Showing papers in "Romanian Journal of Internal Medicine in 2018"

Laparoscopic sleeve gastrectomy and gastroesophageal reflux.

Abstract: The prevalence of obesity is rising, becoming a medical problem worldwide. Also GERD incidence is higher in obese patients compared with normal weight, with an increased risk of 2.5 of developing symptoms and erosive esophagitis. Different treatment modalities have been proposed to treat obese patients, but bariatric surgery due to its complex interactions via anatomic, physiologic and neurohormonal changes achieved the best long-term results, with sustained weight loss and decrease of complications and mortality caused by obesity. The bariatric surgical procedures can be restrictive: laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG), or malabsorptive-restrictive such as Roux-en-Y gastric bypass (RYGB). These surgical procedures may influence esophageal motility and lead to esophageal complications like gastroesophageal reflux disease (GERD) and erosive esophagitis. From the literature we know that the RYGB can ameliorate GERD symptoms, and some bariatric procedures were finally converted to RYGB because of refractory reflux symptoms. For LAGB the results are good at the beginning, but some patients experienced new reflux symptoms in the follow-up period. Recently LSG has become more popular than other complex bariatric procedures, but some follow-up studies report a high risk of GERD after it. This article reviews the results published after LSG regarding gastroesophageal reflux and the mechanisms responsible for GERD in morbidly obese subjects.

Impact of Seminal Plasma Trace Elements on Human Sperm Motility Parameters.

Abstract: Introduction: Human seminal plasma contains a variety of macro and trace elements including magnesium (Mg), copper (Cu), zinc (Zn), and iron (Fe) that have essential roles in normal functioning of semen and its quality. The imbalance of these elements has been reported in several pathologic and male infertility disorders. Therefore, this study aimed to determine the levels of these elements in seminal plasma samples, their relationships with each other and their impact on sperm motility. Methods: Overall, 192 males (96 normospermic and 96 asthenospermic males) were enrolled in the study. Semen samples were collected by masturbation and computer-assisted/aided semen analysis of sperm motility was performed. The samples were centrifuged and seminal levels of Mg, Cu, Zn and Fe were measured using atomic absorption spectroscopy. Results: The levels of Zn did not differ between the two groups, while the levels of Mg, Cu, and Fe were significantly higher in normospermic males. Fe showed a positive correlation with Mg and Cu in asthenospermic group. However, a negative relationship was found between Mg and Fe levels and between Mg and sperm concentration in the normospermic group. Fe levels were higher in the normospermic group compared to the asthenospermic group. Nevertheless, increased Fe levels caused a decrease in most of sperm motility fractions. Conclusion: Elements play major roles in male fertility and directly affect sperm quality. According to the results of this study, the levels of Zn do not affect the sperm quality and motility, while Fe, Cu and Mg are decreased in males with sperm motility problems. Nevertheless, Fe levels can adversely affect sperm motility in normospermic men.

Correlation between neutrophil-to-lymphocyte ratio and severity scores in septic patients upon hospital admission. A series of 50 patients

Abstract: INTRODUCTION The neutrophil-to-lymphocyte ratio (NLR) as calculated from the white cell differential blood count is a marker that has been used as a prognostic index when assessing patients suffering from several clinical syndromes, including sepsis. The aim of this study was to evaluate the relationship between NLR and the commonly used severity scores of sepsis SOFA, APACHE II and SAPS II in a population of emergency admitted adult patients with sepsis in a tertiary center. METHODS A prospective observational study was conducted in the Emergency Department of the University Hospital of Patras, Greece, based on data extracted from 50 patients consecutively enrolled, suffering from sepsis of multiple origin. The study period was from May 01, 2017 until June 30, 2017. The NLR was calculated from the total white blood cell (WBC) count values measured from a peripheral venous blood specimen drawn on admission. C-reactive protein (CRP) was also measured. The sepsis severity prognostic scores APACHE II, SAPS II and SOFA were calculated for each patient. RESULTS NLR was positively correlated with the sepsis severity prognostic scores on admission (SOFA, rs = 0.497, p < 0.001; APACHE II, rs = 0.411, p = 0.003; SAPS II, rs = 0.445, p = 0.001). Total WBC was also significantly correlated with the scores (SOFA, rs = 0.342, p = 0.015; APACHE II, rs = 0.384, p = 0.006; SAPS II, rs = 0.287, p = 0.043). Serum CRP did not show any significant correlation either to NLR or to the sepsis severity scores on admission. CONCLUSIONS NLR is an easily calculated, cost-efficient index that could be used as a tool for clinicians when assessing sepsis patients in the Emergency Department. Although NLR measurement is simple, and rapidly available, future and larger prospective studies are warranted to confirm its definite value as a prognostic index in sepsis patients.

Cardiovascular risk factors in a Roma sample population from Romania.

