Cardiovascular Risk Factors, Angiographical Features and Short-Term Prognosis of Acute Coronary Syndrome in People Living with Human Immunodeficiency Virus: Results of a Retrospective Observational Multicentric Romanian Study

People living with human immunodeficiency virus have increased cardiovascular risk due to a higher prevalence of traditional and particular risk factors such as chronic inflammation, immune dysregulation, endothelial dysfunction, coagulation abnormalities and antiretroviral therapy. In developed countries, coronary artery disease has become the most frequent cardiovascular disease and an important cause of mortality in these patients. The symptomatology of an acute coronary syndrome can be atypical, and the prevalence of each type of acute coronary syndrome is reported differently. Regarding coronary artery disease severity in people living with HIV, the literature data indicates that the presence of single-vessel disease is akin to that of HIV-negative patients, and their short-term prognosis is unclear. This study aims to assess the clinical characteristics, biological parameters, angiographical features and short-term prognosis of acute coronary syndrome in a cohort of Romanian people living with human immunodeficiency virus.

Deficiency of Vitamin D, a Major Risk Factor for SARS-CoV-2 Severity

BACKGROUND

The SARS-CoV-2 outbreak started in March 2020 with more than 120,552,261 cases at present and having caused over 2,667,248 deaths worldwide at the time this paper was written. The clinical signs of SARS-CoV-2 infection are especially evident in the respiratory and cardiovascular systems. Patients can be asymptomatic or present mild respiratory symptoms to severe acute lung injury leading to multiorgan failure and death. The study aims to assess the levels of serum 25-hydroxyvitamin D (25-(OH)-D) in 20 hospitalized patients infected with SARS-CoV-2 and 20 deceased people and to analyze the influence of vitamin D status on the severity of their disease.

METHODS

The present study was conducted on 40 patients who tested positive for SARS-CoV-2 infection. They were divided into two groups: 20 patients admitted to the "Victor Babes" Hospital of Infectious Diseases and 20 postmortem cases autopsied at the Institute of Legal Medicine Timisoara, Romania. During the autopsy, blood and bronchial fluid samples were collected for the laboratory. Automate Viral RNA extraction was performed on the Maxwell 48 RSC Extraction System (Promega, USA) using the Maxwell RSC Viral Total Nucleic Acid Purification kit (Promega, USA). After RNA extraction, the samples were amplified on a 7500 real-time PCR (Applied Biosystems, USA) using the genesig® Real-Time PCR Assay 2G (Primer Design, UK).

RESULTS

The living and deceased patients selected for the research presented decreased vitamin D levels, which are associated with increased levels of D-dimers, C reactive protein (CRP), and interleukin-6 (IL-6). These patients had a severe form of the SARS-CoV-2 disease, which led to death.

CONCLUSIONS

We conclude that deficiency of vitamin D in patients infected with SARS-CoV-2 presents a major risk factor related to the evolution and severity of the disease.

En-face optical coherence tomography analysis of gold and silver nanoparticles in endodontic irrigating solutions: An in vitro study

Optical coherence tomography (OCT) is a non-invasive, non-radioactive optical diagnostic method based on low-coherence interferometry, which achieves images with different orientation. In dentistry, its major advantage is represented by the localization and characterization of the smallest defects in hard dental tissues, dental materials and of the smallest details in dental anatomy (supplementary canals, recesses, isthmuses, or intra-radicular connections). The aim of the present in vitro study was to evaluate using c-scan en-face optical coherence tomography, the optical opacity, and the distribution inside the root canal lumen of several extracted human teeth of silver and gold nanoparticles from special irrigating solutions used in endodontic treatment. Twelve root canals from 5 human teeth were instrumented using the ProTaper Universal system after initial negotiation with hand K-files ISO no. 10 and rotary nickel-titanium PathFile instruments. An initial c-scan OCT analysis was performed for each sample to confirm that the root canal lumen was empty from radiopaque materials (Group 1). Teeth were first irrigated with NanoCare Plus (Group 2) and then with NanoCare Gold (Group 3) and C-scans were repeated after each irrigation method. The OCT investigation started at the tooth apex, at a depth of 1 mm from its tip. Subsequently, 100 slices of 10 microns were obtained from each root canal. Images were captured and then analyzed with ImageJ software to calculate the level of grey inside the root canal lumen. The highest values of grey were obtained in the samples irrigated with NanoCare Gold after NanoCare Plus (Group 3). The present study proved that both nanoparticles inserted in root canal irrigants were evidenced through OCT imagistic analysis due to their optical opacity, which allowed their highlighting in an empty root canal lumen, after the endodontic treatment was performed and the root canal was cleaned and shaped using specific protocols.

