Lipid Profile Paradox: Investigating Improved Lipid Levels in Diabetic Mellitus Patients with Foot Ulcer Infections-A Prospective Descriptive Study.

Type 2 diabetes mellitus (DM) is a chronic metabolic disorder posing multifaceted challenges to global public health. Among its numerous complications, infected diabetic foot ulcers (IDFUs) represent a particularly debilitating consequence. Beyond cardiovascular implications, there is an emerging understanding of the interconnectedness among IDFUs, neuropathy, atherosclerosis, and dyslipidemia. IDFUs, peripheral neuropathy, and atherosclerosis share common risk factors and mechanistic pathways. The primary objective of this study was to characterize the lipid profiles in DM patients with IDFUs, comparing them with DM patients without foot ulcers, and with a control group of healthy subjects. The secondary objectives included evaluating apolipoprotein E (ApoE) levels across these study groups and comparing lipid profiles within IDFU subgroups. A total of 160 patients were assessed for this study. After applying exclusion criteria, 140 participants were included, divided into three groups: Group IDFU (80 patients with IDFUs), Group DM (32 patients with DM but no foot ulcers), and Group Controls (28 healthy controls). Compared to Group DM, Group IDFU demonstrated lower levels of high-density lipoprotein cholesterol (HDL-C) (30.9 ± 12.6 mg/dL vs. 40.8 ± 16.6 mg/dL, p = 0.002), but improved levels of ApoE (160.9 ± 68.4 mg/dL vs. 197.2 ± 69.6 mg/dL, p = 0.01), triglycerides (TG) (126.9 ± 56.2 mg/dL vs. 165.8 ± 79.0 mg/dL, p = 0.004), low-density lipoprotein cholesterol (LDL-C) (84.2 ± 32.3 mg/dL vs. 92.3 ± 39.3 mg/dL, p = 0.1), and total cholesterol (133.6 ± 43 mg/dL vs. 164.6 ± 44.4 mg/dL, p = 0.002). The IDFU patients exhibit improved lipid profiles, excepting HDL-C, which is unusual because IDFU follows complications related to dyslipidemia for DM patients. Anemia, impaired renal function, and elevated TG levels were identified as biomarkers for mortality among patients with IDFUs. The data suggest that a lower level of HDL-C and an improved lipid profile may indicate a systemic end-stage disease manifestation in DM patients with IDFUs.

Covid-19 and Its Impact on Colorectal Cancer Diagnosis in Romania: A Single-Centered 5-year Retrospective Cohort Study.

Background: Colorectal cancer, 3rd in incidence and 2nd in mortality among cancers worldwide, represents the most common malignant tumor of the digestive tract. In Romania, it is the most frequently diagnosed type of cancer (approximately 0.06% of the population/year). During the COVID-19 pandemic the legislation preventing the SARS-CoV-2 viral transmission impairing access to outpatient healthcare services combined with patients fear of SARS-CoV-2 infection had consequences on the diagnosis and treatment of all other pathologies. Methods: A 5-year retrospective cohort study was conducted in a tertiary hospital in Arad, Romania, and included 1329 newly diagnosed colorectal cancer patients. For statistical analysis, Fisher's exact test was used for categorical data and the unpaired test with Welch's correction for continuous data. Results: The age on diagnosis decreased during the early COVID-19 pandemic to 68.50 (95% CI [67.90 69.11]) years, with the highest percentage (7.41%) of early onset colorectal cancer patients, a steady post-pandemic increase in the percentage of male (52.71% in 2019 to 62.20% in 2022) and urban (54.18% in 2018 to 70.10% in 2022) patients, admitted to the hospital due to an emergency presentation (peaking at 83.95% in 2020) and requiring a longer hospitalization period (10.03 [95% CI (8.76-11.30)] days in 2020 to 8.37 [95% CI (7.44-9.30)] days in 2022). The most common colo-rectal cancer diagnosis of patients in our reference population was malignant neoplasm of the rectum (ICD-10 code C20.0), while the most common complications were peritumoral adherence-related disorder, occlusion, and perforation, encountered in patients with comorbidities such as arterial hypertension, ischemic cardiomyopathy, diabetes mellitus, obesity, and non-alcoholic steatohepatitis. Conclusions: Regional particularities should be analyzed to better target the population at risk and to better direct the necessary healthcare resources towards the reference population, especially during crisis periods similar to the COVID-19 pandemic.

Cystic Echinococcosis in Hospitalized Adult Patients from Western Romania: 2007-2022.

