CHSJ

Current issue

Current Health Sciences Journal

vol. 52 no. 3, 2026

1. PREVENT Versus the Pooled Cohort Equations: Implications for Contemporary Atherosclerotic Cardiovascular Risk Assessment

K. ENGLISH, K.A. KUMAR, R. GARCIA

Background: Cardiovascular disease (CVD) encompasses multiple vascular conditions, including heart disease, stroke, and coronary artery disease, driven by traditional risk factors. Prompt identification of individuals at high risk of CVD is important for initiation of lifestyle modifications and pharmacotherapy to reduce the risk of major adverse cardiovascular events. Methods: Narrative evaluation of contemporary CVD risk prediction models, focusing on comparison between the PREVENT equation and prior Pooled Cohort Equations (PCE). Results: Multiple risk scores have been developed, including SCORE2 and PCE, with PREVENT introduced in 2023. The 2026 American College of Cardiology/American Heart Association dyslipidemia guideline now recommends using the PREVENT equation for CVD risk stratification. PREVENT provides updated risk estimates but introduces differences from PCE that may affect clinical decision-making. Conclusion: PREVENT represents a guideline-endorsed advancement in CVD risk prediction with potential advantages over PCE, though understanding its limitations is essential for appropriate application in clinical practice.

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2. Neurological Recovery in the Aging Brain: Challenges and Emerging Therapies

D.M. POPESCU, I.K.S. BOBOC, S. PATRU, M.C. PAPA, A. POPA-WAGNER

Restoration of neurological function after stroke, spinal cord injury and neurodegeneration remains limited by irreversible tissue loss, age-associated changes in neural plasticity and the difficulty of translating experimental repair strategies into sustained clinical benefit. This narrative review critically examines pharmacological neuroprotection, rehabilitation, cellular and extracellular-vesicle therapies, and endogenous neuronal reprogramming, with particular emphasis on ischemic stroke and the aged brain. We then evaluate brain-computer interfaces and related neuroprosthetic technologies for motor assistance, communication, rehabilitative feedback and closed-loop neuromodulation. Advances in artificial intelligence are expanding neural decoding and adaptive control, but technical feasibility must be distinguished from demonstrated clinical effectiveness. Evidence is strongest for established responsive neurostimulation in focal epilepsy and conventional deep brain stimulation in selected Parkinson’s disease patients; other invasive motor, speech and brain-spine interfaces remain at earlier stages of clinical evaluation. We propose that biological interventions and neuroprosthetics may eventually provide complementary therapeutic benefits, while emphasizing that combined approaches remain largely hypothetical. Progress will require rigorous patient selection, durable device performance, validated patient-centered endpoints and assessment of functional gains beyond active device assistance.

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3. Descriptive and Comparative Analysis of Skin Tumors of the Face

