<abstract><title style='display:none'>Abstract</title>Primary biliary cirrhosis is an autoimmune liver disease, characterized by the progressive destruction of the small intrahepatic bile duct epithelial cells and the presence of antimithocondrial antibodies (AMA). Ankylosing spondilitis is a systemic, inflammatory, progressive disease, which usually affects the joints of the spine and the sacroiliac joints. The association of these two is very rare, in literature we found only one single study published in 1994, which describes the occurrence of primary biliary cirrhosis accompanying ankylosing spondylitis in amale patient. The aim of our study is to present the case of our patient, who had ankylosing spondylitis and has developed primary biliary cirrhosis. Our patient has ankylosing spondylitis with peripheral joint involvement, so according to the guidelines we initiated treatment with Sulfasalazine. We know from the literature about the hepatotoxicity of Sulfasalazine in some cases, so within each follow-up examination we monitored the liver function tests, and we also performed complete blood counts. The treatment of ankylosing spondylitis is challenging in this case due to the hepatotoxicity of the medications. Besides Sulfasalazine, our patient continued the treatment for primary biliary cirrhosis (ursodeoxycholic acid with hepatoprotective drugs in higher doses).</abstract>

Primary Biliary Cirrhosis and Ankylosing Spondylitis, A Rare Association

<abstract><title style='display:none'>Abstract</title>GAVE syndrome (gastric antral vascular ectasia) is a rare cause of gastrointestinal bleeding. It affects mainly the elderly. The syndrome was named “watermelon stomach” because of its typical endoscopic appearance of “watermelon stripes” observed at the gastric antral level. We present the case of an 80-year-old female patient, under iron substitution therapy for an iron deficiency anemia previously diagnosed. The woman was admitted to our hospital for non-specific symptoms, severe asthenia and postural instability. The clinical examination noted pallor of skin and sclera, without hematemesis or melena. Paraclinical tests revealed severe hypochromic microcytic anemia and hyposideremia, with a positive fecal occult blood test. Because the patient was refractory to the iron therapy, presenting with severe anemia, which required blood transfusions, we suspected a diagnosis of acute hemorrhagic gastritis. In order to reveal the source of the hemorrhage, an upper gastrointestinal endoscopy was performed, which described the typical appearance of prominent, tortuous, erythematous streaks traversing the antrum and converging toward the pylorus, creating the “watermelon stripes” pattern, with lesions that bleed easily during the biopsy process. In a different endoscopic session, the argon plasma coagulation treatment was applied, resulting in clinical and biological improvement.Gastric antral vascular ectasia is a rare medical condition, insufficiently recognized and poorly understood, which can be treated efficiently by endoscopic means, if it is early diagnosed. Although this condition tends to be underdiagnosed at the present time, doctors may exceed their limits by acquiring a high grade of clinical suspicion.</abstract>

Gave Syndrome – A Rare and Mysterious Cause of Gastrointestinal Hemorrhage in the Elderly

<abstract>
<title style='display:none'>Abstract</title>
Treatment of supraventricular tachycardia with narrow QRS complexes (SVT) includes different therapeutic strategies such as: cardioversion, drug therapy or vagal maneuvers, depending on the patient’s condition, especially if they are hemodynamically stable or unstable. Vagal maneuvers are used to treat SVT during the acute presentation, if the patient is stable. They are recommended by the 2019 European Society of Cardiology guidelines for management of SVT with narrow QRS complexes. These include the Valsalva maneuver (enhanced or not) and carotid sinus massage. They have multiple advantages: they do not require medical equipment, can be performed anywhere (at the bedside or in an outpatient setting), have minimal risk and high effectiveness (19-54 % rate of success).
</abstract>

