rss_2.0Internal Medicine FeedSciendo RSS Feed for Internal Medicinehttps://sciendo.com/journal/INMEDhttps://www.sciendo.comInternal Medicine 's Coverhttps://sciendo-parsed-data-feed.s3.eu-central-1.amazonaws.com/609daf201926b447d337a615/cover-image.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20220522T074906Z&X-Amz-SignedHeaders=host&X-Amz-Expires=604800&X-Amz-Credential=AKIA6AP2G7AKDOZOEZ7H%2F20220522%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Signature=d6b2868501491a850262addd03b513a05cb2d636d80746cb365db710cd1125d7200300The Evolution of Liver Fibrosis in Patients with Viral C Infection Post Oral Antiviral Treatmenthttps://sciendo.com/article/10.2478/inmed-2022-0197<abstract> <title style='display:none'>Abstract</title> <p>Hepatitis C virus infection has been for several decades the major cause of cirrhosis and its complications worldwide. However, an arsenal of new and highly effective oral direct-acting antiviral drugs has changed the course of HCV treatment. The effects of HCV elimination are broad and include an overall reduction in mortality in patients with advanced fibrosis, a reduction of the risk of HCC in patients with advanced fibrosis and a reduction in extrahepatic manifestations including HCV-related non-Hodgkin’s lymphoma, other lymphoproliferative disorders and cryoglobulinemic vasculitis. Fibrosis regression is associated with a broad clinical benefit and remains an important therapeutic target in HCV patients who have obtained RSV.</p> </abstract>ARTICLE2022-04-10T00:00:00.000+00:00Vaccination and Covid 19 Infectionshttps://sciendo.com/article/10.2478/inmed-2022-0201<abstract> <title style='display:none'>Abstract</title> <p>In a world plagued by the same multifaceted Covid 19, pros-cons discussions about vaccines, their effectiveness, side effects, fears, and their inclusion in therapeutic strategies have taken on innumerable colors. In this article we will look at the impact of vaccines from the booster regimens to the effects of the booster, all this being seen through the light of the latest research conducted this year.</p> </abstract>ARTICLE2022-04-10T00:00:00.000+00:00The Role of Physical Deconditioning in Cardiological and Pulmonological Medical Practicehttps://sciendo.com/article/10.2478/inmed-2022-0196<abstract> <title style='display:none'>Abstract</title> <p>The examination of the patient with a recent episode of C19 and residual cardiorespiratory symptoms requires a complete two-line assessment of previously undiagnosed chronic pathology. As conventional investigations were insufficient in clarifying the remaining symptomatology, it was necessary to broaden the range of investigations and to take a different approach to this category of patients.</p> <p>Depending on the symptoms and the patient’s general condition at the beginning of the examination, the attending physician should not disregard the period of restrictions involving significant limitations regarding exercise imposed during the pandemic. Physical exertion minimization and isolation at home have led to a series of functional disorders throughout the body, particularly cardio-respiratory, musculo-articular and neuro-psychiatric disorders.</p> <p>The effects of a sedentary lifestyle or the lack of physical exertion are not limited to elderly individuals, nor to a single system or apparatus, but have undesirable consequences for the whole body. In this context, the pulmonologist was obliged to answer the question “does the patient have a previously undiagnosed chronic respiratory disease before COVID19 or is the patient physically deconditioned?”. This is how the cardio-respiratory exercise test - the stair-climbing exercise test - came into play in assessing this category of patients. As the medical rehabilitation units could not cope with all the patients, it was necessary to create a home-based rehabilitation programme that was cheap, fast, and allowing telephone monitoring and quantifiable results.</p> </abstract>ARTICLE2022-04-10T00:00:00.000+00:00Obesity-Related Hypertensionhttps://sciendo.com/article/10.2478/inmed-2022-0199<abstract> <title style='display:none'>Abstract</title> <p>Obesity is a globally expanding disorder and is the result of the interaction of genetic and environmental factors with the participation of social, behavioural, cultural, physiological, metabolic, and genetic influences. Obesity has profoundly negative effects on the health of the population and induces associated comorbidities such as hypertension, hyperlipidaemia, hyperinsulinemia / insulin resistance. There is ample evidence that obesity causes hypertension, cardiovascular disease, type 2 diabetes, cancer and chronic kidney disease, and the association of obesity with hypertension and other cardiovascular risk factors significantly increases the risk of cardiovascular events.