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Different factors may be involved in the clinical heterogeneity of spinal muscular atrophy disease. The vitamin D receptor (VDR) might be a candidate gene for this disease. Our study aimed to assess the preferential transmission of VDR polymorphisms from parents to SMA children. We genotyped 261 subjects (87 SMA nuclear families) for VDR FokI, BsmI, ApaI, and TaqI polymorphisms. The transmission of the genetic marker was estimated with Plink and FBAT software. It detected a preferential transmission of the rs731236 and rs7975232 variants to SMA1 patients and of rs1544410 variants to SMA2 patients. The variants of rs2228570 were preferentially transmitted to parents of all SMA patients. Haplotype analysis identified that haplotypes C-C-G-A and T-A-A-G seem to be involved in the booth type of SMA whereas the impact of T-A-A-A seems to be limited only to SMA2. Strong linkage disequilibrium (LD) between rs7975232 and rs1544410 was detected in samples from parents. Even though we investigated a small number of nuclear families the results suggest a potential link between VDR polymorphisms and SMA disease.

Abstract: Introduction: Public interest in burnout has grown recently in developed countries, as has media coverage. Burnout has been a topic of scientific research in recent years for psychologists and sociologists alike. They have published numerous articles on the identification and classification of burnout syndrome. The medical staff is quite exposed to burnout because they often experience strong emotions such as the desire to treat or save their patients, fear of failure, occasional failures in the treatment of diseases. Materials and methods: This study aims to highlight the impact of the burnout syndrome in the Emergency Department of the Central Military Emergency Hospital during the COVID-19 pandemic, by conducting a comparative study based on the results of a questionnaire applied to the medical staff before and during the COVID-19 pandemic. Results: The study interviewed 65 participants aged between 20 and 60 years. They had to anonymously answer 16 questions marked with scores from 1 to 4. Comparing the results highlighted by the questionnaire, applied before the COVID-19 period, with those obtained in the questionnaire applied between May and June 2020, we noticed an increase in the level of burnout in all categories interviewed during the pandemic. Conclusions: In conclusion, the high level of contagiousness and the lack of a vaccine or treatment against SARS-CoV2 infection are additional concerns for burnout syndrome among healthcare professionals. Keywords: COVID-19, burnout syndrome, healthcare professionals

Objective: Cerebrovascular Accidents (CVAs) represent the second most prominent cause of death globally, surpassed only by ischemic heart diseases, thus constituting a significant economic burden for healthcare systems. Despite this, little is known about the correlation between the different times of the year and intracerebral hemorrhages. This review investigates said link, as well as seek to identify whether vascular risk factors (i.e. diabetes and high blood pressure) vary through seasons. Method: This paper undertakes the study of 97 patients, all of whom have suffered a hemorrhagic CVA and were hospitalized and treated within the Central Military Emergency University Hospital's Department of Neurology in Bucharest, in the period between 29th of June, 2017 and 29th of July, 2019. The scope of this study is to optimize prophylaxis within the groups most susceptible to the imminent danger of an intracranial hemorrhage during a certain season. Results: Our study has shown that the season with the highest values of morbidity and mortality is autumn, followed closely by spring. Conclusion: Given the set of yielded data, which is mirrored in the case of risk factors, we conclude that the results vary slightly from those put forward in the literature. Therefore, whilst hemorrhaging CVAs have a consequential impact upon society, both through the disastrous effects of the incident per se, and its disabling nature in the long-term, a positive percentage of them could be avoided by changing one's behavior during the high-risk periods

One year after the beginning of the Covid-19 pandemic, on the world graph of daily morbidity can be seen that we are in the downturn of the third epidemic wave, consistent with the downturn of the third wave of daily deaths from/with Covid-19. However, the written press and the audiovisual media continue to present alarming balance sheets several times a day that lead the public to the idea of public danger. Doubts about the adequacy of declaring the pandemic were interpreted by some "naysayers" as doubts about the existence of the disease and the virus, and some loudly expressed their opposition against the prophylactic measures. Increasingly, public opinion, the press, and the judiciary system are shedding light on the causes of these approaches, which claim to be based on scientific criteria but sometimes prove to be pseudo-scientific, causing an "infodemic". The best objective orientation in this informational chaos is based on the mathematical-statistical processing of official data that is centralized daily from all countries of the world and published on the Internet. The statistical calculation suggests that in addition to the inequalities inherent in different populations, there are also cases of over-reporting, overdiagnosis, over-treatment, and/or over-media coverage of the Covid-19 case practice. As a general conclusion, the virus is real, the disease is real, but the risk to public health is not particularly serious except in certain geographical areas. If scientifically established prophylaxis and treatment measures are followed, the pandemic may end this year.

