rss_2.0Romanian Journal of Internal Medicine FeedSciendo RSS Feed for Romanian Journal of Internal Medicine Journal of Internal Medicine 's Cover Validation of the 4C Mortality Score and PRIEST COVID-19 Clinical Severity Score in patients hospitalized with COVID-19 pneumonia in Greece<abstract> <title style='display:none'>Abstract</title> <p><italic>Background:</italic> Prognostic scores can be used to facilitate better management of patients suffering from life-threatening diseases, provided that they have been tested in the population of interest.</p> <p><italic>Aim:</italic> To perform external validation of the 4C Mortality Score and PRIEST COVID-19 Clinical Severity Score.</p> <p><italic>Study Design:</italic> Prospective Observational Study.</p> <p><italic>Methods</italic>: Patients hospitalized with COVID-19 pneumonia in a tertiary hospital in Greece were enrolled in the study. The prognostic scores were calculated based on hospital admission data and ROC curve analysis was performed. We assessed a composite outcome of either in-hospital death or need for invasive ventilation.</p> <p><italic>Results</italic>: Both 4C and PRIEST scores showed good discriminative ability with an AUC value of 0.826 (CI 95%: 0.765-0.887) and 0.852 (CI 95%: 0.793-0.910) respectively. Based on the Youden Index the optimal cut-off for the 4C score was 11 (Sensitivity 75%, Specificity 75.5%) and 10 for the PRIEST score (Sensitivity 83% and Specificity 69.4%). Calibration was adequate for both scores, except for the low and very high risk groups in the PRIEST score.</p> <p><italic>Conclusion:</italic> The 4C Mortality Score and PRIEST COVID-19 Clinical Severity Score can be used for early identification of patients with poor prognosis in a Greek population cohort hospitalized with COVID-19.</p> </abstract>ARTICLE2022-09-25T00:00:00.000+00:00Association between serum midkine levels and tumor size in Indonesian hepatocellular carcinoma patients: a cross-sectional study<abstract> <title style='display:none'>Abstract</title> <p><bold>Background:</bold> The incidence of liver cancer is increased worldwide with 75%–85% are diagnosed as hepatocellular carcinoma (HCC). Current practice has low sensitivity limitations to diagnose the early stages of HCC, thus urging the need for a biomarker with higher sensitivity to detect HCC, specifically in the early stage. This study aimed to determine the association between Midkine levels and progressiveness of hepatocellular carcinoma (HCC), according to tumor size, Barcelona Clinic Liver Cancer (BCLC), and presence of portal venous thrombosis.</p> <p><bold>Methods:</bold> This cross-sectional study involved 100 patients in Adam Malik General Hospital diagnosed with HCC, collected with a consecutive sampling method, whose diagnosis were confirmed by findings of hypervascular on arterial phase imaging and portal vein or delayed phase washout triple-phase CT Scan. Samples are later categorized according to Barcelona Clinic Liver Cancer (BCLC) stages, tumor size, and presence of portal venous thrombosis. Blood samples were drawn to measure serum Midkine using ELISA. Kruskal-Wallis and Mann-Whitney U tests were conducted to determine the difference of Midkine levels based on tumor size, BCLC staging, and presence of portal venous thrombosis.</p> <p><bold>Results:</bold> Serum Midkine level shows a significant difference over tumor size (p=0.014), no significant difference found compared to BCLC stages and presence of portal venous thrombosis.</p> <p><bold>Conclusion:</bold> Serum Midkine levels are associated with the tumor size of HCC, thus helping physicians determine treatment plans.</p> </abstract>ARTICLE2022-09-25T00:00:00.000+00:00Comparison of scoring systems for predicting remission of Type 2 diabetes in sleeve gastrectomy patients<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction:</bold> This study aims to compare the predictive capacity of ABCD, DiaRem2, Ad-DiaRem, and DiaBetter scoring systems for type 2 diabetes mellitus (T2DM) remission in Turkish adult morbidly obese patients who underwent SG.