A 68-Year-Old Man with Depression and Acute Renal Failure Due to Rhabdomyolysis Associated with Alcohol Intoxication While Taking Low-Dose Escitalopram: A Case Report.

BACKGROUND Rhabdomyolysis, an uncommon but recognized adverse effect of selective serotonin reuptake inhibitor (SSRI) antidepressants, can precipitate acute renal injury (AKI), especially when combined with risk factors such as alcohol consumption. This report describes a 68-year-old man with acute renal failure due to rhabdomyolysis associated with alcohol intoxication while taking low-dose escitalopram, an SSRI antidepressant. CASE REPORT The patient, with a history of bipolar affective disorder managed with escitalopram, presented with symptoms of general malaise, diarrhea, myalgias, and transient loss of consciousness following substantial ethanol consumption. Laboratory tests indicated severe rhabdomyolysis with a creatine kinase level of 37 672 U/L and myoglobin level >5710 ng/ml, leading to an AKI diagnosis. The discontinuation of escitalopram, along with hydration and renal replacement therapy, facilitated renal recovery. However, the reintroduction of escitalopram resulted in the recurrence of rhabdomyolysis, suggesting a probable causal link, confirmed using the Naranjo Adverse Drug Reaction Probability Scale. CONCLUSIONS This report highlights the importance of identifying the medication history in patients presenting with acute renal failure and rhabdomyolysis and the association with SSRIs, which can be exacerbated by alcohol. This case underscores the importance of vigilant medication history assessment in patients presenting with AKI and rhabdomyolysis, particularly concerning the use of SSRIs like escitalopram, which can pose heightened risks in the context of alcohol use. It highlights the need for clinical caution in managing patients on long-term SSRI therapy, especially when reintroducing such medications after an episode of rhabdomyolysis.

Anticancer Potential of ß-Carboline Alkaloids: An Updated Mechanistic Overview.

his comprehensive review is designed to evaluate the anticancer properties of ß-carbolines derived from medicinal plants, with the ultimate goal of assessing their suitability and potential in cancer treatment, management, and prevention. An exhaustive literature survey was conducted on a wide array of ß-carbolines including, but not limited to, harmaline, harmine, harmicine, harman, harmol, harmalol, pinoline, tetrahydroharmine, tryptoline, cordysinin C, cordysinin D, norharmane, and perlolyrine. Various analytical techniques were employed to identify and screen these compounds, followed by a detailed analysis of their anticancer mechanisms. Natural ß-carbolines such as harmaline and harmine have shown promising inhibitory effects on the growth of cancer cells, as evidenced by multiple in vitro and in vivo studies. Synthetically derived ß-carbolines also displayed noteworthy anticancer, neuroprotective, and cognitive-enhancing effects. The current body of research emphasizes the potential of ß-carbolines as a unique source of bioactive compounds for cancer treatment. The diverse range of ß-carbolines derived from medicinal plants can offer valuable insights into the development of new therapeutic strategies for cancer management and prevention.

The potential roles of gossypol as anticancer agent: advances and future directions.

Gossypol, a polyphenolic aldehyde derived from cottonseed plants, has seen a transformation in its pharmaceutical application from a male contraceptive to a candidate for cancer therapy. This shift is supported by its recognized antitumor properties, which have prompted its investigation in the treatment of various cancers and related inflammatory conditions. This review synthesizes the current understanding of gossypol as an anticancer agent, focusing on its pharmacological mechanisms, strategies to enhance its clinical efficacy, and the status of ongoing clinical evaluations.The methodological approach to this review involved a systematic search across several scientific databases including the National Center for Biotechnology Information (NCBI), PubMed/MedLine, Google Scholar, Scopus, and TRIP. Studies were meticulously chosen to cover various aspects of gossypol, from its chemical structure and natural sources to its pharmacokinetics and confirmed anticancer efficacy. Specific MeSH terms and keywords related to gossypol's antineoplastic applications guided the search strategy.Results from selected pharmacological studies indicate that gossypol inhibits the Bcl-2 family of anti-apoptotic proteins, promoting apoptosis in tumor cells. Clinical trials, particularly phase I and II, reveal gossypol's promise as an anticancer agent, demonstrating efficacy and manageable toxicity profiles. The review identifies the development of gossypol derivatives and novel carriers as avenues to enhance therapeutic outcomes and mitigate adverse effects.Conclusively, gossypol represents a promising anticancer agent with considerable therapeutic potential. However, further research is needed to refine gossypol-based therapies, explore combination treatments, and verify their effectiveness across cancer types. The ongoing clinical trials continue to support its potential, suggesting a future where gossypol could play a significant role in cancer treatment protocols.

