Medicine and Pharmacy Reports

Future therapeutic perspectives in nonalcoholic fatty liver disease: a focus on nuclear receptors, a promising therapeutic target

Thu, 09 Nov 2023 00:00:00 +0000

Non-alcoholic fatty liver disease (NAFLD) is a major public health problem worldwide, with an increasing incidence, secondary to the increasing incidence of obesity and diabetes, from a very young age. It is associated with metabolic and cardiovascular disorders, as components of the metabolic syndrome (MS). NAFLD is the hepatic manifestation of MS. The pathogenesis of the disease is multifactorial and complex, involving genetic, metabolic, but also environmental factors. Currently, nuclear receptors (NRs) represent a promising therapeutic target in the treatment of non-alcoholic steatohepatitis (NASH). Of these, the most studied receptor was the liver X receptor (LXR), which would have great potential in the treatment of metabolic diseases, namely hypercholesterolemia, atherosclerosis, and NAFLD. However, the therapeutic use of NRs is restricted in medical practice for two reasons: limited knowledge of the structure of the receptor and its inability to modulate certain actions in the target organs and genes. One problem is the understanding of the function and structure of the N-terminal domain which has a major transcriptional activation function (AF1).

Are adipokines related to COVID-19 and its severity? A systematic review and meta-analysis

Mon, 10 Jul 2023 00:00:00 +0000

Introduction. The relationship between several adipokines and COVID-19 severity has lately been evaluated, results being inconclusive. Therefore, we aimed to assess the association between adipokines in COVID-19 and its severity.

Methods. A search was performed in PubMed, Scopus, and Embase using predefined keywords. The Newcastle of Ottawa Scale (NOS) was used for the quality assessment of included studies. The main summary outcome was the mean difference (MD) in adipokine levels.

Results. A total of 8 studies involving 473 individuals were included. A significant MD in serum adiponectin levels was demonstrated in mild vs. severe COVID-19 patients (-5.734 [95% CI -11.215 – -0.252]), with no significant MD in mild vs. moderate (-7.117 [95% CI -19.546 – 5.313]), or moderate vs. severe COVID-19 (-1.846 [95% CI -4.516 – 0.824]). Moreover, no significant MD was found in adiponectin and leptin levels when comparing COVID-19 patients vs. controls (-12.675 [95% CI -36.159 – 10.808]) and (8.034 [95% CI -10.403 – 26.471]), respectively.

Conclusion. Adiponectin levels were significantly increased in patients with severe compared to mild COVID-19. However, no significant MD was found in adiponectin levels in mild vs. moderate and moderate vs. severe COVID-19 patients, nor in adiponectin and leptin levels in COVID-19 patients vs. controls.

Exploring the contrasts: in-depth analysis of human and canine mammary tumors - discoveries at the frontier

Tue, 23 Apr 2024 00:00:00 +0000

We have examined genomic and transcriptomic abnormalities in human and canine samples to evaluate the canine model’s validity for breast cancer research, emphasizing similarities and differences. Both species commonly utilize serum tumor markers and noncoding microRNAs. Immunohistochemistry and immunocytochemistry were employed to illustrate and compare results based on histological diagnoses. In addition to these factors, similarities exist in spontaneous tumor occurrence, age of onset, hormonal influences, and disease progression, including tumor size, clinical stage, and lymph node involvement. Molecular traits such as hormone receptor status, Epidermal Growth Factor Receptor (EGFR), and proliferation markers (Ki67) further endorse the canine model’s utility in breast cancer studies. The advancement of technologies facilitates the identification of new cancer-associated molecules, both coding and non-coding genes, underscoring their potential as prognostic/diagnostic biomarkers and therapeutic targets.

The impact of psychiatric comorbidities associated with depression: a literature review

