Zeitschriften und Ausgaben

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Volumen 60 (2022): Heft 3 (September 2022)

Volumen 60 (2022): Heft 2 (June 2022)

Volumen 60 (2022): Heft 1 (March 2022)

Volumen 59 (2021): Heft 4 (December 2021)

Volumen 59 (2021): Heft 3 (September 2021)

Volumen 59 (2021): Heft 2 (June 2021)

Volumen 59 (2021): Heft 1 (March 2021)

Volumen 58 (2020): Heft 4 (December 2020)

Volumen 58 (2020): Heft 3 (September 2020)

Volumen 58 (2020): Heft 2 (June 2020)

Volumen 58 (2020): Heft 1 (March 2020)

Volumen 57 (2019): Heft 4 (December 2019)

Volumen 57 (2019): Heft 3 (September 2019)

Volumen 57 (2019): Heft 2 (June 2019)

Volumen 57 (2019): Heft 1 (March 2019)

Volumen 56 (2018): Heft 4 (December 2018)

Volumen 56 (2018): Heft 3 (September 2018)

Volumen 56 (2018): Heft 2 (June 2018)

Volumen 56 (2018): Heft 1 (March 2018)

Volumen 55 (2017): Heft 4 (December 2017)

Volumen 55 (2017): Heft 3 (September 2017)

Volumen 55 (2017): Heft 2 (June 2017)

Volumen 55 (2017): Heft 1 (March 2017)

Volumen 54 (2016): Heft 4 (December 2016)

Volumen 54 (2016): Heft 3 (September 2016)

Volumen 54 (2016): Heft 2 (June 2016)

Volumen 54 (2016): Heft 1 (March 2016)

Volumen 53 (2015): Heft 4 (December 2015)

Volumen 53 (2015): Heft 3 (September 2015)

Volumen 53 (2015): Heft 2 (June 2015)

Volumen 53 (2015): Heft 1 (March 2015)

Zeitschriftendaten
Format
Zeitschrift
eISSN
2501-062X
Erstveröffentlichung
30 Mar 2015
Erscheinungsweise
4 Hefte pro Jahr
Sprachen
Englisch

Suche

Volumen 60 (2022): Heft 1 (March 2022)

Zeitschriftendaten
Format
Zeitschrift
eISSN
2501-062X
Erstveröffentlichung
30 Mar 2015
Erscheinungsweise
4 Hefte pro Jahr
Sprachen
Englisch

Suche

11 Artikel
Uneingeschränkter Zugang

Hyper-inflammation after COVID-19 mARN vaccination: at the crossroads of multisystem inflammatory disease and adult-onset Still’s disease. Does terminology matter?

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 3 - 5

Zusammenfassung

Schlüsselwörter

  • COVID-19 vaccine
  • multisystemic inflammatory syndrome
  • adult-onset Still’s disease
  • cytokine storm
  • anakinra
Uneingeschränkter Zugang

Cardiac biomarkers alterations in patients with SARS-CoV-2 infection

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 6 - 13

Zusammenfassung

Abstract

Reliable biomarkers are necessary for the risk stratification of patients infected with SARS-CoV-2. This novel coronavirus is now established to affect several organs in addition to the lungs, most prominently the heart. This is achieved through direct damage to the myocardium and indirect immune-associated effects during the cytokine storm. We performed a literature review aiming to identify the prognostic value of alterations of cardiac biomarkers in SARS-CoV-2 infection. Cardiac biomarkers are significantly elevated in patients with severe COVID-19 and are independent predictors of mortality. High-sensitivity troponin I and T are correlated with multiple inflammatory indexes and poor outcomes. Although cut-off values have been established for most of cardiac biomarkers, lower limits for troponins may have better prognostic values and longitudinal monitoring of cardiac biomarkers can help the clinician assess the patient’s course. Additional measurements of NT-proBNP, can detect the subgroup of patients with poor prognosis.

Schlüsselwörter

  • SARS-CoV-2
  • biomarkers
  • troponins
  • natriuritic peptides
  • prognosis
Uneingeschränkter Zugang

A practical review of diabetes mellitus type 2 treatment in primary care

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 14 - 23

Zusammenfassung

Abstract

The treatment of diabetes mellitus type 2 (DM2) is becoming more complex as new medications are approved. Primary care providers must maintain their medical knowledge on emerging medications for best patient care. This review simplifies the non-insulin treatments of diabetes with an emphasis on the cardio-renal protectants, sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1).

