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

Background and aims. Biomarkers are a simple and inexpensive way to replace the invasive diagnostic test^(1,2). Portal hypertension screening recommendations in cirrhotic patients propose two such biomarkers: the platelet count and liver elastography. This recommendation derives from studies on viral cirrhosis⁽³⁾. Viral cirrhosis is biologically and histologically different from steatosis related cirrhosis and traditional biomarkers used for high-risk varices screening might not be of use in this category. We aimed to evaluate their utility compared to other biomarkers for the prediction of high-risk varices of non-viral etiology in cirrhotic patients.

Methods. Our current study is a monocentric, real-life, cross-sectional analysis of non-viral cirrhosis patients.

Results. 50 patients with suspected cirrhosis, who underwent upper gastrointestinal endoscopy, were included prospectively for over 8 months and 41 were analyzed. The etiology was steatohepatitis (alcohol and non-alcohol related steatohepatitis). Hyaluronic acid (AUC 0.866, r =0.600), prothrombin time (AUC 0.708, r =0.445) and spleen size (AUC 0.763, r =0.337) significantly correlated with high-risk esophageal varices. In the meantime, liver stiffness was difficult to obtain and only correlated modestly with high-risk esophageal varices and platelet count was a poor predictor of high-risk esophageal varices in this mainly steatosis related cohort of cirrhotic patients.

Conclusion. We proposed hyaluronic acid, spleen size and prothrombin time as alternatives biomarkers for portal hypertension in steatohepatitis patients. Their potency should be further proven in larger studies.

Background. Acute pancreatitis represents an inflammatory disease with different grades of severity, ranging from mild to severe presentation. In current practice there are a lot of biomarkers used in diagnosis and prognosis of pancreatitis.

The aim of this study was to evaluate de differences between a group with acute pancreatitis and a group of healthy people regarding the neutrophil to lymphocyte ratio (NLR), thrombocyte to lymphocyte ratio (TLR), as these two could help in the evaluation of prognosis and severity of acute pancreatitis.

Method. The study had two groups: group A, included 100 patients with acute pancreatitis and group B - 30 healthy people.

Results. In the group A there were 65% male and 35 % female with a mean age of 58.07±15.10 years, in the group B there were 50% male and 50% female with a mean age of 48.06±15.47 years. The majority of the people included in both groups were from the urban provenience. We obtained an important difference between group A and group B regarding the neutrophil to lymphocyte ratio and thrombocyte to lymphocyte ratio with an important statistical significance (p<0.001).

Conclusion. Neutrophil to lymphocyte ratio and thrombocyte to lymphocyte ratio could be promising biochemical parameters in diagnosis and prognosis of acute pancreatitis.

Determination of plasma level of D-dimers in patient with acute ischemic stroke can be used as a potential predictor of survival and correlated with the degree of disability of the patient. This study shows a correlation between the serum level of D-dimers in the diabetic patients with acute ischemic stroke, which may result that the level of D-dimers could be a good predictor of survival in acute ischemic stroke but not a predictor of disability and prognosis.

Stroke is a public health problem especially in developed countries, being an important cause of death and disability. The prevalence of chronic kidney disease (CKD) in the general population varies from country to country. The percentage of afflicted patients is on the rise, mainly due to the high incidence of diabetes mellitus (DM) complicated with diabetic nephropathy (DN) and of the kidney vascular diseases (hypertensive nephroangiosclerosis and ischemic nephropathy). In patients with CKD, strokes are relatively frequent, especially hemorrhagic ones, due to a host of risk factors, both modifiable and unmodifiable.

Cardiovascular complications (which may be prevented by risk factors control) are the main culprit for the relatively high mortality rate of CKD patients, frequently leading to their death before the initiation of renal replacement treatment (dialysis, kidney transplant).

Apoptosis is an inborn process that has been preserved during evolution; it allows the cells to systematically inactivate, destroy and dispose of their own components thus leading to their death. This program can be activated by both intra and extracellular mechanisms. The intracellular components involve a genetically defined development program while the extracellular aspects regard endogenous proteins, cytokines and hormones as well as xenobiotics, radiations, oxidative stress and hypoxia. The ability of a cell to enter apoptosis as a response to a „death” signal depends on its proliferative status, the position in the cell cycle and also on the controlled expression of those genes that have the capacity of promoting and inhibiting cell death. The fine regulation of these parameters needs to be maintained in order to ensure the physiological environment required for the induction of apoptosis.

In this review, we first describe evidence for the role of apoptotic pathways in ischemic acute renal failure, and then consider the potential mechanisms that may participate in this model of acute renal tubular injury. Potential therapeutic interventions to prevent tubular apoptosis in renal disease include angiotensin system inhibition, whereby the angiotensin II AT2 receptor blockade seems more promising in apoptosis inhibition than the inhibition of other receptor subtypes. A better understanding of the mechanisms of apoptosis could lead to safer and more specific therapeutic interventions for acute kidney injury.

The European Society of Cardiology and the European Atherosclerotic Society are recommending in the 2019 guideline for dyslipidemia the best management strategies for an individual patient with a given condition.

The guideline recommends the use of new tests to help identify high-risk patients. These include both coronary artery calcium imaging and biomarker tests.

Modifications have also been made to the risk stratification categories, so that patients with atherosclerotic artery disease, diabetes mellitus with target organ damage, familial hypercholesterolaemia and severe chronic kidney disease are all included in very-high risk patients.

The new ESC/EAS guideline for dyslipidemia management compared with the 2016 version include more intensive reduction of LDL-c across CV risk categories. If the goals are not achieved with the maximum tolerated dose of statin, combination with ezetimibe is recommended. An important message of the new guideline is that until this moment there are no known adverse effects of very low LDL-c concentrations.

Current Guidelines for the diagnosis and management of acute pulmonary embolism (PE), as well as all other Guidelines, summarize and evaluate the already available evidence and consensus “with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition”.

In this review we present the most important new recommendations of the latest ESC Guidelines on the diagnosis and management of acute pulmonary embolism.