A. NUTA, M. CIUREA, D. POPA, O. NICA, R. MARINESCU, C. OTOIU, M. PAUNESCU, A. AHMET, B. DOICARU, A.M. CIUREA

Background: Facial skin tumors comprise a wide spectrum of benign and malignant lesions, among which basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) are the most frequent malignancies. Because treatment in this region must achieve complete oncologic excision while preserving both function and appearance, detailed knowledge of the clinicopathological profile of these tumors is essential. This study aimed to evaluate the characteristics of surgically treated facial skin tumors and to compare the main tumor groups with respect to demographic and histopathological features. Materials and Methods: We conducted a retrospective observational study including 297 patients with 368 histopathologically confirmed facial skin lesions who underwent surgical treatment between January 2023 and December 2025 at the Department of Plastic and Reconstructive Surgery, Emergency County Clinical Hospital of Craiova. Demographic data, histopathological diagnosis, BCC subtype, SCC grade, ulceration, deep invasion, anatomical location, and reconstructive techniques were collected. Descriptive statistics were complemented by between-group comparisons using chi-square, Fisher’s exact, and exact binomial tests, with Wilson 95% confidence intervals (CI) for proportions. Results: The sex distribution was balanced, with a non-significant male predominance (53.2%, p=0.296), and benign (51.1%) and malignant (48.9%) lesions occurred in nearly equal proportions (p=0.715). BCC was the most frequent malignancy (125/180), corresponding to a BCC:SCC ratio of approximately 2.7:1. Ulceration was significantly more frequent in BCC than in SCC overall (66.4% vs 42.6%, p=0.008), a difference driven by the uniformly non-ulcerated in situ SCC subgroup; among SCC, ulceration was strongly associated with invasive disease (p<0.001). Within the BCC group, the nodular subtype showed significantly higher rates of ulceration and deep invasion than the indolent adenoid and superficial subtypes (p<0.001 and p=0.007, respectively). The nasal region was the most commonly affected site (43.8%). Reconstruction was individualized according to defect size, location, and tissue availability, with local flaps representing the most frequently used technique. Conclusions: In this surgical series, benign and malignant facial tumors occurred with comparable frequency, BCC predominated among malignancies, and ulceration emerged as a clinically useful marker of invasive behavior. Successful management relies on complete surgical excision combined with individualized reconstruction, while careful histopathological assessment remains essential for risk stratification and follow-up.

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4. Video-Assisted Thoracoscopic Surgery versus Open Sternotomy for Cardiac Procedures: A Cohort Study of Comparative Outcomes

W. ALI, A. RAZA, R. FAISAL, M.A.A. MALIK, A. MANSOOR, O. MUDASSIR, M.N.M.A. MALIK, A.R. AKRAM, S.M. HAIDER, A. AHMADZAI, A. SAEED

Background: Median sternotomy is the conventional method of cardiac surgery, yet has postsurgical complications and long recuperation periods. Video-assisted thoracoscopic surgery (VATS) is a new minimally invasive option that may give patients a better recovery without compromising safety. Methods: A retrospective cohort study was conducted using medical records from tertiary cardiac surgery hospitals. A total of 400 adult patients were included, comprising 187 patients who underwent VATS and 213 who underwent open sternotomy. Demographic and clinical characteristics, ICU stay, hospital stay, ventilation time, postoperative complications, and mortality were assessed. Comparisons were made using Mann-Whitney U and chi-square tests, and multivariable regression analyses were performed to account for confounding factors. Results: Patients in the VATS group had significantly shorter ICU stays (2.0 vs. 3.0 days, p<0.001), hospital stays (6.0 vs. 8.0 days, p<0.001), and ventilation times (16.0 vs. 30.0 hours, p<0.001). Postoperative infection (8% vs. 15%, p=0.028) and bleeding (5% vs. 11%, p=0.041) were less frequent following VATS. There was no significant difference in mortality rates between the groups (2% vs. 3%, p=0.512). The relationship between VATS and better recovery and fewer complications was confirmed by the adjusted analyses. Conclusions: VATS was associated with better postoperative recovery and fewer complications than open sternotomy, despite similar short-term mortality rates. VATS proves to be a safe and effective minimally invasive option for particular cardiac surgery patients, according to these results.

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5. Structured MRI Reporting as an In-Workflow Educational Tool for Rectal Cancer Staging During Radiology Residency: An Exploratory Pilot Study

