Search

We present the case of a 36-year-old patient admitted with dyspnea, subjective sensation of edema of the cervical region, and precordial pain with sudden onset. Pathological antecedents revealed a respiratory intercourse three weeks ago. Laboratory findings indicated an inflammatory syndrome accompanied by hypoproteinemia. We performed an echocardiographic examination which revealed important pericardial effusion and swinging heart aspect with diastolic collapse of the right atrium and ventricle. According to the existing guidelines pericardiocentesis was immediately required. The hemorrhagic pericardial effusion had an intense positive Rivalta reaction with frequent macrophages and malignant atypical cells. The next step was a full-body computer tomography scan, which revealed an expansive mediastinal mass, invading the upper cava vein and pericardium, with mediastinal adenopathy. A biopsy was performed and the pathology examination concluded there was a classical Hodgkin’s lymphoma nodular sclerosis type. Finally the patient was directed to oncology department.

The prognosis of STEMI patients experiencing the no-reflow phenomenon is unfavorable both in the short- and long-term compared to patients who do not develop this pathology, and it is even worse as other cardiovascular risk factors There is a correlation between the no-reflow phenomenon and diabetes mellitus type II and obesity and this conditions represent stong predictors of mortality.

The study investigated the association between the frequency of sweetened beverages intake and body mass index, diet choices, hypertension, and glycaemia in 1158 individuals from north western Romania, aged between 20 and 39 years. We found a high prevalence (87.48%) of soda consumption. There was a linear correlation between the number of sweetened beverages servings/week and unhealthy lifestyle expressed as frequency of fast-food consumption. A significant statistical association was found between soda consumption and prevalence of high blood pressure and impaired fasting glycaemia. Individuals who did not consumed sweetened beverages, had a prevalence of impaired fasting glucose and hypertension of 6% and respectively 13%; those who consumed more than 8 servings/week had a prevalence of impaired fasting glucose and hypertension of 19%. Inappropriate nutrition (lack of fruits and vegetables in food, consumption of fats and processed sugars or added sugars beverages) have increased the incidence of chronic diseases. We consider that public health policies regarding soda consumption are required.

Withaferin A (WFA) was identified as the most active phytocompound of the plant Withania somnifera (WS) and as having multiple therapeutic/ameliorating properties (anticancer, antiangiogenic, anti-invasive, anti-inflammatory, proapoptotic, etc.) in case of various diseases. In drug chemistry, WFA in silico approaches have identified favorite biological targets, stimulating and accelerating research to evaluate its pharmacological activity—numerous anticancer effects manifested in various organs (breast, pancreas, skin, colon, etc.), antivirals, anti-infective, etc., which are not yet sufficiently explored. This paper is a synthesis of the most relevant specialized papers in the field that are focused on the use of WFA in dermatological diseases, describing its mechanism of action while providing, at the same time, details about the results of its testing in in vitro/in vivo studies.

Non-alcoholic fatty liver disease (NAFLD) has a growing prevalence in recent years. Its association with cardiovascular disease has been intensively studied, and certain correlations have been identified. The connection between these two entities has lately aroused interest regarding therapeutic management. In order to find the best therapeutic options, a detailed understanding of the pathophysiology that links (NAFLD) to cardiovascular comorbidities is needed. This review focuses on the pathogenic mechanisms that are behind these two diseases and on the therapeutic management available at this time.

Metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) are diseases that can be influenced by the structure of gut microbiota, whose improvement is often neglected in metabolic pathology. This review highlights the following main aspects: the relationship between probiotics/gut microbes with the pathogenesis of MetS, the particular positive roles of Akkermansia muciniphila supplementation in the onset of MetS, and the interaction between dietary polyphenols (prebiotics) with gut microbiota. Therefore, an extensive and in-depth analysis of the often-neglected correlation between gut microbiota and chronic metabolic diseases was conducted, considering that this topic continues to fascinate and stimulate researchers through the discovery of novel strains and their beneficial properties.