Cervical cerclage in advanced prolapsed fetal membranes - Case presentation

The case presentation of a transvaginal cervical cerclage performed at a 7 cm dilation in a patient in the 22nd week of pregnancy, followed by a prolongation of the pregnancy until the gestational age of 38 weeks, was reported in the context of many similar cases managed by the authors of the article during a program of screening and prevention of preterm birth. The particularity of the case was the lack of a preterm birth in the medical history of the patient and the installation of the isthmus-cervix incompetence in the second pregnancy, after an on term pregnancy. What should be evidenced is the importance transvaginal cervical ultrasound evaluation has in the early diagnosis of this pathology during pregnancy, this being the only method of determining the efficacy of the content of the internal cervical os. Transvaginal cervical exploration has to be implemented as a screening method both in the high-risk patients and in the absence of a suggestive medical history.

Geographical origin identification of Romanian wines by ICP-MS elemental analysis

Trace elemental analysis, besides its ability to determine stable isotopes ratios, represents a possible complementary tool useful to differentiate wines based on their regional origins. Wines and their provenance soils from two major wine producing areas in Southeast Romania ('Valea Calugareasca' and 'Murfatlar'), and also wine from the region of Moldova (Eastern Romania) were analyzed by inductively coupled plasma mass spectrometry (ICP-MS), and statistical data of elemental composition was used to differentiate these wines according to grape type and geographical origin. Moreover, this study gathers relevant elemental trace composition of wines produced in most important Romanian vineyards, thus offering a useful wine differentiation tool by their production district. The results show that the differentiation of Romanian wines according to their provenance is based on the following main elements: Ni, Ag, Cr, Sr, Zn, and Cu for Valea Calugareasca, Rb, Zn, and Mn for Murfatlar, and Pb, Co, and V for Moldova.

Définition d’un plan de mesure reproductible de l’antéversion acétabulaire en tomodensitométrie

PURPOSE

To demonstrate the variability of acetabular anteversion angle measurement at CT and suggest a new and reproducible method of measurement.

MATERIAL AND METHODS

Sawbone pelvis based study: We first realized a series of helical CT of the pelvis, with gradual increase in tilt angle, and measured acetabular anteversion angles on axial sections, then on sections parallel to the superior S1 endplate. Then, we made a series of radial sections centered at the acetabulum, and the anteversion angle was measured on each section. Finally, a test series of five in vivo pelvis was performed to evaluate the feasability of our method.

RESULTS

The acetabular anteversion angle varies with pelvis tilt, whereas measurements obtained from sections parallel to the S1 endplate are constant.

CONCLUSION

Acetabular anteversion angle should be measured from sections parallel to the S1 endplate, in order to minimize errors during total hip arthroplasties.

Acute zonal occult outer retinopathy: towards a set of diagnostic criteria

BACKGROUND

Individuals with acute zonal occult outer retinopathy (AZOOR) present with initially progressive scotomata and photopsia. Characteristically, the extent of the visual field defect is unexplained by fundal examination, but there is marked retinal dysfunction evident electrophysiologically. It is the authors' experience that a group of patients exhibit characteristic clinical and electrophysiological abnormalities, which serve as criteria for a working diagnosis.

METHODS

A retrospective observational case series of 28 patients were identified with the clinical diagnosis of AZOOR who shared similar abnormal electrophysiology. Details of the history and ophthalmic findings were obtained from the case notes.

RESULTS

Electrophysiology demonstrated a consistent pattern of dysfunction both at the photoreceptor/retinal pigment epithelial complex but also at inner retinal levels, essentially comprising a delayed 30 Hz flicker ERG and a reduction in the EOG light rise.

CONCLUSION

This study determines diagnostic criteria applicable to a group of patients with AZOOR, typically those with classic symptomatology. Electrophysiological testing can help avoid lengthy, costly, and potentially invasive investigations, and the unnecessary use of immunosuppressive therapy.

[Innovative bipolar radiofrequency volumetric reduction with "ORL-Set" for treatment of habitual snorers]

BACKGROUND

The present study was undertaken in an effort to assess the use and the efficacy of an innovative radiofrequency system (RaVoR, Select-Sutter, Freiburg i. Br.) and the bipolar electrodes conceived by the author for the treatment of habitual, disruptive snoring. The author's own surgical method takes into account a number of published retrospective studies on radiofrequency application in the treatment of snoring and is based on important anatomical, physiopathological and histological knowledge.

PATIENTS AND METHODS

Thirty-one patients diagnosed with primary snoring and five patients with associated sleep apnea syndrome (SAS) were treated according to the method and with the RaVoR system in the past three years. The intensity as well as the snoring density was assessed on a numeric analogue scale (NAS; ranging from 0 = "patient doesn't snore anymore" to 4 = "patient continues to snore as before"), which was filled out by the partner preoperatively and postoperatively after 6 months and 2 years.

RESULTS

Snoring was reduced in 31 (86 %) patients (NAS </= 2). Ten of them (28 %) stopped snoring altogether, according to their sleeping partners.