A symbiotic association between humans and microbes has been established over time. Disruptions in gut homeostasis have been linked to immune-mediated inflammatory diseases. Factors such as genetics, environment, diet, age, and medication play a major role in shaping the intestinal microbiome. An altered gut microbiome seems to modulate the progression and severity of inflammatory rheumatic diseases. Disruptions in the eubiotic state of the intestinal microbiome might promote intestinal and extraintestinal autoimmune and inflammatory disorders, although the mechanisms involved are not well understood. In this review, we provide a general overview of several studies concerning intestinal microbiome perturbations and their implications in rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus. Furthermore, we discuss the relationship between diet, intestinal microbiota, and inflammation.

Abstract: All large armies (EU and/or NATO) have pharmaceutical production facilities to provide the necessary antidotes for the troops and the population: The French Army Medical Directorate produces many military-specific pharmaceutical products in its own laboratory, the Turkish Army owns its own medicines factory, including CBRN antidotes, the US Army, in addition to a sustained drug purchase program in the pharmaceutical industry has launched a new concept: Pharmacy on demand. Providing the armed forces with antidotes is a necessity, the concept for their endowement in this sense can be based on imports (sometimes impossible to achieve) or on the national development of a specialized production structure. The design or construction of a specific production capacity for antidotes can be accomplished on multiple variants, with a complexity proportional to the identified need. The total costs are high, but the objective and implementation of effective antidote supply mechanisms is a security guarantee for the armed forces and the civilian population (through commercialization to allied forces), given the risks of terrorist threats and hybrid warfare. Keywords: medical protection, antidote, production, technological platform, medical countermeasures, pharmaceutical technique, orphan drug production

Abstract: Demons-Meigs syndrome is a rare benign pathology that can be confused with other benign and malignant pathologies. The clinical picture is marked by an increase in abdominal volume, pelvic-abdominal pain, but it can also be associated with breathing difficulties due to excess ascites fluid and pleurisy. Imaging paraclinical examination easily reveals the three components: ascites, pleurisy, and ovarian mass. Surgical treatment helps to relieve symptoms in a relatively short time. Keywords: Meigs, ovarian tumor, imaging examinations

The treatment of diseases is based on pharmacological and non-pharmacological means, but adequate devices are needed for their application. Medicine uses a wide range of medical devices. Currently, many medical devices are used, many of them being disposable. As recognition of the importance of medical devices, the national authority of the drug is the ANMDM (National Agency for Medicines and Medical Devices). Medical devices are indispensable for therapy, and their evolution has led to an extraordinary diversification of the field and the emergence of industry related to the pharmaceutical industry, with specific laws and regulations.

The international situation requires a strengthening of the national security measures, including in the field of CBRN and public health. The upgraded microbiology laboratories from DM/ MND must be operated at full capacity for the operationalization of an integrated Platform for the research and expertise of biological war and bioterrorism agents. This is necessary for reasons of national security, for CBRN defense and for public health, in the context of biological agents of 3 and 4 risk groups' epidemics. The existing upgraded objectives should be operationalized in order to meet the established scope: scientific research and expertise of biological agents and biological weapons, a laboratory for in vitro analysis and a bio-base for in vivo analysis. The highly secure lab allows working with any high-risk agents: biological, genetic, chemical, radiological, etc., being provided with a special room for the insertion/removal of equipment and their decontamination. Following an increase in the capability requirements concerning laboratories, we have provided in the design concept new technical parameters of the platform and the integration of new compartments with related activities of toxicology, pathology, neuro-psycho-pharmacology, bio-pharmacy, micropharmaceutical, specific testing activities, etc. Creating the integrated platform and its operationalization is necessary in order to meet the requirement of the national security strategy as a collective CBRN defense/protection facility and military-medical scientific research for CBRN medical protection.

Epilepsy is one of the world's oldest diseases. Social stigma, misunderstanding and thus, discrimination have surrounded patients and their families from the beginnings until nowadays. Approximatively up to 80% of epilepsy cases worldwide are found in developing regions. The risk of premature death is two to three times higher than for the general population. There is contradictory evidences concerning the question of whether to inform patients about the possibility of sudden unexpected death in epilepsy (SUDEP). Actual guidelines states that individuals with epilepsy and their families or careers should be given access to information on SUDEP. We have information about how, when and what to say to the patients and families about SUDEP. But it's a delicate subject, and some patients do not want to know that they are at risk for this.

