rss_2.0Internal Medicine FeedSciendo RSS Feed for Internal Medicine Medicine Feed and Tolerability of Interferon Free Therapy - Positive Impact on the Quality of Life of Patients with Chronic Viral Hepatitis C<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> The infection with hepatitis C (HCV) is a major cause of chronic liver diseases, with approximately 71,000.000 chronically infected persons worldwide.</p> <p><bold>Material and methods</bold>. This study includes the results of the evaluation of the quality of life of patients with chronic hepatic diseases, on a group of 122 patients divided into two lots. The study period was January 2020 - december 2022. Our aim was to study the impact of the antiviral therapy on the patients quality of life before and after the interferon free antiviral therapy, as well as to study the quality of life of the patients with chronic viral hepatitis C who did not receive interferon free antiviral therapy because they did not meet the eligibility criteria, but accepted to participate in the study.</p> <p><bold>Results</bold>. Following the analysis and the interpretation of the questionnaire used, we found that the patients who did not receive the treatment presented more frequently a psychosocial unbalance (social activities), psychoemotional and loss of interest for the sexual activity. In the case of patients treated with interferon free regimens we found an improvement of the quality of the whole duration of the therapy, this being correlated, especially, with drug interaction that were limited or easily manageable and had minimal adverse effects, increasing psychoemotional, balance, and the sexual activity was not influenced.</p> <p><bold>Conclusions</bold>. The results of our study indicate that the patients who were treated with the antiviral interferon free therapy become aware the fact that the problems related to the chronic hepatic disease are solvable, which influences the quality of life in a positive way.</p> </abstract>ARTICLEtrue Syndrome - A Diagnosis on the Border Between Medical Specialties<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>. Myeloproliferative disorders define a vast and heteregenous group of neoplastic entities, characterized by malignant proliferation of blood cells. These may affect multiple tissues, some of these malignancies involving organs in which there is lymphoid tissue.</p> <p><bold>Case report</bold>. A 81-year-old female patient was admitted to the Department of Internal Medicine with moderate-to-intense spontaneous pain in the left hypochondrial and in the left abdominal flank, associated with generalized fatigue and loss of appetite. According to the personal medical history, the patient is known with type II diabetes mellitus, being under treatment with oral antidiabetics (metformin 1000 mg), and arterial hypertension under treatment with candesartan. Upon admission, the physical examination revealed cutaneous and mucosal pallor and marked physical weakness. Abdominal palpation revealed pain in the left hypochondrial and in the left abdominal flank, associated with firm and massive splenomegaly, descending towards the umbilicus. Abdominal ultrasound confirmed massive splenomegaly, associated with moderate hepatomegaly. Blood analysis revealed several modifications, indicative of hypochromic normocytic anemia, associated with lymphocytosis, thrombocytopenia and neutropenia. C-reactive protein (CRP) serum levels were in normal range upon admission. All of these modifications suggested a possible leukemogenous or lymphoid malignancy, which resulted in the patient's transfer towards the Department of Hematology, for further investigations.</p> <p><bold>Conclusions</bold>. Massive splenomegaly, associated with anemia and thrombocytopenia in elderly patients, should always indicate a leukemogenous or lymphoid malignancy and a thorough differential diagnosis and collaboration between internists and hematologists is required.</p> </abstract>ARTICLEtrue Factors in Patients with Copd and Atrial Fibrillation – Mini Review<abstract> <title style='display:none'>Abstract</title> <p>Chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) are common pathologies in the elderly patient. The simultaneous occurrence of the two conditions influences the quality of life and increases the rate of exacerbations. About two-thirds of patients with atrial fibrillation have dyspnea. Severe dyspnea in the patient with COPD and AF can be difficult to manage, suggesting an exacerbation of the disease, the onset of atrial fibrillation or even a symptom of associated comorbidities, the most common of which being heart failure.