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Introduction: Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to an infection1 and also an important worldwide health problem. Recent progresses in understanding pathogenesis are reflected in increasing emphasis put on time (Sepsis Update 2018 decreased the time for diagnosis and treatment from 3- 6 hs Sepsis2 to 1 hour). The aim of the study was to combine an early warning score (increased sensitivity- NEWS2) and a biomarker (increased specificity- presepsin) in order to detect earlier an acute illness (infection) before becoming life-threatening. Materials and methods: It was a retrospective, single-center observational cohort study of 125 consecutive patients who were diagnosed with systemic inflammatory response syndrome between July 2016 and July 2018 at Emergency Department of "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania in order to determine sooner, which patient will further develop a sepsis. We used the area under receiver–operator characteristic curves (AUC) to assess the overall discriminatory power of NEWS2, MEDS and presepsin in detecting sepsis, septic shock and the probability of death on admission and compared them with combined scores between NEWS2 and presepsin. Results: Using a combined score and a simple algorithm, the NEWS2 score had changed (12,8%) for 16 patients. For 10 out of 95 (10,52%) without sepsis and 6 out of 30 (20%) of septic patients, more points were added to NEWS2 meaning that more septic patients were diagnosed before an infection become life-threatening Conclusions: In the present study, we have tried to assess the impact of a monitoring score and a rapid POCT biomarker, in a condition when time is of critical importance. Using a verified early warning score, NEWS2, with increased sensibility and low specificity and presepsin, POCT biomarker with increased specificity, we diagnosed sepsis earlier in a number of cases.

Gallstones disease (GD) is a common pathology, with an incidence of approx. 20% in developed countries, a third of these cases being symptomatic. The paper aims to identify the diagnostic and therapeutic features of acute manifestations of gallstones during the COVID-19 pandemic. Materials and method: A retrospective, comparative study was performed of the cases presented to the emergency room (ER) and hospitalized for acute manifestations of gallstones in April-June 2020 vs similar period of 2019. The data regarding clinical form, associated pathology, therapeutic management were analyzed from the ER presentation register, hospitalization sheets and surgical protocols. Results: During the COVID-19 pandemic, the number of hospitalized cases for acute cholecystitis and other acute manifestations of GD was significantly lower than in the same period last year (21 vs 49 patients). In both study groups the main form of presentation was acute catarrhal cholecystitis (52.4% vs 63.2%). During the SARS-Cov-2 pandemic, we report an increased incidence of complicated forms, mainly hydrops (23.8% vs. 4.1%, p <0.05) and angiocholitis (19% vs. 4.1%, p <0.05). Conservative treatment was chosen more frequently during the pandemic (48% vs. 29%). For operated patients, laparoscopic cholecystectomy was the main option, performed in 85.7% in both groups. Conclusions: We maintain that laparoscopic cholecystectomy remains the gold standard for acute cholecystitis, even in the COVID-19 pandemic, as it guarantees the best outcomes for the patients. Conservative management may be an option for mild cases, but it carries the risk of recurrence of symptoms and increased incidence of severe complications.

Objective: This study aimed to examine the relationship between mental adjustment mechanisms and somatic symptoms in cancer survivors, a topic with limited research in Psycho-oncology. Methods: In this exploratory cross-sectional study, 88 cancer patients were surveyed using the Somatic Symptoms Scale (SSS-8), the Somatic Symptom Disorder Scale (SSD-12), and the Mini-Mental Adjustment to Cancer Scale (MINI-MAC). Additional questions were asked regarding cancer stage, treatment, and illness relapses. Data collection occurred over one month at a local oncology unit. Results: Several significant correlations were observed between the scales and subscales of the instruments applied during this study. The most important results showed that maladaptive adjustment mechanisms were significantly associated with somatic symptoms, while adaptive mechanisms were not. However, "fighting spirit," an adaptive mechanism, acted as a moderator between somatic symptoms and their psychological impact (effect size t = 0.157, p 0.05). Lower "fighting spirit" scores correlated with higher SSS-8 and SSD-12 scores, indicating its potential protective role. Conclusion: A more specific assessment of somatic symptoms and their link to mental adaptation to cancer is needed. Psycho-oncological interventions should address both adaptive and maladaptive adjustment mechanisms due to their significant influence on patient outcomes.