Schlüsselwörter

  • diabetes mellitus type 2
  • sodium-glucose cotransporter 2
  • glucagon-like peptide 1 receptor agonists
Uneingeschränkter Zugang

The role of thyroid hormones in carotid arterial wall remodeling in women

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 24 - 33

Zusammenfassung

Abstract

Introduction: Thyroid hormones affect the cardiovascular system, but the precise mechanisms of their effects on the development of atherosclerosis are not entirely clear. The relationship between subclinical hypothyroidism, dyslipidemia and carotid atherosclerosis has been widely investigated, but the findings were controversial. The aim of the present study was to determine whether female subjects with subclinical hypothyroidism (SHypo) have increased carotid intima-media thickness (IMT) compared with euthyroid subjects, as well as to examine the association of SHypo, carotid atherosclerosis and dyslipidemia.

Methods: This research included 100 women aged 30 to 70 years who were divided into two groups: the SHypo group including subjects with signs of subclinical hypothyroidism and the control group of euthyroid subjects. Carotid IMT thickness using B mode ultrasound was determined and its correlation with serum concentrations of fT4, TSH, CRP, and lipid profile including small dense LDL (sdLDL) was analysed.

Results: Subjects with SHypo had significantly increased carotid IMT (IMT ≥ 75th centile) in all three measured segments of the right (p <0.001) and the left (p = 0.001) carotid artery compared to the control group, with a significantly more frequent appearance of plaque (25% vs. 9%; p = 0.05). Significant positive correlations were found between higher TSH and higher IMT values. Increased age, LDL cholesterol, and TSH predicted thickening of the carotid artery IMT.

Conclusions: It is important to screen people showing early, subclinical signs of thyroid gland dysfunction due to its impact on carotid atherosclerosis development.

Schlüsselwörter

  • Carotid intima-media thickness (IMT)
  • cerebrovascular diseases
  • dyslipidemias
  • hypothyroidism
  • LDL cholesterol
Uneingeschränkter Zugang

Association between admission blood glucose and prognosis in non-diabetic patients with first-ever acute myocardial infarction

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 34 - 41

Zusammenfassung

Abstract

Background: Admission hyperglycemia has been associated with major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome.

Methods: In this study we sought to determine the association between admission blood sugar (ABS) and the outcomes of non-diabetic patients with first-ever acute myocardial infarction (MI). Non-diabetic patients with MI were evaluated from March 2016 to March 2019. Baseline characteristics, laboratories, electrocardiogram, and baseline left ventricular ejection fraction (LVEF) were recorded. All patients were followed up and outcomes were obtained. Follow-up data comprised of repeating electrocardiogram and echocardiography at 1 year, and MACCE, including re-MI, stroke, and mortality.

Results: A total of 312 patients with a mean age of 54.2 ± 11.9 years were evaluated. All patients were followed up for a median of 38 months. The frequencies of in-hospital mortality and MACCE at late follow-up were higher in third tertile of ABS compared with those in first and second tertiles (both p <0.05). Based on the Cox regression analysis, the independent predictors of MACCE included age (hazard ratio [HR] 1.068, 95% confidence interval [CI] 1.033 – 1.105, p <0.001), third tertile of ABS >172 mg/dL (HR 21.257, 95% CI 2.832 – 159.577, p=0.003), and baseline LVEF (HR 0.947, 95% CI 0.901 – 0.995, p=0.031).

Conclusion: Admission stress hyperglycemia is associated with increased rates of in-hospital mortality and MACCE at late follow-up in non-diabetic patients with MI. Moreover, elevated ABS, older ages, and a decreased value of baseline LVEF predicted MACCE during follow-up.

Schlüsselwörter

  • myocardial infarction
  • acute coronary syndrome
  • hyperglycemia
  • blood glucose
  • mortality
Uneingeschränkter Zugang

The frailty phenotype in hemodialysis patients and its association with biochemical markers of mineral bone disorder, inflammation and nutrition

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 42 - 48

Zusammenfassung

Abstract

Introduction: Frailty is a state of increased vulnerability to physical stressors. It is common in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD).

