Abstract Objective During the pandemic, the SARS-CoV-2 infection with its different variants had determined high morbidity and mortality. As the clinical autopsies were reduced in our country, complete forensic autopsies had provided important valuable information regarding the pathological changes and pathophysiological mechanisms associated with SARS-CoV-2 infection. Our aim was to focus on different variants of SARS-CoV-2, trying to determine the contribution of SARS-CoV-2 infection to the lethal outcome and to establish the cause of death. Methods Complete autopsies were performed on cases confirmed by polymerase chain reaction for SARS-CoV-2 infection. All autopsies findings and the patient’s comorbidities were analyzed. Results Forty-nine cases were studied. Twenty were female (41%), and 29 were male (59%). The median age at death was 63 years (range 26-93 years), with an upward trend during the four variants of SARS-CoV-2. The age of the cases that died due to their comorbidities and were associated with SARS-Cov-2 infection was higher compared to the age of the cases that died due to SARS-CoV-2 infection. Two thirds of cases died at hospital, most of them with less than one week of hospitalization and one third of them were found dead at home. Most cases without significant health conditions died at home. Conclusions The immediate cause of death for many of our cases was of respiratory origin and most of them died of diffuse alveolar damage. The cases without evident comorbidities were less represented, that highlight the importance of multimorbidity in the development of critical illness.

Abstract Objective This paper aimed to synthesize hybrids of fluoroquinolones with tetracycline class representatives and conduct their preliminary characterization. Methods A reaction between tetracycline representatives (doxycycline, tetracycline), formaldehyde (acting as a molecular connector) and fluoroquinolone representatives (ciprofloxacin, moxifloxacin, and norfloxacin) was attempted through a classical reflux synthesis with an electrical heating source (heating mantles) and a microwave-assisted reflux synthesis. One synthesis group also used cupric chloride dihydrate as a catalyst. The samples were analyzed using Differential Scanning Calorimetry, Electrospray Ionization Mass Spectrometry, or High-Performance Liquid Chromatography. Results The results indicated the formation of a compound different from the parent components in the case of doxycycline-norfloxacin and possibly tetracycline-norfloxacin hybrids. Conclusions Both synthesis methods yielded similar results. The influence of the catalyst did not seem to have been significant. The synthesis method is simple and one-step, using non-toxic solvents. Future studies involving molecular docking and microbiology could be employed to further explore the mechanism of action and the microbiological effects of the hybrids.

Abstract Salmonella is a Gram-negative, non-spore-forming, motile, facultative anaerobic rod. The most studied species are Salmonella typhi and paratyphi (causing typhoid fever) and non-typhi Salmonella species (which can cause different clinical syndromes - gastroenteritis, disseminated infections, etc.). A 61-year-old male patient with multiple comorbidities (including myelofibrosis) presented to the Pulmonology outpatient department, Clinical County Hospital of Târgu Mureș, with a mucopurulent nocturnal cough. Paraclinical examinations showed the presence of a pleural empyema, which was evacuated in local anesthesia. The pleural fluid was sent to the Microbiology Department for bacteriological testing, where a fluoroquinolone-resistant strain of Salmonella spp. was detected. The patient received antibiotic treatment according to the antibiotic susceptibility testing. Due to the persistence of the symptoms, the patient returned two weeks later, when another puncture was performed. Salmonella was isolated again, but the strain showed a higher resistance to antibiotics. The two strains were compared using molecular methods of diagnosis (Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction - ERIC-PCR), the results showing a similarity of 92%. The occurrence of an extra amplicon band in ERIC-PCR suggests an important change in the bacterial genetic material, potentially related to acquisition of antibiotic resistance factors.