Background and aim: After two years of pandemic, planning and budgeting for use of healthcare resources and services is very important. Inpatient COVID-19 hospitalizations costs, regardless of ICD-10 procedure codes, in a Covid-19 support military hospital were analyzed. Methods: The national protocol for the treatment of Covid-19 infection was applied. The costs for laboratory tests, drugs, protection equipment and radiological investigations (imaging techniques such as computed-tomography or radiography), hospitalization days and food were assessed. Results: In our hospital, from August 2020 through June 2021, 241 patients were hospitalized with COVID-19: mean age 59.92±7.8 years, 46% men, 26% military personnel, 11.57±3 days of hospitalization; two third of patients had moderate and severe forms of COVID-19. The main manifestations were: 69% respiratory (18% with severe pneumonia), 3.3% cardiac (2.9% with pulmonary embolism, diagnosed by computed tomography angiography), 28% digestive and 33% psychiatric (most commonly anxiety). The average estimated costs were about 3000€/patient, without significant differences based on disease severity. Equipment costs were 2 times higher than for drugs and 3 times than for laboratory tests. Conclusions: In a Covid-19 support military hospital that cared for patients with predominantly moderate forms of COVID-19, the costs for equipment were much higher than those for treatment. New criteria for hospitalization of these forms of COVID-19 deserve to be analyzed in order to avoid useless costs

Posttraumatic stress disorder (PTSD) is a psychological-psychiatric state caused by exposure to stressful, traumatic events that manifests as a vivid reminiscence of them by flashbacks, nightmares, reccurent memories, emotional and physical manifestations. Cardiovascular diseases (CVD) are of interest in patients suffering from PTSD because there is an increasing body of evidence that these pathologies are linked. Hypertension, dyslipidemia, diabetes, and other cardiovascular risk factors are common in patients with PTSD and all of them increase the incidence of coronary syndromes, both chronic and acute. Posttraumatic stress disorder has a major impact on the lifestyle and health of subjects exposed to trauma or stress. Cardiovascular diseases tend to appear sooner in PTSD diagnosed patients due to a variety of reasons: poor habits, low addressability to health care systems, chronic inflammation status, changes at molecular levels, etc. Otherwise, PTSD tends to be induced by CVD, thus inclining the balance towards whis association. According with data published until now, there is a strong pathophysiologic relatonship between PTSD and some CVD; there is also outlining a vice versa relationship, from some CVD to PTSD.

Mercury is a chemical element that has been known since prehistoric times and has been used over time as a component of paints, in the treatment of various diseases, and later in various industrial compounds. Mercury enters the body transcutaneously, by inhaling or by ingesting food contaminated with mercury. The most common cause of mercury poisoning is eating seafood, but people can get mercury poisoning from industrial processing, thermometers, dental work, and old paints. The most vulnerable are people at occupational risk due to chronic exposure, as well as fetuses in the intrauterine period. Mercury poisoning produces extremely serious effects on the nervous, renal, and gastrointestinal systems. The nature and extent of mercury poisoning depend on factors such as the route of exposure, the rate of exposure, the distribution and biotransformation of mercury in the body, the chemical form of mercury or the mercury compound. Both mercury in the blood and the urine should not exceed 10 μg/L. The critical values of mercury in the blood are >150 μg/L and the lethal ones exceed 800 μg/L. New diagnostic methods allow the rapid and accurate identification of the concentration of mercury in biological products. Treatment is based on the use of chelating agents. However, the prognosis of mercury poisoning is extremely variable, due to the potentially irreversible nature of the lesions.