<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>
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>Systemic lupus erythematosus (SLE) is considered the prototype of autoimmune diseases, the most complex autoimmune pathology and it is characterized by a wide range of immune processes, important antibodies production as well as an impressive spectrum of clinical manifestations. The great variety of lupus signs and symptoms caused difficulties in establishing well-defined classification criteria, as well as sustaining the clinical diagnosis.In 2019, a joint initiative of European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) released a new set of classification criteria for SLE, worldwide SLE experts were involved, this being the largest SLE classification effort up to date.</abstract>

Up to Date in Internal Medicine: From Older to the New 2019 Systemic Lupus Erythematosus Classification Criteria

<abstract>
<title style='display:none'>Abstract</title>
Charcot–Marie–Tooth disease (CMT) is one of the hereditary motor and sensory neuropathies, a group of varied inherited disorders of the peripheral nervous system characterized by progressive loss of muscle tissue and touch sensation across various parts of the body. Currently incurable, this disease is the most commonly inherited neurological disorder, and affects about one in 2,500 people. A CMT diagnosis involves clinical evaluation of muscle function and atrophy, testing of sensory responses, and electromyography and nerve conduction studies.
Often, the most important goal for patients with CMT is to maintain movement, muscle strength, and flexibility. Therefore, an interprofessional team approach with occupational therapy, physical therapy, orthotics, podiatrist, and orthopedic surgeon is recommended. Physical therapy should be involved in designing an exercise program that fits a person’s personal strengths and flexibility, but also in a god evaluation podoscopic assessment. Due to the lack of good sensory reception in the feet, CMT patients need to see a physical therapist in order to stabilize their feet or correct progressive problems by rebalancing the biomechanics of the foot. The procedure involves a computerized assessment, the realization of the plant footprint in the foam and the creation of plantatory therapeutics on the mold.
These plantar orthoses help control foot drop and ankle instability and often provide a better sense of balance for patient. Appropriate footwear is also very important for CMT case, but often with difficulty finding well-fitting shoes because of their high arched feet and hammer toes. The patient will use these plantatory proponents in the right shoes in order to: increase of planting support surface, reduction of varus, slowing down the retraction tendency of plant aponeurosis
</abstract>

The Importance of Rebalancing Foot Biomechanics by Computerized Podoscopic Assessment - Study in Charcot Marie Tooth Syndroms

<abstract><title style='display:none'>Abstract</title>Atrial myxomas are common benign tumors localized in the left atrium (85%). The diagnosis is often made during routine examination due to the fact that they are usually asymptomatic. Sometimes the complications of these benign tumors, consisting in embolic events and obstructive valvular disfunction, may be alarm signs that reveal the underlying pathological condition.We report the case of a 63-years-old female presenting with non-specific symptoms, the echocardiography was the one that showed the left atrial mass. The particularity that made this case special was the fact that the anticoagulation indication for the atrial fibrillation discovered on the ECG was correlated with the presence of the thrombocytopenia, so the final decision was to postpone it till the surgery. After the removal of the atrial tumor the sinusal rhythm was restored and the combination of beta-blockers and antiplatelet was the best therapeutic choice.</abstract>

Atrial Myxoma, the Substrate of Atrial Fibrillation, Accompanied by Thrombocytopenia - Perspectives for the Anticoagulation Option and a Future Surgery Intervention

<abstract>
<title style='display:none'>Abstract</title>
<bold>Introduction.</bold> The largest challenge for patients with COPD is the correct use of inhaler devices. In COPD, inhalation therapy has a key role in symptom control, reducing the exacerbation rate, hospitalization and improving the quality of life. Choosing the active substance(s) administered by inhaler devices is an easy task because of the Gold guideline recommendations, but, when it comes to choosing the inhaler device, it is much more difficult to get recommendations.
<bold>Methods.</bold> Our analysis included 200 subjects divided into two groups and its objective was the identification of some mechanisms that connect education, exacerbation and adherence to treatment, placed in the context of measuring technical skills and patients` preference for a particular inhaler device. All subjects included in the analysis were subjected to a technical skills test that included a set of 10 questions with a 30-minute solving time. The subjects in the working group were put in the position of deciding factor for the choice of an inhaler device, and implicitly for the treatment they would follow during monitoring.
<bold>Results.</bold> In both groups, the lowest treatment dropout rate at T12 was recorded among those with higher levels of education, while those with poor education levels recorded very high dropout rates. In both groups we noticed that, as the level of education increased, technical skills were also increasingly better. Both in the control group and in the working group, dropout subjects at T12 had significantly lower technical skills compared to subjects who did not drop out. The level of technical skills was significantly lower in both groups in subjects with exacerbations. Statistical analysis proved the relationship between the low level of technical skills and exacerbation. The subjects with lower technical skills proved to be more prone to dropout of inhaler therapy as well. The proportion of subjects with exacerbations in the control group was significantly higher than the proportion of those with exacerbations in the work group. The proportion of subjects with exacerbations in the control group was significantly higher than the proportion of those with exacerbations in the work group.
<bold>Conclusions.</bold> The authors consider that the involvement of the patient in choosing the inhaler device had a positive impact on disease control and reducing the rate of exacerbations.
</abstract>

