a holistic view of patient health statuses. The analysis delineated three distinct clusters: Moderate Cognitive Respiratory, Severe Cognitive Respiratory, and Stable Cognitive Respiratory, each characterized by unique profiles that underscore the necessity for tailored therapeutic strategies. These clusters exhibited significant correlations between the severity of respiratory symptoms and their effects on cognitive and affective conditions. The results highlight the benefits of an integrated treatment approach for COPD and asthma, which is personalized based on the intricate patterns identified through clustering. Such a strategy promises to enhance the management of these diseases, potentially elevating the quality of life and everyday functionality of the patients. These findings advocate for treatment customization according to the specific interplays among cognitive, affective, and respiratory dimensions, presenting substantial prospects for clinical advancement and pioneering new avenues for research in the domain of chronic respiratory disease management.

Pre- and Post-COVID-19 Antimicrobial Resistance Pattern of Pathogens in an Intensive Care Unit.

We aimed to determine the trend of the antimicrobial resistance pattern of pathogens isolated in samples collected from patients hospitalized in the intensive care unit (ICU) in selected periods before and after COVID-19. A retrospective study of bacterial pathogens was performed on 1267 patients. Positive bacterial culture data from 1695 samples from the pre-COVID-19 period and 1562 samples from the post-COVID-19 period were obtained. The most frequently isolated bacteria in both periods were Staphylococcus aureus and Klebsiella spp. The resistance rates of Klebsiella spp. Significantly increased against colistin (0.38% to 20.51%), gentamicin (44.62% to 64.85%), and aztreonam (56.35% to 3.60%). There was a significant increase in the resistance rate against colistin for E. coli strains (4.69% to 32.46%) and for Acinetobacter sp. strains (3.37% to 18.09%). More than 50% of the Staphylococcus aureus strains were MRSA, with statistically significant increases in the antimicrobial resistance rate against doxycycline (40.08% to 51.72%), linezolid (0.22% to 3.13%), rifampicin (53.16% to 64.93%), and teicoplanin (26.31% to 53.40%). The study revealed a significantly increasing trend in the antimicrobial resistance rate of Gram-negative pathogens against certain antibiotics, including those used only in cases where there are no other therapeutic options.

Post-COVID-19 Syndrome Based on Disease Form and Associated Comorbidities.

(1) Background: SARS-CoV-2 has infected more than 97 million people worldwide and caused the death of more than 6 million. (2) Methods: Between 1 October and 31 December 2020, 764 patients diagnosed with SARS-CoV-2 infection were selected based on RT-PCR test results. The following parameters were noted: age, gender, origin, days of hospitalization, COVID-19 experienced form, radiographic imaging features, associated comorbidities, and recommended treatment at discharge. (3) Results: The mean age at the time of COVID-19 infection was 55.2 years for men and 55.3 years for women. There was a similar age distribution among patients, regardless of gender. There was a substantial difference between the average lengths of hospitalization and those with residual symptoms-most patients who reported symptoms after discharge had been admitted with moderately severe forms of illness. Fatigue was the main remaining symptom (36%). (4) Conclusions: In conclusion, to clarify the impact of SARS-CoV-2 infection on patients in the long term, further studies are needed to investigate the elements assessed. Well-designed recovery programs will be needed to effectively manage these patients, with multidisciplinary collaboration and a team of professionals involved in all aspects of post-COVID patient health.

Gingival Recession in a Case of Anterior Crossbite with Angle Class I Relationship.

Anterior crossbite is one of the most common orthodontic problems encountered during the dental eruption. Usually, the anomaly becomes evident during mixed dentition, as a result of the disharmony between the dental, skeletal and functional components of the orthognathic system. As complications, the presence of the anterior dental cross bite can lead to the thinning of the vestibular alveolar process of the lower incisors and gingival recession. Periodontal changes could recede spontaneously if orthodontic treatment is applied early, in the presence of good oral hygiene. In this case, gingival recession decreased, but not completely receded after orthodontic treatment, although the patient had a good oral hygiene.

Concomitant lung and intestinal tuberculosis - case report.

Tuberculosis (TB) is responsible for one in five deaths for young women (between 15-44 years old). Almost 9 million persons are diagnosed with TB each year and around 2 million deaths are due to TB or TB complications. Abdominal TB has no specific clinical symptoms, no imagistic and no specific laboratory tests, all these making the diagnosis more difficult. Most often, clinical, radiographic, and histopathological (HP) aspects in TB enteritis are nonspecific and may suggest cancer or inflammatory bowel disease. We present the case of a 42-year-old male patient, with intestinal and lung TB presenting as intestinal obstruction to emphasize the importance of clinical suspicion and histopathology for final diagnosis. Chest and abdomen computed tomography (CT) evidenced a few left-sided pulmonary nodules and wall thickening of some parts of the small and large bowel. Also, CT evidenced nearby mesenteric lymphadenopathy. He was admitted in the Department of Surgery and later confirmed with intestinal TB. Because of modified chest radiography, further investigations identified Mycobacterium tuberculosis in the sputum. Final diagnosis was concomitant lung and intestinal TB confirmed by sputum and histopathology. The patient received proper anti-tuberculous treatment and his condition improved after the first month. The physician treating the organ is the one that should establish the diagnosis of extra-respiratory TB; however, treatment and later follow-up are multidisciplinary. TB should always be suspected in any patient with nonspecific symptoms. The TB case is defined according to disease localization, bacteriological or HP confirmation, therapeutic history and human immunodeficiency (HIV) infection status.