</p> <p><bold>Methods:</bold> This retrospective cohort study included 80 patients who underwent sleeve gastrectomy (SG) operation, were diagnosed with T2DM preoperatively, and had at least one-year follow-up after surgery. Because bariatric surgery is performed on patients with class III obesity (BMI ≥ 40 kg/m2) or class II obesity (BMI ≥ 35 kg/m2) with obesity releated comorbid conditions in our hospital, our study cohort consisted of these patients.</p> <p><bold>Results:</bold> The diagnostic performance of the DiaBetter, DiaRem2, Ad-DiaRem and ABCD for identifying diabetes remission, assessed by the AUC was 0.882 (95% CI, 0.807-0.958, p &lt; 0.001), 0.862 (95% CI, 0.779-0.945, p &lt; 0.001), 0.849 (95% CI, 0.766-0.932, p &lt; 0.001) and 0.726 (95% CI, 0.601-0.851, p = 0.002), respectively. The AUCs of the Ad-Diarem, DiaBetter and DiaRem2 were statistically higher than AUC of the ABCD (all p-value &lt; 0.001). Besides, there was no statistically significant difference in AUCs of the Ad-Diarem, DiaBetter and DiaRem scores (all p-value &gt; 0.05).</p> <p><bold>Conclusion:</bold> Ad-Dairem, DiaBetter and DaiRem scoring systems were found to provide a successful prediction for diabetes remission in sleeve gastrectomy patients. It was observed that the predictive power of the ABCD scoring system was lower than the other systems. We think that the use of scoring systems for diabetes remission, which have a simple use, will become widespread.</p> </abstract>ARTICLE2022-09-25T00:00:00.000+00:00Comparison of Salivary Interleukin-6, Interleukin-8, C - reactive protein levels and Total Antioxidants Capacity of Obese Individuals with Normal Weight Ones<abstract> <title style='display:none'>Abstract</title> <p><bold>Objective:</bold> Obesity is a worldwide concern that may lead in type 2 diabetes, cardiovascular diseases, etc. Several serum biomarkers have been identified in the saliva of obese individuals, including inflammatory cytokines, adipokines, insulin, and cortisol. The present study aimed to compare salivary interleukin-6(IL-6), interleukin-8(IL-8), C-reactive protein (CRP) levels and total antioxidants capacity (TAC) of obese individuals with normal-weighted ones.</p> <p><bold>Methods:</bold> In this case–control study, 92 participants matched in terms of age and gender were placed into two groups according to the body mass index (BMI); case group: BMI&gt;30 and control group: 18.5&lt;BMI&lt;24.99. Unstimulated saliva was collected. ELISA and FRAP method were used to determine IL-6, IL-8, CRP and TAC. Data was analyzed using SPSS 24, at the significant level of 0.05.</p> <p><bold>Results:</bold> Mean salivary levels of IL-6 and IL-8 in the normal individuals were 53.36 and 421.25ng/mL, with 86.09ng/mL and 510.19ng/mL in obese individuals, respectively. There were significant differences in the mean salivary levels of IL-6 and IL-8 between two experimental groups.</p> <p>The mean salivary levels of CRP of control and case group was 2.84 and2.63 ng/mL and the total salivary antioxidant levels in the normal and obese individuals were 0.29 and 0.36, respectively which had no significant different.</p> <p><bold>Conclusion:</bold> According to the results of the present study, salivary levels IL-8 and IL-6 was significantly higher in obese individuals than in those with normal weight. However, the mean salivary CRP and TAC were not significantly different between the obese individuals and normal-weighted ones.</p> </abstract>ARTICLE2022-08-17T00:00:00.000+00:00The Role of Tei Index added to the GRACE risk score for prediction of in-hospital MACE after acute myocardial infarction<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction:</bold> The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute myocardial infarction (AMI). Variable degrees of impairment in left ventricular (LV) systolic and diastolic function might be found after AMI. Tei Index is an echocardiography parameter that represents both systolic and diastolic LV performance. Previous studies demonstrate Tei Index as an independent predictor of Major Adverse Cardiovascular Events (MACE) after AMI. This study investigates whether the addition of Tei Index could improve the GRACE risk score performance to predict inhospital MACE after AMI.