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Gastroesophageal reflux disease (GERD) is known as the most prevalent gastrointestinal disorder in the United States, leading to substantial morbidity, although associated mortality is rare. Based on the appearance of esophageal mucosa on upper endoscopy, GERD is divided into erosive esophagitis (ERD) and nonerosive reflux disease (NERD). Heartburn and acid regurgitation are the typical symptoms of the disease, although some patients may present atypical manifestations such as epigastric pain, nausea, asthma, chronic cough, pharyngitis, laryngitis, sleep disturbances, otitis, and sinusitis. Other signs, such as oral mucosal lesions may result from GERD by direct acid or acidic vapor contact in the oral cavity. Oral manifestations such as tooth erosion, periodontitis, gingivitis, palatal erythema, ulceration, glossitis, oral acid burning sensation, halitosis, xerostomia have recently been reported in GERD patients. A considerable percentage of the patients are affected by oral manifestations before the onset of gastrointestinal symptoms, although in most cases the gastrointestinal signs and symptoms dominate the clinical picture. The injured oral mucosa negatively impacts the quality of life, especially functional limitation, physical inability and psychological disabilities, thus leading to social isolation. There is plenty of non-standardized information on the oral mucosal changes in GERD. In this context, we aimed at synthesizing and analyzing the current available evidence on non-dental oral cavity lesions and complaints that are present in patients diagnosed with GERD.

Introduction. Enrollment of patients with cardiovascular disease in rehabilitation programs may contribute to implementation of a healthy lifestyle, including by promotion of a diet adequate for each patient’s profile. In this context, the current study is aimed at creating a traffic light system model allowing to obtain the development, innovation and diversification of menus and to improve the nutritional programs for this category of patients. Material and method. Based on the data provided by USDA Food Composition Databases, the composition in terms of different nutritive principles was determined for each ingredient and for each final menu. Comparison of menus depending on each nutritive principle, as well as comparison between menus and nutrient requirements according to indications for patients attending cardiovascular rehabilitation programs was made. Results. The traffic light system was developed, using color codes, comparing daily nutrient requirements with preparations’ content. Conclusions. The major benefit of the traffic light system would reside in the fact that starting from classic menus, an intervention on these can be achieved, and healthier, more nutritionally balanced models can be created, according to healthy nutrition principles. These new menus will be calorically and nutritionally adapted for patients attending cardiovascular rehabilitation programs. Key words: nutrition, rehabilitation, traffic light system

Background: Chemerin represents a recently discovered chemokine influencing adipocyte function, lipolysis, apparently positively associated with insulin resistance. Purpose: To evaluate the relationship between chemerin-insulin resistance scores in obese/diabetic patients. Methods: 88 patients (66 women), mean age 61.96 ± 10.15. Cardiovascular risk factors (body weight, waist circumference, lipid fractions, smoking, diabetes, hypertension) and chemerin were assessed. Insulin resistance scores were calculated: Homeostatic model assessment (HOMA) = insulin (μU/mL) * glicemia (mg/dl)/405 and Quantitative insulin sensitivity check index (QUICKI = 1/[lg10 (insulin (μU/mL)) + lg10 (glicemia)]. Patients were categorized in obese only (20.5%), diabetics only (12.5%), obese and diabetics (14.8%) and non-diabetics-non obese (52.3%). Results: 35.3% patients were obese, 27.3% diabetics, 79.5% hypertensive, 17% current smokers, 67% dyslipidaemic. The values of chemerin registered in the four groups were as follows: in diabetic + obese patients 7.98 ± 7.22 pg/ml (median 5.2), diabetics only 7.27 ± 5.24 pg/ml (5.6), obese only 8.42 ± 7.56 pg/ml (median 5.8), non-obese-non-diabetics 9.15 ± 7.64 pg/ml (median 7.15). Globally chemerin did not correlate with waist circumference, HDL-cholesterol, LDL-cholesterol, glicemia, insulin, HOMA index or QUICKI index. Going further with analysis, no significant correlations were found between chemerin and HOMA index and QUICKI index in diabetic + obese patients, obese only patients, diabetics only. But, in non-obese-non-diabetics significant correlations were found – between chemerin and glicemia (r = 0.3), HOMA index (r = 0.3, p = 0.03), QUICKI index (r = −0.310, p = 0.037), but not with waist circumference (r = 0.224, p = NS), HDL (r = 0.08, p = NS) or LDL (r = −0.06, p = NS). Conclusion: Although many things need to be elucidated regarding the chemerin mechanism, it seems very probable to be involved in early insulin resistance.