Wed, 07 Feb 2024 00:00:00 +0000

The comorbidity with anxiety disorders has profound adverse implications on the evolution, prognosis and therapeutic responsiveness of depression, it will prolong the time required to achieve remission of the depressive episode, and patients under treatment will tend to drop out of their therapeutic regimens faster than those with depression but without anxious comorbidity. The purpose of this study is to evaluate the importance of the clinical, etiopathogenetic, prognostic and especially therapeutic connotations given by the presence of psychiatric comorbidities in depression. Articles evaluating the presence of psychiatric comorbidities in depression were analyzed using PubMed, Medline, Scopus, Google Academics and WoS databases. To select the articles, we used keywords: psychiatric comorbidity, depression with anxiety disorders, depression with dysthymia, depression with psychoactive substances, depression with personality disorders. From a psychiatric perspective, the comorbidity of mental disorders can be divided into psychiatric comorbidity, when two or more distinct psychiatric conditions are present in the same individual, and medical comorbidity, when a medical-surgical illness is associated with a mental disorder. The presence of major depression is in itself a predictive factor for a later onset of generalized anxiety disorder. The comorbidity of depression in those with substance abuse or addiction has profound implications on their clinical prognosis. The association of personality disorder has a significant impact on the suicidal behavior of patients with major depression.

Surgical scar management - an evaluation of surgical techniques

Wed, 07 Feb 2024 00:00:00 +0000

The purpose of this narrative review is to analyze surgical techniques for removing scar tissue and minimizing them. A considerable proportion of the population have scars that are related to a traumatic event that they remember accurately, this being especially true for scars on the face, but also on the rest of the body if they are of significant size. The negative consequences of the esthetic damage are felt mainly in the family and at professional level, without losing sight of the fact that any person suffers as a result of the awareness of unsightly wounds or scars. To be successful, an aesthetic intervention must represent the optimal balance between science, the art of plastic surgery and the patient’s expectations. Good communication between surgeon and patient is also needed. We must state that there is no method of total removal of scars; even in the case of complex surgical techniques, the scar cannot be completely excised, but a much more aesthetic appearance can be obtained. Scars cannot be completely removed from the skin, they can improve their appearance by fading or thinning, initially by conservative treatment, later, if necessary, by surgical scar reduction techniques. Improving the appearance of a scar depends on the type of scar, its severity, its surface and location, the causing factors, the time elapsed from production to the application of specialized treatment.

Exploring the influence of nursing diagnosis education on Romanian nurses’ intention, attitudes, and behavior: a cross-sectional study

Mon, 08 Apr 2024 00:00:00 +0000

Background and aims. The introduction of accreditation criteria for hospitals has generated increased interest in applying the nursing process to clinical practice and developing nursing care plans. Nursing diagnosis plays a pivotal role in the formulation of these care plans.

The objective of the study is to investigate the correlation between nursing diagnosis education and nurses’ intentions, attitudes toward the use of nursing diagnosis and the behavior in using it in practice; to explore the differences between nurses’ intentions, attitudes and behavior, considering nurses’ socio-demographic and professional data.

Methods. A cross-sectional design was used. A web-based survey was applied to gather data. A sample of 664 hospital nurses was recruited from five Romanian hospitals.

Results. Education on nursing diagnosis showed significant results in relation to nurses’ intentions (F(2,126.35) = 23.99, p < 0.001), attitudes (χ2 (2,N = 664) = 44.62, p < 0.001) and behavior (F(2,167.69) = 29.53, p < 0.001) in using it in clinical practice. Nurses with education highly focused on nursing diagnosis have significantly stronger intention to use it, more positive attitudes and higher behavior in using it in clinical practice compared to nurses whose education simply had included a nursing diagnosis course, or nurses without any education on the topic. Significant differences were identified in intention (t (83.86) = -4.49, p < 0.001) and attitudes (U = 12697.50, z = - 3.99, p < 0.001, r = -0.0006) of management nurses compared to clinical nurses.

Conclusion. Nursing education on nursing diagnosis significantly impacts nurses’ intentions, attitudes, and behavior in their daily practice. Romanian nurses display slightly positive intention and attitudes toward nursing diagnosis but need more training for effective/practical clinical application.

Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte to monocyte ratio and Systemic Inflammatory Index in sexually transmitted diseases

Tue, 23 Apr 2024 00:00:00 +0000

Introduction. Hematologic biomarkers of inflammation may serve as valuable adjuncts in clinical practice, aiding in several aspects such as differential diagnosis, prognostic assessment for patient stratification and monitoring the efficacy of antimicrobial therapy. The aim of this study was to evaluate the efficacy of Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), Lymphocyte to Monocyte Ratio (LMR), and Systemic Inflammatory Index (SII) in predicting bacterial sexually transmitted infections (STI).

Methods. This prospective study was conducted in the north-west region of Romania and included patients from several medical special units such as dermatology, obstetrics-gynecology, urology, and general practice. The study group comprised patients with a high suspicion of STI, while the control group consisted of healthy subjects. Quantitative data are presented as medians (interquartile ranges).