</p> <p>The risk of developing AF in COPD increases with the severity of airflow obstruction. Factors such as smoking, aging, dyslipidemia, the presence of diabetes, hypertension or heart failure influence the prognosis of patients with COPD and AF. Furthermore, oxidative stress, hypoxia, systemic inflammation or immunological changes decrease the survival rate and may favor the recurrence of AF. In the evolution of concomitant COPD- FA cases, proinflammatory cytokines such as tumor necrosis factor α (TNF-α), monocyte chemotactic protein (MCP-1), interleukin-6 (IL-6), interleukin-8 (IL- 8) intervene.</p> <p>This paper aims at analyzing data related to the factors that would influence the prognosis of patients with COPD and AF.</p> </abstract>ARTICLEtrue Steatosis and its Implications in Patients with Chronic Viral Hepatitis C<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Hepatic steatosis represents a common pathological feature in patients with chronic viral C infection and can be independently associated with obesity, increased alcohol consumption, type 2 diabetes, and hyperlipidemia. These factors can contribute to the development of hepatic steatosis in patients with chronic HCV (Hepatitis C virus) infection.</p> <p><bold>Materials and methods.</bold> 64 patients who underwent treatment with oral antivirals were included and evaluated through non-invasive methods for the degree of hepatic steatosis.</p> <p><bold>Results.</bold> After at least 3 months of sustained viral response, all patients with advanced hepatic steatosis were categorized into lower classes in the Steatotest evaluation.</p> <p><bold>Conclusion.</bold> This study highlights the importance of direct acting antiviral (DAA) treatment in the medical care of patients with chronic viral C infection and hepatic steatosis. Thirty years after the discovery of the hepatitis C virus, treatment with oral antivirals revolutionizes the medical care of patients with this chronic infection.</p> </abstract>ARTICLEtrue Impact of Technical Skills and Education on Exacerbations, Adherence to Treatment and the Choice of Inhaler Device in Patients with COPD<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> The largest challenge for patients with COPD is the correct use of inhaler devices. In COPD, inhalation therapy has a key role in symptom control, reducing the exacerbation rate, hospitalization and improving the quality of life. Choosing the active substance(s) administered by inhaler devices is an easy task because of the Gold guideline recommendations, but, when it comes to choosing the inhaler device, it is much more difficult to get recommendations.</p> <p><bold>Methods.</bold> Our analysis included 200 subjects divided into two groups and its objective was the identification of some mechanisms that connect education, exacerbation and adherence to treatment, placed in the context of measuring technical skills and patients` preference for a particular inhaler device. All subjects included in the analysis were subjected to a technical skills test that included a set of 10 questions with a 30-minute solving time. The subjects in the working group were put in the position of deciding factor for the choice of an inhaler device, and implicitly for the treatment they would follow during monitoring.</p> <p><bold>Results.</bold> In both groups, the lowest treatment dropout rate at T12 was recorded among those with higher levels of education, while those with poor education levels recorded very high dropout rates. In both groups we noticed that, as the level of education increased, technical skills were also increasingly better. Both in the control group and in the working group, dropout subjects at T12 had significantly lower technical skills compared to subjects who did not drop out. The level of technical skills was significantly lower in both groups in subjects with exacerbations. Statistical analysis proved the relationship between the low level of technical skills and exacerbation. The subjects with lower technical skills proved to be more prone to dropout of inhaler therapy as well. The proportion of subjects with exacerbations in the control group was significantly higher than the proportion of those with exacerbations in the work group. The proportion of subjects with exacerbations in the control group was significantly higher than the proportion of those with exacerbations in the work group.</p> <p><bold>Conclusions.</bold> The authors consider that the involvement of the patient in choosing the inhaler device had a positive impact on disease control and reducing the rate of exacerbations.</p> </abstract>ARTICLEtrue's Disease Limited to the Appendix Risk in Acromegaly<abstract> <title style='display:none'>Abstract</title> <p>Acromegaly is associated with cardiovascular disease, the principal cause of increased mortality. Direct cardiac effects of GH/IGF-1 are cardiomyocyte growth and cardiac contractility, cardiac remoddeling. Other important risk factors in acromegaly are hypertension, valvular diseases, arrhytmias. Older patients with long-term uncontrolled disease may develop congestive heart failure as end-stage of acromegalic cardiomyopathy. Early treatment of acromegaly is essential for evolution and prognosis of cardiovascular complications.