Abstract: Background The Roma population has a high prevalence of cardiovascular risk factors, higher mortality, and shorter life expectancy. It is found in the largest number in Romania, but published data are still scarce here. We studied cardiovascular risk factors and disease along with target organ damage on a population of Roma inhabitants from Bucharest, Romania. Methods This cross-sectional study enrolled 806 Roma subjects (18-83 years), in a community-based participatory research manner. Demographics included anthropometric data, a questionnaire on social status, education, medical history, and health deleterious behaviors. Medical evaluation included clinical examination, blood pressure, ankle-brachial index, pulse wave velocity measurements, blood tests (complete blood count, lipid profile, glucose, creatinine, uric acid), dip-stick microalbuminuria, dilated fundoscopy, ECG, and echocardiography. Results Prevalence of all cardiovascular risk factors was high, peaking in abnormal lipid metabolism (82.13%), heavy smoking (63.02% including ex-smokers) and obesity (50.99%). The first and the latter were actually similar to the general population in Romania. Almost half of subjects were at high or very high risk for fatal cardiovascular disease. Conclusions The study shows that the Roma population in a more affluent region in Romania shares a similarly high cardiovascular burden to their surrounding community.

Liver disease symptoms in non-alcoholic fatty liver disease and small intestinal bacterial overgrowth.

Abstract: INTRODUCTION It seems that there is a relationship between small intestinal bacterial overgrowth (SIBO) and non-alcoholic fatty liver disease (NAFLD). The main objective of this study was to evaluate the prevalence of SIBO among NAFLD patients. METHODS In this descriptive-analytical cross-sectional study, 98 eligible NAFLD patients were evaluated for SIBO using hydrogen breath test (HBT). They were divided into SIBO-positive and SIBO-negative groups. Demographic, clinical, and laboratory data were obtained. RESULTS Based on the HBT, 38 patients (39%) had bacteria overgrowth. There were no significant differences between SIBO-positive and SIBO-negative regarding demographic data and BMI classification (P > 0.05). Biochemical variables, the results of abdominal ultrasound, and liver elastography did not show any significant difference between SIBO-positive and SIBO-negative patients (P > 0.05). Patients with SIBO were found to have higher rates of bloating, while abdominal pain was more prevalent in SIBO-negative patients (P < 0.001). CONCLUSIONS SIBO is prevalent in NAFLD and associated with bloating in these patients. Further studies are necessary to elucidate if therapeutic manipulation of gut microbiota reduces the risk of NAFLD, fibrosis, and liver cirrhosis.

First allergenic pollen monitoring in Bucharest and results of three years collaboration with European aerobiology specialists

Abstract: INTRODUCTION Respiratory allergies induced by allergenic plants pollen represent an important public health problem with increasing prevalence and severity. Aerobiologic study of allergenic pollens is performed in many countries on regular basis and correlated with health data from allergists in the frame of national aerobiology networks. Romania has no aerobiology network and pollen measurements have been done between 1999-2012 in West region only. In the frame of COST Action called Sustainable management of Ambrosia artemisiifolia in Europe (SMARTER FA 1203), three years collaboration with Reseau National de Surveillance Aerobiologique (RNSA) from France and the first pollen monitoring center in Bucharest were established.The aim of this paper is to present results of first pollen monitoring in Bucharest, activities of Romanian SMARTER group and collaboration with European aerobiology specialists. MATERIAL AND METHOD We used a Hirst-type pollen trap placed on the roof of the Research Center from "Colentina" Clinical Hospital and the pollen monitoring method based on European Aeroallergen Network (EAN) standardized requirements. Monthly results during the pollen seasons 2014-2016 were sent to RNSA and EAN and posted on the European pollen information site. RESULTS We found high amounts of allergenic pollen, mainly grasses from May to September and Ambrosia artemisiifolia during September. Conlcusions. We concluded that SMARTER offered access to aerobiology training, improved multidisciplinary collaboration and perspectives to further develop national and international projects. More coordinated efforts to develop national aerobiology network and to recuperate the gap comparing to other European countries in the field of aerobiology and respiratory allergology are needed.

Trainee involvement increases precut rates and delays access to the common bile duct without an increase in procedure-related adverse events: a brave new world of ERCP training?

Abstract: BACKGROUND AND AIMS Selective cannulation of the desired duct is a key element in ERCP procedures and an important step in the training of fellows. However, there is limited data about technical success and patient safety for ERCPs conducted in a training setting.We aimed to evaluate the impact of trainee involvement on the cannulation technique and procedure related outcomes at ERCP. MATERIALS AND METHODS We conducted an observational study of all ERCP conducted in an endoscopy unit with an on-going training program. Patient related data and procedure-related data (method of cannulation, time to cannulation, degree of trainee involvement, technical success and procedure-related adverse events) were collected using a standard form. The method of cannulation, time to cannulation and procedure-related adverse events were compared between ERCPs with trainee involvement and those without. RESULTS 641 consecutive ERCPs were evaluated and 474 native papilla cases performed by 4 trainers and 3 trainees were included in the final analysis. Trainees were involved in 171 procedures (36.1%), achieving cannulation of the desired duct in 50.8% of the cases. Cannulation rates were similar in the trainee group compared to the control group (91.7% vs. 88.7%) and there was no increase in the rate of adverse events. However, cannulation time was significantly longer in the trainee group with a significant increase in the rate of precut use (32.1% vs. 23.4%, p < 0.001). CONCLUSIONS Trainee involvement resulted in longer cannulation times and increased use of precut sphincterotomy, but, was not associated with an increased risk of procedure related adverse events.

