Medicine and Pharmacy Reports

The importance of multimodal diagnostic methods for therapeutic decision making for overactive bladder in women

2025-04-28T12:19:10+00:00

Background and aim. Despite overactive bladder (OAB) being a symptomatic diagnosis, all patients require a basic assessment to confirm the diagnosis, as well as to exclude any other underlying cause for lower urinary tract dysfunction. While guidelines clearly define different methods of investigations for OAB, there are reasons to believe that these guidelines reflect more of a “one size fits all” model that may not be appropriate for use in all patients. The study aimed to elucidate the complex and advanced multidisciplinary methods of investigation of OAB patients.

Methods. PubMed, ScienceDirect, Cochrane Library, and Google Scholar databases were used to search for scientific publications from 2013 to 2023 using relevant keywords and phrases.

Results. Data from 708 publications were researched and synthesized, a systematic review was carried out and the detailed and coherent results presented the diagnostic aspects of overactive bladder in women. Relevant citations from selected articles were included, and a synthesis of key information was provided.

Conclusion. These discoveries may assist in detecting OAB earlier, allowing for prompt intervention and potentially preventing the condition from progressing to more severe stages and providing healthcare professionals with valuable tools to enhance the diagnosis and treatment of OAB, potentially improving the quality of life for patients affected by this condition.

The role of pharmacists in ensuring rational antibiotic therapy within the interdisciplinary team

2025-04-28T12:19:11+00:00

The irrational use of antibiotics is one of the biggest threats to public health, as recently highlighted in the documents from the World Health Organization. It includes both the choice of an inappropriate drug, dose, form, or length of therapy for the patient, and a lack of attention to the global cost of treatment. One of the effects of excessive and irrational use of antibiotics worldwide is the increasing number of antibiotic-resistant microorganisms. The growing number of bacterial illnesses and deaths caused by this type of pathogens is of great significance, making the consequences of incorrect antibiotic use both medical and economic.

In the rationalization of pharmacotherapy, the significant role of medical staff, including pharmacists, who have extensive knowledge in the field of antibiotic therapy, is emphasized. The main goal of the rational management of antimicrobial drugs should be to improve patient treatment outcomes and minimize the medical and economic consequences of antibiotic use. Antibiotic therapy rationalization programs are needed in all healthcare facilities, both in open care and in hospital settings. Educational interventions that target primary care physicians and physicians prescribing antibiotics in hospitals are necessary. Additionally, pharmacists, being the most accessible healthcare workers, can build awareness of rational antibiotic therapy among patients.

Colonic polyps in North-Western Romania: a comprehensive single-center analysis of endoscopic and pathological features

2025-04-28T12:19:10+00:00

Background and aims. Most colorectal cancers (CRC) originate from precancerous adenomatous and serrated lesions. Accepted risk determinants for conventional adenomas and CRC include age, male gender and familial history. The aim of our study was to outline the characteristics of colorectal polyps in our center, as well as to uncover associations between them and certain clinical presentations.

Methods. We retrospectively collected the data available in a tertiary center of the patients that underwent colonoscopy for various indications (e.g.: rectorrhagia, abdominal pain, screening, anemia etc.) between the 1st of January 2022 and the 1st of August 2023. We analyzed the age, gender and symptoms of the patients. We analyzed the colorectal polyps detected. We classified the polyps based on location, size, shape, architecture and dysplasia grade. Statistical analysis was conducted to evaluate potential associations between their characteristics.

Results. 248 subjects were identified and included in the study. There were 584 polyps uncovered during the colonoscopies in 248 subjects. 498 polyps were excised and retrieved; 44.5% were right-sided and 55.5% were left-sided. Most of the polyps were < 1 cm (78.2%). There were significantly more adenomatous polyps (68.8%) than non-adenomatous (31.2%). Most of the polyps had a low grade of dysplasia (59.8%). There were significant associations between the polyp size and dysplasia grade, number and location on the transverse colon. Polyps under 1 cm were more likely to be tubular (p=0.008). The age of the patients >50 years was associated with a greater number of polyps (p=0.002). There was a moderate statistically significant association (p=0.0297) between the male gender and the number of adenomatous polyps.

