Yerevan State Medical University

Adenomyosis is a common but frequently underdiagnosed gynecological disorder with significant implications for fertility and reproductive outcomes. Despite advances in imaging, accurate recognition remains challenging due to operator dependency, uterine anatomical variations, and ultrasound artifacts that may mimic disease features. To illustrate the sonographic spectrum of adenomyosis in subfertile women using two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound, evaluate age-related differences in ultrasound lesion morphology, and identify common diagnostic pitfalls encountered during routine scanning. A prospective observational study was conducted between 2022 and 2024 across three reproductive medicine centers. A total of 658 women aged 20-40years undergoing infertility assessment were examined by 2D and 3D transvaginal ultrasound. After excluding 140 cases with inadequate visualization, 518 participants were analyzed. Adenomyosis was diagnosed in 149 women (28.8%) according to the Morphological Uterus Sonographic Assessment (MUSA) criteria. Ultrasound features were compared between two age groups: 20-35years (n = 103) and 36-40years (n = 46). The prevalence of adenomyosis was higher in the 36-40-year group (35.9%) compared to the younger group (26.4%). The diffuse form of adenomyosis predominated (65.1%) and was significantly more frequent in the older age group (p = 0.027). Significant age-related differences were observed for myometrial cysts (87.0% vs 63.1%; p = 0.003), asymmetric wall thickening (91.3% vs 33.0%; p < 0.0001), and fan-shaped shadowing (91.3% vs 67.0%; p = 0.002). Diagnostic challenges were primarily linked to uterine rotation, retroversion, and acoustic shadowing simulating junctional zone irregularity. Adenomyosis in subfertile women exhibits distinct age-related phenotypes, with higher prevalence in 36-40 age group. The increased frequency of specific structural markers in older women-suggests that the sonographic expression of adenomyosis progresses with age. Furthermore, the identification of diagnostic pitfalls, such as uterine retroversion and acoustic shadowing mimicking junctional zone irregularity, indicates that uterine positioning remains a critical confounding factor in the sonographic assessment of adenomyosis.

Purpose: The objectives of this study were to compare the prognostic performance, staging concordance, and eye salvage prediction of the International Intraocular Retinoblastoma Classification (IIRC) and the International Classification of Retinoblastoma (ICRB), and to assess the clinical impact of definitional discrepancies between the two systems. Design: This study used retrospective, observational case series. Participants: A total of 642 eyes with intraocular retinoblastoma (Rb) that received conservative management with intent for globe salvage (2003-2024) were assessed. Methods: Clinical records and imaging were reviewed for tumor characteristics. Each eye was staged according to both IIRC and ICRB criteria. Prognostic performance for eye salvage was analyzed using odds ratios (OR), the concordance index (C-index), and likelihood ratio χ2 tests. Main Outcome Measures: The eye salvage rate and concordance between IIRC and ICRB staging were assessed. Results: The overall eye salvage rate was 73% (471/642), decreasing significantly with larger tumor size, subretinal fluid (SRF) extent, and more seeding (p < 0.0001). The globe salvage was 24% for tumors occupying >50% of the globe compared to 77% for smaller tumors, and 47% for tumors with SRF > 1 quadrant compared to 62% for tumors with SRF ≤ 1 quadrant. Under the IIRC, the salvage rates by group were 98%, 94%, 92%, 51%, and 14% (A-E); under the ICRB, 98%, 94%, 94%, 60%, and 24%. Failure odds (ORs) increased across stages from 2.8 in Group B to 276 in Group E (IIRC) and 145.2 (ICRB). Eighty-seven (14%) eyes were upstaged under the ICRB. Of these, 72 (11%) with tumors > 50% of globe volume shifted from IIRC Group D to ICRB Group E (25% salvage), and 15 (2.3%) with SRF > 3 mm shifted from IIRC Groups B/C to ICRB Group D. The ICRB showed superior discrimination (C-index = 0.824; 95% CI, 0.80250-0.84937) compared with IIRC (C-index = 0.790; 95% CI, 0.768-0.814). Conclusions: Both systems accurately predict eye salvage, but definitional variations significantly affect staging and outcome interpretation. The ICRB improves discrimination for advanced tumors by including large tumors in Group E, while the IIRC provides finer stratification in intermediate disease through SRF extent. Integrating these criteria could yield a unified, more prognostically precise classification for Rb.

