rss_2.0Internal Medicine FeedSciendo RSS Feed for Internal Medicine Medicine Feed 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 Nephrotic Syndrome in Patients with Diabetes Mellitus<abstract> <title style='display:none'>Abstract</title> <p>Type 2 diabetic nephropathy may be the consequence of some non-diabetic form of renal disease, unlike type 1 diabetes mellitus (DM) of long duration (≥10 years) in which severe proteinuria is always related to a well -defined pattern of diabetic nephropathy. The clinical manifestations of diabetic nephropathy are similar in type 1 and type 2 diabetes, while the renal lesions may differ. Diabetic glomerulopathy is the predominant renal lesion in type 1 diabetes, although tubular, interstitial and arteriolar lesions are also present in the advanced stages of renal disease. In contrast, in type 2 diabetes renal lesions are heterogeneous and several patients who fall into this category and who also suffer from diabetic kidney disease have mild or absent glomerulopathy with tubulointerstitial and/or arteriolar abnormalities. In addition, a high prevalence of non-diabetic renal diseases (NDRD), isolated or superimposed on classic diabetic nephropathy lesions have been reported in patients with type 2 diabetes, often reflecting the bias of selecting patients for unusual clinical presentations for renal biopsy. In this case report is illustrated that the nephrotic syndrome in patients with diabetes mellitus is not always associated with diabetic nephropathy non-diabetic renal disease.</p> </abstract>ARTICLEtrue and Late Complications in Aortic Valve Replacement Surgery<abstract> <title style='display:none'>Abstract</title> <p>Congenital aortic bicuspid valve can evolve rapidly and at an early age to a severe aortic disease with significant stenosis and regurgitation. Therefore, cardiovascular surgery with mechanical aortic prosthesis implant is the only therapeutic solution. Despite a successful surgical procedure, complications can be numerous, especially post-operatively, as conduction disorders and arrhythmias. Also, given the recent guidelines recommendations to maintain the INR values above 2,5, chronic oral anticoagulation is critical in the long-term prevention of cardioembolic events. Thus, we are presenting the case of a patient diagnosed with a severe aortic disease secondary to a bicuspid aortic valve, who underwent a Bentall surgical procedure, later suffering a wide spectrum of complications, both immediate and late, especially due to long-term subtherapeutic INR values. The particularities of the case reside both in the multitude of complications that occurred in a particular chronological order and in the interfering mechanisms with the anticoagulant therapy.</p> </abstract>ARTICLEtrue Immunomodulation Therapies as New Options to Cure Urinary Tract Infections<abstract> <title style='display:none'>Abstract</title> <p>With their high prevalence and predisposition to recurrence, urinary tract infections are important contributors to antibiotic prescription worldwide. Studies involving alternative urinary tract infections treatments emerged as a priority in the last years, developing as a response to rapid global dissemination of multi-drug resistant uropathogens. One of these non-antibiotic strategies is based on the hypothesis that recurrent and severe forms of urinary tract infections have a genetic susceptibility pattern, involving the variability of the innate immune response to germs aggression. Yet insufficient studied, the immunology of urinary tract infections is still a subject for new bold researches. By focusing the precise defect that leads to predisposition towards severe or recurrent evolution of the disease and by targeting to correct them, these new therapies examples outlined in our review can bring a ray of hope in the treatment of UTI and the burden they represent.</p> </abstract>ARTICLEtrue Syndrome<abstract> <title style='display:none'>Abstract</title> <p>Takotsubo syndrome occurs in 1-2% of patients admitted in the emergency department with suspicion of ST-segment elevation myocardial infarction (STEMI), over 90% being postmenopause women. Psycho-emotional or physical stress is the main trigger that causes the release of catecholamines, with an important role in the pathophysiology of Takotsubo cardiomyopathy. In most cases, supportive and symptomatic treatment is sufficient, with a dynamic follow-up of the left ventricular (LV) function. Usually, a complete recovery occurs in 3-4 weeks.</p> <p>We are presenting the case of a 67-year-old patient with a severe angina attack which occuredafter a major psycho-emotional stress, with an electrocardiographic appearance of an anterior STEMI and echocardiographic apical ballooning, both compatible with Takotsubo syndrome. Coronary angiography showed a muscle bridge with a systolic compression of 75% on the anterior descending artery (ADA). The evolution was marked by the occurrence of cardiogenic shock remitted under treatment, with complete recovery of LV systolic function.</p> <p>The particularity of the case resides in an acute coronary syndrome (ACS) after a psycho-emotional stress associated with a muscular bridge, as well as the appearance of the cardiogenic shock.</p> </abstract>ARTICLEtrue Association Between Heart Failure with Preserved and Mildly Reduced Ejection Fraction and Depression in the Elderly Patient<abstract> <title style='display:none'>Abstract</title> <p><bold>Background and aim.</bold> Modern society is experiencing an accelerated increase in the number of elderly people, to the detriment of children and young adults, in the context of declining birth rates, high adult mortality and increasing life expectancy due to advances in medicine. Cardiovascular diseases are becoming more common in the general population, representing the leading cause of death, being responsible for a third of the total number of deaths worldwide, and heart failure is the most common cause of hospitalization in patients over 65 years. Depression is one of the most common mental illnesses, presents different clinical pictures, which vary from person to person and in relation to age, being shown that there are somatic disorders due to depression, including cardiovascular disease.</p> <p><bold>Materials and method.</bold> We studied 127 patients hospitalized in the Geriatrics Department of the Calarasi County Emergency Hospital, diagnosed with heart failure (HF), being divided into 2 groups: the first group, which included 63 patients with heart failure with mildly reduced ejection fraction and the second, which included 64 patients with heart failure with preserved ejection fraction.</p> <p><bold>Results.