Segregation through the multiscalar lens.

We introduce a mathematical framework that allows one to carry out multiscalar and multigroup spatial exploratory analysis across urban regions. By producing coefficients that integrate information across all scales and that are normalized with respect to theoretical maximally segregated configurations, this framework provides a practical and powerful tool for the comparative empirical analysis of urban segregation. We illustrate our method with a study of ethnic mixing in the Los Angeles metropolitan area.

Tuberculosis and its particularities in Romania and worldwide.

Tuberculosis (TB) is a global health issue, with a rising incidence since the beginning of this century. It poses a severe mortality risk and also poses a serious economic risk as it reduces the working capacity of an individual in the most productive part of life. Developing countries face widespread tuberculosis infection - up to 95% of all cases and 98% of deaths, respectively. It is a highly contagious infectious disease caused by Mycobacterium tuberculosis (the Koch bacillus) that can be contracted from either humans or animal hosts. Infection is also associated with immunodepressive conditions and can be contacted through airborne, digestive, cutaneous or other routes of transmission. Pulmonary TB can be either primary - when events follow a first contact between the organism and the bacillus, and secondary - in case of a reactivation of a latent primary infection. One of the aims of this review is to present the current epidemiological data of TB infections in Romania, compared to the rest of the world, with an analysis of associated conditions and extra-respiratory TB infections. One of the main conclusions of our review is that optimal management of this complex disease can only be achieved through a coherent national prevention and treatment program, with centralized financing and sufficient epidemiological, imaging and laboratory support, in conjunction with good patient compliance.

Tuberculosis of the oral cavity.

Tuberculosis (TB) of the tongue is not a common finding diagnosis, even if consider endemic areas. Tuberculosis of the tongue sometimes can mimic lingual neoplasm. Oral tuberculosis is rarely primary as mechanism, and frequently secondary to pulmonary tuberculosis. There are many suspect lesions that can be classified as tuberculosis, such as tumor mass, ulcerative lesion or fissure. It is very important for diagnosis to perform histopathological examination of the biopsy. We present here the case of a 74-year-old man who developed lingual tuberculosis with a tumor aspect concomitant with pulmonary tuberculosis. Histopathological and immunohistochemical examinations established the diagnosis of lingual tuberculosis.

Lung Involvement in Multiple Myeloma - Case Study.

INTRODUCTION: Mutiple mieloma (MM) cells are rarely found in extramedullary sites. The sites of extramedullary dissemination reported in the literature are spleen, liver, lymph nodes, kidneys, thyroid gland, adrenal gland, ovary, tests, lung, pleura, pericardium, intestinal tract and skin. We report a case in which the myeloma was diagnosed after we discovered the presence of monoclonal plasma cells in the bronchoalveolar lavage fluid (BAL). Matherial and method: a case in which diagnosis was established from bronchoalveolar lavage (BAL) fluid demonstrating the presence of monoclonal plasma cells in Craiova Pneumology Departament. RESULTS: Analysis of BAL fluid for the presence of plasma cells and for cytoplasmic immunoglobulin DNA provides a noninvasive means of establishing the diagnosis. CONCLUSIONS: Pulmonary parenchyma is an uncommon site of extramedullary involvement in multiple myeloma. Interstitial lung disease as pulmonary manifestation of multiple myeloma is even rarer; only isolated cases with histological proofs have been reported in the literature.

Nonlinear projection methods for visualizing Barcode data and application on two data sets.

Developing tools for visualizing DNA sequences is an important issue in the Barcoding context. Visualizing Barcode data can be put in a purely statistical context, unsupervised learning. Clustering methods combined with projection methods have two closely linked objectives, visualizing and finding structure in the data. Multidimensional scaling (MDS) and Self-organizing maps (SOM) are unsupervised statistical tools for data visualization. Both algorithms map data onto a lower dimensional manifold: MDS looks for a projection that best preserves pairwise distances while SOM preserves the topology of the data. Both algorithms were initially developed for Euclidean data and the conditions necessary to their good implementation were not satisfied for Barcode data. We developed a workflow consisting in four steps: collapse data into distinct sequences; compute a dissimilarity matrix; run a modified version of SOM for dissimilarity matrices to structure the data and reduce dimensionality; project the results using MDS. This methodology was applied to Astraptes fulgerator and Hylomyscus, an African rodent with debated taxonomy. We obtained very good results for both data sets. The results were robust against unbalanced species. All the species in Astraptes were well displayed in very distinct groups in the various visualizations, except for LOHAMP and FABOV that were mixed up. For Hylomyscus, our findings were consistent with known species, confirmed the existence of four unnamed taxa and suggested the existence of potentially new species.

