Volume 18 (2021): Issue 3 (June 2021)

Our investigation sought to understand what the family physicians think about the oxidative stress (OS) and its role in various medical pathologies. Using a structured interview the concept was evaluated on six domains: general interest in OS, general knowledge about OS, acceptability of OS concept as a valid explanation of the daily seen pathologies, the perceived role of OS in rheumatic diseases (and also in non-rheumatic), therapeutic options covering this concept. We found a suboptimal knowledge and utilization of OS in practice but an increasing interest in.

The presence of albuminuria in patients with type 2 diabetes mellitus is a marker of endothelial dysfunction and also one of the criteria for diagnosing diabetic kidney disease. The present study aimed to identify associations between cardiovascular risk factors and renal albumin excretion in a group of 218 patients with type 2 diabetes mellitus. HbA1c values, systolic blood pressure, diastolic blood pressure were statistically significantly higher in patients with microalbuinuria or macroalbuminuria compared to patients with normoalbuminuria (p <0.01). We identified a statistically significant positive association between uric acid values and albuminuria, respectively 25- (OH)2 vitamin D3 deficiency and microalbuminuria (p <0.01).

Hypertension is one of the main risk factors for developing left ventricle failure. The study was conducted at outpatient Clinic – Medlife, Memorial Hospital. It was an observational study. We analyzed the exercise-induced secretion of NT-pro BNP in hypertensive patients with normal ejection fraction and no symptoms or signs of heart failure. Comparing the levels of NT-pro BNP before and after exercise proved to be a good mean for diagnosing left ventricular dysfunction (LVD) in hypertensive patients with left ventricular remodeling.

The aim of this study is to provide partially updated data on observational, non-interventional research that aims to determine the potential clinical and diagnostic implications of the association of bronchiectasis in patients with COPD.

Both COPD and bronchiectasis are two chronic lung diseases with a high prevalence in the general population and can coexist in a large number of cases. Their coexistence is increasingly diagnosed in clinical practice, but this association has not yet been well studied. The overlap of these two pathological entities has been established as a unique phenotype, because patients are prone to more severe and frequent exacerbations. It is therefore important to identify and study the presence of bronchiectasis in patients with COPD, as the clinical, prognostic, and therapeutic implications are different.

Materials and methods. The study was based on a cohort of 100 patients (n) with a positive diagnosis of COPD, following the establishment of the 2 study groups as follows: patients who were identified to also associate the diagnosis of bronchiectasis (x), these being the second study group, the first group including the remaining COPD patients without bronchiectasis (n-x). Therefore, the study, conducted between 2018-2020, contains 100 patients who addressed the Marius Nasta Institute of Pneumoftiziology, Bucharest, managed and followed for 12 months after inclusion, according to the developed scientific research protocol.

Patients were included in the study after an anamnesis as complete as possible and subsequent completion of the informed consent form. The ethical aspects were respected by the existence of the agreement of the Ethics Commission of the Institute of Pneumoftiziology “Marius Nasta”, Bucharest, for the study and by the presence of the informed consent of the patient (attached to each medical record / per hospitalized patient).

The comparative evaluation of the 2 groups of patients, group I (COPD) and group II (COPD and Bronchiectasis), consisted of periodic clinical-paraclinical monitoring (T0, T3, T6, T12), highlighting the negative impact of the presence of bronchiectasis in patients with COPD.

Results. The study cohort includes 100 patients: group I - 38 patients (diagnosis of COPD) and group II - 62 patients (diagnosis of COPD + BE), 20% being female patients. The mean age of the patients was 65.26 years. The occurrence of “de novo” bronchiectasis was identified in 4.84% of patients. Lung lobes involvement was identified in patients in group II, COPD + BE confirmed, while patients in group I had no bronchial damage. The number of exacerbations was higher in patients with BCOS.

The presence of infections with potentially pathogenic microorganisms and, in particular, with Pseudomonas aeruginosa, is a variable frequently associated with the presence of bronchiectasis in patients with COPD, being considered a predictor of mortality in these patients.

Discussions. BCOS syndrome is a time and resources consumer, so early diagnosis is essential to improve patients’ quality of life and increase survival.