The aim of this study was to analyze the presence of frailty phenotype among HD patients and to evaluate their interrelationship with different biochemical markers.

Methods: For the frailty assessment the Frailty Phenotype by Fried et al. was used, where frailty was reported if three of the following criteria were met: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and low physical activity. From 281 HD patients, 126 patients were frail, 58 were pre-frail (two criteria were met) and the rest of the study population were robust (97 patients). BMI was calculated for all patients and venous blood samples were taken to determine laboratory parameters for bone alkaline phosphatase (BAP), phosphate (P), potassium (K), C-reactive protein (CRP) and albumin.

Results: Patients who were on HD longer than 60 months have more characters of frailty. (p=0.019). A statistically significant positive correlations between frailty score and BAP (rho = 0.189; p = 0.001), and CRP (rho = 0.233; p < 0.001) were observed, and significant negative correlations between frailty score and albumin (rho = - 0.218; p < 0.001) and K (rho = - 0.198; p = 0.001).

Conclusions: The associations of frailty with markers of mineral bone disorder, inflammation and nutrition indicate the importance of these parameters in the indirect assessment of the frailty phenotype in HD patients.

Schlüsselwörter

  • frailty
  • hemodialysis
  • mineral bone disorder
  • inflammation
  • nutrition
Uneingeschränkter Zugang

Characteristics and outcomes of patients with COVID-19 and liver injury: a retrospective analysis and a multicenter experience

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 49 - 55

Zusammenfassung

Abstract

Background and aims. Patients with COVID-19 frequently present abnormal elevated liver function tests of unknown clinical significance. We aimed to investigate the characteristics and factors influencing outcome in patients with confirmed SARS-CoV-2 infection and liver injury on admission.

Methods. This is a retrospective observational study of patients hospitalized in two COVID units in Romania. Relevant data on clinical and laboratory parameters and medication administered during the admission were analyzed to identify predictors of a negative outcome. Patients with confirmed COVID-19 and liver function tests (LFTs) above the upper limit of normal were included in the analysis.

Results. From 1,207 patients, we identified 134 patients (11%) with abnormal LFTs during hospitalization. The majority of patients had mildly elevated levels and a predominantly cholestatic pattern of liver injury. Patients who received lopinavir/ritonavir were more likely to have increased ALAT levels (p<0.0001). Sixteen patients had pre-existing chronic liver disease, and they were more likely to suffer from severe COVID-19 (p=0.009) and have a negative outcome (p<0.001), but on multivariate analysis, only the severity of COVID-19 was predictive of death (OR 69.9; 95% CI 6.4-761.4).

Conclusions. Mild liver injury is relatively common in COVID-19 and possibly influenced by medication. Patients with chronic liver disease are at high risk for negative outcome, but the severity of the infection is the only predictor of death.

Schlüsselwörter

  • COVID-19
  • liver injury
  • SARS-CoV-2
  • drug-induced liver injury
  • hepatitis
  • hydroxychloroquine
  • lopinavir/ritonavir
  • antiviral therapy
Uneingeschränkter Zugang

Discontinuation of Eculizumab treatment after hematological remission in patients with atypical and drug-induced hemolytic uremic syndrome

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 56 - 65

Zusammenfassung

Abstract

Introduction. The aim was to evaluate the effect of therapeutic plasma exchange (TPE) and eculizumab on hematological and renal survival in atypical hemolytic uremic syndrome (aHUS), and additionally, to examine the reliability of discontinuation of eculizumab treatment.

Methods. This was an observational and retrospective study of 18 patients diagnosed with aHUS.

Results. The median age of the study population was 30 (22–66) years. Four of 18 patients achieved hematological remission with the TPE alone. However, one patient died after three sessions of TPE. Eculizumab was used in 13 patients and no death was observed. One year after treatment, improved kidney function was observed in 2 of 3 (66%) patients for TPE and 5 of 9 (56%) patients for Eculizumab. We discontinued eculizumab treatment in 9 patients. One of the patients who had a C3 gene mutation experienced disease relapse after Eculizumab discontinuation. None of the patients who had drug associated aHUS developed disease relapse after Eculizumab discontinuation.

