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Introduction: Venous thromboembolism (VTE), in its clinical spectrum, includes both deep venous thrombosis (DVT) and pulmonary embolism (PE). It is a disease with high incidence and morbidity in hospital and community settings. Venous thromboembolism has various risk factors and there are studies proving that the risk of increasing the incidence of the disease is proportional to the risk factors. Diagnosis, treatment and complications of lower limb deep vein thrombosis (DVT) depend on the anatomical location and extent of the process. The post-thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) and clinically it is characterized by chronic pain, edema, enlarged veins, skin induration and other signs of the affected limb, while, in severe cases, it can develop venous ulcers. The incidence of peripheral trophic disorders by age and the prevalence of risk factors for deep vein thrombosis of the lower limbs were examined in this regard. Materials and method: A retrospective study (January 2013 - December 2015) was conducted by collecting data from medical documents available in ""Floreasca"" Emergency Hospital Bucharest, Romania. The patients diagnosed with deep vein thrombosis, on the basis of Doppler ultrasound, were divided into two groups, according to age: group A (59 patients aged ≤50 years) and group B (130 patients aged> 50 years). A number of data from the medical anamnesis, along with clinical and paraclinical data were collected by us and we were interested in the incidence of peripheral trophic disorders caused by deep vein thrombosis of the lower limbs correlated with the risk factors. The study showed the incidence of deep venous thrombosis in a certain age and a certain environment of origin. The incidence of patients who have had a VTE history is half the patients with deep vein thrombosis who have had prophylactic anticoagulant therapy before hospitalization. The incidence of patients who have had prophylactic anticoagulant therapy before hospitalization is 61.1% of the patients with deep vein thrombosis and a VTE history. The incidence of trophic disorders caused by deep vein thrombosis of the lower limbs in patients who have had prophylactic anticoagulant therapy before hospitalization and in patients who also had a history of VTE is higher in those over 50 years old. The study showed the association of some risk factors for venous thrombosis with an age-related factor. Conclusions: Improving preventive strategies and an optimally efficient utilization of these strategies for patients at risk of venous thrombosis can lead to improved clinical outcomes in practice and also to the post-thrombotic syndrome prevention. Taking into consideration the risk factors by age group and a better understanding of epidemiology and the risk factors for the first or recurrent venous thrombosis can lead to optimal use of prophylactic strategies and improved quality of life. DVT affects all age groups and the incidence associated with PTS is high, therefore the prevalence of PTS in general population is considerable.

Introduction: The gastrointestinal stromal tumors (GIST) are dominated by KIT and PDGFRA mutation. The immunohistochemical detection of CD117, a protein express by KIT gene, is essential for the diagnosis and those that are negative always represented a diagnostic challenge Case reports: In this article we present a series of 4 cases of CD117 negative GIST tumors, diagnosed and surgically resected in Fundeni Clinical Institute and an overview of the histogenesis, diagnostic problems and management of c-kit negative GIST. All patients were males and the tumors were located in the stomach and small bowel. Conclusion: It is important for the pathologists to beware of the fact that a CD117 negative in the context of a typical morphological appearance does not exclude a GIST tumor and also the oncologist must be aware not to exclude the therapy with imatinib based on the negativity of CD117.

"Background: It is well known that patients with polycystic kidney disease (PKD) are at increased risk of developing cerebral aneurysms, however, this association has not been well studied for patients with polycystic liver disease (PLD). Material and methods: Cross-sectional descriptive study, which included 15 adult patients diagnosed with polycystic liver disease at the Gastroenterology and Hepatology Department of Fundeni Clinical Institute. Standard neurological exam and brain MRI were performed in all patients on a 1.5 Tesla MRI. Brain imaging protocol included T1/T2, T1SE, T2-FLAIR, DWI, SWI, 2D-TOF, 3D-TOF. Results: The majority of patients (93%) were females. The mean age was 53 ± 5 years old. Patients with AD-PKD and polycystic hepatic disease predominated (60%). Aneurysms were found in only one patient diagnosed with AD-PKD (in whom three aneurysms were described). The overall prevalence of cerebral aneurysms in our patient group was 7%. However, none of the patients with isolated PLD was found to have intracranial aneurysms. Other brain imaging abnormalities were frequent but nonspecific (mostly attributable to vascular-degenerative changes). Conclusions: Given these results, and due to the small number of patients in our study, it is hard to appreciate if polycystic liver disease is indeed associated with an increased risk of cerebral aneurysms. "