Sarcopenia in diabetic nephropathy: a cross-sectional study

Abstract: Objective To investigate the relationship between sarcopenia and diabetic nephropathy Methods 56 diabetic patients without complications, 50 diabetic patients with nephropathy, 53 healthy controls included in this present study Demographic characteristics such as sex, age, anthropometric measurements such as weight, body mass index [BMI], hip circumference, waist circumference and upper arm circumference were measured Sarcopenia diagnosis was based on European Working Group on Sarcopenia in Older People [EWGSOP] criteria which consist of hand grip strength, 6-meter walking test and muscle mass Results The frequency of sarcopenia increased gradually from 151% in healthy control group to 214% in the diabetes group, and 34% in diabetic nephropathy group (X2 for trend, p = 0029) The frequency of sarcopenia was similar in diabetes and diabetic nephropathy group However, the frequency of sarcopenia was higher in diabetic nephropathy than healthy controls (OR = 289, CI [111-751] in logistic regression) Conclusion In the present study, the prevalence of sarcopenia was higher in patients with diabetic nephropathy compared to healthy controls

Procalcitonin as a diagnostic and prognostic marker in diabetic foot infection. A current literature review

Abstract: Diabetic foot ulcers (DFUs) are a very common cause of mortality and morbidity. The distinction between infected and non-infected DFU remains a very challenging task for clinicians in everyday practice. Even when infection is documented, the spectrum of diabetic foot infection is wide, ranging from cellulitis and soft tissue infection to osteomyelitis. Procalcitonin (PCT), a well-established sepsis biomarker, has been used in the diagnosis of several infections including osteomyelitis in patients with diabetes mellitus. This review gathers and presents all the relevant data, up until now, regarding the use of PCT as an assessment tool in diabetic patients with foot infection. Current evidence suggests that PCT levels could aid clinicians in distinguishing infected from non-infected DFUs as well as in the distinction between soft tissue infection and bone involvement, but further and larger studies are warranted to confirm these findings.

Lipid profile pattern in pediatric overweight population with or without NAFLD in relation to IDF criteria for metabolic syndrome: a preliminary study.

Abstract: Background and aims The aim of this study is to assess the lipid profile pattern of pediatric overweight and/or obese patients with Non-Alcoholic Fatty Liver Disease (NAFLD) in relation to IDF Consensus Criteria for Metabolic Syndrome (MetS). Material and methods We conducted a cross-sectional preliminary study on 45 consecutive pediatric patients. Overweight or obese children aged from 3 to 18 years were included. Standardized measurement of blood pressure and anthropometric parameters were performed. Biological evaluation included inflammatory status, lipid profile, glycemic profile, full blood count and liver function tests. Abdominal ultrasound was performed in all patients. Results Prevalence of MetS was 44.4%. A number of 21 patients (46.7%) had NAFLD. MetS patients had higher risk for NAFLD (OR = 9.5, 95% CI = 2.42-37.24). Also patients with positive familial history of type 2 diabetes had a 6.61 fold higher risk for NAFLD (OR = 6.61, 95% CI = 1.74-25.1). We performed a subgroup analysis in patients under ten years old. Patients under the age of ten which had both NAFLD and MetS met more frequently the hypertriglyceride criterion. After adjusting for age and MetS presence, triglyceride levels independently associated with NAFLD (adjusted R square = 0.46, unstandardized B coefficient = 34.51, 95% CI = 4.01-65.02, p = 0.02). Conclusion NAFLD obese patients had higher prevalence of MetS, higher BMI and particular lipid profile pattern. Triglyceride levels independently associated with NAFLD after adjusting for age and MetS presence. According to our findings we suggest early triglyceride testing (even below the age of ten) in selected patients.