Conclusion. Eculizumab treatment is a life-saving therapy in aHUS. Treatment discontinuation may be considered at least six months after hematologic remission in patients who had stable renal function or no expectancy for renal survival. Moreover, drug-associated cases seem to tend not to develop disease relapse in the long term.

Schlüsselwörter

  • atypical hemolytic uremic syndrome
  • eculizumab
  • therapeutic plasma exchange
  • discontinuation
  • prognosis
Uneingeschränkter Zugang

Anti-dense fine speckled (DFS) antibody: its staining pattern in indirect immunofluorescence and its clinical relevance

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 66 - 76

Zusammenfassung

Abstract

Background: Dense fine speckled (DFS) pattern is defined by very intense, heterogeneous speckled staining of nucleoplasms of interphase HEp-2 cells and chromosomal areas of metaphase cells. The association of Anti-DFS70 and rheumatologic signs, symptoms, and diagnosis were evaluated.

Methods: One-hundred-eight anti-DFS70 positives who got consecutively admitted to the Rheumatology clinic between January and June 2020 were analyzed. The clinical and laboratory findings of positives for anti-DFS70 antibody were compared with those with DFS pattern ANA IFA staining rates. Also, anti-DFS70 positivity rates and their correlation with the DFS staining pattern were analyzed retrospectively in 1016 CTD patients.

Results: The most common complaint was joint pain seen in 77 (71.3%) and the most common laboratory abnormality was RF-positivity observed in 10/108 (9.3%) who had anti-DFS70 positivity. The most common ANA staining pattern was DFS (72/108; 66.7%); one-third had other than DFS. No statistical significance was found for the association of any of the rheumatological complaints and laboratory findings with the DFS staining pattern. ANA analysis was performed in a total of 964/1016 (94.88%) CTD patients and 44 (4.56%) of these positive for anti-DFS70. The correlation coefficient showed good correlations between the DFS pattern staining and anti-DFS70 antibody positivity (r=+0.773, p<0.001).

Conclusions: Anti-DFS70-positives have a low rate of CTD. A low anti-DFS70 positivity rate was observed in patients with CTD. As such, it can be considered that anti-DFS70 does not predict CTD or even excludes it.

Schlüsselwörter

  • Anti nuclear antibody
  • anti-DFS70
  • connective tissue disease
  • extractable nuclear antigen
Uneingeschränkter Zugang

Non-secretory myeloma in young man mimicking the Gorham disease: case report and the literature review

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 77 - 84

Zusammenfassung

Abstract

Multiple myeloma is a neoplasm of plasma cells affecting mostly the elderly with incidence peaks between 60 and 70 years. This disease is exceedingly rare in younger people, especially in adults under 30-year-old. Non-secretory multiple myeloma accounts for 1–5% of all cases of multiple myeloma. It is also a rare condition in young adult patients, and only six cases have been reported [1]. We herein describe a rare case of non-secretory myeloma in a 22-year-old male, explaining from chest wall pain, without general manifestation. Plain radiography and CT scans revealed diffuse osteolytic lesion mimicking the Gorham disease. A bone marrow biopsy was conducted, revealing the diagnosis of myeloma.

Schlüsselwörter

  • multiple myeloma
  • Gorham disease
  • young people
  • non-secretory
Uneingeschränkter Zugang

Lupus-related protein-losing enteropathy associated with pseudo-pseudo Meigs’ syndrome and successfully treated with hydroxychloroquine

