rss_2.0Internal Medicine FeedSciendo RSS Feed for Internal Medicine Medicine 's Cover Predictive Role of Variceal Band Ligation in the Development of Portal Vein Thrombosis in Cirrhotic Patients<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> It is well known that portal vein thrombosis (PVT) can accelerate liver decompensation, reducing overall survival<sup>(1)</sup>. In the literature, the topic whether PVT is a risk factor for variceal bleeding or it influences the effectiveness of variceal band ligation (VBL) remains of great interest</p> <p><bold>The aim</bold> of this study was to assess if VBL is a potential risk factor for PVT development. An observational and retrospective study was conducted in a single tertiary center from 2010 to 2021 and included data from 285 patients with liver cirrhosis.</p> <p><bold>Results.</bold> Of the 285 patients, gender distribution described 47.32% female (n =135) and 52.8% male (n =150) with a mean age of 55 years (range =23-79). The average MELD score was 12.5 (range 7-27).</p> <p>Of the total number of patients, 48.8% (n=139) had previous VBL: 20% (n=57) underwent primary prophylactic VBL and 34.7% (n=99) underwent secondary prophylaxis. Thus, 285 VBL procedures had been performed and the average number of VBL session was 2 (range 1-10)</p> <p>The mean time follow up was 92.55 months (range 22-230. During the follow up period PVT was diagnosed in 41.4% of patients (n =118) of which 67.77% (n =80) had at least one previous session of VBL: 33% of patients (n =39) had performed primary prophylaxis and 34.74% (n =41) secondary. A logistic regression was conducted to assess if VBL (primary and/or secondary prophylaxis) are risk factors for PVT development. The model was significant for primary prophylaxis (p =0.002, OR 3.28, CI 1.53-7.02) resulting that the risk of PVT is increasing around 3 times after primary prophylactic VBL.</p> <p><bold>Conclusion.</bold> Our study showed a certain predisposition for cirrhotic patients to develop PVT after VBL performed as primary prophylaxis thus raising the question: does VBL impact the occurrence of PVT in cirrhotic patients?</p> <p>Furthermore, to our knowledge, this is the first study in the literature that focuses on this topic. More studies should be performed to evaluate and describe the relationship between VBL and the risk of PVT.</p> </abstract>ARTICLE2022-07-13T00:00:00.000+00:00Clinico-Pathological Correlations of Poststreptococcal Glomerulonephritis<abstract> <title style='display:none'>Abstract</title> <p>Postinfectious glomerulonephritis is associated with bacterial, viral, fungal, and parasitic infectious agents and histologically appears most often as acute diffuse endocapillary or proliferative glomerulonephritis secondary infection with: group A streptococcus, streptococcus viridans, staphilococus aureus, diploccocus pneumoniae, Brucella melitensis, Salmonella typhi, Yershinia enterocolitica, Plasmodium falciparum, meningococcus, Mycoplasma, Klebsiella, varicella, variola, mumps.</p> <p>Less commonly, it appears as diffuse crescentic glomerulonephritis and a lot of infectious causes are incriminated like: streptococcus, legionella, varicella, Treponema pallidum or as focal crescentic glomerulonephritis: streptococcus A. It rarely appears as mesangiocapillary glomerulonephritis secondary infection with: streptococcus viridans, hepatitis C virus; diffuse or focal mesangial proliferative glomerulonephritis: hepatitis B virus, salmonella, adenovirus, influenza virus, salmonella; focal segmental, necrotizing and sclerosing glomerulonephritis: bacterial endocarditis; membranous glomerulonephritis: hepatitis B virus, syphilis, filarial, Mycobacterium, plasmodium falciparum; focal proliferative: Mycoplasma; mesangiolytic glomerulonephritis :Echo virus.</p> <p>Poststreptococcal glomerulonephritis (PSGN) is caused by prior infection with specific nephritogenic strains of group A beta-hemolytic streptococcus. The clinical presentation of PSGN varies from asymptomatic, microscopic hematuria to the full-blown acute nephritic syndrome, characterized by red to brown urine, proteinuria (which can reach the nephrotic range), edema, hypertension, and acute kidney injury. The prognosis is generally favorable, especially in children, but in some cases, the long-term prognosis is not benign. Managing a case of PSGN requires cooperation between internists, nephrologists, infectious disease consultants, pharmacists, and nursing staff, functioning as an interprofessional team, to provide excellent care for their patients.</p> </abstract>ARTICLE2022-07-13T00:00:00.000+00:00Coronary Artery Disease in People Living with Human Immunodeficiency Virus<abstract> <title style='display:none'>Abstract</title> <p>People living with HIV live longer now due to highly active antiretroviral therapy. Due to their increased life expectancy, they have an increased cardiovascular risk cause by the traditional risk factors (smoking, use of ilicit drugs, obesity/lipodystrophy, dyslipidemia, diabetes, hypertension) and particular risk factors (endothelial dysfunction, inflammation, coagulation abnormalities, viral coinfections and antiretroviral therapy. The pathophysiology of accelerated atherosclerosis is complex. Coronary artery disease become an important cause of mortality in these patients. The incidence of coronary artery disease and especially of acute myocardial infarction is generally low among HIV patients, but it may by twice as high as in patients with the similar characteristics. Medical treatment for coronary disease in these patients has no special particularities comparing to general population, but possible drug interactions must be considered. Indication for coronary revascularization, either angioplasty, or aorto-coronary by-pass follows general indications for general population.