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Volume 55 (2017): Edition 2 (June 2017)

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Détails du magazine
Format
Magazine
eISSN
2501-062X
Première publication
30 Mar 2015
Période de publication
4 fois par an
Langues
Anglais

Chercher

Volume 55 (2017): Edition 4 (December 2017)

Détails du magazine
Format
Magazine
eISSN
2501-062X
Première publication
30 Mar 2015
Période de publication
4 fois par an
Langues
Anglais

Chercher

10 Articles
Accès libre

A step by step approach in differential diagnosing of adrenal incidentaloma (epinephroma), (with comments on the new Clinical Practice Guidelines of the European Society of Endocrinology)

Publié en ligne: 15 Nov 2017
Pages: 188 - 197

Résumé

Abstract

Objectives. To present a step by step approach for the diagnosis of adrenal incidentaloma (AI).

Method. An extensive review of the literature was conducted, searching the Pub-Med and Google Scholar using the Mesh terms; Adrenal; Incidentaloma; Adrenal tumours; Radiology; Diagnosis. We also did a cross-referencing search of the literature. Comments on the new European guidelines are presented.

Results. The majority of the tumours are non-functioning benign adenomas. The most important radiological characteristic of an adrenal incidentaloma is the radiation attenuation coefficient. Wash out percentage and the imaging characteristics of the tumour may help in diagnosis.

Conclusion. Density less than 10 HU is in most cases characteristic of a lipid rich benign adenoma. More than 10 HU or/and history of malignancy raise the possibility for cancer. 1 mg dexamethasone test and plasma metanephrines should be done in all patients. If there is history of hypokalemia and/or resistant hypertension we test the plasma aldosterone to plasma renin ratio (ARR). Newer studies have shown that tumours even nonfunctioning and less than 4 cm may increase the metabolic risks so we may consider surgery at an earlier stage.

Mots clés

  • Adrenal incidentaloma
  • Epinephroma
  • Diagnosis
  • Radiology
  • Treatment
  • ESE guidelines
Accès libre

IL-17 and Th17 cells in systemic sclerosis: a comprehensive review

Publié en ligne: 15 Nov 2017
Pages: 198 - 204

Résumé

Abstract

T cells (especially T helper cells) seem to be strongly associated with systemic sclerosis pathogenesis. Th17-IL-17 axis was proved to be involved in the pathogenesis of multiple autoimmune diseases. By performing a comprehensive research of the literature indexed in PubMed database, the current review summarizes current knowledge related to Th17 and IL-17 in systemic sclerosis. While there is promising data suggesting inhibition of Tregulatory and Th1 signals on one hand and promotion of Th17 and Th2 signals on the other, studies that include prospective and integrated analysis of Tregulatory, Th17, Th1, Th2 (cells and derived cytokines) on the same cohort of Ssc patients are warranted.

Mots clés

  • Systemic sclerosis
  • IL-17A
  • Th17
  • IL-17F
Accès libre

Serum levels of nitrite/nitrate, lipid profile, and Fasting Plasma Glucose and their associations in subclinical hypothyroid women before and after a two month treatment by levothyroxine

Publié en ligne: 15 Nov 2017
Pages: 205 - 211

Résumé

Abstract

Background. Subclinical hypothyroidism (sHT) is a condition defined by elevated TSH values with normal levels of free thyroid hormones. Altered metabolic status is one of the consequences of sHT which can affect serum levels of FPG, lipid profile, and nitric oxide which propounds cardiovascular consequences per se. The aim of this study was to determine the possible effects of sHT on nitrite/nitrate levels, as a marker of endothelial performance.

Materials and Methods. 50 females were enrolled in this study, 25 women as control group and 25 women as case group (evaluated two times: before and after levothyroxine therapy). Blood samples were collected and levels of FPG, lipid profile components, and nitric oxide were measured spectrophotometrically. The data were analyzed using SPSS version 18 software.

Results. The levels of lipid profile (except for TG between before and after group, p < 0.05) and nitric oxide did not differ in groups while FPG was significantly higher in case groups in comparison to control group (p < 0.001). Nitric oxide had no correlations with any of variables except for LDL in after treatment group (p < 0.05 and r = 0.397).

Conclusion. Nitric oxide does not have correlation with components of lipid profile (except for LDL) or FPG and has no differences in subclinical hypothyroid patients and control group. Levothyroxine therapy during 2 months cannot alter the levels of nitric oxide in subclinical hypothyroid patients.