</p> </abstract>ARTICLE2022-04-10T00:00:00.000+00:00A Clinical Trial of the Relationship Between Anxiety and Lung Function and Respiratory Symptoms in Patients with Asthma, Copd and Copd-Asthma. Assessment of Life Qualityhttps://sciendo.com/article/10.2478/inmed-2022-0195<abstract> <title style='display:none'>Abstract</title> <p>Anxiety is a comorbidity among patients with chronic respiratory diseases such as asthma, COPD and COPD-asthma. Anxiety disorders in this population have a considerable influence on asthma management, because they influence the perception of symptoms, and anxiety related to treatment can influence compliance. Patient noncompliance with treatment for chronic respiratory diseases compromises the success of treatment and the patient’s quality of life, while increasing medical costs. Therefore, the aim of our study was to provide patient-centered care and determine which dimension of anxiety is associated with asthma, COPD and COPD-asthma in the general population after controlling age, background and sex. In order to obtain information on the response to treatment, questionnaires on symptom control (Asthma Control Test (ACT), COPD Assessment Test (CAT)) and asses anxiety using the ASQ questionnaire. The result obtained indicates that no compliant person presented a high score of the dimensions (somatic, behavioral and cognitive dimension.) and predominates of anxiety a low overall score. The symptoms associated with anxiety have a low, medium overall score but also a high score on the first visit. The first and second age categories have a low score in both the behavioral and somatic dimensions. In the age category 3 and 4 are people with low score and medium score behavioral dimension and cognitive dimension. In conclusion we can say that through repetitive control we obtained increased treatment compliance was achieved, leading to improved lung function, symptoms control and therefore reduced anxiety in the case of patients with asthma, COPD and COPD-asthma.</p> </abstract>ARTICLE2022-04-10T00:00:00.000+00:00Comparative Study of the Laboratory, Imagery and Therapeutic Profile of Patients Hospitalized at the Gastroenterology Versus Surgery Department Diagnosed with Cholangitis after Cholecystectomyhttps://sciendo.com/article/10.2478/inmed-2022-0194<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Post-cholecystectomy cholangitis represents a controversial issue within the medical literature due to the polymorphism of the generating causes and due to the difficulties connected to its diagnosis and therapy.</p> <p><bold>Material and methods.</bold> The assessment of the study was performed on two batches of patients, namely 221 patients hospitalized at Surgery Departments and another batch of 109 patients hospitalized at the Gastroenterology Department all having post-cholecystectomy cholangitis as their main diagnosis. The assessment criteria were suggestive laboratory and imagery investigations and therapeutic management.</p> <p><bold>Results.</bold> If we compare the laboratory profile of both batches, we can see that only the non-specific inflammatory syndrome has shown significant differences statistically (way more frequent in case of patients hospitalized at the Gastroenterology Department), while the biliary-excretion, the cholestatic and hepatic cytolysis syndromes had approximately the same prevalence. In both batches, the treatment methods used were mainly pharmacology methods, and in a small number of cases retrograde endoscopic cholangiopancreatography. There were also a few cases where invasive surgery was applied.</p> <p><bold>Conclusion.</bold> An increased clinical suspicion, an early recognition based on laboratory and imagery investigations, a prompt therapy initiation, and a balanced and correct anti-microbial management, endoscopic and surgical, need the implication of complex teams of clinicians.