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Romanian Journal of Internal Medicine

<abstract><title style='display:none'>Abstract</title><bold>Background and aims.</bold> The incidence of Barrett’s Esophagus (BE) is increasing worldwide, thus diagnosis is becoming a major key of interest in preventing esophageal adenocarcinoma. Because the status of BE in Romania is unclear, we performed a narrative review to comprehensively evaluate all published articles on BE from Romania.<bold>Methods.</bold> We conducted a systematic literature search of PubMed data base and of all Romanian medical journals. The abstracts and the titles of the identified studies were reviewed to exclude the studies that did not answer the search question. In addition we performed a manual search to identify articles on this topic published earlier in local journals or not indexed on internet.<bold>Results.</bold> A total of 17 articles were found. 8 studies and 9 reviews were identified, with a total of 8,829 participants enrolled. The results showed that the median age ranges between 54–59 years, with a predominance for male sex, the main risk factors, such as gastroesophageal reflux disease, obesity, smoking, hiatal hernia, are also present in Romania and infection with H. pylori has a protective effect. The diagnosis of Barrett’s esophagus in Romania is established in agreement with international guidelines.<bold>Conclusions.</bold> There are not many publications on BE in Romania. However the data in this country are similar to those reported in other countries. The management is carried out according to standard guidelines. Diagnosing BE relies on endoscopic techniques and classification systems. Risk factors such as gastroesophageal reflux, hiatal hernia, obesity and Helicobacter pylori are considered in Romanian articles. More studies are welcome on this matter in our country.</abstract>

Abstract

Iuliu Hatieganu University of Medicine and Pharmacy

Keywords

<article-title>Barrett’s Esophagus in Romania: what do we know?</article-title>

Barrett’s Esophagus in Romania: what do we know?

{"article-title":"Barrett\u2019s Esophagus in Romania: what do we know?"}

<abstract><title style='display:none'>Abstract</title>Pancreatic cancer (PC) is an exceptionally lethal malignancy with increasing incidence and mortality worldwide. One of the principal challenges in the treatment of PC is that the diagnosis is usually made at a late stage when potentially curative surgical resection is no longer an option. General clinicians including internists and family physicians are well positioned to identify high-risk individuals and refer them to centers with expertise in PC screening and treatment where screening modalities can be employed. Here, we provide an up-to-date review of PC precursor lesions, epidemiology, and risk factors to empower the general clinician to recognize high-risk patients and employ risk reduction strategies. We also review current screening guidelines and modalities and preview progress that is being made to improve screening tests and biomarkers.It is our hope that this review article will empower the general clinician to understand which patients need to be screened for PC, strategies that may be used to reduce PC risk, and which screening modalities are available in order to diminish the lethality of PC.</abstract>

<article-title>Screening for pancreatic cancer: a review for general clinicians</article-title>

Screening for pancreatic cancer: a review for general clinicians

{"article-title":"Screening for pancreatic cancer: a review for general clinicians"}

<abstract><title style='display:none'>Abstract</title>Sepsis is an overwhelming reaction to infection that comes with high morbidity and mortality, which requires urgent interventions in order to improve outcomes.<italic>Surviving Sepsis</italic> is an international campaign that aims to improve sepsis outcomes. The 2016 guideline modifies the previous definition of sepsis and proposes some specific diagnostic and therapeutic measures, such as the protocolized use of fluid resuscitation and antibiotics.We aim to summarize the main recommendations of the 2016 guideline that are relevant to the internist and evidence-base update them to the year 2020. In the current context, this review doesn’t address patients affected by SARS-COV2 induced disease.</abstract>

<article-title>Sepsis, a 2020 review for the internist</article-title>

{"article-title":"Sepsis, a 2020 review for the internist"}

<abstract><title style='display:none'>Abstract</title><bold>Background.</bold> After the inclusion of all-trans retinoic acid (ATRA) into the treatment of Acute Promyelocytic leukemia (APL), a notable improvement concerning the survival rates of patients with APL has been observed. However, the population-based studies demonstrated that there was no marked improvement in the survival of patients after the 2000s. We aim to describe the clinical response and prognosis of adult patients diagnosed with APL and examine the change in these outcomes by the time period of diagnosis.<bold>Methods.</bold> We retrospectively reviewed thirty-six unselected APL patients who were diagnosed between September 2003 and February 2016.<bold>Results.</bold> The probability of survival at two years was 58%, while disease-free survival (DFS) was 87%. The overall early death (ED) rate was 33% and remain stable over time [42% in 2003–2009 vs. 24% in 2010–2016 (p=.20)]. In addition, the 2-year overall survival (OS) rates were 47% in 2003–2009 and 70% in 2010–2016 (p=.29), and no differences were noted. Univariate analyses showed possible predictors of poor OS were defined as leukocytosis (≥10x109/L), high Sanz score, hemorrhage, infection, disseminated intravascular coagulopathy (DIC) at presentation and microgranular morphologic subtype.<bold>Conclusions.</bold> This study shows that long-term survival remains low in APL patients, particularly related to a high ED rate. Initiatives to reduce ED are exceedingly substantial for improving the survival in APL.</abstract>

