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

Background. It is well known that the NT-proBNP in obese subjects is much lower than in normal weight subjects, making difficult to interpret it. In current practice the patients are frequently obese. In these conditions, a new biomarker, not influenced by weight, could be useful in acute-decompensated heart failure (ADHF).

Aim. To determine CA-125 changes in obese and normal weight patients with ADHF.

Method. The study group included 110 patients (mean age 72±10 years, 63% men) with ADHF caused by ischemic cardiomyopathy. The subjects were clinically, ecocardiographically and biologically (NT-proBNP, CA-125) evaluated.

Results. The mean BMI was 27.6±5.8 kg/m² and 35 (33%) subjects were obese. CA-125 at admission was 53±33 U/mL and decreased at discharge to 34±17 U/mL, without any difference between males and females.

There was a significant difference between NT-proBNP at admission in obese versus normoponderal patients (3207±1432 pg/mL versus 4457±2737 pg/mL (p=0.02)), which was maintained at discharge (1711±816 pg/mL versus 2674±1475 pg/mL (p=0.03)).

In the same time, the CA-125 did not show statistically significant differences between obese and normoponderal subjects at admission (56±29 U/mL versus 51±20 U/mL (p=0.63)) and discharge (36±20 U/mL versus 33±16 U/mL (p=0.56)).

Conclusions. CA-125 could be an useful biomarker in monitoring the obese patients with ADHF, better than NT-proBNP.

Lipid parameters along with the biological markers of myocardial necrosis play an essential role in highlighting the patient at an increased risk of developing the no-reflow phenomenon from an STEMI. This phenomenon is due to primary PCI failure of blood flow in the coronary microcirculation, although the artery involved in the infarction is disintegrated.

Background and objectives. Health-related quality of life (HRQoL) is a very important outcome in patients with chronic liver disease. Thus, the present study attempts to assess the family quality of life of these patients, since it is well known that families have always represented the primary environment of most people.

Matherial and methods. A sample of 30 participants with a family member who had CLD were recruited to be interviewed through the Romanian adaptation of the Family Quality of Life Survey – general version 2006 (FQOLS-2006), an evaluation tool developed in Canada with the purpose of studying families’ quality of life among. Primary caregivers completed the FQOL Survey. The data was analysed to describe population characteristics and to explore the relationship between the main domains and dimensions of QoL and the patients and caregivers characteristics.

Results. The findings showed highest domain scores for Support from services and Family relationships and lowest for Support from others. Dimension scores were highest for Importance and lowest for Stability. Overall FQOL approximated average (78.5±13.4). Younger patients scored lower rates of FQOL domains. Alcohol-related liver disease led to lower rates of all the domains, except from Support from others and Leisure and Recreation activities. Patients with liver cirrhosis or liver cancer negatively influence their caregiver’s success in career. Also, families of liver cirrhosis patients reported the lowest level of satisfaction among all respondents.

Conclusions. The results of this study suggest that there are some significant areas of family life highly influenced by a chronic liver disease diagnosis in one of their members.

The current HAART has modified natural history of HIV infection and it has practically turned the disease into a manageable chronic condition. Even though the benefits of HAART use are overwhelmingly greater than possible metabolic syndrome and cardiovascular disease risks, close management of those patients is called for, especially due to the fact that general population risk factors now overlap with specific ones in this population.

Cardiovascular screening for HIV-infected patients who are receiving HAART must be done constantly with a collaboration between the infectious disease specialist and the internist.

There is a complex link between obesity and obstructive sleep apneea (OSA), and there are new guidelines for comprehensive lifestyle interventions (CLI) for weight loss, with beneficial results on obese patients with OSA. A structured algorithm is proposed, step by step, according to BMI. All these recommendations are evidence based, a large meta-analysis is further discussed as an evidence base.

Implications in clinical practice outline: the effectiveness of lifestyle changes in reducing OSA outcomes, higher efficiency for complex interventions on male patients with severe OSA, duration of the intervention and combination with CPAP usage are not statistically correlated with lifestyle interventions effects on OSA. Different types of food affect sleep quality, high fat diets and processed meat are correlated with OSA. Higher adherence to Mediterranean Diets, that is very common used in CLI is a predictor for OSA outcomes improvement. Metabolic bariatric surgery MBS, indicated for a specific group of patients will ameliorate OSA. Building a long term partnership with the patients with OSA and obesity will ensure adherence to therapeutically measures and finally good results in improving quality of life.

