Background and Objective: Doctors should have full loyalty to their patients, while patients should be able to trust that physicians will act only in their best interests. However, doctors may be faced with situations where they must choose between the patient’s interests and those of a third party. This article presents the results of a study that aimed to identify situations of duality in the decision-making process of medical workers, which can compromise their ethical behavior. Materials and Methods: A cross-sectional study was carried out on a sample of 1070 participants, employed in 120 healthcare facilities in the Republic of Moldova. An online questionnaire was completed anonymously. Descriptive statistics for discrete data were performed by estimating absolute and relative frequencies. To perform the multivariate analysis, the logistic regression was applied. Results: A large number (74.4%) of respondents admitted that they had faced situations of conflicts of interest. Every third respondent (35.3%) had experienced ethical dilemmas when access to expensive treatments should be ensured. Every fourth respondent experienced a conflict between the patient’s interests and those of the institution (26.1%) or the insurance company (23.3%). As age increases, the probability of reporting the dilemma decreases. Physicians reported such dilemmas almost 3 times more often than nurses. A low rate of staff sought support when faced with dilemmas. Half of the respondents (50.6%) preferred to discuss the problem only with a colleague, and 40.1% preferred to find solutions without anyone’s help. There were significant gaps within organizations in terms of the ethical dimension of the decision-making process. Conclusions: Managers should adopt clear institutional policies and tools to identify and prevent situations of dual loyalty. Ethical support should be offered to employees facing such situations. The need to promote an institutional climate based on trust and openness becomes evident.

Background: Depression and anxiety are associated with increased perception of pain severity. Because patients with a depressive disorder and anxiety often report pain, their sensitivity to experimental pain is controversial, probably due to differences in sensory testing methods and the lack of normal values. Material and methods: The study was conducted on 140 selected subjects. The pain test was performed using a technique, called the submaximal effort tourniquet technique. Before the start of the study, a set of psychometric inventories and tests was prepared (visual analog scale, Beck Depression Inventory, Spielberger’s State and Trait Anxiety Inventory). Results: No differences in pain perception have been found in men and women as well as in relation to age, thus gender and age cannot be a predictor in pain perception. The anxiety has no effect on pain perception. The depression can be considered a predictor of pain intensity because a change in depression levels determines a change in pain intensity perception at the 3rd minute. If the depression category was changed from a patient with no depression to one with mild depression, pain intensity at minute 3 increased by approximately one point on the visual analog scale (B=.954, CI95% .200, 1.709, p=.014). Conclusions: Depression can be considered a predictor in the evolution of pain perception. Not so much the depression score, but the increase in the severity of depression can predict the evolution of pain perception.

Background/Objectives: Cancer Therapy-Related Cardiac Dysfunction (CTRCD) is a major complication in patients with non-Hodgkin lymphoma (NHL), potentially leading to heart failure and other severe cardiovascular events. Early identification of patients at risk is crucial for timely interventions. Methods: A prospective analytical cohort study was conducted on 127 adult NHL patients to evaluate chemotherapy-related cardiac dysfunction over a 6-month period, with the aim of assessing early adverse cardiac effects. Assessments included echocardiography, cardiorespiratory exercise testing, 24-h Holter monitoring, and measurement of cardiac-specific biomarkers (troponin I and NT-proBNP) to identify early subclinical cardiac changes. Results: A predictive model for CTRCD was developed using clinical, serological, echocardiographic, cardiopulmonary, and treatment-related parameters in patients with non-Hodgkin lymphoma. The model demonstrated high overall accuracy (94.2%) and strong discriminative ability (AUC 0.95; precision-sensitivity AUC 0.824) for 6-month cardiotoxicity. SHAP analysis identified the most influential predictors as baseline SDNNi, mean daily heart rate, total doxorubicin dose, NT-proBNP, QT corrected interval, hemoglobin, age, left atrial volume, and diastolic function indices (E/e′, E/A). Lower cardiopulmonary reserve was also associated with increased risk. Conclusions: The predictive model developed in this study serves as a practical and robust tool for assessing the risk of cancer therapy-related cardiac dysfunction.

Introduction: Metabolic disorders are a public health issue because of the complications they cause, but they are also a major risk factor for the onset of gout. Aim: The current study set out to demonstrate clinically how the clinical-paraclinical evaluation methodology had advanced as well as to assess comorbidity in gout patients using diabetes mellitus (DM). We also wanted to examine the pancreatic dysfunction in gout patients of different ages (by assessing the glucose and glycolated Hb analyses). Materials and methods: Two hundred gout patients (mean age, men 60±8.0 years, women 63±9.0 years) were included in a descriptive, cross-sectional study. The diagnosis of gout was made according to the classification criteria for gout according to ACR and EULAR 2015. The raw data were analyzed using SPSS v. 26.0. Results: In the study, type 2 diabetes mellitus (DM2) was encountered with a comparable frequency among both middle-aged and elderly patients (33.8% and 41.8%, respectively, p=0.26). In only 15% of cases, DM2 preceded the development of gout (in 3% with the beginning and 12% with late onset), while the developmental age of the DM2 prior to gout was comparable (50.9±2.8 years in age group 1 and 55.1±6.9 years in age group 2). We found that elderly people experience gout much more frequently (up to 41%) when DM2 is present. However, DM2 is not considered a predictor of gout. Conclusions: In gout patients under the age of 59 inclusive, the mean age at diabetes onset is significantly lower than the age (37.49.6 years) at which diabetes develops in the general population. Early onset of diabetes is associated with early development of gout.

Introduction: Renal lobulation (also known as fetal or embryonic lobulation) is a rare variation during development in which renal lobules have a visible anatomical space between them, and this can be seen in 0.5–4% of adults. Material and methods: this study was conducted on 54 human kidneys from patients who died due to causes unrelated to renal pathology which were fixed in a 10% formaldehyde solution and then carefully dissected. Results: The group with fetal lobulation (n = 16) was associated with a length M = 9.89 (SD = 0.6, p = 0.15). By comparison, the kidneys without lobulation (n = 38) were associated with a numerically longer length M = 10.29 (SD = 0.607, p = 0.098). To test the hypothesis that lobulation is associated with a statistically significant different length a Mann–Whitney test was performed, which indicated that the length of the kidneys is smaller in scase of lobulation U = 198, Z = −2.04, p = 0.04. Cross-tabulation also demonstrated that kidney lobulation may be influenced by the presence of polar arteries with r = 0.41 (p < 0.02). The likelihood ratio was 7.28, df 1, p = 0.003, with an odds ratio of 6.857 (CI 95% = 1.84–25.61). Logistic regression analysis demonstrated that kidneys with lobulation were 6.85 times more likely to have polar arteries than kidneys without lobulation. Conclusions: the data from our research indicate that even though no pathological conditions have been linked with lobulated kidneys, the incidence of vascular variations (specifically polar arteries) is higher when there is persistent fetal lobulation.