Effect of perinatal exposure to glyphosate and its mixture with 2,4-D and dicamba on rat dam kidney and thyroid function and offspring's health.

The increasing use of the herbicide mixture of glyphosate, dicamba and 2-4-D to deal with glyphosate-resistant weeds raises concerns regarding human health and environmental risks. This study aimed to evaluate the effects of developmental exposure to glyphosate and a herbicide mixture containing glyphosate, dicamba and 2-4-D on rat dams' kidney and thyroid function and offspring's health. Pregnant Wistar rats were exposed from day-6 of gestation till weaning to regulatory relevant doses of glyphosate corresponding to the European Union (EU) acceptable daily intake (ADI; 0.5 mg/kg bw/day), and the no-observed-adverse-effect level (NOAEL; 50 mg/kg bw/day), and to a mixture of glyphosate, dicamba and 2,4-D all at the EU ADI (0.5, 0.002 and 0.3 mg/kg bw/day) respectively. After weaning the dams were sacrificed and blood and organs were collected. The pups' health was assessed by measuring viability, gestational and anogenital indices. Perinatal exposure to GLY alone and the herbicide mixture resulted in anti-androgenic effects in male offspring. In dams, exposure to glyphosate resulted in kidney glomerular and tubular dysfunction as well as increased thyroid hormone levels in a dose-dependent manner. Furthermore, exposure to the herbicide mixture resulted in effects similar to those observed with glyphosate at the NOAEL, suggesting at least an additive effect of the herbicide mixture at doses individually considered safe for humans.

Analysis of Temperatures Generated during Conventional Laser Irradiation of Root Canals-A Finite Element Study.

The success of endodontic treatment is dependent on the removal of bacteria. A modern strategy to reduce bacterial load is laser irradiation. During this procedure, there is a local increase in temperature with possible side effects. The aim of this study was to determine the thermal behavior of a maxillary first molar when performing the conventional irradiation technique using a diode laser. For this study, a 3D virtual model of a maxillary first molar was created. The preparation of the access cavity, the rotary instrumentation of the palatal root canal and the laser irradiation protocol were simulated. The model was exported in a finite element analysis program where the temperature and heat flux were studied. Temperature and heat flux maps were obtained, and the temperature increase on the internal wall of the root canal was analyzed. The maximum temperature value exceeded 400 °C and was maintained for less than 0.5 s. The obtained temperature maps support the bactericidal effect of diode laser and the limitation of damage to surrounding tissues. On internal root walls, the temperature reached several hundred degrees Celsius, but for very short durations. Conventional laser irradiation is an adjuvant method of decontamination of the endodontic system.

An Interpenetrating Polymer Network Hydrogel Based on Cellulose, Applied to Remove Colorant Traces from the Water Medium: Electrostatic Interactions Analysis.

The main objective of this work was the removal of eosin Y and green malachite from an aqueous medium by using a cellulose-based biodegradable interpenetrated network (IPN). The IPN was obtained by the sequenced synthesis method. In the first step, cellulose was crosslinked with epichlorohydrin (ECH). In the second step, the obtained gels were swollen in a reactive mixture solution, which was based on the monomers 2-hydroxyethyl methacrylate (HEMA) and 1,6- hexanediol diacrylate (HDDA). After this, swelling equilibrium was reached through the gels' exposition to UV radiation. An infrared spectroscopy (FTIR) was used to analyze the bond stretching, which confirmed the IPN's formation. The swelling kinetics in aqueous mediums with different pH values showed a high swelling at a basic pH value and a low response in neutral and acidic media. The IPNs showed an improvement in water uptake, compared to the networks based on PHEMA or cellulose. The IPN was used to remove dyes from the water. The results showed that a high percentage of green malachite was removed by the IPN in six minutes of contact time. The experimental results were confirmed by the docking/modeling method of the system (IPN/Dye). The different physical interactions between the IPN and the dyes' molecules were investigated. The interactions of the hydrogen bonds with malachite green were stronger than those with eosin Y, which was in good agreement with the experimental results.

Arrhythmias and Conduction Disturbances in Patients with Systemic Sclerosis-A Systematic Literature Review.