Association of cognitive-emotional regulation strategies to depressive symptoms in type 2 diabetes patients

Abstract: Aim The present cross-sectional observational study aimed to investigate the relation between cognitive-emotional regulation strategies and depressive symptoms in type 2 diabetes patients in the context of sociodemographic and clinical factors, of diabetes distress, perception of illness consequences and previous depression. Method Multiple logistic regression was performed on the responses of 354 adults with type 2 diabetes (58.5% women; mean ± SD age: 61.14 ± 8.5 years; diabetes duration: 9.7 ± 6.4 years; BMI: 30.9 ± 5.3 kg/m2). Depressive symptoms were present in 16.9% and diabetes distress in 45.5%. Participants completed questionnaires on depression (BDI-II), cognitive-emotional regulation strategies (CERQ), diabetes distress (DDS), illness perceived consequences (IPQ-R). Results Of the cognitive-emotional strategies, lower positive reappraisal of diabetes (OR:0.49;CI:0.34-0.70) and increased catastrophizing (OR:2.08; CI:1.47-2.91) were found to increase the likelihood of experiencing depressive symptoms in the presence of higher diabetes distress (OR: 1.53; CI:1.07-2.19), increased negative perception of diabetes consequences (OR:2.02; CI:1.34-3.06) and the presence of previous depression (OR:4.18; CI:2.03-8.63). Conclusion To our knowledge, this is the first study to report on cognitive-emotional regulation strategies in type 2 diabetes and provides evidence for the beneficial influence of positive reappraisal and adverse effect of catastrophizing on depressive symptoms in the context of diabetes distress, perceived consequences of diabetes and previous history of depression.

CD4+CD25+CD127low FoxP3+ regulatory T cells in Crohn's disease.

Abstract: BACKGROUND Regulatory T (Treg) cell plays a key role in autoimmune diseases. We evaluated the regulatory function and frequency of Treg cells and secreted IL-10, IL-35 concentration in Crohn's disease (CD). METHODS Twenty-three patients with CD and 25 healthy controls (HC) were included in this study. We analysed the alteration of Tregs frequency using flow cytometry for CD4, CD25, CD127 and FoxP3 markers. Surface expression of CD4, CD25 and CD127 markers were used for isolation of relatively pure Treg cells. Suppressive activity of Tregs was determined by measuring their ability to inhibit the proliferation of T responder (Tres) cells. In addition, the amounts of IL-10 and IL-35 cytokines in co-culture supernatants were measured by ELISA assay after stimulation with anti-CD2/CD3/CD28. RESULTS CD patients had significantly lower frequency of CD4+ CD25+ CD127low FoxP3+ Treg cells in comparison with controls (2.17 ± 1.04 vs. 2.83 ± 1.07, p = 0.0352). Additionally, Treg cells mediated suppression was not significantly different in CD patients compared to controls. There was a significant difference in IL-10 secretion in response to anti-CD2/CD3/CD28 stimulation compared with HC (p = 0.0074). CONCLUSION The frequency of CD4+ CD25+ CD127low FoxP3+ Tregs decreased in active stage of CD but there was no impaired suppressive function of CD4+ CD25+ CD127low FoxP3+ Treg cells. We suggest that an alteration in the balance of Tregs and T effectors may contribute to pathogenesis of CD.

Pancreas divisum: a reemerging risk factor for pancreatic diseases.

Abstract: Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. The attention towards the PD has grown significantly since there are reports that this condition may cause acute relapsing pancreatitis, chronic pancreatitis and chronic abdominal pain syndrome. Furthermore, over the years, there have been multiple reports of PD associated with different types of tumors. There is evidence that PD can be associated with pancreatic tumors (up to 12.5% of cases). The golden standard for diagnosing PD is endoscopic retrograde cholangiopancreatography, but since it is an invasive procedure magnetic resonance cholangiopancreatography with secretin is a good alternative. In case the patient is symptomatic, endoscopic or surgical treatment should be performed. This review describes the key points of the pathophysiology, diagnostic modalities, risks of pancreatitis and tumors, as well as treatment options of PD.

Association of neutrophil-to-lymphocyte ratio and microalbuminuria in patients with normal eGFR.

Abstract: AIMS The aim of this study was to evaluate the association between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and microalbuminuria in patients with normal estimated glomerular filtration rate (eGFR). METHODS 174 patients who had eGFR ≥ 60 mL/min/1.73 m2 were studied. Patients were divided into two groups according to the urinary albumin excretion as microalbuminuric group (n = 105) and normoalbuminuric group (n = 69). NLR and PLR levels were calculated. RESULTS NLR was significantly higher (p < 0.05) in microalbuminuric patients (1.91 ± 0.70) compared with normoalbuminuric patients (1.63 ± 0.53). A positive correlation was found between urine albumin excretion and NLR in the whole study group (r = 0.214, p < 0.005). CONCLUSIONS Higher NLR levels were found in microalbuminuric patients with normal eGFR. Also a significant positive correlation was observed between albuminuria and NLR.