Vagal Maneuvers in Treating Acute Supraventricular Tachycardia with Narrow QRS

<abstract>
<title style='display:none'>Abstract</title>
Muscle cramps appearing in liver cirrhosis substantially affect the quality of life of these patients. The prevalence of painful muscle cramps can be up to 88%. The exact mechanism by which these muscle cramps occur is unknown. The management of this symptom is not easy because there is no uniformly accepted recommendation about what kind of supplementation or medicine (or both) can be used exactly. The aim of our study is to review the treatment options for muscle cramps in liver cirrhosis.
We found in the literature (using the keywords „liver cirrhosis", „muscle cramps", „treatment" and „quality of life") 32 articles of this topic. Treatment options currently are: vitamin supplementations (vitamin E, 1 - α hydroxy vitamin D), amino acid supplementations (taurine, branched - chain amino acids, L - carnitine, albumin), mixed herbal medicines (Niuche-Shen-Qui-Wan), zinc and medications (eperisone hydrochloride, quinine and quinidine sulphate, baclofen, methocarbamol, orphenadrine). Vitamin supplementations and amino acid supplementations are targeting the possible pathophysiological causes of muscle cramps (nerve function or energy metabolism alterations which are unique to liver cirrhosis). New aspects started to use medications especially antispasmodic agents (methocarbamol, orphenadrine) and antispasticity agents (baclofen) to relieve muscle cramps. We also found a multicenter study and two systematic reviews (performed in 2013 and 2014). From 2014 there is no systematic article appeared in this topic and we considered it important to survey the new treatment options next to the treatment options already known.
</abstract>

Treatment Possibilities of Muscle Cramps in Patients with Liver Cirrhosis

<abstract><title style='display:none'>Abstract</title>Cushing’s syndrome (CS) is a clinical condition resulting from chronic exposure to glucocorticoid excess. Hypercortisolism contributes significantly to the early development of systemic disorders by direct and/or indirect effects. Complications such as obesity, hypertension, diabetes, dyslipidemia, and hypercoagulability cause premature atherosclerosis and increase cardiovascular mortality. These associated abnormalities increase cardiovascular risk not only during the active phase of the disease but also long after the remission of hypercortisolism. Clinical management of these patients should be particularly careful and control of cardiovascular risk factors is necessary for a long period.</abstract>

The Cardiovascular Risk in Cushing’s Syndrome

<abstract><title style='display:none'>Abstract</title><bold>Objectives.</bold> This study aimed to examine peripheral artery disease severity impact on psychological profile of arteriopathy patients.<bold>Material and methods.</bold> The prospective study included consecutive PAD patients admitted to the 2nd Department of Internal Medicine and the Department of Cardiology of the Emergency Clinical Hospital “Sf. Spiridon” Iasi, between January and September, 2017.<bold>Rezults.</bold> The group included 139 PAD patients, 80.6% male and 19.4% female, with an average age of 63.23±9.44 years. PAD stages have a very strong association with level of quality of life (p&lt;0.0001). All Leriche-Fontaine classification categories were significantly associated with the depressive symptoms (p&lt;0.0001). The stress level was moderate in stages IIA, IIB and III and extremely severe in the terminal stage. The prevalence of anxiety was lowest in incipient PADstages with the highest value in stage III.<bold>Conclusions.</bold> The fragment of the PhD study presented the psychological profile in the PAD staging and advocates a personalized, wide-ranging approach to the arteriopathy patient including pain and depressive-anxiety management, with amajor impact on the quality of life at terminal stages.</abstract>

Beyond the Arteries in Peripheral Artery Disease

<abstract><title style='display:none'>Abstract</title>
The SARS-COV-2 pandemic had an important impact on the diagnosis of all pathologies, including lung cancer. According to Global Cancer Observatory 2020, lung cancer is the leading cause of cancer death (18%).
The study aims are the comparative evaluation of lung cancer diagnosis and optimal identification of the factors that influenced the establishment of this diagnosis in the pre-pandemic and SARS-COV-2 pandemic periods. This retrospective study included patients &gt;18 years-old, diagnosed with lung carcinoma on surgical specimens in „Marius Nasta” Institute of Pneumophtisiology, grouped in two cohorts: pre-pandemic (March 01, 2019 - February 29, 2020, N=370) and pandemic (March 01, 2020 - February 28, 2021, N=177).
Demographic, clinical, and paraclinical information have been collected from the Institute's database, and statistically analyzed (IBM SPSS Statistics 21). The number of newly diagnosed bronchopulmonary carcinoma decrease almost by half during the first year of the SARS-COV-2 pandemic. We noticed a significant increase in the number of patients with professional exposure (p=0.040), atypical resections (p≤0.001), and tumors that couldn't be completely resected (p=0.001), and an ascending trend of lung carcinoma diagnosis in women smokers, even though it wasn't statistically significant (p=0.098). The proportion of newly diagnosed women from rural medium significantly decreased, from 36.45% to 17.65% (p=0.023). The SARS-COV-2 pandemic debut determined a significant under-diagnosis of lung cancer, with an increase in advanced tumors at the time of diagnosis. It is important to further analyze the situation in our country, given the fact that the literature review reported different results, depending on the geographic area.
</abstract>