</p> <p><bold>Methods:</bold> A prospective cohort study was conducted on 75 patients who presented with AMI. Total GRACE score was calculated on patient admission and echocardiography was conducted within 72 hours of hospitalization for measurement of MPI. All patients were observed for the incidence of MACE during hospitalization. The incremental predictive value of the GRACE risk score alone and combined with Tei Index was assessed by the change in area under the curve (AUC) by DeLong’s method, likelihood ratio test (LRT), and continuous net reclassification improvement (cNRI).</p> <p><bold>Results:</bold> The addition of Tei Index to the GRACE risk score significantly improves the predictive value of the GRACE risk score (increase in AUC from 0.753 for the GRACE risk score to 0.801 for the GRACE score combine with Tei Index, p=0.354; LRT=4.65, p=0.030; cNRI=0.515, p=0.046).</p> <p><bold>Conclusions:</bold> Adjustment of Tei Index to GRACE risk score might improve risk prediction of in-hospital MACE after AMI.</p> </abstract>ARTICLE2022-08-17T00:00:00.000+00:00Elevated interleukin-17A levels despite reduced microRNA-326 gene expression in celiac disease patients under gluten-free diet<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction:</bold> The microRNA-326 (miR-326) gene, by targeting ETS Proto-Oncogene 1 (ETS1), regulates the differentiation and interleukin-17A production of T helper 17 (Th17) cells. Celiac disease (CD) is an intestinal autoimmune disorder, in which the cascade of Th17 cells plays an important role in its pathogenicity. The aim of this study was to evaluate the expression changes of miR-326 and its two target genes ETS1 and IL-17A in celiac disease patients under a gluten-free diet (GFD). We expected the expression of miR-326 and IL-17A gene to decrease, and the expression of the ETS1 gene to increase, following the adherence to GFD.</p> <p><bold>Methods:</bold> Peripheral blood samples of 40 CD patients under GFD (for more than 1 year) and 40 healthy individuals were collected. RNA was extracted, cDNA was synthesized and the miR-326, ETS1 and IL-17A gene expressions were evaluated by the quantitative polymerase real-time qPCR method. P-value ˂ 0.05 was considered statistically significant.</p> <p><bold>Results:</bold> Although miR-326 mRNA expression was significantly lower in CD patients (P = 0.001), no significant difference was observed in ETS1 mRNA level between the two groups (P = 0.54), but IL-17A was significantly overexpressed in CD patients (P=0.002). No significant correlation was observed between the expression of the studied genes and the patientsʼ symptoms and Marsh classification.</p> <p><bold>Conclusion:</bold>Adherence to the GFD for one to two years did not have the expected effect on the expression of genes in this panel. The most important finding that contradicted our hypothesis was the observation of high IL-17A levels in CD patients despite dieting, which may be related to the protective effect of this cytokine on intestinal tight junctions, which needs to be confirmed in further studies.</p> </abstract>ARTICLE2022-09-22T00:00:00.000+00:00Intravenous treatment adherence of patients with chronic inflammatory rheumatic diseases during the COVID-19 pandemic: experience of a single center<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction:</bold> Patients with chronic inflammatory rheumatic diseases (CIRD) who receive intravenous therapy requiring hospitalization are likely to be more affected than those with receiving oral therapy during COVID-19 pandemic. We aimed to investigate the effect of the COVID-19 pandemic on adherence to treatment in patients with CIRD receiving intravenous treatments.</p> <p><bold>Methods:</bold> We evaluated patients with CIRD who were treated with intravenous immunosuppressive therapy such as rituximab (RTX), cyclophosphamide (CTX), infliximab (IFX), tocilizumab (TCZ) and abatacept (ABA) in our inpatient rheumatology clinic. The patientsʼ medical treatment compliance and clinical follow-up were evaluated. Treatment discontinuation was decided according to postponement of at least one dose and discontinuation of CIRD treatments. Demographics and clinical characteristics were compared between treatment-incompliant (TI) and treatment-compliant (TC) groups.