Results. The median values of SII, NLR, and SIRI were higher in the group of subjects with sexually transmitted diseases compared to the control group [604.06 (432.36 - 880.02) vs. 556.89 (388.63 - 874.19); 2.61 (1.57 - 3.3) vs. 2.29 (1.66 - 3.26); and 0.95 (0.53 - 1.52) vs. 0.89 (0.67 - 1.34)]. Regarding PLR, the median values were lower in the group of subjects with sexually transmitted diseases compared to the control group [138.1 (99.19 - 169.6) vs. 140.65 (117 - 190.32)]. As for LMR, the median values were equal between the two groups [4.64 (3.74 - 6.11) vs. 4.64 (3.75 - 5.45)]. Nevertheless, the differences did not reach the significance level.

Conclusion. Our study suggests that inflammatory biomarkers might aid in detecting bacterial STIs, but their significance was not statistically confirmed. Further research on alternative laboratory tests is needed for improved STI diagnosis and management.

Radiomics in the CT diagnosis of ovarian cystic malignancies - a pilot study

Fri, 14 Jul 2023 00:00:00 +0000

Background and aims. The conventional computed tomography (CT) appearance of ovarian cystic masses is often insufficient to adequately differentiate between benign and malignant entities. This study aims to investigate whether texture analysis of the fluid component can augment the CT diagnosis of ovarian cystic tumors.

Methods. Eighty-four patients with adnexal cystic lesions who underwent CT examinations were retrospectively included. All patients had a final diagnosis that was established by histological analysis in forty four cases. The texture features of the lesions content were extracted using dedicated software and further used for comparing benign and malignant lesions, primary tumors and metastases, malignant and borderline lesions, and benign and borderline lesions. Texture features’ discriminatory ability was evaluated through univariate and receiver operating characteristics analysis and also by the use of the k-nearest-neighbor classifier.

Results. The univariate analysis showed statistically significant results when comparing benign and malignant lesions (the Difference Variance parameter, p=0.0074) and malignant and borderline tumors (the Correlation parameter, p=0.488). The highest accuracy (83.33%) was achieved by the classifier when discriminating primary tumors from ovarian metastases.

Conclusion. Texture parameters were able to successfully discriminate between different types of ovarian cystic lesions based on their content, but it is not entirely clear whether these differences are a result of the physical properties of the fluids or their appartenance to a particular histopathological group. If further validated, radiomics can offer a rapid and non-invasive alternative in the diagnosis of ovarian cystic tumors.

Are single nucleotide polymorphisms in the IL-2 gene biomarkers for Hashimoto’s thyroiditis?

Fri, 26 Apr 2024 06:02:51 +0000

Background and aims. Hashimoto’s thyroiditis (HT) is an autoimmune disorder that can lead to hypothyroidism. The pathophysiology of HT involves the production of antithyroid antibodies that attack the thyroid tissue, causing inflammation and progressive fibrosis. Recent studies demonstrated a strong correlation between Interleukin-2 (IL-2) levels and the development of autoimmune diseases, suggesting that this cytokine may play a crucial role in the pathogenesis of HT.

Methods. In this study, we determined the presence of the point mutation +114T/G in the IL-2 gene in patients with HT compared with a control group, and also the serum level of anti-thyroid peroxidase (TPOAbs) and anti-thyroglobulin (TgAbs) antibodies in HT patients with vs. without the mutation. The sequences of the IL-2 gene obtained from subjects were determined by the Sanger sequencing method.

Results. Our study did not reveal that the +114T/G polymorphism of the IL-2 gene is a susceptibility or protective factor for HT. No significant correlations were observed between the reference genotype, hetero- and homozygous +114T/G polymorphism and TPOAbs, respectively TgAbs serum levels in HT patients.

Conclusions. Further studies of more cases are needed to identify more polymorphisms in the IL-2 gene and study their correlations with HT.

The carcinogenic capacity of arsenic in normal epithelial breast cells and double-positive breast cancer cells

Mon, 22 Jan 2024 00:00:00 +0000

Background and aims. The carcinogenic effect of arsenic is a subject of controversy in relation to breast cancer. In our current research, we aimed to simulate the effects of chronic low-level arsenic exposure on breast cells by intoxicating MCF-10A and MCF-7 cells with 1 μM Arsenic trioxide (As2O3) for 3 weeks (3w) and 6 weeks (6w), respectively.