Background and Objectives: Characterization of patients with endocarditis regarding demographic, clinical, biological and imagistic data, blood culture results and possible correlation between different etiologic factors and host status characteristics. Material and methods: This is a retrospective observational descriptive study conducted on patients older than 18 years admitted in the past 10 years, in the Cardiology Clinic of the Clinical County Emergency Hospital Oradea Romania, with clinical suspicion of bacterial endocarditis. Demographic data, clinical, paraclinical investigations and outcome were registered and analyzed. Results: 92 patients with definite infective endocarditis (IE) according to modified Duke criteria were included. The mean age of patients was 63.80 ± 13.45 years. A percent of 32.6% had health care associated invasive procedure performed in the 6 months before diagnosis of endocarditis. Charlson’s comorbidity index number was 3.53 ± 2.029. Most common clinical symptoms and signs were: shortness of breath, cardiac murmur, fever. Sixty-six patients had native valve endocarditis, 26 patients had prosthetic valve endocarditis and one patient was with congenital heart disease. Blood cultures were positive in 61 patients. Among positive culture patient’s staphylococcus group was the most frequently involved: Staphylococcus aureus (19.6%) and coagulase negative Staphylococcus (18.5%). Most frequent complications were heart failure, acute renal failure and embolic events. Conclusions: Staphylococcus aureus IE was associated with the presence of large vegetations, prosthetic valve endocarditis and intracardiac abscess. Coagulase negative Staphylococcus (CoNS) infection was associated with prosthetic valve dysfunction. Streptococcus gallolyticus etiology correlated with ischemic embolic stroke and the presence of large vegetations. Cardiovascular surgery was recommended in 67.4% of patients but was performed only on half of them. In hospital death occurred in 33.7% of patients and independent predictors of mortality were congestive heart failure and septic shock.

Diabetic neuropathy (DN) is a frequent complication of diabetes mellitus (DM) with severe consequences as it progresses and influences all human body systems. This review discusses the risk factors for DN, the main characteristics of the clinical forms of DN, the screening methods and the current therapeutic options. Distal symmetric DN is the primary clinical form, and DM patients should be screened for this complication. The most important treatment of DN remains good glucose control, generally defined as HbA1c ≤7%. Symptomatic treatment improves life quality in diabetic patients. Pharmacological agents such as alpha (α)-lipoic acid and benfotiamine have been validated in several studies since they act on specific pathways such as increased oxidative stress (α-lipoic acid exerts antioxidant effects) and the excessive production of advanced glycosylation products (benfotiamine may inhibit their production via the normalization of glucose). Timely diagnosis of DN is significant to avoid several complications, including lower limb amputations and cardiac arrhythmias.

The coronavirus disease (COVID)-19 pandemic is a major challenge for the health systems worldwide. Acute respiratory distress syndrome (ARDS), is one of the most common complications of the COVID-19 infection. The activation of the coagulation system plays an important role in the pathogenesis of ARDS. The development of lung coagulopathy involves thrombin generation and fibrinolysis inhibition. Unfractionated heparin and its recently introduced counterpart low molecular weight heparin (LMWH), are widely used anticoagulants with a variety of clinical indications allowing for limited and manageable physio-toxicologic side effects while the use of protamine sulfate, heparin's effective antidote, has made their use even safer. Tissue-type plasminogen activator (tPA) is approved as intravenous thrombolytic treatment. The present narrative review discusses the use of heparin and tPA in the treatment of COVID-19-induced ARDS and their related potential physio-toxicologic side effects. The article is a quick review of articles on anticoagulation in COVID infection and the potential toxicologic reactions associated with these drugs., Highlights • Anticoagulant therapy is essential in decreasing fibrin deposition and microthrombus formation in the ARDS and in the treatment of pro-thrombotic complications. • Administration of tPA in ARDS patients could provide anti-inflammatory effects. • Heparin and tPA may be useful in these patients minimizing the risk for ARDS complications and/or reducing the pressure on the ventilator support in the Intensive Care Unit