</p> <p><bold>Results:</bold> A total of 181 CIRD patients were enrolled. Rheumatoid arthritis was the most common disease requiring intravenous immunosuppressive treatment followed by axial spondyloarthritis and Behçet’s disease. Joint involvement was the most common followed by lung and kidney involvements. Rituximab was the most widely used intravenous immunosuppressive treatment for the CIRD. 34% patients have postponed at least one dose of their intravenous CIRD treatment and 25% discontinued. Fear of COVID-19 and SARS-CoV-2 positivity were the most common reasons. The TI group had a longer disease duration and a higher frequency of inflammatory arthritis than the TC group (p=0.013 and p=0.044, respectively).</p> <p><bold>Conclusions:</bold> Fear of COVID-19 and SARS-CoV-2 positivity seemed to be the major reasons for discontinuing/postponing intravenous treatments in CIRD patients. Patients with long disease duration and less systemic involvement may be more prone to discontinuing their treatments.</p> </abstract>ARTICLE2022-09-22T00:00:00.000+00:00Stroke risk scores for prediction of mortality and hemorrhages in atrial fibrillation patients<abstract> <title style='display:none'>Abstract</title> <p><bold>Background:</bold> Atrial fibrillation (AF) is an emerging epidemic worldwide, responsible for a twofold increase in mortality, independent of other risk factors. Stroke prevention is the cornerstone of AF management. However, oral anticoagulation imposes an increased risk of bleeding. Several risk scores have been developed for estimating both the thromboembolic and the bleeding risks. The aim of the study was to determine the usefulness of different stroke risk scores as predictors of mortality and hemorrhagic events in AF patients.</p> <p><bold>Methods:</bold> We retrospectively enrolled 211 AF patients hospitalized in the Cardiology Ward of our tertiary hospital. The primary endpoints were mortality and non-minor bleeding events. The mean follow-up period was 378 days for bleeding events and 5 years and 1 month for mortality. For each patient, we evaluated the following stroke risk scores: CHADS2, CHA2DS2-VASc, R2CHADS2, ABC, ATRIA, GARFIELD.</p> <p><bold>Results:</bold> The mean age in our cohort is 66, with a slight predominance of women (52.2%). For a CHA2DS2-VASc ≥ 4 as well as for a score of 2-3, 5-year survival was worse than for patients with a score of 0–1(chi-squared=8.13; p=0.01). Similarly, all subgroups of patients with an ABC &lt;2%, had a worse 5-year survival when compared with an ABC score of ≥2% (chi-squared=12.85; p=0.005). C-statistics show a modest predictive value for mortality, for all stroke scores except Garfield, with similar AUCs, the highest being for CHA2DS2-VASc (AUC 0.656; p=0.0001). CHA2DS2-VASc also correlates with bleeding events, having a good predictive ability (AUC 0.723; 95%CI 0.658–0.782, p=0.001), mildly superior to HAS-BLED (AUC 0.674; 95% CI 0.523–0.825; p = 0.04) and very close to Garfield-bleeding (0.765; 95%CI 0.702–0.80; p=0.0001).</p> <p><bold>Conclusions:</bold> CHA2DS2-VASc is comparable to HAS-BLED and Garfield-bleeding in predicting bleeding events in AF patients. CHA2DS2-VASc and ABC correlate directly and consistently with mortality rate. For CHA2DS2-VASc, the AUCs for our endpoints are similar to the ones for stroke prediction, highlighting the potential of extending its applicability to various outcomes.