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Introduction: Studies regarding antibiotics administration during pregnancy and atopic dermatitis (AD) in children are only few. In this context, the objective of our study was to investigate the potential association between the timing of intrauterine exposure to antibiotics or prenatal antibiotic administration in general and AD occurrence in children.

Methods: This was a cross-sectional study in 1046 subjects. The exposure to antibiotics during pregnancy was initially evaluated using simple logistic regressions. Then, each period of antibiotics administration was adjusted with the other periods of antibiotics exposure (model 1) and with the other variables associated with AD in our database (model 2).

Results: In simple logistic regression analysis, the administration of antibiotics during pregnancy, as a whole period, presented a trend of association with AD (OR = 1.28, %CI: 0.99 – 1.65). When we analyzed antibiotic administration during each trimester of pregnancy, only antibiotherapy during the 3rd trimester was associated with AD (OR = 2.94, %CI: 1.21 – 7.12). After adjusting with all the other important risk factors associated with AD in the database, antibiotics administration during the 3rd trimester of pregnancy was still independently associated with AD (OR=2.64, %CI: 1.01 – 6.91).

Conclusion: Antibiotic administration during the 3rd trimester of pregnancy was independently associated with AD in children.


Sufficient caloric intake is important to maintain the balanced health status, especially during the period of aging, as aging and sickness share paths. Maintaining adequate nutritional balance is the best preventive measure to counteract the risk of malnutrition. There are several causes for malnutrition in elderly people, and some techniques like anthropometric measurements, laboratory and clinical parameters could help to diagnose malnutrition in these patients. The use of a simple validated questionnaire called the ‘Mini Nutritional Assessment’ measures the nutritional status of elderly patients. In this review, we discuss about the malnutrition in elderly people with and without a known cause and we present some of nutritional intervention. There are promising strategies that help overcoming malnutrition.


Introduction. Central obesity is characterized by the accumulation of abdominal fat which may lead to several diseases including insulin resistance. The prevalence of central obesity is higher in male and the incidence in young adult males is increased. Central obesity is also related to low testosterone levels. The research aimed to assess the relationship between the testosterone levels and insulin resistance of young adult males with central obesity.

Methods. This was a cross-sectional study, the subjects were young adult males of 18 to 25 years old. The central obesity consisted of 50 samples and non-central obesity comprised 90 samples. The examination of testosterone and insulin was performed by the ECLIA method, glucose used the enzymatic method, the insulin resistance was calculated by using the HOMA-IR index.

Results. The mean of the testosterone level in central obesity was lower than non-central obesity (5.24+1.17 vs 7.18+1.54 ng/mL, p<0.001). HOMA-IR index in central obesity was higher than non-central obesity (4.29 + 2.23 vs 2.46 + 1.72), p<0.001). Testosterone levels had negative correlation with HOMA-IR (r=-0.470, p<0.001). There was significant difference in HOMA-IR among the quartiles of testosterone levels.

Conclusion. There is negative correlation between testosterone level with HOMA-IR, the lower the testosterone level the higher the insulin resistance in young adult males.


The European Society of Cardiology and the European Atherosclerotic Society are recommending in the 2019 guideline for dyslipidemia the best management strategies for an individual patient with a given condition.

The guideline recommends the use of new tests to help identify high-risk patients. These include both coronary artery calcium imaging and biomarker tests.

Modifications have also been made to the risk stratification categories, so that patients with atherosclerotic artery disease, diabetes mellitus with target organ damage, familial hypercholesterolaemia and severe chronic kidney disease are all included in very-high risk patients.

The new ESC/EAS guideline for dyslipidemia management compared with the 2016 version include more intensive reduction of LDL-c across CV risk categories. If the goals are not achieved with the maximum tolerated dose of statin, combination with ezetimibe is recommended. An important message of the new guideline is that until this moment there are no known adverse effects of very low LDL-c concentrations.