Abstract Objective: The aim of this article is to determine the predictive value of the leukocyte-glycemic index in the long-term evolution of diabetic patients with peripheral arterial disease following endovascular treatment. Methods: This retrospective observational study enrolled 127 diabetic patients diagnosed with peripheral arterial disease requiring endovascular treatment. Patients were categorized into two groups based on the severity of the infrapopliteal atherosclerotic lesions identified during the pre-operative Computer Tomography Angiography examination. Group 1 includes patients without severe damage to the infrapopliteal artery, while Group 2 includes patients with severe infrapopliteal artery damage, identified by stenosis greater than 70% on all infrapopliteal arteries. The primary outcome was to assess the association between leukocyte-glycemic index value at baseline and the severity of infrapopliteal atherosclerotic lesions and long-term major amputation after percutaneous transluminal angioplasty. Results: Patients in Group 2 had a higher incidence of cardiovascular events (p=0.009), stage IV Leriche-Fontaine (p=0.016), and incidence of major amputation (p<0.001), as well as an increased value of leukocyte-glycemic index (p=0.004). During the follow-up, patients with above-median leukocyte-glycemic index value have a higher risk of major amputation (p=0.034), as seen in the Kaplan-Meier analysis. Moreover, at cox-regression, elevated biomarker values were associated with long-term risk of major amputation, independent of age, sex, cardiovascular risk factors, and below-the-knee arterial occlusion (HR:2.69, p=0.001). Conclusions: Elevated values of leukocyte-glycemic index are associated with the severity of infrapopliteal atherosclerotic lesions and major amputation in the long term.

Abstract Objective: The main objective of the current study was to examine the outcome of critically ill patients in relation to clinical and thoracic injuries. The secondary objectives were to assess the role of CT in the evaluation of the diaphragm and to provide an analysis of prognostic abilities with respect to diaphragm changes. Methods: This single-center retrospective observational cohort study was conducted in the ICU of Târgu Mureș County Emergency Clinical Hospital, Romania. This study identified 52 critically ill blunted or penetrating chest trauma patients admitted to the ICU from 01 January 2021 to 31 December 2021. CT scan was used to identify thorax injuries and diaphragm thickness. The outcome of all patients was analyzed. Results: Most of the patients experienced traffic accidents (44.23%) or falls (26.93%). The predominant characteristics associated with chest trauma were rib fractures (92.30%), lung contusions (63.50%), and pneumothorax (53.80%). The most common injury seen in the study was rib fractures, accounting for 92.30% of cases. This was followed by lung contusions, which were present in 63.50% of patients, and pneumothorax, which occurred in 53.80% of cases. It was examined ROC AUC for thickness of the right and the left diaphragm and severity scores. When assessing the thickness of the diaphragm in deceased and survivors, no statistically significant differences were found. Conclusion: Although no significant differences were found regarding the prognosis between the survivors and the deceased, diaphragm thickness might potentially serve as a predictor for the severity of the injury.

Abstract Objectives : The aim of our study was to determine the effectiveness and biocompatibility of the use of solid clasp dentures with silver plating in the restoration of partial defects of the dentition. Methods : The study involved 23 patients with partial secondary adontia after oral rehabilitation. At the first stage, before the start of treatment and after a month of using a clasp prosthesis, patients underwent studies of blood biochemical parameters, Schiller-Pisarev’s test and Papillary-marginal-alveolar index. At the second stage of the research, silver electroplating was applied to the metal parts of the clasp prosthesis and after a month of use, its effect on oral hygiene and blood biochemical parameters was assessed. Results : After installation of the removable prosthesis with solid structures, the PMA index after the use of silver-plated clasp prosthesis decreased to medium severity, which is explained by positive impact on the inflammatory process in the gums. We can see the stability of biochemical parameters of blood in patients with solid removable prostheses can serve as a justification for the administration of silver electroplating for prophylactic and therapeutic purposes. Conclusions : The effectiveness of the use of silver plating in the treatment of partial defects of the dentition eliminates the clinical manifestations of the pathological condition and prevents possible complications in the oral cavity.

Abstract Bronchopulmonary cancer represents the neoplasms associated with the highest mortality rate, despite diagnostic and therapeutic advances in recent decades. Early diagnosis is often difficult due to the paucity of symptoms or superinfections. Screening subjects at risk of developing lung cancer include clinical, bacteriological, inflammatory status, and genetic profile assessment. The personal microbiome has an essential role in the physiology of the human body. The gut-lung axis plays an essential role in carcinogenesis, being involved in various pathways. The lung microbiome can contribute to the development of lung cancer either directly by acting on tumor cells or indirectly by modulating the tumor-associated immune response. The gut microbiome can directly affect the response to immunotherapy in patients with non-small cell lung cancer.