Conclusions. Male gender, age greater than 50 years, history of colorectal polyps are risk factors for the development of colorectal polyps in the studied population. A history of more than 2 polyps and a size greater of 1 cm can be associated with higher rates of dysplasia.

Evolution of metabolic disorders after resection of pheochromocytomas and paragangliomas: a single-center study

2025-04-28T12:19:11+00:00

Background and aims. Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, responsible for inappropriate secretion of catecholamines, inducing metabolic disorders, increasing basal metabolic rate. Our study aimed to analyze the metabolic profile pre- and post-operatively in patients undergoing surgery for pheochromocytomas and paragangliomas and additionally to determine the predictive factors of metabolic remission.

Methods. This was a retrospective, unicentric, descriptive, and analytical study with a duration of 9 years. It includes data from 35 patients followed up for pheochromocytoma or paraganglioma in the Endocrinology-Diabetology and Nutrition Department of a University Hospital Center. All patients underwent surgery for pheochromocytoma or paraganglioma.

Results. Among the 35 patients, 51.4% of the patients with pheochromocytomas had diabetes mellitus, and 42.8% had dyslipidemia. We found that high levels of catecholamines were associated with the onset of diabetes. We also noted that patients with a long history of the disease were statistically at greater risk of developing dyslipidemia. After surgery, the body mass index of our patients had statistically increased, and 50% of patients experienced resolution or improvement of their diabetes. Improvement of dyslipidemia was observed in 53% of patients. We also found that the percentage of dyslipidemia was higher in patients who did not resolve their diabetes.

Conclusion. Diabetes mellitus and dyslipidemia are metabolic complications that must be investigated in patients with pheochromocytoma. Post-operative monitoring of body mass index and changes in glycemic and lipid levels is essential to adapt therapeutic management.

Return to work of head and neck cancer patients after curative radiotherapy

2025-04-28T12:19:11+00:00

Background. Our objective was to evaluate the rate of reemployment after having curative radiotherapy for head and neck cancer and to identify the barriers of successful return to work in this patient population.

Methods. The study was retrospective, cross-sectional, analytical and cohort type, it included 52 consecutive patients attending follow-up visits after curative radiotherapy for head and neck cancer at a single tertiary center. Participants completed a survey to assess demographics, tumor characteristics, lifestyle choices and quality of life questionnaires. We analyzed the rate of reemployment and the association with different parameters.

Results. At the time of the survey, the successful return to work rate among head and neck cancer survivors was 55.8%. Most of the returners, 93%, started to work within 14 months from the time of the diagnosis. Educational level, work type and tumor stage were predictive for successful return to work. The main barriers for reemployment were physical symptoms such as fatigue, speech disorders and eating problems. Conclusions. Head and neck cancer survivors who manage to return to work have a better quality of life and global health status than those who could not return. The most vulnerable patients are those with lower education, doing manual work and with advanced stage cancer. Optimized radiotherapy planning to reduce radiation induced late effects in conjunction with coordinated rehabilitation programs are needed to facilitate head and neck cancer survivors’ reemployment.

Physician migration in Romania: a study on the emigration preferences within the Cluj County healthcare system

2025-04-28T12:19:11+00:00

Introduction. Medical migration represents the movement of healthcare professionals from one country to another. The migration of Romanian doctors has evolved as a captivating and diverse phenomenon in the complex framework of global healthcare. As Romania struggles with its healthcare issues, many of its experienced medical personnel travel to foreign areas, lured by various factors ranging from economic concerns to the desire to gain clinical experience. The aim of this study is to elucidate the dynamics of this migratory phenomenon among physicians from Cluj County, Romania, between 2017 and 2022.

Methods. This retrospective study was performed between 2017 to 2022, and it was based on data from Cluj County Romanian College of Physicians, which included 571 specialist and consultant physicians from Cluj County who permanently migrated to other countries.

Results. Between 2017 and 2022, a total of 571 physicians permanently migrated from Cluj, Romania, to various other countries. Analysis of the gender distribution among these emigrants reveals a predominant female presence (58.1%) and a trend toward younger emigrating physicians, predominantly those under 30 years. In terms of professional specialties, Anesthesia and Intensive Care, as well as General Medicine/Family Medicine, are the most represented specialties, constituting 11% and 9.1% of the emigrating physicians, respectively. There was a declining trend from 2017 to 2021, followed by an upward trend in 2021.

