Hepatocellular Carcinoma Treatment by Using TACE: a literature review

Hepatocellular Carcinoma (HCC) is the most prevalent liver malignancy. Trans arterial chemoembolization (TACE) is the gold standard treatment for Barcelona Clinic Liver Cancer (BCLC) stage B patients, who are considered to have unresectable HCC. In the following review it is shown that BCLC stage B group is too heterogenous, at the same time some patient may present a better outcome by receiving a more aggressive procedure, while others may benefit from systemic therapy. Those methods suggest which is the optimal treatment for BCLC stage B patients and when to apply it. Apart from alternatives to TACE, this review has highlighted other situations when TACE may be used – BCLC stage A or C.

Prevalence and Risk Factors of Depression in Turkish Geriatric Population: Gender Differences in a Field Study

"Background: Aging is associated with increased morbidity, mortality, hospitalization, and loss of functional status related to common mental disorders in the elderly. The aim of this study is the need to identify new and unmet problem areas in geriatric depression and develop efficient interventions for gender-based differences. Methods: The cross-sectional, field-based study was conducted with 2269 participants. The nurses serving in primary health care facilities collected data. The Questionnaire consisted of socio-demographic characteristics, illnesses, medications, Non-communicable diseases (NCDs), EQ-5D, General Health Status (GHS), Geriatric Depression Scale (GDS) and Visual Analog Scale for health status (VAS) was collected in face-to-face interviews at the participants' homes. Results: In the study, the mean age was 73.3 (6.7), 50.3% were male. Of the older individuals' 71.8% had a chronic disease and 62.2% used at least one medication. The prevalence of depression was 31.2%. Women had a higher prevalence (35.6%) of severe depression than men (26.7%). Age, living alone, being single, being unemployed, having a chronic disease, and perception of poor health condition was associated with high depressive scores in the elderly whereas education, working status, and having a chronic disease were important factors in men. Conclusions: Depression evaluation in primary health care is an important part of geriatric health check-ups. The incidence of depressive symptoms significantly changes according to gender. Gender-based strategies like increasing the retirement age for men and providing post-retirement job opportunities can be effective in reducing depression. "

Providencia Species – Involvement in Pathology and Multidrug Resistance in a Romanian County Hospital

The aim of the study was to evaluate the distribution on hospital wards, the spectrum of infections and the pattern of antimicrobial resistance of Providencia strains identified between 01.01.2018-31.12.2020 in the samples of the patients hospitalized in the Clinical County Emergency Hospital of Brasov. 380 strains of Providencia species were identified in the medical and surgical wards, especially in ICU (76.84%), Internal medicine ward (5.79%) and General surgery (3.95%). More frequently, Providencia spp. were isolated from tracheobronchial secretions (35.79%), pus (22.89%) and urine (19.74%). The levels of antimicrobial resistance of Providencia strains were very high for all the tested antimicrobials.

The Aldosterone-to-Renin Ratio as a Screening Test in Primary Aldosteronism

Primary hyperaldosteronism is one of the most common causes of secondary hypertension and it is associated with a higher risk of developing extracardiac complications than that of people diagnosed with primary hypertension. We present a six-month study done at the MedLife Hospital in Brașov on 62 patients who had one or more indications for primary hyperaldosteronism screening. The main conclusions drawn from this study are that there is a strong need for starting screening in primary hyperaldosteronism from an earlier age, as the target population can have a high vulnerability from a cardiovascular and a renal standpoint and that the aldosterone-to-renin ratio screening test should be recommended to a higher number of people in the target population, the positivity rate in the group studied being 47%.

Optic Nerve Pilocytic Astrocytoma With Leptomeningeal Dissemination – Case Report

"Pilocytic astrocytoma is the most frequent type of brain tumor diagnosed during childhood. It originates from midline structures and is associated with good prognosis, with an estimated survival rate higher than 95%. We presented the case of a male patient diagnosed at the age of 6 with pilocytic astrocytoma located in the right optic nerve with associated chiasm infiltration. Incomplete resection of the tumoral process was performed, without any additional therapy, as association of chemotherapy or radiotherapy is still controversial among specialists. The patient had an unpredictable severe evolution of the disease, with associated leptomeningeal dissemination and extreme worsening of neurological and endocrinologic status. Six years after diagnosis, despite complex medical efforts the patient died. This article raises awareness of leptomeningeal dissemination risk, a rare evolution in cases of pilocytic astrocytoma. Early diagnosis, complete tumoral resection, tumor location and careful long-term follow up are key factors for long-term survival. "