<article-title>Real-life outcomes of unselected acute promyelocytic leukemia patients: a single-center 14-year experience</article-title>

Real-life outcomes of unselected acute promyelocytic leukemia patients: a single-center 14-year experience

<abstract><title style='display:none'>Abstract</title><bold>Introduction.</bold> Bladder cancer is the most common malignancy involving the urinary system. Recent research tends to emphasize the role of oxidative stress products in the carcinogenesis of bladder cancer. The level of oxidative stress can be measured by assessing the MDA levels. This study aimed to evaluate serum MDA levels in patients with bladder cancer, as well as to determine its potential role as a biomarker in the diagnosis of the disease and progression risk considerations.<bold>Methods.</bold> The study was designed as a cross-sectional study and included 90 patients, divided into three groups with 30 patients each: Ta, T1and T2–T4 group, based on histopathological findings after transurethral resection of the tumor. The control group included 30 healthy volunteers. MDA level was determined using the spectrophotometric method.<bold>Results.</bold> Serum MDA level in patients with bladder cancer [0.86 (0.78–1.05) μmol/L] was significantly higher than the serum MDA level in control group [0.70 (0.69–0.72) μmol/L] (p &lt; 0.001). Serum MDA level in Ta group [0.73 (0.70–1.05) μmol/L], T1 group [0.85 (0.80–1.12) μmol/L] and in T2–T4 group [0.91 (0.84–1.04) μmol/L] was significantly higher than the serum MDA level in control group [0.70 (0.69–0.72) μmol/L] (p &lt; 0.01). MDA level in T1 and T2–T4 group was significantly higher than the MDA level in Ta group (p &lt; 0.01). No significant difference was observed in MDA level between T1 and T2–T4 group (p = NS). A statistically significant positive correlation was found between tumor size and serum MDA level in patients with bladder cancer (rho = 0.254 p &lt; 0.01).<bold>Conclusions.</bold> The results of the present study suggest that MDA serum level might play a significant role as a biomarker in the diagnosis of bladder cancer, as well as in the monitoring of its progression.</abstract>

Department of Physiology, Faculty of Medicine

Department of Pathophysiology, Faculty of Medicine

<article-title>Serum malondialdehyde (MDA) level as a potential biomarker of cancer progression for patients with bladder cancer</article-title>

Serum malondialdehyde (MDA) level as a potential biomarker of cancer progression for patients with bladder cancer

<abstract><title style='display:none'>Abstract</title><bold>Background.</bold> We sought to evaluate the clinical impacts of the early administration of trophic doses of a glutamine/arginine enriched enteral nutrition formula (ENF) with a high protein density to cachectic hypoalbuminemic hospitalized patients intolerant to enteral nutrition.<bold>Methods.</bold> A retrospective analysis was conducted using the nutritional and non-nutritional data of patients admitted to our institution from April 2017 through August 2019. Patients who died or were discharged before completing ≥1 weeks of hospital admission, or those whose data could not be obtained were excluded. Among other variables, percent changes in serum albumin levels (%∆ALB), C – reactive protein (CRP) and their ratios were expressed as Mean ± SD using the Independent Samples T-test, while categorical variables were expressed as numbers with percentages by using χ2 test. Two tested groups were determined based on the use of ENF: Group I received trophic doses of ENF, while Group II received no enteral nutrition.<bold>Results.</bold> The overall hospital length of stay (LOS) and overall 28-day hospital mortality were significantly lower in Group I when compared with Group II with Means ± SDs of (11.32 ± 2.19 days vs 23.49 ± 4.33 days) and (13.13% vs. 28.16%), respectively. Also, significantly higher (%∆ALB) for Group I compared with group II (43.48% ± 7.89% vs. 33.45% ± 6.18%), respectively was observed.<bold>Conclusion.</bold> In malnourished hypoalbuminemic patients suffering from feeding intolerance, early trophic administration of glutamine/arginine enriched high protein density ENF was well tolerated and may be associated with increased plasma albumin levels, reduced LOS, and overall 28-day mortality, and hence may be considered in such patients.</abstract>