Introduction. Inflammatory rheumatic diseases are sometimes the first manifestation of neoplasia.

Case presentation. A 57 year old female patient, heavy smoker, is admitted to our clinic for 2 days old pulp necrosis of the third finger, right hand, with onset of ischemia 1 week before admission. Other manifestations were Raynaud’s phenomenon, dry mouth, dysphagia and shortness of breath after moderate physical activity with a duration of about 6 months. She was repeatedly followed-up by a pulmonologist with chest computer tomography, which detected a dimensional evolutionary mediastinal lymph node, but not investigated further. The patient had skin thickening of the hands and face, microstomia and an area of dry necrosis of 1.5/1cm in the pulp of the third finger, right hand. Laboratory tests show the presence of antinuclear antibodies with positive anti SS-A antibodies and elevated levels of serum inflammatory markers. Vascular surgery examination excludes thromboangiitis obliterans or other large vessel diseases. The presumptive diagnosis is undifferentiated connective tissue disease with systemic sclerosis and Sjögren syndrome elements, most likely secondary to the mediastinal tumor. Mediastinal biopsy shows a heterogeneous metastasis of unknown origin, and further investigations: immunohistochemistry, multiple gene mutations tests, computed tomography scan of the chest, abdomen, and pelvis, mammography, Papanicolaou test and positron emission tomography scan did not identify the primary tumor, thus delaying oncologic treatment.

Conclusion. Case of undifferentiated connective tissue disease with elements of systemic sclerosis and Sjögren syndrome, most probably paraneoplastic, with chest metastasis of unknown origin, in which diagnosis and treatment were delayed due to lack of primary tumor identification.

Infective endocarditis is an infection of the endocardial surface of the heart. Usually, it affects one or more heart valves or an intracardiac device. Neurologic events (silent or symptomatic) account for 20 to 40% of all patients with infective endocarditis.

We are presenting the case of a 57 -year-old man with cardiovascular risk factors admitted to our clinic for aphasia. His medical history included a recent stroke and small fiber neuropathy with a gradual onset for the past six months. Despite extensive investigations, no cause for strokes and neuropathy could be found. To identify a potential source of embolism, a transoesophageal echocardiography was performed. It revealed vegetation attached to both aortic and mitral valves. Blood cultures were positive for Streptococcus gallolyticus. The patient underwent emergency aortic and mitral valve replacement and a 6-week course of antibiotic treatment with ceftriaxone and gentamicin with the improvement of both aphasia and peripheral neuropathy.

Central nervous system complications such as encephalopathy, seizures, stroke or severe cerebral hemorrhage are commonly described in infective endocarditis, but peripheral nervous system involvement is rarely reported in the literature. Although no cause for neuropathy has been found, it is difficult to asses whether it was a complication of the infective endocarditis.

Background. Groove pancreatitis or paraduodenal pancreatitis represents a rare type of pancreatitis, and can be classified into cystic dystrophy of the duodenal wall in heterotopic pancreas, paraduodenal cyst or myoadenomatosis.

Case presentation. We present a case of a 58 year old man, drinker and smoker who was admitted in the Department of Gastroenterology for abdominal pain, weight loss and nausea. From his history we have noticed frequent presentations of recurrent acute pancreatitis in the last two years. Laboratory tests have revealed cholestasis, high value of lipase and high value of amylase, with normal value of CA 19.9. The magnetic resonance from the last two years showed the same appearances: a large and edematous head of pancreas, a thickening of the wall of adjacent duodenum and an inhomogeneous area with cystic transformation in the head of the pancreas. We performed endoscopic ultrasound with fine needle aspiration. The histopathological result showed only inflammatory cells. We have established the diagnosis of groove pancreatitis.

Conclusion. Groove pancreatitis represents a rare condition, with an incidence of 0.4%-14% on biopsies. Endoscopic ultrasound is the best method for diagnosis, it could evaluate also the duodenal wall.