Beneficial effects of combined therapy with lacidipine and candesartan in obese hypertensive patients

Abstract: Introduction Obesity is becoming one of the leading risk factors of coronary heart disease, hypertension, cerebrovascular disease. Despite the presence of a large number of antihypertensive agents and scientific substantiation of antihypertensive treatment principles it would be wrong to assume that the problem is completely solved. Development of endothelial dysfunction is one of the key pathogenic mechanisms in hypertension. This process is proven to have contributed by immune inflammation activation which is mediated by pro-inflammatory cytokines and oxidative stress. Aims To investigate the additional benefits of the combined antihypertensive therapy with lacidipine and candesartan on the basis of studying their antioxidant properties, impact on endothelial function and pro-inflammatory cytokines activity in hypertensive patients with overweight and obesity. Methods A combination of a calcium channel blocker and angiotensin receptor blocker (lacidipine 2 mg, 4 mg, and candesartan 4mg, 8mg, 16mg) was prescribed to 30 patients with essential hypertension of grades 1-3, 30 to 65 years old (mean age - 54.7 ± 5.8 years), who previously have not been receiving regular antihypertensive therapy. Results During the course of combined antihypertensive therapy with lacidipine and candesartan, a significant reduction in i-NOS activity, TNF-α to its type I soluble receptor ratio (TNF- α/sTNF-αRI), and oxidative stress marker - 8-iso-PgF2α has been observed. Activity of e-NOS, levels of SOD and catalase, in contrast, have increased by the end of observation period. Conclusion The improvement of endothelial function due to lower level of oxidative stress and a significant decrease of immune activation has been observed in hypertensive patients with overweight and obesity under the influence of combined antihypertensive therapy with lacidipine and candesartan.

Downregulation of tumor-suppressor gene LHX6 in cancer: a systematic review.

Abstract: Introduction LIM Homeobox 6 (LHX6) encodes a LIM homeodomain transcription factor, contributes to tissue development and morphogenesis, and is mostly expressed in medial ganglionic eminence and odontogenic mesenchyme. However, it has been reported to play a role in cancer progression. This narrative review summarizes literatures that emphasize the molecular regulation of LHX6 in tumorigenesis. Methods In our systematic review, the PubMed database was used for the literature search using the combination of words that included "LHX6" and "cancer". Relevant studies, including in vitro, in vivo experiments, and clinical studies, were analyzed in this review. Results We found evidences that LHX6 might be important in the inhibition of tumor cell proliferation, growth, invasion, and metastasis through the suppression of Wnt/β-catenin signaling pathway. Moreover, LHX6 is observed to be downregulated in certain types of cancer due to hypermethylation, thus hindering its tumor suppressing ability. In addition, hypermethylation can also be used to determine the stage of cancer development. Conclusion The downregulation of LHX6 expression might be responsible in promoting cancer progression. Future studies are necessary to investigate the potential of LHX6 as a novel cancer biomarker as well as its therapeutic implications towards certain types of cancer.

Comparison of coronary risk factors and angiographic findings in younger and older patients with significant coronary artery disease.

Abstract: BACKGROUND Coronary artery disease (CAD) is uncommon among young adults and may have certain characteristics that are different from those in older patients. The aim of the current study was to determine the risk factors of CAD, important laboratory data and angiographic findings in young patients with CAD and to compare them with the old patients. METHODS Patients with typical chest pain whose CAD was confirmed by coronary angiography were included in the study. These patients were divided into 2 groups: ≥ 45 and < 45 years old; the risk factors of CAD and angiographic findings were determined in each group and further compared. RESULTS Finally, 231 patients with CAD were included in the study. Thirty-five (30.4%) of patients younger than 45 years and 58 (50.0%) aged ≥ 45 had diabetes mellitus (P = 0.002). Statistically remarkable differences were observed between the two groups regarding hypertension (P < 0.001), myocardial infarction (P < 0.001), Gensini score Median (P < 0.001), ejection fraction in echocardiography (P < 0.001) and fasting blood sugar in laboratory data (P = 0.006). The older group, compared with the younger one, had higher left anterior descending (LAD) artery (P < 0.001), right coronary artery (RCA) (P < 0.001), 3 vessel disease (P < 0.001) and 2-vessel disease (P = 0.044); on the other hand, 1-vessel disease was higher in patients aged < 45(P < 0.001). CONCLUSION The risk profile and angiographic findings are different in young patients with CAD compared to older patients. Young patients with CAD tend to be male with a positive familial history, but with less diabetes or hypertension. The older patients had higher 3 vessel disease, 2-vessel disease and left anterior descending (LAD) artery and right coronary artery (RCA) involvements. In contrast, 1-vessel disease was higher in young patients aged <45.

Malignancy in a retrospective cohort of 17 patients with Dermatomyositis or Polymyositis in southern Tunisia.

