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

Background. Understanding the underlying cause of mortality in sepsis has broad implications for both trials design and clinical care. A one-size-fits-it-all treatment without considering underlying comorbidities and particularities of a specific patient may have a huge impact on prognosis.

Materials and methods. We performed a retrospective, single center observational study of patients admitted in Emergency Department taking into account the suspicion of an infection, serious enough to produce a systemic inflammatory response syndrome. Of this population, we selected the septic patient (Sepsis-3 definition) and studied the impact of comorbidities on prognosis.

Results. 125 patients were included. We found that institutionalized patient and respiratory insufficiency were the factors with the biggest impact on prognosis. Close to that, the age was a factor to be taken into account when discussing about prognosis. Other factors as malignancy, diabetes mellitus, cardiac and renal failure were not associated with ominous prognosis, although may have an impact. Two scores (MEDS and NEWS2) and a biomarker were also found to be useful when making a prognosis in such patients.

Conclusions. In this retrospective cohort, the institutionalized patient and patients with with respiratory have poor prognosis, while in other diseases, MEDS, NEWS2 and presepsin were reliable prognostic factors.

The thromboembolism of an asymptomatic carotid artery stenosis (CAS) causes stroke in 10-15% cases and in Europe, stroke causes more than 1 million deaths a year. This important cause of mortality may be evaluated by duplex ultrasound (DUS).

In five decades of experience, carotid DUS has proven to be a risk -free procedure, being widely available, easy to use, inexpensive, painless and quite reproducible.

The purpose of this article was to try to extend the usual indications of DUS assessment of carotid atherosclerosis (CA) in order to offer a tool for less experienced ultrasonographers to gather useful information for optimizing patient’s management. We tried to review the literature and to provide a simple, easy to apply algorithm for estimating the presence and severity of CA.

The purpose of our review is to bring to the clinical specialities physicians’ attention the recommendations regarding diabetes mellitus (DM) management presented in the 2019 ESC/EASD Guidelines on diabetes, pre-diabetes and cardiovascular diseases. Key aspects from the guideline regarding blood pressure, lipid and glucose modern management are presented with focus of reducing cardiovascular risk in diabetes mellitus patients. The clinician must not forget that every DM patient is a candidate for a future cardiovascular event and that multifactorial and patient-adapted therapy is the key approach in reducing this risk.

Not so much emphasize in literature and studies, obesity consequences on respiratory function may influence chronic obstructive pulmonary disease COPD and asthma, triggering important healthcare issues. Pulmonary function is a mortality predictor. The largest populational study European Community Respiratory Health Survey shows the impact of overweight and obesity on pulmonary function by decreasing forced expiratory volume in first second FEV1 and forced vital capacity FVC.

By the contrary, weight loss is decreasing both. Inflammatory and mechanical mechanisms should be considered in lung function impairment, as a consequence of obesity. Important aspect, lifestyle, will consider tobacco, physical activity, diet. Adopting a healthy lifestyle with a Mediterranean Diet MD will preserve a good pulmonary function on long term. We detailed below specific dietary recommendations, favorable nutrients or foods to be avoided.

In conclusion comprehensive lifestyle interventions should become populational based interventions for a better prevention for pulmonary diseases and NCD’s and finally for a better health status.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) is prone to thrombotic events with pathogenic mechanism that are still incompletely understood. Occurrence of antiphospholipid antibodies, especially anticardiolipin antibodies, was described in many viral infections and could be part of the chain in micro-thrombosis occurrence in COVID-19. We herein present three cases of COVID-19 patients without any known immune background. For two of the patients, the laboratory tests show neither inflammatory syndrome, nor elevated D-dimer. Even if pauci-symptomatic patients, pulmonary involvement in as much as 10 - 25% was identified on chest computer tomography exam. In addition, a third patient, with more important pulmonary involvement (25-50%), inflammatory response and elevated D-dimer levels is presented. None of the patients had prolonged activated partial-thromboplastin time. IgM and/ or IgG anticardiolipin antibodies were found positives in all three cases.