Systemic sclerosis (SSc) is an autoimmune disease characterized by skin and internal organ fibrosis and microvascular impairment, which can affect major organs, including the heart. Arrhythmias are responsible for approximately 6% of deaths in patients with SSc, and mainly occur due to myocardial fibrosis, which causes electrical inhomogeneity. The aim of this study was to determine the frequency of arrhythmias and conduction disturbances in SSc cohorts, and to identify the characteristics and risk factors associated with the occurrence of dysrhythmias in patients with SSc. A systematic literature review using PubMed, Embase, Web of Science and Scopus databases was performed. Full-text articles in English with arrhythmias as the main topic published until 21 April 2022 were included. Most prevalent arrhythmias were premature supraventricular and ventricular contractions, while the most frequent conduction disturbance was represented by right bundle branch block (RBBB). Elevated concentrations of N-terminal prohormones of brain natriuretic peptides (NT-pro BNP) were associated with numerous types of atrial and ventricular arrhythmias, and with the occurrence of RBBB. A lower value of the turbulence slope (TS) emerged as an independent predictor for ventricular arrhythmias. In conclusion, dysrhythmias are frequent in SSc cohorts. Paraclinical and laboratory parameters are useful instruments that could lead to early diagnosis in the course of the disease.

Contributions to the Study on the Effects of Incorrect Implantation of Knee Prostheses Depending on the Degree of Varus / Valgus.

INTRODUCTION: The human knee is one of the most complex human joints, by the number of components, by the stresses to which it is subjected, by the complicated spatial geometry of the components and by the existence of multiple contacts between different components. MATERIAL AND METHOD: A series of modern devices and equipment that were used for the three-dimensional reconstruction of the components of the analyzed systems. RESULTS: Also, the elements of a knee prosthesis were modeled in a parameterized virtual environment and six orthopedic systems were compared. These systems have been studied using the finite element method using loads specific to normal human gait. DISCUSSION: The results obtained consisting of maps of displacements, deformations and stresses were stored, analyzed and compared. CONCLUSIONS: Finally, important conclusions were highlighted.

An Experimental and Virtual Approach to Hip Revision Prostheses.

(1) Introduction: The changes in the joint morphology inevitably lead to prosthesis, but the hip pathology is complex. The hip arthroplasty is a therapeutic solution and can be caused, most frequently, by primary and secondary coxarthrosis due to or followed by traumatic conditions. The main aim of this study was to find the method of revision hip prosthesis that preserves as much bone material as possible and has sufficiently good mechanical strength. (2) Materials and Methods: In this study, in a first step, the two revision prostheses were performed on bone components taken from an animal (cow), and then, they were tested on a mechanical testing machine until the prostheses physically failed, and the force causing their failure was determined. (3) Results: These prostheses were then modelled in a virtual environment and tested using the finite element method (FEM) in order to determine their behaviour under loading from normal human gait. Displacement, strain, and stress maps were obtained. (4) Discussion: Discussions on hip revision prostheses, method, and theory analysis are presented at the end of the paper. (5) Conclusions: Important conclusions are drawn based on comparative analyses. The main conclusion shows that the both orthopaedic prostheses provide a very good resistance.

About the Experimental and Virtual Analysis of Orthopedic Implant Systems for the Revision of the Hip Prosthesis with Morcellated Bone Graft and Reconstruction Net.

INTRODUCTION: Prosthesis loosening is an alteration of the function and position of a total hip prosthesis with reference to the initial surgical moment. The main mechanism unanimously accepted for aseptic prosthetic losses at the level of the cup is represented by the biological mechanism. MATERIAL AND METHOD: Experimental and virtual, interdisciplinary tools, techniques and methods were used to determine the behavior of the hip replacement prosthesis with the morcellated graft and the reconstruction net. Performing an orthopedic assembly with a morcellated bone graft and reconstruction net. An assembly was performed on a hip joint taken from an animal (cow). The biological material and the components of the prosthesis were prepared similarly to the revision prosthesis intervention. Experimental testing of orthopedic assembly with morcellated bone graft and reconstruction net. This assembly was tested on a universal machine to determine the maximum force at which it yields. This was 1790 Kgf, i.e. 17559 N. Virtual experimental testing of the hip joint with orthopedic revision assembly with a morcellated bone graft and reconstruction net for normal gait loading. The orthopedic assembly with the morcellated graft and the reconstruction net was reconstructed in the virtual environment. Normal load was used. Results maps were obtained. CONCLUSIONS: Analyzing the results from the two tests, experimental and virtual, and important conclusions were drawn regarding this orthopedic assembly.

Role of Helicobacter pylori in the triggering and evolution of hemorrhagic gastro-duodenal lesions.