Mots clés

  • Subclinical hypothyroid
  • Levothyroxine
  • Nitrite/nitrate
  • Lipid profile
  • Fasting plasma glucose
Accès libre

Raised TSH is associated with endothelial dysfunction in Metabolic Syndrome: A case control study

Publié en ligne: 15 Nov 2017
Pages: 212 - 221

Résumé

Abstract

Introduction. Endothelial dysfunction has been considered as one of the important factors in pathogenesis of Metabolic Syndrome (Met S). Subclinical hypothyroidism (SCH) has also been reported to be associated with Met S. The aim of our study is to evaluate the association of raised TSH with mediators of endothelial dysfunction in Met S with Subclinical hypothyroidism as compared to healthy controls.

Methods. Study population consisted of 100 subjects, out of which 50 were cases of Met S and 50 were healthy controls. Met S group were further divided into two, based on the presence & absence of SCH. Serum insulin, T3, T4, TSH were measured by chemiluminescence based immunoassay (CLIA). Serum nitric oxide (NO) levels were measured by Modified Griess’s method and serum endothelin-1 (ET-1) levels were measured by ELISA.

Results. Out of 50 cases of Met S, SCH was diagnosed in 22. The mean serum TSH levels were significantly higher in Met S cases as compared to healthy controls (5.7 ± 1.2 μIU/mL vs. 2.3 ± 1.6 μIU/mL, P <0.0001). Mean serum NO levels were significantly lower in Met S cases as compared to healthy control (15.4 ± 10 μM vs. 21 ± 10 μM, p = 0.009). Mean serum ET-1 levels were significantly higher in Met S cases as compared to healthy controls (2.68 ± 1.7 fmol/mL vs. 2.1 ± 0.84 fmol/mL, p = 0.011). On Pearson’s correlation analysis, TSH showed positive correlation with ET-1 (r = 0.341, p = 0.001) and negative correlation with NO (r = −0.331, p = 0.001). Binary logistic regression analysis showed that TSH, NO and ET-1 has significant odd’s ratio for predicting Met S.

Conclusion. Met S cases were screened for thyroid abnormalities and found to have 44% of SCH along with co-existing endothelial dysfunction. Raised TSH in SCH could cause endothelial dysfunction which may lead to Met S and associated co-morbidities. Present study gives new insight in linking endothelial dysfunction and raised TSH in Met S. Therefore, Met S cases should be screened for SCH and treated appropriately to attenuate endothelial dysfunction and associated comorbidities in Met S.

Mots clés

  • Metabolic Syndrome X
  • Hypothyroidism
  • Nitric Oxide
  • Endothelin-1
Accès libre

The frequency of bone fractures among patients with chronic kidney disease not on dialysis: two-year follow-up

Publié en ligne: 15 Nov 2017
Pages: 222 - 228

Résumé

Abstract

Introduction. Renal osteodystrophy is a severe complication of chronic kidney disease (CKD) that increases morbidity and mortality in these patients. Mineral and bone disorder starts early in CKD and affects the incidence of bone fractures. The aim of this study was to observe the frequency of diverse bone fractures in patients with CKD not on dialysis.

Methods. This cohort study included 68 patients that were followed during the two-year period. The patients were divided into two cohorts: one that developed bone fractures and the other that did not. There were 35 (51.5%) men and 33 (48.5%) women. The mean age of patients ranged 62.88±11.60 years. During follow-up serum values of chronic kidney disease – mineral and bone indicators were measured. The methods of descriptive and analytical statistics were used in order to analyze obtained data.

Results. During this two-year follow-up seven patients developed bone fractures. Among them, females dominated (6 patients) compared to males (only 1 patient). The most common were fractures of forearm. The mean level of parathyroid hormone (PTH) at the beginning of the monitoring was higher in the group of patients with bone fractures (165.25 ± 47.69 pg/mL) in regard to another group (103.96 ± 81.55 pg/mL). After two-year follow-up, this difference became statistically significant at the level p < 0.05. Patients that developed bone fractures had higher FRAX (Fracture Risk Assessment) score compared to another group.

Conclusion. In our study, about 10% of patients had bone fractures in the two-year follow-up period. Patients who developed fractures had a higher PTH level and FRAX score.