</p> </abstract>ARTICLEtrue Progression of Alveolar Hemorrhage in COVID 19-Induced ANCA-Associated Vasculitis Case of a Young Girl Suffering from Genetically Confirmed Wilson Disease with Orthotopic Liver Transplantation<abstract> <title style='display:none'>Abstract</title> <p>A rare genetical autosomal recessive disorder called Wilson disease (WD) is characterized by excess copper being deposited in numerous major organs, mainly the liver and brain causing hepatic, neurological and mental symptoms. WD is caused by mutations in the gene ATP7B. Although not always present, Kayser-Fleischer (KF) ring is the pathognomonic indication of WD and is caused by the deposition of copper in the corneas of the eyes. The condition worsens with time and, if ignored, may lead to fatality, liver illness and problems with the central nervous system. Preventing serious long-term damage and perhaps fatal consequences may be possible with early diagnosis and treatment. The goal of treatment is to lower the level of accumulated copper in the body and then maintain it to normal levels.</p> <p>We present the case of a 26-year-old patient, known herself and also her sister with genetically confirmed hepato-lenticular degeneration, who came to our clinic for bilateral gonalgia with mixed mechanical and inflammatory character and for chronic low back pain. Other signs and symptoms of WD may include joint and bone disease, including osteoporosis and the development of osteophytes in the large joints, which is why the patient was investigated both clinico-biologically and imagistically in order to establish the optimal specialist treatment.</p> </abstract>ARTICLEtrue TB Faces in the New Context of Drug Users<abstract> <title style='display:none'>Abstract</title> <p>Tuberculosis has taken on a new face in the context of emergent drug use. The combination of conditions such as HIV infection, hepatitis B or C, arising from the use of injectable drugs create serious problems in hospitals. In this new context, the authors analyze epidemiological aspects, predisposing factors, clinical expressions and therapeutic solutions for these cases, but also the programs that must be adopted to allow the control of this new worldwide challenge.</p> </abstract>ARTICLEtrue Depending on Age Between Saliva and Plasma Parameters<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Because of the increasing interest in the study of saliva, many methods have become available that can allow us to perform multiple and rapid analyzes of the composition of salivary secretion using advanced techniques of nanotechnology and fluid micro- engineering. The objectives of our study were to identify immunoglobulin levels variations with age.</p> <p><bold>Materials and methods.</bold> We conducted an analysis to check the correlation between saliva and plasma parameters on 24 patients. The study population was divided into 2 groups based on age, with a cut-off at 35 years. The differences on the variables between two groups were evaluated by TTEST and CORREL.</p> <p><bold>Results.</bold> Total plasma calcium, as well as ionic calcium have increased values in group 2, the increase being statistically significant (p =0.04) only for ionic calcium. Significant correlation of plasma and salivary values in the case of IgA / IgG ratio, and also a significant correlation of salivary and plasma concentrations for IgG were identified in our study.</p> <p><bold>Conclusions.</bold> The correlation between plasma and salivary parameters is closely related to age and these can be used as markers for diagnosis and evaluation of various pathologies. Also, regarding women, salivary calcium and phosphate concentrations increase with age showing peak values around menopause.</p> </abstract>ARTICLEtrue Between the Value of Serum Cholinesterase and Child-Pugh and MELD-NA Scores in Cirrhotic Patients<abstract> <title style='display:none'>Abstract</title> <p>A variety of laboratory tests are used in the evaluation of the hepatic patients. Serum cholinesterase is reduced in liver disfunction in contrast with other enzymes. The aim of this study was to assess the value of serum cholinesterase in evaluation of the liver reserve function in cirrhotic patients. A total of 70 patients were divided into 3 groups according to the Child-Pugh Score. Using corelation analysis, the correlation between serum cholinesterase and albumin and serum plasma prothrombin time was analysed. Cirrhotic patients were grouped into A, B and C grades as per Child-Pugh score.