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Volume 60 (2022): Issue 4 (December 2022)

Volume 60 (2022): Issue 3 (September 2022)

Volume 60 (2022): Issue 2 (June 2022)

Volume 60 (2022): Issue 1 (March 2022)

Volume 59 (2021): Issue 4 (December 2021)

Volume 59 (2021): Issue 3 (September 2021)

Volume 59 (2021): Issue 2 (June 2021)

Volume 59 (2021): Issue 1 (March 2021)

Volume 58 (2020): Issue 4 (December 2020)

Volume 58 (2020): Issue 3 (September 2020)

Volume 58 (2020): Issue 2 (June 2020)

Volume 58 (2020): Issue 1 (March 2020)

Volume 57 (2019): Issue 4 (December 2019)

Volume 57 (2019): Issue 3 (September 2019)

Volume 57 (2019): Issue 2 (June 2019)

Volume 57 (2019): Issue 1 (March 2019)

Volume 56 (2018): Issue 4 (December 2018)

Volume 56 (2018): Issue 3 (September 2018)

Volume 56 (2018): Issue 2 (June 2018)

Volume 56 (2018): Issue 1 (March 2018)

Volume 55 (2017): Issue 4 (December 2017)

Volume 55 (2017): Issue 3 (September 2017)

Volume 55 (2017): Issue 2 (June 2017)

Volume 55 (2017): Issue 1 (March 2017)

Volume 54 (2016): Issue 4 (December 2016)

Volume 54 (2016): Issue 3 (September 2016)

Volume 54 (2016): Issue 2 (June 2016)

Volume 54 (2016): Issue 1 (March 2016)

Volume 53 (2015): Issue 4 (December 2015)

Volume 53 (2015): Issue 3 (September 2015)

Volume 53 (2015): Issue 2 (June 2015)

Volume 53 (2015): Issue 1 (March 2015)

Journal Details
Format
Journal
eISSN
2501-062X
First Published
30 Mar 2015
Publication timeframe
4 times per year
Languages
English

Search

Volume 53 (2015): Issue 2 (June 2015)

Journal Details
Format
Journal
eISSN
2501-062X
First Published
30 Mar 2015
Publication timeframe
4 times per year
Languages
English

Search

11 Articles
Open Access

Romanian Allergology in the actual European context

Published Online: 14 Oct 2015
Page range: 111 - 117

Abstract

Abstract

Allergic diseases represent an important health problem in the most of developed countries, due to continuous increasing prevalence, with significant individual and social consequences. Allergic diseases may raise serious problems in clinical practice, derived from complexity of clinical forms and mechanisms and from rising incidence of severe cases, with high fatality risk. Taking into consideration the dramatic increase of all allergies forms during the last decades, they are considered a real “epidemic” of the XXIst century, being classified by the World Health Organization as the fourth most frequent chronic diseases. The European authorities pay more attention to allergic diseases in last years and discuss the actual situation of the allergology specialty in different countries, with the aim of harmonization and improvement of medical assistance in this field. The aim of this paper is presentation of some relevant aspects of allergology specialty and practice in our country in the actual European context, mainly unmet needs and difficulties, taking into consideration recommendations and priorities recently issued by European authorities. We hope for a better recognition of the specialty and improved interdisciplinary collaboration.

Keywords

  • allergology
  • allergic diseases
  • European context
  • specialty

Cuvinte cheie:

  • alergologie
  • boli alergice
  • context european
  • specialitate
Open Access

Cytokines in inflammatory bowel disease

Published Online: 14 Oct 2015
Page range: 118 - 127

Abstract

Abstract

Inflammatory bowel diseases are chronic afflictions, characterized by active and remission periods. Inflammation is the most common type of response that the human body uses as a defense mechanism against aggressors from the environment. The frequency and degree of inflammation depends on the size of the affected tissues. The gastrointestinal tract is, by far, the most susceptible tissue to inflammatory responses, because of its constant exposure to various antigenic, mutagenic and toxic factors.

In inflammatory bowel diseases there is a loss of immune tolerance to intestinal flora that is mediated by various substances, including cytokines. Cytokines represent a key signal in the intestinal immune response. Activated dendritic cells and macrophages secrete cytokines that actively intervene in inflammation regulation, in both Crohn’s disease and ulcerative colitis. After their secretion by antigen presented cells, cytokines activate and differentiate T cells, stirring up the adaptive immune response.

