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200 papers
Localized Thoracic Swelling in a School-Aged Child: Suspected Trauma or Something More Serious? A Case Report.
Petridou M, Magaliou V, Voskidis C … +5 more , Boutouridou E, Babacheva E, Savvidou ND, Katsiki E, Anastasiadis K
Maedica (Bucur) · 2026 Mar · PMID 41978874 · Full text
INTRODUCTION: Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue neoplasm, typically located at the deep tissues of the trunk and extremities, that occurs mostly in the young adult age. Very few cases of childre...
INTRODUCTION: Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue neoplasm, typically located at the deep tissues of the trunk and extremities, that occurs mostly in the young adult age. Very few cases of children affected are reported in the literature, that interestingly tend to present with superficially sited tumors. Though benign in appearance, LGFMS can potentially behave as a malignant tumor with local recurrence or even distal metastases. CASE DESCRIPTION: We report a case of a six-year-old boy with a rare presentation of an asymptomatic superficial thoracic mass, that raised our suspicion due to its progressively enlarging size and when surgically excised it proved to be a LGFMS. CONCLUSION: This case raises awareness for atypical presentations of LGFMS in children with superficial growing lesions, which can be misdiagnosed and therefore maltreated. Complete excision and long-term surveillance are the main treatment components for the patients' safety, since the potential of malignancy cannot be ruled out in this type of tumor.
Prevalence and Determinants of Type 2 Diabetes Mellitus in a North Indian Population: a Community-Based Cross-Sectional Study.
Singh UK, Singh SK, Hemaliya C … +5 more , Kumar R, Kumar N, Bhattnagar R, Singh J, Meena LP
Maedica (Bucur) · 2026 Mar · PMID 41978873 · Full text
INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a rapidly growing public health challenge in India, driven by urbanization, lifestyle transitions and increasing obesity. Early identification of associated cardiometaboli...
INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a rapidly growing public health challenge in India, driven by urbanization, lifestyle transitions and increasing obesity. Early identification of associated cardiometabolic risk factors is essential to reduce complications and improve disease outcomes. OBJECTIVES: To assess the prevalence of diabetes and prediabetes and to evaluate associated clinical and socioeconomic risk factors among patients attending a tertiary care center in North India. METHODS: This cross-sectional study included 696 participants who were evaluated for glycemic status, anthropometric measurements, blood pressure and comorbidities. Diabetes and prediabetes were classified according to standard guidelines. Obesity was defined using Asian-specific body mass index (BMI) cut-offs and hypertension was categorized based on established criteria. Sociodemographic and clinical data were collected using structured questionnaires. Statistical analysis was performed using appropriate comparative tests, with p<0.05 being considered statistically significant. RESULTS: Among the study population, 89.08% of subjects had diabetes and 10.92% prediabetes. Overweight and obesity were observed in 31.88% and 19.34% of participants, respectively. Hypertension was highly prevalent, with 34.52% of subjects being classified as Stage 2 and 17.96% Stage 1 hypertension. A positive family history was reported in 23.85% of cases. Most patients had a disease duration of less than five years (56.32%). The clustering of obesity, hypertension and diabetes indicated a significant cardiometabolic overlap. CONCLUSION: The study highlights a substantial burden of diabetes and its associated modifiable risk factors in a North Indian population. Strengthening early detection strategies, lifestyle modification programs and integrated management approaches is essential to reduce long-term complications and improve public health outcomes.
Genetic Testing in Breast Cancer: Narrative Review and Clinical Insights.
Bistriceanu I, Ungureanu CO, Stoica RA … +6 more , Giuglea C, Grigorean VT, Roca D, Mihaila R, Iordache N, Ginghina O
Maedica (Bucur) · 2026 Mar · PMID 41978872 · Full text
BACKGROUND: Identifying hereditary breast cancer is increasingly important, as germline pathogenic variants not only influence lifetime cancer risk but also guide surveillance, preventive strategies and targeted treatmen...
BACKGROUND: Identifying hereditary breast cancer is increasingly important, as germline pathogenic variants not only influence lifetime cancer risk but also guide surveillance, preventive strategies and targeted treatments. While breast cancer genes (BRCA1 and BRCA2) remain central to hereditary breast and ovarian cancers, progress in cancer genetics has shifted clinical practice toward broader multigene testing approaches. METHODS: We reviewed the recent literature on the molecular basis of hereditary breast cancer, current genetic testing strategies, guideline-based indications, and the psychological, ethical and social challenges of genetic risk disclosure. RESULTS: Next-generation sequencing (NGS)-based multigene panels enable the efficient identification of high- and moderate-penetrance variants, supporting personalized screening, risk-reducing interventions and treatment selection, including eligibility for enzyme poly ADP ribose polymerase (PARP) inhibitors. However, clinical implementation remains limited by persistent barriers, such as variants of uncertain significance and unequal access to genetic counselling and testing services. CONCLUSIONS: Genetic testing is reshaping breast cancer care by bridging prevention and precision oncology. Improving access, strengthening counselling pathways and optimizing variant interpretation are essential steps to ensure that genomic advances translate into real-world clinical benefits.