The no-reflow phenomenon following primary percutaneous coronary intervention (PPCI) in acute ST-elevation myocardial infarction (STEMI) patients is a predictor of unfavorable prognosis. Patients with no-reflow have many complications during admission, and it is considered a marker of short-term mortality. The current research emphasizes the circumstances of the incidence and complications of the no-reflow phenomenon in STEMI patients, including in-hospital mortality. In this case-control study, conducted over two and a half years, there were enrolled 656 patients diagnosed with STEMI and reperfused through PPCI. Several patients (n = 96) developed an interventional type of no-reflow phenomenon. One third of the patients with a no-reflow phenomenon suffered complications during admission, and 14 succumbed. Regarding complications, the majority consisted of arrhythmias (21.68%) and cardiogenic shock (16.67%). The anterior localization of STEMI and the left anterior descending artery (LAD) as a culprit lesion were associated with the highest number of complications during hospitalization. At the same time, the time interval &gt, 12 h from the onset of the typical symptoms of myocardial infarction (MI) until revascularization, as well as multiple stents implantations during PPCI, correlated with an increased incidence of short-term complications. The no-reflow phenomenon in patients with STEMI was associated with an unfavorable short-term prognosis.

The article's abstract is no available.

Background and objectives: Diabetic foot ulcer (DFU) is one of the serious complications of diabetes, being related to frequent and long-term hospitalisation, reduced quality of life of the patient, amputations, a high rate of morbidity and mortality. The bacterial aetiology is complex, sometimes involving more than one pathogen, playing a major role in the infection prognosis and development of microbial resistance. This study evaluated the current state of the aetiology, clinical and pathological characteristics of DFU in a single diabetes centre in order to provide some specific measures to prevent it. Materials and Methods: This retrospective study was conducted on patients with diabetes mellitus (252 individuals diagnosed with DFU) between January 2018&ndash, December 2019. All participants were assessed based on their clinical characteristics, including complications of diabetes and pathological and microbiological evaluations. Results: The present research revealed that diabetic foot ulcer prevalence was higher in males than in females and higher in type 2 diabetic patients than in type 1 diabetic patients. The patients with diabetic foot ulcer were older, had a higher body mass index (BMI), longer diabetic duration and had more diabetic complications, such as retinopathy, diabetic polyneuropathy and diabetic kidney disease, than patients without diabetic foot ulceration. Conclusions: Taking into account all factors involved, including the aetiology and the antibiotic susceptibility pattern of these isolates, planning the suitable treatment options of patients is possible.

This study explored the link between insulin sensitivity, insulin resistance and leptinaemia in people with prediabetes with and without non-alcoholic fatty liver disease (NAFLD). A total of 143 prediabetes patients were evaluated in the study. Ultrasonography was used for diagnosis of NAFLD, and fasting insulin, postprandial insulin, leptin levels, common clinical/biochemical determinations were determined. In total, 69 (48.25%) of the patients were diagnosed with NAFLD and 74 (51.75%) without NAFLD. Leptin values correlated statistically with fasting insulin in prediabetes patients, while in the patients that were also diagnosed with NAFLD the correlation was stronger. Values of log-leptin

Numerous epidemiological and clinical studies demonstrate the beneficial effects of naturally occurring, polyphenol supplementations, on cardiovascular system. The present review emphasizes on the risk factors associated with cardiovascular disorders (involving heart and blood vessels), and overview of preclinical and clinical trials on polyphenols for the treatment of cardiovascular diseases. The review collaborates PUBMED, Google Scholar and Research gate databases, which were explored using keywords and their combinations such as polyphenols, cardiovascular disease, flavonoids, atherosclerosis, cardiovascular risk factors and several others, to create an eclectic manuscript. The potency and efficacy of these polyphenols are mainly depending upon the amount of consumption and bioavailability. Recent data showed that polyphenols also exert beneficial actions on vascular system by blocking platelet aggregation and oxidation of low-density lipoprotein (LDL), ameliorating endothelial dysfunction, reducing blood pressure, improving antioxidant defenses and alleviating inflammatory responses. Several studies evidently support the cardioprotective actions mediated by polyphenols, however, some studies or long-term follow-up of human studies, did not demonstrate decisive outcomes because of variations in dose regimen and lack of appropriate controls. Therefore, more data is required to explore the therapeutic benefits of bioactive compounds as a preventive therapy for CVDs.