Cytokines have an important role in the pathogenesis of inflammatory bowel diseases. The identification of new cytokines, as well as the changing of the pathogenesis paradigms in inflammatory bowel diseases has been done on animal tests and clinical studies. Thus, there is promising evidence basis for future therapy research based on cytokines, and anti-cytokine antibodies.

Keywords

  • inflammatory bowel disease
  • immune response
  • cytokines
Open Access

New insight into the rheumatoid vasculitis

Published Online: 14 Oct 2015
Page range: 128 - 132

Abstract

Abstract

Vasculitis in rheumatoid arthritis (rheumatoid vasculitis, RV) has a heterogeneous clinical presentation that includes skin disorders, neuropathy, eye symptoms and systemic inflammation. Rheumatoid vasculitis is an unusual complication of longstanding, severe rheumatoid arthritis (RA).

While RA affects the body’s joints, vasculitis is a condition in which blood vessels become inflamed. Rheumatoid vasculitis occurs in approximately 2 to 5% of patients who have RA. The blood vessels most often involved are arteries that bring blood to the skin, nerves, and internal organs. Veins can also be involved. Rheumatoid vasculitis is skin condition that is a typical feature of RA, presenting as peripheral vascular lesions that are localized (purpura, cutaneous ulceration, and gangrene of the distal parts of the extremities). The cause of RV is unknown, but given the prominence of immune components and the pathologic changes in involved blood vessels, an autoimmune process is suggested. Compared to other forms of vasculitis, there has been relatively little research in recent years on the specific entity of RV. There is some evidence that the incidence of RV has decreased over the past several decades, perhaps because of a better treatment of the underlying RA. In the present review, we discuss the clinical features, laboratory tests, the pathogenesis of RV.

Keywords

  • rheumatoid vasculitis
  • clinical features
  • laboratory tests
  • pathogenesis
Open Access

Role of signal-averaged electrocardiography and ventricular late potentials in patients with chronic obstructive pulmonary disease

Published Online: 14 Oct 2015
Page range: 133 - 139

Abstract

Abstract

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk for cardiac arrhythmias. Ventricular late potentials (VLP) on signal-averaged electrocardiography (SAECG) are associated with an increased risk for malignant ventricular arrhythmias. Our aim is to investigate the modifications of SAECG parameters and the presence of VLP as possible indicators of proarrhythmic substrate in patients with COPD. We prospectively enrolled 41 consecutive patients in the COPD group and 63 patients without any history of pulmonary disease, matched for age and hypertension history, in the control group. Pulmonary function tests, arterial blood gases, echocardiography, 24-hour Holter monitoring and SAECG were performed. We measured total filtered QRS duration (QRSf), duration of high frequency, low-amplitude signals < 40 V (HFLA40), and root mean square voltage in the last 40 ms (RMS40). VLP were considered if at least two of these parameters were abnormal.

Results. We did not register any significant differences in QRSf, HFLA40 or RMS40 between the two groups. In the COPD group there was a non-significant higher percentage of patients with VLP in comparison with the control group. In the COPD patients we registered a significantly higher number of isolated premature ventricular beats and of combined complex ventricular arrhythmias, consisting of polymorphic PVC, couplets, triplets or nonsustained ventricular tachycardias. None of these arrhythmic parameters correlated with SAECG variables or with the presence of VLP.

Conclusion. In COPD patients parameters measured on signal-averaged electrocardiography and ventricular late potentials analysis have little value in risk stratification for ventricular arrhythmias.

Keywords

  • COPD
  • chronic obstructive pulmonary disease
  • arrhythmias
  • late potential
  • signal-averaged electrocardiography
Open Access

Serum ghrelin level is associated with cardiovascular risk score

Published Online: 14 Oct 2015
Page range: 140 - 145

Abstract

Abstract

Ghrelin, a newly discovered bioactive peptide, was originally reported to induce growth hormone release. Recent studies have shown beneficial hemodynamic effects of ghrelin in the cardiovascular system to support the wide distribution of its receptors in cardiovascular tissues. The aim of the study was to determine whether cardiovascular risk factors influence plasma ghrelin levels.