Methods. We assessed the cellular responses to As2O3 through various assays, including confocal fluorescence microscopy, flow cytometry for cell cycle analysis, Transwell invasion assay, scratch assay, and colony assay. Additionally, we analyzed the mutation burden in all the exposed cells by using the next generation sequencing technology.

Results. Our findings indicate that As2O3 has a minor carcinogenic effect in normal cells, with no definitive evidence of malignant transformation observed after 6 weeks of exposure. In the case of breast cancer cells, As2O3 exhibits a dual effect, both inhibitory and stimulatory. It leads to reduced colony formation ability at 6 weeks, while enhancing the cells’ ability for invasion. The mutations triggered by As2O3 exposure are distributed across genes with both tumor-suppressive and oncogenic functions. Five mutations are common to both cell lines, involving the following genes: Kinase Insert Domain Receptor (KDR) (c.798+54G>A), Colony Stimulating Factor 1 Receptor (CSF1R) (c.*37AC>C, c.*35C>TC), SWI/SNF-Related Matrix-Associated Actin-Dependent Regulator of Chromatin Subfamily B Member 1 (SMARCB1) (c.1119-41C>T), and Fms-like Tyrosine Kinase 3 (FLT3) (c.1310-3T>C). Additionally, Human Epidermal Growth Factor Receptor 4 (ERBB4/HER4) (c.421+58A>G) and Human Epidermal Growth Factor Receptor 2 (HER2/ERBB2) (c.2307+46A>G) mutations were exclusively found in MCF-10A cells exposed to As2O3. Furthermore, MCF-7 cells exhibited unique mutations in the KIT Proto-Oncogene (KIT) (c.1594G>A) and TP53 (c.215C>G).

Conclusion. In summary, our study reveals that a 6-weeks exposure to arsenic has a limited carcinogenic effect in normal breast cells and a dual role in breast cancer cells.

Experimental investigation of tension-reducing effectiveness of keystone perforator island flap

Tue, 23 Apr 2024 00:00:00 +0000

Background and aim. Nowadays, the reconstruction of large and complex defects with keystone perforator island flaps (KPIF) has gained popularity in plastic and reconstructive surgery. The keystone perforator island flap was described as a curvilinear shaped trapezoidal design flap, with two V-Y advancement flaps end-to-side. It is a multiperforator advancement flap, based on multiple fasciocutaneous or musculocutaneous perforators, described by Behan in 2003. These flaps have a simple harvest technique, an easy-to-implement design, and they are time and cost-saving. Their blood supply lends a versatile and robust character, with less complications. Nonetheless, their biomechanical properties and effectiveness are unclear, the wound-closure tension-reducing effect is not well documented in existing literature. The present study aims to investigate the wound closure tension-reducing effect of type I, type IIA, type Sidney Melanoma Unit I (SMU) and type SMU II KPIFs. The main purpose of this study was to clarify the tension-reducing effect of the KPIF technique, which can contribute to the understanding of the biomechanical benefits of the KPIF.

Methods. This is an experimental, in vivo study, based on twelve white race porcine models (PIC-FII-377), as their anatomy and wound healing process is very similar to that of humans. In this study, 42 wounds that could not be closed by primary wound closure, known as ‘unclosable’ elliptical defects, were created in six different anatomical regions. The criteria used for not achieving primary wound closure were the breaking of 0 nylon suture or the edges of the wound. Each defect was closed with different types of keystone perforator island flap: type I, type IIA, type Sydney Melanoma Unit I and type Sydney Melanoma Unit II. Keystone perforator island flaps were used in 42 cases. Intraoperative tissue tension was measured by an AXIS FB50, 50 N force gauge tensiometer. In all cases a wide elliptical excision was performed for the primary defect. Before reconstruction, tissue tension was measured across the widest point of the elliptical primary defect. Skin incision was performed for the first flap, without division of deep fascia. After preparing first flap, tension was measured at the widest point of the wound. Furthermore, deep fascia for the second flap was divided, tissue tension across the widest point of the primary defect was measured. Finally, tension was measurement across the widest point of the donor-site after closure of the defect-side flap and V–Y closure of either end of keystone perforator island flap.

