A "Mix and Match" in Hemochromatosis-A Case Report and Literature Focus on the Liver.

Hemochromatosis is a genetic disorder characterized by increased iron storage in various organs with progressive multisystemic damage. Despite the reports dating back to 1865, the diagnosis of hemochromatosis poses a challenge to clinicians due to its non-specific symptoms and indolent course causing significant delay in disease recognition. The key organ that is affected by iron overload is the liver, suffering from fibrosis, cirrhosis or hepatocellular carcinoma, complications that can be prevented via early diagnosis and treatment. This review aims to draw attention to the pitfalls in diagnosing hemochromatosis. We present a case with multiorgan complaints, abnormal iron markers and a consistent genetic result. We then examine the relevant literature and discuss hemochromatosis subtypes and liver involvement, including transplant outcome and treatment options. In summary, hemochromatosis remains difficult to diagnose due to its symptom heterogeneity and rarity; thus, further education for practitioners of all disciplines is useful in facilitating its early recognition and management.

Malignant (necrotizing) externa otitis: the experience of a single hyperbaric centre.

INTRODUCTION: Malignant otitis externa (MOE) is a potentially life-threatening infection of the soft tissues of the external ear, quickly spreading to involve the periosteum and bone of the skull base. Treatment includes antibiotics and eventually surgery. Hyperbaric oxygen treatment (HBOT) has been proposed as an adjunctive therapy. However, in the tenth consensus conference, this disease was considered as a non-indication for HBOT. The aim of this study was to evaluate the effectiveness of HBOT in MOE treatment. METHODS: Retrospective and observational study was conducted of patients with MOE treated in our centre. Staging of the disease was made according to the clinicopathological classification system. RESULTS: From March 1998 to November 2016, 16 patients were referred. 6% patients were on stage 1 of the disease at the time they were referred, 20% in stage 2, 7% in stage 3a, 13% in stage 3b and 53% in stage 4. Seven (43.75%) patients had VII nerve palsy and three (18.75%) patients had multiple nerve palsy. Average length of symptoms of disease was 5 months (maximum 11 months). Average number of sessions was 33 and the length of hospitalization prior to HBOT (median 90 days) was significantly longer than the time between beginning HBOT and cure (p = 0.028, Wilcoxon signed rank test). There were no fatalities due to MOE and all patients were considered free of disease after HBOT. CONCLUSION: HBOT was well tolerated and revealed to be a helpful adjuvant treatment in MOE. According to our data, HBOT should be considered for patients who failed conventional treatments and in severe cases.

Endovascular Stenting for Idiopathic Stenosis of the Superior Mesenteric Vein: A Case Report.

Idiopathic superior mesenteric vein (SMV) stenosis, where no clear causative factor is identifiable, remains a clinical rarity. We present a detailed case report of a patient with idiopathic stenosis of the SMV who underwent successful endovascular stenting. This report outlines the patient's clinical presentation, diagnostic imaging findings, procedural approach by the interventional radiology team, and subsequent management. Endovascular stenting is a viable therapeutic option for patients with idiopathic SMV stenosis. This case demonstrates that with appropriate interventional and post-procedural management, long-term stent patency and thrombosis prevention can be achieved. The success of this case encourages further investigation into endovascular treatments for venous stenoses.

An Investigative Analysis of Therapeutic Strategies in Hepatocellular Carcinoma: A Raetrospective Examination of 23 Biopsy-Confirmed Cases Emphasizing the Significance of Histopathological Insights.