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 85 - 89

Zusammenfassung

Abstract

We herein report the first case of lupus-related protein-losing enteropathy associated with pseudo-pseudo Meigs’ syndrome. Lupus-related protein-losing enteropathy and pseudo-pseudo Meigs’ syndrome are extremely rare complications in patients with systemic lupus erythematosus, Both have a similar clinical course characterized by producing marked ascites, and respond to steroids in typical cases. However, in our case, steroid monotherapy was inadequate and the addition of hydroxychloroquine was effective for their treatment. Furthermore, no reports have previously confirmed elevated CA 125 levels with lupus-related protein-losing enteropathy or increased 99mTc-HSA activity with pseudo-pseudo Meigs’ syndrome. In addition, we are the first to report an evaluation of the histopathology of lupus-related protein-losing enteropathy. Previously reported cases have been described as being caused by either pseudo-Meigs’s syndrome or lupus-related protein-losing enteropathy as the cause of the rare pathology that causes marked pleural effusion and ascites in patients with systemic lupus erythematosus, but it has not been evaluated whether the other is co-occurring. Our case highlights that there is a potential case of overlapping lupus-related protein-losing enteropathy and pseudo-Pseudo-Meigs’s syndrome. Furthermore, it is possible that patients with marked ascites with elevated CA 125 levels were mistakenly diagnosed with Meigs’s syndrome or pseudo-Meigs’s syndrome associated with malignant or benign ovarian tumors and underwent surgery. Clinicians should not forget SLE with pseudo-Pseudo-Meigs’s syndrome as one of the differential diagnoses for marked ascites with elevated CA 125 levels.

Schlüsselwörter

  • cancer antigen 125
  • lupus-related protein-losing enteropathy
  • pseudo-Pseudo-Meigs’s syndrome
  • technetium-99m-labeled human serum albumin scintigraphy
11 Artikel
Uneingeschränkter Zugang

Hyper-inflammation after COVID-19 mARN vaccination: at the crossroads of multisystem inflammatory disease and adult-onset Still’s disease. Does terminology matter?

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 3 - 5

Zusammenfassung

Schlüsselwörter

  • COVID-19 vaccine
  • multisystemic inflammatory syndrome
  • adult-onset Still’s disease
  • cytokine storm
  • anakinra
Uneingeschränkter Zugang

Cardiac biomarkers alterations in patients with SARS-CoV-2 infection

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 6 - 13

Zusammenfassung

Abstract

Reliable biomarkers are necessary for the risk stratification of patients infected with SARS-CoV-2. This novel coronavirus is now established to affect several organs in addition to the lungs, most prominently the heart. This is achieved through direct damage to the myocardium and indirect immune-associated effects during the cytokine storm. We performed a literature review aiming to identify the prognostic value of alterations of cardiac biomarkers in SARS-CoV-2 infection. Cardiac biomarkers are significantly elevated in patients with severe COVID-19 and are independent predictors of mortality. High-sensitivity troponin I and T are correlated with multiple inflammatory indexes and poor outcomes. Although cut-off values have been established for most of cardiac biomarkers, lower limits for troponins may have better prognostic values and longitudinal monitoring of cardiac biomarkers can help the clinician assess the patient’s course. Additional measurements of NT-proBNP, can detect the subgroup of patients with poor prognosis.

Schlüsselwörter

  • SARS-CoV-2
  • biomarkers
  • troponins
  • natriuritic peptides
  • prognosis
Uneingeschränkter Zugang

A practical review of diabetes mellitus type 2 treatment in primary care

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 14 - 23

Zusammenfassung

Abstract

The treatment of diabetes mellitus type 2 (DM2) is becoming more complex as new medications are approved. Primary care providers must maintain their medical knowledge on emerging medications for best patient care. This review simplifies the non-insulin treatments of diabetes with an emphasis on the cardio-renal protectants, sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1).

Schlüsselwörter

  • diabetes mellitus type 2
  • sodium-glucose cotransporter 2
  • glucagon-like peptide 1 receptor agonists
Uneingeschränkter Zugang

The role of thyroid hormones in carotid arterial wall remodeling in women

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 24 - 33

Zusammenfassung

Abstract

Introduction: Thyroid hormones affect the cardiovascular system, but the precise mechanisms of their effects on the development of atherosclerosis are not entirely clear. The relationship between subclinical hypothyroidism, dyslipidemia and carotid atherosclerosis has been widely investigated, but the findings were controversial. The aim of the present study was to determine whether female subjects with subclinical hypothyroidism (SHypo) have increased carotid intima-media thickness (IMT) compared with euthyroid subjects, as well as to examine the association of SHypo, carotid atherosclerosis and dyslipidemia.