</p> </abstract>ARTICLE2022-04-10T00:00:00.000+00:00Prolonged Febrile Syndrome in a Patient with Inflammatory Bowel Diseasehttps://sciendo.com/article/10.2478/inmed-2022-0202<abstract> <title style='display:none'>Abstract</title> <p>Patients with inflammatory bowel disease (with or without immunosuppressive treatment) have a fragile immune status that predisposes to opportunistic infections. Cytomegalovirus (CMV) is an opportunistic pathogen that determines a large variety of clinical syndromes especially in immunocompromised patients. In inflammatory bowel disease (IBD) patients, his role has long been debated and it is thought that it can complicate the course of the disease. The most frequent clinical manifestation in inflammatory bowel disease patients is represented by CMV colitis, however other clinical manifestations can be met and must also be considered.</p> <p>We present the case of a young male patient with ulcerative colitis that came to our attention for prolonged febrile syndrome and IBD flare, that was finally confirmed to have CMV disease.</p> </abstract>ARTICLE2022-04-10T00:00:00.000+00:00Renal Involvement in Sjogren S Syndromehttps://sciendo.com/article/10.2478/inmed-2022-0203<abstract> <title style='display:none'>Abstract</title> <p><bold>Background.</bold> Primary Sjogren’s syndrome (pSS) is a chronic progressive autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands, which affects the salivary and lacrimal glands, presenting dryness of the mouth and eyes. Renal involvement is easily ignored by the physicians because the clinical symptoms are often insidious. The most common renal disease in pSS is tubulointerstitial nephritis, responsible for renal tubular acidosis in 20%.</p> <p><bold>Case report.</bold> A 36-year-old woman with polyuria and polydipsia for 10 years ago was admitted to the hospital because asymptomatic hypokalemia, kidney stones, and rashes. This woman presented nephrogenic diabetes insipidus and chronic metabolic acidosis for one year, conditions treated with amiloride and sodium bicarbonate. Anti-Sjögren’s antibody A and B were checked and were both found to be positive. At presentation, she had elevated serum osmolality of 301, with a very low urine osmolality of 61, and serum sodium of 143. A metabolic acidosis with hypokalemia and elevated urine pH are consistent with distal renal tubular acidosis (RTA). A kidney biopsy was obtained, which revealed tubular interstitial fibrosis with infiltration of lymphocytes and plasmacytes who extended into intact cortical parenchyma and was consistent with active chronic interstitial nephritis.</p> <p><bold>Conclusions</bold>. Our presenting patient presented renal manifestations of pSS, including diabetes insipidus, renal tubular acidosis type I, tubulointerstitial nephritis, and nephrolithiasis. None of these findings are common presentations of pSS. The presence of all of these symptoms in one individual makes this patient an atypical way to diagnose a primary Sjogren’s syndrome.</p> </abstract>ARTICLE2022-04-10T00:00:00.000+00:00The Association Between Neutrophil and Lymphocyte Ratio and Exercise Capacity at Patients with Cardiovascular Diseasehttps://sciendo.com/article/10.2478/inmed-2022-0200<abstract> <title style='display:none'>Abstract</title> <p>The neutrophil to lymphocyte ratio (N/L) is an indicator of systemic inflammation and a prognostic marker in patients with several cardiovascular diseases (CVDs). Exercise capacity (EC) plays an important role in predicting morbidity and mortality especially in patients with coronary artery disease and heart failure. Studies have been conducted to evaluate the correlation between N/L ratio and EC in CVDs. We searched the PubMed (MEDLINE) database using the keywords “neutrophil”, “lymphocyte”, “neutrophil to lymphocyte ratio”, “cardiovascular disease”, “exercise capacity” and derivatives. Considering the dispersion of these studies as well as reports on prognostic value of N/L ratio in CVDs, we have summarized these findings as a review article. A significant association between higher N/L ratio and low EC was identified, both of which has predictive and prognostic value especially for patients with heart failure.