Results. In this study were included 12 porcine model (PIC-FII-377). A number of 42 keystone perforator island flaps were performed in this study, in six different anatomical regions, ranging between 3.3 x 12 cm and 16 x 30 cm. All elliptical defects were unclosable, with varying sizes ranging between 2 x 4 cm and 8 x 20 cm. The mean tension that was required to close all wounds with primary closure initially was 24.51 N ± 10.73 N. After using a type I KPIF a tension decrease of -7.04 N ± 4.93 N was seen, in the case of type IIA KPIF the tension decreased to -12.43 N± 5.63 N. Furthermore, after reconstruction with type SMU I KPIF the tension decreased to -7.38N ± 5.21N. After using a type SMU II KPIF a tension decrease of -10.52 N± 5.74 N was seen.

Conclusions. The main purpose of this study was to clarify the tension-reducing effect of the KPIF technique, which can contribute to the understanding of the biomechanical benefits of the KPIF. The outcomes of the present study suggest that type I, type IIA, type SMU I, and SMU II of keystone perforator island flaps have a significant tension-reducing effects, especially the technique that involves the division of the deep fascia. The results of this experimental research thoroughly explain the benefits of these flaps. The effectiveness of the flap and doubts on biomechanical properties have not been answered so far. It will encourage more plastic surgeons to use the flap, especially given its proven benefits.

Optical properties of zirconia-reinforced lithium silicate veneers obtained with CAD/CAM milling and hot-pressing techniques: a comparative in vitro study

Ioana-Ligia Pîrvulescu, Andrei Faur, Codruţa Ille, Anca Jivănescu — Mon, 04 Sep 2023 00:00:00 +0000

Background and aims. Dental veneers have become increasingly required among patients, but little is known about the optical properties of veneers obtained from the same ceramic material through different processing techniques.

Methods. In this study we compared the translucency and the opalescence parameters of zirconia-reinforced lithium silicate (ZLS) veneers restorations fabricated through CAD/CAM milling and hot-pressing techniques on the upper central incisor. Eighty specimens divided into 8 groups (n=10) were sectioned (Celtra Duo) and heat pressed (Celtra Press) to obtain 0.8 mm thickness. The optical parameters were calculated from the color difference against different backgrounds. Analysis of variance, one way ANOVA and post-hoc multiple comparison tests were used to evaluate and compare the optical properties of the same material, with a significance level of p < 0.05.

Results. The processing method had significant effect on optical parameters. Celtra Duo HT proved to be the material with the highest transparency degree. The hot-pressing technique led to higher opacity than CAD/CAM milling technique.

Conclusions. For a bio-mimetic aesthetic prosthetic restoration, the ceramic materials must have the same translucency and opacity as the real tooth. The results of this study revealed that high translucency ZLS obtained through hot pressing technique was the material of choice, as it fulfilled these requirements.

Comparative study on the results of orthodontic diagnostics by using algorithms generated by Artificial Intelligence and simple algorithms

Tue, 13 Feb 2024 00:00:00 +0000

Introduction. Artificial intelligence (AI) is computer-generated intelligence, as opposed to the natural intelligence of humans and some animals. Kaplan and Haenlein define AI as “the ability of a system to correctly interpret external data, to learn from such data and use what it has learned to achieve specific goals and tasks through a flexible adaptation”. The term “artificial intelligence” is used colloquially to describe machines that mimic the “cognitive” functions that people associate with other human minds. One of the areas where technological advances have brought significant changes is orthodontics, especially in terms of diagnosis and orthodontic prediction.

The aim of this study is to conduct a comparative analysis between the results obtained by using the complete algorithms that define Artificial Intelligence and the simple algorithms of classical medical software, used in the detection of the position and shape of teeth in various orthodontic anomalies.

Methods. A group of 45 patients with maxillary-dento anomalies Angle Class I (DDM with crowding and deviation of the superior inter-incisive line) was studied. Two types of algorithms were used in the study group: modern type I algorithms and simple algorithms used in classical software to detect the position of the frontal teeth. Through the symmetrical points of the face the facial axes were determined, and after the detection of the contour of each tooth the incisional curve was calculated. The median line was analyzed against the vertical axis of the face, and the incisional curve towards the horizontal axis.

Results. The study shows that AI algorithms offer an increased level of tooth position detection, compared to traditional softwares. Complex algorithms, specific to Artificial Intelligence, showed superior detection, and more stability in the analysis.