Cystic echinococcosis (CE) is a neglected parasitic disease caused by the tapeworm Echinococcus granulosus. The aim of this study was to assess the epidemiological features of human cystic echinococcosis in patients from Western Romania. We retrospectively investigated the medical records of patients hospitalized with CE between 1 January 2007 and 1 September 2022. A total of 366 patients (range 18-90 years) were recorded. The number of hospitalized individuals was higher in patients aged 50-59 years (83/366, 22.7%), in females (194/366, 53%), and in residents of rural areas (225/366, 61.5%). The liver was the most common localization of the cysts (302/366, 82.5%). Ninety-eight patients (26.8%) presented complications, including biliary fistula, allergies, and infection of the cyst. Patients with complications had a longer mean hospital stay (15.7 ± 8.3 days) compared to patients without complications (11.5 ± 7.3 days) (p < 0.001). The results of this study revealed that patients diagnosed with CE required hospitalization and extended medical care, indicating that this zoonotic disease remains a significant public health problem in Western Romania. Public health authorities should enhance CE surveillance by implementing control programs and mandatory notification of new cases.

A Comprehensive View on the Quercetin Impact on Colorectal Cancer.

Colorectal cancer (CRC) represents the third type of cancer in incidence and second in mortality worldwide, with the newly diagnosed case number on the rise. Among the diagnosed patients, approximately 70% have no hereditary germ-line mutations or family history of pathology, thus being termed sporadic CRC. Diet and environmental factors are to date considered solely responsible for the development of sporadic CRC; therefore; attention should be directed towards the discovery of preventative actions to combat the CRC initiation, promotion, and progression. Quercetin is a polyphenolic flavonoid plant secondary metabolite with a well-characterized antioxidant activity. It has been extensively reported as an anti-carcinogenic agent in the scientific literature, and the modulated targets of quercetin have been also characterized in the context of CRC, mainly in original research publications. In this fairly comprehensive review, we summarize the molecular targets of quercetin reported to date in in vivo and in vitro CRC models, while also giving background information about the signal transduction pathways that it up- and downregulates. Among the most relevant modulated pathways, the Wnt/ß-catenin, PI3K/AKT, MAPK/Erk, JNK, or p38, p53, and NF-κB have been described. With this work, we hope to encourage further quests in the elucidation of quercetin anti-carcinogenic activity as single agent, as dietary component, or as pharmaconutrient delivered in the form of plant extracts.

Clinical significance of tumor necrosis factor-alpha and carcinoembryonic antigen in gastric cancer.

Tumour necrosis factor (TNF)-α plays an important role in inflammatory, infectious, and tumor processes, and it is closely related to the early stages of gastric cancer. It is a pro-inflammatory cytokine, produced not only by macrophages and monocytes but also by the lymphocytes, mast cells, neutrophils, keratinocytes, smooth muscle cells, and some tumor cell lines. Large amounts of TNF are released upon contact of macrophages, CD4 + T lymphocytes, and natural killer (NK) cells with lipopolysaccharides, bacterial products, and interleukin 1. TNF-alpha inducing protein (Tipa) is a unique carcinogenic factor of Helicobacter pylori, secreted into culture broth. The biological activities of TNF alpha and deletion mutant were studied. TNF alpha protein specifically binds to cell-surface nucleolin and then enters the gastric cancer cells, where TNF-a and chemokine gene expressions are induced by NF-jB activation. Nucleolin localizes on the surface of gastric cancer cells, and interaction between TNF alpha and cell-surface nucleolin causes a cancer-oriented microenvironment that increases the risk of gastric cancer. This paper discusses a mechanism of gastric cancer development and the clinical significance of tumor necrosis-alpha and carcinoembryonic antigen in gastric cancer.

Pathological and immunohistochemical study of colon cancer. Evaluation of markers for colon cancer stem cells.

Colorectal cancer is a major public health problem worldwide with increasing morbidity and mortality. Numerous exogenous and endogenous factors are involved in colorectal carcinogenesis: age, sex, diet, smoking, alcohol consumption, exposure to harmful environmental factors, intestinal microbiota, bacterial and viral infections, the ability of the host immune system to respond, genetic factors, etc. The present study analyzed histopathologically and immunohistochemically a number of 36 cases of colorectal adenocarcinomas. The existence of an accentuated cell pleomorphism was noted, which corresponds to different clones of tumor cells, in the same tumor coexisting aspects of tubular adenocarcinoma, mucinous areas and even signet-ring cell. The tumor stroma was mainly of the desmoplastic type, but also of the lax type, more or less infiltrated with inflammatory cells. Evaluation of immunomarkers for cancer stem cells (CSCs) showed that none of the markers used alone [cluster of differentiation (CD)133, CD44, aldehyde dehydrogenase 1 family member A1 (ALDH1A1), CD24, CD26] show CSCs.