Methods: This research included 100 women aged 30 to 70 years who were divided into two groups: the SHypo group including subjects with signs of subclinical hypothyroidism and the control group of euthyroid subjects. Carotid IMT thickness using B mode ultrasound was determined and its correlation with serum concentrations of fT4, TSH, CRP, and lipid profile including small dense LDL (sdLDL) was analysed.

Results: Subjects with SHypo had significantly increased carotid IMT (IMT ≥ 75th centile) in all three measured segments of the right (p <0.001) and the left (p = 0.001) carotid artery compared to the control group, with a significantly more frequent appearance of plaque (25% vs. 9%; p = 0.05). Significant positive correlations were found between higher TSH and higher IMT values. Increased age, LDL cholesterol, and TSH predicted thickening of the carotid artery IMT.

Conclusions: It is important to screen people showing early, subclinical signs of thyroid gland dysfunction due to its impact on carotid atherosclerosis development.

Schlüsselwörter

  • Carotid intima-media thickness (IMT)
  • cerebrovascular diseases
  • dyslipidemias
  • hypothyroidism
  • LDL cholesterol
Uneingeschränkter Zugang

Association between admission blood glucose and prognosis in non-diabetic patients with first-ever acute myocardial infarction

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 34 - 41

Zusammenfassung

Abstract

Background: Admission hyperglycemia has been associated with major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome.

Methods: In this study we sought to determine the association between admission blood sugar (ABS) and the outcomes of non-diabetic patients with first-ever acute myocardial infarction (MI). Non-diabetic patients with MI were evaluated from March 2016 to March 2019. Baseline characteristics, laboratories, electrocardiogram, and baseline left ventricular ejection fraction (LVEF) were recorded. All patients were followed up and outcomes were obtained. Follow-up data comprised of repeating electrocardiogram and echocardiography at 1 year, and MACCE, including re-MI, stroke, and mortality.

Results: A total of 312 patients with a mean age of 54.2 ± 11.9 years were evaluated. All patients were followed up for a median of 38 months. The frequencies of in-hospital mortality and MACCE at late follow-up were higher in third tertile of ABS compared with those in first and second tertiles (both p <0.05). Based on the Cox regression analysis, the independent predictors of MACCE included age (hazard ratio [HR] 1.068, 95% confidence interval [CI] 1.033 – 1.105, p <0.001), third tertile of ABS >172 mg/dL (HR 21.257, 95% CI 2.832 – 159.577, p=0.003), and baseline LVEF (HR 0.947, 95% CI 0.901 – 0.995, p=0.031).

Conclusion: Admission stress hyperglycemia is associated with increased rates of in-hospital mortality and MACCE at late follow-up in non-diabetic patients with MI. Moreover, elevated ABS, older ages, and a decreased value of baseline LVEF predicted MACCE during follow-up.

Schlüsselwörter

  • myocardial infarction
  • acute coronary syndrome
  • hyperglycemia
  • blood glucose
  • mortality
Uneingeschränkter Zugang

The frailty phenotype in hemodialysis patients and its association with biochemical markers of mineral bone disorder, inflammation and nutrition

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 42 - 48

Zusammenfassung

Abstract

Introduction: Frailty is a state of increased vulnerability to physical stressors. It is common in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD).

The aim of this study was to analyze the presence of frailty phenotype among HD patients and to evaluate their interrelationship with different biochemical markers.

Methods: For the frailty assessment the Frailty Phenotype by Fried et al. was used, where frailty was reported if three of the following criteria were met: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and low physical activity. From 281 HD patients, 126 patients were frail, 58 were pre-frail (two criteria were met) and the rest of the study population were robust (97 patients). BMI was calculated for all patients and venous blood samples were taken to determine laboratory parameters for bone alkaline phosphatase (BAP), phosphate (P), potassium (K), C-reactive protein (CRP) and albumin.

Results: Patients who were on HD longer than 60 months have more characters of frailty. (p=0.019). A statistically significant positive correlations between frailty score and BAP (rho = 0.189; p = 0.001), and CRP (rho = 0.233; p < 0.001) were observed, and significant negative correlations between frailty score and albumin (rho = - 0.218; p < 0.001) and K (rho = - 0.198; p = 0.001).

Conclusions: The associations of frailty with markers of mineral bone disorder, inflammation and nutrition indicate the importance of these parameters in the indirect assessment of the frailty phenotype in HD patients.