We present the case of a 46-year old patient with Child-Pugh class C cirrhosis with MEDL-Score 16, and hepatocellular carcinoma invading the inferior vena cava and the right atrium. The etiology of cirrhosis is type 1 hereditary hemochromatosis with positive HFE C282Y/C282Y and H63D/H63D mutations. A systematic review of the literature was performed and only 30 cases of hepatocellular carcinoma with tumor thrombosis extending into the right atrium have been described. To our knowledge, this is the first case that evidences the presence in hereditary hemochromatosis of hepatocellular carcinoma with atypical invasion into the right atrium. Screening of patients with a family history of hereditary hemochromatosis allows detection of the disease in the asymptomatic phase, allowing initiation of early therapy and improved prognosis.

Objectives. We evaluated platelet counts in end-stage renal disease and chronic viral hepatitis. Materials and Methods. We studied 70 patients with end-stage renal disease and chronic viral hepatitis and compared them to a control group of 45 patients without hepatitis. Results. The presence of viral hepatitis was associated with a higher prevalence of thrombocytopenia. Correlations between age, C-reactive protein, liver stiffness measurement, and platelet count were observed. C-reactive protein levels > 10 mg/dl were associated with a lower risk of thrombocytopenia in patients with end-stage renal disease and chronic viral hepatitis, yet age > 60 years, dialysis vintage > 10 years, aspartate and alanine aminotransferase levels > 20 IU/L, albumin levels < 3.5 g/dl, and fibrosis stage ≥ 3 were not related. Conclusions. Chronic viral hepatitis leads to a higher prevalence of thrombocytopenia. Platelet counts in these patients begin to decrease significantly once liver fibrosis reaches stage III.

Metabolic syndrome (MS) is a clustering entity characterized by obesity, hypertension, hyperglycemia, dyslipidemia, and insulin resistance. Early detection of atherosclerosis is important in patients with MS because cardiovascular diseases are the main cause of mortality in these patients.We aimed to investigate the factors influencing arterial stiffness, pulse wave velocity, and the augmentation index, respectively, in 150 subjects with MS (94 women and 56 men; mean age 60.56 ± 9.8 years). Arterial stiffness was measured using the TensioMed™ Arteriograph. We tested the relationship between arterial parameters and insulin resistance measured by the determination of insulinemia (the ELISA method) and the homeostasis model assessment index (HOMA).In multivariate analysis we identified the independent factors that influence arterial stiffness: systolic blood pressure (coefficient of determination 3.586; P 0.0001), serum triglycerides (coefficient of determination 3.579; P 0.0001), and age (coefficient of determination 3.510; P = 0.001) are independent predictive factors for pulse wave velocity. The independent predictive factors of the augmentation index were the body mass index (coefficient of determination 0.55; P = 0.009), the presence of diabetes mellitus (coefficient of determination 4.7; P = 0.03), mean arterial pressure (coefficient of determination 0.44; P 0.0001), gender (coefficient of determination 9.2; P 0.0001), age (coefficient of determination 0.3; P 0.0001), and heart rate (coefficient of determination 0.66; P 0.0001). Insulin resistance (HOMA index) was a predictor of the brachial augmentation index (β coefficient 3.4; P 0.001) and was not a predictor of pulse wave velocity (β = -0.3; P = 0.6) in our study.Given the known predictive value of pulse wave velocity for cardiovascular events, identifying the factors responsible for the increase in arterial stiffness is extremely important.

Introduction Hyperhomocysteinemia is considered an independent risk factor for cardiovascular disease. Oxidative stress is one of the major pathogenic mechanisms in non-alcoholic fatty liver disease and atherosclerosis. Aim Our study aimed to evaluate serum homocysteine levels and oxidative stress in patients with biopsy-proven non-alcoholic steatohepatitis and possible association with cardiovascular risk measured by carotid artery intima-media thickness (c-IMT). Patients and methods 50 patients with non-alcoholic steatohepatitis and 30 healthy controls, age and gender matched, were recruited. Lipid profile, liver biochemical markers, serum homocysteine, vitamins B6 and B12, folic acid, glutathione (reduced and total), erythrocyte superoxide dismutase, whole blood glutathione peroxidase, malondialdehyde and carotid intima-media thickness were assayed. Results Patients had an altered lipid profile and liver biochemical markers; carotid intima-media thickness and serum homocysteine levels were significantly higher compared to controls, but there were no differences in folate, B12 and B6 vitamins levels. Patients had significantly lower levels of glutathione peroxidase activity, total and reduced glutathione and higher levels of malondialdehyde, but unchanged superoxide dismutase activity compared to control group. Also, serum homocysteine level showed significant positive correlation with waist circumference, body mass index, free cholesterol, triglycerides, LDL-cholesterol, amino transferases and negative correlation with reduced and total glutathione, superoxide dismutase and γ-GT. Conclusion Non-alcoholic steatohepatitis is an independent cardiovascular risk factor, associated with elevated homocysteine levels, oxidative stress and c-IMT. c-IMT could be used as an indicator of early atherosclerotic changes initiated by dyslipidemia and oxidative stress, while higher level of homocysteine might be an effect of liver damage.