Non-Operative Management for Renal and Splenic Trauma – A Case Report

Management of abdominal trauma has evolved over the past decades and most of trauma patients can be managed conservatively. This article demonstrates the effectiveness of non-operative management (NOM) in a patient with grade IV renal trauma and grade II splenic trauma that was treated in the urology department of Emergency Clinical County Hospital of Brasov after a car crash. Clinical examination showed bruises on the right shoulder and macroscopic haematuria that suggest renal trauma. The abdomen was spontaneously painles, no signs of acute abdomen but severe pain in the left lumbar area, with no additional relevant medical history. The CT scan revealed laceration of the valvular area of the left kidney, spleen contusion and retroperitoneal haematoma with contrast spreading in the iliopsoas muscle region, classifying renal trauma as stage IV and splenic trauma as stage II on American Association for the Surgery of Trauma injury scale. The trauma is classified as serious with an Injury Severity Score of 18, and Resciniti CT score of 2, therefore NOM is recommended. Despite high grade trauma, the patient was haemodynamically stable, with a heart rate of 90 bpm, blood pressure of 105/65 mmHg and haemoglobin of 10.4g/dl. Under constant observation and with the help of a multidisciplinary team, the therapeutic focus was directed on local protocol consisting of pharmacological treatment with fluid resuscitation, antibiotic therapy, analgesics, haemostatics, anticoagulant therapy and multiple blood transfusions consisting of fresh frozen plasma and packed red blood cells. Starting with day 6, the haemoglobin levels normalized, no further blood transfusion beeing necessary. The patient was discharged and didn’t developed complications in the following 6 months. The NOM in the case of grade IV renal trauma and a grade II splenic trauma is effective, provided the patients are haemodynamically stable and constant reevaluations are performed.

Risk Factors and Aetiological Agents of Urethritis in Men with Urethritis in Brașov County

"Introduction: Despite advances in the diagnosis and treatment of urethritis, they remain a global public health problem worldwide. Patients with urethritis have a higher risk sexual behavior than the general population. Aim: The aim of the study was to evaluate the risk factors and the etiological pathogens of urethritis in men among Brașov county. Patients and methods: A retrospective study was conducted in Medlife-PDR Clinic from Brașov, România, from Jan 2016 to Nov, 2020. 111 male patients aged from 17 to 78 years (mean age 34.5±10.26) presenting with dysuria, micturition discomfort and/or urethral discharge were included in the study. Results: The highest incidence of urethritis was among men aged 21-40 years. The acquisition of urethral infection was related to their young age, low educational level, multiple sexual partners and lack of condom use, most having extramarital relations including commercial sex. N. gonorrhoeae was identified as a causative agent in 18 (16.22%) patients with urethritis, C. trachomatis in 39 (35.14%) patients, Mycoplasma spp. in 5 (4.5%) patients, Ureaplasma spp. in 30 (27.03%) patients, Trichomonas vaginalis in 6 (5.4%) patients. A concurrent infection with N. gonorrhoeae and C. trachomatis was identified in one patient (0.01%). In 12 patients (9.9%) other infectious agents were identified and in one case the aetiological agent could not be identified (0.01%). Conclusion: By identifying risky sexual behaviors, clinicians may be able to provide educational counseling as well as assistance in the diagnosis and treatment of urethritis. "

Patients’ Perceptions Regarding the Availability of Primary Care Services in Romania - A Pilot Survey Among Users of Primary Care Services in Braşov County

In Romania, users’ perceptions about availability of services in primary care have not been explored since 2009, when a national report was produced, and little is therefore known about the subject. The study aims to identify perceptions of primary healthcare service users regarding the availability of services in primary care. This research is a pen-and-paper self-administered survey applied to an opportunity sample of people, addressing family doctor’s practices, from 17 selected settlements of Brasov county. Overall, the analysis of population’s perceptions on the primary care system in Brasov County shows a high degree of satisfaction among the patients despite a narrow spectrum of services offered by family doctors.

Evaluation of Antimicrobial Resistance of Uropathogenes Involved in Urinary Tract Infections in ICU Patients

The aim of the retrospective study was the analysis of antibiotic resistance patterns of bacteria involved in urinary tract infections in patients hospitalized during 2019 in the Intensive Care Unit of the Clinical County Emergency Hospital Brasov. The main bacteria involved were Escherichia coli (38,68%), Klebsiella species (23,69%) and Enterococcus species (15,68%). Various degrees of resistance to the tested antibiotics were observed. ESBL strains were detected at Escherichia coli (20,72.%) and Klebsiella species (10,29%). Carbapenem resistant strains were detected at Klebsiella spp. (48,48%), P. aeruginosa (56,25%) and Acinetobacter spp. (85,71%). MRSA, VRE and HLAR strains were also detected in the studied group.

Hormonal Fluctuations Related to Depressive Symptoms in Menopause

Depression has a high incidence among perimenopausal women. This systematic review focuses on the connection between hormonal fluctuations and depressive symptoms. The 5% chances of depression are correlated with increasing additional year between menarche and menstrual transition (MT) onset. The higher rates of depressive symptoms were associated with more substantial variation in serum estradiol. Progesterone > 6 ng / dL has been linked with lower rates of depressive symptoms. The results may also indicate an interaction of ovarian hormones, serotonin deficiency and cortisol in this process.