</p> </abstract>ARTICLE2022-07-13T00:00:00.000+00:00Omicron Variant Behavior in a Couple: Vaccinated Versus Non-Vaccinated<abstract> <title style='display:none'>Abstract</title> <p>Infection with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) may present as the common cold, or in a series of cases can also result in severe or fatal pneumonia with severe respiratory distress. Since the virus’s first appearance in December 2019, multiple studies have focused on clinical manifestations and biological features of different COVID variants in these five pandemic waves. Also, the variety of symptoms, the severity of the disease and the assessment of risk factors in each individual has continuously evolved among these two years, due to updated data published worldwide. The current paper presents the case of two patients, husband and wife, who develop a similar COVID-19 infection with only mild symptoms, although their disease history and COVID vaccination status is very different. They were among the first confirmed Omicron variant cases by genome sequencing in Romania and their favorable outcome despite the risk factors was encouraging for our every day practice.</p> </abstract>ARTICLE2022-07-13T00:00:00.000+00:00Post-Covid-19 Immunological Disorder: A Possible Pathological Entity in a 43 Year Old Man<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>. Post-COVID-19 systemic inflammatory syndrome is considered to be an aquired immunological disorder, which may develop in some individuals after the remission of infection with SARS-CoV-2 and defined by inflammatory clinical manifestations (fever, arthralgias, cutaneous and mucosal pallor, physical weakness) and modified biological parametres (normochromic normocytic anaemia, increased serum levels of C reactive protein and rheumatoid factor), with no proof of an infectious process, to which corticotherapy may be a suitable therapeutic strategy.</p> <p><bold>Case report</bold>. A 43 year old male was admited in the Department of Internal Medicine for high fever (39,4°C), moderate polyarthralgias and physical weakness, with a negative test result of SARS-CoV-2 RT-PCR. The patient had been previously diagnosed with a moderate-to-severe form of COVID-19, a month prior to the current admission. The patient also experienced transitory dry cough for a month, with no other relevant clinical abnormalities. Upon physical examination, cutaneous and scleral pallor was observed and lung auscultation revealed hardened vesicular murmur bilaterally. Blood analysis revealed normochromic normocytic anaemia and increased serum levels of rheumatoid factor and of C reactive protein, which suggested a nonspecific inflammatory syndrome.</p> <p>Although blood cultures and other microbiological tests were negative for an infectious process, a chest X-ray was performed, which detected the presence of a nodular formation in the superior left lung lobe. Several differential diagnoses were taken into consideration, including pulmonary sarcoidosis and granulomatosis with polyangiitis, both of which were excluded, clinically and biologically.</p> <p>A thoracic computed tomography (CT) was later performed, which revealed the presence of a tumoral nodule in the left lung, associated with multiple mediastinal and supraclavicular lymphadenopathies, indicative of lung cancer. However, lung cancer was also excluded upon the histopathological examination of paratracheal lymphnodes, which detected multiple areas of parenchymal necrosis surrounded by dense inflammatory infiltrates, formed predominantly by histiocytes. All of these findings resulted in the diagnosis of a post-COVID-19 rheumatoid syndrome, the only therapeutic strategy being the administration of high doses of intravenous and oral methylprednisolone, which improved the patient’s health.</p> <p><bold>Conclusion</bold>. Post-COVID-19 immunological disturbances should be taken into consideration in patients who experience repetitive clinical and biological inflammatory manifestations after the remission of the infection with SARS-CoV-2, which may be improved through high dose corticosteroid therapy.