The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Monica Mihaela Cirstoiu

Monica Mihaela Cirstoiu

Metaplastic Breast Cancer – a Rare, Aggressive Condition with a Poor Prognosis

Metaplastic breast cancer (MBC) is a rare, aggressive form of breast cancer first described by pathologists in 2000. It is usually discovered in advanced stages and has a low survival rate. It is divided into various subtypes: lowgrade adenosquamous, fibromatosis-like metaplastic, squamous cell, spindle cell, metaplastic with mesenchymal differentiation (including chondroid, osseous, or other types), mixed metaplastic, and myoepithelial carcinomas. Surgery is the treatment of choice, followed by adjuvant chemotherapy and/or radiotherapy. We present the case of a 44-year-old woman with metaplastic breast cancer, reviewing the characteristics of this condition, the particularities of the case, and the treatment chosen in this particular situation.

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Correlation Between Early Diagnosis of Ovarian Neoplasm and Long-Term Prognosis

Ovarian cancer is the seventh most commonly diagnosed cancer in women, with the highest mortality rate among female genital cancers. Due to the nonspecific symptoms and the lack of effective screening strategies, ovarian cancer is often diagnosed in an advanced stage of the disease, with a 5-year survival rate of 25%. The efforts of specialists are aimed at identifying screening methods, with the lowest possible rates of false positive or false negative results in order to diagnose the disease at an early stage, when the 5-year survival rate is 92%. In this study we analyzed the incidence of ovarian cancer in the last five years in the Bucharest University Emergency Hospital, being registered 153 cases of ovarian cancer. The aim of this paper is to analyze the correlation between the early diagnosis of ovarian cancer and the long-term prognosis.

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Obstetrical and Neonatal Outcome of Pregnancies Complicated with SARS-CoV-2 Infection

COVID-19 pandemic had an impact without precedent. Pregnant women are part of the vulnerable population and the extent of SARS-CoV-2 infection consequences on obstetrical and neonatal outcome are still studied. It’s been speculated, based on what is known about other pathogenic viruses, SARS-CoV-2 virus can interfere with placental defense mechanisms and increase the miscarriage and preterm birth rate. Often, pregnant women infected with SARS-CoV-2 virus develop mild pneumonia. Severe pneumonia occurs very rarely and is statistically significant related to neonatal death. Our study has been conducted in a multidisciplinary hospital unit and included 184 pregnant women with SARS-COV-2 infection who gave birth in our hospital, diagnosed through polymerase chain reaction. There have been analyzed data regarding the maternal symptomatology, the gestational age, the method of giving birth, complications that have occurred during birth, the newborns weight and neonatal outcome through Apgar score. There have been three cases of severe infection with maternal death and one case with neonatal death.
Overall, 20% of patients had mild symptomatology, 2% had severe form and the rest of the patients were asymptomatic. We found a high rate of preterm birth and intrauterine growth restriction and an increase incidence of acute fetal distress followed by caesarean section. SARS-CoV-2 virus affects both the mother and the fetus as a whole and, subsequently, individually. Our results show the adverse obstetrical and neonatal outcome in peripartum period complicated with SARS-CoV-2 infection even in asymptomatic and mild-symptomatic cases.

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Pandora’s Box: Autoimmune Hypothyroidism Treatment During Pregnancy

There are international protocols for the management of hypothyroidism induced by autoimmune thyroid disease during pregnancy. In this descriptive study, we analyzed the implementation of international protocols regarding these pathologies, in local clinical practice. Analyzing the cases admitted to the Obstetrics and Gynecology department of Bucharest University Emergency Hospital on a period of 55 months, we identified the pregnancies with autoimmune hypothyroidism treated with Levothyroxine (LT4). We determined the prevalence of specific immunological markers for autoimmune hypothyroidism in pregnant women, we analyzed whether they are associated with distinct clinical phenotypes and ultrasound characteristics, and also, we evaluated the treatment of choice. Measurement of thyroglobulin antibodies, thyroid peroxidase antibodies, Thyroid-Stimulating Hormone, free fractions of Triiodothyronine and Thyroxine with substitute treatment instituted early (in the first 2 weeks postnatal) determine the normalization of cognitive development, especially in areas known for iodine deficiency, including Romania.

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Comparative Analysis of Vertical Transmission of SARS-CoV-2 Antibodies in Vaccinated and Non-Vaccinated Pregnant Women

Pregnancy is a risk factor for developing a severe, complicated form of COVID-19. Medical reports have revealed that pregnancy increases three times the risk of ICU admission and 1.7 times the risk of death in patients with COVID-19. The crossing of the placenta by the antibodies generated through vaccination offer a level of protection that should not be ignored. We aimed to comparatively analyze the levels of SARS-CoV-2 IgG and IgM antibodies in pregnant women who have had this infection during pregnancy or have undergone a complete vaccination cycle during pregnancy, as well as antibody levels in newborns. The inclusion criterion was history of SARS-CoV-2 infection during pregnancy or COVID-19 complete vaccination. For each case the peri-partum values of IgG and IgM SARSCoV- 2 antibodies were analyzed in the same laboratory along with those of their newborns. The vaccination rate in our study group was about 6%. All cases had a significant value of protective IgG SARS-CoV-2 antibodies and the level of protective antibodies of the newborns closely followed maternal values. From the cases with SARS-CoV-2 infection during pregnancy, only 16.6% had a protective level of antibodies and 75% of the newborns from these cases had protective levels of IgG SARS-CoV-2 antibodies. Our results clearly plead in favor of vaccination in pregnancy
which provides significant benefits for both mothers and infants.

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