Schlüsselwörter

  • frailty
  • hemodialysis
  • mineral bone disorder
  • inflammation
  • nutrition
Uneingeschränkter Zugang

Characteristics and outcomes of patients with COVID-19 and liver injury: a retrospective analysis and a multicenter experience

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 49 - 55

Zusammenfassung

Abstract

Background and aims. Patients with COVID-19 frequently present abnormal elevated liver function tests of unknown clinical significance. We aimed to investigate the characteristics and factors influencing outcome in patients with confirmed SARS-CoV-2 infection and liver injury on admission.

Methods. This is a retrospective observational study of patients hospitalized in two COVID units in Romania. Relevant data on clinical and laboratory parameters and medication administered during the admission were analyzed to identify predictors of a negative outcome. Patients with confirmed COVID-19 and liver function tests (LFTs) above the upper limit of normal were included in the analysis.

Results. From 1,207 patients, we identified 134 patients (11%) with abnormal LFTs during hospitalization. The majority of patients had mildly elevated levels and a predominantly cholestatic pattern of liver injury. Patients who received lopinavir/ritonavir were more likely to have increased ALAT levels (p<0.0001). Sixteen patients had pre-existing chronic liver disease, and they were more likely to suffer from severe COVID-19 (p=0.009) and have a negative outcome (p<0.001), but on multivariate analysis, only the severity of COVID-19 was predictive of death (OR 69.9; 95% CI 6.4-761.4).

Conclusions. Mild liver injury is relatively common in COVID-19 and possibly influenced by medication. Patients with chronic liver disease are at high risk for negative outcome, but the severity of the infection is the only predictor of death.

Schlüsselwörter

  • COVID-19
  • liver injury
  • SARS-CoV-2
  • drug-induced liver injury
  • hepatitis
  • hydroxychloroquine
  • lopinavir/ritonavir
  • antiviral therapy
Uneingeschränkter Zugang

Discontinuation of Eculizumab treatment after hematological remission in patients with atypical and drug-induced hemolytic uremic syndrome

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 56 - 65

Zusammenfassung

Abstract

Introduction. The aim was to evaluate the effect of therapeutic plasma exchange (TPE) and eculizumab on hematological and renal survival in atypical hemolytic uremic syndrome (aHUS), and additionally, to examine the reliability of discontinuation of eculizumab treatment.

Methods. This was an observational and retrospective study of 18 patients diagnosed with aHUS.

Results. The median age of the study population was 30 (22–66) years. Four of 18 patients achieved hematological remission with the TPE alone. However, one patient died after three sessions of TPE. Eculizumab was used in 13 patients and no death was observed. One year after treatment, improved kidney function was observed in 2 of 3 (66%) patients for TPE and 5 of 9 (56%) patients for Eculizumab. We discontinued eculizumab treatment in 9 patients. One of the patients who had a C3 gene mutation experienced disease relapse after Eculizumab discontinuation. None of the patients who had drug associated aHUS developed disease relapse after Eculizumab discontinuation.

Conclusion. Eculizumab treatment is a life-saving therapy in aHUS. Treatment discontinuation may be considered at least six months after hematologic remission in patients who had stable renal function or no expectancy for renal survival. Moreover, drug-associated cases seem to tend not to develop disease relapse in the long term.

Schlüsselwörter

  • atypical hemolytic uremic syndrome
  • eculizumab
  • therapeutic plasma exchange
  • discontinuation
  • prognosis
Uneingeschränkter Zugang

Anti-dense fine speckled (DFS) antibody: its staining pattern in indirect immunofluorescence and its clinical relevance

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 66 - 76

Zusammenfassung

Abstract

Background: Dense fine speckled (DFS) pattern is defined by very intense, heterogeneous speckled staining of nucleoplasms of interphase HEp-2 cells and chromosomal areas of metaphase cells. The association of Anti-DFS70 and rheumatologic signs, symptoms, and diagnosis were evaluated.

Methods: One-hundred-eight anti-DFS70 positives who got consecutively admitted to the Rheumatology clinic between January and June 2020 were analyzed. The clinical and laboratory findings of positives for anti-DFS70 antibody were compared with those with DFS pattern ANA IFA staining rates. Also, anti-DFS70 positivity rates and their correlation with the DFS staining pattern were analyzed retrospectively in 1016 CTD patients.