M.A. ENE, L.M. FLORESCU, A.G. NASCU, C.M. CIOFIAC, R.V. TEICA, I.A. CIRLIG, A.S. DOMENCO, I.A. GHEONEA

Objectives: This exploratory pilot study assessed whether structured reporting (SR) could improve primary rectal cancer MRI reports among radiology residents in a low-exposure training setting. Methods: A pre-study survey was administered to 56 residents at a single training center; 45 responded (80.4%), and only five reported more than 15 prior rectal cancer MRI cases. Twelve residents were stratified by prior exposure and randomized into two balanced groups. In Phase A, Group 1 reported three cases using free text (FT), while Group 2 used an SR template. Afterward, Group 1 attended a focused mini-course, whereas Group 2 received individualized case-based feedback. In Phase B, both groups reported three new cases using SR. For each case, 15 descriptors were classified as omitted, incorrect, or correct. Results: In Phase A, SR was associated with fewer omissions than FT reporting (5.6% vs. 24.4%; p=0.004). Correctness was descriptively higher with SR (65.6% vs. 47.8%; p=0.108), while error rate was also higher (30.0% vs. 22.2%; p=0.044). In Phase B, no significant between-group differences were observed. In Group 1, switching from FT to SR reduced omissions (24.4% to 0.0%; p=0.031). Conclusions: SR was associated with immediate improvements in report completeness among radiology residents. Its educational value may derive from converting unreported descriptors into explicit interpretative attempts, creating opportunities for targeted feedback, and serving as an educational scaffold. Larger multicenter studies with delayed follow-up are needed to confirm these findings and assess long-term learning effects.

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6. Assessment of the KRAS rs61764370 Polymorphism as a Genetic Risk Factor for Colorectal Cancer in a Romanian Population-A Preliminary Study

T.C. BERISHA, M. SCHENKER, A.M. CIUREA, A.M. MEHEDINTEANU, R.A. SCHENKER, SS. SOSOI, P. O. STOVICEK, M.G. CUCU, B.C. ALBU, F. BURADA, M.L. CARA

Background: The KRAS 3?UTR let-7 complementary site 6 (LCS6) polymorphism rs61764370 has been proposed as a susceptibility marker for colorectal cancer (CRC), but most published work has addressed prognosis and treatment response rather than disease risk, and no case-control data exist for Eastern European populations. Methods: We genotyped rs61764370 by TaqMan allelic discrimination in 107 patients with histologically confirmed colorectal adenocarcinoma and 329 cancer-free controls from South-West Romania. Susceptibility was assessed under codominant, dominant, recessive, and allelic models. Results: Genotype distributions were consistent with Hardy-Weinberg equilibrium in both cases (p=0.596) and controls (p=1.000). The G allele frequency was 10.3% in cases and 7.0% in controls. The TG genotype was more frequent in cases (20.6%) than controls (13.4%), but no comparison reached significance: codominant OR=1.671 (p=0.074), dominant OR=1.633 (p=0.086), and allelic OR=1.524 (p=0.119). The recessive model could not be reliably estimated, as no GG homozygote was found among cases and only one among controls. Genotype distribution was not significantly associated with sex, tumor location, stage, or histological grade. Conclusions: rs61764370 was not significantly associated with colorectal cancer susceptibility in this Romanian population. Estimates were consistently above unity but imprecise, and the near absence of GG homozygotes precluded evaluation of recessive inheritance. Larger studies are required before a modest susceptibility effect can be excluded.

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7. Reliability and Validity of the Greek Version of the Needs Assessment Tool for Family Caregivers of Cancer Patients