Non-alcoholic fatty liver disease (NAFLD) is a component of metabolic syndrome that significantly increases the cardiovascular risk of patients with glucose metabolism alterations. This study identified the prevalence of NAFLD, predictors of NAFLD and explored the link between insulin sensitivity, insulin resistance and leptinemia in 143 patients registered with prediabetes. Abdominal ultrasound was performed, and fasting insulin, postprandial insulin, leptin levels, common clinical/biochemical determinations were assessed. Certain variables that can predict NAFLD existence were determined and it was found that there is a high prevalence of NAFLD in patients with prediabetes. In univariate analysis, statistically significant associations (P

Metabolic syndrome is associated with increased risk of cardiovascular disease. This study investigated the correlation between adipocyte and inflammation biomarkers, and metabolic syndrome and its components. The study included 80 patients with normal body-mass index and 80 obese patients. The groups were assessed for serum values of adiponectin, leptin and highly sensitive C reactive protein (hsCRP), the homeostatic model assessment of insulin resistance (HOMA-IR), as well as the influence of these biochemical markers on the prevalence of metabolic syndrome and its components. Leptin, HOMA-IR and hsCRP had statistically significant (P

Obesity and overweight are major contributors to the morbidity and mortality of modern civilization. This study determined the prevalence of certain risk factors for adiposity and assesses their impact on overweight/obesity prevalence. Nine hundred individuals were evaluated, aged between 18-65 years, including clinical examination, evaluation of medical history, BMI determination and completion on questionnaires assessing nutritional intake and presence of depression symptoms. Overweight prevalence was 29.56% and obesity prevalence was 21.33%. Fast-food consumption was the most frequent risk factor for adiposity found in 61.67% of individuals, eating

Congenital anomalies of digits (CAD) can occur as isolated malformations, in combination with other malformation of the limbs, or as part of a genetic syndrome. The purpose of this work is to provide an overview of CAD, on morphological, genetic and epidemiological basis.We conducted a retrospective analysis of a cohort of 301 patients with CAD. Following the Swanson classification, the list of anomalies under study included: adactyly and oligodactyly, syndactyly and symphalangism, polydactyly, macrodactyly, amniotic bands syndrome, and generalized skeletal anomalies.In Bihor County, Romania, the Department of Medical Genetics recorded 4916 patients with congenital anomalies (2.03% out of 241 601 live newborns) between 1984 and 2018. Of these, 301 (6.1%) patients had CAD. The prevalence of CAD was 1:800 living newborns. The most common CAD were polydactyly, followed by syndactyly, brachydactyly, adactyly and oligodactyly. Upper extremities were four times more frequently affected than lower extremities, while both upper and lower extremities were affected in a quarter of all cases. CAD were isolated in 64% of patients, while 14% were associated with other anomalies of the extremities and 22% were associated with recognized genetic syndromes.Our study, by its size and the long period of clinical observation, provides opportunities to generalize and compare our data with similar studies, offering the possibility for improved knowledge of the epidemiology of CAD and potential improvements in genetic counseling.

The spectrum and antibiotic sensitivity of isolated strains vary between departments, hospitals, countries, the discrepancies are related to the use and dosage of these antibiotics. The purpose of our research was to compare the type of pathogens and the susceptibility of the isolated strains, as well as the use of antibiotics in the surgical departments of the Emergency Clinical County Hospital, Oradea, Romania, for one year, all the patients admitted to the mentioned sections were monitored. Antibiotic sensitivity of isolated strains was expressed using cumulative antibiogram. The total consumption of antibiotics was 479.18 DDD/1000 patient-days in the surgical sections. The most commonly used drugs were cephalosporins third and first generation, and clindamycin. Infections of wounds, urinary tract and fluids were most commonly diagnosed, and the most isolated was Escherichia coli, followed by Staphylococcus aureus and Enterococcus faecalis. The most commonly prescribed antimicrobial was ceftriaxone, but its sensitivity was low. This study revealed that the intake of antimicrobials in the surgical sections is increased and the comparison of antimicrobial prescriptions, sensitivity rates, and the spectrum of isolated pathogens showed differences between antimicrobials.