</p> </abstract>ARTICLE2022-04-10T00:00:00.000+00:00Insights into Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitishttps://sciendo.com/article/10.2478/inmed-2022-0198<abstract> <title style='display:none'>Abstract</title> <p>Non-alcoholic fatty liver disease (NAFLD) constitutes a common pathological condition of the liver, the prevalence of which is currently increasing in western countries. NAFLD is frequently diagnosed in males and its incidence is higher in individuals with type 2 diabetes mellitus and obesity. Hence, the disease is considered to be the hepatic manifestation of the metabolic syndrome. A multitude of interconnected risk factors have been described over the years – genetic, hormonal and nutritional, which play important roles in the development of NAFLD. Insulin resistance is considered to be the central pathophysiological condition that promotes the disease in diabetic patients, whereas dyslipidemia and cardiovascular comorbidities (arterial hypertension, ischaemic heart disease) are frequently associated conditions. Although there are currently numerous pathophysiological mechanisms involved in NAFLD that are still unknown or poorly understood, there has been some advancements concerning the pathogenesis of the disease and its progression towards its severe form, known as non-alcoholic steatohepatitis (NASH). In the absence of a clear diagnosis and carefully controlled treatment, NAFLD/NASH may evolve towards liver cirrhosis, liver failure or hepatocellular carcinoma. However, the disease may also generate systemic effects, including the development of chronic kidney disease (CKD). The diagnosis of NAFLD/NASH is based both on its clinical manifestations, revealed by a carefully conducted patient history and physical examination of the patient, and on other investigations; histopathological findings upon liver biopsy, liver ultrasonography and the use of transient elastography (or FibroScan) are some of the most important investigations in NAFLD/NASH. The understanding of the most important risk factors and pathogenic mechanisms of the disease is fundamental for the elaboration of the most efficient treatment, to prevent chronic liver disease or the development of hepatocellular carcinoma.</p> </abstract>ARTICLE2022-04-10T00:00:00.000+00:00Oxygen and Covidhttps://sciendo.com/article/10.2478/inmed-2021-0190<abstract> <title style='display:none'>Abstract</title> <p>In severe cases of SARS-CoV-2 infection, death occurs as a result of hypo-oxygenation of peripheral tissues. The lung, severely damaged, can not ensure the transfer of oxygen to the blood. It is necessary to increase the alveolar concentration of oxygen by supplementation, with or without mechanical ventilation. The relatively poor outcomes are related to the fact that the entire chain of oxygen transport to the mitochondria is compromised. The oxygen transport capacity is drastically reduced especially by overproduction of immature red blood cells and hemoglobin damage. The oxygen excess is toxic to the lung, causing characteristic lesions that evolve to fibrosis and that add to the respiratory distress induced by COVID19. The administration of oxygen in a concentration well above the level in the atmosphere causes a real explosion of oxidizing free radicals, which are particularly aggressive.</p> <p>It is recommended to use oxygen sparingly, at the borderline of coverage of the demand, for a duration as limited as possible, as well as the combination of antioxidants.</p> </abstract>ARTICLE2021-12-30T00:00:00.000+00:00Sludge Balls – A Surprising Final for a Biliary Cholichttps://sciendo.com/article/10.2478/inmed-2021-0193ARTICLE2021-12-30T00:00:00.000+00:00Nonalcoholic Fatty Liver Disease – Cardiovascular Risk Factor in Pacients with Type 2 Diabetes Mellitushttps://sciendo.com/article/10.2478/inmed-2021-0187<abstract> <title style='display:none'>Abstract</title> <p>Scopul studiului a fost de a determina relaţia între doi factori de risc cardiovascular cunoscuţi (ateroscleroza subclinică şi hipertensiunea arterială) şi ficatul gras nonalcoolic (NAFLD - nonalcoholic fatty liver disease) la pacienţii cu diabet zaharat de tip 2. Au fost incluşi 92 de subiecţi cu diabet zaharat de tip 2 trataţi cu antidiabetice orale sau doar regim igienodietetic. Ultrasonografia abdominală şi ultrasonografia Doppler au fost utilizate pentru a evalua severitatea steatozei hepatice şi a aterosclerozei subclinice, prin măsurarea grosimii intimămedie carotidiană (GIM). Vârsta medie a lotului de studiu a fost de 60,38 ±10,37 ani. Mai mult de 90% dintre subiecţi au prezentat diferite stadii de încărcare grasă hepatică. 