"Colorectal cancer is one of the main causes of death by cancer in the European Union and in Romania. Lynch Syndrome is an autosomal dominant inherited disease that affects around 3% of all colorectal cancer patients, defined by mutations in the mismatch repair genes (MLH1, MSH2, MSH6, PMS2). Aside from the high risk for colorectal cancer (CRC), they exhibit a high risk for endometrial cancer, ovarian cancer, gastric cancer, pancreatic cancer, brain cancer, small bowel cancer, and sebaceous gland cancer. Diagnosis is often made by the gastroenterologist, usually when he meets a young patient with symptoms suggesting the presence of a colonic tumor and a family history of CRC. The role of the gastroenterologist is to investigate the best practices in order to have an early diagnosis and to prevent interval cancers according to the newest guidelines or other gastrointestinal tract tumors associated with Lynch Syndrome. Registries play an important role in the optimal surveillance of these particular categories of patients and should be put into place in every country. They will allow clinicians to have a better understanding of the disease and a more standardized quality of care for them."

The pandemic called COVID-19 disease has an exponential course since the first cases were reported showing in 9th of May, 2020, more than 4 million cases of COVID-19. United States and European Council (EC), together with other European Union institutions, were closely monitoring the situation in order to take quick action. Objective: The aim of this article is to analyze the response to COVID 19 pandemic outbreak in term of strategy and money flow of Romanian health system in order to identify the strength and weakness and prepare for other similar provocative challenges. Global and national strategy: United States Government is delivering a comprehensive package of services to support international partners around the world in combatting this disease adding American expertise for global benefit, saving lives by improving international partners abilities to respond to the COVID-19, and reducing secondary impacts. Meanwhile European Union is focused on 6 major coordinates limit the spread of the virus, ensure and provide medical supplies, decrease negative economic impact, support jobs, promoting research and help European citizens to repatriate. Despite all negative elements a proper and relatively quick response of Romanian Public Health System was noticed and the taken measures were harmonized and synchronized with the European coordinates, prioritize initiatives, build an action plan, establish a communication plan, workforce optimization and management strategy. Conclusion: Global shock needs global response, with little or no government interventions, economic costs will be huge.

Background: The incidence of congenital diaphragmatic hernia (CDH) has been reported to be 1 in 2000-5000 newborns. The late presentation can occur in 5-30% of all cases and it can be harder to diagnose, as symptoms are usually vague and non-specific. Methods: We performed a retrospective review of chart files of all patients admitted to our hospital with the diagnosis of congenital diaphragmatic hernia between 2010 and 2021. Result: Of the ninety-two cases of CDH treated in our hospital between 2010 and 2021, twenty-six (28%) were late presenting. In the late-presenting CDH group, we found a slight female preponderance, with fifteen female patients (58%) and eleven male patients. A posterolateral left defect in the diaphragm was noted in fifteen cases (58%), a right defect was noted in just one case (4%) and ten patients (38%) were diagnosed with an anterior diaphragmatic hernia. The age at diagnosis varied from 2 months to 14 years. Associated anomalies were noted in just four cases. In all cases, a thoracoabdominal radiograph was performed and ten patients also had a CT scan. Primary repair was performed in 25 of the 26 patients. The mortality rate in our study population was 11%, we reported 3 cases with unfavorable evolution. Conclusion: CDH presenting beyond the neonatal period is a usual finding and it represents a true diagnostic challenge.