CONCLUSION

The bipolar radiofrequency method with the ORL-Set (RaVoR) has proven to be a safe and effective means for the treatment of snoring and some cases of SAS.

TCR binding differs for a bacterial superantigen (SEE) and a viral superantigen (Mtv-9)

Both superantigens (SAG) and many anti-TCR monoclonal antibodies (mAb) have specificity for the V beta region of the TCR encoded by TCRBV genes. For instance the bacterial SAG staphylococcal enterotoxin E (SEE), the retroviral SAG MTV-9 and the mAb OT145 each react with human T cells expressing BV6S7. This BV gene encodes two common alleles. We found that SEE and the mAb preferentially activate T cells expressing BV6S7*1 as opposed to BV6S7*2, but Mtv-9 activates T cells expressing either allele. Thus binding to the TCR differs between the two SAGs. A mutation in the TCR HVR-4 region of BV6S7*1 (G72E), where the two BV6S7 alleles differ, indicated that HVR-4 is a component of the binding site for SEE and for the mAb OT145. BV6S7*2 has a charged E72 which may result in electrostatic repulsion of SEE, as SEE contains a similarly acidic aspartic acid residue at a TCR interaction site (204D).

Open clinical study of Clopixol-Acuphase (zuclopenthixol acetate) treatment followed by Clopixol Depot in acute psychoses with long-term course tendency

The evolution of 28 patients displaying acute forms of psychoses (schizophrenia, mania, exacerbation of psychosis in chronic cases) was studied under the treatment with Acuphase Acetate continued with Clopixol Depot. In both therapies a tioxantenic neuroleptic is involved for the acute form of the illness (Acuphase) and for the maintenance treatment (Clopixol Depot). The assessment of the results was carried out on individual observation files using Global Rating Scale (G.R.S.), B.P.R.S. and paraclinical measurement to appreciate the biological tolerance. Favourable effects of treatment were evident in the first 4 days and in six cases even within the first 24 hours. The whole group of patients showed a significant decrease of morbidity evolving from a high severity to a medium and reduced one. The biological tolerance was very good, 6 to 12 months' care.

[Intraoperative cholangiography in acute cholecystitis]

Intraoperative control of the main bile duct is compulsory during surgeries for acute cholecystitis. The surgical cholangiography is essential within the investigation means and methods. Starting from their own experience and the literature data, the authors establish the indicators for intraoperative cholangiography in acute cholecystitis with reference to the specific methodology.

[Neglected peritonitis]

The analysis of 130 cases of neglected peritonitis shows the seriousness of the disease, that increases considerably with the time elapsed from the onset of the disease till the admission into the hospital. The peritonitis may have different causes, the most frequent ones being acute appendicitis and perforating ulcer. The related affections, when present, amplify, modify or, on the contrary make the symptoms confused. When a neglected peritonitis is suspected, the surgery is required, followed by an intensive treatment afterwards.

Cellular edema in nervous tissue

The paper presents some mechanisms which determine or accompany cellular brain edema: intracellular and extracellular osmolality alteration, neuronal excitation, increased extracellular K+ concentration, anoxia, ischemia and hepatic encephalopathy.

Metastatic nonfunctioning parathyroid carcinoma: ultrastructural evidence of secretory granules and response to chemotherapy

A 69-year-old woman was admitted to the hospital because of recurrent cervical nodules, a large anterior mediastinal mass, and malignant left pleural effusion. Light and electron microscopy of the resected cervical nodules and cytology of the pleural fluid showed findings consistent with parathyroid carcinoma. There was no evidence of hyperparathyroidism on clinical evaluation, multiple serum calcium and phosphorus determinations, skeletal survey, intravenous pyelogram, or radioimmunoassay of intact and carboxy-terminal parathyroid hormones in the serum. Electron microscopy revealed secretory granules in the cytoplasma of malignant cells. A dramatic and complete resolution of the mediastinal mass and pleural effusion occurred after 18 months of chemotherapy with "MACC" (methotrexate, adriamycin, cyclophosphamide and CCNU).

[Clinical and therapeutic aspects of traumatic diaphragmatic hernia]

The authors present 5 cases of diaphragmatic hernia occuring after thoracoabdominal trauma (in one case the hernia was in the right hemidiaphragm, associated with partial hepato-thorax, the other four were in the left hemidiaphragm and were associated with intra-thoracic herniation of the stomach, transverse large bowel, large epiploon, loops of the small bowel and of the spleen). In three cases the lesion was treated by the thoracic route while in the other two the abdominal route was preferred. In one of the cases splenectomy and segmental transverse colectomy were performed by the transthoracophrenic approach. This was necessary because of the length of the pedicles, as well as of the risks entailed by an eventual attempt at re-positioning the viscera.