Assessment of Stroke Patients Admitted to a Tertiary Emergency County Hospital of Mehedinți - Romania.

Cerebrovascular accidents (CVA)-strokes represent a major public health problem worldwide, due to the large number of people affected. Also, there is a large number of people who die from stroke, especially in developing countries. Our study included a group of 119 patients, diagnosed with stroke and admitted to the Emergency Hospital of Drobeta Turnul-Severin, Mehedinți county, between 2016-2020. The analysis of risk factors and associated comorbidities showed that stroke can affect both the elderly and young people, under 20 years old. However, approximately 4/5 of CVA patients (79.83%) were aged over 50 years old. If non-ischemic strokes predominated in patients under the age of 50, after this age there is a tendency to balance the incidence between the eight main forms of stroke. No significant differences were observed regarding the social environment of the patients, which shows that the risk factors are almost identical in both social environments. Among the modifiable risk factors, we highlighted: high blood pressure in 55.46% of cases, obesity in 19.33% of cases, atherosclerosis in 10.92% of cases, diabetes mellitus in 10.92%, kidney failure in 6.72% of cases. The data we obtained show that there are possibilities to reduce the incidence of stroke by controlling and reducing the modifiable risk factors.

Serum Amino Acid Profiling in Children with Autistic Spectrum Disorder: Insights from a Single-Center Study in Southern Romania.

The objective of this study was to analyze the serum amino acid profile in children diagnosed with autistic spectrum disorder (ASD) in southern Romania. The analysis aimed to provide insights into the underlying metabolic dysregulations associated with ASD. ASD is a neurodevelopmental disorder characterized by impaired social interaction, communication deficits, and restricted repetitive behaviors. Although the exact cause of ASD is largely unknown, recent evidence suggests that abnormalities in amino acid metabolism may contribute to its pathogenesis. Therefore, studying the amino acid profile in children with ASD could offer valuable information for understanding the metabolic disturbances associated with this complex disorder. This single-center study examined serum samples from children diagnosed with ASD, utilizing advanced analytical techniques to quantify the levels of different amino acids, amino acid derivatives, and amino acid-like substances. The results showed a lower level of taurine and a higher level of asparagine and leucine in the ASD group versus the control group. In the ASD group, we observed significant differences in tryptophan and alpha-aminobutyric acid levels based on age, with higher tryptophan levels in children older than 7 years when compared to children younger than 7 years; however, no significant correlations were found with the ASD group older than 7 years old. Additionally, younger children with ASD exhibited higher levels of alpha-aminobutyric acid than older children with ASD. The findings from this study contribute to the growing body of knowledge on the metabolic aspects of ASD, highlighting potential biomarkers and therapeutic targets for improving the management and treatment of ASD in children.

HPV and Other Risk Factors Involved in Pharyngeal Neoplasm-Clinical and Morphopathological Correlations in the Southwestern Region of Romania.

Oropharyngeal squamous cell carcinoma (OPSCC) development is strongly associated with risk factors like smoking, chronic alcohol consumption, and the living environment, but also chronic human papilloma virus (HPV) infection, which can trigger cascade cellular changes leading to a neoplastic transformation. The prevalence of these factors differs among different world regions, and the prevention, diagnosis, and prognosis of OPSCC are highly dependent on them. We performed a retrospective study on 406 patients diagnosed with OPSCC in our region that were classified according to the tumor type, localization and diagnosis stage, demographic characteristics, risk factors, and histological and immunohistochemical features. We found that most of the patients were men from urban areas with a smoking habit, while most of the women in our study were diagnosed with tonsillar OPSCC and had a history of chronic alcoholism. During the immunohistochemical study, we analyzed the tumor immunoreactivity against anti-p16 and anti-HPV antibodies as markers of HPV involvement in tumor progression, as well as the correlation with the percentage of intratumoral nuclei immunomarked with the anti-Ki 67 antibody in serial samples. We observed that the percentage of Ki67-positive nuclei increased proportionally with the presence of intratumoral HPV; thus, active HPV infection leads to an increase in the rate of tumor progression. Our results support the implementation of strategies for OPSCC prevention and early diagnosis and can be a starting point for future studies aiming at adapting surgical and oncological treatment according to the HPV stage for better therapeutic results.