</p> </abstract>ARTICLE2022-09-22T00:00:00.000+00:00Lung cancer and combined pulmonary fibrosis and emphysema with anti-ARS antibody<abstract> <title style='display:none'>Abstract</title> <p>A 59-year-old man who had smoked for 23 pack-years was admitted to our hospital because of two-month history of back pain. The chest computed tomography scan demonstrated combined pulmonary fibrosis and emphysema (CPFE) and an irregular shaped nodule in the left lower lobe of the lung. A biopsy obtained from samples from subcarinal lymph nodes revealed non-small cell lung cancer. Anti-aminoacyl-tRNA synthetase (ARS) antibody was elevated up to 166 U/mL, although he had no symptoms suggestive connective tissue diseases. It is well known that most of CPFE patients are current or former heavy smokers, and some researchers described the relationship between CPFE and connective tissue diseases. To our best knowledge, this was the first report of lung cancer in patient with anti-ARS antibody-positive CPFE. In some anti-ARS antibody-positive patients, smoking might have a relationship with development of CPFE and lung cancer.</p> </abstract>ARTICLE2022-09-22T00:00:00.000+00:00A pilot study of changes in urinary podocalyxin levels during normal pregnancy and labor<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction:</bold> Increased urinary podocalyxin, a surrogate marker of podocyte detachment, has been shown in preeclampsia and eclampsia, but there is a paucity of data of the effect of normal pregnancy on its urinary excretion. We aimed to describe these changes in this pilot study.</p> <p><bold>Methods:</bold> Urine podocalyxin levels were measured in 115 pregnant women. Of these, 12 women were in the second trimester of gestation, 57 in the third trimester and 46 women were in labor.</p> <p><bold>Results:</bold> The median [IQR] urinary podocalyxin levels were 0.81 [0.27, 3.68], 0.92 [0.44, 5.49] and 64.7 [30.5, 106.3] ng/mg creatinine in the second trimester, third trimester, and during labor, respectively (p&lt;0.0001). Patients with hematuria during labor had higher levels of urinary podocalyxin (128.6 [79.8, 169.6] ng/mg creatinine. There was a moderate correlation between gestational age and urinary podocalyxin levels (r=0.63, p&lt;0.0001).</p> <p><bold>Conclusion:</bold> Urinary podocalyxin levels were low in normal pregnancies and increased significantly during labor and with hematuria.</p> </abstract>ARTICLE2022-09-22T00:00:00.000+00:00Epidermal Growth Factor Receptor immunohistochemical expression in hepatocellular carcinoma without Epidermal Growth Factor Receptor exons 18–21 mutations<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction:</bold> EGFR targeted therapies, have been proved beneficial for patients with HCC, nevertheless additional research on EGFR immunoexpresion and EGFR mutations is still needed, especially in population in which it has not been done yet. The aim of this study is to evaluate EGFR immunoexpression in HCC without EGFR exons 18–21 mutations and to evaluate its influence on survival in HCC patients in North Macedonia.</p> <p><bold>Methods:</bold> We studied 31 cases of HCC for EGFR immunohistochemical expression and EGFR exons 18–21 mutations. The following clinical parameters were analyzed: Hepatitis B and C virus infection, presence of cirrhosis, tumor size, enlarged lymph nodes, metastases, alpha fetoprotein level and overall survival. Presence of the EGFR immunosignal (membranous and cytoplasmic) and the percentage of positive tumor cells in the entire tumor tissue specimen were semi-quantitatively determined.</p> <p><bold>Results:</bold> Hepatitis B and C virus infection, tumor size, metastatic disease and EGFR immunoexpression have influence on patient’s survival. No EGFR exons 18–21 mutations were detected in this group of HCCs. EGFR expression of 61%–80% in tumor tissue significantly influenced survival of the patients (p &lt; 0.01). Multiple Cox regression confirmed tumor size of 5–10 cm (p &lt; 0.05), tumor size &gt; 10 cm (p &lt; 0.01) and EGFR expression in range of 61% to 80% (p &lt; 0.05) as independent survival predictors in patients with HCC.</p> <p><bold>Conclusion:</bold> EGFR overexpression in range of 61% to 80% was an independent survival predictor in patients with HCC, implying that these patients could benefit from EGFR inhibition. However, the absence of EGFR mutations in exons 18–21 in any of the cases of this study suggest that single drug EGFR targeted therapy in patients with HCC may be insufficient.