61% dintre pacienţi au avut valori anormale ale GIM. 75% dintre pacienţi au prezentat valori crescute ale tensiunii arteriale. S-a demonstrat o relaţie semnificativă statistic între gradul de steatoză hepatică şi GIM (r =0.3636, p =0.0004). De asemenea, s-a constatat o corelaţie semnificativă între gradul de încărcare grasă hepatică şi tensiunea arterială sistolică. Rezultatele susţin ipoteza că NAFLD poate reprezenta un predictor cardiovascular prin relaţia sa directă cu GIM şi tensiunea arterială.</p> </abstract>ARTICLE2021-12-30T00:00:00.000+00:00Albumin and Proximal Tubular Cells in Progressive Renal Diseasehttps://sciendo.com/article/10.2478/inmed-2021-0188<abstract> <title style='display:none'>Abstract</title> <p>The presence of albuminuria has long been recognized as an adverse prognostic feature in patients with renal disease. Those patients with appreciable albuminuria are much more likely to develop tubulointerstitial scarring and fibrosis and progress to end-stage renal failure. For many years it was thought that excess albuminuria was simply a marker of a more severe renal disease which was more likely to progress as a result of this severity rather than as a result of the albuminuria itself. This conviction was strengthened by the general assumption that albumin was a benign or inert molecule serving primarily to exert oncotic pressure and act as a carrier within the circulation.</p> <p>More recently this view has been challenged with the accumulation of evidence suggesting that albumin is able to influence the function of cells with which it makes contact in the manner of a signaling molecule.</p> </abstract>ARTICLE2021-12-30T00:00:00.000+00:00Impact of Comorbidities on the Long-Term Prognosis of Patients with Intermittent Claudicationhttps://sciendo.com/article/10.2478/inmed-2021-0186<abstract> <title style='display:none'>Rezumat</title> <p><bold>Introducere.</bold> Arteriopatia obliterantă a membrelor inferioare (AOMI) reprezintă consecinţa afectării aterosclerotice a arterelor distale, cu o prevalenţă crescută în special în rândul pacienţilor de gen masculin. Prezentarea clinică este variabilă, de la prezenţa clasică a claudicaţiei intermitente şi până la apariţia semnelor clinice de ischemie acută la nivelul membrelor inferioare. Diagnosticul este stabilit în cele mai multe cazuri pe baza indicelui gleznă-braţ cu o valoare sub 0,9. Managementul terapeutic are drept deziderate principale reducerea riscului de apariţie a unui eveniment acut cardiovascular, îmbunătăţirea statusului functional şi prevenirea declinului fizic şi psihic deopotrivă. Recuperarea cardiovasculară joacă un rol important, având implicaţii prognostice pe termen scurt şi lung.</p> <p><bold>Materiale şi metode.</bold> Studiul prezentat în lucrarea de faţă este unui descriptiv, retrospectiv, bazat pe un lot de 70 de pacienţi diagnosticaţi cu AOMI care au fost evaluaţi în cadrul Clinicii de Recuperare Cardiovasculară. Au fost constituite două loturi, în funcţie de prezenţa sau nu a claudicaţiei intermitente (60 pacienţi, respectiv 10 pacienţi).</p> <p><bold>Rezultate.</bold> Analiza statistică a inclus o varietate de parametri demografici, clinico-paraclinici şi terapeutici deopotrivă, urmărind să se evidenţieze factorii cu impact asupra apariţiei şi progresiei claudicaţiei intermitente şi, implicit, efectul acestora asupra prognosticului pe termen lung. Genul masculin, fumatul, hipertensiunea arterială, diabetul zaharat, prezenţa bypass-ului aortocoronarian în antecedente şi profilul lipidic modificat sunt parametri semnificativi statistic în studiul prezentat.</p> <p><bold>Concluzii.</bold> Evoluţia AOMI este marcată de simptomatologie şi de corecţia factorilor de risc prezenţi, recuperarea cardiovasculară asigurând la aceşti pacienţi îmbunătăţirea statusului functional şi creşterea calităţii vieţii.</p> </abstract>ARTICLE2021-12-30T00:00:00.000+00:00When Isn't Extreme Hypernatremia Followed by Cerebral Hemorrhage? A Case Report and a Review of Literaturehttps://sciendo.com/article/10.2478/inmed-2021-0191<abstract> <title style='display:none'>Abstract</title> <p><bold>Background.</bold> Hypernatremia is an electrolyte disturbance frequently encountered in patients in intensive care units (ICUs). On admission, 2-6% of patients have hypernatremia, and 7-26% develop hypernatremia during their stay. Hypernatremia was found to be an independent risk factor for mortality. While the underlying pathology of hypernatremia can be characterized as a net increase in total sodium or a net loss of free water, clinical diagnosis of the underlying pathology is not always clear. Tetraparetic patients are a special risk group for hypernatremia. They are immobilized for long periods and depend entirely on nursing.