Sarcomatoid renal cell carcinoma with clear cells and eosinophilia: a case report and short review of the literature.

Sarcomatoid renal cell carcinoma (SRCC) is an aggressive form of de-differentiated renal cell carcinoma. We report a case of a 79-year-old male who presented himself to the Department of Emergency complaining of macroscopic hematuria for the last two days and a back pain located in the lumbar region persisting for around a month; there were no major changes in the initial laboratory tests. Abdominal ultrasonography identified a renal mass located in the lower pole of the left kidney. The computed tomography (CT) scan with iodine-based contrast revealed the left kidney had a complete deletion of corticomedullary differentiation and a large renal mass located in the lower pole with inhomogeneous iodophilia, which measured around about 15 cm in transversal diameter and 13.6 cm in craniocaudal diameter. Nephrectomy of the left kidney was performed. Histopathological and immunochemistry tests diagnosed a SRCC with clear cells and eosinophilia. We present these findings along with a short review of the literature.

Diagnostic difficulties in giant benign phyllodes tumor.

Phyllodes tumors (PTs) are rare tumors of the breast, which encompass both stromal and epithelial components. The maximum incidence is in the fourth decade of life. Most of these tumors are benign, but about one third can be malignant acting as sarcomas. Due to their rarity and atypical clinical behavior (especially for the giant ones), the management of these tumors is usually difficult. We report a case of a 24-year-old woman who presented in the Department of Oncology for rapid increase in volume of the left breast. She had no personal pathological or family history. Initial clinical exam showed a large irregular mass in the left breast of approximately 30 cm and palpable lymph nodes in the ipsilateral axilla. A core needle biopsy for the tumor was performed with histopathological (HP) result that revealed an aspect suggesting fibroadenoma/PT. Contrast-enhanced computed tomography (CT) scan identified lymph node enlargement in the left axilla and a peripheral nodule in the lung about 5.5/3.4 mm with no specific features. The patient was then transferred to the Department of Surgery, where left mastectomy and axillary lymph node sampling were performed. HP result of the surgical specimens confirmed the presence of both fibroadenoma and PT, with clear margins above 1 cm, but recommended immunohistochemistry (IHC) to clearly specify benign versus borderline type. Five lymph nodes out of six resected presented microscopic reactive changes. We performed a search of literature using the keywords "giant", "benign" and "phyllodes". The results were used to summarize and discuss some of the main features of this type of tumors as well as diagnostic and therapeutic difficulties.

Inflammation: predictive factor for negative evolution of prostate diseases.

The most frequent prostate diseases depending on age are prostatitis in young men, benign prostate hypertrophy in men over 50 years old, and prostate cancer (PCa) in elderly patients. The purpose of our study is to evaluate the role of inflammation in the progression of prostate diseases. We used clinical and paraclinical techniques for the positive diagnosis [serum prostate-specific antigen (PSA) determination, we performed transrectal ultrasound to asses the prostate volume and prostate biopsy or transurethral resection of the prostate, where it was imposed]. The prostate tissue specimens were analyzed histopathologically and immunohistochemically. Our results show that PCa patients with higher inflammation rates had a higher Gleason score in both the castration-resistant prostate cancer (CRPC) group and the castration-sensitive group. We have noticed that patients with high inflammation grade also had a much higher International Prostate Symptom Score (IPSS). In conclusion, we can say that in our study, inflammation played an important role in the evolution of benign and malignant prostate diseases; its presence has influenced directly the severity of symptoms, and the aggressiveness of the diseases.

Replaced common hepatic artery originating from the superior mesenteric artery and prepancreatic, anterior course in a patient with cephalic pancreaticoduodenectomy - case report.

The presence of hepatic arterial variations is particularly important for patients undergoing cephalic pancreaticoduodenectomy, because it can lead to unnecessary incidents or postoperative complications. We present the case of a patient with pancreatic head neoplasm in which the cephalic pancreaticoduodenectomy was performed and the origin of common hepatic artery from superior mesenteric artery, with an anterior, prepancreatic course.

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.

Hemobilia by idiopathic aneurysm of cystic artery, fistulized in the biliary ways - clinical case.