Methods. We evaluated in the Rehabilitation Hospital Cluj-Napoca, Cardiology - Department 88 consecutive subjects, 65 (73.86%) being women, with mean age 61.7±10.33 years. We assessed the presence of cardiovascular risk factors (obesity, arterial hypertension, diabetes mellitus, metabolic syndrome, smoking and lipid fractions). Plasma ghrelin levels were determined with a commercial ELISA kit (pg/ml).

Results. After the evaluation of cardiovascular risk factors, we found no statistically significant difference between ghrelin levels in the patients with vs those without cardiovascular risk factors (p>0.05). A negative correlation was found between ghrelin levels and age, r = −0.32 (p <0.05). Using the HeartScore Internet tool we calculated the cardiovascular risk for each patient according to the risk score system (SCORE) for high cardiovascular risk countries. Statistically, the risk of fatal cardiovascular events in the next 10 years was indirectly correlated with the ghrelin levels in each patient - correlation between ghrelin levels and SCORE system r=−0.25, p=0.015. In conclusion, low serum ghrelin concentrations are associated with an increased global cardiovascular risk, calculated based on the European SCORE scale. However, we could not demonstrate a direct relationship between any of the major risk factors and ghrelin.

Keywords

  • ghrelin
  • cardiovascular risk factors
  • SCORE
Open Access

Role of Duke treadmill score in the diagnosis of ischemic heart disease in women

Published Online: 14 Oct 2015
Page range: 146 - 152

Abstract

Abstract

Ischemic heart disease is underdiagnosed in women due to atypical symptomatology as well as to the lower specificity of several paraclinical tests, such as exercise stress testing. The aim of the study was to ascertain whether the Duke treadmill score (DTS) could be an efficient parameter in the diagnosis of ischemic heart disease in women.

Material and method. 105 patients were enrolled in the study, 45.71% women with average age ranged between 20 and 70 years, investigated in the Rehabilitation Hospital, Cardiology-Departament, Cluj-Napoca, Romania. All the patients were clinically assessed as concerns the presence of cardiovascular risk factors, and they underwent electrocardiographic, echocardiographic and treadmill stress tests. DST was calculated according to the formula: exercise time – 5 x (ST deviation expressed in mm–4 x Angina Index).

Results. DTS was lower in women as compared to men: 2.54±5.36 vs. 6±4.69, p=0.0006. 54.28% of the patients were ranged with a low DTS risk category, whereas 45.71% belonged to a moderate and high risk category. DTS was significantly lower in women than in men with high blood pressure (2.03±4.8 vs. 5.8±4.28), hypercholesterolemia (1.14±4.51 vs. 6.24±4.13), diabetes mellitus (1.83 ± 3.73 vs. 6.13±4.8), and obesity (2.42±5.35 vs. 5.81±4.64). By analyzing the presence of cardiovascular risk factors only in women, we noticed that only those with high blood pressure (2.03±4.89 vs. 8.13 ±7.85) and hypercholesterolemia (2.31±4.76 vs. 3.89±5.95) had a statistically significant low DTS (p<0.05). In conclusion, our research, which showed differences in DTS between women and men, raises concerns about the early diagnosis of ischemic heart disease in women.

Keywords

  • women
  • Duke score
  • ischemic heart disease
Open Access

An insight into statin use and its association with muscular side effects in clinical practice

Published Online: 14 Oct 2015
Page range: 153 - 160

Abstract

Abstract

Background. Muscular complaints are known side-effects of statin therapy, ranging from myalgia to clinically important myositis and rhabdomyolysis. We investigated the statin use and association with the presence and characteristics of muscular complaints.

Methods. We conducted a prospective observational study in internal medicine departments. Patients with statin therapy before hospitalization were interviewed for muscular complaints. When muscular complaints were reported, information on type and severity of muscular symptoms, location and time to onset was collected.

Results. We identified 85 patients with statin treatment at hospital admission out of 521 included. Nine (10.59%) patients reported muscular complaints associated with statin therapy. A cluster of symptoms (cramps, stiffness, decreased muscle power) was reported, affecting both upper and lower limbs. The severity of pain was in most of the cases moderate or severe. All patients reported that pain was intermittent. Five reported that pain was generalized. Symptoms appeared in the first month of treatment or three months after the drug initiation. Creatine kinase was raised in one patient. In two cases drug interactions were probably responsible for muscular complaints.