Histological changes of gingival epithelium in diabetic patients with periodontal disease.

UNLABELLED: The pathogenesis of the periodontal disease is complex, because it derives from the initiation and maintenance of the chronic inflammatory process by the plenty microbial flora and its numerous bacterial products. The purpose of our study was to make evidence of the histopathological changes occurring in the gingival epithelium in patients with both diabetes mellitus and periodontal disease. MATERIALS AND METHODS: Our study was carried out on gingival tissue from 68 diabetic patients with specific symptoms of periodontitis. The preparations were processed by Hematoxylin-Eosin staining technique and trichromic staining after the Goldner-Szekely method. RESULTS: Although non-specific, since they have been generally found in chronic gingival inflammation, the noticed changes were significant and some of them had specific aspects for the diabetic patients: gingival epithelium changes like acanthosis type; the presence of inflammatory cells such as polymorphonuclear leukocytes and/or lymphocytes among the cells of the stratified squamous epithelium; surface ulceration areas covered by hematic and fibrino-leukocytary detritus; the epitheliocytes keratinization in the superficial layers. CONCLUSIONS: The diabetic patients with periodontitis frequently associate hypertrophy changes of the gingival epithelium with the epithelial permeability alteration and the presence of the intraepithelial inflammatory cells, subsequently leading to degenerative lesions and epithelial ulceration.

Clinical and therapeutic aspects in dento-alveolar disharmony (DAD) with crowding.

UNLABELLED: Dento-alveolar disharmony (DAD) with crowding represents a predispose factor for periodontal pathology installing, especially when septic inflammation is associated. In this context, the identification of integrity or presence of the periodontal structure modifications becomes essential, any discovered element of periodontal pathology transforming into an important factor for a correct and beneficial orthodontic or periodontal-orthodontic therapy setup. The purpose of our study was to reveal the relations between the DAD existence and periodontal modifications within a lot of 528 subjects of 7 to 19 years old wearing different DAD who asked for an orthodontic control, and also the effects of orthodontic therapy upon periodontal structures for the situations in which this therapy was instituted. 74,87% was the percentage for patients with DAD and crowding who accepted the initiation of an orthodontic treatment and 12,75% of them had a friable C type periodontium (with great possibility to evolve towards a periodontal pathology), 25,62% had chronic gingivitis, and in 15,43% there have been noticed gingival recessions more than 2 mm. The orthodontic treatment was finalized for 44,96% of the patients, in 13,43% we noticed the persistence of C type periodontium, in 8,95% of gingival recessions more than 2 mm, in 25,37% chronic gingivitis and in 22,38% hypertrophic gingivitis. CONCLUSION: it is important to initiate an exhaustive control of the patient with DAD before, during and after the orthodontic treatment, especially if the patient is susceptible to develop a periodontal pathology, and also to maintain a good oral hygiene along the treatment.

Inflammatory reaction in chronic periodontopathies in patients with diabetes mellitus. Histological and immunohistochemical study.

Chronic periodontopathies and diabetes mellitus are two clinical entities, which reciprocally condition one another. The periodontal disease is considered a major complication, which induces an unfavorable evolution of diabetes mellitus. Diabetes mellitus is an endocrine disease which favors the occurrence of periodontopathy through gum's microvascular disorders, the selection and development of an aggressive bacterial plaque and through an exaggerate inflammatory response to the microflora within the oral cavity. Both diabetes mellitus and periodontal disease have an increasing incidence in the whole world. Development of periodontopathy is related to the aggression of bacterial flora in dental plaque, flora that is influenced on its turn by the evolution of diabetes mellitus. In our study, we have evaluated the inflammatory reaction in periodontium in patients with slowly and progressive periodontitis in patients with diabetes mellitus who had diabetes longer than five years. It has been found that all patients presented a chronic inflammatory infiltrate, abundant, with round mononuclear cells of lymphocyte, plasma cells and macrophage type, with non-homogenous arrangement, more intensely where the covering epithelium presented erosions or necrotic areas. Out of the immunity system cells, the most numerous where of T-lymphocytes type.

Gingival inflammatory infiltrate analysis in patients with chronic periodontitis and diabetes mellitus.