Abstract: INTRODUCTION The prognosis of dermatomyositis (DM)/ polymyositis (PM) in adults is partly related to their association with neoplasia. The aim of our study was to report the epidemiologic, clinical, paraclinical, therapeutic and evolutionary aspects of DM associated with malignancy in patients from Sfax, south eastern of Tunisia. METHODS A retrospective cohort study of patients with DM or PM admitted in Dermatology and Internal Medicine Departments of Hedi Chaker University Hospital of Sfax between 1996 and 2015. Cases of DM or PM associated with malignancy were retained. RESULTS Seventeen cases (13.5%) of DM or PM associated with malignancy were noted. Fourteen patients had DM and 3 patients had PM. The Sex ratio M / F was 0.3 and the mean age at diagnosis was 56.5 years. In DM patients, malignancy preceded the myositis in 64.2% of cases. In PM patients, only one patient was known to have breast cancer and the myositis revealed the cancer for 2 others. Treatment consisted of corticosteroids associated with methotrexate in 4 cases. Outcome was fatal in 5 cases (29.4%), due to the underlying cancer in 3 cases. Swallowing disorders related to DM/PM were responsible for death in 2 cases. CONCLUSION There are no specific clinical or biological features in paraneoplastic DM. In our series, breast neoplasm represented the first cancer associated with DM. Cancers of nasopharynx, colon and urinary tract had the second position.

The diagnostic and prognostic value of serum endocan in patients with cirrhotic cardiomyopathy.

Abstract: Background We aimed to determine the relationship between endocan and cirrhotic cardiomyopathy. Materials and methods Patients with liver cirrhosis and no heart disease were included in a prospective observational study with liver disease decompensation and death as primary outcomes. Results 83 cirrhotic patients were included and 32 had cirrhotic cardiomyopathy. Endocan levels were significantly lower in patients with cirrhotic cardiomyopathy (5.6 vs. 7 ng/mL, p = 0.034). Endocan correlated with severity of cirrhosis, time to decompensation or death from liver disease (OR 4.5 95% CI 1.06-31.1). Conclusion Endocan is a promising biomarker of severity of cirrhosis and may help in the diagnosis of cardiac dysfunction in this population.

The severity of coronary artery disease was not associated with non-alcoholic fatty liver disease in a series of 264 non-diabetic patients who underwent coronary angiography

Abstract: BACKGROUND It is now suggested an association between non-alcoholic fatty liver disease (NAFLD) and the occurrence of coronary artery disease even in non-diabetic patients. We will determine the rate of NAFLD and its main determinants in non-diabetic patients undergoing coronary angiography. METHODS This cross-sectional study was accomplished on 264 patients who were candidates for coronary angiography during the year 2016. Coronary angiography has been done to depict the presence or absence of coronary involvement, and the severity of coronary artery disease by determining the number of vessels involved and also the SYNTAX score. During 48 hours after coronary angiography, the patients underwent abdominal ultrasonography for detection of NAFLD. RESULTS The overall prevalence of NAFLD in the patients was 72.3%. The prevalence of NAFLD in those with and without coronary involvement was 71.9% and 73.1% respectively, with no notable difference (p = 0.837). The mean SYNTAX score in the patients with and without NAFLD was 22.32 ± 11.10 and 21.75 ± 10.71 respectively with no difference (p = 0.702). According to the multivariable regression models, the presence of NAFLD could not predict the likelihood of coronary artery disease (OR = 0.879, p = 0.669) or its severity assessed by the SYNTAX score (beta = 0.046, p = 0.456). NAFLD grade was also not a determinant for coronary artery disease (OR = 1.139, p = 0.178) or its severity (beta = 0.058, p = 0.165). CONCLUSION It seems that the presence and grade of NAFLD may not be correlated with atherosclerotic involvement of coronary arteries and its severity in non-diabetic patients. Future large studies and trials could elucidate the independent role of fatty liver in nondiabetic non-alcoholic patients.

Impact of dermatologic adverse reactions on QOL in oncologic patients: results from a single-center prospective study

Abstract: Introduction Skin toxicity in patients receiving novel therapeutic cancer agents has become a very important marker in determining drug activity, but it can also severely impact their quality of life. About half of the patients receiving this type of oncologic treatment will develop cutaneous reactions, that is why adequate understanding and management of these side effects is very important for drug adherence and patients' quality of life. Materials and methods We conducted a prospective study of consecutive patients who received oncologic treatment in our institution and presented with dermatologic side effects. The severity of skin toxicity was assessed using the DLQI score and patients were prospectively followed to evaluate response to therapy. Univariate analysis of factors influencing the impact of skin toxicity on patient QOL was conducted. Results 52 patients were enrolled in the study. Patients who developed grade 3 and 4 skin toxicity had a higher DLQI score, with a greater impact on quality of life, but with better clinical outcome at 3 months follow-up, based on RECIST. Patients with moderate or severe cutaneous AE were more likely to achieve complete or partial response to therapy than those with mild AE (16/33 vs. 3/19, p = 0.035). Interestingly, female patients had a significantly poorer quality of life than male patients as assessed by the DLQI score (7.28 ± 7 vs. 3.7 ± 3.6, p = 0.038). Conclusion Cutaneous side effects are often encountered in cancer patients and their severity can be a surrogate marker for a positive clinical tumor response to therapy.

Biological therapies in psoriasis - revisited.