</p> </abstract>ARTICLE2022-09-22T00:00:00.000+00:00Validation of salivary glucose as a screening tool of diabetes mellitus<abstract> <title style='display:none'>Abstract</title> <p><bold>Background:</bold> Improved prognosis and delay of clinical complications in diabetes mellitus can be ensured by early screening and regular monitoring after diagnosis. This requires venipuncture at regular intervals of time causing anxiety and discomfort to the patient. Hence, development of a painless, non-invasive procedure is desirable for which saliva is a potential tool. Also, this would provide easy and cost-effective means for large scale screening and epidemiological intervention.</p> <p><bold>Aim:</bold> To measure fasting plasma glucose (FPG) and compare and correlate with salivary glucose levels in normal and diabetic individuals. Also, the correlation between glycated hemoglobin (HbA1c) and salivary glucose is studied in the diabetics and controls.</p> <p><bold>Methods:</bold> Blood and salivary glucose was estimated by GOD-POD method and glycated hemoglobin by HPLC. Statistical analysis was done on SPSS 16. Mean, Standard deviation, independent t test, ANOVA (f test), Pearson’s correlation coefficient along with regression analysis was carried out and comparison was done between the control and diabetic groups and the different subgroups within the diabetic group.</p> <p><bold>Results:</bold> A significant difference between the salivary glucose levels in subjects indicating that a deranged glycemic status is reflected in saliva. Also, salivary glucose increases in proportion to an increase in the FPG and HbA1C of the diabetics. The regression coefficient was calculated and a formula was derived for prediction of FPG and HbA1c using salivary glucose.</p> <p><bold>Conclusion:</bold> Saliva can be used as a screening tool for diabetes. Standardization of the technique and setting up a reference range will also make it useful in diagnosing diabetes mellitus.</p> </abstract>ARTICLE2022-09-22T00:00:00.000+00:00Acute myelogenous leukemia – current recommendations and approaches in molecular-genetic assessment<abstract><title style='display:none'>Abstract</title><p>Acute myelogenous leukemia is a multi-step hematological malignancy, affecting function, growth, proliferation and cell cycle of myeloid precursors. Overall assessment of patients with the disease requires among everything else, a comprehensive investigation of the genetic basis through various methods such as cytogenetic and molecular-genetic ones. This clarification provides diagnostic refinement and carries prognostic and predictive value in respect of essential therapeutic choices.</p><p>With this review of the literature, we focus on summarizing the latest recommendations and preferred genetic methods, as well as on emphasizing on their general benefits and limitations. Since none of these methods is actually totipotent, we also aim to shed light over the often-difficult choice of appropriate genetic analyses.</p></abstract>ARTICLE2022-06-14T00:00:00.000+00:00Systematic approach to celiac disease: a comprehensive review for primary providers<abstract><title style='display:none'>Abstract</title><p>Celiac disease is an immune-mediated illness to gluten exposure in genetically susceptible patients. It is characterized by chronic lymphocytic inflammation of the small bowel leading to villous atrophy and its associated complications. The global prevalence of celiac disease is increasing, due in part to improved screening tests and simplified diagnostic criteria. Novel therapies are being developed and include proteolytic enzymes, sequestering agents, and immunotherapies. A strict gluten-free diet, however, remains the mainstay of treatment. In this comprehensive review, we discuss the epidemiology, definitions, diagnosis, and treatment of celiac disease.