Micronutrient Research in Autism Spectrum Disorder. A Clinical Study.

Autistic spectrum disorders are part of the category of neurodevelopmental disorders, characterized by: difficulties in communication and social interaction, restrictive and repetitive patterns of behaviours and activities, which are present throughout the developmental period, and can be diagnosed in the first five years of life. Due to the increase in the incidence of this disorder in recent years, it has become a topic of great interest both to specialists in child and adolescent psychiatry and to researchers in the field. Given the polymorphism of Autism Spectrum Disorder and the need to discover factors that better explain the etiology of this disorder, studies related to biomarkers are extremely varied. One of the areas of study that have exercised particular interest is related to the involvement of metals in the pathology of autism spectrum disorder. Apart from the controversies related to heavy metals that according to studies affect the developmental process, there are studies that suggest that some micronutrients such as zinc, copper, selenium, iron, magnesium, may be involved in the etiology of autism spectrum disorder. Starting from these studies, we set out to investigate to what extent these essential metals for the body are involved in the etiology of autism spectrum disorder and how they influence the severity of symptoms.

Histopathological and immunohistochemical study of periodontal changes in chronic smokers.

Periodontal disease is a chronic inflammatory, multifactorial condition, that, in the absence of an early and adequate treatment, may lead to a progressive damaging of the alveolar tissues that support the teeth (periodontal ligament, cement and alveolar bone) followed by teeth mobility and, subsequently, their loss. Periodontal disease is one of the most common inflammatory disease affecting adult individuals all over the world, being considered a real worldwide pandemic. This disease may influence the progression of certain systemic diseases: diabetes mellitus, cardiovascular diseases, ischemic cardiomyopathy, myocardial infarction, stroke, neurodegenerative diseases, chronic kidney diseases, cancer, etc. The association between smoking and periodontal disease was described in numerous clinical and epidemiological studies, suggesting that products derived from tobacco burning may change the clinical aspects and the disease progression. The present study analyzed microscopically and immunohistochemically 58 periodontal fragments, from 50 patients, chronic smokers, clinically diagnosed with severe periodontitis. There were highlighted major changes in the gingival epithelium (epithelium thickening, acanthosis, intraepithelial edema, infiltrates of neutrophils or lymphocytes, epithelial necrosis), in the periodontal conjunctive tissue (more or less intense inflammatory infiltrates, microhemorrhages, vascular congestion, intense immunohistochemical expression for some matrix metalloproteinases). The periodontal changes may be the expression of both toxic factors present in tobacco smoke and due to the changes caused by tobacco in the microbial flora of the oral cavity.

Macroscopic Changes in Oral Mucosa and Hygiene Indicators in Smokers.

Smoking is the most important factor affecting the oral cavity by components born in the tobacco combustion process and acting directly on the oral mucous membranes, dental arch and indirectly on the teeth support. Recent studies show the tobacco action on the oral cavity, manifestations in the form of gingivitis, bacterial plaque, dental plaque, papillary bleeding at drilling, periodontitis. PURPOSE OF THE STUDY: In this study, we have set out to assess the macroscopic modifications of oral cavity on smokers. MATERIALS AND METHODS: The participants in the study were divided into two groups, the first group of smokers with a smoking period over 5 years and the control group of nonsmokers. The patients in the two groups underwent a physical examination and an objective clinical examination, the resulting data being compared with the control group. RESULTS: For the bacterial plaque indicatorin the smoker group there was obtained a mean value of 35.68±12.45, compared to a mean value of 16.32±6.61 for the nonsmoker group, the dental plaque indicatorfor the smoker group had a mean value of 2.24±1.02, higher than the one in the nonsmoker group, namely 0.94±0.68, and for the drilling bleeding indicator we obtained a mean value of 19.54±7.89 in the nonsmoker group, which is lower than that in the smoker group, namely 42.86±14.93. CONCLUSIONS: Smoking is a cause that maintains and aggravates the periodontal disease, including the risk of periodontitis, allowing the aggravation of gingivitis, considered a reversible surface inflammation of the gum mucosa which, by accumulation of dental plaque, the dental plaque accompanied by incorrect oral hygiene, favors the progression to periodontitis.