BACKGROUND: The Liver Imaging Reporting and Data System (LI-RADS) combines standardized terminology with a classification system for imaging findings in patients with HCC, therefore rendering diagnostic biopsy unnecessary in many cases. This retrospective study included 23 patients with a biopsy diagnosis of HCC, performed either before or after local interventional procedures, in order to evaluate the histopathologic changes induced by previous procedures and their potential influence on the response to immune therapy. MATERIAL AND METHODS: The study encompassed a cohort of patients diagnosed with Hepatocellular Carcinoma (HCC). Diagnosis was established via contrast-enhanced computer tomography or magnetic resonance imaging that identified LI-RADS-5 nodules in conjunction with historical liver disease and elevated alpha-fetoprotein (AFP) levels or via histological examination confirming positivity for glypican3, heat shock protein 70, and glutamine synthetase. The study detailed the liver disease etiology, LI-RADS scores, characteristics and dimensions of HCC nodules, serum AFP concentrations, Edmondson-Steiner grading, and the expression of programmed cell death ligand 1 (PD-L1) in the tumor cells. RESULTS: Among the study's cohort of Hepatocellular Carcinoma (HCC) patients, a portion had not received any prior treatments, while the remainder experienced local HCC recurrence following trans-arterial chemoembolization or radiofrequency ablation. Observations indicated elevated alpha-fetoprotein (AFP) levels in those who had not undergone any previous interventions, showing statistical significance. The Edmondson-Steiner classification predominantly identified grade III differentiation across patients, irrespective of their treatment history. Furthermore, an increase in intra-tumoral programmed cell death ligand 1 (PD-L1) expression was noted in patients who had not been subjected to previous therapies. CONCLUSION: Liver biopsy offers valuable insights for patients with Hepatocellular Carcinoma (HCC), assisting in the tailoring of immune therapy strategies, particularly in cases of recurrence following prior local interventions.

Pancreatic Adenocarcinoma: Imaging Modalities and the Role of Artificial Intelligence in Analyzing CT and MRI Images.

Pancreatic ductal adenocarcinoma (PDAC) stands out as the predominant malignant neoplasm affecting the pancreas, characterized by a poor prognosis, in most cases patients being diagnosed in a nonresectable stage. Image-based artificial intelligence (AI) models implemented in tumor detection, segmentation, and classification could improve diagnosis with better treatment options and increased survival. This review included papers published in the last five years and describes the current trends in AI algorithms used in PDAC. We analyzed the applications of AI in the detection of PDAC, segmentation of the lesion, and classification algorithms used in differential diagnosis, prognosis, and histopathological and genomic prediction. The results show a lack of multi-institutional collaboration and stresses the need for bigger datasets in order for AI models to be implemented in a clinically relevant manner.

Responsibility as an Ethics and Sustainability Element during the Pandemic.

This article addresses two perspectives of responsibility: as an element of taking action and as ethics towards one's fellow citizens and the environment. These aspects have been used since the beginning of the pandemic. In this context, we wanted to determine the mechanism that triggers increased responsibility. We have considered two possible initial processes: one external and one learned from the family in early childhood or trained/learned during studies. Based on that, three concerns were brought to our attention. First, we targeted the impact of the pandemic on respondents' degree of responsibility for their livelihoods. Second, we wanted to determine to what extent the new situation increased the interviewee's involvement only in some activities. The third statement called into question the causal relation between the influence of extrinsic elements on a highly educated person's degree of responsibility. The focus group was the active population of the industrial sector in the North-West border area of Romania. The data obtained are the result of the sociological survey implementation. The people in the region were subject to several new limiting external factors. The results show that the unique challenges up to that point made them more accountable for their actions in a situation that affected them directly (pandemic). It also can be underlined that lifelong education is important in forming healthy principles of responsibility.

Liver Transplant in Patients with Hepatocarcinoma: Imaging Guidelines and Future Perspectives Using Artificial Intelligence.

Hepatocellular carcinoma is the most common primary malignant hepatic tumor and occurs most often in the setting of chronic liver disease. Liver transplantation is a curative treatment option and is an ideal solution because it solves the chronic underlying liver disorder while removing the malignant lesion. However, due to organ shortages, this treatment can only be applied to carefully selected patients according to clinical guidelines. Artificial intelligence is an emerging technology with multiple applications in medicine with a predilection for domains that work with medical imaging, like radiology. With the help of these technologies, laborious tasks can be automated, and new lesion imaging criteria can be developed based on pixel-level analysis. Our objectives are to review the developing AI applications that could be implemented to better stratify liver transplant candidates. The papers analysed applied AI for liver segmentation, evaluation of steatosis, sarcopenia assessment, lesion detection, segmentation, and characterization. A liver transplant is an optimal treatment for patients with hepatocellular carcinoma in the setting of chronic liver disease. Furthermore, AI could provide solutions for improving the management of liver transplant candidates to improve survival.