AI-Based Detection of Periapical Lesions in Endodontic Radiographs: a Diagnostic Accuracy Study.
Marwaha J, Imran AH, Patel RN … +3 more , Mustafa M, Arya A, Banik A
Maedica (Bucur) · 2026 Mar · PMID 41978871 · Full text
BACKGROUND: Periapical lesions pose a serious diagnosis problem in endodontics and there is high inter-observer variability in the conventional interpretation of radiographs. It has a solution in artificial intelligence...
BACKGROUND: Periapical lesions pose a serious diagnosis problem in endodontics and there is high inter-observer variability in the conventional interpretation of radiographs. It has a solution in artificial intelligence (AI) technologies, which will improve the accuracy and consistency of diagnosis. This paper set out to determine the diagnostic accuracy of an AI system based on deep learning in identifying periapical lesions in endodontic radiographs as compared to clinical assessment and histopathological confirmation by an expert. METHODS: A retrospective diagnostic accuracy study on 1,247 periapical radiographs of patients who had endodontic treatment or periapical surgery with histopathological verification was done. The architecture of a convolutional neural network (CNN) with EfficientNetB4 was trained using 80% of the dataset, where 10% was to be used as a validation and 10% as a test set. The diagnostic performance was assessed against the histopathological findings as the reference standard. The same radiographs were independently evaluated by three experienced endodontists. Sensitivity and specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) as well as area under the receiver operating characteristic curve (AUC-ROC) were determined. RESULTS: The AI model had a total accuracy of 91.2 [standard deviation (SD) 1.7], a sensitivity of 93.4 (SD 1.5) and a specificity of 88.6 (SD 2.1). Endodontists had an average of 78.6 ± 4.3, which was highly lesser than the AI model (p <0.001). Agreement among clinicians (between different observers) was moderate (0.612). The AI model was superior in all categories of lesion sizes, showing significant improvement in cases of small lesions (less than 3 mm), with an accuracy of 87.8 compared to that of clinicians (64.2) (p<0.001). CONCLUSION: The model of AI built has shown better accuracy in detection of periapical lesions when compared with expert clinical assessment, especially when small lesions were involved. Such AI-based diagnostic tools may be important in facilitating endodontic diagnosis and treatment planning.
Urinary Tract Infections in Children - Microbiological Challenges and Mechanisms of Bacterial Resistance.
Marinescu AD, Marinescu MC, Moisa SM … +1 more , Cinteza EE
Maedica (Bucur) · 2026 Mar · PMID 41978870 · Full text
Urinary tract infections (UTIs) are common both in adults and particularly in children. It is estimated that the number of UTI cases has reached 4.49 billions in 2021, while common and often successfully treated with ant...
Urinary tract infections (UTIs) are common both in adults and particularly in children. It is estimated that the number of UTI cases has reached 4.49 billions in 2021, while common and often successfully treated with antibiotics UTIs pose the risk for sepsis, kidney complications and occurrence of antibiotic-resistant microbial strains. Symptoms of UTIs in children vary from non-specific, such as fever and lethargy, to specific such as difficult voiding, dysuria and suprapubic, abdominal or lumbar pain. Urinary tract infections may be lower (cystitis) or upper (pyelonephritis) and the etiological diagnosis is based on urinalysis and urine culture. There are several resistance mechanisms that commonly occur across different bacterial species (some of them being found in the same family) responsible for pediatric UTIs. For instance, an extensive mechanism of resistance is the production of beta-lactamase. Gram-negative bacilli may also develop polymyxin resistance; Staphylococcus aureus may become methicillin resistant and vancomycin resistance may appear in both S. aureus and Enterococcus spp. The present review presents the mechanisms of resistance of bacteria involved in UTIs in children.
Patterns and Determinants of Maxillofacial Trauma in Manipur: Prevalence of Protective Gear Use and Influence of Alcohol Consumption.
Singh WT, Singh DN, Singh KC … +3 more , Singh SG, Devi PA, Malvika W
Maedica (Bucur) · 2026 Mar · PMID 41978869 · Full text
Motor vehicle collisions, violence between individuals, falls, sports-related accidents and firearm injuries are frequent causes of maxillofacial trauma, which is a significant public health concern. Alcohol intoxication...