Fever of unknown origin (FUO) is a diagnosis that describes a prolonged febrile illness without an established cause, despite investigations. From the first definition of the medical condition (given by Petersdorf and Beeson in 1961) the diagnostic criteria have changed over time, intending to improve the management and outcome of these patients. The main causes of FUO fall into 4 categories: infectious, non-infectious (inflammatory), neoplastic and diverse causes. The etiology of FUO has changed over time, due to ever-changing disease patterns and the development of diagnostic techniques. A significant percentage of patients with FUO remain without an etiologic diagnosis, despite advanced diagnostic tests. Gathering potentially diagnostic clues through history, physical examination and nonspecific key paraclinical abnormalities is the basis for the diagnosis of FUO.

Background: As total hip replacement cases increase year after year, registry-wide data becomes increasingly important in order to assess pathology distribution, reimbursement efficiency as well as physician performance. In order to assess all these factors patient evolution needs to be documented after surgery as well, but the main impediment to doing this is losing patients to follow-up. For this reason, the present study aims to perform a descriptive analysis of the hospital's internal registry data as well as to determine what percentage of patients can be expected to return to follow-up after total hip replacement. Methods: A query of the hospital's internal registry data in the last years was performed. Patient demographics, county distribution as well as ICD-10 code usage were documented. Data standardization was performed to determine the probability and cumulative distribution of the patient's age. The chi2 test of independence was used to assess whether there is a correlation between the patient's gender and ICD-10 codes. Pot hoc power analysis was performed to assess the accuracy of correlation analysis. Results: Only 29.6% of the patients undergoing total hip replacement are from the county within which the hospital is located. 25% of the patients were under 60 years old. Conclusions: Current registry data reveals that most patients undergoing total hip replacement are around 67.5 ± 11 years old, suffer from unilateral or bilateral primary or secondary hip osteoarthritis and only 29.6% of them are likely to return to follow-up.

Background: More than half of patients with locally advanced esophageal cancer are unresponsive to first-line chemotherapy. To date, there is no standard second-line regimen; new agents, such as immune-checkpoint inhibitors or anti-Neurotrophic Tropomyosin-Related Kinas agents, have only been recently recommended. This study aimed to assess the benefits of classical second-line chemotherapy in terms of survival and tolerance. Materials and Methods: This retrospective analysis assessed the benefits and tolerance of different second-line regimens of chemotherapy in progressive, locally advanced or metastatic oesophageal cancer treated at the department of Radiotherapy-Oncology at the Institute of Oncology between January 2011 and January 2017. Results: The analysis found 87 patient files with a median age 59.5 years (ranging between 41 and 84), of which 40.2% (35 patients) failed the first-line platinum and 5- fluorouracil combination. Histology favoured adenocarcinomas (63.2%). The patients were in good clinical condition, with ECOG 0–1 in 86.1% (74 patients), and less than five percent had more than three metastatic sites (3.4%, 3 patients). The regimens were mostly two-drug cytotoxic (53.9%, 47 patients): FOLFIRI in 18 patients (20.7%), FOLFOX in 18 patients (20.7%), vinorelbine–platinum combination in 11 patients (12.6%), and docetaxel in 40 patients (38.7%). The median treatment duration was 7.74 weeks (range 1 to 12). The general response rate was 47.1% (41 patients), including stable disease. The median time to progression was 7.61 weeks, with a range between 1.6 and 8.6 weeks, with no differences in this respect among the fourth type of treatment received (p = 0.170). Grade 3–4 toxicities, including neutropenia, gastrointestinal problems, and metabolic disorders, were observed in 44 patients (50.6%). The median event-free survival was 2 months (range between 1 and 6.3), and 63.2% (55 patients) subsequently received a third line of chemotherapy. Conclusion: Second-line chemotherapy is still the first-choice recommendation in all fit patients with advanced oesophageal cancer. The new agents are efficacious only in cases with PD-L1 positive or high microsatellite instability.