Mots clés

  • chronic kidney disease
  • mineral and bone disorder
  • fracture
  • renal osteodystrophy
  • bone
Accès libre

The value of peripheral blood eosinophil count in predicting in-stent restenosis in patients with stable angina pectoris undergoing drug eluting stenting

Publié en ligne: 15 Nov 2017
Pages: 229 - 236

Résumé

Abstract

Introduction. In-stent restenosis (ISR) remains a major limitation of percutaneous coronary intervention (PCI). A role for peripheral blood cells as major regulators of immune and inflammatory systems has been proposed. We aim to evaluate the relationship between eosinophil count and development of restenosis after drug-eluting stent (DES) implantation.

Methods. In this prospective study, all consecutive patients undergoing elective DES implantation for chronic stable angina (CSA) in a university-affiliated heart center within a 6-month period were enrolled and followed for another 6 months. Complete blood count with differentiation was performed 6 weeks after the index procedure. During the follow-up period, the cohort of patients who developed ISR was compared to the cohort of patients without ISR, descriptively and the total number of eosinophilic white cells was used to predict the occurrence of ISR.

Results. 153 men and 48 women with CSA underwent PCI with DES implantation, from which, 26 patients needed repeat coronary angiography for recurrent symptoms. There was an established ISR in 17 (8.5%) patients. The total number of eosinophils in their peripheral blood was 267 ± 132 cells/μL in patients with ISR, significantly higher than the number of eosinophils in those without ISR 174 ± 133 cells/μL (P-value < 0.010). Eosinophil count remained an independent predictor of ISR in multivariate analysis as the eosinophil count value over 242 cells/μL had sensitivity of 66.7% and specificity of 84.5% for the presence of ISR.

Conclusion. The total number of eosinophils, counted 6 weeks after DES implantation, prevails as the sole predictor of ISR occurrence in our study. This suggests an association between immune sensitivity reaction to DES material and development of ISR in patients after PCI.

Mots clés

  • Eosinophil
  • in-stent restenosis
  • stent
  • complete blood count
  • percutaneous coronary intervention
Accès libre

Pulmonary thromboembolism in an emergency hospital: Are our patients different?

Publié en ligne: 15 Nov 2017
Pages: 237 - 244

Résumé

Abstract

Introduction. Pulmonary thromboembolism (PTE) represents a medical emergency and is the third most common cause of mortality after myocardial infarction and stroke. The purpose of this study was to describe the characteristics and management of patients with PTE admitted in a referral emergency hospital in Romania.

Material and methods. We retrospectively reviewed all cases of PTE diagnosed in one of the largest emergency hospitals in Bucharest during a 2-year period (January 2014 – December 2016). Patients with acute PTE were identified by a database search of the diagnostic codes of all discharge diagnoses. Demographic, clinical and paraclinical tests data was retrieved from medical records.

Results. 221 patients (48.87% male, mean age 61.76 years (range 21-94 years)) were diagnosed with PTE in our hospital (0.31% of all hospitalizations). Dyspnea was the most frequent symptom reported (78.9%), followed by pleuritic chest pain (23.9%) and unilateral leg pain (15.8%). Upon presentation, 12.6% of patients had high-risk PTE. Up to 72.8% of patients had at least one thrombotic risk factor, while cancer (14%) was the most frequent amongst them. The mean length of hospitalization was 10.3 ± 4.6 days. Unfractioned heparin (UFH) was the preferred anticoagulant during hospital stay (73.7%, p < 0.001). Vitamin K antagonists (AVK) were the preferred anticoagulant (71.7%, p < 0.001) after discharge, whereas non-antivitamin K oral anticoagulants (NOAC) were recommended in 26.3% of patients. Thrombolysis was used in 18 (8.4%) cases. Mortality was 0.9%. Younger patients more frequently associated thrombophilia or a previous thromboembolic event and clinical signs of DVT at presentation. Older patients associated more frequently a history of hospitalization for heart failure or atrial fibrillation during the previous 3 months and a history of cancer. The clinical presentation in older patients was more severe, with higher PESI scores (103.6 ± 33.4 vs. 55.5 ± 17.9, p<0.001) and a longer hospital stay (10.7 ± 4.7 vs. 9.2 ± 3.9, p = 0.03). The type of anticoagulant treatment did not differ depending on age.