Motor vehicle collisions, violence between individuals, falls, sports-related accidents and firearm injuries are frequent causes of maxillofacial trauma, which is a significant public health concern. Alcohol intoxication and a lack of use of protective gear are two factors that are known to raise the risk and complexity of these injuries. Despite its clinical and societal impact, region-specific data on the distribution of maxillofacial trauma by anatomical site and etiology in Manipur, India, remain limited. This observational investigation was conducted to determine the patterns of maxillofacial fractures in terms of anatomical location and causative factors, identify the prevalence of protective equipment usage and explore the relationship between alcohol consumption and the etiology, anatomical site and severity of facial injuries. A prospective observational study was conducted over a two-month period at tertiary care hospitals in Manipur, enrolling 44 patients with radiographically confirmed maxillofacial trauma. Data on demographic characteristics, clinical presentation and imaging findings were systematically collected. The severity of facial injuries was assessed using the AIS-90 facial injury scale. Association between alcohol intoxication and various injury parameters were analyzed using the Chi-square test (p value < 0.05). Males constituted the predominant proportion of patients (84.1%), with a mean age of 31.1 years. Fractures of the mandible were most common (50%), followed by dentoalveolar (15.9%) and midfacial fractures (11.4%). Road traffic accidents (RTAs) were the predominant cause (61.4%), followed by assault (13.6%) and accidental falls (9.1%). Only 2.3% of patients reported using protective gear at the time of injury. Alcohol intoxication was observed in 40.9% of cases and was significantly associated with RTAs (p value <0.05), fracture site (p value < 0.005) and severity (p value < 0.05). Motor vehicle collisions were identified as the leading cause of maxillofacial injuries, with alcohol intoxication and inadequate use of protective equipment markedly increasing both the risk and severity of trauma. Enforcement of helmet and seatbelt regulations, public awareness on alcohol-related risks and promotion of protective gear use are essential to reduce maxillofacial injuries in the region.
Diverse Presentations of Mycobacterial Disease: a Case Series of Disseminated BCGosis in an Infant and Cutaneous Mycobacterium abscessus Infection in an Adolescent in Central India with Scoping Review of the Literature.
Choubey S, Siddiqui F, Sharda B … +6 more , Maurya AK, Gupta A, Shinde M, Maheshwari M, Jaiswal P, Purwar S
Maedica (Bucur) · 2026 Mar · PMID 41978868 · Full text
BACKGROUND: Bacillus Calmette-Guérin (BCG)-related complications, non-tuberculous mycobacteria (NTM) and classical tuberculosis (TB) are all examples of mycobacterial diseases. Accurate pathogen identification and host i...
BACKGROUND: Bacillus Calmette-Guérin (BCG)-related complications, non-tuberculous mycobacteria (NTM) and classical tuberculosis (TB) are all examples of mycobacterial diseases. Accurate pathogen identification and host immunological state are essential for diagnosis and treatment. CASE PRESENTATION: A four-month-old male child with disseminated BCG (Bacillus Calmette-Guérin) infection and TB as a result of STAT1 deficiency (Mendelian susceptibility to mycobacterial diseases MSMD) and a 17-year-old girl with a chronic cutaneous and soft tissue Mycobacterium abscessus infection are the two different examples that we describe. Granulomatous inflammation and acid-fast bacilli (AFB) were present in both individuals. The infant was awaiting hematopoietic stem cell transplantation after receiving extended antimycobacterial therapy but did not survive. Following the failure of initial empirical antitubercular treatment (ATT), the adolescent needed NTM-targeted combination therapy with clarithromycin, amikacin, and ethambutol. CONCLUSION: The need of careful clinical evaluation and ongoing diagnostic vigilance is underscored by the highlighted diagnostic problems. These instances show how unusual mycobacterial illness presentations might cause delays in diagnosis, especially in susceptible groups. Accurate diagnosis depends on confidence in complete diagnostic methods, which include thorough clinical examination, suitable imaging, microbiological testing and immunological assessment. This case series emphasizes how important it is to combine interdisciplinary skills in order to handle complex diagnoses, identify uncommon mycobacterial infections in a timely manner and direct efficient treatment plans, all of which improve patient outcomes.
Successful Treatment of Cutaneous Leishmania infantum Infection with Immunocryosurgery after Failure of the Respective Monotherapies.
Barakou O, Moulias C, Mavridou K … +4 more , Filis G, Lampri E, Bassukas I, Gaitanis G
Maedica (Bucur) · 2026 Mar · PMID 41978867 · Full text
Herein, we present a case of cutaneous leishmaniasis successfully treated with a modified immunocryosurgery protocol. A 46-year-old male Caucasian presented with two nodules on the forehead of eight-month duration. He re...
