Imaging Approach in the Diagnostics and Evaluation of the Psoriasis Plaque: A Preliminary Study and Literature Review.

(1) Background: the aim of the study was to demonstrate its usefulness in the field of imaging evaluation of plaque morphology in psoriasis vulgaris, with an emphasis on the use of confocal microscopy and other advanced skin-imaging techniques. (2) Methods: we conducted a prospective study over two years (July 2022-April 2024), on patients diagnosed with moderate or severe psoriasis vulgaris, treated in the dermatology department of our institution. We selected 30 patients, of whom 15 became eligible according to the inclusion and the exclusion criteria. A total of 60 psoriasis plaques were analyzed by dermatoscopy using a Delta 30 dermatoscope and Vidix 4.0 videodermoscope (VD), by cutaneous ultrasound (US) using a high-resolution 20 MHz linear probe, and by confocal microscopy, along with histopathological analysis. (3) Results: the study included fifteen patients with vulgar psoriasis, diagnosed histopathologically, of whom six were women and nine were men, with an average age of 55. Between two and six plaques per patient were selected and a total of sixty psoriasis plaques were analyzed by non-invasive imaging techniques. Twelve lesions were analyzed with ex vivo fluorescence confocal microscopy (FCM), compared to histology. US showed that the hyperechoic band and the lack of damage to the subcutaneous tissue were the most common criteria. The epidermis and dermis were found to be thicker in the area of psoriasis plaques compared to healthy skin. Dermatoscopy showed that the specific aspect of psoriasis plaques localized on the limbs and trunk was a lesion with an erythematous background, with dotted vessels with regular distribution on the surface and covered by white scales with diffuse distribution. The presence of bushy vessels with medium condensation was the most frequently identified pattern on VD. Good correlations were identified between the histological criteria and those obtained through confocal microscopy. (4) Conclusions: the assessment and monitoring of patients with psoriasis vulgaris can be conducted in a more complete and all-encompassing manner by incorporating dermatoscopy, ultrasonography, and confocal microscopy in clinical practice.

Preterm birth and stillbirth during COVID-19 pandemic in Bihor County/Romania.

Background: International studies have reported conflicting data about the effects of COVID-19 pandemic policy measures on maternal and neonatal health. A major impact was reported on stillbirth and prematurity. The published literature suggests that the economic setting influenced the effects of imposed mitigation measures with a more severe effect in low-income countries. Objectives: Our objective is to compare pregnancy outcomes at the only tertiary Maternity Hospital in Bihor County-Romania before and during the COVID-19 pandemic. This study aims to observe and document differences in perinatal outcomes across these periods, without inferring direct causation related to the pandemic or its associated restrictions. Materials and methods: We used data from the registries of Public Health Services Bihor to conduct a retrospective cohort analysis of preterm births and stillbirths during the COVID-19 pandemic in Bihor County, Romania. Pregnancy outcomes were compared between the pandemic period (March 2020-February 2022) to the corresponding historical pre-COVID-19 period (March 2018-February 2020). Maternal socio-demographic variables and neonatal characteristics of these periods were also examined. Results: The COVID-19 pandemic period was associated with an increase in the stillbirth rate (RR: 1.53, 95% CI, 1.05-2.23). Preterm birth was significantly impacted during this period and showed changes when analyzing gestational age (RR: 0.88, 95% CI, 0.79-0.96) or birth weight (RR: 0.91, 95% CI, 0.82-1.00). The main cause of stillbirth was intrauterine asphyxia due to placental causes (67.6%) or cord pathology (12.6%), the most frequently encountered maternal pathology was cardiovascular (28.3%) or infectious (21.7%). Our study revealed no significant changes in terms of maternal and neonatal characteristics during the two-year pandemic period. Conclusions: Lockdown restrictions in Bihor County, Romania were associated with an increase in stillbirths, whilst preterm birth rate decreased. This raises concerns about whether pandemic policy measures may have led to a failure in identifying and offering proper care for pregnant women who were more likely to experience an antepartum loss. Further studies across the globe are needed in order to integrate comparable data that will help develop adequate protocols and policies for protecting maternal and child health during the next pandemic that will follow.

Tubal Blockage Surgery: A Retrospective Cohort Study on Clinical Characteristics and Reproductive Outcomes Within Six Years.