Conclusion. In our emergency hospital, PTE is a relatively rare cause of hospitalization; the rate is, however, comparable with other major hospitals. Dyspnea and pleuritic chest pain was the clinical presentation dyad. UFH was the preferred anticoagulant for in-hospital treatment while AVK was the preferred option for long term treatment and recurrence prophylaxis; however an increasing number of patients are prescribed NOAC. In older patients clinical severity was higher upon presentation, hospitalization duration was increased and cancer was more frequently associated. Younger patients associated more frequently a primary hypercoagulable state and recurrent thromboembolism. Mortality rate was low during hospitalization, comparable with that seen in other studied populations.

Mots clés

  • pulmonary embolism
  • hospitalization
  • risk factors
  • computed tomography
  • anticoagulation
Accès libre

The integration of the molecular methods in the diagnosis algorithm for the poliovirus detection in the sewage water: comparing concentration and detection methods. A Pilot Study

Publié en ligne: 15 Nov 2017
Pages: 245 - 248

Résumé

Abstract

Introduction. Two cases of circulating vaccine-derived poliovirus type 1(cVDPV1), from southwestern Ukraine, bordering Romania, were confirmed in 2015 and the environmental enterovirus surveillance was enhanced in our country. The molecular detection of human enteroviruses as a screening test followed by isolation on cell culture lines or sequencing could be proposed as a new diagnosis algorithm.

Material and Methods. The sensitivity of two molecular methods for the detection of enterovirus strains in 10 mL of sewage water (15 samples) was studied with Film Array ME panel BioFire (Biomerieux, France) and Xpert EV assay (Cepheid, USA). These are standardized methods for the detection of microorganisms in the cerebrospinal fluid (CSF).

Results. Of the 15 samples, six enterovirus strains were detected using Film Array ME, four enterovirus strains were detected using Xpert EV assay, while only two nonpolio enterovirus strains were isolated on RD cell line, using the standard WHO algorithm. However, only one of the strains detected by the standard WHO algorithm was detected by one of the molecular methods.

Conclusions. The molecular methods for enterovirus detection are more sensitive than the virus isolation on cell culture lines, but in one case the virus isolated on RD cell line was not detected by the molecular methods. The results could be influenced by the small number of the samples investigated, by the volume and the concentration method used for samples tested, and by the limits of detection (LoD) of the enterovirus species in the samples, depending on the method used.

Mots clés

  • poliovirus
  • sewage water
  • multiplex PCR
  • Xpert EV assay
  • Film Array ME
Accès libre

The Dilemma in Treatment of hemodialysis patients with catheter-induced right atrial thrombi (CRAT): A case report

Publié en ligne: 15 Nov 2017
Pages: 249 - 252

Résumé

Abstract

Catheter-induced right atrial thrombi (CRAT) is a serious complication of central venous catheterization. Herein we report a case of large hypermobile right atrial thrombi in a 57-year-old man with hemodialysis catheter in the right internal jugular vein.

Mots clés

  • Atrial thrombi
  • Catheter induced right atrial thrombi
  • Hemodialysis catheter
  • End stage renal disease
Accès libre

An atypical type I gastric neuroendocrine tumor

Publié en ligne: 15 Nov 2017
Pages: 253 - 256

Résumé

Abstract

Background. Gastric neuroendocrine tumors (GI-NETs) are rare lesions, usually discovered incidentally during endoscopy. Based on their pathology, there are 4 types of GI-NETs. Type I are multiple small polypoid lesions with central ulceration located in the gastric body or the fundus, associated with atrophic gastritis usually noninvasive and very rarely metastatic. We report on a rare case of a gastric NET arising from the muscularis propria layer of the pyloric ring.

Case report. We present the case of a 65-year old woman with a history of alcoholic cirrhosis, investigated for melena. Upper endoscopy revealed a 30 mm submucosal pedunculated polypoid lesion located on the pylorus protruding in the duodenum, with normal overlying mucosa, fundic gastric atrophy and multiple small polyps at this level, with no active bleeding. CT scan did not reveal any distant metastases. An ultrasound endoscopy was performed, and a round hypoechoic heterogeneous solitary mass, evolving from the pyloric muscle was described. Considering a 30-mm tumor evolving from the gastric muscle layer in the absence of local invasion and with no distant metastases we decided against an endoscopical resection and we referred the patient to surgery. A laparoscopic wedge resection was performed. The pathology report described a 30/25 mm welldifferentiated neuroendocrine tumor invasive in the muscularis mucosa (pT3).

