Secondary hyperparathyroidism (SHPT) in chronic kidney disease often necessitates parathyroidectomy (PTX), but this definitive treatment can precipitate hungry bone syndrome (HBS)—a profound, prolonged hypocalcemia caused by the rapid skeletal uptake of minerals after surgery. HBS results from the abrupt cessation of parathyroid hormone (PTH)-driven bone resorption while bone formation continues, leading to intensive mineral deposition (mainly calcium) into chronically demineralized bone. Clinically, HBS ranges from asymptomatic biochemical disturbances to life-threatening hypocalcemia with tetany, seizures, and/or cardiac arrhythmias. This illustrative review synthesizes current knowledge of HBS pathogenesis and management in the context of SHPT. We detail how the high-turnover bone remodeling state of SHPT (osteitis fibrosa cystica) creates an expansive unmineralized osteoid pool that avidly mineralizes post-PTX. We also explore molecular mechanisms (e.g., RANKL/OPG dysregulation, Wnt/β-catenin activation, osteocyte-driven signals, and calcium-sensing receptor effects) that underpin this process. Key preoperative risk factors for HBS include very elevated PTH and alkaline phosphatase levels, large skeletal calcium deficits, younger patient age, and total PTX. We outline the typical postoperative course of HBS, phased from immediate acute hypocalcemia to a nadir and gradual recovery. Prevention and management strategies are emphasized, centered on vigilant monitoring and aggressive calcium and calcitriol supplementation, with preoperative optimization (e.g., vitamin D loading, calcimimetics) to mitigate severity. By enhancing risk stratification and perioperative care, clinicians can improve outcomes and safely navigate patients through this challenging complication of endocrine surgery.

The predictions on the influence of the SARS-CoV-2 pandemic on access to medical services in Romania predicted a 35% drop in oncological hospitalizations in 2020 compared to the previous decade, raising the hypothesis that patients with colorectal cancer can become indirect victims of the ongoing pandemic. Therefore, the aim of the current research was to observe how the COVID-19 pandemic influenced colorectal cancer surgery in Romania, to determine the level of addressability towards specialized care, to compare the cancer staging between the pandemic and pre-pandemic periods, and to observe the risk factors for disease progression. This retrospective study was spread over three years, respectively, from March 2019 to March 2022, and included a total of 198 patients with a history of colorectal cancer surgery. It was decided to perform a parallel comparison of 2019, 2020, and 2021 to observe any significant changes during the pandemic. Our clinic encountered a significant decrease in all interventions during the pandemic; although the number of CRC surgeries remained constant, the cases were more difficult, with significantly more patients presenting in emergency situations, from 31.3% in 2019 to 50.0% in 2020 and 57.1% in 2021. Thus, the number of elective surgeries decreased significantly. The proportion of TNM (tumor-node-metastasis) staging was, however, statistically significant between the pre-pandemic and pandemic period. In 2019, 13.3% of patients had stage IIa, compared with 28.8% in 2020 and 13.1% in 2021. Similarly, the proportion of very advanced colorectal cancer was higher during the pandemic period of 2020 and 2021 (12.0% in 2019 vs. 12.5% in 2020 and 25.0% in 2021), which was represented by a significantly higher proportion of patients with bowel perforation. Patients with an advanced TNM stage had a 6.28-fold increased risk of disease progression, followed by lymphovascular invasion (HR = 5.19). However, the COVID-19 pandemic, represented by admission years 2020 and 2021, did not pose a significant risk for disease progression and mortality. In-hospital mortality during the pandemic also did not change significantly. After the pandemic restrictions have been lifted, it would be advisable to conduct a widespread colorectal cancer screening campaign in order to identify any instances of the disease that went undetected during the SARS-CoV-2 pandemic.

Background/Objectives: Secondary hyperparathyroidism (SHPT) affects 30–50% of end-stage renal disease patients. Parathyroidectomy (PTX), while effective for medication-refractory SHPT, carries 20–70% risk of hungry bone syndrome (HBS)—severe sustained hypocalcemia requiring intensive care and prolonged hospitalization. Accurate preoperative risk stratification using biochemical markers and validated prediction tools is critical for optimal preventive management. Methods: We conducted a comprehensive narrative review synthesizing evidence on HBS predictors after PTX in SHPT, evaluating traditional and novel bone turnover markers, clinical risk factors, and multivariate prediction models, through a structured literature search and analysis. Results: Preoperative bone turnover status represents the strongest contributor to HBS risk. Traditional biomarkers—particularly parathyroid hormone (PTH > 1000–2400 pg/mL) and alkaline phosphatase (ALP > 150–300 U/L)—demonstrate moderate-to-strong individual predictive power. Novel bone turnover markers (bone-specific ALP, P1NP, TRAP-5b) offer incremental value, especially in CKD populations where renal clearance affects traditional markers. Combined risk prediction models substantially outperform single biomarkers, achieving area under curve values of 0.87–0.95. The simple NYU 2-point score (ALP > 150 U/L + PTH > 1000 pg/mL) showed 96.8% accuracy, with 100% negative predictive value. More complex tools like nomograms (C-index 0.92–0.94) and machine-learning algorithms (AUC 0.88) provide enhanced discrimination by integrating multiple continuous parameters. Additional clinical factors—younger age (<48 years), prolonged dialysis (≥5 years), low preoperative calcium, high gland weight, and absence of autotransplantation—further refine risk assessment. Postoperative calcium typically reaches nadir at 48–72 h, defining the critical monitoring window. Conclusions: High-turnover bone biomarkers and combined risk models effectively identify high-risk SHPT patients. Risk-stratified protocols (i.e., prophylactic supplementation, intensive monitoring, and selective ICU admission) can substantially reduce HBS-related morbidity. Ongoing efforts should focus on validating these predictive tools across diverse populations and integrating them into clinical practice, thereby facilitating real-time HBS risk assessment and protocol-driven care.