Background and Objectives: Chronic Kidney Disease (CKD) affects 6,7% of the adult population in Romania and is associated with high morbidity. About one out of three adults with diabetes has kidney disease. According to current literature data, the prevalence of diabetes is very high, up to 11,6%, of whom 2,4% had undiagnosed diabetes, and is the leading cause of kidney damage and the need for renal replacement therapy (RRT). COVID-19 has brought with it a lot of unanswered questions, regarding the risk factors, the disease evolution, and the treatment possibilities. It became clear that diabetic kidney disease (DKD) is among the independent risk factors that predict unfavorable outcomes upon SARS-CoV-2 infection, so we aimed to evaluate the characteristics of diabetic and non-diabetic dialyzed patients, COVID-19 positive. Materials and Methods: It is an observational, single-center study that analyzed type 2 diabetes mellitus and non–diabetic patients in maintenance hemodialysis hospitalized for SARS CoV-2 infection. Results: A total of 101 adult dialyzed patients were admitted with a SARS-CoV-2 RT-PCR positive test, out of which 42 had a long history of diabetes mellitus type 2 and 59 of them have been known with other etiologies of CKD. Hypertension and heart disease were the most commonly associated comorbidities. Inflammatory markers and anemia were significantly increased in diabetic patients compared to non-diabetic. Conclusions: We found that anemia was more severe in patients COVID-19-positive MHD T2DM patients.

"The recent increase in life expectancy is the main argument for a better understanding of the pathophysiological mechanisms underlying aging. These, once known, can provide possible links to therapies to prevent aging or slow down the process. Normal aging is associated with a progressive decrease in the glomerular filtration rate. Accurate estimation of GFR in the elderly is under the suspicion of multiple errors mainly due to sarcopenia and decreased protein intake. Differentiation between chronic kidney disease and the physiological decline of GFR might be a challenge in clinical practice and this has consequences on the evolution and treatment of the numerous comorbidities of the elderly. The current trend to use non-invasive diagnostic techniques explains the need to identify a serological marker to help differentiate between decreased GFR secondary to kidney aging or the development of chronic kidney disease."

"Introduction: As general population tends to have increasing life expectancy, the risk associated with developing chronic kidney disease (CKD) with multiple incapacitating concequences, also increases. Method: For the present study, we registered the data from the observation files of 37 patients diagnosed with CKD undergoing treatment by chronic hemodialysis and noted the CKD associated diagnoses included in the notion of comorbidities. We monitored their statistical incidence both in the whole group and separately, in women and men using TTEST and CORREL. Results: The median age of the subjects was 55.86 (± 12.00) years. The study population mean weight was 74.90 (± 14.44) kg, with a mean weight of 69.33 kg for female subjects, and 77.92 kg for males, respectively. Diabetes was identified in 35.13% of patients, whilst heart failure was present in 16.21% of patients. Conclusions: Following the analysis of the information about the patients with CKD in the dialysis program, which we included in the study group, we observed the existence of variations that occur with age, significant correlations between age and weight and between albuminemia and weight. The most common comorbidity is high blood pressure followed by anemia. "

Background: Coronavirus disease 2019 (COVID-19) was recognized by the World Health Organization (WHO) as a global pandemic on March 11, 2020. Since then, researchers worldwide have focused their attention on identifying effective treatments and developing vaccines to combat this disease. Aim: To report the effectiveness of the drugs employed in the COVID-19 treatment protocols based on data from clinical trial studies conducted from the beginning of the pandemic until December 10, 2020. Methods: Following the PRISMA guidelines, we conducted an advanced search in several electronic databases. A total of 13553 studies was screened by two people simultaneously and separately based on the article title, abstract and full-text. The quality of the studies was evaluated using the Cochrane criteria. Results: Of the 13553 studies identified, 50 clinical trials were included in this systematic review. Of these, three studies explored the use of remdesivir, nine studies the use of hydroxychloroquine, five studies the use of lopinavir/ritonavir, six studies the use of favipiravir, one study the use of tocilizumab, two studies the use of interferon beta-1a and two studies the use of umifenovir.