The majority of studies concerning Helicobacter pylori (H. pylori) are oriented towards the implication of infection with H. pylori in processes that end in the formation of neoplasia, without assessing the impact of the bacterium in triggering acute gastroduodenal hemorrhagic episodes. The present study includes 166 patients with upper digestive hemorrhage, admitted to the ATI Clinic, the Gastroenterology Clinic or to the Surgery II Clinic of the County Emergency Clinical Hospital in Craiova, Romania between 2017 and 2019. All patients were monitored for evolution and received treatment according to current guidelines, and hemorrhagic lesions were biopsied. In the study group, 56.8% of the patients with upper gastrointestinal bleeding (UGIB) were positive for H. pylori and 43.2% were negative. In patients less than 50 years of age, non-steroidal anti-inflammatory drug (NSAID) use and H. pylori infection had a cumulative effect in causing bleeding lesions, but in patients older than 50 years of age, the use of NSAIDs was replaced by therapies with oral antiplatelet or anticoagulant agents. The need for hemostasis surgery was more common in patients who exhibited H. pylori-positive UGIB compared to H. pylori-negative (16 vs. 9.7%). In patients with H. pylori-positive hemorrhagic lesions, gastric resection was frequently required to obtain hemostasis. Persistence of H. pylori infection in patients with a history of gastric resection (4.1%) still predisposes to a hemorrhagic or neoplastic complication.

Extracorporeal Septoplasty-A Well Proven Technique for Treatment of Crooked Noses.

Crooked noses (noses with complex septal and pyramidal deviations) are an important challenge for both plastic surgeons and otolaryngologists. Extracorporeal septoplasty, described by Gubisch constitutes an effective solution to this problem. The article describes a series of 7 cases (5 males and 2 females) in which this method was used during open rhinoseptoplasty. The technique we used is described in detail. All the patients showed improvement of the nose appearance and good nasal air flow. Hypertrophy of the right inferior turbinate complicated one case, but was resolved with electro cauterization. Although the learning curve is slow and it claims the surgeon's imagination, the method is sometimes the only solution in complex cases of septal deviation. Our short series demonstrates that good indication and careful dissection are prerequisites for success in difficult cases.

Histological aspects of full-thickness skin grafts augmented with platelet-rich fibrin in rat model.

BACKGROUND AND OBJECTIVES: The restoration of the damaged tissue commences very early with a regulated sequence of biochemical events set into motion to repair the damage. While the understanding of this entire process is still incomplete, it has been established that platelets play a decisive role not only in hemostasis, but also in the wound healing process, through an abundance of growth factors and other signaling cytokines modulating the inflammatory response. To this end, we attempted to evaluate the effect of a platelet-rich biomaterial - platelet-rich fibrin (PRF) - in the augmentation of full-thickness skin grafts (FTSGs). MATERIALS AND METHODS: Skin defects were performed on the rats' dorsum and covered with FTSGs. The test group wound bed was treated with PRF before the suture of the graft. Skin graft specimens were obtained from the control and test group rats for histological and immunohistochemical examination on the 21st postsurgical day. Our study included 40 male Wistar rats. Average thickness of epidermal cell layers was recorded for each wound site. The average fibroblast count was compared between the control and test (PRF-augmented FTSG) groups. Blood vessel count and vascular density - the blood vessels were identified under low-power microscopy. The prominent vascular areas were then scanned in higher-power fields; individual vessels were marked and counted by hand. Vascular density was calculated. Mean vascular count for each graft was then calculated. RESULTS: The mean thickness of the epidermal layer was significantly higher and closer to the physiological epidermal thickness, in the test group than in the control group. The average fibroblast and fibrocyte count in the dermal layer in FTSGs augmented with PRF was higher than in the control group. We discovered a statistically insignificant increase in the blood vessel count and vascular density of the test group, compared to the control group. CONCLUSIONS: Our limited data supports the theory that the addition of PRF to FTSG recipient wound beds has the potential to improve graft take and regulate the proliferation of a thicker and more uniform epidermis, while decreasing healing time and dermal necrosis rates.

Histological findings from rat calvaria defect augmented with platelet-rich fibrin by using two consecutive periosteal incisions.

BACKGROUND AND OBJECTIVES: Platelet-rich fibrin (PRF) is a new generation of biomaterial that proved to be an effective tool in numerous clinical uses. This study aims at expanding the range effectiveness of PRF in promoting bone healing by histological evaluation. MATERIALS AND METHODS: We performed a pair of two calvaria defects on 35 Wistar rats. The left defect was left empty as a control and the right defect was augmented with PRF. After 45 days, the experiment was terminated and the calvaria were collected and underwent morphological and histological analysis. RESULTS: New bone formations have been shown to be prevalent in the PRF augmented defect. CONCLUSIONS: PRF increases the body's natural ability to heal and regenerate bone.

Sepsis and identification of reliable biomarkers for postoperative period prognosis.