Phytochemical Statistical Mapping of Red Grape Varieties Cultivated in Romanian Organic and Conventional Vineyards.

Red grapes are rich in phytochemicals such as phenolics and flavonoids, which are strongly correlated with their antioxidant activity. Thus, grapes as-harvested and grape extracts, especially those obtained from their seeds and pulp, have been reported to have health benefits, and accordingly, grapes and their derivatives are considered potential functional food ingredients. The total phenolic content, total flavonoid content, and the antioxidant activity of skin, pulp, and seeds of four grape varieties grown both in conventional and organic vineyards were examined in this study. Phytochemical characteristics of one native Romanian variety, Feteasca Neagra, were compared with data measured for three red grape varieties more commonly cultivated worldwide (Merlot, Pinot Noir, and Muscat Hamburg). It was found that the seeds of the Pinot Noir variety grown in an organic system contained the highest total phenolics of 169.53 ± 7.32 mg gallic acid equivalents/g and the highest total flavonoid content of 388.25 ± 10.72 mg quercetin equivalents/g, values corresponding to high antioxidant activity (312.84 ± 12.81 mg ascorbic acid equivalents/g). The total flavonoid content in the hydroalcoholic extracts obtained from seeds of Pinot Noir (organic vineyard) was around 24.5-fold higher than that of the skin of Pinot Noir (conventional vineyard). Experiments showed that seeds of all four tested grape varieties are good sources of total flavonoids, not only of total phenolics. When referring to the organic vineyard, the skin and pulp grapes showed good results for the total phenolic content. The antioxidant activities of the hydroalcoholic extracts were well-correlated with the total phenolic content and total flavonoid content. Lower values of these parameters were found for extracts obtained from skin and pulp than for those obtained from seeds of the same grape variety regardless of the culture management system (organic/conventional). Data mining techniques such as regression analysis, principal component analysis, and clustering analysis were applied to establish the potential correlation between the phytochemical content and the antioxidant activities of the red grapes on the one hand, and grape variety, anatomical parts, and vineyard type (organic/conventional) on the other hand.

Geochemical Responses to Natural and Anthropogenic Settings in Salt Lakes Sediments from North-Eastern Romanian Plain.

Chemical analysis was performed on sediment core samples collected from three salt lakes, Amara Lake, Caineni Lake, and Movila Miresii Lake, located in the northeast of the Romanian Plain. The concentration of 10 main elements, 6 heavy metals (HMs), 8 rare earth elements (REEs), and 10 trace elements (TEs)-determined using neutron activation analysis (NAA)-showed variability dependent on the depth sections, lake genesis and geochemical characteristics (oxbow, fluvial harbor/liman and loess saucer type). The assessment of pollution indices (contamination factor, pollution load index, geoaccumulation index, and enrichment factor) highlighted low and moderate degrees of contamination for most of the investigated elements. Principal component analysis (PCA) extracted three principal components, explaining 70.33% (Amara Lake), 79.92% (Caineni Lake), and 71.42% (Movila Miresii Lake) of the observed variability. The principal components extracted were assigned to pedological contribution (37.42%-Amara Lake, 55.88%-Caineni Lake, and 15.31%-Movila Miresii Lake), salts depositions (due to the lack of a constant supply of freshwater and through evaporation during dry periods), atmospheric deposition (19.19%-Amara Lake, 13.80%-Caineni Lake, and 10.80%-Movila Miresii Lake), leaching from soil surface/denudation, rock weathering, and mixed anthropogenic input (e.g., agricultural runoff, wastewater discharges) (13.72%-Amara Lake, 10.24%-Caineni Lake, and 45.31%-Movila Miresii Lake).

Preparation and Characterization of Microalgae Styrene-Butadiene Composites Using Chlorella vulgaris and Arthrospira platensis Biomass.