Conclusion. In the studied set of patients muscular symptoms were a rather frequent effect of statin therapy. As this side-effect could be troublesome for patients and could lead to more severe outcomes, their timely detection and management is important.

Keywords

  • statins
  • myopathy
  • muscular side-effects
Open Access

Efficacy of long-term low-dose sulodexide in diabetic and non-diabetic nephropathies

Published Online: 14 Oct 2015
Page range: 161 - 169

Abstract

Abstract

Background and Aims. Sulodexide has been reported to have antiproteinuric and nephroprotective properties. We investigated the effects of long-term low-dose Sulodexide on proteinuria and renal function in patients with chronic kidney disease (CKD) caused by diabetic nephropathy (DN), hypertensive nephropathy (HN) and primary glomerulonephritis (GN).

Material and Methods. 100 patients with CKD received low-dose Sulodexide 50 mg/day for 12 months. Treatment efficacy was evaluated as proteinuria reduction compared to baseline; response was defined as a decline in proteinuria below 0.3 g/d. Renal function evolution was assessed by eGFR variation from baseline.

Results. All patients presented reduction of proteinuria, with global mean value of proteinuria decrease of 0.85 ± 1.34 g/d (p<0.0001). Patients with HN had the highest mean percentage of proteinuria reduction (73±29%) and the lowest mean time period to achieve responder status (6.6±2.4 months), compared to patients with DN (57±29%, 8±2.9 months) and GN (63±24%, 10.7±1.2 months). Renal function as mean eGFR remained stable or improved during the study; significant increase was found only in HN group (3.41 ± 6.38 ml/min/1.73m2, p=0.043). Multivariate regression analysis identified that responder status was significantly associated with gender, baseline eGFR, baseline proteinuria and etiology of CKD. Concomitant administration of ACEIs or/and ARBs did not influence the response to Sulodexide therapy.

Conclusions. Independently of ACEIs or/and ARBs therapy, long-term low-dose Sulodexide is efficient as antiproteinuric and renoprotective therapy in patients with CKD caused by DN, GN and HN. Better response is achieved in patients with lower degree of renal dysfunction.

Keywords

  • sulodexide
  • nephropathy
  • proteinuria
  • renal function
  • CKD progression
Open Access

Single-centre epidemiological study on the incidence of hepatic hydatid cyst

Published Online: 14 Oct 2015
Page range: 170 - 173

Abstract

Abstract

Echinococcosis is a parasitic disease caused by Echinococcus granulosus tapeworm through its larva infestation. Hydatid cyst has become a health problem interesting by the demographic changes in recent years. If until recently it was a disease of the pastors or breeders and animal lovers in rural areas, the increase in number of the stray animals in the streets of big cities has moved the curve incidence and prevalence of this disease onto the city. Worldwide pathology is prevalent in the Mediterranean, South America and Turkey. The present study examines patients admitted with the diagnosis of hydatid cyst in the surgery department of Colentina Clinical Hospital, Bucharest, across a period of six years. The results demonstrate that the incidence is higher among women (58%) than in men (41.3%). Also, statistical data processing shows that the prevalence/incidence is higher in urban areas compared to rural areas. We want the results of this research to lead to hypotheses that can be demonstrated by analytical studies, because, without fundamental knowledge provided by descriptive studies, it is almost impossible to ask about the aetiology and effects of treatments that can be used in the management of hydatid cyst.

Keywords

  • incidence
  • Romania
Open Access

Pulmonary veno-occlusive disease: a rare cause of pulmonary hypertension in systemic sclerosis. Case presentation and review of the literature

Published Online: 14 Oct 2015
Page range: 175 - 183

Abstract

Abstract

Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary arterial hypertension (PAH). Because of the similar clinical picture of dyspnea on exertion and signs of right heart failure, PVOD is difficult to distinguish from idiopathic PAH. However, the distinction is mandatory because PVOD has a worse prognosis and, more importantly, the administration of PAH specific therapy (vasodilators) can precipitate severe acute pulmonary oedema. We present a challenging case of PAH in a patient with systemic sclerosis in whom a marked decrease in functional capacity after the initiation of bosentan therapy led to the diagnosis of PVOD. Management of PVOD patients is challenging and referral for lung transplantation should be done at the moment of diagnosis.

