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

The prognosis of STEMI patients experiencing the no-reflow phenomenon is unfavorable both in the short- and long-term compared to patients who do not develop this pathology, and it is even worse as other cardiovascular risk factors There is a correlation between the no-reflow phenomenon and diabetes mellitus type II and obesity and this conditions represent stong predictors of mortality.

Aim. Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are in a bidirectional relationship. This prospective study focused on associations between parameters common to the pathogenesis of insulin resistance, inflammation and hepatic steatosis in T2DM patients with metabolic imbalance.

Methods. We used clinical data, insulin resistance and inflammation indices, and hepatic steatosis markers from 120 patients.

Results. The patients (44% men, mean age 58) had a mean body mass index (BMI) of 32 kg/m² and mean T2DM history of 6 years. With exceptions, significant correlations were found between metabolic, inflammatory and hepatic parameters.

Conclusions. In T2DM patients with poor glycemic control, hepatic steatosis correlates significantly with insulin resistance and inflammation. Increased prevalence and poor prognosis of these diseases together justify the need for NAFLD screening of diabetic patients.

Clostridium difficile is a microorganism - a Gram-positive anaerobic bacterium that has developed and hyperspecialized the ability to form spores. Outside the host, Clostridium difficile germinates spores which are resistant to unfavorable environment and for an extremely long time period. Clostridium difficile infection frequently occurs on a background of major disturbances in the balance of the normal intestinal flora caused by use for therapeutic purposes of broad-spectrum antibiotics. Patients infected with Clostridium difficile in medical facilities are usually elderly people, immunosuppressed or subjected to an antibiotic medication regimen. Wide-scale community use of antibiotics and proton-pump inhibitors induces favorable conditions for the germination of Clostridium difficile spores in the gastrointestinal tract.

Clostridium difficile biocolonizes many domestic and wild animals. Clostridium difficile is a complex bacterium, capable of developing resistance forms that parasitize the gastrointestinal tract of humans, and also many animals. An important source of the Clostridium difficile infection is represented primarily by antibiotic medication administered in communities without medical recommendation, as well as food.

Chronic hepatitis C and sarcoidosis are both well-known diseases. Some studies support the hypothesis that the hepatitis C virus (HCV) may trigger sarcoidosis⁽¹⁾. We present a case of chronic hepatitis C, developing a silent lung systemic disease with subcutaneous and ganglionar nodules, ultimately proving to be sarcoidosis. The clinical picture is complicated by a hepatic nodule, challenging the treatment course. The unveiling of a sarcoidosis in a previously HCV infected patient may not be accidental, the course of infection could be influenced by systemic disease. The therapy of chronic hepatitis C in the context of sarcoidosis is very challenging and demands a careful monitoring⁽²⁾.

Porto-pulmonary hypertension (PPH) is the association between portal hypertension (PoH) due to liver disease or extra hepatic etiology and pulmonary hypertension (PH). It’s prevalence ranges between 2 and 16 % ^(1,2)and it’s diagnosis requires the exclusion of alternative causes of PH which can be sometimes challenging, especially in the context of a wide range of comorbidities that a patient with chronic liver disease can present with. We describe a 72 years-old man with a clinical presentation of right heart failure and signs of severe PH shown by the echocardiography. The blood tests were positive for anti-HCV antibodies and CT-imaging showed signs of cirrhosis and PoH. Complementary exams and review of the literature allowed use to rule out other potential causes constituting the differential diagnosis of the PH in this patient.

Acute coronary syndromes exhibit rapid and variable ischemic dynamics, with consecutive electrocardiographic changes, sometimes in the absence of angina.

We report the case of a 50 year-old man, admitted for suspected angor de novo, asymptomatic upon admission, and with a normal electrocardiogram. After a few hours, the repeated electrocardiogram displays biphasic T waves in V2–V4, in the absence of symptoms, and then marked ST elevation in the same territory, without chest pain. The patient is transferred with a STEMI diagnosis, and the coronary angiography documents a critical sub-occlusive stenosis in the proximal segment of the left anterior descending artery (LAD), for which a drug-eluting stent is inserted, with a favourable evolution.

Wellens syndrome is defined by characteristic electrocardiographic changes of T waves in leads V2–V4, occurring in the context of unstable angina, usually without pain. They express a critical stenosis in the proximal LAD artery. Recognition of the Wellens syndrome is crucial, as these “pre-infarction” changes tend to evolve, sometimes rapidly, to an extensive anterior myocardial infarction. The rapid and unpredictable ischemic electrocardiographic changes make this case remarkable, as they occur in an asymptomatic patient with unstable angina (angor de novo), thus underlining the need for careful supervision in such patients.

We present the evaluation of a 82 years old patient, diagnosed with long QT syndrome at 75 years (QTc =550 ms) and obstructive hypertrophic cardiomyopathy from 2011, complicated with ventricular fibrillation and torsade de pointes (QTc =840ms). In this situation, it was decided to follow via electrocardiography (ECG) her first and second degree relatives (daughter - 53 years old – QTc =505 ms, granddaughter - 23 years old – QTc =448ms), and to inform them about the importance of performing the cardiac echography to exclude a possible obstructive hypertrophic cardiomyopathy, and of the genetic testing. After the implantation of the ICD (implantable cardiac defibrillator) and on treatment with beta-blockers, the patient did not repeat any arrhythmic events, but still had the same electrocardiographic aspect of long QT interval. Due to the fact that the patient had a lot of other diseases, the administration of treatment which can prolong the QT interval was avoided. Long QT syndrome represents a congenital or acquired pathology, which sometimes can be induced by some drugs, and requires a correct diagnosis in order to establish an individualized pharmaceutical or surgical treatment, and to prevent the risk of sudden death by cardiac arrhythmias.

GAVE syndrome (gastric antral vascular ectasia) is a rare cause of gastrointestinal bleeding. It affects mainly the elderly. The syndrome was named “watermelon stomach” because of its typical endoscopic appearance of “watermelon stripes” observed at the gastric antral level. We present the case of an 80-year-old female patient, under iron substitution therapy for an iron deficiency anemia previously diagnosed. The woman was admitted to our hospital for non-specific symptoms, severe asthenia and postural instability. The clinical examination noted pallor of skin and sclera, without hematemesis or melena. Paraclinical tests revealed severe hypochromic microcytic anemia and hyposideremia, with a positive fecal occult blood test. Because the patient was refractory to the iron therapy, presenting with severe anemia, which required blood transfusions, we suspected a diagnosis of acute hemorrhagic gastritis. In order to reveal the source of the hemorrhage, an upper gastrointestinal endoscopy was performed, which described the typical appearance of prominent, tortuous, erythematous streaks traversing the antrum and converging toward the pylorus, creating the “watermelon stripes” pattern, with lesions that bleed easily during the biopsy process. In a different endoscopic session, the argon plasma coagulation treatment was applied, resulting in clinical and biological improvement.

Gastric antral vascular ectasia is a rare medical condition, insufficiently recognized and poorly understood, which can be treated efficiently by endoscopic means, if it is early diagnosed. Although this condition tends to be underdiagnosed at the present time, doctors may exceed their limits by acquiring a high grade of clinical suspicion.