</bold> The main risk factor present in the studied patients was dyslipidemia, which is present in 90% of patients with a mildly ejection fraction and in 88% of patients with a preserved ejection fraction. Hypertension was also present in 75% of patients in the first group and in 63% of those in the second group. Depression was present in 67% of patients with mildly reduced ejection fraction and in 64% of those with preserved ejection fraction. The degree of depression was higher among women, 11% of those with HF with mildly reduced ejection fraction and 14% of those with preserved ejection fraction had major depression. The degree of depression increases with age, patients over 80 years presented predominantly moderate-severe depression (41% of patients in the first group, and 50% in the second). Patients with NYHA class III heart failure had predominantly moderate-to-severe depression: 50% of patients with mildly reduced ejection fraction and 67% of those with preserved ejection fraction.</p> <p><bold>Conclusion.</bold> Depression is an important independent risk factor for heart failure in the elderly patients. Due to the fact that the symptoms of the two pathologies are often similar, the diagnosis of depression can be difficult to make, which is why it should be investigated in all patients with heart failure. It is important to understand the peculiarities of the polypathology of the elderly, which often poses problems for the diagnosis and treatment of the clinician.</p> </abstract>ARTICLEtrue Cancer and Diabetes Relationship: An Evidence-Based Overview for Healthcare Providers<abstract> <title style='display:none'>Abstract</title> <p>As the third most frequently diagnosed cancer through the worldwide, colorectal cancer (CRC) is the fourth leading cause and account for around 8% of all cancer-related death. Diabetes mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia and inflammation due to deficiency in insulin secretion or dysregulation of the insulin action pathway, which further leads to dysfunction and failure of multiple organs. Many advances have been made in the diagnosis and management of rectal cancer. Although colorectal cancer survival is severely dependent on the stage of disease at diagnosis, it might also be influenced by several risk factors. The relationship between colorectal cancer and diabetes is a complex one and can raise problems in both diagnosis and the management of patients with both conditions. Metabolic pathways of the type II diabetes, glucose intolerance and obesity can be considered as a link to rectal cancer. This article provides not just an overview of the epidemiology, diagnosis and management of CRC and DM, but also highlights of CRC and DM relationship.</p> </abstract>ARTICLEtrue Esophageal Chest Pain -A Comprehensive Review<abstract> <title style='display:none'>Abstract</title> <p><bold>Background and aim.</bold> Noncardiac chest pain (NCCP) is a medical condition described as acute, recurrent, or chronic chest pain, that is difficult to distinguish from ischemic heart pain, when the cardiac source has been excluded. Noncardiac chest pain represents a challenging clinical situation in gastroenterology practice, requiring sometimes a high amount of clinical investigation for a specific diagnostic. In some cases, the etiology is represented by esophageal diseases. This review aims to present the updated knowledge of the esophageal origin of NCCP.</p> <p><bold>Methods</bold>. A search was performed in the main databases containing medical publications. The following search terms were used: noncardiac chest pain, esophageal chest pain (ECP), pathophysiology, noncardiac chest pain etiology, gastroesophageal reflux disease (GERD), motility esophagus disorders, functional chest pain. Observational studies were included. Studies that described only cardiac chest pain were excluded.</p> <p><bold>Results</bold>. Noncardiac chest pain requires precise recognition of signs, symptoms and diagnostic testing in clinical practice. Due to financial constraints on subsequent care, an accurate algorithm based on clinical noncardiac chest pain guidelines should be followed. Esophageal chest pain represents a challenging diagnosis.</p> <p><bold>Conclusions</bold>. Noncardiac chest pain is a prevalent and alarming symptom. Esophageal chest pain etiology should be considered once a cardiac source has been excluded.</p> </abstract>ARTICLEtrue Cystitis, Rare Cause of Septic Shock Syndrome, a Permanent Challenge for the Nephrologist<abstract> <title style='display:none'>Abstract</title> <p>The term “rhabdomyolysis” defines a clinical and biological syndrome, potentially life-threatening, that occurs after the lysis of skeletal striated muscle fibers whose contents are released into the general circulation. The development of rhabdomyolysis can be associated with a wide variety of diseases, injuries, drugs, toxins and various viral infections.</p> <p>Recently, SARS-coV-2 has been reported as the cause of rhabdomyolysis, especially in those with severe forms of COVID-19. Very few cases describe the occurrence of this syndrome in patients with moderate forms of the disease.</p> <p>We will present the case of a patient with a mild to moderate form of the SARS-CoV-2 infection in contrast to the rhabdomyolysis syndrome, and also the lack of kidney damage.</p> </abstract>ARTICLEtrue An Amalgam of Never Ending Clinical Manifestations<abstract> <title style='display:none'>Abstract</title> <p>Thrombophilia is a blood coagulation disorder, in which blood has an increased tendency to clot, with both arterial and venous localization, being responsible for multiple manifestations: secondary arterial hypertension, stroke, acute pancreatitis or intracardiac masses. We are presenting the case of a 21-year-old male patient, hypertensive, known with thrombophilia, who was sent for the echocardiographic evaluation of an intracardiac mass attached to the posterior leaflet of the mitral valve. The echocardiography and transesophageal echocardiogram showed a hyperechogenic, homogeneous intracardiac mass, attached to the posterior leaflet of the mitral valve, the clinical context and the echocardiographic appearance being suggestive for a thrombus. Given the context of thrombophilia and the hypertension’s characteristics, we considered a secondary form of hypertension, the incriminated mechanism being represented by microthrombosis in the renal arterial circulation. There were two complications in the evolution of the patient: stroke and the recurrent acute pancreatitis, both being explained in the context of thrombophilia. The discharge echocardiography showed a favorable evolution, with a complete resolution of the thrombus under the anticoagulant treatment.</p> </abstract>ARTICLEtrue