Abstract: Psoriasis is a chronic, immune mediated disorder affecting approximately 2% of the population. Even in our days, patients with psoriasis are confronted with stigmatization and social rejection. As a result, their quality of life is significantly impaired. Biological therapies have revolutionized the treatment of moderate to severe psoriasis. The aim of this paper is to look over the most important biological therapies available for the management of plaque-type psoriasis.

Therapeutic adherence in patients with systemic lupus erythematosus: a cross-sectional study.

Abstract: INTRODUCTION The aim of the research was the study of the adherence to treatment in patients with systemic lupus erythematosus. METHODS Cross-sectional study including 132 consecutive patients with systemic lupus erythematosus (SLICC, 2012 classification criteria). We collected clinical and socio-demographic data, socio-economic status; we assessed SLEDAI-2k disease activity, and estimated the adherence to treatment by Morisky questionnaire. RESULTS Our results demonstrated that low adherence to treatment in patients with systemic lupus erythematosus was in only 11.36% of patients, while 43.18% and 45.46% of the patients were scored as moderate and high adherence, respectively. A moderate/high adherence to treatment was associated to a high level of education (r = -0.51, p < 0.05, 95% CI = -0.25 to -0.66), low disease activity (r = 0.38, p < 0.05, 95% CI = 0.25 to 0.53) and low indices of physician global assessment (r = -0.31, p<0.05, 95% CI = -0.23 to -0.71). The sub-analysis of the adherence to each drug demonstrated that the highest adherence was to treatment with glucocorticosteroids - 92.85%, followed by hydroxychloroquine and aspirin - 92.15% and 89.79%, respectively. CONCLUSION In our cohort, the adherence to treatment was high in 45.46%, moderate in 43.18% and low in only 11.36% cases. High adherence to treatment was associated to low disease activity. The adherence was positively influenced by the age at the onset of the disease and a high educational level.

Hyponatremia, bone mineral density and falls in the elderly; Results from AHAP study.

Abstract: Background Hyponatremia (HN) can be associated with osteoporosis, falls and bone fractures in the elderly. Recent researches demonstrated different results about the correlation of HN with bone mineral density and bone fractures. Methods This analytic research came from the AHAP project in northern IRAN. All people aged 60 years and over were included in the study. Individuals with severe comorbidities and then who had concurrent conditions which could have impact on bone mineral densities (BMD) such as long-term use of steroids, calcium and/or vitamin D supplements, bisphosphonates, calcitonin, thiazides and hormonal medications were excluded. Results One thousand and one hundred and thirteen older persons entered in the study. More than 10 percent of the participants had HN (serum Na+ level ≤ 137mEq/L). No significant difference has been observed between hyponatremic and nonhyponatremic individuals about their balance abilities; bone mineral density; incidence of falls and/or bone fracture during the previous 6 months; dependency in activities of daily living; and osteoporosis. Conclusion HN was not a prevalent problem in older adults who met the inclusion criteria of this research. No significant difference has been observed between HN and bone mineral density and falls in the elderly.

Serum and alveolar procalcitonin had a weak diagnostic value for ventilator-associated pneumonia in patients with pulmonary infection score ≥ 6.

Abstract: BACKGROUND Measuring the serum and alveolar procalcitonin level as inflammatory marker in the diagnosis of ventilator-associated pneumonia (VAP) has been taken into account. In this study, serum and alveolar procalcitonin levels in patients with suspected VAP and patients with confirmed VAP were compared. METHODS This cross-sectional study was conducted using 50 intubated intensive care unit (ICU) patients, connected to ventilator, from October 2014 to April 2015. 50 patients with clinical pulmonary infection score ≥6 were divided into two groups. Patients whose bronchoalveolar lavage (BAL) has shown the growth of more than 104 CFU/mL were included in confirmed VAP group and other patients were included in suspected VAP group. Serum and alveolar procalcitonin levels were measured and compared between both groups. RESULTS Mean age of patients was 69.10 ± 42.13 with a range of 16-90 years, out of which 23 patients were male (46%) and 27 patients were female (54%). Moreover, patients' mean clinical pulmonary infection score was reported to be 7.02 ± 1.07. There was a significant relationship between serum and alveolar procalcitonin in suspected patients and patients with an approved form of pneumonia (p = 0.001 and 0.027). Area under the curve for alveolar procalcitonin was 0.683 (sensitivity = 57%; specificity = 80%) and for serum procalcitonin 0.751 (sensitivity = 71%; specificity = 73%) for the diagnosis of VAP. CONCLUSION According to the results of the present study, we can diagnose ventilator-associated pneumonia earlier and more accurately by measuring procalcitonin level (particularly alveolar type) in intensive care unit patients.

