Real-World Data Analysis of Pregnancy-Associated Breast Cancer at a Tertiary-Level Hospital in Romania.

Background and objectives: Breast cancer is among the most common cancer types encountered during pregnancy. Here, we aimed to describe the characteristics, management, and outcomes of women with pregnancy-associated breast cancer at a tertiary-level hospital in Romania. Material and Methods: We retrospectively and prospectively collected demographic, oncological, and obstetrical data for women diagnosed with cancer during pregnancy, and who elected to continue their pregnancy, between June 2012 and June 2020. Complete data were obtained regarding family and personal medical history and risks factors, cancer diagnosis and staging, clinical and pathological features (including histology and immunohistochemistry), multimodal cancer treatment, pregnancy management (fetal ultrasounds, childbirth, and postpartum data), and infant development and clinical evolution up to 2020. Cancer therapy was administered following national guidelines and institutional protocols and regimens developed for non-pregnant patients, including surgery and chemotherapy, while avoiding radiotherapy during pregnancy. Results: At diagnosis, 16.67% of patients were in an advanced/metastatic stage, while 75% were in early operable stages. However, the latter patients underwent neoadjuvant chemotherapy rather than up-front surgery due to aggressive tumor biology (triple negative, multifocal, or HER2+). No patient achieved complete pathological remission, but only one patient relapsed. No recurrence was recorded within 12 months among early-stage patients. Conclusions: In this contemporary assessment of real-world treatment patterns and outcomes among patients with pregnancy-associated breast cancer, our findings were generally consistent with globally observed treatment outcomes, underscoring the need for a multidisciplinary team and reference centers.

Alcohol and Psychoactive Drugs in Pregnancy.

Although often difficult to diagnose, the use of psychoactive drugs during pregnancy has become a commonly encountered occurrence. The present article aims to clarify the effects of alcohol, tobacco, narcotics, antidepressants, stimulants, halucinogenes and canabioids consumption on pregnancy and the newborn. There are differences within the types of drugs consumption: use/abuse/addiction of psychoactive medication during pregnancy. The fetal alcohol syndrome occurs in case of alcohol exposure during pregnancy. It is characterized by fetal alcohol spectrum disorders, lower neurobehavioral scores, mental retardation, heart defects and special facial features. Heroin consumption can lead to prematurity, intrauterine growth restriction, stillbirth or to hemorrhage in the third trimester of pregnancy; it can be associated with malnutrition, venereal diseases, hepatitis, pulmonary complications or preeclampsia. During pregnancy, the effects of cocaine use include cardiovascular complications, neurological complications, infections (sexually transmitted diseases - gonorrhea, Chlamydia infections, syphilis, HPV), obstetric complications (premature birth, fetal death, abruptio placentae). In the fetus, the consequences of cocaine consumption can trigger limb defects, urinary tract malformations, fetal microcephaly, perinatal cerebral infarctions. In conclusion, identifying the profile of pregnant drug users can trigger better care both for the mother, and for the fetus; information and prevention campaigns should provide data on their adverse effects on pregnancy.

Von Willebrand Disease type 2 in pregnancy - A critical clinical association.

Von Willebrand disease (vWD) is the most common inherited bleeding disorder. Its association with pregnancy is infrequent. Here we report three cases of vWD associated with pregnancy. The clinical features of this combination are very suggestive. However, difficulties are still encountered during the diagnosis process. The first case was diagnosed for the first time during the patient's second pregnancy despite several episodes of vaginal bleeding and suggestive clinical symptomatology. The second case was diagnosed during childhood and the patient was properly managed during this pregnancy. The third case was diagnosed at a pre-anesthesia consult, at 36 weeks gestation, before performing a cesarean section on request, despite a clinical suggestive symptomatology. All of the cases received prophylactic treatment with Haemate P® (CSL Behring, Marburg, Germay) 24hours before birth. No serious bleeding episodes were noticed during delivery or postpartum period. Two healthy babies were delivered from the cases Nos. 2 and 3. It is acknowledged that vaginal bleeding is common during first trimester of pregnancy. However, this study indicates that repeated bleeding episodes corroborated with a clinical suggestive symptomatology (epistaxis, heavy menstrual period, and easy bruising after minor trauma) should orient the diagnosis to vWD.