Herein, we present a case of cutaneous leishmaniasis successfully treated with a modified immunocryosurgery protocol. A 46-year-old male Caucasian presented with two nodules on the forehead of eight-month duration. He reported an unsuccessful attempt to treat the lesions with a session of cryosurgery elsewhere. During the clinical examination, two adjacent hard mobile nodules that did not infiltrate the underlying tissues were notable. Their diameter was 10 mm and 15 mm, respectively. There were no clinical, laboratory or imaging data in favor of a systemic infection. Histology and polymerase chain reaction (PCR) of the tissue confirmed a Leishmania infantum cutaneous leishmaniasis. Therapy with application of 5% imiquimod cream three times per week was initiated. After seven weeks of treatment and despite the substantial local inflammatory reaction, there was no evidence of clinical resolution of the lesions. Treatment was paused and five weeks later the two nodules had merged into a single lesion measuring 40x25 mm. Treatment with three times per week topical imiquimod was reinstated with scheduled cryosurgery sessions, within the context of a modified immunocryosurgery protocol, i.e., cryosurgery sessions during continuous imiquimod application. The patient was treated for a total period of nine weeks. The treatment comprised topical imiquimod and two cryosurgery sessions (open spray liquid nitrogen, two cycles, 15 seconds each) at weeks 3 and 6. At the end of treatment there was complete clinical remission of the lesion leaving an atrophic scar that significantly improved during follow-up. The patient remained disease free for 24 months. The applied modification of the standard immunocryosurgery protocol (three times per week imiquimod application, multiple cryosurgery sessions) achieved treatment of a L. infantum cutaneous leishmaniasis that was refractory to the respective monotherapies.
The Role of α-2 Adrenergic Receptor Agonist Dexmedetomidine Alone or in Combination with Ropivacaine in Postoperative Pain Management Following Breast Surgery.
Grigoraki A, Tsirtsridou V, Stylianaki A … +1 more , Mariolis T
Maedica (Bucur) · 2026 Mar · PMID 41978866 · Full text
OBJECTIVES: Postoperative pain following breast surgery remains a significant clinical challenge and may delay recovery while increasing the need for systemic analgesics. Dexmedetomidine, a selective α-2 adrenergic recep...
OBJECTIVES: Postoperative pain following breast surgery remains a significant clinical challenge and may delay recovery while increasing the need for systemic analgesics. Dexmedetomidine, a selective α-2 adrenergic receptor agonist, has been shown to enhance the analgesic effects of local anesthetics. This randomized comparative study aimed to evaluate the analgesic efficacy of dexmedetomidine administered alone or in combination with ropivacaine in patients undergoing modified radical mastectomy. MATERIALS AND METHODS: This prospective randomized trial was conducted in Hippokrateio Hospital of Athens, Greece, between October 2021 and September 2022, in the first Propaedeutic Surgical Clinic, National and Kapodistrian University of Athens. Ninety female patients (Angle Side Angle - ASA I-II) aged 25-65 years old, who had been scheduled for modified radical mastectomy, were randomized into three groups (n = 30 each). Group R received 0.375% ropivacaine, Group D, dexmedetomidine (1 μg/kg) and Group RD, a combination of both agents. A standardized volume of 10 mL was infiltrated using a landmark-guided technique along the anatomical course of the long thoracic nerve and the adjacent peri-incisional fascial plane before wound closure. Postoperative pain was evaluated using the visual analog scale (VAS) at 0, 4, 8, 16, and 24 hours and only at rest measured in our study. Rescue analgesia with intravenous paracetamol and tramadol was recorded. Statistical analysis included one-way and repeated-measures ANOVA, with significance set at p < 0.05. RESULTS: The RD group demonstrated clinically meaningful threshold VAS scores at all-time points (p < 0.001) and required substantially less rescue analgesia than Groups R and D, confirming the additive analgesic effect of dexmedetomidine when combined with ropivacaine. CONCLUSIONS: The combination of dexmedetomidine and ropivacaine significantly improves postoperative analgesia following modified radical mastectomy without increasing adverse effects. Dexmedetomidine appears to be a safe and effective adjuvant within multimodal analgesia strategies.
Parallel Configuration of the Cystic and Common Hepatic Ducts: a Surgical Odyssey.
Kyrochristou GD, Kyrochristos D, Siokas M … +3 more , Gkouvas V, Vlachos K, Lianos GD
Maedica (Bucur) · 2026 Mar · PMID 41978865 · Full text
INTRODUCTION: Laparoscopic cholecystectomy is among the most frequently performed surgical procedures worldwide; however, it carries a persistent risk of iatrogenic bile duct injury, particularly in the presence of anato...
INTRODUCTION: Laparoscopic cholecystectomy is among the most frequently performed surgical procedures worldwide; however, it carries a persistent risk of iatrogenic bile duct injury, particularly in the presence of anatomical variations. Misinterpretation of biliary anatomy remains a leading cause of serious complications, underscoring the importance of recognizing rare variants and adopting safe surgical strategies. CASE REPORT: We report the case of a 78-year-old patient undergoing elective laparoscopic cholecystectomy for recurrent cholecystitis and cholangitis. Given the history of repeated inflammatory episodes, dense adhesions and intraoperative technical difficulties were anticipated. Intraoperatively, dense adhesions and a contracted gallbladder were encountered. Indocyanine green fluorescence imaging revealed uncertain anatomical landmarks, demonstrating a rare parallel configuration of the cystic duct and common hepatic duct. Due to unsafe conditions, conversion to open surgery was performed, allowing safe ligation of the cystic duct. The postoperative course was uneventful. CONCLUSION: This case highlights the critical role of anatomical awareness, intraoperative vigilance and timely adoption of bailout strategies to ensure a safe cholecystectomy and prevent biliary injuries.