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.

Antibiotic sensitivity spectrum of isolated strains differs according to hospital departments, the hospitals themselves, and countries. Discrepancies also exist in terms of antibiotic use and dosage. The aim of the present study is to compare the antibacterial agents, the types of infections, the number and type of pathogens, and the sensitivity to antibiotics used in the Intensive Care Unit (ICU) of the Emergency Clinical County Hospital of Oradea, Romania. Over a one-year period, data were gathered from the pharmacy computer system and medical records of inpatients. WHO Anatomical Therapeutic Chemical (ATC)/defined daily doses (DDD) methodology was used to assess drug administration data, and antibiotic use was expressed as DDD/1000 PD (patient days). The antibiotic susceptibility of isolated strains was expressed through the cumulative antibiogram. The overall consumption of antimicrobial agents was 1247.47 DDD/1000 PD. The most common drugs used were cephalosporins and fluoroquinolones (52.97% of the total). Ceftriaxone was the most commonly used, followed by levofloxacin. Infections of the respiratory and urinary tract were the most frequently diagnosed infections. The most commonly isolated bacteria type was Acinetobacter baumannii (22.12% overall), isolated especially from the respiratory tract and resistant to all the β–lactam antibiotics including carbapenems. Antimicrobials intake at the ICU is much higher compared to medical and surgical wards. After we tested the existence of a possible connection between antibiotic consumption and antibiotic resistance of bacteria, it was revealed that on our sample exists a poor positive association.

Active screening for resistant multidrug strain carriers remains an important component of infection control policy in any healthcare setting indifferent of financial and logistical costs. The objective of our study was to determine the spectrum of bacterial colonization individually among intensive care unit patients. A retrospective observational study was performed in the Intensive Care Unit of Emergency Clinical County Hospital of Oradea during 2017. Medical records of the patients were used for evaluation of source of ICU admission, previous antibiotic therapy, comorbidities, and length of hospital stay. Nasal and groin swabs for MRSA detection and rectal swabs for ESBL, VRE, and CRE detection were collected upon ICU admission of all patients in the first 24 hours and after 7 days. Swab samples were processed for isolation and identification of these resistant multidrug strains. Bacterial colonization on admission was detected in a quarter of patients included in the study. Carbapenemase-producing bacteria were the most common colonizers (21.16%). On admission, 12.06% of patients have been colonized by ESBL-producing members of the family Enterobacterales. Risk factors for colonization on admission to the ICU were chronic liver diseases and chronic renal failure for ESBL infection and chronic liver disease for CRE in male patients. Evaluation of Carmeli’s score for male patients showed association only with CRE colonization. Chronic renal failure was found as risk factor for ESBL colonization in female patients. The prevalence of MRSA was 5.23% and less than 1% for VRE. There was no association between any risk factors studied and the presence of S. aureus or VRE upon admission. The 7-day ICU stay also proved to be an increased risk for ESBL and CRE infection.

Pancreatic cancer (PC) is one of the most aggressive forms of cancer. Negative prognosis is mainly due to the late diagnosis in advanced stages, when the disease is already therapeutically overcome. Studies in recent years have focused on identifying biomarkers that could play a role in early diagnosis, leading to the improvement of morbidity and mortality. Currently, the only biomarker widely used in the diagnosis of PC is carbohydrate antigen 19-9 (CA19.9), which has, however, more of a prognostic role in the follow-up of postoperative recurrence than a diagnostic role. Other biomarkers, recently identified as the methylation status of ADAMTS1 (A disintegrin and metalloproteinase with thrombospondin motifs 1) and BNC1 (zinc finger protein basonuclin-1) in cell-free deoxyribonucleic acid (DNA), may play a role in the early detection of PC. This review focuses on the diagnosis of PC in its early stages.