The Impact of Technical Skills and Education on Exacerbations, Adherence to Treatment and the Choice of Inhaler Device in Patients with COPD

<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

<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>
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>
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>
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>
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>
<bold>Introduction.</bold> Although cardiovascular disease remains the leading cause of mortality regardless of gender, the female gender has remained an underrepresented population in studies in this field. Sustained initiatives by the European Society of Cardiology have brought to the fore the importance of studying gender differences regarding the safety profile of cardiovascular drugs in women. Common cardiovascular adverse drug reactions include atrioventricular conduction disorders.
<bold>Materials and methods.</bold> The present study followed the clinical and paraclinical features of female patients with a primary diagnosis of bradycardia in relation to bradycardic medication. We included a group of 359 female patients, divided according to the presence or absence of bradycardia medication into a study group (n=206) and a control group (n=153).
<bold>Results.</bold> Patients with associated bradycardic medication frequently required emergency admission (P &lt; 0.001), with prolonged hospitalization (P &lt; 0.001). The main atrioventricular conduction disorders identified were atrial fibrillation with slow ventricular response (P = 0.028), sinus bradycardia (P = 0.009) and sinus pauses (P = 0.009). Among comorbidities, heart failure (P&lt;0.001) and chronic kidney disease (P&lt;0.001), were common in the study group. Echocardiographic parameters of left ventricular (P=0.002) and biatrial (P&lt;0.001) dilatation, as well as severe left ventricular systolic dysfunction (P=0.009), showed statistical significance in this group. The most used drugs were beta-blockers, amiodarone, and digoxin.
<bold>Conclusions</bold>. Our results indicate, as factors associated with medication-related bradyarrhythmias in female gender: heart failure with severe systolic dysfunction, renal dysfunction, atrial fibrillation, and left ventricular dilatation.
</abstract>

Adverse Drug Reactions and Atrioventricular Conduction Disorders - A Female Gender Related Aproach

<abstract><title style='display:none'>Abstract</title>COVID-19 epidemic caused by an influenza-like virus strain (SARS-CoV-2) invaded the world. The World Health Organization (WHO) announced this infection outbreak as a global pandemic on 11 March 2020. From one day to another the number of new cases is growing and also the number of deaths. This infection emerged earlier in Wuhan City and rapidly spread throughout China and around the world since December 2019. Another silent pandemic disease spreading mainly in industrialized countries is obesity. The best example is US were about 34% of the Americans are obese.In actual context, it can be said there is a coalition of 2 pandemics. In Romania, obesity and overweight prevalence assessed by Predatorr study is at a high level: 34,7% overweight and 31,9% obesity. Systemic inflammation in obesity is the central mechanism leading to lung function decline. There are two main questions a) is obese more sensible to viral infection or b) potentially more contagious? The answer is positive to both. Recent WOF official position stated that obesity is a risk factor for developing severe forms of COVID-19. Donna Ryan’s message, as president of World Obesity Federation WOF, US emphasized at the beginning of April the risk for severe complications for persons with obesity who contracted the infection with SARS-CoV-2. Nutritional support in COVID-19 should prefer oral feeding, whenever is possible. A special attention should be dedicated to a healthy microbiome and intestinal immunity. Energy intake should be 25-30 kcal/body weight, with 1.2-2 g/kg proteins. Enteral nutrition will be recommended in severe cases. Evidence is supporting the recommendation that for people at risk of developing COVID-19 to consider for few weeks a dosage of 10000 UI/day of vitD3, than a maintainance dose of 5000 UI/day. The target must be to stabilize a level of 40-60 ng/ml for 25(OH) D concentration. Pulmonary rehabilitation, smoking cessation, included in a healthy lifestyle will be further steps after patients recovery from this infection.Facing this pandemic coalition, our messages should be stronger in stimulating prevention of obesity. Since more than a half of Romanian population is already overweight or obese, healthy lifestyle should become a daily prescription, not just a luxury recommendation. Daily, right messages from doctors acting like role models, in a partnership between general practitioner and other specialties like diabetologists, pneumologists, cardiologists, nutritionists will be efficient weapons against this cruel coalition: Obesity and COVID 19.</abstract>

Two Pandemics Coalition: Covid-19 and Obesity

<abstract>
<title style='display:none'>Abstract</title>
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.
</abstract>