V. SAKELLARIOU, I. TSATSOU, M. MANTZOROU, N. SKANDALAKI, O. GOVINA, T. I. KONSTANTINIDIS

Background: Cancer deeply impacts family caregivers, leading to significant burden, unmet needs, and a decline in their overall quality of life. The primary aim of this study was to evaluate the reliability and validity of the Greek version of the Needs Assessment Tool for Family Caregivers-Cancer (NAFC-C). Methodology: A cross-sectional study was conducted at a tertiary anticancer hospital in Athens involving a convenience sample of 100 caregivers. Participants completed the Greek version of the 27-item NAFC-C and the revised Bakas Caregiving Outcomes Scale (BCOS). Reliability was tested using Cronbach’s alpha for internal consistency and Intraclass Correlation Coefficients (ICC) for test-retest stability. Validity was assessed through Confirmatory Factor Analysis (CFA) and correlation with the BCOS. Results: Participants were primarily female (72%), married (74%), and most frequently the patient’s spouse (44%).The CFA confirmed that the four-factor model, comprising psychosocial, medical, financial, and daily unmet needs, provided an excellent fit for the Greek population. Strong positive correlations were observed between these factors, particularly between psychosocial and medical unmet needs (r=0.99). Convergent validity was confirmed through a moderate but significant negative correlation between the total NAFC-C score and the BCOS scale (r=-0.35, p<0.001) indicating that higher unmet needs were associated with less favorable caregiving outcomes. The instrument also demonstrated high internal consistency, with a total Cronbach’s alpha of 0.894 and individual factor alphas ranging from 0.601 to 0.755.Additionally, test-retest reliability was confirmed with ICC values for the 27 items ranging from 0.51 to 0.95 (p<0.05), demonstrating strong stability over time. Conclusion: The Greek version of the NAFC-C is a valid and reliable instrument for evaluating the diverse needs of informal cancer caregivers. Its implementation in clinical practice can help healthcare professionals identify overlooked caregiver needs and improve the overall quality of care for both patients and their families in the Greek healthcare system.

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8. Diagnostic Performance of Complete Blood Count-Derived Inflammatory Indices in Ankylosing Spondylitis: A Case-Control Study

C.A. BOENGIU, A.M. BOENGIU, C.C. DRAGOMIRESCU, A.M. BUGA, A.L. BARBULESCU

Ankylosing spondylitis (AS) is an inflammatory disease associated with persistent inflammation and progressive structural damage. Conventional markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), may remain normal despite active disease, highlighting the need for additional biomarkers. Hematological inflammatory markers from routine blood tests have emerged as inexpensive indicators of systemic inflammation. This study assessed the diagnostic performance of hematological inflammatory indices in AS and investigated their relationship with clinical status and functional capacity. This retrospective case-control pilot study included 17 radiographic AS patients and 16 controls. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) were calculated. ROC analysis estimated discriminative ability, and Spearman correlation evaluated associations with BASDAI, ASDAS, and HAQ scores. NLR, PLR, SII, SIRI, and AISI were markedly elevated in AS versus controls, whereas MLR did not differ significantly. NLR had the best discriminative performance (AUC=0.930), followed by SII (AUC=0.912) and PLR (AUC=0.857). At the optimal cut-off (>3.028), NLR achieved 94.12% sensitivity and 93.75% specificity. None of the indices correlated significantly with disease activity or functional status. CBC-derived inflammatory indices, especially NLR and SII, exhibited good discriminative performance for AS, even when conventional inflammatory markers were not significantly different. Further large-scale, multicenter prospective studies are necessary to confirm these results and establish their clinical applicability.

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9. AI-Assisted Tooth Detection and Segmentation Workflow on Orthopantomograms Using the FDI Notation

D.A. LUTESCU, C.C. MANOLE, R. ILINCA, R.C.W. CHAU, A.C. DIDILESCU

Background: Automated tooth detection and segmentation on orthopantomograms (OPGs) is a foundational task for AI-based dental diagnostics. Most published studies have focused on subsets of the dentition or employed rectangular bounding boxes that inadequately capture overlapping dental structures. This study developed and evaluated a YOLO26s-seg instance segmentation model for polygon-based detection and FDI-based identification of all 32 permanent tooth classes on a publicly available panoramic dataset. Methodology: A convenience sample of 282 OPGs from the Tufts Dental Database was annotated with polygon-based FDI labels using an in-house browser-based platform. The dataset was partitioned at the patient level into training (n=197), validation (n=42), and test (n=43) subsets. A YOLO26s-seg model was trained using transfer learning at 1280×1280 resolution with laterality-preserving augmentation. Results: On the held-out test set, the model achieved box-level precision of 0.883 and recall of 0.892, mAP50 of 0.896 (95% CI: 0.865-0.923) for detection and 0.890 (95% CI: 0.858-0.919) for segmentation, and mAP50-95 of 0.620 and 0.556, respectively. Twenty-eight of 32 classes exceeded a box-level mAP50 of 0.80, with three of the four lowest-performing classes located in the mandibular left quadrant. Conclusions: YOLO26s-seg achieved strong mAP50 performance for instance segmentation and FDI identification of all 32 permanent tooth classes. The workflow provides a transparently reported research benchmark; clinical effectiveness was not evaluated.