Current Guidelines for the diagnosis and management of acute pulmonary embolism (PE), as well as all other Guidelines, summarize and evaluate the already available evidence and consensus “with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition”.

In this review we present the most important new recommendations of the latest ESC Guidelines on the diagnosis and management of acute pulmonary embolism.


Apoptosis is an inborn process that has been preserved during evolution; it allows the cells to systematically inactivate, destroy and dispose of their own components thus leading to their death. This program can be activated by both intra and extracellular mechanisms. The intracellular components involve a genetically defined development program while the extracellular aspects regard endogenous proteins, cytokines and hormones as well as xenobiotics, radiations, oxidative stress and hypoxia. The ability of a cell to enter apoptosis as a response to a „death” signal depends on its proliferative status, the position in the cell cycle and also on the controlled expression of those genes that have the capacity of promoting and inhibiting cell death. The fine regulation of these parameters needs to be maintained in order to ensure the physiological environment required for the induction of apoptosis.

In this review, we first describe evidence for the role of apoptotic pathways in ischemic acute renal failure, and then consider the potential mechanisms that may participate in this model of acute renal tubular injury. Potential therapeutic interventions to prevent tubular apoptosis in renal disease include angiotensin system inhibition, whereby the angiotensin II AT2 receptor blockade seems more promising in apoptosis inhibition than the inhibition of other receptor subtypes. A better understanding of the mechanisms of apoptosis could lead to safer and more specific therapeutic interventions for acute kidney injury.


Background/Aim: Oral cancer is one of the ten most common cancers in the world, recently positioned as a sixth one, unfortunately with poor prognosis after treatment because of the late diagnostics in advanced stages of the disease. Aim of this study was to present the basic criteria in assessment the accuracy/efficacy, specificity and sensitivity, the positive and negative predicted values of the conventional oral examination (COE) as the easiest and most acceptable procedure in detection of the early changes of the suspicious oral tissue changes compared to the diagnostic gold standard – tissue biopsy in two different groups of examinees.

Material and Methods: Sixty patients divided into two study groups (one with potentially malignant oral lesions and a second consisted of clinically suspicious oral cancer lesions) were examined with COE and subjected to histopathological confirmation - tissue biopsy. All examined patients underwent the diagnostic protocol by the American Joint Commission on Cancer, selected under certain inclusion and exclusion criteria.

Results: Sensitivity of COE in the group of examinees with oral potentially malignant lesions is 83.33%, its specificity is 20.83%, the positive predictive value is 20.83% and the negative predictive value is 83.33%. The accuracy of the COE method is 33.33%. The sensitivity, in the group of patients with oral cancer is 96.43%, specificity is 0%, the positive predictive value is 93.10% and the negative predictive value is 0%. The accuracy of this method is 90%.

Conclusions: The accuracy reaches a value over 90% for the group with lesions with highly suspected malignant potential – oral cancer, and sets the thesis that COE as screening method for oral cancer or premalignant tissue changes is more valuable for the patients with advanced oral epithelial changes, but is recommended to be combined with some other type of screening procedure in order to gain relevant results applicable in the everyday clinical practice.


Introduction. Although type 1 diabetes mellitus is largely associated with autoimmune thyroid disease and this entity has been recently referred to as autoimmune polyglandular syndrome type 3 variant, the autoimmune polyglandular syndrome type 3 variant in patients with rheumatoid arthritis has not been reported so far. We herein describe the first case of rheumatoid arthritis that was associated with autoimmune polyglandular syndrome type 3 variant.

Case report. A 77-year-old woman with a 15-year history of rheumatoid arthritis (RA) and a 10-year history of type 2 diabetes mellitus (T2D) presented with polyarthralgia and hyperglycaemia. Methotrexate 16 mg/week had been started from the onset and was continued, and adalimumab 40 mg/day was started for RA. Insulin treatment was also started for the diabetes. Laboratory examinations revealed high levels of C-reactive protein (CRP), rheumatoid factor, anti-cyclic citrullinated peptide antibody, and matrix metalloprotease 3. She was admitted multiple times as the symptoms recurred after treatment. Subsequently, based on the clinical course and investigations, she was diagnosed with type 1 diabetes mellitus and Graves’ disease occurring during the course of RA and T2D. Her clinical course improved after reinforcement of insulin therapy and the addition of thiamazole therapy.