Introduction and objectives This research undertakes a comprehensive evaluation of demographic information and medical antecedents, in addition to intraoperative observations, for patients diagnosed with tubal obstruction. Furthermore, we delineate the therapeutic procedures implemented to achieve bilateral tubal patency. The overarching objective of this study is to ascertain the efficacy of the aforementioned therapeutic procedures and to establish an optimal timeframe before the necessity for exogenous intervention becomes apparent. Material and methods This study conducted a retrospective analysis of patients diagnosed with infertility due to tubal obstruction at the Oradea County Clinical Hospital, spanning a six-year period from 2017 through 2022. We evaluated numerous factors, including demographic data of the patients, intraoperative observations, and the exact site of the obstruction within the fallopian tubes. Additionally, we monitored patients post-procedure to assess their potential for fertility following the intervention. Our study involved a comprehensive examination of 360 patients in total. The primary objectives of our research were to provide clinicians with significant insights regarding the likelihood of spontaneous conception subsequent to surgical interventions and to propose guidelines on establishing an adequate waiting period prior to recommending other interventions. We employed a mix of descriptive and inferential statistical methods to analyze the data amassed. Results This study encompassed an initial patient population of 360 included in the study following specific exclusion criteria; the remaining 218 patients constituted the study cohort. The mean±SD age of the patients was 27.9±4.4. Out of the entire cohort, 47 patients presented with minimal adhesions, while 117 patients exhibited blockages in one fallopian tube. A total of 54 patients were diagnosed with bilateral tubal defects. Post-intervention, patients were monitored and it was noted that 63 patients achieved pregnancy. The correlation analysis indicated the significant impact of tubal defect characteristics and patient age on fertility outcomes. The most favorable fertility outcomes were observed to be influenced by factors such as patient age and blockage location, while a higher body mass index (BMI) was found to exert a negative impact on fertility. Temporal analysis revealed that 52 patients conceived within the initial six months post-intervention, whereas only 11 patients became pregnant in the subsequent months. Conclusions Our research indicates that age, parity, and tubal damage severity predict tubal intervention success. Fimbriolysis was the most successful, while outcomes for salpingotomy varied. Conception significantly declined 12 months post-intervention, suggesting this is a reasonable waiting limit for a successful pregnancy.

A multicenter cross-sectional study of episiotomy practice in Romania.

RATIONALE, AIMS, AND OBJECTIVES: The aim of this study was to focus attention on episiotomy practice in Romanian maternity units in order to identify factors associated with the very high rate of the procedure in Romania and to consider strategies to reduce it. METHODS: In this clustered cross-sectional study, a total of 11 863 patients were recorded in eight Romanian maternity units to assess the prevalence of episiotomy. A random effects Poisson model was used to estimate the prevalence rate in univariate and multivariate models. RESULTS: Among the 11 863 patients included for analysis, 8475 (71.4%) had an episiotomy. The prevalence of episiotomy was 92.7% for the first vaginal birth, 73.2% for the second vaginal birth, and 35% for the third vaginal birth. The overall rate of suturing was higher than the episiotomy rate for all patients (total rate 79.2%). The likelihood of exiting the maternity ward with an intact perineum after the first vaginal birth was less than 5% at the first vaginal birth. CONCLUSIONS: In conclusion, routine episiotomy is the norm in Romanian maternity units, with episiotomy rates among the highest in Europe. Episiotomy use is mainly driven by local professional norms, experiences, previous training, and practitioners' decisions rather than evidence, guidelines, or variations in patient needs at the time of vaginal birth.

Morphological and ultrasound findings in multiple pregnancy placentation.

The incidence of multiple pregnancy has significantly increased over the past decades, reaching different statistics to double, triple, or even overcome these numerical orders globally. Zygosity and chorionicity are the key elements in the multiple pregnancy but the placentation issue should be correlated primarily with zygosity, unlike chorionicity that should be correlated with the outcome and complications of multifetal gestation. Multiple pregnancy is by itself a special maternal-fetal condition, and the monochorionic one, moreover, due to specific complications. These aspects make early assessment of chorionicity and amnionicity a priority. Ultrasound is essential in pregnancy but pathological placental examination after delivery is complementary, in order to have a complete overview of potential mechanisms and pathogenesis affecting twin gestation. In this review, we highlight both ultrasound aspects specific to multifetal placentation, complemented by macro and microscopic morphological aspects, which underpin the obstetric imaging.

Morphological and ultrasound findings in the placenta of diabetic pregnancy.

The purpose of this study is to analyze the morphological, histological, immunohistochemical and ultrasound findings in the placenta of maternal type 1 and gestational diabetes, to compare the pathological changes of the placental structure in the two types of metabolic disruptions, but also to establish correlations with the expression of these findings, influenced by different associated conditions. This multicenter study includes 53 pregnancies, of which 37 with pregestational and 16 with gestational diabetes. All cases undergone specific obstetric ultrasound assessment and detailed placental scan. There were assessed 49 singleton and four twin pregnancies, all of which having live births as fetal outcome. Maternal preexisting hypertension, preeclampsia and obesity were the main associated conditions. Placental ultrasound scan revealed increased placental thickness even from the second trimester, with significant increases in the first half, and placentomegaly at the end of the third trimester. Macroscopic analysis of the placentas and umbilical cords has shown that the placentas of women with diabetes are heavier, and abnormal cord insertion has been also found. Gross analysis of maternal and fetal surfaces of the placentas revealed certain changes in both metabolic conditions. We observed 14 types of placental pathological findings in pregestational and 11 in gestational diabetes. In diabetic placenta, it is not appropriate to discuss about specific changes, but rather about a pathological diabetic pattern, influenced by associated conditions. Preconceptional and first trimester glycemic control is the key element, and euglycemia throughout pregnancy is a purpose whose accomplishment depends the maternal-fetal outcome.