Keywords

  • Pulmonary arterial hypertension
  • pulmonary venoocclusive disease
  • Systemic sclerosis
Open Access

Acute Lymphoblastic Leukemia after previously treated, relapsed Chronic Lymphocytic Leukemia: A Case Report

Published Online: 14 Oct 2015
Page range: 184 - 188

Abstract

Abstract

We present the case of a 71-year-old woman diagnosed with chronic lymphocytic leukemia who received multiple chemotherapeutic lines and evolved to acute lymphoblastic leukemia. The patient was Rai stage 0 at the time of the diagnosis and was monitored for almost 9 years. After that, the disease progressed and the patient began chemotherapy (fludarabine/cyclophosphamide combination), obtained complete remission and relapsed one year later after finishing treatment. She received multiple therapeutic regimens, accompanied by multiple infectious complications. After 8 years of evolution since she started chemotherapy, bone marrow aspirate and immunophenotyping revealed acute lymphoblastic leukemia. The occurrence of acute leukemia in CLL is rare and may arise from the same clone; however, most cases appear after patients have received chemotherapy, suggesting that they are therapy-related.

Keywords

  • chronic lymphocytic leukemia
  • acute lymphoblastic leukemia
  • second malignancy
  • Richter transformation
11 Articles
Open Access

Romanian Allergology in the actual European context

Published Online: 14 Oct 2015
Page range: 111 - 117

Abstract

Abstract

Allergic diseases represent an important health problem in the most of developed countries, due to continuous increasing prevalence, with significant individual and social consequences. Allergic diseases may raise serious problems in clinical practice, derived from complexity of clinical forms and mechanisms and from rising incidence of severe cases, with high fatality risk. Taking into consideration the dramatic increase of all allergies forms during the last decades, they are considered a real “epidemic” of the XXIst century, being classified by the World Health Organization as the fourth most frequent chronic diseases. The European authorities pay more attention to allergic diseases in last years and discuss the actual situation of the allergology specialty in different countries, with the aim of harmonization and improvement of medical assistance in this field. The aim of this paper is presentation of some relevant aspects of allergology specialty and practice in our country in the actual European context, mainly unmet needs and difficulties, taking into consideration recommendations and priorities recently issued by European authorities. We hope for a better recognition of the specialty and improved interdisciplinary collaboration.

Keywords

  • allergology
  • allergic diseases
  • European context
  • specialty

Cuvinte cheie:

  • alergologie
  • boli alergice
  • context european
  • specialitate
Open Access

Cytokines in inflammatory bowel disease

Published Online: 14 Oct 2015
Page range: 118 - 127

Abstract

Abstract

Inflammatory bowel diseases are chronic afflictions, characterized by active and remission periods. Inflammation is the most common type of response that the human body uses as a defense mechanism against aggressors from the environment. The frequency and degree of inflammation depends on the size of the affected tissues. The gastrointestinal tract is, by far, the most susceptible tissue to inflammatory responses, because of its constant exposure to various antigenic, mutagenic and toxic factors.

In inflammatory bowel diseases there is a loss of immune tolerance to intestinal flora that is mediated by various substances, including cytokines. Cytokines represent a key signal in the intestinal immune response. Activated dendritic cells and macrophages secrete cytokines that actively intervene in inflammation regulation, in both Crohn’s disease and ulcerative colitis. After their secretion by antigen presented cells, cytokines activate and differentiate T cells, stirring up the adaptive immune response.

Cytokines have an important role in the pathogenesis of inflammatory bowel diseases. The identification of new cytokines, as well as the changing of the pathogenesis paradigms in inflammatory bowel diseases has been done on animal tests and clinical studies. Thus, there is promising evidence basis for future therapy research based on cytokines, and anti-cytokine antibodies.

Keywords

  • inflammatory bowel disease
  • immune response
  • cytokines
Open Access

New insight into the rheumatoid vasculitis

Published Online: 14 Oct 2015
Page range: 128 - 132

Abstract

Abstract

Vasculitis in rheumatoid arthritis (rheumatoid vasculitis, RV) has a heterogeneous clinical presentation that includes skin disorders, neuropathy, eye symptoms and systemic inflammation. Rheumatoid vasculitis is an unusual complication of longstanding, severe rheumatoid arthritis (RA).