The food industry is a high consumer of polymer packing materials, sealing materials, and engineering components used in production equipment. Biobased polymer composites used in the food industry are obtained by incorporating different biogenic materials into the structure of a base polymer matrix. Renewable resources such as microalgae, bacteria, and plants may be used as biogenic materials for this purpose. Photoautotrophic microalgae are valuable microorganisms that are able to harvest sunlight energy and capture CO2 into biomass. They are characterized by their metabolic adaptability to environmental conditions, higher photosynthetic efficiency than terrestrial plants, and natural macromolecules and pigments. The flexibility of microalgae to grow in either low-nutrient or nutrient-rich environments (including wastewater) has led to the attention for their use in various biotechnological applications. Carbohydrates, proteins, and lipids are the main three classes of macromolecular compounds contained in microalgal biomass. The content in each of these components depends on their growth conditions. In general, proteins represent 40-70% of microalgae dry biomass, followed by carbohydrates (10-30%) and lipids (5-20%). A distinctive feature of microalgae cells is the presence of light-harvesting compounds such as photosynthetic pigments carotenoids, chlorophylls, and phycobilins, which are also receiving growing interest for applications in various industrial fields. The study comparatively reports on polymer composites obtained with biomass made of two species of green microalgae: Chlorella vulgaris and filamentous, gram-negative cyanobacterium Arthrospira. Experiments were conducted to reach an incorporation ratio of the biogenic material into the matrix in the 5-30% range, and the resulting materials were characterized by their mechanical and physicochemical properties.

Current trends in gene therapy for retinal diseases (Review).

The eye is considered an effective target for genetic therapy, as it has a privileged immune status, it is easily accessed for medication delivery and it is affected by a number of inherited disorders. In particular, the retina is considered for gene therapy due to the fact that it can be visualized with ease, it does not have lymphatic vessels, nor a direct blood network for the outer layers and its cells do not divide after birth, and thus transgene expression is not affected. As gene therapy is currently on a continuously progressive development trend, this emerging field of gene manipulation techniques has yielded promising results. This involves the development of treatments for a number of debilitating and blinding diseases, which were to date considered intractable. However, numerous unanswered questions remain as regards the long-term efficacy and safety profile of these treatments. The present review article discusses the current research status regarding genetic manipulation techniques aimed at addressing visual impairment related to retinal disorders, both inherited and degenerative.

Analysis of Sustainable Communication Patterns during the Telework Period in Western Romanian Corporations.

The research was conducted in a particular context, the recent pandemic. It is a comparative study of the methods and quality of communication in global companies between 2021 and 2022. The corporations involved in the research are important providers of flexible production, quality, and logistics solutions that cover customers' real needs. They are active in the automotive industry and units involved in mass production in the electronics industry, household appliances, and cosmetics industries. In their case, it was noted that to achieve operational objectives such as developing employee skills, using advanced technologies, and exceeding customer expectations, it is important to use innovative methods and tools such as single platforms, which allow access to the most important information from a distance, anywhere, anytime. It is significant that, according to the research, the preferred method of communication by employees, regardless of the existing conditions, is face-to-face. Primarily, this method is chosen because it provides an open area of interpersonal interaction. The participants observe non-verbal attitudes or can perceive emotions and feelings. Their personality can be identified through unintentional contact to obtain constructive feedback through guidance and counseling. Moreover, it can be formed and develop productive, intentional connections. Stakeholders' efficient and effective open dialogs are encouraged in this sense.

Vibrational Spectroscopy Combined with Chemometrics as Tool for Discriminating Organic vs. Conventional Culture Systems for Red Grape Extracts.

Food plants provide a regulated source of delivery of functional compounds, plant secondary metabolites production being also tissue specific. In grape berries, the phenolic compounds, flavonoids and non-flavonoids, are distributed in the different parts of the fruit. The aim of this study was to investigate the applicability of FTIR and Raman screening spectroscopic techniques combined with multivariate statistical tools to find patterns in red grape berry parts (skin, seeds and pulp) according to grape variety and vineyard type (organic and conventional). Spectral data were acquired and processed using the same pattern for each different berry part (skin, seeds and pulp). Multivariate analysis has allowed a separation between extracts obtained from organic and conventional vineyards for each grape variety for all grape berry parts. The innovative approach presented in this work is low-cost and feasible, being expected to have applications in studies referring to the authenticity and traceability of foods. The findings of this study are useful as well in solving a great challenge that producers are confronting, namely the consumers' distrust of the organic origin of food products. Further analyses of the chemical composition of red grapes may enhance the capability of the method of using both vibrational spectroscopy and chemometrics for discriminating the hydroalcoholic extracts according to grape varieties.

