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Volume 19 (2022): Edition 2 (February 2022)

Volume 19 (2022): Edition 1 (January 2022)

Volume 18 (2021): Edition 6 (December 2021)

Volume 18 (2021): Edition 5 (October 2021)

Volume 18 (2021): Edition 4 (August 2021)

Volume 18 (2021): Edition 3 (June 2021)

Volume 18 (2021): Edition 2 (May 2021)

Volume 18 (2021): Edition 1 (January 2021)

Volume 17 (2020): Edition 6 (December 2020)

Volume 17 (2020): Edition 5 (October 2020)

Volume 17 (2020): Edition 4 (June 2020)

Volume 17 (2020): Edition 3 (June 2020)

Volume 17 (2020): Edition 2 (May 2020)

Volume 17 (2020): Edition 1 (March 2020)

Volume 16 (2019): Edition 6 (December 2019)

Volume 16 (2019): Edition 5 (October 2019)

Volume 16 (2019): Edition 4 (August 2019)

Volume 16 (2019): Edition 3 (June 2019)

Volume 16 (2019): Edition 2 (April 2019)

Volume 16 (2019): Edition 1 (January 2019)

Volume 15 (2018): Edition 6 (December 2018)

Volume 15 (2018): Edition 5 (December 2018)

Volume 15 (2018): Edition 4 (August 2018)

Volume 15 (2018): Edition 3 (July 2018)

Volume 15 (2018): Edition 2 (May 2018)

Volume 15 (2018): Edition 1 (March 2018)

Détails du magazine
Format
Magazine
eISSN
1220-5818
Première publication
28 Feb 2018
Période de publication
6 fois par an
Langues
Anglais

Chercher

Volume 19 (2022): Edition 2 (February 2022)

Détails du magazine
Format
Magazine
eISSN
1220-5818
Première publication
28 Feb 2018
Période de publication
6 fois par an
Langues
Anglais

Chercher

10 Articles
Accès libre

The Predictive Role of Variceal Band Ligation in the Development of Portal Vein Thrombosis in Cirrhotic Patients

Publié en ligne: 13 Jul 2022
Pages: 7 - 15

Résumé

Abstract

Introduction. It is well known that portal vein thrombosis (PVT) can accelerate liver decompensation, reducing overall survival(1). 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

The aim 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.

Results. 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).

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)

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.

Conclusion. 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?

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.

Mots clés

  • liver cirrhosis
  • portal hypertension
  • portal vein thrombosis
  • esophageal varices
  • variceal band ligation
Accès libre

Predictors of Peripheral Artery Disease Progression. Is there Any Role for Vascular Age?

Publié en ligne: 13 Jul 2022
Pages: 17 - 35

Résumé

Abstract

Background. 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.

Aim. 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.

Methods. 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.

Results. 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.

The median left ventricular mass index (LVMI) was 108.5 g/m2 and concentric hypertrophy was present in 29.9% of patients. Patients with hypertension had LVMI of 113.12 g/m2 and those without hypertensiun, had 105.6 g/m2. 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%.

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 m2. 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.

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<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).

Conclusion. 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.

Mots clés

  • vascular age
  • cardiovascular risk factors
  • peripheral artery disease
  • intima-media thickness
Accès libre

Modern Treatment of Hepatitis C Infection

Publié en ligne: 13 Jul 2022
Pages: 37 - 52

Résumé

Abstract

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.

Mots clés

  • hepatitis C virus
  • hepatic cirrhosis
  • Direct-acting antiviral
Accès libre

The Implication of Videocapillaroscopy in Rheumatoid Arthritis and Psoriatic Arthritis

Publié en ligne: 13 Jul 2022
Pages: 55 - 61

Résumé

Abstract

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.

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.

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.

Mots clés

  • nailfold capillaroscopy
  • capillary density
  • rheumatoid arthritis
  • psoriatic arthritis
Accès libre

Clinico-Pathological Correlations of Poststreptococcal Glomerulonephritis

Publié en ligne: 13 Jul 2022
Pages: 63 - 70

Résumé

Abstract

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.

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.

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.

Mots clés

  • poststreptococcal glomerulonephritis
  • haematuria
  • immunofluorescence
  • nephritic syndrome
Accès libre

Coronary Artery Disease in People Living with Human Immunodeficiency Virus

Publié en ligne: 13 Jul 2022
Pages: 71 - 75

Résumé

Abstract

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.

Mots clés

  • coronary artery disease
  • HIV
  • antiretroviral therapy
Accès libre

Post-Covid-19 Immunological Disorder: A Possible Pathological Entity in a 43 Year Old Man

Publié en ligne: 13 Jul 2022
Pages: 77 - 94

Résumé

Abstract

Background. 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.