While RA affects the body’s joints, vasculitis is a condition in which blood vessels become inflamed. Rheumatoid vasculitis occurs in approximately 2 to 5% of patients who have RA. The blood vessels most often involved are arteries that bring blood to the skin, nerves, and internal organs. Veins can also be involved. Rheumatoid vasculitis is skin condition that is a typical feature of RA, presenting as peripheral vascular lesions that are localized (purpura, cutaneous ulceration, and gangrene of the distal parts of the extremities). The cause of RV is unknown, but given the prominence of immune components and the pathologic changes in involved blood vessels, an autoimmune process is suggested. Compared to other forms of vasculitis, there has been relatively little research in recent years on the specific entity of RV. There is some evidence that the incidence of RV has decreased over the past several decades, perhaps because of a better treatment of the underlying RA. In the present review, we discuss the clinical features, laboratory tests, the pathogenesis of RV.

Keywords

  • rheumatoid vasculitis
  • clinical features
  • laboratory tests
  • pathogenesis
Open Access

Role of signal-averaged electrocardiography and ventricular late potentials in patients with chronic obstructive pulmonary disease

Published Online: 14 Oct 2015
Page range: 133 - 139

Abstract

Abstract

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk for cardiac arrhythmias. Ventricular late potentials (VLP) on signal-averaged electrocardiography (SAECG) are associated with an increased risk for malignant ventricular arrhythmias. Our aim is to investigate the modifications of SAECG parameters and the presence of VLP as possible indicators of proarrhythmic substrate in patients with COPD. We prospectively enrolled 41 consecutive patients in the COPD group and 63 patients without any history of pulmonary disease, matched for age and hypertension history, in the control group. Pulmonary function tests, arterial blood gases, echocardiography, 24-hour Holter monitoring and SAECG were performed. We measured total filtered QRS duration (QRSf), duration of high frequency, low-amplitude signals < 40 V (HFLA40), and root mean square voltage in the last 40 ms (RMS40). VLP were considered if at least two of these parameters were abnormal.

Results. We did not register any significant differences in QRSf, HFLA40 or RMS40 between the two groups. In the COPD group there was a non-significant higher percentage of patients with VLP in comparison with the control group. In the COPD patients we registered a significantly higher number of isolated premature ventricular beats and of combined complex ventricular arrhythmias, consisting of polymorphic PVC, couplets, triplets or nonsustained ventricular tachycardias. None of these arrhythmic parameters correlated with SAECG variables or with the presence of VLP.

Conclusion. In COPD patients parameters measured on signal-averaged electrocardiography and ventricular late potentials analysis have little value in risk stratification for ventricular arrhythmias.

Keywords

  • COPD
  • chronic obstructive pulmonary disease
  • arrhythmias
  • late potential
  • signal-averaged electrocardiography
Open Access

Serum ghrelin level is associated with cardiovascular risk score

Published Online: 14 Oct 2015
Page range: 140 - 145

Abstract

Abstract

Ghrelin, a newly discovered bioactive peptide, was originally reported to induce growth hormone release. Recent studies have shown beneficial hemodynamic effects of ghrelin in the cardiovascular system to support the wide distribution of its receptors in cardiovascular tissues. The aim of the study was to determine whether cardiovascular risk factors influence plasma ghrelin levels.

Methods. We evaluated in the Rehabilitation Hospital Cluj-Napoca, Cardiology - Department 88 consecutive subjects, 65 (73.86%) being women, with mean age 61.7±10.33 years. We assessed the presence of cardiovascular risk factors (obesity, arterial hypertension, diabetes mellitus, metabolic syndrome, smoking and lipid fractions). Plasma ghrelin levels were determined with a commercial ELISA kit (pg/ml).

Results. After the evaluation of cardiovascular risk factors, we found no statistically significant difference between ghrelin levels in the patients with vs those without cardiovascular risk factors (p>0.05). A negative correlation was found between ghrelin levels and age, r = −0.32 (p <0.05). Using the HeartScore Internet tool we calculated the cardiovascular risk for each patient according to the risk score system (SCORE) for high cardiovascular risk countries. Statistically, the risk of fatal cardiovascular events in the next 10 years was indirectly correlated with the ghrelin levels in each patient - correlation between ghrelin levels and SCORE system r=−0.25, p=0.015. In conclusion, low serum ghrelin concentrations are associated with an increased global cardiovascular risk, calculated based on the European SCORE scale. However, we could not demonstrate a direct relationship between any of the major risk factors and ghrelin.