Aneurysm of the cystic artery is not common, and it is a rare cause of hemobilia. Most of reported cases are pseudoaneurysms resulting from either an inflammatory process in the abdomen or abdominal trauma. We report a healthy individual who developed hemobilia associated with cystic artery aneurysm. Visceral artery aneurysms are rare and can rupture with potentially grave outcome due to excessive bleeding. The patient was managed with cholecystectomy and concomitant aneurysm repair.

The assessment of matrix metalloproteinase-9 expression and angiogenesis in colorectal cancer.

Colorectal cancer (CRC) is one of the most frequent types of cancer in the world. Between tumor cells and the stroma mutual interconnections are established that favors the tumor development and metastasis. In this respect, the extracellular matrix is remodeled so that it may become totally different from a morphologic perspective than the stroma of the organ in which the tumor develops. Matrix metalloproteinases (MMPs) have an essential role in the remodeling of the tumor stroma. We assessed the expression of MMP-9 on a number of 31 stage III colorectal adenocarcinomas. Generally, MMP-9 had a high but inconstant expression in tumor cells. The highest expression was found in poorly and moderately differentiated carcinomas, with a lower expression in well-differentiated colorectal cancers. Occasionally, MMP-9 expression was identified also in peritumoral macrophages and in stromal cells. Metastasis-free lymph nodes had an intense positive reaction in both macrophages and lymphocytes. The intensely positive reaction was observed for the macrophages and lymphocytes in the tumor necrosis regions. The process of angiogenesis was generally correlated with the intensity of MMP-9 reaction.

Comparative analysis of microvessel density quantified through the immunohistochemistry expression of CD34 and CD105 in rectal cancer.

Endothelial cells are highlighted using a variety of endothelial markers. One of the best known markers is CD34, a surface antigen. The most used immunohistochemical marker for identification of activated endothelial cells is CD105. We chose to compare these two markers in order to evaluate angiogenesis of the rectal cancers by determining the microvessel density (MVD). Our study included 31 patients with rectal cancer between 2010-2014, who underwent rectal resection at Arad and Timisoara Counties Hospitals, Romania. We used MVD quantification by highlighting the tumor blood vessels with two different endothelial markers using the immunohistochemical protocols. The CD34 evaluation of MVD was 37 vessels/field/×200 peritumoral (PT), compared with normal rectal mucosa with 17 vessels/field/×200. Intra-tumoral (IT) MVD for CD34 positive vessels was between 7 and 120 vessels/field/×200. Average IT MVD CD105+ was 13.7 vessels/field/×200, the PT MVD CD105+ was 10 vessels/field/×200. Usually, IT MVD CD105 is smaller than PT MVD CD105, a pattern that was not respected in our study. There was a statistical significant correlation between IT MVD CD34 and PT MVD CD34 with p=0.008, also IT MVD CD34 and IT MVD CD105 with p=0.009, PT MVD CD34 with PT MVD CD105, p=0.001. PT MVD CD34 had a statistical significant correlation with T, p=0.004. IT MVD CD105 associated with T, p=0.004, and with N, p=0.004. The evaluation of both CD34-CD105 showed the role of angiogenesis in the cancer proliferation and local spread, the angiogenesis level being maintained high even in the advanced stages of the disease. There was observed a difference between the intratumoral and peritumoral MVD, the study of this difference possibly leading to a better assessment of prognosis and adjusted therapies in the future.

Fenugreek powder exerts protective effects on alcoholised rats' kidney, highlighted using ultrastructural studies.

Trigonella foenum-graecum (TFG) seeds exert a protective antioxidant effect and membrane protector through their rich content in polyphenolic flavonoids. The previous research focused on the hypoglycemic action of the seeds, with scarce studies on the preventive effects in the pathology of the kidney. Our work was conducted on an experimental in vivo model; the animals were given two different concentrations of TFG seeds, consequently to alcohol intoxication. Transmission electron microscopy (TEM) analysis showed vacuolation in cytoplasm, edemas at the apical pole of the nephrocytes, diffusion of the cytoplasmic and mitochondrial matrix and the increase in number of the lysozymes and especially peroxisomes, as well as the congestion of blood capillaries. In the case of the groups T5R and T10R, which received Trigonella powder together with ethanol, the structural and ultrastructural changes produced by the ethylic intoxication were more reduced, being somewhat improved in the T5R group. Therefore, the majority of the cells nuclei have retained their spherical shape, being at the same time predominantly euchromatic, with little heterochromatin and evenly dispersed. Our results suggest the use of Trigonella seeds as a food supplement to prevent cellular deterioration and improve renal morphology and function.