</p></abstract>ARTICLE2022-06-14T00:00:00.000+00:00Anti-cyclic citrullinated peptide antibody-positive rheumatoid arthritis caused by bacterial organizing pneumonia in a patient with Sjogren’s syndrome<abstract><title style='display:none'>Abstract</title><p>A 58-year-old woman with a history of Sjogren’s syndrome was admitted to our hospital with cough, decreased right lung breath sounds and arthralgia in both thumbs. Chest computed tomography showed consolidation with air bronchogram in the right lung. Levels of anti-cyclic citrullinated peptide antibody and rheumatoid factor levels were significantly elevated. She was diagnosed with rheumatoid arthritis induced by bacterial organizing pneumonia. Treatment with salazosulfapyridine was added for rheumatoid arthritis and arthralgia gradually improved. This case highlights that respiratory infections could lead to anti-cyclic citrullinated peptide antibody-positive rheumatoid arthritis in patients with Sjogren’s syndrome.</p></abstract>ARTICLE2022-06-14T00:00:00.000+00:00Peculiar encounter of sarcoidosis and solid pseudopapillary tumor of the pancreas<abstract><title style='display:none'>Abstract</title><p><bold>Objective:</bold> Current literature indicates a connection between sarcoidosis and malignancy, prompting advanced screening in uncertain cases. Solid pseudopapillary tumors (SPT) of the pancreas are rare entities that can be confirmed by adding imaging results to immunohistochemistry staining. The aim of this article is to describe a rare association of sarcoidosis and SPT.</p><p><bold>Materials and methods:</bold> Case report.</p><p><bold>Results</bold>: A young female patient with no prior medical history presents with shortness of breath and fatigue. The diagnosis of pulmonary and hepatic sarcoidosis is placed upon laboratory and radiographic changes. Intermittent abdominal pain prompts an MRI that shows the presence of a tumoral mass in the tail of the pancreas. Surgical resection of the mass is performed and histological examination indicates a SPT, subsequently confirmed by immunohistochemistry.</p><p><bold>Conclusion:</bold> This is the third reported case of concomitant sarcoidosis and solid pseudopapillary tumor of the pancreas.</p></abstract>ARTICLE2022-06-14T00:00:00.000+00:00New markers of oxidative stress in lichen planus and the influence of hepatitis C virus infection – a pilot study<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Lichen planus (LP) is a mucocutaneous T-cell mediated disorder of unknown etiology. There is growing evidence that oxidative stress is an important player in the pathogenesis of LP. Therefore, we have investigated oxidative stress markers in LP and the influence of hepatitis C virus (HCV) infection, a frequently associated condition, on oxidative stress in LP patients.</p> <p><bold>Method.</bold> We have determined the serum levels of 4- hydroxynonenal (4-HNE) and symmetric dimethylarginine (SDMA), as markers of oxidative stress, and total antioxidant capacity (TAC), as a marker of the antioxidant defence, in 4 groups: group A – HCV positive patients with LP (n=12), group B – HCV positive patients without LP (n=12), group C – HCV negative patients with LP (n=31) and group D – control group (n=26).</p> <p><bold>Results.</bold> In LP patients, we have identified an increased level of lipid peroxidation (4-HNE – group A – 8.41±1.11 μg/mL, group B - 7.97±2.17 μg/mL, group C – 7.81±1.96 μg/mL and group D – 6.15±1.17 μg/mL) and alterations in arginine methylation (SDMA – group A – 1.10±0.24 μmol/L, group B – 1.03±0.16 μmol/L, group C – 0.84±0.19 μmol/L and group D – 0.50±0.06 μmol/L) associated with a diminished antioxidant defence (TAC – group A – 234.50±49.96, μmol/L group B – 255.83±41.41 μmol/L, group C – 269.83±43.33 μmol/L and group D – 316.46 ±29.33 μmol/L), processes augmented by the association with HCV infection.</p> <p><bold>Conclusion.</bold> There is an imbalance between oxidants and antioxidants in patients with LP, an imbalance that is augmented by the presence of HCV infection. SDMA could be regarded as a novel biomarker of oxidative stress among these patients. To the best of our knowledge this is the first study to investigate the influence of HCV infection on oxidative stress in LP patients.