The Impact of the SARS-COV-2 Pandemic on the Diagnosis of Lung Cancer Patients

<abstract><title style='display:none'>Abstract</title>
Heart failure is not a single disease but a clinical syndrome with symptoms and/or signs caused by a structural/functional cardiac abnormality and represents a public health problem, leading to significant functional impairment, morbidity, and poor quality of life. In 2023, 64 million people had been diagnosed with heart failure and needed specific treatment. An important percentage is associated with diabetes mellitus type 2 (T2DM) as well. Because of the large etiology of this syndrome treatment should be leaded by the cause who underwent to heart failure. A few glucose-lowering therapies showed their efficacy in treating heart failure for patient with or without T2DM such as sodium glucose cotransporter inhibitors (SGLT-2 inhibitors) but the role of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is still investigated. At this point, evidence show no improvement in heart failure with reduced ejection fraction (HFrEF) treated with GLP-1 RAs but in heart failure with preserved ejection fraction (HFpEF) proves otherwise.
</abstract>

The Role of GLP 1 Receptor Agonists in Treating Heart Failure: Useful or Not?

<abstract><title style='display:none'>Abstract</title>
Anti-synthetase syndrome (ASS) is a rare autoimmune disease whose hallmark consists of the presence of autoantibodies directed against aminoacyl transfer RNA (tRNA) synthetases thus making it a distinctive pathology of the broad spectrum of idiopathic inflammatory myopathies (IIM). Clinically, lung involvement in the form of interstitial lung disease (ILD) and myositis are typical findings. Inflammatory myopathies should always raise the suspicion of an adjancent tumoral process and therefore prompt the clinician to perform a thorough screening. We present the case of a 55 year old caucasian male who was diagnosed with amyopathic ASS and a clear cell renal carcinoma (Grawitz tumor), along with the consequent therapeutic challenges.
</abstract>

Hidden in Plain Sight: Pitfalls of a Case of Amyopathic Anti-Synthetase Syndrome Associated with Grawitz Tumor

<abstract><title style='display:none'>Abstract</title>
A great number of studies confirm the fact that haemostatic anomalies occur rather often in endocrine diseases. Multiple endocrine and metabolic disorders can alter the haemostatic balance and favour thrombotic risk, with stroke being the most frequent and feared clinical manifestation. Hormonal factors are important, especially in arterial thrombosis, and, to a lesser extent, in venous thrombosis. This process causes ischaemic lesions, with the most severe clinical manifestations being stroke and myocardial ischaemia.
</abstract>

Hormonal Mechanisms in Thrombosis

<abstract><title style='display:none'>Abstract</title>
Heart failure is one of the most complex pathologies and most prevalent diseases, with around 64 million people affected globally (2% of the total adult population). In the initial phase of heart failure, studies have shown that the autonomic nervous system is in a state of imbalance, with an increase in the influence of the sympathetic nervous system on the heart. Persistence of long-term activation of the autonomic nervous system produces a decrease in the levels of myocardial catecholamines and also promotes down-regulation of beta-1 receptors.
This article is a systematic review of papers from four well-known and important scientific databases on the subject of power spectral analysis of ECG Holter monitoring in patients with heart failure. The PRISMA technique was used to identify the most relevant articles on this subject, and their results were presented based on importance of their use for the diagnosis of heart failure, for risk stratification of sudden death or arrhythmias, for the evaluation of certain treatments used, or for other possible pathophysiological mechanisms involved in the evolution of the disease.
</abstract>

Evaluation of Autonomic Nervous System Through Spectral Analysis in Patients with Ischemic Heart Failure: A Systematic Review

<abstract>
<title style='display:none'>Abstract</title>
Atypical hemolytic uremic syndrome (aHUS) represents a major challenge due to its rare nature and severe impact on patients, characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. This paper describes the case of a 41-year-old patient diagnosed with aHUS in the context of malignant arterial hypertension and severe renal impairment, manifested by anuria and significant azotemic retention syndrome. The complex management of the case, including the use of Eculizumab, a complement inhibitor, highlighted significant therapeutic benefits, especially in improving hematological parameters.
Despite a positive response, challenges related to dosing, monitoring treatment efficacy, and maintaining remission without relapses emphasize the need for adapted therapeutic strategies and a deeper understanding of the disease mechanisms. This case also highlights the importance of individualized approaches and consideration of the possible benefits of dose adjustments based on specific clinical and pharmacological parameters, as well as continuous evaluation of treatment efficacy and safety, in the context of such a variable and potentially devastating syndrome as aHUS.
</abstract>

Complement Blockade, a New Therapeutic Approach in Malignant Hypertension

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