Current diagnosis and management strategies in pachychoroid spectrum of diseases (Review).

This review presents a systematic analysis of the literature regarding the pachychoroid disease spectrum nomenclature, diagnosis criteria and therapeutic options. Pachychoroid related diseases are a new concept, introduced into the ophthalmological nomenclature in 2013 and evolving both as concept and as classification since then. The six disorders included in this phenotype have some common characteristics (thick choroid, pachyvessels, attenuation of the choriocapillaris), but also show individual features. The classification of the pachychoroid spectrum was revised many times, with the recent addition of the focal choroidal excavation (FCE) and peripapillary pachychoroid syndrome (PPS). As the terminology is developing, so is the number of case reports and case series from the initial report in 2013 to 57 reports in 2019. This review takes into account both the current literature and the clinical experience of the authors, emphasizing the understanding of the pathogenesis and aiming to update the therapeutic options available.

Artificial intelligence and deep learning in ophthalmology - present and future (Review).

Since its introduction in 1959, artificial intelligence technology has evolved rapidly and helped benefit research, industries and medicine. Deep learning, as a process of artificial intelligence (AI) is used in ophthalmology for data analysis, segmentation, automated diagnosis and possible outcome predictions. The association of deep learning and optical coherence tomography (OCT) technologies has proven reliable for the detection of retinal diseases and improving the diagnostic performance of the eye's posterior segment diseases. This review explored the possibility of implementing and using AI in establishing the diagnosis of retinal disorders. The benefits and limitations of AI in the field of retinal disease medical management were investigated by analyzing the most recent literature data. Furthermore, the future trends of AI involvement in ophthalmology were analyzed, as AI will be part of the decision-making regarding the scientific investigation, diagnosis and therapeutic management.

Outcomes of simultaneous vs. sequential pars plana vitrectomy and cataract surgery.

The coexistence of cataract and vitreoretinal diseases is common in clinical practice. The technological achievements of the last decade in both types of surgeries, allow simultaneous interventions on lens and retina. This retrospective study assessed the morphofunctional results obtained after performing simultaneous surgeries in a series of 87 patients presenting with both pathologies. The cases were retrospectively reviewed from their clinical records from 2017 to 2019. The patients were divided into two groups: group 1 comprising 41 cases underwent the combined procedure and group 2 comprising 46 patients underwent vitrectomy, followed by cataract surgery after 3-10 months. The functional and anatomical outcomes and the complications were assessed pre- and post-operatively. The statistical analysis was carried out by MaxStat software. The final best corrected visual acuity (BCVA), in group 1 was <0.1 in 4.88% of the cases, 0.1 to 0.3 in 17.07%, 0.3 to 0.5 in 51.22% and >0.5 in 26.83% eyes. In group 2, the final BCVA, after both surgeries were completed was <0.1 in 8.7% cases, 0.1 to 0.3 in 30.43%, 41.3% were 0.3 to 0.5 and 19.57% were >0.5. During the cataract surgery, the most common intraoperative complication was miosis, followed by posterior capsule rupture. Postoperative, 12.2% cases from group 1 developed an immediate inflammatory reaction in the anterior chamber, and 17.07% presented with posterior capsular opacification (PCO). Simultaneous surgery is safe and effective in obtaining a good morphological and functional result and offers the advantage of a clear eye media that allows a safer vitrectomy and thus a quicker rehabilitation of the patient. The analysis of the risks and benefits of each procedure should be taken into account and the cases selected individually for either simultaneous or sequential surgery in order to obtain the best outcomes.

Phytochemical Profiles, Antioxidant and Antibacterial Activities of Grape (Vitis vinifera L.) Seeds and Skin from Organic and Conventional Vineyards.