Conclusions. Usually, type I neuroendocrine tumors are located in the body or the fundus of the stomach without submucosal invasion. The interesting feature in our case was that the tumor originated from the pylorus, making it an atypical presentation for a neuroendocrine tumor.

Mots clés

  • ultrasound endoscopy
  • gastric neuroendocrine tumor
  • surgery
10 Articles
Accès libre

A step by step approach in differential diagnosing of adrenal incidentaloma (epinephroma), (with comments on the new Clinical Practice Guidelines of the European Society of Endocrinology)

Publié en ligne: 15 Nov 2017
Pages: 188 - 197

Résumé

Abstract

Objectives. To present a step by step approach for the diagnosis of adrenal incidentaloma (AI).

Method. An extensive review of the literature was conducted, searching the Pub-Med and Google Scholar using the Mesh terms; Adrenal; Incidentaloma; Adrenal tumours; Radiology; Diagnosis. We also did a cross-referencing search of the literature. Comments on the new European guidelines are presented.

Results. The majority of the tumours are non-functioning benign adenomas. The most important radiological characteristic of an adrenal incidentaloma is the radiation attenuation coefficient. Wash out percentage and the imaging characteristics of the tumour may help in diagnosis.

Conclusion. Density less than 10 HU is in most cases characteristic of a lipid rich benign adenoma. More than 10 HU or/and history of malignancy raise the possibility for cancer. 1 mg dexamethasone test and plasma metanephrines should be done in all patients. If there is history of hypokalemia and/or resistant hypertension we test the plasma aldosterone to plasma renin ratio (ARR). Newer studies have shown that tumours even nonfunctioning and less than 4 cm may increase the metabolic risks so we may consider surgery at an earlier stage.

Mots clés

  • Adrenal incidentaloma
  • Epinephroma
  • Diagnosis
  • Radiology
  • Treatment
  • ESE guidelines
Accès libre

IL-17 and Th17 cells in systemic sclerosis: a comprehensive review

Publié en ligne: 15 Nov 2017
Pages: 198 - 204

Résumé

Abstract

T cells (especially T helper cells) seem to be strongly associated with systemic sclerosis pathogenesis. Th17-IL-17 axis was proved to be involved in the pathogenesis of multiple autoimmune diseases. By performing a comprehensive research of the literature indexed in PubMed database, the current review summarizes current knowledge related to Th17 and IL-17 in systemic sclerosis. While there is promising data suggesting inhibition of Tregulatory and Th1 signals on one hand and promotion of Th17 and Th2 signals on the other, studies that include prospective and integrated analysis of Tregulatory, Th17, Th1, Th2 (cells and derived cytokines) on the same cohort of Ssc patients are warranted.

Mots clés

  • Systemic sclerosis
  • IL-17A
  • Th17
  • IL-17F
Accès libre

Serum levels of nitrite/nitrate, lipid profile, and Fasting Plasma Glucose and their associations in subclinical hypothyroid women before and after a two month treatment by levothyroxine

Publié en ligne: 15 Nov 2017
Pages: 205 - 211

Résumé

Abstract

Background. Subclinical hypothyroidism (sHT) is a condition defined by elevated TSH values with normal levels of free thyroid hormones. Altered metabolic status is one of the consequences of sHT which can affect serum levels of FPG, lipid profile, and nitric oxide which propounds cardiovascular consequences per se. The aim of this study was to determine the possible effects of sHT on nitrite/nitrate levels, as a marker of endothelial performance.

Materials and Methods. 50 females were enrolled in this study, 25 women as control group and 25 women as case group (evaluated two times: before and after levothyroxine therapy). Blood samples were collected and levels of FPG, lipid profile components, and nitric oxide were measured spectrophotometrically. The data were analyzed using SPSS version 18 software.

Results. The levels of lipid profile (except for TG between before and after group, p < 0.05) and nitric oxide did not differ in groups while FPG was significantly higher in case groups in comparison to control group (p < 0.001). Nitric oxide had no correlations with any of variables except for LDL in after treatment group (p < 0.05 and r = 0.397).

Conclusion. Nitric oxide does not have correlation with components of lipid profile (except for LDL) or FPG and has no differences in subclinical hypothyroid patients and control group. Levothyroxine therapy during 2 months cannot alter the levels of nitric oxide in subclinical hypothyroid patients.