</p> <p>The results showed that cholinesterase levels tend to decrease according to the Child-Pugh score. The cholinesterase correlated with the albumin serum levels, value of Child-Pugh score and MELD-Na score and didn’t corelate to INR. In conclusion, correlated with the damage severity of the liver cells cholinesterase may respond to liver reserve function.</p> </abstract>ARTICLEtrue Rehabilitation of Patients Following Myocardial Infarction<abstract> <title style='display:none'>Abstract</title> <p>Myocardial infarction (MI) - represents cardiomyocytes necrosis due to prolonged myocardial ischemia, occurring in the context of an imbalance between myocardial oxygen supply and consumption. According to the National Bureau of Statistics, in 2017, mortality from cardiovascular diseases made up 58.4% of all deaths, of which ischemic heart disease (IHD) constituted 52.5% and 8.5% were due to acute myocardial infarction.</p> <p>Cardiovascular rehabilitation is used to optimize the physical, psychological and social functioning of the patient who suffered a myocardial infarction. The session includes 3 phases: the warm-up, the actual training and the recovery (relaxation) phase. The program is individualized, so it is necessary to correctly select the type, intensity, duration and frequency for maximum therapeutic effect.</p> <p>Exercise-based medical rehabilitation is a supplement to drug therapy and post-infarction interventional surgery, as it improves cardiopulmonary function, optimizes drug therapy, decreases risk factors, increases exercise tolerance, improves mental status, reduces the risk of repeated heart attack and cardiac mortality. There are fewer complications due to bed rest and increased performance as a result of improved hemodynamic and metabolic function. As part of a cardiac rehabilitation program, physical activity helps with psychological adaptation and contributes to a successful return to work.</p> </abstract>ARTICLEtrue the Guidelines: Anticoagulant Treatment of Patients with Recent Portal Vein Thrombosis in the Setting of Liver Cirrhosis<abstract> <title style='display:none'>Abstract</title> <p>Portal vein thrombosis, in the clinical setting of liver cirrhosis, is a complication which increases mortality rate by leading to specific complications. Its presence also serves as a negative prognostic factor for these patients. Specialized literature, although rich in papers on this subject, presents loose and sometimes contradictory information regarding its prognosis and specific treatment. This paper brings into discussion the issue of recent portal vein thrombosis in cirrhotic patients, with emphasis on indications for initiation of anticoagulant therapy and the optimal drug of choice. It also highlights the utility of using correct terminology for facilitating clinical approach of guideline recommendations as well as increasing the quality of published scientific papers.</p> <p>The coagulation homeostasis of the cirrhotic patient presents many particularities that can make the optimal therapeutic choice extremely difficult when portal vein thrombosis is established. Absence of randomized clinical trials and lack of consensus regarding anticoagulant treatment in these patients leaves it up to the clinician to decide when and what anticoagulant to use. Analysis of the newest guidelines and recent meta-analysis made it possible to identify the right context for initiating therapy with the most used anticoagulants currently: low molecular weight heparin, vitamin K antagonists and direct oral anticoagulants.</p> </abstract>ARTICLEtrue in Treatment and the Importance of Radiotherapy in a Synchronous Endometrial and Breast Cancer<abstract> <title style='display:none'>Abstract</title> <p>We report the case of a 69-year-old-female with synchronous endometrial and breast cancer. The imaging and pathology results confirmed the diagnosis. The patient underwent surgery and chemotherapy for endometrial cancer, and surgery followed by external beam radiotherapy for breast cancer. The patient’s clinical condition and imaging showed a favorable evolution after 2 months of follow-up.</p> </abstract>ARTICLEtrue Involved in the Mineral-Bone Disorders Secondary to Chronic Hemodialysis<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Chronic kidney disease (CKD) is one of the most prevalent public health problems of the elderly population. End-Stage Renal Disease (ESRD)’s most common treatment is dialysis. There are some dissimilarities between the sexes that are apparent in the status and the possible outcomes of CKD. This study aims to shed some light on these somewhat overlooked wwwvariations and their implications.