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10. Integrated Clinicopathological Assessment of Endometrial Polyps as Heterogeneous Proliferative Lesions in Reproductive-Aged Women

V.T. MOTATEANU, R.G. CAPITANESCU, M. OLINCA, T.A. GEORGESCU, N.D. OPRESCU, A.C. COMANESCU, S. PAITICI, A.V. TETILEANU, N.L. VOICU, C. BERCEANU

Background: Endometrial polyps (EPs) are heterogeneous focal proliferative lesions with variable clinical, ultrasonographic (US), and histopathological features across reproductive age. Objective: To characterize EPs in reproductive-aged women using an integrated clinical, US, histopathological, and immunohistochemical (IHC) approach, with emphasis on age-associated differences. Methods: This retrospective multicenter study included 62 premenopausal women aged 28-49 years with histopathologically confirmed EPs. Participants were equally stratified into Group A (28-38 years, n=31) and Group B (39-49 years, n=31). Clinical, metabolic, US, histopathological, and representative IHC data were comparatively assessed. Results: Abnormal uterine bleeding was significantly more frequent in Group B than in Group A (90.32% vs 41.94%, p<0.001). Group B also showed higher frequencies of irregular cycles, infertility, mixed histological subtypes, and heterogeneous lesion and background endometrial morphology, together with larger lesions and increased endometrial thickness. Glandular crowding was significantly more frequent in Group B (54.84% vs 29.03%, p=0.039), while cystic glandular dilatation, increased gland-to-stroma ratio, nuclear atypia, and disordered proliferative or hyperplastic background endometrium were also more common. Most lesions were solitary and regularly contoured, with a feeding vessel identified in 64.52% of cases. IHC assessment demonstrated loss of PAX2 expression and a high, heterogeneous Ki-67 proliferative index in representative lesions. Conclusion: EPs in reproductive-aged women display age-associated clinical and morphological heterogeneity. Integrating clinical presentation, US morphology, histopathological architecture, and background endometrial features may provide a more comprehensive framework for lesion assessment.

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11. Evaluating Health Literacy In Patients with Type 2 Diabetes Treated in Primary Health Care in the Attica Region of Greece

M. MILAKA, E. VLACHOU, I. KALEMIKERAKIS, A. KOULOURI, I. TSATSOU, A. KAVGA-PALTOGLOU

Background: Effective management of Type 2 Diabetes Mellitus (T2DM) requires high health literacy (HL). This study evaluated the multidimensional HL of patients with T2DM in Primary Health Care (PHC) structures in Greece, which serve as the first point of contact for DM management. Methodology: This quantitative, cross-sectional study included 201 patients from PHC structures in Attica. Participants completed the Literacy Assessment Scale for Diabetes (LAD), the Diabetes Knowledge Test (DKT), and the Diabetes Numeracy Test-5 (DNT-5). Results: Participants demonstrated high oral reading ability (LAD mean: 57.8) but moderate diabetes knowledge (DKT mean: 9.0) and numeracy (DNT-5 mean: 2.0). Statistically significant moderate positive correlations were found between all three scales (p<0.001), with the strongest relationship between knowledge and numeracy (r=0.56). Educational level was the most robust positive predictor across all domains. Conversely, increased age and comorbidities significantly hindered numeracy skills. Patients living with DM for more than five years demonstrated significantly higher DKT and DNT-5 scores in the adjusted models. Conclusions: A significant gap exists between basic reading ability and diabetes comprehension. PHC models should shift from physician-centric information delivery to multidisciplinary, interactive approaches, to ensure patient understanding and improve self-management outcomes.