Case report. 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.

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.

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.

Conclusion. 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.

Mots clés

  • post-COVID-19
  • immunological disturbance
  • inflammation
  • corticotherapy
Accès libre

Omicron Variant Behavior in a Couple: Vaccinated Versus Non-Vaccinated

Publié en ligne: 13 Jul 2022
Pages: 95 - 101

Résumé

Abstract

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.

Mots clés

  • COVID-19
  • pneumonia
  • Omicron variant
Accès libre

Cholestasis, Chronic Pruritus and Hepatitis C -the Importance of the Differential Diagnosis Should Not Be Underestimated

Publié en ligne: 13 Jul 2022
Pages: 103 - 110

Résumé

Abstract

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.

Mots clés

  • chronic pruritus
  • cholestasis
  • hepatitis C
  • hepatoprotective treatment
Accès libre

A Surprising Cause of Dysphagia

Publié en ligne: 13 Jul 2022
Pages: 111 - 112

Résumé

10 Articles
Accès libre

The Predictive Role of Variceal Band Ligation in the Development of Portal Vein Thrombosis in Cirrhotic Patients

Publié en ligne: 13 Jul 2022
Pages: 7 - 15

Résumé

Abstract

Introduction. It is well known that portal vein thrombosis (PVT) can accelerate liver decompensation, reducing overall survival(1). 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

The aim 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.

Results. 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).

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)

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.

Conclusion. 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?

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.

Mots clés

  • liver cirrhosis
  • portal hypertension
  • portal vein thrombosis
  • esophageal varices
  • variceal band ligation
Accès libre

Predictors of Peripheral Artery Disease Progression. Is there Any Role for Vascular Age?

Publié en ligne: 13 Jul 2022
Pages: 17 - 35

Résumé

Abstract

Background. 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.

Aim. 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.

Methods. 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.

Results. 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.

The median left ventricular mass index (LVMI) was 108.5 g/m2 and concentric hypertrophy was present in 29.9% of patients. Patients with hypertension had LVMI of 113.12 g/m2 and those without hypertensiun, had 105.6 g/m2. 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%.

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 m2. 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.

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<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).

Conclusion. 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.

Mots clés

  • vascular age
  • cardiovascular risk factors
  • peripheral artery disease
  • intima-media thickness
Accès libre

Modern Treatment of Hepatitis C Infection

Publié en ligne: 13 Jul 2022
Pages: 37 - 52

Résumé

Abstract

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.

Mots clés

  • hepatitis C virus
  • hepatic cirrhosis
  • Direct-acting antiviral
Accès libre

The Implication of Videocapillaroscopy in Rheumatoid Arthritis and Psoriatic Arthritis

Publié en ligne: 13 Jul 2022
Pages: 55 - 61

Résumé

Abstract

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.

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.

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.

Mots clés

  • nailfold capillaroscopy
  • capillary density
  • rheumatoid arthritis
  • psoriatic arthritis
Accès libre

Clinico-Pathological Correlations of Poststreptococcal Glomerulonephritis

Publié en ligne: 13 Jul 2022
Pages: 63 - 70

Résumé

Abstract

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.

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.

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.

Mots clés

  • poststreptococcal glomerulonephritis
  • haematuria
  • immunofluorescence
  • nephritic syndrome
Accès libre

Coronary Artery Disease in People Living with Human Immunodeficiency Virus

Publié en ligne: 13 Jul 2022
Pages: 71 - 75

Résumé

Abstract

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.

Mots clés

  • coronary artery disease
  • HIV
  • antiretroviral therapy
Accès libre

Post-Covid-19 Immunological Disorder: A Possible Pathological Entity in a 43 Year Old Man

Publié en ligne: 13 Jul 2022
Pages: 77 - 94

Résumé

Abstract

Background. 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.

Case report. 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.

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.

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.

Conclusion. 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.

Mots clés

  • post-COVID-19
  • immunological disturbance
  • inflammation
  • corticotherapy
Accès libre

Omicron Variant Behavior in a Couple: Vaccinated Versus Non-Vaccinated

Publié en ligne: 13 Jul 2022
Pages: 95 - 101

Résumé

Abstract

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.

Mots clés

  • COVID-19
  • pneumonia
  • Omicron variant
Accès libre

Cholestasis, Chronic Pruritus and Hepatitis C -the Importance of the Differential Diagnosis Should Not Be Underestimated

Publié en ligne: 13 Jul 2022
Pages: 103 - 110

Résumé

Abstract

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.

Mots clés

  • chronic pruritus
  • cholestasis
  • hepatitis C
  • hepatoprotective treatment
Accès libre

A Surprising Cause of Dysphagia

Publié en ligne: 13 Jul 2022
Pages: 111 - 112

Résumé

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