A Statistical Assessment of Information, Knowledge and Attitudes of Medical Students Regarding Contraception Use.

OBJECTIVE: To evaluate how contraception use is linked to information, knowledge and attitudes towards family planning and contraception of medical students. METHODS: This is a voluntary cross-sectional study using an anonymous questionnaire applied to 62 medical students. The questionnaire had the following main structure: characteristics of the studied population, information on contraception, knowledge about contraception methods, attitudes regarding family planning and contraception, and contraception use. Statistical analysis was performed using STATISTICA 8.0 software and statistical significance of the data was verified using the t-statistic test. RESULTS: The survey had a 95% response rate. Seventy seven percent of the studied population consisted of females aged between 20-40 years, with 85.50% of them being 20-25 years old. The overwhelming majority of respondents believed it was important to be informed on the subject and considered themselves to be well informed on contraception. The internet and courses are the main sources of information. Of all respondents, 75.41% had routine discussions with their partners regarding contraception, 53.23% talked about it with family members and 46.77% with their physician; 90.16% had at least one gynecological examination and 47.54% got themselves tested for sexually transmitted diseases. The condom and the contraceptive pill were the main contraceptive methods for the respondents. CONCLUSIONS: Romanian medical students share similar features to their peers in European developed countries. We used a statistical analysis to demonstrate that information, knowledge and attitudes on contraception are closely linked to contraceptive choice.

Telocytes, a distinct type of cell among the stromal cells present in the lamina propria of jejunum.

Conventionally, cells described in the stroma of the intestinal wall are fibroblasts/fibrocytes, mast cells, plasma cells, eosinophils, macrophages and, interstitial cells of Cajal (ICCs), the latter being considered as the pacemakers of gastrointestinal rhythmicity. Recently, a new type of stromal cell called telocyte (TCs) was found in various cavitary and non-cavitary organs (www.telocytes.com). We show here direct electron microscopical evidence for the presence of TCs in the lamina propria of rat jejunum just beneath the epithelial layer of the mucosal crypts and in between the smooth muscle cells (SMCs) of muscularis mucosae. TCs are characterized by: several very long (tens to hundreds of µm) prolongations called telopodes (Tps). Tps (with caliber below the resolving power of light microscopy) display podomeres (thin segments ≤ 0.2 µm) and podoms (dilations accommodating caveolae, mitochondria, and endoplasmic reticulum). Tps present dichotomous branching and form a three dimensional network close to immune cells, SMCs or nerve bundles. TCs could play a role in intercellular signaling and control of local tissue homeostasis.

Imatinib inhibits spontaneous rhythmic contractions of human uterus and intestine.

The interstitial cells of Cajal (ICC) in the digestive tract and ICC-like cells in extradigestive organs express the c-kit tyrosine-kinase receptor, and have been implicated as pacemakers of smooth muscle spontaneous activity. We used imatinib mesylate (Glivec) to investigate whether c-kit activity of Cajal-like cells in human myometrium is involved in spontaneous rhythmic contractions of human uterine smooth muscle, taking intestinal smooth muscle as a reference tissue. We show that imatinib concentration-dependently inhibited the myogenic contractions of human myometrium in the organ bath, while it significantly affected noradrenaline or K(+)-induced contractions only at concentrations exceeding 50 muM. An inhibitory antibody directed against the extracellular domain of the platelet derived growth factor receptor (PDGFR), another target of imatinib that is expressed by the uterine muscle cells themselves, failed to affect myogenic contractions. These results suggest that Cajal-type cells of human myometrium, as well as ICC of intestinal smooth muscle, participate in myogenic contractile mechanisms, via a novel ligand-independent c-kit/CD117 tyrosine-kinase signaling.