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12. The Interrelationship Between Psychosocial Adjustment and Spiritual Well-Being in Haemodialysis Patients and Their Family Caregivers

M. SKOULATOU, I. KALEMIKERAKIS, O. GOVINA, A. KAVGA-PALTOGLOU

Background: Patients undergoing maintenance haemodialysis and their family caregivers experience substantial psychosocial challenges. The objective of this study is to examine the associations between psychosocial adjustment and spiritual well-being in patients on maintenance haemodialysis and their family caregivers, and to identify factors independently associated with psychosocial adjustment. Methodology: A multicenter cross-sectional observational study was conducted with 130 patient-caregiver dyads in haemodialysis units in Greece. Data were collected through validated questionnaires assessing psychosocial adjustment, spiritual well-being, and sociodemographic characteristics. Correlational and univariate statistical analyses were performed. Variables associated with psychosocial adjustment in the univariate analyses were subsequently entered into multiple linear regression models to identify factors independently associated with psychosocial adjustment. Results: Patients demonstrated moderate difficulties in psychosocial adjustment, while caregivers showed moderate- to-good adjustment. Both groups reported moderate-to-high spiritual well-being. In correlational analyses, higher spiritual well-being was associated with better psychosocial adjustment, while psychosocial adjustment scores of the two groups were positively correlated. In multivariable analyses, spiritual well-being measures remained independently associated with several psychosocial adjustment domains. Younger age and employment were associated with better adjustment, whereas diabetes mellitus, cardiovascular disease, and more frequent caregiver accompaniment to haemodialysis were associated with greater adjustment difficulties. Conclusions: Spiritual well-being was associated with psychosocial adjustment in both patients and caregivers. Significant associations were also observed between patients’ and caregivers’ psychosocial adjustment. Several demographic, clinical, caregiving-related, and spiritual factors remained independently associated with patients’ psychosocial adjustment. These findings support the importance of psychosocial and spiritual dimensions within haemodialysis care.

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13. The Systemic Immune-Inflammation Index Reflects Disease Activity and Functional Limitation in Spondyloarthritis: A Single-Center Cross-Sectional Analysis

R.D. UNGUREANU, C.E. BITA, M.N. VOICU, A. TURCU-STIOLICA, S.C. FIRULESCU, M. TURCU-STIOLICA, A.L. BARBULESCU, S.C. DINESCU, A. TCACIUC, F.A. VREJU

Objectives: The Systemic Immune-Inflammation Index (SII) has emerged as a promising biomarker in inflammatory rheumatic diseases, yet its behavior across spondyloarthritis (SpA) subtypes remains poorly characterized. This study aimed to evaluate SII and its associations with disease activity (BASDAI), functional impairment (BASFI), and clinical subgroups in SpA patients. Material and Methods: This cross-sectional study included 64 patients with SpA classified according to ASAS criteria: 32 with axial SpA, 8 with peripheral SpA, and 24 with psoriatic SpA. SII was calculated as (Platelets × Neutrophils)/Lymphocytes. Between-group comparisons were performed using Kruskal-Wallis, Chi-square/Fisher’s exact, and Mann-Whitney U tests. Spearman correlations were computed between SII, BASDAI, BASFI, age, and BMI. The study adhered to STROBE guidelines for cross-sectional studies. Results: The mean SII was 834±505, with no significant differences across SpA subtypes (?²(2)=0.44, p=0.80, ?²=7.05×10?³). SII correlated significantly with BASDAI (?=0.350, p<0.01) and BASFI (?=0.316, p<0.05), and inversely with BMI (?=?0.250, p<0.05). ROC analysis for discriminating active disease (BASDAI?4) yielded an AUC of 0.612 (95% CI 0.421-0.803), with an optimal SII cutoff of 565 (sensitivity 63.5%, specificity 58.3%, PPV 86.8%, NPV 26.9%). SII did not differ significantly by diabetes (p=0.73), though hypertension showed a borderline trend (p=0.09). Conclusions: SII correlates significantly with disease activity and functional impairment across the SpA spectrum, supporting its potential as a readily accessible, subtype-agnostic inflammatory biomarker. The proposed cutoff of 565 for active disease requires validation in larger cohorts. Longitudinal studies are needed to establish SII’s utility in treatment monitoring.