Conclusion. In patients with rheumatoid arthritis, the autoimmune polyglandular syndrome type 3 variant should be considered as the cause of the deterioration.


Background/Aim: The purpose of this in-vitro study was to compare the resin-bonded fixed partial dentures (RBFPD) fabricated using two different structural designs and two different antibacterial adhesive lutting protocols in regard to their resistance to debonding.

Material and Methods: Forty samples for a model with single missing molar were divided into 4 groups (M1, M2, C1, C2) (n=10). M1 and M2 were prepared in accordance with modified inlay slot-cavity retained RBFPD design; C1 and C2 were prepared according to conventional inlay slot-cavity retained RBFPD design. M1 and C1 cavities were treated with 2% chlorhexidine-based (CHX) cavity disinfectant and 10-methacryloyloxydecyl dihydrogen phosphate (MDP) containing adhesive system; M2 and C2 cavities were treated with MDP and 12-methacryloyloxydodecylpyridinium bromide (MDPB) containing adhesive system featuring antibacterial cavity cleansing effect. The RBFPDs were made of base-metal alloy and their fit surfaces sandblasted with aluminium oxide (Al2O3). Adhesive resin cement was used for cementation, and the RBFPD retainers were interlocked into their corresponding inlay cavities using composite resin. After 1 week being immersed in aqueous environment, the RBFPDs were subjected to tensile loading at a crosshead speed of 1 mm/min until failure. One way ANOVA and Tukey HSD tests were used for statistical evaluation (α=0.05). Mode of failure and tooth damage was also noted.

Results: Mean tensile bond strength values were 356 N for M1, 305 N for M2, 467 N for C1, and 455 N for C2. Tensile strength values of C1 and C2 were significantly higher than those of M1 and M2 (p<0.05). The mode of failure was mostly adhesive in character at the metal-cement interface in all groups. Tooth fracture was observed nearly in all specimens. No significant difference was detected between the antibacterial adhesive lutting protocols (p>0.05).

Conclusions: The RBFPDs with the conventional design were found to be more retentive than those with the modified design. Using an adhesive system featuring antibacterial properties with no need of separate antibacterial agent application during bonding may be favourable.


Introduction. The purpose of this study was to compare the role of the thrombophilic variants among two groups of high risk patients with vascular disorders and recurrent pregnancy loss.

Methods. 200 patients, including 76 with thrombotic accidents and 124 with two or more idiopathic recurrent miscarriage during the first trimester, were tested for the presence of Factor V (F V) Leiden G1691A, Factor II (F II) G20210A, plasminogen activator inhibitor (PAI) 4G/5G, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms using Real time polymerase chain reaction (RT – PCR) in the Laboratory of Medical Genetics, Varna, Bulgaria between June 2016 and May 2019. Frequencies of thrombophilic gene polymorphisms were compared among the two populations and to the expected genotype frequencies.

Results. Individuals with a history of vascular disorders had a significantly higher frequency of F V Leiden variant compared to women with recurrent miscariage. There was no statistical difference between the analyzed patients for the other three thrombophilic polymorphisms. The allelic frequencies and the expected genotype frequencies of the F V, F II and MTHFR polymorphisms were calculated according to Hardy-Weinberg equilibrium. The percentages of the homozygotes for F V and F II were higher than expected in the two groups of patients. For the MTHFR there was no difference.

Conclusion. F V Leiden remains the strongest risk factor for vascular disorders and recurrent pregnancy loss. Screening for this variant should be recommended to patients with thrombotic accidents and women with repeated miscarriage. The role of F II, PAI and MTHFR remains controversial.