UNLABELLED: Diabetes mellitus and periodontal disease are two pathological entities that destructively emphasize each other. The aim of our study was the histological and immunohistochemical analyze of the inflammatory infiltrate in the gingival tissue at patients with diabetes mellitus (DM) and periodontal disease. MATERIALS AND METHODS: The study was achieved on gingival tissue from 40 patients with DM and specific symptoms of periodontal disease. We used Hematoxylin-Eosin and trichromic Goldner-Szekely staining and CD20cy and CD45RO antibodies. RESULTS: In patients with DM under 10 years, we found an intense periodontal lymphocyte inflammatory infiltrate and in patients with a DM evolution more than 10 years, the lymphocyte inflammatory infiltrate had a less intensity. The pattern was mostly diffuse in lamina propria. Many patients had a very abundant plasmocyte infiltrate. During immunohistochemical exam, 25 cases presented CD20 positive immunostaining. The intensity of the inflammatory infiltrate with B-lymphocytes was very low (score 1). All immunohistochemical analyzed cases presented CD45RO positive immunostaining, with a mixed pattern of the T-cell lymphocyte infiltrate. CONCLUSIONS: The nflammatory infiltrate in diabetic periodontal disease was polymorph, mostly with a diffuse pattern in gingival chorion. The intensity of the lymphocyte infiltrate was higher in patients with chronic periodontitis and DM less than 10 years. Positive CD45RO T-lymphocytes were more numerous compared to positive CD20 B-lymphocytes and they were present intra and under epithelial in the gingival of all the patients, no matter of the DM time evolution.

[Inhaled corticosteroids in COPD and the risk of pneumonia]. / Corticoterapia inhalatorie in BPOC si riscul pneumoniei.

Concern is continuing about increased risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD) who use inhaled corticosteroids. The aim of this work is to present a few results from the literature about this problem.

DNA barcode analysis: a comparison of phylogenetic and statistical classification methods.

BACKGROUND: DNA barcoding aims to assign individuals to given species according to their sequence at a small locus, generally part of the CO1 mitochondrial gene. Amongst other issues, this raises the question of how to deal with within-species genetic variability and potential transpecific polymorphism. In this context, we examine several assignation methods belonging to two main categories: (i) phylogenetic methods (neighbour-joining and PhyML) that attempt to account for the genealogical framework of DNA evolution and (ii) supervised classification methods (k-nearest neighbour, CART, random forest and kernel methods). These methods range from basic to elaborate. We investigated the ability of each method to correctly classify query sequences drawn from samples of related species using both simulated and real data. Simulated data sets were generated using coalescent simulations in which we varied the genealogical history, mutation parameter, sample size and number of species. RESULTS: No method was found to be the best in all cases. The simplest method of all, "one nearest neighbour", was found to be the most reliable with respect to changes in the parameters of the data sets. The parameter most influencing the performance of the various methods was molecular diversity of the data. Addition of genetically independent loci--nuclear genes--improved the predictive performance of most methods. CONCLUSION: The study implies that taxonomists can influence the quality of their analyses either by choosing a method best-adapted to the configuration of their sample, or, given a certain method, increasing the sample size or altering the amount of molecular diversity. This can be achieved either by sequencing more mtDNA or by sequencing additional nuclear genes. In the latter case, they may also have to modify their data analysis method.

Evaluation of dental and maxillary development in patients with cleft lip alveolus.

Our purpose was to determine in 20 unilateral cleft lip and alveolus subjects characteristics of the maxillary permanent teeth and maxillary arch development. Clinical and radiographic examinations have been carried out to identify congenitally missing teeth and sagittal skeletal patterns. Study cast assessment was undertaken to evaluate mesiodistal widths of individual teeth, intercanine and intermolar distances for the maxillary arch, as well as dental relationships. We observed that the congenital absence of the upper incisors was higher on the cleft side than on the non-cleft side. There was a statistically significant difference between the mesiodistal widths of cleft-side permanent upper lateral incisors, and their antimeres (p<0.05). Most of the patients presented a class II dental relationship on the affected side comparing to class I/class III Angle on the unaffected side. We concluded that patients with isolated cleft lip and alveolus present perturbations in dental and maxillary arch development, a more severe disruption being recorded on the cleft side.

[Importance of diagnosis and treatment of obstructive sleep apnea to prevent postoperative complications]. / Importanta depistarii si tratamentului sindromului apneei obstructive de somn în prevenirea complicatiilor postoperatorii.

Sleep Apnea is a medical condition, frequently undiagnosed, that leads to significant morbidity and reduced quality of life. Patients with obstructive sleep apnea (OSA) are particularly vulnerable of developing postoperative complications when having surgery or other invasive interventions under general anesthesia; pulmonary and cardiac disorders increase the risk of perioperative complications. We propose in this article to present the importance of polysomnography in the preoperative diagnosis of patients with OSA, initiations of CPAP therapy, treatment of associated disorders for reducing peri-operatory risk of these patients.