</p> </abstract>ARTICLE2022-07-13T00:00:00.000+00:00A Surprising Cause of Dysphagia Treatment of Hepatitis C Infection<abstract> <title style='display:none'>Abstract</title> <p>In 2016, the World Health Organization set „Viral hepatitis elimination by 2030” as a goal, which is predicated upon 2 advances: on the one hand, the efficacy of hepatitis B vaccine and, on the other, the sustained viral response to direct-acting antiviral (DAA) therapy for infection with hepatitis C virus (HCV). Romania also adopted this initiative considering the available results confirming the efficiency of this policy. Viral clearance results in reduced morbidity and mortality by liver injury and also by any associated HCV infection manifestations. In order to fulfill the target stated by the WHO any patient with detectable viremia must be treated. Unlike interferon-based regimes, DAA therapy for HCV infection is applicable to all groups of patients, regardless of the severity of their liver injury. Other advantages are high efficiency levels, proved in clinical trials as well as in the real world, oral administration route, good safety profile, a very good rate of sustained virological response in patients with decompensated cirrhosis and the possibility of prescribing them to children older than 8. Despite the remarkable progress, an ideal antiviral therapy has not yet been discovered. The direct-acting antiviral therapy in use today has 3 targets: NS3/4A, NS5A, NS5B. None of the drugs is designed to be used alone. For convenience, the pharmaceutical industry has developed pills containing combinations of 2 or 3 active drugs, which completely changed the hepatitis C treatment paradigm.</p> </abstract>ARTICLE2022-07-13T00:00:00.000+00:00Cholestasis, Chronic Pruritus and Hepatitis C -the Importance of the Differential Diagnosis Should Not Be Underestimated<abstract> <title style='display:none'>Abstract</title> <p>Chronic pruritus appears the most frequently in dermatological conditions but it can also be present in liver disease. Primary biliary cirrhosis (PBC, or also known as primary biliary cholangitis) or primary sclerosing cholangitis (PSC) are liver diseases which are manifesting with the appearance of cholestasis: high levels of alkaline phosphatase (ALP) and/or gamma -glutamyl transferase (GGT). Clinically, cholestasis causes chronic pruritus. In some cases, cholestasis syndrome and chronic pruritus may also occur in viral hepatitis C. The purpose of this paper is to present the case of a female patient who presented with chronic pruritus and fatigue and later we diagnosed her with hepatitis C. Physical examination showed only scrachings and a liver with 3 cm below the right costal rim but laboratory tests evidenced a cholestasis syndrome and a hepatocytolysis syndrome. Knowing from the literature that the occurrence of cholestasis concomitantly with chronic pruritus are characteristic manifestations of cholestatic liver disease (PBC, PSC) with a prevalence of about 80%, so we tested the patient on antimitochondrial antibodies (AMA) for PBC and pANCA for PSC with negative results. We continued the investigations and found that the patient had hepatitis C with positive anti – HCV antibodies. It was very interesting to see that on the hepatoprotective treatment, cholestasis syndrome and hepatocytolysis syndrome also improved.</p> </abstract>ARTICLE2022-07-13T00:00:00.000+00:00The Implication of Videocapillaroscopy in Rheumatoid Arthritis and Psoriatic Arthritis<abstract> <title style='display:none'>Abstract</title> <p>Videocapillaroscopy is an easy, noninvasive examination method that detects morphological microvascular abnormalities, such as nailfold capillaries. This method has a low cost, has high sensitivity and specificity, has reproductibility and the results can be easily interpreted.</p> <p>Besides its importance in the evaluation of Raynaud’s phenomenon and systemic sclerosis, nailfold capillaroscopy may play an important role in the diagnosis, evaluation and prognosis of other rheumatic diseases, such as rheumatoid arthritis and psoriatic arthritis. Because there are not enough data, currently, capillaroscopy is not routinely used in these patients.</p> <p>The aim of this review is to present the implications of the videocapillaroscopy in rheumatic diseases, other than systemic sclerosis, in order to promote this method as a routine investigation in rheumatic patients.</p> </abstract>ARTICLE2022-07-13T00:00:00.000+00:00Predictors of Peripheral Artery Disease Progression. Is there Any Role for Vascular Age?<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>. Peripheral artery disease (PAD) is a distinct atherosclerotic syndrome marked by stenosis or occlusion of the arteries, particularly of the lower extremities. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease, comprising smoking, hypertension, hypercholesterolemia and diabetes. The factors involved in the progression of PAD are less well defined. Vascular age (VA) is represented by the apparent age of the vascular system derived from the associated cardiovascular risk factors. This concept has been used so far mainly in primary prevention, being usefull for communication with the patient.</p> <p><bold>Aim.</bold> The purpose of the study was to investigate the factors involved in the progression of arterial stenosis in patients already having PAD. Moreover, we tried to determine the utility of VA in increasing patient compliance with therapeutic decisions.</p> <p><bold>Methods.</bold> Between 1st February 2015 - 31st December 2015, 270 consecutive patients (pts) referred for vascular echo-Doppler assessment were enrolled in the study. 