Exercise-Induced NT-pro BNP Secretion in Hypertensive Patients Without Heart Failure Can Diagnose the Subclinical Left Ventricle Dysfunction

<abstract><title style='display:none'>Abstract</title>Acute pancreatitis (AP) represents an inflammatory condition,-with a wide spectrum of local and systemic complications. Early stratification of severity of pancreatitis is an important step in guiding the management of the disease and improving outcomes. Throughout the years many researchers have looked at various risk stratification parameters which could be used from the admission of patients, however current available scores are cumbersome.Our aim was to evaluate the role of biochemical and hematological parameters in the early stratification of severity of AP, regarding the length of hospitalization.We conducted an observational study which included 100 patients with AP admitted to the Gastroenterology Department over a period 18 months. AP diagnosis was set according to 2013 ACG criteria. Demographic, clinical and imaging data related to the pancreatitis flare were collected from their charts. Length of hospital stay was used as surrogate marker for severity of AP. We evaluated different biochemical and hematological parameters which influenced the length of hospitalization.Several hematological parameters and ratio did not correlate with length of hospital stay in our study cohort, however there was a significant relation of hyperglycemia and alkaline phosphatase levels with hospitalization duration.Early risk stratification in AP remains difficult with routine blood work done at admission. Glycemic control and serum level of alkaline phosphatase seems to be correlated with length of hospital stay.</abstract>

Early Risk Stratification in Acute Pancreatitis: The Role of Biochemical and Hematological Parameters

<abstract>
<title style='display:none'>Rezumat</title>
<bold>Introducere.</bold> Arteriopatia obliterantă a membrelor inferioare (AOMI) reprezintă consecinţa afectării aterosclerotice a arterelor distale, cu o prevalenţă crescută în special în rândul pacienţilor de gen masculin. Prezentarea clinică este variabilă, de la prezenţa clasică a claudicaţiei intermitente şi până la apariţia semnelor clinice de ischemie acută la nivelul membrelor inferioare. Diagnosticul este stabilit în cele mai multe cazuri pe baza indicelui gleznă-braţ cu o valoare sub 0,9. Managementul terapeutic are drept deziderate principale reducerea riscului de apariţie a unui eveniment acut cardiovascular, îmbunătăţirea statusului functional şi prevenirea declinului fizic şi psihic deopotrivă. Recuperarea cardiovasculară joacă un rol important, având implicaţii prognostice pe termen scurt şi lung.
<bold>Materiale şi metode.</bold> Studiul prezentat în lucrarea de faţă este unui descriptiv, retrospectiv, bazat pe un lot de 70 de pacienţi diagnosticaţi cu AOMI care au fost evaluaţi în cadrul Clinicii de Recuperare Cardiovasculară. Au fost constituite două loturi, în funcţie de prezenţa sau nu a claudicaţiei intermitente (60 pacienţi, respectiv 10 pacienţi).
<bold>Rezultate.</bold> Analiza statistică a inclus o varietate de parametri demografici, clinico-paraclinici şi terapeutici deopotrivă, urmărind să se evidenţieze factorii cu impact asupra apariţiei şi progresiei claudicaţiei intermitente şi, implicit, efectul acestora asupra prognosticului pe termen lung. Genul masculin, fumatul, hipertensiunea arterială, diabetul zaharat, prezenţa bypass-ului aortocoronarian în antecedente şi profilul lipidic modificat sunt parametri semnificativi statistic în studiul prezentat.
<bold>Concluzii.</bold> Evoluţia AOMI este marcată de simptomatologie şi de corecţia factorilor de risc prezenţi, recuperarea cardiovasculară asigurând la aceşti pacienţi îmbunătăţirea statusului functional şi creşterea calităţii vieţii.
</abstract>

Impact of Comorbidities on the Long-Term Prognosis of Patients with Intermittent Claudication

<abstract><title style='display:none'>Abstract</title>Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection and it is an important global health problem. After the Sepsis 3 definition, sepsis is only the tip of the iceberg. Only when is life-threatening, an infection is declared sepsis, so the rapid medical intervention is paramount. As the sepsis is a so important medical condition in daily clinical practice, many scores and biomarkers were studied in order to have a better risk stratification in early phases of an infection. By design, some scores were intended to be used in Emergency Departments (ED), Intensive Care Units (ICU), or in specific wards.Ideally, the intervention should take place as rapid and earlier as possible. A possible research direction should be based on a rapidly, low-resources, none or minimum equipment requested for measuring parameters for determining a EWS (increased sensitivity) used with a biomarker (rapidly determined) for gaining specificity in order to buy time, further used to reduce the length of stay in ICU and mortality. Verified and revised scores as NEWS2 and biomarkers such as procalcitonin and presepsin offer a research direction to be explored.</abstract>

Risk Stratification in Sepsis: What We Can Do in the Emergency Room?

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