Conclusions. Medical migration significantly impacts Romania’s Cluj County healthcare, intensifying workforce shortages and possibly in the future compromising patient care. Failure to address this may perpetuate systemic vulnerabilities, hindering optimal healthcare provision and necessitating some reforms for resilience and sustainability.

Skull base chordomas - emphasis on surgical strategy and recurrence-free survival

2025-04-28T12:19:11+00:00

Background and aim. Chordomas arise from remnants of the notochord. The aim of this study is to report a series of cases with operated skull base chordomas, with reviewing clinical data, assessing surgical strategy and outcome.

Methods. We performed a 13-year retrospective study, between 2009 and 2022, in which we included patients operated for skull base chordomas. Results. There were 6 males and 9 women, mean age 52.8 ± 16.55 years. Tumor site was clivus (13 patients), left cavernous sinus (one case) and sphenoidal sinus (one case). We performed endoscopic endonasal approach (18 times), transcranial subtemporal approach and combined approach. We achieved GTR in 8 patients, NTR in 4 patients, STR in 7 patients and biopsy in 1 patient. Grade of resection was associated with recurrence incidence (p=0.002). Histological exam revealed conventional chordoma in 14 cases, chondroid chordoma in 5 cases and dedifferentiated (chondrosarcoma) in 1 case. Patients’ neurological status improved following surgery (p=0.000). Five patients underwent adjuvant conventional radiotherapy. Five patients presented local recurrence. All recurrences were reoperated using endoscopic endonasal approach. Survival analysis identified grade of resection and adjuvant radiotherapy as predictive factors for recurrence-free survival.

Conclusions. Surgery is the treatment of choice in skull base chordomas. Surgical approach should be tailored according to tumor original site and extensions. Midline chordomas are proper candidates for endoscopic endonasal approach, while lateral lesions require transcranial surgery. Combined approaches should be used in extensive tumors. GTR and radiotherapy prolong recurrence-free survival. Further studies on larger samples of patients are needed.

Laparoscopic sealing devices on animal models: searching the least harmful for the surrounding tissue

2025-04-28T12:19:11+00:00

Background and aims. Sealing devices can produce mechanical and thermal damage to collateral tissue, with few studies analyzing these effects. However, the least harmful device for the surrounding tissue will achieve optimal functional results.

Methods. We compared the tissue damage made by different laparoscopic electro-cauterization instruments while using them as hemostatic means on the stomach and epiploon of Wistar rats, respectively on the diaphragm and urinary bladder of a porcine model. Five devices were used based on either radio frequency diathermy or ultrasound energy, with one coagulation cycle for the automatic hemostasis. Infrared thermography tracked thermal injury on the collateral tissue made by each device on the porcine model.

Results. We analyzed the collateral tissue with irreversible thermal damage caused by each sealing device with infrared thermography with ANOVA statistical test. Based on histopathological examination, we calculated the mean value of the area with edema and coagulation necrosis caused by these maneuvers of hemostasis as a pattern of tissue damage around the sealing mark of every hemostatic device.

Conclusions. Compared with bipolar sealing devices, ultrasound-based devices offered better collateral tissue preservation, with the smallest damaging temperature spread, on animal models. Further research on ultrasound vs. bipolar sealing devices used as hemostatic tools could more accurately assess their impact on functional outcomes in real life surgery setting.

The influence of different types of bevels on the fracture resistance of directly restored lower anterior teeth

2025-04-28T12:19:11+00:00

Background and aims. In recent years, dental trauma has been on the rise. The most common, regarding permanent dentition, are uncomplicated fractures (involving enamel or enamel and dentin) of the maxillary central incisors, followed by maxillary lateral incisors and mandibular central incisors. In anterior teeth, high impact stresses are frequently produced and because of this it is necessary that the restoration has a high fracture resistance. The aim of this study is to evaluate the influence of marginal cavity preparations (45° bevel and chamfer bevel) on the fracture resistance of teeth treated with direct composite resins.