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14. Photodynamic Therapy for Peripheral Ossifying Fibroma: A Case Report and Review of Literature

S. ACHARYA, V. SHARMA, P. SHUKLA, M. SRIVASTAVA

In general practice, clinicians oftenly come across various types of gingival growth. For which mostly the poor oral hygiene or effect of certain medication is responsible for the same. Histologically these lesions are also termed as “reactive lesion of gingiva”. In the present case report, a young adult with POF was diagnosed, clinically managed and follow up for 6 months for any recurrence. Uniqueness of the case report lies in the use of multiwave soft tissue laser diode to overcome the noncompliance towards surgical excision. Added benefit like less operative, post-operative pain, ease of soft tissue ablation, hemostasis, instant sterilization and reduced bacteraemia over conventional deep excision of the overgrowth is discussed as well.

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15. Posttraumatic Diaphragmatic Hernia Managed by Laparoscopic Repair: Case Report and Review of the Literature

A. DOBRINESCU, T. BRATILOVEANU, A. MANOLICA, B. MARUNELU, M. ENACHE, V.M. SURLIN

Posttraumatic diaphragmatic hernia (PTDH) is an uncommon but potentially life-threatening consequence of blunt or penetrating thoracoabdominal trauma, occurring in an estimated 1-7% of such injuries. Because clinical and radiological signs are frequently subtle or masked by associated injuries, PTDH is missed at initial presentation in up to 30% of cases and may become apparent only months or years later, when herniated abdominal viscera cause obstruction, incarceration or strangulation. We report a 62-year-old woman who, approximately three months after a blunt (crush/rollover) thoracoabdominal trauma, presented with pain at the base of the left hemithorax and dyspnoea; chest imaging demonstrated a left-sided diaphragmatic hernia with intrathoracic herniation of the stomach. The patient underwent laparoscopic repair, with reduction of the herniated stomach and reinforcement of the diaphragmatic defect using a composite mesh (Ventralight). The postoperative course was favourable. We correlate this case with a review of the literature covering the pathophysiology and morphology of diaphragmatic injury, the diagnostic accuracy of available imaging and endoscopic modalities, the American Association for the Surgery of Trauma (AAST) diaphragm injury grading, and current evidence-based operative strategies, including the indications for primary suture versus mesh reinforcement and the technical principles of laparoscopic repair. This case underscores the importance of maintaining a high index of suspicion for diaphragmatic injury based on trauma mechanism alone, and supports laparoscopy as a safe and increasingly preferred approach for both acute and delayed PTDH repair in haemodynamically stable patients.

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16. Pulmonary Complications in Wiskott-Aldrich Syndrome

G. PEREIRA FIGUEIREDO, L. CAMPANHA GARCIA, M.A. DURAN NARDOCCI, T.FERREIRA TAVARES, A. ANTUNES CETLIN

Wiskott-Aldrich Syndrome (WAS) is a rare primary immunodeficiency that presents with thrombocytopenia, eczema, and recurrent respiratory infections, leading to severe pulmonary complications. This report describes the case of a 32-year-old man with the classic form of WAS who opted not to undergo hematopoietic stem cell transplantation. The patient developed bilateral bronchiectasis and subsequently an aspergilloma, presenting with recurrent, difficult-to-control hemoptysis. Due to severe thrombocytopenia and borderline pulmonary function, surgical resection was contraindicated. Following a multidisciplinary discussion, bronchial artery embolization was used as the primary measure for hemorrhage control, combined with antimicrobial and antifungal therapy. The case illustrates the complex therapeutic dilemma in managing the pulmonary sequelae of WAS in the context of advanced lung disease, highlighting the importance of a multidisciplinary approach for high-risk patients, as well as exposing the socioeconomic challenges faced by individuals with rare diseases.

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