Volume 19 (2022): Issue 1 (January 2022)

Introduction. Post-cholecystectomy cholangitis represents a controversial issue within the medical literature due to the polymorphism of the generating causes and due to the difficulties connected to its diagnosis and therapy.

Material and methods. The assessment of the study was performed on two batches of patients, namely 221 patients hospitalized at Surgery Departments and another batch of 109 patients hospitalized at the Gastroenterology Department all having post-cholecystectomy cholangitis as their main diagnosis. The assessment criteria were suggestive laboratory and imagery investigations and therapeutic management.

Results. If we compare the laboratory profile of both batches, we can see that only the non-specific inflammatory syndrome has shown significant differences statistically (way more frequent in case of patients hospitalized at the Gastroenterology Department), while the biliary-excretion, the cholestatic and hepatic cytolysis syndromes had approximately the same prevalence. In both batches, the treatment methods used were mainly pharmacology methods, and in a small number of cases retrograde endoscopic cholangiopancreatography. There were also a few cases where invasive surgery was applied.

Conclusion. An increased clinical suspicion, an early recognition based on laboratory and imagery investigations, a prompt therapy initiation, and a balanced and correct anti-microbial management, endoscopic and surgical, need the implication of complex teams of clinicians.

Anxiety is a comorbidity among patients with chronic respiratory diseases such as asthma, COPD and COPD-asthma. Anxiety disorders in this population have a considerable influence on asthma management, because they influence the perception of symptoms, and anxiety related to treatment can influence compliance. Patient noncompliance with treatment for chronic respiratory diseases compromises the success of treatment and the patient’s quality of life, while increasing medical costs. Therefore, the aim of our study was to provide patient-centered care and determine which dimension of anxiety is associated with asthma, COPD and COPD-asthma in the general population after controlling age, background and sex. In order to obtain information on the response to treatment, questionnaires on symptom control (Asthma Control Test (ACT), COPD Assessment Test (CAT)) and asses anxiety using the ASQ questionnaire. The result obtained indicates that no compliant person presented a high score of the dimensions (somatic, behavioral and cognitive dimension.) and predominates of anxiety a low overall score. The symptoms associated with anxiety have a low, medium overall score but also a high score on the first visit. The first and second age categories have a low score in both the behavioral and somatic dimensions. In the age category 3 and 4 are people with low score and medium score behavioral dimension and cognitive dimension. In conclusion we can say that through repetitive control we obtained increased treatment compliance was achieved, leading to improved lung function, symptoms control and therefore reduced anxiety in the case of patients with asthma, COPD and COPD-asthma.

The examination of the patient with a recent episode of C19 and residual cardiorespiratory symptoms requires a complete two-line assessment of previously undiagnosed chronic pathology. As conventional investigations were insufficient in clarifying the remaining symptomatology, it was necessary to broaden the range of investigations and to take a different approach to this category of patients.

Depending on the symptoms and the patient’s general condition at the beginning of the examination, the attending physician should not disregard the period of restrictions involving significant limitations regarding exercise imposed during the pandemic. Physical exertion minimization and isolation at home have led to a series of functional disorders throughout the body, particularly cardio-respiratory, musculo-articular and neuro-psychiatric disorders.

The effects of a sedentary lifestyle or the lack of physical exertion are not limited to elderly individuals, nor to a single system or apparatus, but have undesirable consequences for the whole body. In this context, the pulmonologist was obliged to answer the question “does the patient have a previously undiagnosed chronic respiratory disease before COVID19 or is the patient physically deconditioned?”. This is how the cardio-respiratory exercise test - the stair-climbing exercise test - came into play in assessing this category of patients. As the medical rehabilitation units could not cope with all the patients, it was necessary to create a home-based rehabilitation programme that was cheap, fast, and allowing telephone monitoring and quantifiable results.

Hepatitis C virus infection has been for several decades the major cause of cirrhosis and its complications worldwide. However, an arsenal of new and highly effective oral direct-acting antiviral drugs has changed the course of HCV treatment. The effects of HCV elimination are broad and include an overall reduction in mortality in patients with advanced fibrosis, a reduction of the risk of HCC in patients with advanced fibrosis and a reduction in extrahepatic manifestations including HCV-related non-Hodgkin’s lymphoma, other lymphoproliferative disorders and cryoglobulinemic vasculitis. Fibrosis regression is associated with a broad clinical benefit and remains an important therapeutic target in HCV patients who have obtained RSV.