Keywords

  • ghrelin
  • cardiovascular risk factors
  • SCORE
Open Access

Role of Duke treadmill score in the diagnosis of ischemic heart disease in women

Published Online: 14 Oct 2015
Page range: 146 - 152

Abstract

Abstract

Ischemic heart disease is underdiagnosed in women due to atypical symptomatology as well as to the lower specificity of several paraclinical tests, such as exercise stress testing. The aim of the study was to ascertain whether the Duke treadmill score (DTS) could be an efficient parameter in the diagnosis of ischemic heart disease in women.

Material and method. 105 patients were enrolled in the study, 45.71% women with average age ranged between 20 and 70 years, investigated in the Rehabilitation Hospital, Cardiology-Departament, Cluj-Napoca, Romania. All the patients were clinically assessed as concerns the presence of cardiovascular risk factors, and they underwent electrocardiographic, echocardiographic and treadmill stress tests. DST was calculated according to the formula: exercise time – 5 x (ST deviation expressed in mm–4 x Angina Index).

Results. DTS was lower in women as compared to men: 2.54±5.36 vs. 6±4.69, p=0.0006. 54.28% of the patients were ranged with a low DTS risk category, whereas 45.71% belonged to a moderate and high risk category. DTS was significantly lower in women than in men with high blood pressure (2.03±4.8 vs. 5.8±4.28), hypercholesterolemia (1.14±4.51 vs. 6.24±4.13), diabetes mellitus (1.83 ± 3.73 vs. 6.13±4.8), and obesity (2.42±5.35 vs. 5.81±4.64). By analyzing the presence of cardiovascular risk factors only in women, we noticed that only those with high blood pressure (2.03±4.89 vs. 8.13 ±7.85) and hypercholesterolemia (2.31±4.76 vs. 3.89±5.95) had a statistically significant low DTS (p<0.05). In conclusion, our research, which showed differences in DTS between women and men, raises concerns about the early diagnosis of ischemic heart disease in women.

Keywords

  • women
  • Duke score
  • ischemic heart disease
Open Access

An insight into statin use and its association with muscular side effects in clinical practice

Published Online: 14 Oct 2015
Page range: 153 - 160

Abstract

Abstract

Background. Muscular complaints are known side-effects of statin therapy, ranging from myalgia to clinically important myositis and rhabdomyolysis. We investigated the statin use and association with the presence and characteristics of muscular complaints.

Methods. We conducted a prospective observational study in internal medicine departments. Patients with statin therapy before hospitalization were interviewed for muscular complaints. When muscular complaints were reported, information on type and severity of muscular symptoms, location and time to onset was collected.

Results. We identified 85 patients with statin treatment at hospital admission out of 521 included. Nine (10.59%) patients reported muscular complaints associated with statin therapy. A cluster of symptoms (cramps, stiffness, decreased muscle power) was reported, affecting both upper and lower limbs. The severity of pain was in most of the cases moderate or severe. All patients reported that pain was intermittent. Five reported that pain was generalized. Symptoms appeared in the first month of treatment or three months after the drug initiation. Creatine kinase was raised in one patient. In two cases drug interactions were probably responsible for muscular complaints.

Conclusion. In the studied set of patients muscular symptoms were a rather frequent effect of statin therapy. As this side-effect could be troublesome for patients and could lead to more severe outcomes, their timely detection and management is important.

Keywords

  • statins
  • myopathy
  • muscular side-effects
Open Access

Efficacy of long-term low-dose sulodexide in diabetic and non-diabetic nephropathies

Published Online: 14 Oct 2015
Page range: 161 - 169

Abstract

Abstract

Background and Aims. Sulodexide has been reported to have antiproteinuric and nephroprotective properties. We investigated the effects of long-term low-dose Sulodexide on proteinuria and renal function in patients with chronic kidney disease (CKD) caused by diabetic nephropathy (DN), hypertensive nephropathy (HN) and primary glomerulonephritis (GN).

Material and Methods. 100 patients with CKD received low-dose Sulodexide 50 mg/day for 12 months. Treatment efficacy was evaluated as proteinuria reduction compared to baseline; response was defined as a decline in proteinuria below 0.3 g/d. Renal function evolution was assessed by eGFR variation from baseline.