Methods. For this study, 24 extracted mandibular incisors were used. All soft tissue debris and tartar were removed. During the study, the teeth were kept in saline to prevent dehydration. The teeth were divided into three groups of 8 teeth each. Group number 1 was used as a control and named C, in group number 2, named CH, incisors were prepared with a chamfer type of bevel, and in group number 3, named B45, incisors were prepared with a 45° bevel. After preparing all mandibular incisors, they were directly restored with nano-ceramic composite (Ceram.x® Duo, Dentsply Sirona). Subsequently, all three groups were fractured to determine the maximum compressive load using the Instron 3366 universal testing machine. To ensure a standardized fracturing process, all incisors were embedded in self-polymerizing acrylic resin up to the neck to replicate the conditions in the oral cavity.

Results. The Student’s T-test was employed for statistical analysis, revealing a statistically insignificant difference between the CH and B45 groups. Nonetheless, it was noted that the average values of maximum compressive loads in the chamfer bevel group were higher compared to those in the 45° bevel group, indicating its superior resistance to fracture. Additionally, the results of the fracture resistance test demonstrated that intact mandibular incisors are three times more resistant to fracture than mandibular incisors prepared and restored with dental bevels.

Conclusion. Intact teeth present a superior fracture resistance compared to teeth that have been subjected to trauma or carious processes, requiring coronal restoration; dental restorations made with a chamfer bevel marginal preparation withstand higher forces with improved fracture resistance compared to those made with a 45° bevel marginal preparation.

Antibiotics consumption in neurosurgery versus appendectomy: a call for antibiotic stewardship initiatives

2025-04-28T12:19:11+00:00

Background and aims. Surgical site infection (SSI) remains a significant global health concern, including in Indonesia. The administration of prophylactic antibiotics plays a pivotal role in the prevention and the reduction in mortality rates associated with SSIs. Prophylactic antibiotic use is recommended in surgical procedures that are at risk of infection, including in clean surgical operations that last more than three hours and clean-contaminated surgeries. The objective of this study was to analyze the quantity of prophylactic antibiotic consumption and to compare the consumption of antibiotics between neurosurgery (clean surgery) and appendectomy (clean-contaminated surgery).

Methods. Data in this observational study were obtained from the medical records of patients who underwent neurosurgery and appendectomy at two hospitals in Surabaya: one private and one public hospital. The quantity of antibiotic consumption will be analyzed descriptively and presented as a defined daily dose (DDD) per 100 bed days.

Results. Research findings revealed a higher quantity of antibiotic consumption in elective neurosurgery, representing 47.43 DDD/100 bed-days, in comparison to 21.26 DDD/100 bed-days and 76.34 DDD/100 bed-days in elective and emergency appendectomy, respectively. The most frequently used antibiotics were broad-spectrum antibiotics, which included cefixime (36.91 DDD/100 bed-days) and ceftriaxone (5.45 DDD/100 bed-days) in elective neurosurgery; and ceftriaxone (14.94 vs 50.86 DDD/100 bed-days) and metronidazole (5.75 vs 19.16 DDD/100 bed-days) in elective and emergency appendectomy, respectively.

Conclusion. The consumption of prophylaxis antibiotics remains a significant concern. In order to develop strategies to prevent bacterial resistance through an antibiotic stewardship program, it is essential to evaluate antibiotic consumption and monitor trends over time.

Phytochemical profile and a preliminary in ovo screening of the ethanolic extract of Coffea arabica green seeds

2025-04-28T12:19:11+00:00

Aims. Coffea arabica has garnered significant attention for its potential therapeutic applications due to its rich phytochemical profile, including chlorogenic acids, flavonoids, and alkaloids like caffeine, which are associated with antioxidant, anti-inflammatory, and antimicrobial effects. This study aimed to (i) evaluate the phytochemical composition of an ethanolic extract derived from green seeds of Coffea arabica and (ii) perform a preliminary in ovo screening to determine its mucosal tolerability, irritant potential, and pro-angiogenic activity using the chick embryo chorioallantoic membrane (CAM) model.