Mots clés

  • Subclinical hypothyroid
  • Levothyroxine
  • Nitrite/nitrate
  • Lipid profile
  • Fasting plasma glucose
Accès libre

Raised TSH is associated with endothelial dysfunction in Metabolic Syndrome: A case control study

Publié en ligne: 15 Nov 2017
Pages: 212 - 221

Résumé

Abstract

Introduction. Endothelial dysfunction has been considered as one of the important factors in pathogenesis of Metabolic Syndrome (Met S). Subclinical hypothyroidism (SCH) has also been reported to be associated with Met S. The aim of our study is to evaluate the association of raised TSH with mediators of endothelial dysfunction in Met S with Subclinical hypothyroidism as compared to healthy controls.

Methods. Study population consisted of 100 subjects, out of which 50 were cases of Met S and 50 were healthy controls. Met S group were further divided into two, based on the presence & absence of SCH. Serum insulin, T3, T4, TSH were measured by chemiluminescence based immunoassay (CLIA). Serum nitric oxide (NO) levels were measured by Modified Griess’s method and serum endothelin-1 (ET-1) levels were measured by ELISA.

Results. Out of 50 cases of Met S, SCH was diagnosed in 22. The mean serum TSH levels were significantly higher in Met S cases as compared to healthy controls (5.7 ± 1.2 μIU/mL vs. 2.3 ± 1.6 μIU/mL, P <0.0001). Mean serum NO levels were significantly lower in Met S cases as compared to healthy control (15.4 ± 10 μM vs. 21 ± 10 μM, p = 0.009). Mean serum ET-1 levels were significantly higher in Met S cases as compared to healthy controls (2.68 ± 1.7 fmol/mL vs. 2.1 ± 0.84 fmol/mL, p = 0.011). On Pearson’s correlation analysis, TSH showed positive correlation with ET-1 (r = 0.341, p = 0.001) and negative correlation with NO (r = −0.331, p = 0.001). Binary logistic regression analysis showed that TSH, NO and ET-1 has significant odd’s ratio for predicting Met S.

Conclusion. Met S cases were screened for thyroid abnormalities and found to have 44% of SCH along with co-existing endothelial dysfunction. Raised TSH in SCH could cause endothelial dysfunction which may lead to Met S and associated co-morbidities. Present study gives new insight in linking endothelial dysfunction and raised TSH in Met S. Therefore, Met S cases should be screened for SCH and treated appropriately to attenuate endothelial dysfunction and associated comorbidities in Met S.

Mots clés

  • Metabolic Syndrome X
  • Hypothyroidism
  • Nitric Oxide
  • Endothelin-1
Accès libre

The frequency of bone fractures among patients with chronic kidney disease not on dialysis: two-year follow-up

Publié en ligne: 15 Nov 2017
Pages: 222 - 228

Résumé

Abstract

Introduction. Renal osteodystrophy is a severe complication of chronic kidney disease (CKD) that increases morbidity and mortality in these patients. Mineral and bone disorder starts early in CKD and affects the incidence of bone fractures. The aim of this study was to observe the frequency of diverse bone fractures in patients with CKD not on dialysis.

Methods. This cohort study included 68 patients that were followed during the two-year period. The patients were divided into two cohorts: one that developed bone fractures and the other that did not. There were 35 (51.5%) men and 33 (48.5%) women. The mean age of patients ranged 62.88±11.60 years. During follow-up serum values of chronic kidney disease – mineral and bone indicators were measured. The methods of descriptive and analytical statistics were used in order to analyze obtained data.

Results. During this two-year follow-up seven patients developed bone fractures. Among them, females dominated (6 patients) compared to males (only 1 patient). The most common were fractures of forearm. The mean level of parathyroid hormone (PTH) at the beginning of the monitoring was higher in the group of patients with bone fractures (165.25 ± 47.69 pg/mL) in regard to another group (103.96 ± 81.55 pg/mL). After two-year follow-up, this difference became statistically significant at the level p < 0.05. Patients that developed bone fractures had higher FRAX (Fracture Risk Assessment) score compared to another group.

Conclusion. In our study, about 10% of patients had bone fractures in the two-year follow-up period. Patients who developed fractures had a higher PTH level and FRAX score.

Mots clés

  • chronic kidney disease
  • mineral and bone disorder
  • fracture
  • renal osteodystrophy
  • bone
Accès libre

The value of peripheral blood eosinophil count in predicting in-stent restenosis in patients with stable angina pectoris undergoing drug eluting stenting

Publié en ligne: 15 Nov 2017
Pages: 229 - 236

Résumé

Abstract

Introduction. In-stent restenosis (ISR) remains a major limitation of percutaneous coronary intervention (PCI). A role for peripheral blood cells as major regulators of immune and inflammatory systems has been proposed. We aim to evaluate the relationship between eosinophil count and development of restenosis after drug-eluting stent (DES) implantation.