Sepsis is currently defined as the presence of organ dysfunction occurring as the result of a disturbed host response to a serious infection. Sepsis is one of the most common diseases, which cause mortality and a considerable absorber of healthcare resources. Despite progress in technology and improving knowledge of pathophysiology, the disease mechanism is still poorly understood. At present, diagnosis is based on non-specific physiological criteria and on the late identification of the pathogen. For these reasons, the diagnosis may be uncertain, treatment delayed or an immunomodulatory therapy cannot be established. An early and reliable diagnosis is essential to achieve better outcomes on disease progression. The host response to infection involves hundreds of many mediators of which have been proposed as biomarkers. There is a need for new diagnostic approaches for sepsis, new sepsis biomarkers that can aid in diagnosis, therapeutic decision and monitoring of the response to therapy. The differentiation of sepsis from non-infectious systemic inflammatory response syndrome is difficult, and the search for a highly accurate biomarker of sepsis has become one important objective of the medicine. The goal of our review is to summarize the recent advances on the most commonly studied serum biomarkers, evaluated in clinical and experimental studies, for early diagnosis of sepsis and their informative value in diagnosis, prognosis, or response to therapy. In this context, we have tracked the clinical utility of measuring serum biomarkers, such as procalcitonin, pro- and anti-inflammatory cytokines, C-reactive protein, leptin and their combinations. Currently, has not been identified an ideal biomarker to aid in the diagnosis of sepsis. It is hoped that the discovery of new serum markers, as well as their combinations, will serve for the diagnosis and prognosis of sepsis.

Prognostic factors in squamous cell carcinoma of the lower lip - an immunohistochemical study.

Squamous cell carcinoma (SCC) of the lip represents 15-30% of SCC of cephalic extremity, located on the lower lip in about 90% of cases. The present paper aimed to define the profile of SCC of the lip with major risk factors. The study included 20 selected cases diagnosed with lower lip SCC, using a panel of antibodies which addressed cell proliferation (Ki67), perturbation of the cell cycle (p53), angiogenesis (VEGF - vascular endothelial growth factor), factors related to tumor cell interaction with the extracellular matrix (CD44). Ki67 immunoexpression was identified in all the cases. Poorly differentiated (PD) SCC presented a mean value of Ki67 positivity index (PI) significantly higher compared to well-differentiated (WD) and moderately differentiated (MD) SCC. We found significantly higher mean values of Ki67 PI in pT3 lesion, compared with pT2 and pT lesions, and with no statistically significant differences in lip SCC with associated lymph node metastasis (pN1), compared to those with no lymph node metastasis (pN0). PD SCC presented a higher mean value of p53 PI compared to WD and MD SCC, but without significant differences. Analysis indicated significantly higher values in pT3 lesions and in pT2 and pT1 and in pN1 SCC. In WD SCC, CD44 immunoexpression had a higher intensity. For PD and MD SCC the immunolabelings presented low÷moderate heterogeneous intensity. WD lip SCC presented a statistically significant higher mean value for CD44 PI compared to MD and PD SCC, and not statistically significant higher in pT1, pT2 then in pT3 and in pN0 cases then in pN1. WD lip SCC presented statistically significant higher mean value of VEGF PI related to those with MD and PD SCC. VEGF PI values were higher in pT1, pT2 then in pT3 and in the pN0 SCC, but without statistically significant differences. We found a positive linear correlation for Ki67÷p53, although statistically not significant and for CD44÷VEGF statistically significant (p=0.001). Also, the analysis identified negative a linear statistically significant correlation for Ki67÷CD44 and for Ki67÷VEGF statistically significant as well (p=0.001). Immunohistochemical investigations in lip SCC, regarding the expression of p53, Ki67, CD44 and VEGF, revealed results that suggest their ability to assess the prognosis and progression of tumor evolution.

Ultrasonography role in the evaluation of a giant cell tumor of the flexor pollicis longus tendon.

Hand tendons lesions represent a challenge for an accurate diagnosis, an optimal treatment strategy, the description of the lesion and its location being an important step. The non-invasive ultrasound evaluation was demonstrated to be an important diagnostic method in these types of lesions, especially in those situations where clinical evaluation failed to reveal the pathological changes and therefore has an important role in the adequate management.

Ultrasonography in the diagnosis and management of non inflammatory conditions of the hand and wrist.

High resolution ultrasonography has already become an important tool in the diagnosis and management of inflammatory arthritis of the hand and wrist but lately it has been proven to be the method of choice in the evaluation of traumatic lesions of tendons, annular pulleys, nerves, and ligaments and at the same time in detecting foreign bodies. The objective of this paper is to review and describe the current knowledge on these US findings and to highlight the ultrasonography role in the evaluation of non-inflammatory conditions of the hand and wrist.