Results: The most common complaint was joint pain seen in 77 (71.3%) and the most common laboratory abnormality was RF-positivity observed in 10/108 (9.3%) who had anti-DFS70 positivity. The most common ANA staining pattern was DFS (72/108; 66.7%); one-third had other than DFS. No statistical significance was found for the association of any of the rheumatological complaints and laboratory findings with the DFS staining pattern. ANA analysis was performed in a total of 964/1016 (94.88%) CTD patients and 44 (4.56%) of these positive for anti-DFS70. The correlation coefficient showed good correlations between the DFS pattern staining and anti-DFS70 antibody positivity (r=+0.773, p<0.001).

Conclusions: Anti-DFS70-positives have a low rate of CTD. A low anti-DFS70 positivity rate was observed in patients with CTD. As such, it can be considered that anti-DFS70 does not predict CTD or even excludes it.

Schlüsselwörter

  • Anti nuclear antibody
  • anti-DFS70
  • connective tissue disease
  • extractable nuclear antigen
Uneingeschränkter Zugang

Non-secretory myeloma in young man mimicking the Gorham disease: case report and the literature review

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 77 - 84

Zusammenfassung

Abstract

Multiple myeloma is a neoplasm of plasma cells affecting mostly the elderly with incidence peaks between 60 and 70 years. This disease is exceedingly rare in younger people, especially in adults under 30-year-old. Non-secretory multiple myeloma accounts for 1–5% of all cases of multiple myeloma. It is also a rare condition in young adult patients, and only six cases have been reported [1]. We herein describe a rare case of non-secretory myeloma in a 22-year-old male, explaining from chest wall pain, without general manifestation. Plain radiography and CT scans revealed diffuse osteolytic lesion mimicking the Gorham disease. A bone marrow biopsy was conducted, revealing the diagnosis of myeloma.

Schlüsselwörter

  • multiple myeloma
  • Gorham disease
  • young people
  • non-secretory
Uneingeschränkter Zugang

Lupus-related protein-losing enteropathy associated with pseudo-pseudo Meigs’ syndrome and successfully treated with hydroxychloroquine

Online veröffentlicht: 17 Mar 2022
Seitenbereich: 85 - 89

Zusammenfassung

Abstract

We herein report the first case of lupus-related protein-losing enteropathy associated with pseudo-pseudo Meigs’ syndrome. Lupus-related protein-losing enteropathy and pseudo-pseudo Meigs’ syndrome are extremely rare complications in patients with systemic lupus erythematosus, Both have a similar clinical course characterized by producing marked ascites, and respond to steroids in typical cases. However, in our case, steroid monotherapy was inadequate and the addition of hydroxychloroquine was effective for their treatment. Furthermore, no reports have previously confirmed elevated CA 125 levels with lupus-related protein-losing enteropathy or increased 99mTc-HSA activity with pseudo-pseudo Meigs’ syndrome. In addition, we are the first to report an evaluation of the histopathology of lupus-related protein-losing enteropathy. Previously reported cases have been described as being caused by either pseudo-Meigs’s syndrome or lupus-related protein-losing enteropathy as the cause of the rare pathology that causes marked pleural effusion and ascites in patients with systemic lupus erythematosus, but it has not been evaluated whether the other is co-occurring. Our case highlights that there is a potential case of overlapping lupus-related protein-losing enteropathy and pseudo-Pseudo-Meigs’s syndrome. Furthermore, it is possible that patients with marked ascites with elevated CA 125 levels were mistakenly diagnosed with Meigs’s syndrome or pseudo-Meigs’s syndrome associated with malignant or benign ovarian tumors and underwent surgery. Clinicians should not forget SLE with pseudo-Pseudo-Meigs’s syndrome as one of the differential diagnoses for marked ascites with elevated CA 125 levels.

Schlüsselwörter

  • cancer antigen 125
  • lupus-related protein-losing enteropathy
  • pseudo-Pseudo-Meigs’s syndrome
  • technetium-99m-labeled human serum albumin scintigraphy

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