Rare Case Report of Hb J Meerut Hemoglobinopathy - a Hospital Insight in the Saurashtra-Kutch Region of Gujarat.
Anandani G, Goswami P, Bhankhodia V … +2 more , Dangar A, Thesiya YM
Maedica (Bucur) · 2026 Mar · PMID 41978864 · Full text
Hemoglobin comprises numerous variants, with fast-moving hemoglobin categorized as rare occurrences. These variants are primarily caused by the substitution of a negatively charged amino acid residue in the α, β, or γ gl...
Hemoglobin comprises numerous variants, with fast-moving hemoglobin categorized as rare occurrences. These variants are primarily caused by the substitution of a negatively charged amino acid residue in the α, β, or γ globin chains. Cation exchange high-performance liquid chromatography (CE-HPLC) is an automated and accurate diagnostic tool for hemoglobinopathies. The α-globin variant Hb J Meerut is infrequently observed, having been reported in various populations globally, yet it is notably rare in Gujarat, India. We hereby report two cases of Hb J Meerut hemoglobinopathy in Saurashtra-Kutch region of Gujarat, India. Preventive strategies including pre-marital and antenatal screening, coupled with public awareness and genetic counseling, are vital to mitigate the silent burden of hemoglobinopathies.
The Role of Side Effects in Adherence of Patients with Obstructive Sleep Apnea Syndrome to Continuous Positive Airway Pressure Therapy.
Burcea R, Mihaltan FD
Maedica (Bucur) · 2026 Mar · PMID 41978863 · Full text
Continuous positive airway pressure (CPAP) therapy is the main therapeutic method for obstructive sleep apnea syndrome (OSAS). The way of accommodating the patient with the CPAP mask is very important for adherence to th...
Continuous positive airway pressure (CPAP) therapy is the main therapeutic method for obstructive sleep apnea syndrome (OSAS). The way of accommodating the patient with the CPAP mask is very important for adherence to therapy. In this study, we tried to determine the patient-reported causes for suboptimal use of CPAP therapy and to draw up some recommendations for their management, with the aim to improve adherence to CPAP therapy. The present study investigated 86 patients diagnosed with OSAS who were divided into two categories by CPAP adherence (at least four hours per night therapy in at least 70% of the recommended days): CPAP adherent patients (n = 50) and non-adherent patients (n = 36). All participants completed a questionnaire to report the side effects of therapy and the main reasons for suboptimal use of CPAP therapy. The reported causes for the inappropriate use of therapy with statistical significance included side effects of the mask and device, misperception of disease severity and lack of confidence that CPAP therapy is useful for treating OSAS. Dry mouth, the main side effect reported by both adherent and non-adherent patients, was not a predictor of statistical significance for adherence to therapy. Suboptimal use of therapy, a statistically significant factor for adherence to treatment, occurred in some of the OSAS patients who developed anxiety related to CPAP device. Many non-adherent participants used an air humidifier attached to CPAP to treat dry mouth as a side effect, which did not help increase adherence in this group of patients. Multiple factors may be involved in OSAS patients' adherence to CPAP therapy. Of these, side effects in therapy can play an important role and resolving them can be an essential factor for patient adherence.
Burden of Vitamin D Deficiency in Female Patients in Different Stages of Life: a Retrospective Study.
Biswas K, Mir AA, Kushwaha V … +2 more , Kumar D, Acharya NN
Maedica (Bucur) · 2026 Mar · PMID 41978862 · Full text
OBJECTIVES: Vitamin D deficiency is linked to rickets in children, precocious puberty in adolescents, polycystic ovarian syndrome in adults and osteoporosis in older adults. Its requirements for females differ according...
OBJECTIVES: Vitamin D deficiency is linked to rickets in children, precocious puberty in adolescents, polycystic ovarian syndrome in adults and osteoporosis in older adults. Its requirements for females differ according to the stages of life. This study aims to estimate the proportion of vitamin D deficiency in female patients at different stages of life. MATERIALS AND METHODS: This cross-sectional retrospective study was done on female patients undergoing vitamin D estimation from January to December 2024 in All India Institute of Medical Sciences, Raebareli, India.. Vitamin D estimation in serum was conducted on VITROS 5600 Immunodiagnostic Systems by chemiluminescence immunoassay technique. Serum levels of ≥30 ng/mL, 20-30 ng/mL and < 20 ng/mL were considered normal, insufficient and deficient, respectively. Data was collected in a Microsoft Excel spreadsheet and analysed by IBM SPSSv25. RESULTS: Vitamin D estimation was done on 8 403 female patients. Deficient, insufficient and normal vitamin D levels were seen in 33.3%, 31.0% and 35.7% of subjects, respectively. Analysis according to the life stages highlighted that adolescents (13-18 years) had the highest (46.8%) deficiency, followed by young adults (19-24 years) (40.0%). Mean vitamin D levels were the lowest (24.2±15.9 ng/dL) in adolescents (13-18 years) and the highest (40.9±27.6 ng/dL) in newborns and babies (0-1.9 years) (F=22.8, p=0.00). Significant seasonal differences in vitamin D levels were observed, with the lowest (25.9±18.8 ng/dL) being seen in February and the highest (31.8±17.1 ng/dL) in August (F=7.1, p=0.00). CONCLUSION: Across the stages of life in female patients, adolescents (13-18.9 years) had the highest burden of vitamin D deficiency. Incorporating vitamin D supplementation under the national health programme for adolescent females will be beneficial.