Treating malignant melanoma when a rare BRAF V600M mutation is present: case report and literature review

Abstract: Recent years have brought major advances in the treatment of malignant melanoma. One such an advance is the treatment with BRAF tyrosine-kinase inhibitors in metastatic malignant melanomas that harbor mutations in the BRAF gene. The trials that have been performed in this setting have demonstrated superior response rates and increased overall survival, however, they mostly included patients with melanomas carrying the more common V600E and V600K mutations, not being able to assess the benefit of these treatments in situations where more rare mutations of the BRAF gene are present. We present the evolution of a patient with malignant melanoma with a rare V600M mutation in the BRAF gene, that was eventually treated with vemurafenib. Also we present a brief review of the major phase III trials that showed benefit with tyrosine-kinase inhibitors in BRAF mutated melanoma, with respect to the BRAF mutations included.

How much bloating in the irritable bowel syndrome

Abstract: The irritable bowel syndrome (IBS) is the most common chronic gastrointestinal disorder referred to gastroenterologists. One of the most common manifestations of IBS is bloating. Abdominal bloating is defined as subjective sensation of abdominal distension associated with girth increment. Therefore, it is described in the Rome IV criteria as bloating/abdominal distension. Bloating symptoms are reported by 10-30% of the general population and it was rated as the most bothersome symptom by 60% of IBS patients; the lack of specificity of this complaint prevented bloating to be included between the diagnostic criteria for IBS. Indeed, bloating may be reported also in healthy people or in other functional conditions. This paper looks to the evolutions of the concepts on bloating according to the Rome working groups from the beginning until now and it represents a comprehensive review on the prevalence and pathogenesis of bloating.

Macrophage activation syndrome associated with systemic lupus erythematosus treated successfully with the combination of steroid pulse, immunoglobulin and tacrolimus

Abstract: Macrophage activation syndrome (MAS), a variant of secondary hemophagocyticlymphohistiocytosis, is a potentially life-threatening complication of inflammatory and autoimmune diseases. We present a case of MAS as a rare manifestation of systemic lupus erythematosus. Although initial treatment with corticosteroid, with or without cyclosporine A, is justified in patients with MAS, evidence regarding the effectiveness of this treatment protocol remains to be clarified. Our patient was successfully treated with a combination of intravenous immunoglobulin therapy and intravenous methyl predonisolone pulse therapy, which was followed by a course of oral prednisolone and oral tacrolimus. Based on our experience, we propose tacrolimus to provide a more useful adjuvant treatment to corticosteroid therapy than cyclosporine A.

Left anterior descending coronary artery dissection during ventricular tachycardia ablation - case report.

Abstract: Fascicular left ventricular tachycardia (VT) is the second most frequent idiopathic left VT in the setting of a structurally normal heart. Catheter ablation is curative in most patients with low complication rates. We report a case of ostial left anterior descending coronary artery (LAD) occlusion during fascicular ventricular tachycardia ablation. Dissection was the most likely cause of LAD obstruction. To the authors' best knowledge, this is the first case reporting selective LAD dissection during electrophysiology study with no left main coronary artery (LMCA) affection.

Romanian Registry of Hypertrophic Cardiomyopathy - overview of general characteristics and therapeutic choices at a national level.

Abstract: Introduction Hypertrophic cardiomyopathy (HCM) is a disease with increased left ventricular (LV) wall thickness not solely explained by abnormal loading conditions, with great heterogeneity regarding clinical expression and prognosis. The aim of the present study was to collect data on HCM patients from different centres across the country, in order to assess the general characteristics and therapeutic choices in this population. Methods Between December 2014 and April 2017, 210 patients from 11 Romanian Cardiology centres were enrolled in the National Registry of HCM. All patients had to fulfil the diagnosis criteria for HCM according to the European Society of Cardiology guidelines. Clinical, electrocardiographic, imaging and therapeutic characteristics were included in a predesigned online file. Results Median age at enrolment was 55 ± 15 years with male predominance (60%). 43.6% of the patients had obstructive HCM, 50% non-obstructive HCM, while 6.4% had an apical pattern. Maximal wall thickness was 20.3 ± 4.8 mm (limits 15-37 mm) while LV ejection fraction was 60 ± 8%. Heart failure symptoms dominated the clinical picture, mainly NYHA functional class II (51.4%). Most frequent arrhythmias were atrial fibrillation (28.1%) and non-sustained ventricular tachycardia (19.9%). Mean sudden cardiac death risk score (SCD-RS) was 3.0 ± 2.3%, with 10.4% of the patients with high risk of SCD. However, only 5.7% received an ICD. Patients were mainly treated with beta-blockers (72.9%), diuretics (28.1%) and oral anticoagulants (28.6%). Invasive treatment of LVOT obstruction was performed in a small number of patients: 22 received myomectomy and 13 septal ablation. Cardiac magnetic resonance was reported in only 14 patients (6.6%). Conclusions The Romanian registry of HCM illustrates patient characteristics at a national level as well as the gaps in management which need improvement - accessibility to high-end diagnostic tests and invasive methods of treatment.