<article-title>The clinical impacts of early using glutamine/arginine enriched high protein density formula at trophic dose in intolerant enteral nutrition cachectic hypoalbuminemic hospitalized patients</article-title>

The clinical impacts of early using glutamine/arginine enriched high protein density formula at trophic dose in intolerant enteral nutrition cachectic hypoalbuminemic hospitalized patients

<abstract><title style='display:none'>Abstract</title><bold>Background.</bold> In December 2019, China has experienced an outbreak of novel coronavirus disease 2019 (COVID-19). Coronavirus has now spread to all of the continents. We aimed to consider clinical characteristics, laboratory data of COVID-19 that provided more information for the research of this novel virus.<bold>Methods.</bold> We performed a retrospective cohort study on the clinical symptoms and laboratory findings of a series of the 100 confirmed patients with COVID-19. These patients were admitted to the hospitals affiliated to Babol University of Medical Sciences (Ayatollah Rohani, Shahid Beheshti and Yahyanejad hospitals) form 25 February 2020 to 12 March 2020.<bold>Results.</bold> Nineteen patients died during hospitalization and 81 were discharged. Non-survivor patients had a significantly higher C-reactive protein (CRP) (MD: 46.37, 95% CI: 20.84, 71.90; P = 0.001), white blood cells (WBCs) (MD: 3.10, 95% CI: 1.53, 4.67; P &lt; 0.001) and lower lymphocyte (MD: –8.75, 95% CI: –12.62, –4.87; P &lt; 0.001) compared to survivor patients Data analysis showed that comorbid conditions (aRR: 2.99, 95% CI: 1.09, 8.21, P = 0.034), higher CRP levels (aRR: 1.02, 95% CI: 1.01, 1.03, P = 0.044), and lower lymphocyte (aRR: 0.82, 95% CI: 0.73, 0.93, P = 0.003) were associated with increased risk of death.<bold>Conclusions.</bold> Based on our findings, most non-survivors are elderly with comorbidities. Lymphopenia and increased levels of WBCs along with elevated CRP were associated with increased risk of death. Therefore, it is best to be regularly assessed these markers during treatment of COVID-19 patients.</abstract>

Department of Biostatistics and Epidemiology

Social Departments of Health Research Center

<article-title>Clinical and laboratory findings from patients with COVID-19 pneumonia in Babol North of Iran: a retrospective cohort study</article-title>

Clinical and laboratory findings from patients with COVID-19 pneumonia in Babol North of Iran: a retrospective cohort study

<abstract><title style='display:none'>Abstract</title><bold>Introduction.</bold> The prevalence of obesity is increasing worldwide in high, low, and middle-income countries such as Indonesia. Obesity rate is higher in females in Indonesia. Obesity has important contribution in the occurrence of insulin resistance (IR) and type 2 diabetes mellitus. Several anthropometric measurements such as waist circumference (WC), body mass index (BMI), body mass (BM), total body fat percentage (Fat%) and visceral fat (VF) are related to IR. This study aimed to investigate which of those measurements could be used as a better predictor of IR in non-menopausal Indonesian adult females.<bold>Methods.</bold> Total of 80 non-menopausal Indonesian adult females ranging from 21 to 40 years were recruited in this study. Insulin resistance was measured by using Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) equation. Subjects with HOMA-IR index &gt;75th percentile with cut-off 2.74 were defined as IR. Waist circumference, BMI and BM were measured, while TF and VF were measured by bioelectrical impedance analysis (BIA).<bold>Results.</bold> HOMA-IR had significant correlation with WC (r = 0.563, p &lt; 0.001), BMI (r = 0.537, p &lt; 0.001), BM (r = 0.515, p &lt; 0.001), VF (r = 0.515, p &lt; 0.001), Fat% (r = 0.490, p &lt; 0.001). The area under curve of VF (0.809), BMI (0.807), WC (0.805), and BM (0.799) are slightly larger than and Fat% (0.766).<bold>Conclusion.</bold> Insulin resistance had strong correlation with all anthropometric measurements, but the correlation was less significant with Fat%.</abstract>

Department of Clinical Pathology, Faculty of Medicine

Department of Internal Medicine, Faculty of Medicine

<article-title>Anthropometric features in predicting insulin resistance among non-menopausal Indonesian adult females</article-title>

Anthropometric features in predicting insulin resistance among non-menopausal Indonesian adult females