Gastric antral vascular ectasia (GAVE) is an important cause of gastro-intestinal bleeding. The most common clinical presentation of GAVE is chronic occult bleeding that leads to symptomatic iron deficiency anemia, but some cases could present with acute massive bleeding. Frequently, patients are dependent by iron suplimentation, or in severe cases even blood transfusions. Endoscopic therapy is frequently necessary in acute or chronic blood loss. Over the past several years, treatment for GAVE has continued to evolve as the number of available effective therapeutic interventions has increased. These included: YAG laser, argon plasma coagulation (APC), endoscopic band ligation, cryotherapy and surgical anterectomy. Argon plasma coagulation is the most commonly used technique, but has been associated with several complications like sepsis, post-APC bleeding, gastric outlet obstruction and increased incidence of hyperplastic polyps. Endoscopic band ligation (EBL), a mechanical procedure, has been reported in the past years as an effective salvage therapy for GAVE that is refractory to other approaches, or even as the first line treatment. We present a case of nodular GAVE treated succesfully with endoscopic band ligation after unsuccesufull sessions with argon plasma coagulation.

Worldwide, adults and childhood obesity are increasing alarmingly, being a major health problem. Obesity is correlated with an increased incidence of various systemic diseases including cancer, heart diseases, and diabetes mellitus type 2. Risk factors for obesity are dysbiosis, genetic, socioeconomic, behavioural and environmental. The gut microbiota has beneficial effects on human health, like host immune system stimulation, being influenced by pH, or nutrient intake. Studies performed on humans and animal models reported differences regarding microbiota at lean and obese individuals. The consumption of probiotics and prebiotics may balance the microbiota with positive effects in obesity. The main aim of this review is to reveal the interaction between dysbiosis and obesity

Yolk sac tumor or endodermal sinus tumor is a rare malignant ovarian germ cell tumor (is a borderline tumor) diagnosed in young females up to 25 years old. Histopathological it resembles the mesenchyme of the primitive yolk sac. Microscopically it presents the following triad: Schiller-Duval bodies, reticular aspect and PAS+ hyaline droplets (α-fetoprotein). The diagnosis of Yolk sac tumor is made by dosing serum α-fetoprotein, ultrasound and MRI – DWI imaging. It requires surgical treatment, followed by chemotherapy (new therapies – platin or carboplatin, etoposide, bleomycin) [1]. Survival prognosis at 5 years is of 80% for stage I. Differential diagnosis is with Brenner tumor, ovarian clear cell carcinoma, dysgerminoma, malignant teratomas, androblastoma, dermoid cyst.

Multiple sclerosis is a chronic autoimmune disease, characterized by the appearance of demyelinating lesions with inflammatory character in the CNS. Given the unpredictable evolution of the disease, numerous attempts have been initiated to find some pathogenic factors and by default targeted treatment methods. The intestinal microbiota of these patients is often significantly altered compared to the healthy population and given the complex connections between the intestine and the central nervous system, the idea of causality between dysbiosis and this condition was launched. The intestinal mucosa represents the interface between the external environment and the organism, so that it is considered the starting point of some local immunological processes but with systemic resonance, especially neurological. The classic medication scheme widely used to treat MS nowadays can also affect the integrity of the intestinal mucosa by breaking the fine balance at this level. Data from recent studies around the subject open new treatment opportunities around preserving the intestinal microbiota and strategies like vitamin A intake and fat-soluble vitamin D supplementation, probiotic complexes or faecalis microbiota transplantation appear more promising and easier to apply in daily clinical practice.

Laparoscopic sleeve gastrectomy (LSG) is becoming popular between the bariatric procedures. There are few studies available in the literature about LSG impact on esophageal motility, with debatable results. Technically, it modifies the anatomy of the esophago-gastric junction; it can damage the phreno-esophageal ligament and decrease the lower esophageal sphincter pressure that will predispose to reflux. Gastroesophageal reflux disease (GERD) is already common in obese patients due to frequent hiatal hernia, high intraabdominal pressure, increased transient lower esophageal sphincter relaxations (TLESR), altered esophageal motility and poor esophageal clearance. LSG can worsen gastroesophageal reflux disease, but also the weight loss achieved after it and the decrease of acid production in the small gastric pouch will probably reduce the GERD symptoms. Dysphagia and odynophagia were reported after sleeve gastrectomy, but usually associated with anatomical narrowing of the gastric sleeve, caused by esophageal dismotility or secondary to diabetes mellitus, low tiamine level, the use of opioids and non-steroidal anti-inflammatory drugs, even hypothyroidism. In addition to upper GI tract endoscopy, high-resolution esophageal manometry (HRM) should be required for all patients planning to undergo a LSG, and in the follow-up period according to the contractility pattern.