Histopathological and immunohistochemical aspects of bone tissue in aseptic necrosis of the femoral head.

Femoral head osteonecrosis, also known as avascular necrosis, is a disease with a multifactorial etiology, characterized by a profound change of bone architecture, which leads to the diminishing of bone resistance and femoral head collapse. The main causes that lead to femoral head necrosis are represented by the decrease of local blood perfusion and increase of intraosseous pressure, because of an excessive development of adipose tissue in the areolas of the trabecular bone tissue in the femoral head. The histopathological and immunohistochemical (IHC) study performed by us showed that most of bone trabeculae were damaged by necrotic-involutive processes, their sizes being reduced, both regarding their length and their diameter; generally, the spans were thin, fragmented, distanced among them, which led to the occurrence of some large areolar cavities, full of conjunctive tissue, rich in adipocytes. Some of the residual bone spans even presented microfractures. In the structure of the trabecular bone tissue, numerous cavities showed lack of content, which indicates the death of osteocytes inside, while the endosteum appeared very thin, with few osteoprogenitor, flattened, difficult to highlight cells. The IHC study showed a low reaction of the bone reparatory processes and a reduced multiplication capacity of bone cells involved in the remodeling and remake of the diseased bone tissue. Nevertheless, there were identified numerous young conjunctive cells (fibroblasts, myofibroblasts), positive to proliferating cell nuclear antigen (PCNA), cells that have a high capacity of multiplication, participating in the formation of a fibrous conjunctive tissue (sclerous) instead of the damaged bone trabeculae. The formation of fibrous conjunctive tissue causes the reduction of mechanical resistance of the femoral head and its collapse. The IHC study of the microvascularization in the femoral head damaged by aseptic osteonecrosis showed the presence of a very low vascular system, both in the residual bone trabeculae and in the sclerous conjunctive tissue. Of the inflammatory cells present in the spongy bone tissue of the femoral head affected by osteonecrosis, the most numerous ones were the macrophages. Both macrophages and T- and B-lymphocytes had a heterogenous distribution.

The process of liver fibrosis in chronic hepatitis C - histological and immunohistochemical study.

Liver fibrosis is one of the most serious histopathological (HP) lesions that, together with the inflammatory process and the hepatocyte lesions, determine the change of the liver architecture, having as a clinical result the onset of liver failure phenomena. Hepatitis C virus represents one of the most frequent conditions leading to the onset of liver fibrosis and favors the progression of the disease towards hepatocellular carcinoma. We evaluated the HP and immunohistochemical (IHC) aspects on fragments of liver biopsies taken from 104 patients diagnosed with chronic hepatitis C and altered capacity of work. In our study, we observed a growth of the portal (Kiernan) spaces by the presence of a chronic inflammatory infiltrate, the presence of collagen fibers and conjunctive matrix. The density and dimensions of collagen fibers were correlated with the severity of the liver disease, in the severe forms being highlighted porto-portal and porto-central fibrous bridges. The IHC examinations highlighted the change of the phenotype of perisinusoidal dendritic cells, the growth of the myofibroblast cells in the portal spaces, the growth of the macrophage number in the inflammatory infiltrate and of the Kupffer cells in the liver parenchyma.

Synchronous gastric tumors - case presentation.