Results. All patients presented reduction of proteinuria, with global mean value of proteinuria decrease of 0.85 ± 1.34 g/d (p<0.0001). Patients with HN had the highest mean percentage of proteinuria reduction (73±29%) and the lowest mean time period to achieve responder status (6.6±2.4 months), compared to patients with DN (57±29%, 8±2.9 months) and GN (63±24%, 10.7±1.2 months). Renal function as mean eGFR remained stable or improved during the study; significant increase was found only in HN group (3.41 ± 6.38 ml/min/1.73m2, p=0.043). Multivariate regression analysis identified that responder status was significantly associated with gender, baseline eGFR, baseline proteinuria and etiology of CKD. Concomitant administration of ACEIs or/and ARBs did not influence the response to Sulodexide therapy.

Conclusions. Independently of ACEIs or/and ARBs therapy, long-term low-dose Sulodexide is efficient as antiproteinuric and renoprotective therapy in patients with CKD caused by DN, GN and HN. Better response is achieved in patients with lower degree of renal dysfunction.

Keywords

  • sulodexide
  • nephropathy
  • proteinuria
  • renal function
  • CKD progression
Open Access

Single-centre epidemiological study on the incidence of hepatic hydatid cyst

Published Online: 14 Oct 2015
Page range: 170 - 173

Abstract

Abstract

Echinococcosis is a parasitic disease caused by Echinococcus granulosus tapeworm through its larva infestation. Hydatid cyst has become a health problem interesting by the demographic changes in recent years. If until recently it was a disease of the pastors or breeders and animal lovers in rural areas, the increase in number of the stray animals in the streets of big cities has moved the curve incidence and prevalence of this disease onto the city. Worldwide pathology is prevalent in the Mediterranean, South America and Turkey. The present study examines patients admitted with the diagnosis of hydatid cyst in the surgery department of Colentina Clinical Hospital, Bucharest, across a period of six years. The results demonstrate that the incidence is higher among women (58%) than in men (41.3%). Also, statistical data processing shows that the prevalence/incidence is higher in urban areas compared to rural areas. We want the results of this research to lead to hypotheses that can be demonstrated by analytical studies, because, without fundamental knowledge provided by descriptive studies, it is almost impossible to ask about the aetiology and effects of treatments that can be used in the management of hydatid cyst.

Keywords

  • incidence
  • Romania
Open Access

Pulmonary veno-occlusive disease: a rare cause of pulmonary hypertension in systemic sclerosis. Case presentation and review of the literature

Published Online: 14 Oct 2015
Page range: 175 - 183

Abstract

Abstract

Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary arterial hypertension (PAH). Because of the similar clinical picture of dyspnea on exertion and signs of right heart failure, PVOD is difficult to distinguish from idiopathic PAH. However, the distinction is mandatory because PVOD has a worse prognosis and, more importantly, the administration of PAH specific therapy (vasodilators) can precipitate severe acute pulmonary oedema. We present a challenging case of PAH in a patient with systemic sclerosis in whom a marked decrease in functional capacity after the initiation of bosentan therapy led to the diagnosis of PVOD. Management of PVOD patients is challenging and referral for lung transplantation should be done at the moment of diagnosis.

Keywords

  • Pulmonary arterial hypertension
  • pulmonary venoocclusive disease
  • Systemic sclerosis
Open Access

Acute Lymphoblastic Leukemia after previously treated, relapsed Chronic Lymphocytic Leukemia: A Case Report

Published Online: 14 Oct 2015
Page range: 184 - 188

Abstract

Abstract

We present the case of a 71-year-old woman diagnosed with chronic lymphocytic leukemia who received multiple chemotherapeutic lines and evolved to acute lymphoblastic leukemia. The patient was Rai stage 0 at the time of the diagnosis and was monitored for almost 9 years. After that, the disease progressed and the patient began chemotherapy (fludarabine/cyclophosphamide combination), obtained complete remission and relapsed one year later after finishing treatment. She received multiple therapeutic regimens, accompanied by multiple infectious complications. After 8 years of evolution since she started chemotherapy, bone marrow aspirate and immunophenotyping revealed acute lymphoblastic leukemia. The occurrence of acute leukemia in CLL is rare and may arise from the same clone; however, most cases appear after patients have received chemotherapy, suggesting that they are therapy-related.

Keywords

  • chronic lymphocytic leukemia
  • acute lymphoblastic leukemia
  • second malignancy
  • Richter transformation

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