Methods. In this prospective study, all consecutive patients undergoing elective DES implantation for chronic stable angina (CSA) in a university-affiliated heart center within a 6-month period were enrolled and followed for another 6 months. Complete blood count with differentiation was performed 6 weeks after the index procedure. During the follow-up period, the cohort of patients who developed ISR was compared to the cohort of patients without ISR, descriptively and the total number of eosinophilic white cells was used to predict the occurrence of ISR.

Results. 153 men and 48 women with CSA underwent PCI with DES implantation, from which, 26 patients needed repeat coronary angiography for recurrent symptoms. There was an established ISR in 17 (8.5%) patients. The total number of eosinophils in their peripheral blood was 267 ± 132 cells/μL in patients with ISR, significantly higher than the number of eosinophils in those without ISR 174 ± 133 cells/μL (P-value < 0.010). Eosinophil count remained an independent predictor of ISR in multivariate analysis as the eosinophil count value over 242 cells/μL had sensitivity of 66.7% and specificity of 84.5% for the presence of ISR.

Conclusion. The total number of eosinophils, counted 6 weeks after DES implantation, prevails as the sole predictor of ISR occurrence in our study. This suggests an association between immune sensitivity reaction to DES material and development of ISR in patients after PCI.

Mots clés

  • Eosinophil
  • in-stent restenosis
  • stent
  • complete blood count
  • percutaneous coronary intervention
Accès libre

Pulmonary thromboembolism in an emergency hospital: Are our patients different?

Publié en ligne: 15 Nov 2017
Pages: 237 - 244

Résumé

Abstract

Introduction. Pulmonary thromboembolism (PTE) represents a medical emergency and is the third most common cause of mortality after myocardial infarction and stroke. The purpose of this study was to describe the characteristics and management of patients with PTE admitted in a referral emergency hospital in Romania.

Material and methods. We retrospectively reviewed all cases of PTE diagnosed in one of the largest emergency hospitals in Bucharest during a 2-year period (January 2014 – December 2016). Patients with acute PTE were identified by a database search of the diagnostic codes of all discharge diagnoses. Demographic, clinical and paraclinical tests data was retrieved from medical records.

Results. 221 patients (48.87% male, mean age 61.76 years (range 21-94 years)) were diagnosed with PTE in our hospital (0.31% of all hospitalizations). Dyspnea was the most frequent symptom reported (78.9%), followed by pleuritic chest pain (23.9%) and unilateral leg pain (15.8%). Upon presentation, 12.6% of patients had high-risk PTE. Up to 72.8% of patients had at least one thrombotic risk factor, while cancer (14%) was the most frequent amongst them. The mean length of hospitalization was 10.3 ± 4.6 days. Unfractioned heparin (UFH) was the preferred anticoagulant during hospital stay (73.7%, p < 0.001). Vitamin K antagonists (AVK) were the preferred anticoagulant (71.7%, p < 0.001) after discharge, whereas non-antivitamin K oral anticoagulants (NOAC) were recommended in 26.3% of patients. Thrombolysis was used in 18 (8.4%) cases. Mortality was 0.9%. Younger patients more frequently associated thrombophilia or a previous thromboembolic event and clinical signs of DVT at presentation. Older patients associated more frequently a history of hospitalization for heart failure or atrial fibrillation during the previous 3 months and a history of cancer. The clinical presentation in older patients was more severe, with higher PESI scores (103.6 ± 33.4 vs. 55.5 ± 17.9, p<0.001) and a longer hospital stay (10.7 ± 4.7 vs. 9.2 ± 3.9, p = 0.03). The type of anticoagulant treatment did not differ depending on age.

Conclusion. In our emergency hospital, PTE is a relatively rare cause of hospitalization; the rate is, however, comparable with other major hospitals. Dyspnea and pleuritic chest pain was the clinical presentation dyad. UFH was the preferred anticoagulant for in-hospital treatment while AVK was the preferred option for long term treatment and recurrence prophylaxis; however an increasing number of patients are prescribed NOAC. In older patients clinical severity was higher upon presentation, hospitalization duration was increased and cancer was more frequently associated. Younger patients associated more frequently a primary hypercoagulable state and recurrent thromboembolism. Mortality rate was low during hospitalization, comparable with that seen in other studied populations.