Conclusions. COPD and Bronchiectasis are two conditions commonly encountered in current practice, with relatively similar clinical, pathophysiological and molecular consequences, and overlap syndrome has a higher risk of morbidity and mortality compared to each of the conditions taken separately. This study highlighted the negative impact of bronchiectasis in patients with COPD, clinically by increasing the number of exacerbations, affecting the quality of life, and reducing survival. Early identification of this phenotype, entitled BCOS in the literature, is necessary because therapeutic management is influenced by the particular clinical-paraclinical evidence of this new clinical syndrome.

Although the data obtained in this paperwork were in absolute agreement with the data of other existing studies in the literature, the number of patients included in the study was not high enough, and the pandemic context of the COVID-19 that broke out in Romania in March 2020 had quite obvious negative repercussions on the course of the study.

According to tradition, every year, at the Congress of the European Society of Cardiology new clinical guidelines, usefull for our daily pratice, are launched. This year a new guideline for the management of non-ST-segment elevation myocardial infarction (NSTEMI) was presented. Substantial resources had been invested to sustain the research efforts in order to improve the diagnosis and therapeutic tools for this disease.

In this article we present the main differences between this guideline and the previous one, regarding the utility of the cardiac biomarkers, diagnosis and risk stratification algorithms, and last, but not least, medical and invasive treatment tools.

“Essential” hypertension is related to multiple mechanisms that affect cardiac output and peripheral resistance and is a consequence of the interaction between external factors and genetic factors. Neuro-hormonal factors are essential in the pathophysiology of hypertension and among them the renin-angiotensin-aldosterone system (RAAS) has a main role in the physiological and pathological response of the cardiovascular system.

RAAS functions as an endocrine system, but also has paracrine and autocrine functions in many tissues and organs. RAAS regulates extracellular fluid volume and peripheral resistance via systemic and local actions in various tissues. RAAS also participates in endothelial dysfunction, inflammation and vascular fibrosis, cardiac fibrosis and cardiovascular remodelling, with worsening hypertension and target organ injury. Aldosterone is involved in “essential” hypertension via discrete variations in the regulation of aldosterone synthesis in the absence of confirmed primary hyperaldosteronism. A complete evaluation of these systems is needed for a thorough understanding of hypertension.

Colorectal cancer (CRC) is one of the most commonly diagnosed cancers worldwide and is a major cause of cancer-related mortality. While environmental and genetic factors have a major and well-known contribution in its pathogenesis, research has suggested that nutrition and lifestyle may also play a central role in the development of this neoplasm. Moreover, metabolic, hormonal and biochemical changes in the digestive tract can create a favorable ground for tumor development in the colonic epithelium.

Gallstone disease are a very common gastrointestinal disease that often remains asymptomatic, without being a major health problem. However, epidemiological studies have shown a link between the occurrence of right-sided colon cancers and the presence of gallstones which led to an increasing interest in the mechanisms that may underlie this association. Although the two pathologies share numerous risk factors (obesity, metabolic syndrome, hypercholesterolemia, diabetes, high-fat diet, sedentary lifestyle, old age), gallstones may be at the intersection of several CRC pathways. Whether it’s metabolic changes in bile acids and cholesterol, changes of the gut microbiota, or even inflammation, gallstones could independently promote the appearance of colorectal tumors.

In this review article, we aim to provide an assessment of the factors and mechanisms by which gallstones and cholecystectomy could influence the development of CRC. It is also important to consider whether the profile of the gallstone patient could be included in individualized screening programs for the early detection of CRC.

Obesity-hypoventilation syndrome (OHS) is the most severe complication of obesity, being burdened by numerous cardiovascular complications and an increase in the mortality rate. Late recognition of this syndrome is common.

Approaching the patient with suspicion or confirmed with OHS requires a multidisciplinary team. Positive pressure treatment remains the first line therapy, with the highest efficiency. Weight loss should be recommended in all patients. Apparently, bariatric surgery is superior to lifestyle changes.

Early detection and prompt treatment are of paramount importance to minimize adverse effects, which has necessitated consideration of this article.