Sun Exposure Patterns Affect Melanoma Location but Not Prognostic Features.
Vasiu LS, Iordache IV, Raducu L … +2 more , Caraban BM, Jecan CR
Maedica (Bucur) · 2026 Mar · PMID 41978861 · Full text
OBJECTIVES: Cutaneous melanoma (CMM) is an aggressive malignancy whose incidence continues to rise worldwide. Ultraviolet (UV) radiation from natural and artificial sources is a major environmental risk factor and is cla...
OBJECTIVES: Cutaneous melanoma (CMM) is an aggressive malignancy whose incidence continues to rise worldwide. Ultraviolet (UV) radiation from natural and artificial sources is a major environmental risk factor and is classified as a Group 1 carcinogen by the International Agency for Research on Cancer. The present study aimed to evaluate the association between sun exposure patterns and the clinicopathological characteristics of patients with cutaneous melanoma, focusing on tumor thickness and markers of tumor aggressiveness. MATERIALS AND METHODS: This retrospective cohort study included 115 patients with histologically confirmed primary cutaneous melanoma treated in our Plastic Surgery Department between January 2018 and December 2022. Demographic, clinical and histopathological data were collected from medical records and Breslow thickness was categorized as thin (≤2 mm) or thick (>2 mm). Statistical analysis included chi-square and Mann-Whitney U tests, followed by multivariate logistic regression to identify predictors of increased tumor thickness. A p-value < 0.05 was considered statistically significant. RESULTS: Statistically significant associations were identified between several clinicopathological variables and melanoma characteristics. Sun exposure pattern was significantly associated with tumor anatomical location [χ²(6) = 85.11, p < 0.001], with chronic exposure predominantly linked to melanomas of the posterior trunk, while intermittent exposure was more frequently observed in melanomas of the lower limbs. Patients with thick melanoma were significantly older than those with thin tumors (p = 0.032). Melanoma thickness was also significantly associated with histological subtype (p = 0.002), ulceration (p < 0.001), and mitotic activity (p = 0.002), with nodular melanoma, ulcerated tumors, and lesions with increased mitotic activity more frequently presenting greater Breslow thickness. Metastatic disease occurred more often in patients with thick melanomas (p = 0.046). In multivariate analysis, mitotic activity remained an independent predictor of thick melanoma [OR = 1.75, p < 0.001], while ulceration showed borderline significance (odds ratio [OR) = 4.14, p = 0.050]. Overall, sun exposure pattern was associated with melanoma location but not with markers of tumor aggressiveness. CONCLUSION: Sun exposure pattern was associated with melanoma anatomical location but not with tumor aggressiveness. Increased mitotic activity was the strongest independent predictor of thick melanoma, while ulceration showed borderline significance. These findings suggest that intrinsic tumor characteristics play a greater role in melanoma progression than sun exposure patterns.
Predicting In-Hospital Death in Patients with Bowel Obstruction Using the Revised Cardiac Risk Index and Cardiovascular Disease History - Insights from a Cohort Study.
Deica AV, Paduraru LF, Paduraru DN … +3 more , Bolocan A, Daniel I, Andronic O
Maedica (Bucur) · 2026 Mar · PMID 41978860 · Full text
In this study, we aim to elucidate how cardiovascular disease influences short-term prognosis in bowel obstruction in terms of mortality and duration of hospitalization. In order to clarify these unresolved issues, we c...
In this study, we aim to elucidate how cardiovascular disease influences short-term prognosis in bowel obstruction in terms of mortality and duration of hospitalization. In order to clarify these unresolved issues, we conducted a retrospective cohort study, including 186 patients who underwent surgical treatment for bowel obstruction in an emergency hospital between the 1st of January 2019 and the 31st of December 2022. The total number of cardiovascular disease diagnoses and the revised cardiac risk index score were independent predictors of in-hospital mortality and time to in-hospital death. Of all individual cardiovascular diagnoses considered in the present study, only heart failure was an independent predictor of in-hospital death. Cardiovascular disease history, and especially high cardiovascular comorbidity, as well as revised cardiac risk index are associated with in-hospital mortality in patients with bowel obstruction.