Chemotherapy-Induced Cardiotoxicity (CIC) has become a growing concern in modern oncology. While chemotherapy remains one of the most effective treatments against cancer, its potential to harm the heart often limits its use. The underlying mechanisms involve oxidative stress, mitochondrial dysfunction, and inflammation, all contributing to the gradual weakening of cardiac muscle. As cancer survival improves, the burden of cardiovascular complications is more visible than ever, emphasizing the need for early recognition, prevention, and long-term management. This review draws upon published literature, recent clinical trials, and translational research to explore current understanding and future directions in CIC. Studies on anthracyclines and HER2 inhibitors were reviewed in depth, along with new data on diagnostic biomarkers, imaging techniques, and evolving therapeutic strategies. Particular attention was given to the role of pharmacogenomics, preventive interventions, and emerging therapies aimed at protecting or restoring cardiac function in patients undergoing chemotherapy. CIC can present as heart failure, arrhythmia, hypertension, myocardial ischemia, or thromboembolism. Factors such as age, obesity, cumulative drug exposure, and genetic predisposition significantly raise the risk. Recent advances have improved early detection-troponins, natriuretic peptides, and echocardiography with Global Longitudinal Strain (GLS) allow for identification before overt symptoms appear. Preventive strategies, including dose adjustments, liposomal formulations, and the cardioprotective agent dexrazoxane, have shown measurable benefits. Established cardiotoxicity can be managed with conventional heart failure medications, antihypertensives, and anticoagulants. Experimental approaches-ranging from mitochondrial stabilizers and histone deacetylase inhibitors to mesenchymal stem cell therapy-show promise in reversing cardiac injury. CIC reflects a complex interaction between cancer biology, treatment intensity, and patientspecific vulnerability. A proactive, multidisciplinary approach involving both oncologists and cardiologists is key to balancing cancer control with heart health. Lifestyle measures such as regular exercise and dietary optimization can further strengthen cardiovascular resilience. Advances in genetic testing, molecular imaging, and regenerative therapy are gradually shifting the field toward more personalized cardio-oncology care. Chemotherapy-induced cardiotoxicity continues to challenge clinicians striving for a cure without compromise. The future of cancer care lies in integrating precision medicine with preventive cardiology to minimize cardiac injury while maintaining therapeutic efficacy. Continued research into molecular targets, biomarkers, and cell-based therapies offers genuine hope for improving both survival and quality of life in cancer patients.

Impacted canines are very frequent, and their management is fundamental in aesthetics and functional occlusion. The planning and choice of an adequate surgical-orthodontic treatment for the discovery of impacted teeth is essential. Four clinical cases are presented that show the clinical and imaging considerations for diagnosis, treatment, and prognosis, with the description of surgical approaches with open, closed techniques and a combination of both, for impacted maxillary and mandibular teeth in pediatric patients. The follow-up has allowed correct management in the orthodontic traction of the impacted teeth with good periodontal health.

Background: Periodontal disease is currently a significant problem in dentistry. According to WHO, inflammatory periodontal diseases are one of the most common dental diseases in the world after dental caries. Since the last decades of the 20th century to the present day, there has been an increase in the incidence of VH and HIV. The aim of this study was to compare periodontal lesions in patients with HBV, HCV and HIV. Material and methods: The study included 281 patients who were divided into 3 groups. Patients of group I with HBV n= 95 - 24 (25.3%) women and 71 (74.7%) men, the average age was 40.17±13.48; group II with HCV n= 96 - 35 (36.5%) women and 61 (63.5%) men, the average age was 50.05±13.29 and group III with HIV n= 90 - 9 (10%) women and 81 (90%) men, the average age was 45.2±8.34. All patients had their stomatological status examined according to pre-developed criteria, which included an external examination of the lips and corners of the mouth, an assessment of the condition of the marginal and alveolar part of the gums, the dental-periodontal complex. Results: To identify possible characteristics of dental status in HBV, HCV, and HIV infections, we conducted a comparative analysis of the condition of the marginal and alveolar gingiva between groups of patients with VH and HIV. The proportion of individuals with gingival hyperemia in the study groups varied significantly, this symptom was observed in patients in the HIV group 87.8%, which is 1.3 times more common than in the HBV group 66.3% and 4.4 times more common than in the HCV group 19.8% (p&lt;0.001). The comparison of the mean PI index scores revealed a statistically significant difference (p&lt;0.001) between patients in the HBV and HCV groups, where the mean PI index scores were 4.08±0.41 and 4.51±0.64, respectively Conclusion: Thus, the marginal and alveolar gingiva, unlike HBV and HCV, are more frequently affected by HIV, manifesting as bleeding, swelling, hyperemia, and papillae looseness. The latter is found almost exclusively in HIV patients, while cyanosis is found only in HCV patients. When comparing HBV and C, hyperemia, swelling, and bleeding are more frequently observed in HBV.