The therapeutic benefits of extracts obtained from different red grape fractions were thoroughly studied, however, data regarding the comparison of phytochemical extracts prepared from the same varieties coming from organic versus conventional management systems are rather lacking. The present study aimed at comparing some of the phytochemical characteristics and antimicrobial activity of hydroalcoholic (50% v/v) extracts obtained from four varieties of red grapes cultivated respectively in organic and conventional vineyards. Total flavonoid content, total phenolic compounds, and antioxidant activity were determined by molecular absorption spectroscopy. Antimicrobial activity of the studied extracts was evaluated against common bacterial strains isolated from different habitats according to specific lab procedures. The analyses were performed in solid broths by applying the disk diffusion method, which allowed for the simultaneous determination of the spectrum of the sensitivity of the tested bacteria as well as the values of the minimum inhibition concentration (MIC). It was found that favorable antagonistic activities against the tested bacteria strains were exhibited by the hydroalcoholic extracts from the seeds of the organic varieties, respectively the skin of the conventional varieties.

Lumbar artery aneurysm: A rare manifestation of vasculopathy in a patient with neurofibromatosis type 1.

Lumbar artery aneurysms are rare but important to diagnose, since rupture can have serious consequences due to life-threatening hemorrhage. A 49-year-old male with Neurofibromatosis type 1 (NF-1) was admitted to the emergency room with abrupt onset of severe abdominal pain. Ultrasound examination was normal, noncontrast CT revealed a tapered retroperitoneal mass adjacent to the right psoas muscle. A multiphased contrast-enhanced CT scan raised suspicion of an arterial lumbar aneurysm and was confirmed by selective catheter based angiography. The patient underwent successful treatment with endovascular coiling and the patient was discharged within a few days after an uneventful course.

Histopathological findings in the advanced natural evolution of the SARS-CoV-2 infection.

We are reporting a case of natural evolution and pathological data from a young person that was diagnosed with coronavirus disease 2019 (COVID-19). All data has been collected from the autopsy of a 30-year-old female, which was performed by the Department of Forensic Medicine from Emergency County Hospital, Drobeta Turnu Severin, Mehedinti County, Romania. The infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed by reverse transcription polymerase chain reaction (RT-PCR) on the lung tissue which was obtained during autopsy. This case provides the opportunity to study the natural evolution of COVID-19 pneumonia in a young person with clinical signs of pneumonia but without associated comorbidities. The patient had not received any treatment. The histopathological examination of the lung revealed a process of productive proliferation, proteinaceous and fibrin-macrophagic interalveolar spaces exudate, and lesions consistent with vasculitis. In the heart, we identified a cardiac thrombus. These changes are likely to suggest an advanced natural evolution of SARS-CoV-2 virus infection.

Cardiac computed tomography previous to atrial fibrillation ablation - effects of technological improvements and protocol optimization. / Tomografia computorizada cardíaca prévia a ablação de fibrilhação auricular ­ efeitos da evolução tecnológica e otimização de protocolos.

BACKGROUND: Cardiac computed tomography (CT) can provide a precise tridimentional anatomic map and exclude intra-cardiac thrombus. We aimed to access the impact of CT protocol optimization and technological evolution on the contrast and radiation dose as well as on image quality previous to atrial fibrillation (AF) ablation. METHODS: From a prospective registry of consecutive patients who underwent cardiac CT in a single center, we selected 270 patients in whom the CT was done for evaluation prior to AF ablation and they were distributed in 3 groups: Group1: the first 150 patients included; Group2: the last 60 patients performed with the same CT scanner; Group3: the first 60 exams performed with the new CT scanner. Quality of the protocol was access based on radiation dose, contrast volume used, the use of a second (delayed) acquisition, and on quantitative image quality analisis (signal to noise and contrast to noise ratios; density homogeneity racio between LA and LAA). RESULTS: We found a significant radiation dose as well as contrast dose reduction between the first and last subgroups (G1: 5,6mSv and 100ml; G2: 1,3mSv and 90ml; G3: 0,6mSv and 65ml). Even though group 3 had less radiation and contrast used it still had better quantitative image quality (signal/noise of 13,5; contrast/noise 14,8; density homogeneity racio of 0,92). CONCLUSION: Protocol optimization and technology both contributed to significant lower radiation dose and contrast volume used on cardiac CTs prior to AF ablation, without compromising image quality.