Non-alcoholic fatty liver disease (NAFLD) constitutes a common pathological condition of the liver, the prevalence of which is currently increasing in western countries. NAFLD is frequently diagnosed in males and its incidence is higher in individuals with type 2 diabetes mellitus and obesity. Hence, the disease is considered to be the hepatic manifestation of the metabolic syndrome. A multitude of interconnected risk factors have been described over the years – genetic, hormonal and nutritional, which play important roles in the development of NAFLD. Insulin resistance is considered to be the central pathophysiological condition that promotes the disease in diabetic patients, whereas dyslipidemia and cardiovascular comorbidities (arterial hypertension, ischaemic heart disease) are frequently associated conditions. Although there are currently numerous pathophysiological mechanisms involved in NAFLD that are still unknown or poorly understood, there has been some advancements concerning the pathogenesis of the disease and its progression towards its severe form, known as non-alcoholic steatohepatitis (NASH). In the absence of a clear diagnosis and carefully controlled treatment, NAFLD/NASH may evolve towards liver cirrhosis, liver failure or hepatocellular carcinoma. However, the disease may also generate systemic effects, including the development of chronic kidney disease (CKD). The diagnosis of NAFLD/NASH is based both on its clinical manifestations, revealed by a carefully conducted patient history and physical examination of the patient, and on other investigations; histopathological findings upon liver biopsy, liver ultrasonography and the use of transient elastography (or FibroScan) are some of the most important investigations in NAFLD/NASH. The understanding of the most important risk factors and pathogenic mechanisms of the disease is fundamental for the elaboration of the most efficient treatment, to prevent chronic liver disease or the development of hepatocellular carcinoma.

Obesity is a globally expanding disorder and is the result of the interaction of genetic and environmental factors with the participation of social, behavioural, cultural, physiological, metabolic, and genetic influences. Obesity has profoundly negative effects on the health of the population and induces associated comorbidities such as hypertension, hyperlipidaemia, hyperinsulinemia / insulin resistance. There is ample evidence that obesity causes hypertension, cardiovascular disease, type 2 diabetes, cancer and chronic kidney disease, and the association of obesity with hypertension and other cardiovascular risk factors significantly increases the risk of cardiovascular events.

The neutrophil to lymphocyte ratio (N/L) is an indicator of systemic inflammation and a prognostic marker in patients with several cardiovascular diseases (CVDs). Exercise capacity (EC) plays an important role in predicting morbidity and mortality especially in patients with coronary artery disease and heart failure. Studies have been conducted to evaluate the correlation between N/L ratio and EC in CVDs. We searched the PubMed (MEDLINE) database using the keywords “neutrophil”, “lymphocyte”, “neutrophil to lymphocyte ratio”, “cardiovascular disease”, “exercise capacity” and derivatives. Considering the dispersion of these studies as well as reports on prognostic value of N/L ratio in CVDs, we have summarized these findings as a review article. A significant association between higher N/L ratio and low EC was identified, both of which has predictive and prognostic value especially for patients with heart failure.

In a world plagued by the same multifaceted Covid 19, pros-cons discussions about vaccines, their effectiveness, side effects, fears, and their inclusion in therapeutic strategies have taken on innumerable colors. In this article we will look at the impact of vaccines from the booster regimens to the effects of the booster, all this being seen through the light of the latest research conducted this year.

Patients with inflammatory bowel disease (with or without immunosuppressive treatment) have a fragile immune status that predisposes to opportunistic infections. Cytomegalovirus (CMV) is an opportunistic pathogen that determines a large variety of clinical syndromes especially in immunocompromised patients. In inflammatory bowel disease (IBD) patients, his role has long been debated and it is thought that it can complicate the course of the disease. The most frequent clinical manifestation in inflammatory bowel disease patients is represented by CMV colitis, however other clinical manifestations can be met and must also be considered.

We present the case of a young male patient with ulcerative colitis that came to our attention for prolonged febrile syndrome and IBD flare, that was finally confirmed to have CMV disease.

Background. Primary Sjogren’s syndrome (pSS) is a chronic progressive autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands, which affects the salivary and lacrimal glands, presenting dryness of the mouth and eyes. Renal involvement is easily ignored by the physicians because the clinical symptoms are often insidious. The most common renal disease in pSS is tubulointerstitial nephritis, responsible for renal tubular acidosis in 20%.

Case report. A 36-year-old woman with polyuria and polydipsia for 10 years ago was admitted to the hospital because asymptomatic hypokalemia, kidney stones, and rashes. This woman presented nephrogenic diabetes insipidus and chronic metabolic acidosis for one year, conditions treated with amiloride and sodium bicarbonate. Anti-Sjögren’s antibody A and B were checked and were both found to be positive. At presentation, she had elevated serum osmolality of 301, with a very low urine osmolality of 61, and serum sodium of 143. A metabolic acidosis with hypokalemia and elevated urine pH are consistent with distal renal tubular acidosis (RTA). A kidney biopsy was obtained, which revealed tubular interstitial fibrosis with infiltration of lymphocytes and plasmacytes who extended into intact cortical parenchyma and was consistent with active chronic interstitial nephritis.

Conclusions. Our presenting patient presented renal manifestations of pSS, including diabetes insipidus, renal tubular acidosis type I, tubulointerstitial nephritis, and nephrolithiasis. None of these findings are common presentations of pSS. The presence of all of these symptoms in one individual makes this patient an atypical way to diagnose a primary Sjogren’s syndrome.