Mots clés

  • pulmonary embolism
  • hospitalization
  • risk factors
  • computed tomography
  • anticoagulation
Accès libre

The integration of the molecular methods in the diagnosis algorithm for the poliovirus detection in the sewage water: comparing concentration and detection methods. A Pilot Study

Publié en ligne: 15 Nov 2017
Pages: 245 - 248

Résumé

Abstract

Introduction. Two cases of circulating vaccine-derived poliovirus type 1(cVDPV1), from southwestern Ukraine, bordering Romania, were confirmed in 2015 and the environmental enterovirus surveillance was enhanced in our country. The molecular detection of human enteroviruses as a screening test followed by isolation on cell culture lines or sequencing could be proposed as a new diagnosis algorithm.

Material and Methods. The sensitivity of two molecular methods for the detection of enterovirus strains in 10 mL of sewage water (15 samples) was studied with Film Array ME panel BioFire (Biomerieux, France) and Xpert EV assay (Cepheid, USA). These are standardized methods for the detection of microorganisms in the cerebrospinal fluid (CSF).

Results. Of the 15 samples, six enterovirus strains were detected using Film Array ME, four enterovirus strains were detected using Xpert EV assay, while only two nonpolio enterovirus strains were isolated on RD cell line, using the standard WHO algorithm. However, only one of the strains detected by the standard WHO algorithm was detected by one of the molecular methods.

Conclusions. The molecular methods for enterovirus detection are more sensitive than the virus isolation on cell culture lines, but in one case the virus isolated on RD cell line was not detected by the molecular methods. The results could be influenced by the small number of the samples investigated, by the volume and the concentration method used for samples tested, and by the limits of detection (LoD) of the enterovirus species in the samples, depending on the method used.

Mots clés

  • poliovirus
  • sewage water
  • multiplex PCR
  • Xpert EV assay
  • Film Array ME
Accès libre

The Dilemma in Treatment of hemodialysis patients with catheter-induced right atrial thrombi (CRAT): A case report

Publié en ligne: 15 Nov 2017
Pages: 249 - 252

Résumé

Abstract

Catheter-induced right atrial thrombi (CRAT) is a serious complication of central venous catheterization. Herein we report a case of large hypermobile right atrial thrombi in a 57-year-old man with hemodialysis catheter in the right internal jugular vein.

Mots clés

  • Atrial thrombi
  • Catheter induced right atrial thrombi
  • Hemodialysis catheter
  • End stage renal disease
Accès libre

An atypical type I gastric neuroendocrine tumor

Publié en ligne: 15 Nov 2017
Pages: 253 - 256

Résumé

Abstract

Background. Gastric neuroendocrine tumors (GI-NETs) are rare lesions, usually discovered incidentally during endoscopy. Based on their pathology, there are 4 types of GI-NETs. Type I are multiple small polypoid lesions with central ulceration located in the gastric body or the fundus, associated with atrophic gastritis usually noninvasive and very rarely metastatic. We report on a rare case of a gastric NET arising from the muscularis propria layer of the pyloric ring.

Case report. We present the case of a 65-year old woman with a history of alcoholic cirrhosis, investigated for melena. Upper endoscopy revealed a 30 mm submucosal pedunculated polypoid lesion located on the pylorus protruding in the duodenum, with normal overlying mucosa, fundic gastric atrophy and multiple small polyps at this level, with no active bleeding. CT scan did not reveal any distant metastases. An ultrasound endoscopy was performed, and a round hypoechoic heterogeneous solitary mass, evolving from the pyloric muscle was described. Considering a 30-mm tumor evolving from the gastric muscle layer in the absence of local invasion and with no distant metastases we decided against an endoscopical resection and we referred the patient to surgery. A laparoscopic wedge resection was performed. The pathology report described a 30/25 mm welldifferentiated neuroendocrine tumor invasive in the muscularis mucosa (pT3).

Conclusions. Usually, type I neuroendocrine tumors are located in the body or the fundus of the stomach without submucosal invasion. The interesting feature in our case was that the tumor originated from the pylorus, making it an atypical presentation for a neuroendocrine tumor.

Mots clés

  • ultrasound endoscopy
  • gastric neuroendocrine tumor
  • surgery

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