Complex Features of Tumor-Infiltrating Lymphocytes (TILs) and Stromal Response After Neoadjuvant Breast Chemotherapy.
Tapoi D, Carabas BA, Costache M
Maedica (Bucur) · 2026 Mar · PMID 41978859 · Full text
Neoadjuvant chemotherapy (NAC) has become a cornerstone in the management of early-stage breast cancer, offering the dual benefits of downstaging tumors to facilitate surgical resection and providing an in vivo assessmen...
Neoadjuvant chemotherapy (NAC) has become a cornerstone in the management of early-stage breast cancer, offering the dual benefits of downstaging tumors to facilitate surgical resection and providing an in vivo assessment of treatment sensitivity (1-3). The tumor microenvironment (TME), comprising a complex network of stromal cells, immune cells and extracellular matrix, plays a pivotal role in modulating therapeutic response (4-6). Within this ecosystem, tumor-infiltrating lymphocytes (TILs) have emerged as a robust biomarker, while stromal response to therapy - characterized by fibrosis, hyalinization and elastosis - reflects host tissue remodeling and may modulate immune function (1, 7-9) along the stromal response to therapy, characterized by features such as fibrosis, hyalinization and elastosis, reflects the host's tissue remodeling processes and may influence immune cell function and tumor behavior (10-13). This study investigates the dynamic interplay between TILs and stromal features in breast cancer following NAC, aiming to elucidate their combined prognostic and predictive significance (9, 14, 15).
The Impact of Enhanced Recovery after Surgery Protocol on Health-Related Quality of Life Following Colorectal Surgery: a Literature Review.
Makrynika E, Garmpis N, Mantas D
Maedica (Bucur) · 2026 Mar · PMID 41978858 · Full text
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols are widely adopted in colorectal surgery to reduce postoperative complications, length of stay and costs, but their impact on health-related quality of life (H...
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols are widely adopted in colorectal surgery to reduce postoperative complications, length of stay and costs, but their impact on health-related quality of life (HRQoL) is less clear. METHODS: A literature review was conducted through PubMed (MEDLINE) to December 2024, including randomized trials and observational studies evaluating ERAS implementation in colorectal surgery with HRQoL as primary or secondary outcome, using validated or clearly described HRQoL instruments. RESULTS: Fifteen studies met the inclusion criteria, encompassing heterogeneous patient populations, procedures and ERAS pathways. Early randomized trials generally reported no significant differences in global HRQoL scores between ERAS and standard care, although ERAS cohorts frequently showed faster recovery of instrumental activities of daily living, earlier return to leisure or work and shorter hospitalization without increased complications. More recent studies, including larger prospective series, increasingly demonstrated higher HRQoL scores in ERAS groups across multiple domains using instruments such as EORTC QLQ-CR38 and WHOQOL-BREF, and identified non-ERAS perioperative care as an independent negative prognostic factor for long-term HRQoL improvement. No study reported detrimental effects of ERAS on HRQoL. CONCLUSIONS: The available evidence, although limited and methodologically heterogeneous, suggests that ERAS protocols in colorectal surgery have a neutral to beneficial impact on HRQoL, while maintaining well-established clinical advantages. Future research should include rigorously designed studies with HRQoL as a primary endpoint, standardized ERAS components and consistent use of validated HRQoL tools to allow more definitive recommendations.
The Impact of Lifestyle and Physical Activity on Self-Reported Bruxism Symptoms in Young Adults.
Nica IK, Farcasiu AT, Imre M
Maedica (Bucur) · 2026 Mar · PMID 41978857 · Full text
OBJECTIVES: Bruxism is an oral habit that sums symptoms like tooth clenching, grinding and jaw contractions. This study aimed to evaluate self-assessment bruxism among dental students. MATERIAL AND METHODS: A questionnai...
OBJECTIVES: Bruxism is an oral habit that sums symptoms like tooth clenching, grinding and jaw contractions. This study aimed to evaluate self-assessment bruxism among dental students. MATERIAL AND METHODS: A questionnaire assessing the perception of bruxism symptoms was administered to a cohort of students (n=301) from "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. Data regarding demographics, lifestyle and current symptoms were collected. RESULTS: Statistically significant associations between sedentary behavior (lack of sport participation) and bruxism symptoms were found. Participants who did not practice a sport were more likely to report sleep grinding (36.1% vs. 24.5%, p=0.041), increased tooth wear (21.5% vs. 10.9%, p=0.027) and clenching upon waking (31.4% vs. 20.9%, p=0.049). Conversely, those who reported never clenching during stressful situations were more likely to be physically active (43.6% vs. 25.1%, p=0.009). Similarly, absence of clenching during tense moments was associated with sports participation (47.3% vs. 27.7%, p=0.005). CONCLUSION: Psychosocial factors and lifestyle significantly impact the presence of bruxism symptoms. The results of the present study suggest that physical activity may reduce the risk of bruxism-associated symptoms. However, correlating perceived symptoms with objective clinical assessment remains necessary.