<abstract><title style='display:none'>Abstract</title>Cardiac abnormalities are frequently reported in acute subarachnoid hemorrhage (SAH) patients. However, frank ST-elevation and myocardial dysfunction mimicking acute coronary syndrome is a rare occurrence. Systemic and local catecholamine release mediate myocardial injury and may explain raised troponin levels, concordant regional wall motion abnormalities and systolic dysfunction. These findings can pose a significant problem in the acute setting where “time-is-muscle” paradigm can rush clinicians towards a “rule-in” diagnosis of acute myocardial infarction.We present the case of a 60-year-old male who arrived at a regional emergency department with loss of consciousness, chest pain and headache. His ECG showed ST-elevation in precordial leads with corresponding region wall motion abnormalities and dynamically elevated troponin levels which supported a diagnosis of acute myocardial infarction. Percutaneous coronary intervention was attempted but found no hemodynamically significant lesions and the patient was managed conservatively with antithrombotic treatment. Further work-up for his headache led to the diagnosis of aneurysmal SAH and subsequent endovascular coiling. The patient was discharged with a good clinical outcome. We discuss the potential catastrophic consequences of interpreting neurologic myocardial stunning as STEMI. Use of potent antithrombotic therapies, like bridging thrombolysis, in this setting can lead to dismal consequences. Clinical history should still be carefully obtained in the acute setting in this era of sensitive biomarkers.</abstract>

Department of Radiology and Medical Imaging

“Carol Davila” University of Medicine and Pharmacy

<article-title>Stress cardiomyopathy misinterpreted as ST-segment elevation myocardial infarction in a patient with aneurysmal subarachnoid hemorrhage: a case report</article-title>

Stress cardiomyopathy misinterpreted as ST-segment elevation myocardial infarction in a patient with aneurysmal subarachnoid hemorrhage: a case report

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Editor-in-Chief Gheorghe-Andrei Dan, University of Medicine and Pharmacy "Carol Davila", Colentina University Hospital, Romania †Coman Tanasescu, University of Medicine and Pharmacy "Carol Davila", Romania Deputy/ Managing Editor Cristian Baicus, University of Medicine and Pharmacy "Carol Davila", Colentina University Hospital, Romania Editorial Advisory Board Monica Acalovschi (Romania) Dimitrios Anyfantakis (Greece) Serban Balanescu (Romania) Daniela Bartos (Romania) Antonio Bayes de Luna (Spain) Miron A. Bogdan (Romania) Ion V. Bruckner (Romania) Razvan M. Chirila (USA) Maria Dorobantu (Romania) Pierre Duhaut (France) Dan L. Dumitrascu (Romania) Carmen Fierbinteanu-Braticevici (Romania) Krzysztof J. Filipiak (Poland) Zlatko Fras (Slovenia) Carmen Ginghina (Romania) Alexandru Incze (Romania) Constantin Ionescu-Targoviste (Romania) Juan Carlos Kaski (UK) Petru Manu (USA) Felipe Martinez (Argentina) Antonio Martinez-Rubio (Spain) Mona Munteanu (France) Dana Pop (Romania) Irinel Popescu (Romania) Francesco Portaluppi (Italy) Pietro Portincasa (Italy) Tania Potpara (Serbia) Vlad Ratziu (France) Adalbert Schiller (Romania) Adrian Streinu-Cercel (Romania) Radu Tanasescu (UK) Reimar W. Thomsen (Denmark) Gabriel Ungureanu (Romania) Doina Velican (Romania) Dragos Vinereanu (Romania) Marius M. Vintila (Romania) Victor Voicu (Romania) Mihai Voiculescu (Romania) Radu Voiosu (Romania) Dumitru Zdrenghea (Romania) Editorial Board Anca R. Dan, Colentina University Hospital (Romania) Paul Balanescu, University of Medicine and Pharmacy Carol Davila (Romania) Language Editors Olga Dumitru Technical Editors Iolanda Povara Contact <A href="mailto:editor@intmed.ro">editor@intmed.ro</A> Publisher De Gruyter Poland Bogumiła Zuga 32A Str. 01-811 Warsaw, Poland T: +48 22 701 50 15

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<DIV align=justify> Romanian Journal of Internal Medicine has been published since 1965, and is devoted to promoting internal medicine and its subspecialties in Romania and Eastern Europe. The journal appears quarterly and it publishes, after a peer-review process, original scientific articles, review articles, editorials, case reports and other information relevant to internal medicine and related fields, evidence-based medicine and medical education. Our intended readership includes clinicians, clinical researchers, managers, medical educators and other persons involved in providing medical care. Romanian Journal of Internal Medicine is published by "N Gh Lupu" Foundation of Internal Medicine and Romanian Academy". </DIV>

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

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