Volume 18 (2021): Issue 2 (May 2021)

Background and aim. Coronary artery disease (CAD) is one of the most important causes of death worldwide. ST-elevation myocardial infarction (STEMI) is an acute form of presentation in patients with CAD. Percutaneous coronary intervention (PCI) is the treatment of choice in STEMI patients. Generally, a stent is placed after the culprit lesion is dilated in order to ensure the patency of the coronary artery. In-stent restenosis (ISR) is a possible chronic complication in this setting. The following study is one of the few of its kind, since it investigates ISR in a cohort of Romanian patients who underwent PCI in the setting of STEMI. Our current descriptive study aims at highlighting the characteristics of these patients and identifying potential risk factors in this specific population, which could be validated by a further larger study.

Methods. We studied 68 patients from “Dr. Carol Davila” Central Military Emergency University Hospital in Bucharest, Romania, who presented with STEMI in 2016. The mean time for angiographic reevaluation was 111 days.

Results. 94% (64) of the patients underwent primary PCI, while in 6% (4) of the cases thrombolysis was initially attempted before PCI. The most prevalent risk factors that we identified were: arterial hypertension (61%), dyslipidemia (60%) and smoking or history of smoking (47%). The anterior myocardial infarction was the most prevalent (49%). Only 6% of the patients had a documented history of CAD, while on the other hand chronic occlusions were observed in most patients (85%). Of note is that only 11% of the patients reported recurrent angina before the angiographic reevaluation.

Conclusion. Common cardiovascular risk factors are also involved in ISR. Their poor management in the case of Romanian patients with STEMI increases the risk of ISR. The lack of symptoms in patients with ISR constitutes a warning sign for clinicians and shows that ISR is a complication which can be easily omitted. Therefore, its incidence is probably underestimated.

Medications prescribed for chronic diseases such as asthma, chronic obstructive pulmonary disease (COPD) or asthma-COPD overlap (ACO) syndrome should be administered in the long term and compliance becomes a health care concern. Noncompliance adversely affects the outcome of treatment and results in the consumption of human and material resources. The aim of our study was to identify the factors that cause non-compliance with treatment in children, adolescents, and adults with asthma/COPD/ACO in Romania, the methods by which these factors can be understood and corrected, and the evaluation of symptoms. To achieve the goal, regular visits were carried out with symptom control questionnaires (Asthma Control Test (ACT), COPD Assessment Test (CAT)) and FEV1 evaluation using spirometry. The results obtained indicate low long-term compliance (12.35%) due to patients’ abstinence from regular check-ups. In conclusion, we can say that the factors related to doctors have been successfully corrected, but it remains a challenge in correcting the factors related to patients and the health regime.

Introduction and objective. Blood pressure (BP) goals and glycemic targets are only reached in 40% and 50% of patients, respectively. The objective of this observational retrospective cohort study was analyzing BP control with antihypertensive therapy in patients with diabetes mellitus (DM) and arterial hypertension (HTN) in clinical practice.

Methods. 156 hospitalized hypertensive patients with type 2 DM were divided into 2 groups (G): G1 - uncomplicated and G2 - complicated DM, with micro- and macrovascular involvement, followed retrospectively for 2 years. BP control with antihypertensives was analyzed with respect to DM control, complications, hospital readmissions for cardiovascular disease and all-cause mortality.

Results. Of the 156 patients, 71 (45.6%) males, mean age 66.7 ± 9.8 years, 94 (60.3%) were included in G2. Ninety-one patients (58.3%) were rehospitalized, G2 patients having a significantly higher risk of readmission (p=0.006). BP was controlled in 57.7% patients at first, and in 59.3% patients on the last hospitalization, while DM was initially controlled in 49.3% patients, and in 54.9% on the last readmission.

The number of antihypertensive drug classes was significantly higher in G2 (3.5 vs 3.1, p=0.03). Fifteen (9.6%) patients were initially on fixed-dose combinations (FDC). All-cause mortality after 2 years was 12.2%, strongly associated with DM complications (p=0.005), with a protective effect from controlled DM (p=0.045).

Conclusion. More than forty percent of the patients had uncontrolled long term HTN with frequent re-hospitalizations and increased mortality. Better BP control could be achieved by changing therapy, notably by FDC, promoting patient adherence.