</p> <p><bold>Case report.</bold> We presented a challenging case of a 49-year-old patient with a history of subarachnoid hemorrhage, complicated with an episode of extreme hypernatremia accompanied by hydrocephalus.</p> <p><bold>Conclusion.</bold> Even though the most serious complication of hypernatremia is subarachnoid hemorrhage, the severe episode of hypernatremia did not result in re-bleeding. The patient's extreme serum sodium levels (197 mmol/L) mentioned in the literature as incompatible with life, together with the absence of re-bleeding, confers particularity to the current case.</p> </abstract>ARTICLE2021-12-30T00:00:00.000+00:00Treatment Possibilities of Muscle Cramps in Patients with Liver Cirrhosishttps://sciendo.com/article/10.2478/inmed-2021-0189<abstract> <title style='display:none'>Abstract</title> <p>Muscle cramps appearing in liver cirrhosis substantially affect the quality of life of these patients. The prevalence of painful muscle cramps can be up to 88%. The exact mechanism by which these muscle cramps occur is unknown. The management of this symptom is not easy because there is no uniformly accepted recommendation about what kind of supplementation or medicine (or both) can be used exactly. The aim of our study is to review the treatment options for muscle cramps in liver cirrhosis.</p> <p>We found in the literature (using the keywords „liver cirrhosis", „muscle cramps", „treatment" and „quality of life") 32 articles of this topic. Treatment options currently are: vitamin supplementations (vitamin E, 1 - α hydroxy vitamin D), amino acid supplementations (taurine, branched - chain amino acids, L - carnitine, albumin), mixed herbal medicines (Niuche-Shen-Qui-Wan), zinc and medications (eperisone hydrochloride, quinine and quinidine sulphate, baclofen, methocarbamol, orphenadrine). Vitamin supplementations and amino acid supplementations are targeting the possible pathophysiological causes of muscle cramps (nerve function or energy metabolism alterations which are unique to liver cirrhosis). New aspects started to use medications especially antispasmodic agents (methocarbamol, orphenadrine) and antispasticity agents (baclofen) to relieve muscle cramps. We also found a multicenter study and two systematic reviews (performed in 2013 and 2014). From 2014 there is no systematic article appeared in this topic and we considered it important to survey the new treatment options next to the treatment options already known.</p> </abstract>ARTICLE2021-12-30T00:00:00.000+00:00Stage 4 COPD, Chronic Pulmonary Heart Disease and COVID 19 Infectionhttps://sciendo.com/article/10.2478/inmed-2021-0192<abstract> <title style='display:none'>Abstract</title> <p>Chronic obstructive pulmonary disease (COPD) is a chronic disease of the respiratory airways due to partially reversible obstruction of the airflow caused by an abnormal inflammatory response to toxic substances, most often cigarette smoke. COVID-19 is a mild to severe respiratory disease caused by a coronavirus from the genus Betacoronavirus. Chronic cor pulmonale is a severe complication of COPD. Stroke is common in the course of COVID disease,with a major impact on the patient.</p> </abstract>ARTICLE2021-12-30T00:00:00.000+00:00Adverse Drug Reactions and Atrioventricular Conduction Disorders - A Female Gender Related Aproachhttps://sciendo.com/article/10.2478/inmed-2021-0179<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Although cardiovascular disease remains the leading cause of mortality regardless of gender, the female gender has remained an underrepresented population in studies in this field. Sustained initiatives by the European Society of Cardiology have brought to the fore the importance of studying gender differences regarding the safety profile of cardiovascular drugs in women. Common cardiovascular adverse drug reactions include atrioventricular conduction disorders.</p> <p><bold>Materials and methods.</bold> The present study followed the clinical and paraclinical features of female patients with a primary diagnosis of bradycardia in relation to bradycardic medication. We included a group of 359 female patients, divided according to the presence or absence of bradycardia medication into a study group (n=206) and a control group (n=153).