</p> <p><bold>Materials and methods</bold>. We conducted an observational study on subjects with CKD, undergoing hemodialysis for at least 2 years. For participation, we selected an equal number of men and women, which were divided into 2 groups according to gender. Plasma levels of the following parameters were monitored: creatinine, urea, bicarbonate, phosphorus, calcium, alkaline phosphatase, vitamin D, FGF-23 and TNF-alpha. The differences of the variables between the two groups were evaluated using TTEST and CORREL test.</p> <p><bold>Results</bold>. A significant correlation was between the plasma levels of FGF-23 and gender (p =0.02). Regarding the plasmatic levels of urea, besides the expected difference in pre- and post- dialysis levels, we obtained a significant correlation between its post-dialysis value and gender (p =0.045). In regard to the plasmatic levels of the alkaline phosphatase, there was a significant correlation between its value and gender (p =0.01).</p> <p><bold>Conclusions.</bold> There is a significant correlation between the plasmatic levels of creatinine, urea, alkaline phosphatase, vitamin D, FGF-23 and gender. Women present lower levels of creatinine and urea, while men present lower plasmatic levels of vitamin D, alkaline phosphatase and FGF-23.</p> </abstract>ARTICLEtrue Clinical Approach of Lupus Nephritis Associated with Catastrophic Antiphospholipid - Antibody Syndrome - Review and Case Report<abstract> <title style='display:none'>Abstract</title> <p>Glomerulonephritis is a major cause of morbidity in systemic lupus erythematosus (SLE). In fact, immune complex formation and deposition in the kidney results in intraglomerular inflammation with recruitment of leukocytes and activation and proliferation of resident renal cells. Intense injury may destroy resident renal cells by necrosis or apoptosis resulting in fibrinoid necrosis. When injury is less intense, endocapillary cells respond by proliferating and production of extracellular matrix (proliferative lesions). Renal biopsy, examination of urine sediment and measurement of C3 levels (and to less anti-DNA titers) are essential for the management of lupus nephritis. Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by thrombotic episodes in the arterial or venous circulation, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies, and anti-β2glycoprotein-I antibodies (anti-β2GPI). Catastrophic APS (CAPS) is a very rare (---lt---1%) and extremely severe variant of APS. It is characterized by multiple systems and thrombotic organ involvement that occurs in a very short period (days to weeks). Renal involvement is a common feature in CAPS, the most frequent finding is thrombotic microangiopathy (TMA), but other chronic lesions of APSN can also be found.</p> </abstract>ARTICLEtrue Pancreas, A Rare Cause of Dyspepsia in COVID-19<abstract> <title style='display:none'>Abstract</title> <p>The SARS-CoV-2 pandemic and its specific respiratory pathology has generated extensive research that has highlighted the specific nature of the disease (COVID-19). Thrombotic processes in the macrocirculation and microcirculation were among the first reported, accompanying respiratory (pulmonary) manifestations. Of the COVID-19 complications, thrombosis in the venous system (venous thrombosis and pulmonary embolism) and the atrial system (stroke) are the most numerous and severe in terms of evolution and prognosis. The prophylaxis of thrombotic processes in COVID-19, initially empirical, has gained a scientific basis based on research and experience of clinicians.</p> <p>The current paper presents general data on macro- and microcirculatory thrombosis and the rationale for thromboprophylaxis. Thromboprophylaxis in non-hospitalized COVID-19 patients, “non-critical” and “critical” hospitalized patients and possible post-hospital thromboprophylaxis are presented.</p> <p>Heparins (HGMM and HNF) are the most commonly indicated and used antithrombotic agents. Other antithrombotic agents - antiplatelets and direct anticoagulants (oral - DOAC) have a very limited and possibly negative role in thromboprophylaxis in COVID-19.</p> </abstract>ARTICLEtrue of Biological Parameters in Patients with Severe Aortic Stenosis Undergoing TAVI - Results at One Month<abstract> <title style='display:none'>Abstract</title> <p>Aortic stenosis is one of the most common valve diseases in patients over 60 years of age. Lack of prompt surgical correction by conventional valve replacement or interventional transcatheter aortic valve implantation (TAVI) increases the risk of morbidity and mortality, in the context of worsening clinical picture. Since the first interventional transcatheter valve implantation procedure in 2012 and to date, the evolution of technology and refinement of medical techniques has led to the refinement of the treatment method and thus to the improvement of the prognosis of patients with aortic stenosis undergoing TAVI after only one month.</p> </abstract>ARTICLEtrue