In this study are investigated the cardiovascular risk factors that as shown in literature also represent risk factors for early glomerular function alteration in type 2 diabetes mellitus patients. The patients were divided according to their glomerular filtration rate in 2 groups, one group of patients with GFR ≥90 mL/min/1.73 m (118 patients) and the other with GFR between 60-89 mL/min/1.73 m² (126 patients). Older age, hypertension, poor glycemic control, increased BMI, high LDL-cholesterol, high triglyceride level, insulin resistance and high level of apolipoprotein-B appeared to be more prevalent in patients with type 2 diabetes mellitus with mildly reduced kidney function. Even patients with mildly reduced GFR (without confirmed diabetic kidney disease) have an important aggregation of cardiovascular risk factors and their early identification is important for controlling them in order to further prevent glomerular decline.

Diabetic kidney disease (DKD) is a common and serious microvascular complication of diabetes mellitus (DM), which is characterized by an elevated urinary albumin excretion rate, elevated blood pressure, and declined renal function. Approximately 30-40% of DM patients will develop DKD, which is the leading cause of end-stage renal disease (ESRD) and renal failure. Genetic factors appear critical in DKD pathogenesis based upon the evidence including aggregation in families, variable incidence rates of DKD between different races, and the highly heritable nature of diabetic renal clinic and histologic changes.

Each 10 mmHg increase in mean systolic blood pressure (BP) was associated with a 15% increase in the hazard ratio for development of both micro- and macroalbuminuria and impaired kidney function defined as eGFR <60 ml/min per 1.73 m² or doubling of the blood creatinine level. Broadly, a baseline systolic BP >140 mmHg in patients with DM2 has been associated with higher risk of ESRD and death.

The ACE genes may predict diabetic nephropathy in some groups, the rate of progression and the antiproteinuric response to ACE inhibitors.

Introduction. Adult Onset Still Disease (AOSD) is a systemic inflammatory disease, of unknown etiology, affecting young adults. It is, at least in part, a diagnosis of exclusion. Characterized by high fever with spikes, with or without complete defervescence outside of said spikes, arthritis, and evanescent rash. Also, sore throat, hepatomegaly, splenomegaly, serositis, lymphadenopathy might be present. Fatal risk is mainly attributed to Macrophage Activation Syndrome. Biologically its main trait is a marked inflammatory syndrome with unusually elevated ferritin levels.

Case presentation. 31 year old male, known with a history of alopecia areata, treated with Diprophos, last dose one month prior to admission, with fever, odynophagia, sore throat, diffuse myalgia, debuted twelve days before.

On blood samples, at admission and during his hospital stay, marked inflammatory signs are present (elevated ESR up to 100mm/h, C-reactive protein up to 37.4mg/dl and marked ferritin of 6240 ng/ml) accompanied by leukocytosis with neutrophilia, lymphopenia, low grade normochromic, normocytic anemia, thrombocytosis, slightly elevated liver function tests, cholestasis (GGT 502 U/L, ALKP 255 U/L) with normal bilirubin, D-dimers over 3000 with lowering values to 1344, spontaneous INR at 1.57. Normal values for rheumatoid factor, no antinuclear antibodies present, negative serology for hepatitis B, C, HIV, atypical bacterial infections (Chlamydia, Coxiella, Mycoplasma) Epstein-Barr Virus, syphilis, vasculitis markers (pANCA, cANCA) and anti-double stranded DNA, all coupled with 5 different hemocultures and 3 different urocultures all negative.

Repeated ENT evaluation was within normal, chest X-Ray, echocardiography and CT scans of neck, thorax and abdomen reported back no significant abnormalities.

Thus, by applying Yamaguchi criteria, after a complex evaluation of the case, the diagnosis is AOSD, and during his stay at the Internal Medicine department of Col ea Clinical Hospital, despite antiinflammatory, antithermic, antibiotic and corticosteroid treatment, the patient remains symptomatic, with high fever (up to 38.8 degrees Celsius) with chills and diffuse myalgias. At the indication of a rheumatologist, inside a specialty clinic, pulse-therapy with Methylprednisolone is initiated (500mgs a day for 5 days) with fever remission for more than 72 hours. The corticosteroid treatment is continued at home, with the patient self-monitoring for symptoms. Two months after corticoid therapy was initiated, the patient is almost without any symptoms (alopecia areata still present partially) and the inflammatory syndrome is greatly diminished.

Conclusion. We present the case of a 31 year old male, with AOSD, defined by Yamaguchi criteria, with persistent symptomatology, mainly as high fever, without response to usual treatment, with the exception of pulse-therapy with Methylprednisolone. The diagnosis proved to be difficult, in part being one of exclusion, but also the clinical presentation, so unspecific, might easily lead to a different diagnosis.