Familial amyloidosis is a rare type of amyloidosis, difficult to diagnose. We present the case of a woman with chronic heart failure. Low ejection fraction and concentric left ventricle hypertrophy with granular sparkling were seen by echocardiography and cardiac magnetic resonance imaging. Based on myocardial biopsy and genetic tests, the diagnosis of transthyretin familial amyloidosis, secondary to the Glu54Gln gene mutation, was made. The presentation contains the diagnostic algorithm used in the case of our patient, including clinical, biochemical, imaging, histological and genetic examinations, for the purpose of a complete diagnosis.

Metabolic syndrome (MS) is a clustering entity characterized by obesity, hypertension, hyperglycemia, dyslipidemia, and insulin resistance. Atherosclerotic lesions may be a complication of MS, arising from endothelial dysfunction and induced by decreased nitric oxide (NO) production. NO is synthesized by nitric oxide synthase (eNOS), encoded by the NOS3 gene, and displays anti-inflammatory, vasodilatory, and antiproliferative effects.We aimed to investigate the relationship between the G894T polymorphism of the eNOS gene and metabolic syndrome (including its components) and the association of this polymorphism with arterial function, assessed by determining pulse wave velocity and the augmentation index.The study included 100 consecutive patients, 55% with metabolic syndrome (based on IDF criteria -study group), 45% without MS (control group). Arterial stiffness was measured using TensioMedTMArteriograph. The presence of the homozygous (TT) or heterozygous (GT) state was associated, compared to subjects without the mutation (GG), with an increased prevalence of arterial hypertension, diabetes mellitus, with an increase of abdominal circumference, an increase of triglycerides, without significantly influencing the level of HDL. No significant differences were found between patients with G894T polymorphism compared to those without the mutation regarding the arterial stiffness. The eNOS gene polymorphism: 894G]T was significantly associated with the presence of MS; the polymorphism in homozygous and heterozygous state was associated with an increased risk of metabolic syndrome. G894T polymorphism did not significantly influence the values of the studied arterial parameters (pulse wave velocity, aortic and brachial augmentation index).

Background Hyaluronic acid (HA), ASAT to Platelet Ratio Index (APRI), ASAT/ALAT ratio, Fibrosis 4 score (FIB4) and FibroScan were studied as non-invasive markers of liver fibrosis (F) in chronic viral hepatitis B (CHB) and C (CHC), in an attempt to avoid the complications of liver puncture biopsy, considered the gold standard in the evaluation of F. The aim of our research was to study whether HA, APRI, ASAT/ALAT ratio, FIB4 and FibroScan are useful non-invasive markers in predicting severe F in Romanian patients. Patients and Methods This was a prospective multicenter transversal and observational study, which included 76 patients with CHB/CHC. The independent effect of studied markers was tested using multiple binary logistic regression. Results In patients with CHB and CHC, the APRI cut-off value for F4 was 0·70 ng/mL (Se = 77%, Sp = 78%), the FIB4 cut-off value was 2·01 (Se = 77%, Sp = 69%), and the FibroScan cut-off value was 13·15 (Se = 92%, Sp = 88%). For patients with CHB/CHC, there was a significant linear positive correlation between F and HA (r = 0·42, P = 0·001), FibroScan (r = 0·67, P < 0·001), APRI (r = 0·46, P < 0·001) and FIB4 (r = 0·51, P < 0·001). Considering age, sex and body mass index as possible confounding factors or covariates in multivariable logistic modelling, FibroScan was the unique test that able to significantly highlight the presence of F4 score in CHB/CHC patients (P = 0·009) while FIB4 test seems to have a tendency to statistical significance. Conclusion FibroScan, APRI and FIB4 are useful non-invasive tests for the evaluation of F4 in patients with CHB and CHC.