B-Cell Lymphoma 2 Mitochondria-Mediated Apoptotic Pathway in Cervical Carcinoma.
Karahaliou C, Mastronikoli S, Tsiambas E … +6 more , Fotiades P, Niotis A, Kyrousis G, Lazaris AC, Kavantzas N, Agrogiannis G
Maedica (Bucur) · 2026 Mar · PMID 41978856 · Full text
INTRODUCTION: Cervical carcinoma is a leading cause of female malignant-depended morbidity and mortality worldwide. Although modern gynecological screening, including Papanicolaou (PAP) test and human papillomavirus (HPV...
INTRODUCTION: Cervical carcinoma is a leading cause of female malignant-depended morbidity and mortality worldwide. Although modern gynecological screening, including Papanicolaou (PAP) test and human papillomavirus (HPV) DNA/m RNA tests, provides an optimal management in female health, there is an increasing need for understanding the role of specific molecular pathways implicated in the disease. Among them, apoptosis plays a crucial role in the progression of the malignancy and also in the response rates to chemo-targeted therapeutic regimens. OBJECTIVE: The purpose of the current molecular review was to explore the role of mitochondrial-based anti-apoptotic and apoptotic pathways in cervical carcinoma molecular substrate and their established and also potential chemo-targeted inhibitors. MATERIAL AND METHOD: A systematic review of the literature was carried out based on the international database PubMed including 50 significant papers in the examined scientific field. The following keywords were used: apoptosis, mitochondria, cervical, carcinoma, B-cell lymphoma. RESULTS: B-cell lymphoma (BCL) proteins' expression in cervical carcinoma demonstrates differences among the corresponding patients. Especially, overactivation of BCL-2 seems to lead in an aggressive cervical carcinoma phenotype (advanced stage, poor prognosis) due to its strong anti-apoptotic action. CONCLUSIONS: Mitochondria play a crucial role in the apoptotic phenomenon regarding cervical carcinoma. BCL-2 overexpression induces the resistant to normal apoptotic signalling pathway leading to an immortalization-like status of the malignant cells. This event is crucial for the survival and response rates in the patients with BCL-2 abnormal activity. Furthermore, it seems that high risk HPV types activate BCL-2 by the increased oncogenic influence of E6/E7 viral genes. For these reasons, a broad spectrum of anti-BCL-2 inhibitors is under experimental, basic research and clinical evaluation regarding cervical carcinoma patients.
Hearing Loss in Systemic Lupus Erythematosus: a Systematic Review.
Hanna Y, Tlais M, Natour D … +8 more , Mazraani Y, Obeid N, Sarraf G, Zalzali I, Moghnie Y, Harouny T, Chebbo H, Farhat H
Maedica (Bucur) · 2026 Mar · PMID 41978855 · Full text
BACKGROUND: Hearing loss is an underrecognized manifestation of systemic lupus erythematosus (SLE). Proposed mechanisms include autoimmune inner ear injury, vascular occlusion related to antiphospholipid syndrome (APS) a...
BACKGROUND: Hearing loss is an underrecognized manifestation of systemic lupus erythematosus (SLE). Proposed mechanisms include autoimmune inner ear injury, vascular occlusion related to antiphospholipid syndrome (APS) and ototoxicity from medications such as hydroxychloroquine (HCQ). Although multiple case reports and observational studies have described this complication, the overall burden and clinical significance remain unclear. METHODS: A systematic review of PubMed, Embase, Web of Science, Scopus and the Cochrane Library was conducted up to September 2025, following PRISMA guidelines. Eligible studies included cohort, case-control, cross-sectional studies, case series, case reports and temporal bone analyses reporting auditory outcomes in SLE patients. Data on prevalence, clinical presentation, pathophysiology and management were extracted. Risk of bias was assessed using validated tools appropriate to each study design. RESULTS: The search identified 236 records; after removal of duplicates and screening, 10 studies were included. These comprised case reports, small series, histopathology and larger observational studies. Reported prevalence of sensorineural hearing loss in SLE ranged from ~27% in pooled analyses to ~55-56% when extended high-frequency audiometry was used. Pathological studies demonstrated vasculitis, stria vascularis atrophy and hair cell loss in SLE patients. Case-based evidence consistently linked sudden hearing loss to antiphospholipid antibodies, supporting a vascular occlusive mechanism. Hydroxychloroquine ototoxicity was described in isolated cases, often reversible after discontinuation, but not consistently supported in larger studies. CONCLUSION: Hearing loss in SLE is more prevalent than in the general population and arises through multifactorial mechanisms. Early recognition and tailored management, including corticosteroids for autoimmune-mediated cases, anticoagulation for APS and discontinuation of suspected ototoxic drugs, may improve outcomes. Routine audiological monitoring should be considered to reduce the risk of irreversible disability in this patient population.
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