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Carnitine palmitoyltransferase-II deficiency: case presentation and review of the literature<abstract> <title style='display:none'>Abstract</title> <p>Carnitine palmitoyltransferase-II deficiency, an autosomal recessive disorder, is the most common cause of recurrent rhabdomyolysis in adults. Recognition and avoidance of triggers, such as heavy exercise and stress, is key in prevention of further episodes; however, even with preventative measures, many patients will continue to experience periodic symptoms, including rhabdomyolysis. Avoidance of renal failure, correction of electrolyte disturbances and halting further muscle breakdown are the goals of treatment. It is essential for clinicians to recognize the signs and symptoms of acute disease in CPT-II deficiency. We present a case of recurrent rhabdomyolysis requiring hospitalization in a patient with CPT-II deficiency and review the literature for common clinical manifestations, diagnostics, and treatment strategies.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Clinical risk scores for the prediction of incident atrial fibrillation: a modernized review<abstract> <title style='display:none'>Abstract</title> <p>Atrial fibrillation (AF) is considered the most common sustained arrhythmia. Major cardiovascular risk factors that have been identified to initiate and perpetuate AF include age, sex, arterial hypertension, heart failure, valvular heart disease and diabetes mellitus. In the literature, several studies aimed to formulate easily – applied and accurate risk stratification scores, based on antecedent cardiovascular events, comorbidities and biomarkers for the prediction of new-onset AF. The present narrative review addresses the most universally accepted and efficient clinical scores, with an extended applicability in different populations and ages, particularly scores derived from the Framingham Heart Study, the Atherosclerosis Risk in Communities, the Malmo Diet and Cancer Study, as well as the CHARGE-AF, the CHADS2, CHA2DS2-VASc, HATCH and CH2EST scores. Identification of incident AF can be challenging, thus dictating for utilization of validated clinical instruments in everyday clinical practice.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Imaging characteristics of nontuberculous mycobacterial pulmonary nodules<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Nontuberculous mycobacteriosis (NTM) of the lungs can develop nodules. In order to clarify some of the characteristics of lung NTM nodules, we examined volume doubling time (VDT) and maximum standardized uptake value (SUVmax) in positron emission tomography (PET) of pathologically diagnosed NTM nodules.</p> <p><bold>Methods</bold>. From November 2012 to August 2018, clinical and radiological information were retrospectively investigated in eight patients who were surgically resected and diagnosed as NTM. These eight patients were followed up until November 2020 and were confirmed to have no appearance of lung cancer or reappearance of lung NTM nodules. The VDT was calculated using the Schwartz formula.</p> <p><bold>Results.</bold> The median maximum diameter of the nodule at the time of the first CT scan was 16.0 (range: 9.9–20.0) mm. The median maximum diameter of the nodule on CT performed before the surgical biopsy was 18.8 (range: 10.4–32.8) mm. The median doubling time calculated from these results was 203 (range: 20–568) days. Caseous granulomas and acid-fast bacilli were histologically confirmed in all eight patients. Culture of excised nodules revealed <italic>Mycobacterium intracellulare</italic> in five patients and <italic>Mycobacterium avium</italic> in three patients. Six patients received PET, and median SUVmax was: 7.0 (range: 3.3–21.0). Median VDT was around 200 days. Some patients had irregular-shaped nodules.</p> <p><bold>Conclusions.</bold> CT/PET-CT characteristics of lung nodules are not reliable in differentiating lung NTM nodules from malignant ones. To avoid unnecessary resection, it may be better to collect various information on imaging findings in the nodule itself and in opacities other than the nodule.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00en-us-1