Synchronous gastric tumors, and, especially the presence of an adenocarcinoma and gastrointestinal stromal tumors, are less frequent. We present the case of a 75-year-old patient, with no gastrointestinal pathology in the medical history, who was admitted for marked asthenia, nausea, coffee grounds vomiting, inappetence, dizziness, weight loss and periodical epigastralgias. The clinical and imagistic examinations highlighted an ulcerative, infiltrative, bleeding tumor formation, present on the anterior side and subcardially on the small curvature. During the surgery, there was highlighted a second tumor, whitish, of about 2.5 cm, prominent under the peritoneal serous, of firm consistency and with an adherence to the stomach muscles. For removing the two tumors, there was performed total gastrectomy with esophagus-jejunal termino-lateral anastomosis, with jejunum ansa "in omega". The histopathological and immunohistochemical examinations established that the first tumor was a poorly differentiated carcinoma, and the second was a gastrointestinal stromal tumor. The patient's evolution was a good one, both clinically and biologically, the imagistic examinations performed after six and 12 months highlighting the lack of local relapses and absence of metastases.

Do medical students really understand plagiarism? - Case study.

In the last decade, more and more medicine students are involved in research, either in the form of a research project within specialized courses or as a scientific article to be presented at student international conferences or published in prestigious medical journals. The present study included 250 2nd year medical students, currently studying within the University of Medicine and Pharmacy of Craiova, Romania. There were collected 239 responses, with a response rate of 95.6%. In our study, the results showed that foreign students within the University of Medicine and Pharmacy of Craiova did have some issues understanding plagiarism with fewer foreign students (34%) than Romanian students (66%) recognizing that simply changing words does not avoid plagiarism. In our opinion, there should be put more emphasis upon plagiarism implications and its aspects, as well, with a permanent order to try to prevent future attempts of plagiarizing among medical students as future researchers within the medical science field.

Comparing the antifibrotic effect on the liver of Telmisartan and Pentoxifylline, in a Wistar rat experimental model.

Chronic liver diseases are characterized by higher or lower changes of the liver lobe architecture (parenchymatous and vacuolar), the accumulation of inflammatory and collagen infiltrates, mainly in the Kiernan spaces and a progressive evolution to liver cirrhosis. Despite the progresses made in knowing the mechanisms of liver fibrosis and the development of some antiviral drugs with a high potential, that can induce fibrosis regression, there still continues to exist the need for a specific antifibrotic treatment. In our study, we used four groups of Wistar rats: a reference group and three groups that received 40% carbon tetrachloride (CCl4), intraperitoneally, twice a week, for four weeks; after one week since starting the administration of CCl4, one of the three groups received, through oral gavage, Telmisartan (TS) 8 mg÷kg, and another received Pentoxifylline (PTX) 20 mg÷kg, dissolved in saline solution, for four weeks. The antifibrotic action of the two drugs was analyzed by evaluating the histopathological and immunohistochemical changes of hepatocytes, hepatic stellate cells (Ito cells) and macrophages (Kupffer cells). The study highlighted that in the group treated with TS, the process of fibrillogenesis was significantly reduced, in comparison to the group treated with PTX and with the reference group.

A rare case of ovarian splenosis.

Splenosis is a very rare entity that often appears following a traumatic rupture of the spleen or after splenectomy and represents heterotopic transplantation of splenic tissue. The ovary is reported as an atypical and rare localization. We report a case of a middle-aged woman, which presented with a left adnexal mass. Transvaginal ultrasonography, computed tomography (CT) and high-field 3T magnetic resonance imaging (MRI) revealed the left adnexal mass. Laparoscopy was performed, and histological and immunohistochemical examination revealed that resected mass was splenic tissue.

Mesenchymal hamartoma of the left liver lobe in an 18-month-old female patient.

Mesenchymal hamartoma of the liver (MHL) is a benign and rare hepatic lesion, with an uncertain etiology and a potential for developing into an undifferentiated distant embryonal sarcoma after an incomplete resection. It mainly presents as progressive abdominal distension with normal blood works. Most cases are diagnosed in the first two years of life, with a higher frequency in boys and on the right liver. We report the case of a mesenchymal hamartoma of the left liver in an 18-month-old girl, with a rough evolution and a literature review. There were performed an abdominal computed tomography (CT) scan and resection of the lesion. The macroscopic and histological examination described a 16.5×17.9×10.5 cm multicystic mass as a MHL lesion. MHLs may have a malignant potential and in the clinical presence of a "neoplastic" syndrome there requires a good diagnosis and drastic surgical treatment.