Conclusion. Technological evolution and the development of machine learning capabilities have opened new perspectives in guiding orthodontic treatments through artificial intelligence (AI).

Autologous leucocyte and platelet rich in fibrin (L-PRF) – is it a competitive solution for bone augmentation in maxillary sinus lift? A 6-month radiological comparison between xenografts and L-PRF

Mon, 08 Apr 2024 00:00:00 +0000

Maxillary lateral sinus floor elevation, or external sinus lift, is a widespread surgical intervention in the dental field. Insertion of implants in the posterior region of the maxilla often requires reconstruction of the remaining native bone that has insufficient volume.

Background and aims. Much of the research published involves using artificial products, like xenografts and resorbable collagen membranes, after a prior Cone Beam Computer Tomography (CBCT) investigation. Nowadays, more accessible access, less financial costs, a biological approach, and faster healing are objectives that surround this procedure. Leucocytes and platelets rich in Fibrin (L-PRF) are a natural component with a high concentration of growth factors. Due to its regenerative properties and lack of complications, it is used in several medical fields, like orthopedics, dermatology, and oral surgery. This retrospective study aims to compare results in bone height and volume obtained through external sinus lift, either by using xenografts or autologous plasma rich in fibrin, by evaluating the quantity of new bone formation from a radiological point of view.

Methods. Fifty-eight Caucasian patients were included in this retrospective study; 48 were submitted to xenograft procedure, and 10 were selected for L-PRF grafting material with simultaneous implant placement. Lack of clinical and histological studies performed on patients with L-PRF surgeries limited us in choosing a larger group for the radiological analysis. CBCT evaluation was performed before surgery and 6 months after. All patients selected for the study presented good general and oral health, acute oral and sinus infections excluded; smoking and periodontal disease were also criteria of exclusion. Two operators performed the measurements in pre-established landmarks in different time frames. The two independent groups were compared with the Wilcoxon rank-sum test for quantitative data. Qualitative characteristics were described as counts and percentages. All analyses were performed in an R environment for statistical computing and graphics.

Results. Mean bone height gain in the xenograft group in the regions was as follows: 7.44 for the anterior landmark, 12.14 for the median and 8.28 for the distal. The mean group height gained for the L-PRF group was 0.1 anteriorly, -0.18 for the median measurement, and 0.23 distally. We obtained excellent overall reliability for all the height measurements between the two operators.

Conclusions. Further studies must be conducted to establish new sets of surgical protocols in case L-PRF alone is found to be a reliable, stable, biological alternative to the well-documented xenografts in external sinus lifts. Radiological results, although promising, must be further applied in long term clinical survival of the implants in the grafted sites. Also, studies combining L-PRF in conjunction with xenograft might bring improved clinical results in terms of reduced postoperative complications and accelerated healing.

Approaching fertility in congenital adrenal hyperplasia: exploring P30L mutation-induced 21-hydroxylase deficiency with a presentation between non-classical and simple virilizing phenotypes. A case report

Alina Maria Herdean, Adana Maria Radulescu, Ioana Rada Popa Ilie — Fri, 16 Jun 2023 00:00:00 +0000

Congenital adrenal hyperplasia (CAH) is determined in the vast majority of cases by mutations in the CYP21A2 gene, which cause the deficiency of the 21 hydroxylase enzyme, which is involved in the synthesis of cortisol and aldosterone. Generally, CAH phenotype and disease severity can be predicted with the genotypes and is related to the residual activity of 21 hydroxylase enzyme. It is divided into classical CAH with salt wasting and simple virilizing forms and non-classical or late-onset CAH forms, respectively. Patients with 21 hydroxylase deficiency, including those with non-classic forms face immense challenges to their fertility. Glucocorticoid therapy has been shown to be useful in obtaining and maintaining a pregnancy among these patients, but it must be used with caution. Given the relevance of CAH in reproductive medicine as well as the diagnostic challenges posed by the phenotypic overlap with polycystic ovary syndrome and by overlap of its own phenotypes (classic CAH-nonclassic CAH), we present the case of a woman with CAH due to 21 hydroxylase deficiency caused by the P30L mutation with a clinical and biochemical presentation between the non-classical form and the classic simple virilizing form. Further, the successful fertility management in this patient and an overview of fertility management in CAH is depicted, as well.