</p> <p><bold>Results.</bold> Patients with associated bradycardic medication frequently required emergency admission (P &lt; 0.001), with prolonged hospitalization (P &lt; 0.001). The main atrioventricular conduction disorders identified were atrial fibrillation with slow ventricular response (P = 0.028), sinus bradycardia (P = 0.009) and sinus pauses (P = 0.009). Among comorbidities, heart failure (P&lt;0.001) and chronic kidney disease (P&lt;0.001), were common in the study group. Echocardiographic parameters of left ventricular (P=0.002) and biatrial (P&lt;0.001) dilatation, as well as severe left ventricular systolic dysfunction (P=0.009), showed statistical significance in this group. The most used drugs were beta-blockers, amiodarone, and digoxin.</p> <p><bold>Conclusions</bold>. Our results indicate, as factors associated with medication-related bradyarrhythmias in female gender: heart failure with severe systolic dysfunction, renal dysfunction, atrial fibrillation, and left ventricular dilatation.</p> </abstract>ARTICLE2021-11-15T00:00:00.000+00:00The Profile of Romanian Patient with Central Sleep Apnea and Heart Failurehttps://sciendo.com/article/10.2478/inmed-2021-0181<abstract> <title style='display:none'>Abstract</title> <p>Sleep-related breathing disorders are highly prevalent in patients with established cardiovascular disease, especially Heart failure (HF). Central sleep apnea (CSAS) share several pathophysiological features with obstructive sleep apnea, but each with a unique pathology and specific treatment. There are considerably fewer published patient profile reports in association with CSAS-HF. The treatment for association CSAS-HF varies and depends on the etiology of respiratory disorder and leaves considerable room for improvement for future investigations. Despite progress over the last 3 decades, HF continues to have high morbidity and mortality rates. At this time, it is also uncertain whether CSAS is a consequence of HF with reduced ejection fraction or it is in fact a risk factor for the evolution of underlying cardiac pathology.</p> <p>Therefore, this retrospective study highlights the interaction between CSA and HF, with particular attention to age differences, a frequent reported risk factor, in a Romanian large cohort. Were included adults &gt; 18 years old, with sleep apnea syndrome (apnea-hypopnea index-AHI&gt;5 per hour of sleep with at least 50% of central on polygraphy-PG and after on polysomnographic-PSGsleep study) in the presence of sleep symptoms, with known HF with preserved LVEF (&gt;40%) in a previous internal/cardiology department. Were excluded those &lt; 18years old, with other sleep apneas (obstructive, mixed or complex), other sleep disorders (by PSG), inadequate PSG records,or patient refusal. Anthropometric data, clinical findings, vital parameters, comorbidities, treatments and investigations (see below) were analyzed in the population and also in subgroups.</p> <p>The majority of this study population (12 patients) were male, older, with normal weight, symptomatic and comorbidities. As many as 90% of the patients presented severe CSAS and 77.8% associated Cheyne–Stokes respiration (CSR). The comparative analysis of the subgroups in which according to the literature the associated pathologies manifest differently showed that there have not been noted major differences or statistically significant correlation between these two groups and cardiac outcomes.Still, in the group over 65 years we found that people were more predisposed to suffer from high BP, judging by the elevated level of the systolic blood pressure value, and another relevant comorbidities were atrial fibrillation, had more apneas and hypopneas during sleep and severe CSA were the most common. Following titration, AHI, central apnea index, desaturation index decreased with clinically significant. This study appeals to the importance of sleep health, an even more important aspect for Romania, where this associations underreported and even unrecognized, and thus the general condition of patients can worsen. Further research, based on other criteria of difference, is needed as the evidence is still lacking regarding the long-term consequences of CSA and long-term impact of current strategies in HF population.</p> </abstract>ARTICLE2021-11-15T00:00:00.000+00:00en-us-1