Antifibrotic action of telmisartan in experimental carbon tetrachloride-induced liver fibrosis in Wistar rats.

BACKGROUND AND AIMS: Liver fibrosis is the increasingly accumulation of extracellular matrix (ECM), caused by chronic liver injuries, and represents a difficult clinical challenge in the entire world. Currently, the advanced knowledge of the cellular and molecular mechanisms of liver fibrosis showed that collagen-producing cells, like activated hepatic stellate cells (HSCs), portal fibroblasts and myofibroblasts are activated by fibrogenic cytokines, such as angiotensin II, transforming growth factor-beta 1 (TGF-ß1), and leptin. Because of these, we tested telmisartan, an angiotensin II (AT1) receptor blocker and a peroxisome proliferator-activated receptor-γ (PPARγ) partial agonist, for investigate its antifibrotic action, on experimental model of carbon tetrachloride-induced liver fibrosis. MATERIALS AND METHODS: In this research, we used two groups of Wistar rats, which received intraperitoneal (i.p.) injection of carbon tetrachloride (CCl4) 40% dissolved in olive oil, twice weekly for four consecutive weeks (initial dose of 5 mL÷kg, and other doses 3 mL÷kg). After one week, one group was received by gavage telmisartan (TS) dissolved in saline 0.9%, daily in dose of 8 mg÷kg, for 28 days. One group of Wistar rats was used for control. The antifibrotic action of telmisartan was investigated on the pathological changes of the liver and immunohistochemical analysis for hepatic stellate (Ito) cells (HSCs) reaction using anti-alpha-smooth muscle actin (anti α-SMA) antibody and macrophages cells (Kupffer cells) reaction using anti-CD68 antibody. RESULTS AND CONCLUSIONS: In group treated with telmisartan, hepatic fibrogenesis process was significantly reduced, in comparison with CCl4 group.

Bioethical dilemmas in using animal in medical research. Challenges and opportunities.

PURPOSE: The study aims to present the main ethical dilemmas that research on animals raised for anyone involved in this process, starting from the idea that there are rights of animals to be known and respected. BACKGROUND: The evolution of medicine is inextricably linked to the production of new drugs, the occurrence of surgical techniques; none of these can be possible without the study of experimental animals, in vivo experimentation being part of the process of medical research. CONTENT: The article analyzes the main ethical dilemmas related to the use of animals in medical research, in the current legislative context and historical perspective of achieving such studies. DISCUSSION AND CONCLUSIONS: The use of animals in medical research must be conducted in accordance with clearly established moral rules, which facilitate reducing to the maximum the negative effects on the animals, avoiding unnecessary suffering to them and especially to facilitate progress achievement with the minimum possible animals sacrificed.

Study of restorative processes in brain laceration in the first seven days after traumatic brain injury.

Traumatic brain injuries represent the main cause of death and invalidity all over the world. Persons surviving a severe traumatic brain injury often present long-term disabilities, sensitive and motor deficits, cognitive, vegetative or mental disorders. Brain injuries are directly caused by the traumatic agent, and indirectly caused by the action of cells involved in the restorative process. The main cells involved in the restorative process are microglias and astrocytes. By using an experimental model, we investigated the reaction of these cells in the first week after a severe brain injury, followed by brain laceration. Of the two cell types, the most rapid and intense reaction was held by the macroglias, also known as resident macrophages of the central nervous system. Alongside the activation of local microglias, in the restorative process there were also involved blood monocytes that turned into macrophages. 24 hours after the injury, the number of macrophage cells÷mm² at brain wound level increased 2-4 times, after three days - 10-12 times, and after seven days - over 20 times. The astrocyte reaction was slower, their activation being signaled no sooner than three days from injury, when their number in the perilesional brain parenchyma increased approximately two times, while after seven days - approximately 4-5 times. Both astrocytes and macrophages (microglias), besides their beneficial effects in restoring traumatic brain injuries, may have unfavorable effects upon the nervous cells in the immediate proximity of the injury. Destruction of vascular network by the traumatic agent, and the extremely slow restore of vascularization, partially explain brain neurons death on extend areas.