106 pts with non-significant arterial stenosis were prospectively evaluated. All pts underwent complete clinical examination, carotid, femoral ultrasound, echocardiography and laboratory evaluation. Presence of atherosclerotic plaques in the carotid arteries were recorded. Medical history, drug use, smoking behavior, blood pressure, duration of diabetes, presence of premature atherosclerotic PAD in relatives, characterized by disease diagnosis before the age of 50 years, were evaluated. Serum total cholesterol (TC), HDL cholesterol (HDL-C), serum glucose, A1c hemoglobine (HbA1c), serum creatinine, estimated glomerular filtration rate (eGFR) were determined. VA was estimated using Framingham score and intima-media thickness (IMT). The primary end-point was the occurrence of significant peripheral artery stenosis (PAS), defined as a two-fold increase Doppler velocity across the stenosis.</p> <p><bold>Results.</bold> At baseline, median age of enrolled pts was 57 years, with male predominance (69,8%). Less than 40% had high blood pressure (39.3%), 36.4% had treated hypertension.</p> <p>The median left ventricular mass index (LVMI) was 108.5 g/m<sup>2</sup> and concentric hypertrophy was present in 29.9% of patients. Patients with hypertension had LVMI of 113.12 g/m<sup>2</sup> and those without hypertensiun, had 105.6 g/m<sup>2</sup>. Diabetes mellitus (DM) was present in 20.6% of patients, majority treated (88%). Among them, 10.3% had more than 10 years duration of DM. Median HbA1c was 5.8%. The majority of the patients are smokers (75.5%). Mean pack-years of smoking was 29.8. During the 4.5 years follow-up, 31.25% quit smoking. The median ejection fraction (EF) was 51.6%.</p> <p>The median TC concentration was 191.6 mg/dl and median HDL-c level was 62.9 mg/dl. 45.8% of the patients received treatment with statins. Premature atherosclerotic PAD in relatives was present in 25.2 % of the patients, and carotid atheromas (CA) in 35.5%. Aortic calcifications (AC) were found in 37.4% of the patients. Median arterial elastance (Ea) was 2.07 mmHg/ml. Median serum creatinine was 1.03 mg/dl and eGFR was 75.6 ml/ml/1.73 m<sup>2</sup>. Median value of the VA calculated by IMT (VA-IMT) was 65.5 years and the median VA calculated by cardiovascular risk factors (VA-RF) was 62.9 years. After 4.5 years of follow-up, 35 (32.7%) patients developed significant PAS. 22 patients had popliteal artey stenosis (62.85%) and 13 patients had superficial femoral artery stenosis (37.15%). During the 4.5 years follow-up, 25 patients (31.25%) quit smoking. Median age of population who developed significant PAS at follow-up was 62.6 years and 39.2% were males.</p> <p>Individuals who developed stenosis tended to be smokers, older, receiving hypertensive and statin therapy, having diabetes, especially more than 10 years duration, having dyslipidemias and CA. They all had higher VA-IMT and VA-RF values compared to patients that did not develop PAS. Median value of VA-IMT was 72.6 years and VA-RF was 74.2 years (p&lt;0,001 for both parameters). They also had significantly higher values of Ea, with median value of 2.16 mmHg/ml. There were no statistically significant differences between the two groups in cardiac performance, LV mass, percentage of LV concentric hypertrophy, presence of AC, premature PAD in relatives, renal function and blood pressure values. In logistic regression analysis, pack-years of smoking, HbA1c %, presence of CA and HDL-C were independently associated with significant PAS progression. From the 25 patients which quit smoking, only 6 developed significant PAS (24%), as compared to 29 (52.7%) from the 55 patients which remained active smokers (p =0.016).</p> <p><bold>Conclusion.</bold> We demonstrated that some of the classical cardiovascular risk factors were involved in PAD progression: smoking, dyslipidemia, diabetes, carotid atherosclerosis. At multivariate analysis the independent variables associated with PAD progression were pack-years of smoking, glycosilated hemoglobin and HDL-cholesterol values and presence of CA. VA assessed by cardiovascular risk scales and by directly measured IMT both predict the progression of PAD, as did Ea, but without independent predictive value for the outcome. Nevertheless, VA was usefull in comunicating with the patients, influencing their perception of disease progression and adherence to therapy, improving shared decision making, mainly quitting smoking. We have shown that even after 4.5 years of smoking cessation there was a measurable effect on PAD progression.</p> </abstract>ARTICLE2022-07-13T00:00:00.000+00:00The Evolution of Liver Fibrosis in Patients with Viral C Infection Post Oral Antiviral Treatment<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 Infections<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 Practice<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 Hypertension<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 Quality<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 Cholecystectomy<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 Disease<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 Syndrome<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 Disease<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 Steatohepatitis<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+00:00en-us-1