Abstract Background : Emotional disorders are highly prevalent among medical students, impacting their academic performance and general quality of life. It was shown that cognitive-behavioral and emotion regulation strategies are efficient for reducing anxiety and depressive symptoms in young people. Objective : This study aims to compare the efficiency of standard individual Cognitive-Behavioral Therapy (CBT) to a group intervention based on the Unified Protocol for Transdiagnostic Treatment (UPTT) of emotional disorders in two groups of medical students with similar baseline characteristics. Method : The sample of this research was composed of 64 medical students in total, of which 34 were included in the CBT group (Mage= 19.5 years, SD= 0.96) and 30 were included in the UPTT group (Mage= 19.4 years, SD= 0.93). The level of irrational beliefs and emotional distress were measured before and after the interventions, which were carried out by certificated psychotherapists. Results : Statistically significant differences were observed between pre-test and post-test in both groups. The level of irrational beliefs dropped after the CBT (M=62.91, SD=21.30, p<0.05) and the UPTT intervention (M=67.33, SD=34.89, p<0.05), respectively. Similarly, the profile of emotional distress changed after the CBT (M=77.62, SD=16.97, p<0.05) and the UPTT intervention (M=68.77, SD=20.06, p<0.01). Conclusion : Psychological interventions relying on cognitive-behavioral approaches, including standard, individual psychotherapy and a group intervention designed according to a transdiagnostic protocol, are suitable methods for reducing emotional disorders among medical students.

Abstract Objective: To find the anxiolytic effects in a psychogenic stress model in mice, the present study has investigated the interaction between propranolol and dextromethorphan. Methods: 50 Albino Swiss male mice were housed in groups of 10 per cage. The beta-adrenergic receptor blocker propranolol (20 mg/kg bw), the N-methyl-D-aspartate (NMDA) receptor dextromethorphan (30 mg/kg bw), and their combination were administered 10 minutes after exposure to predator odor. The treatments included diazepam as positive control and normal saline as negative control. Anxiety-like behaviors were evaluated using the elevated plus-maze test (EPM) 7 days after stress induction. Results: Regarding the length of stay (F=25.53; p<0.0001)/number of entries in the open arms (F=3.533; p=0.0416), time (F=6.127; p=0.0045)/number of entries in the closed arms (F=5.690; p=0.0141), time in center-point (F=3.577; p=0,0295), and total distance traveled (F= 4.711; p=0.0145), there was a significant difference among the treated groups. Propranolol and dextromethorphan treated groups expressed lower time in the closed arms vs Placebo (p=0.0089, respectively p=0.0111). In addition, the time spent in the open arms was higher in propranolol group vs placebo group (p=0.0215). Conclusions: Considering obtained data, there was a decrease of symptoms in the sympathetic nervous system and the psychological stress disappeared in mice applying a treatment of 20 mg/kg bw propranolol. Our findings indicated that dextromethorphan partially mediated the anxiolytic-like activity. However, the combination of these two drugs did not express anxiolytic effects.

Abstract Introduction: Arteriovenous fistula dysfunction has been associated with a range of problems such as thrombosis, stenosis, dilatation, and infection. Case presentation: We present the case of a 64-year-old patient with chronic kidney disease on hemodialysis and with aneurysmal dilatation of the ulnar-basilic arteriovenous fistula, having an increased risk of rupture. A temporary dialysis catheter is placed in the left femoral vein, an aneurysmal basilic vein is ligated at the anastomosis, aneurysmal dilatation is emptied by compression, and a right radiocephalic arteriovenous fistula is performed. The patient undergoes hemodialysis on the second day and subsequently three times a week for six weeks until the new arteriovenous fistula develops. He returns for aneurysmal sac resection. Conclusion: The purpose of this paper is the presentation and management of a 15-year-old ulnar-basilic arteriovenous fistula with multilocular aneurysmal development and an imminent rupture.