Methods. An ethanolic extract was prepared from C. arabica green seeds and subjected to LC-MS analysis for the identification and quantification of polyphenols. The antioxidant capacity was assessed through the DPPH radical-scavenging assay, comparing extract performance to ascorbic acid as a standard. In ovo testing was conducted using the HET-CAM assay to observe potential irritation on the CAM surface and to evaluate angiogenic activity. Chick embryos were monitored for vascular changes, irritant signs (hemorrhage, lysis, coagulation), and overall tolerability post-application over six days.

Results. Phytochemical analysis confirmed the presence of chlorogenic acid and 4-O-caffeoylquinic acid in the extract. The extract exhibited substantial antioxidant activity (66.38%), though slightly lower than that of ascorbic acid (97.36%). In the HET-CAM assay, no signs of irritation or toxicity were observed, and the extract was well tolerated for up to six days post-application. Additionally, the extract promoted angiogenesis, with increased vascularization observed, suggesting a stimulatory effect on neovascularization without inducing tissue damage.

Conclusions. The ethanolic extract of Coffea arabica green seeds demonstrates promising antioxidant and pro-angiogenic properties, alongside high mucosal biocompatibility. These findings support its potential applications in therapeutic and cosmetic formulations, particularly those targeting tissue regeneration and skin repair. Further studies are recommended to explore the underlying mechanisms and to confirm efficacy in more advanced biological models.

Primary ciliary dyskinesia: a case report of double DNAH11 mutant alleles

2025-04-28T12:19:10+00:00

Primary ciliary dyskinesia (PCD), a rare disorder, is genetically varied. Mutations in proteins involved in the structure, function, or assembly of cilia are known to determine situs inversus, male infertility, and chronic destructive airway disease. PCD is inherited by an autosomal recessive pattern of inheritance in most cases. Nonetheless, patterns of autosomal dominant and X-linked inheritance have been mentioned. A history of recurrent upper and lower respiratory tract infections raised clinical suspicion of primary ciliary dyskinesia in a 10-year-old patient. Genetic tests were performed using next-generation sequencing technology (Illumina NextGen) with the multiplex ligation-dependent probe amplification technique for primary ciliopathies and syndromes subject to differential diagnosis. Genetic testing identified two pathogenic variants, not previously associated with a case report in the literature, c.7727A>G (p.Asp2576Gly) and c.8578G>A (p.Gly2860Ser), within the DNAH11 gene, which is associated with autosomal recessive PCD. The result also reported mutations in other genes involved in autosomal recessive PCD (DNAH8, DNAH9 and ZMYND10), which were classified as variants with uncertain clinical significance. Transmission electron microscopy of respiratory cilia and nasal nitric oxide measurement cannot be used to diagnose PCD in patients with DNAH11 mutations because the structure of cilia is normal, and the levels of NO are not constantly low. High-speed video microscopy analysis can be helpful because DNAH11 mutations cause a distinct phenotype of PCD. Nevertheless, the mutation analysis of various PCD-causing genes remains the easiest to conduct and with good results. Genetic research on PCD has identified a number of significant ciliary genes in recent years, offering fresh perspectives on the molecular processes underlying cilia assembly and function. This facilitates the development of new methods for the diagnosis, prevention, and treatment of PCD. However, because it is a highly complex and heterogeneous disease, the field of gene diagnosis and therapy in PCD is still in its infancy.

A rare case of Wilkie`s syndrome with infantile hypertrophic pyloric stenosis

2025-04-28T12:19:10+00:00

Wilkie’s syndrome is a rare clinical disorder characterized by partial or complete obstruction of the duodenum. Infantile hypertrophic pyloric stenosis (IHPS) is defined as hyperplasia of the smooth muscle fibers of the pylorus, which is considered responsible for narrowing the pyloric canal and eventually obstructing the gastric outlet. This paper presents a case of a 3-month-old boy who had been vomiting after feeding for one month. The main symptoms, postprandial vomiting, dehydration, alkalosis, and weight reduction, point to the IHPS disease. Imaging studies also confirmed the diagnosis. During the surgical treatment, a concomitant condition known as Wilkie’s syndrome was also evidenced. The team performed a complex surgical treatment of a patient diagnosed with both Wilkie’s syndrome and IHPS within one single surgical operation. Surgical treatment with pyloromyotomy and duodenal-duodenal anastomosis within one operation is an optimal option for one-stage treatment of patients with IHPS and Wilkie’s syndrome.