Introduction: Lipid metabolism plays a crucial role in breast cancer’s progression, treatment response, and prognosis. Alterations in triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) have been implicated in tumor aggressiveness and chemotherapy outcomes. This review examines the relationship between dyslipidemia and breast cancer, with a focus on chemotherapy-induced lipid alterations and their prognostic significance. Methods: A comprehensive literature search was conducted in PUBMED, Web of Science, and Google Scholar, identifying 108 unique studies. After applying the inclusion criteria, 21 studies were selected for analysis, covering lipid profile changes before, during, and after chemotherapy, as well as their impact on treatment response and clinical outcomes. Results: Breast cancer patients exhibited lower baseline TC, TG, and LDL-C levels compared to healthy controls; however, chemotherapy significantly increased these markers while decreasing HDL-C from 1.1 to 0.9 mmol/L. The incidence of dyslipidemia rose from 42.98% pre-treatment to 58.28% post-treatment. Chemotherapy-induced lipid alterations were most pronounced in anthracycline- and taxane-based regimens, leading to a 38% increase in TGs and a 23% reduction in HDL-C. While some studies reported that lipid levels normalized post-treatment, others indicated persistent dyslipidemia up to 12 months later. High baseline HDL-C was associated with a better chemotherapy response, whereas elevated TGs and LDL-C correlated with increased tumor aggressiveness, lower pathological complete response rates, and a higher relapse risk. Patients with persistently high post-treatment TGs had significantly worse disease-free survival, with a 30% relapse rate compared to 18% in those with normal TG. Preliminary evidence suggests that lipid-lowering therapies, such as statins, may offer therapeutic benefits in breast cancer by targeting the cholesterol synthesis pathways involved in tumor growth, though further clinical trials are required. Conclusions: Dyslipidemia is a key metabolic factor influencing breast cancer’s progression, treatment response, and long-term prognosis. Chemotherapy-induced lipid alterations may persist, increasing cardiovascular risk and potentially affecting therapeutic efficacy. Routine lipid monitoring and metabolic interventions could enhance treatment outcomes and survivorship. Future research should focus on developing lipid-targeted strategies to optimize breast cancer management.

Background and Clinical Significance: The current paper presents a retrospective case of a 79-year-old female patient admitted to the Dermatology Clinic of Emergency City Hospital in Timisoara, Romania, in January 2022, reporting intense pruritus and burning sensation of the skin exacerbated at night. Case Presentation: The previously mentioned symptoms appeared approximately six months prior, with gradual and continuous progression. Clinical examination revealed widespread hyperkeratosis on diffuse erythematous background across the entire body, accompanied by crusted lesions predominantly on the arms and legs. Laboratory values showed elevated absolute eosinophil count as well as a positive culture swab to Staphylococcus aureus. Two incisional skin biopsies were performed. Microscopic examination in Hematoxylin–Eosin staining revealed thickened stratum corneum with numerous oval-shaped mites with exoskeleton and striations and moderate perivascular lympho-eosinophilic infiltrate in the superficial dermis, leading to a positive diagnosis of crusted scabies. Following etiological treatment, the patient’s evolution was undulating and on the 10th day of hospitalization presented marked dyspnea, followed by cardiorespiratory arrest, leading to the patient’s death. Conclusions: The patient’s outcome could be explained by a Th2-mediated allergic response to Sarcoptes scabiei allergens, in addition to the presence of Staphylococcus aureus on the damaged skin, as dysbiosis can further support an uncontrolled Th2 reaction, leading to anaphylaxis.

Background/Objectives: Secondary hyperparathyroidism (SHPT) is a prevalent complication in end-stage renal disease, often necessitating surgical intervention when refractory to medical therapy. The optimal surgical strategy—subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with/without autotransplantation (TPTX ± AT)—remains debated, especially considering postoperative complications like persistent HPT and hungry bone syndrome (HBS). This study aimed to compare early surgical outcomes and identify predictors for postoperative complications in patients undergoing SPTX and TPTX + AT. Methods: We conducted a retrospective, single-center observational study involving 93 dialysis patients who underwent PTX for drug-refractory SHPT. Patients were analyzed according to surgical procedure (SPTX vs. TPTX + AT), focusing on postoperative complications such as cervical bleeding, reintervention rates, and the incidence of HBS. Multivariate logistic regression was utilized to identify predictors of these outcomes. Results: TPTX + AT demonstrated superior control of HPT, with significantly lower rates of reintervention compared to SPTX (7.1% vs. 23.5%, p = 0.037). However, TPTX + AT was associated with a higher incidence of HBS (57.1% vs. 35.3%, p = 0.039). Independent predictors of reintervention included absence of concomitant thymectomy, preoperative hypercalcemia, fewer visualized glands preoperatively, and preoperative PTH > 2000 pg/mL. Elevated alkaline phosphatase levels (>300 U/L), severe bone pain, and the TPTX procedure itself were significant predictors of HBS. Conclusions: Surgical strategy for SHPT should be individualized, balancing the lower recurrence risk associated with TPTX + AT against its higher likelihood of postoperative hypocalcemia. Preoperative biochemical markers and clinical features could potentially influence operative decision-making and optimize patient outcomes.