Reducing cardiovascular risk (CVR) is the main focus of diabetes mellitus (DM) management nowadays. Complex pathogenic mechanisms that are the subject of this review lead to early and severe atherosclerosis in DM patients. Although it is not a cardiovascular disease equivalent at the moment of diagnosis, DM subjects are affected by numerous cardiovascular complications, such as acute coronary syndrome, stroke, or peripheral artery disease, as the disease duration increases. Therefore, early therapeutic intervention is mandatory and recent guidelines focus on intensive CVR factor management: hyperglycaemia, hypertension, and dyslipidaemia. Most important, the appearance of oral or injectable antidiabetic medication such as SGLT-2 inhibitors or GLP-1 agonists has proven that an antidiabetic drug not only reduces glycaemia, but also reduces CVR by complex mechanisms. A profound understanding of intimate mechanisms that generate atherosclerosis in DM and ways to inhibit or delay them are of the utmost importance in a society where cardiovascular morbidity and mortality are predominant.

Jacobsen syndrome (JS) is a contiguous gene syndrome caused by partial deletion of the long arm of chromosome 11. The syndrome is rare and there are very few observations regarding the pubertal period of the affected individuals. We report the case of a 22-year-old female, with JS, monitored since the age of three months. She presented intrauterine growth retardation, failure to thrive and feeding difficulties from the first year of the life, and she learned to walk at the age of four years. Phenotypically, the case is characterized by distinctive facial and limb abnormalities. She shows spasticity and profound delay in gross and fine motor skills. Additionally, she has severe learning difficulties, non-verbally communicates, and displays hetero-aggressive and auto-aggressive behavior. The evolution of puberty was characterized by hypogenitalism and primary amenorrhea. Thrombocytopenia and IgM deficiency became apparent also at puberty. Array comparative genomic hybridization (aCGH) analysis confirmed a deletion of 16.3 Mb on 11q23.3-q23.4. We report this case as the first documented case of JS in Romania, as well as for clinical particularities (long period of survival and late appearance of hematological and immunological disorders).

The study of bacterial pathogeny represents a very important issue for the forensic specialists, clinicians, managers and healthcare policymakers. The purpose of this experimental research is to study the virulence of some infectious microbial agents (Pseudomonas Aeruginosa, Staphylococcus Aureus, Escherichia Coli, Proteus Mirabilis, Erysipelothrix Rhusiopathiae), some of them frequently involved in violent deaths presenting septic states, by inoculating them in white mice Mus Musculus (MMs), in the presence of competing factors of death, reproducing this way a model of human violent death consecutive of septic complications that occur in the evolution of some traumas.The results of the study show that the survival period of the MMs depends on the microbial agent of the inoculated strain, the dilution of the culture suspension, the presence of associated lesions, age. In decreasing order, according to the value of LD50, the most virulent strains are Erysipelothrix Rhusiopathiae, Escherichia Coli, Proteus Mirabilis, followed by Staphylococcus Aureus and Pseudomonas Aeruginosa. The lethality index increases proportionally with the virulence of the etiologic agent and the presence of the associated lesions, confirming once again the similarity with�physiopathological mechanisms that exist in human pathology.

We investigated the immunohistochemical expression of E-cadherin (product of CDH1 gene) and its correlation with clinical-pathological parameters and survival rate in the molecular groups of breast cancer. Our study included female breast cancer patients diagnosed at the Municipal Emergency Clinical Hospital Timisoara followed up five years since diagnosis using formalin fixed paraffin embedded tissue. The traditional prognostic factors (age, tumor size, histological type, histological grade, anatomical status of the lymph nodes) were abstracted from histopathology reports and we set prognostic index (the Nothingham and lymph-node prognosis index). Molecular classification on selected cases was performed in agreement with data from the literature: luminal A, B, HER2+, triple-negative. We noted positive (membranar) expressions in 43 cases (70.49 %). Negative immunoreactions for E-cadherin have been observed in all cases of lobular carcinomas (4 cases), as well as 6 cases of mixed carcinomas. A significant correlation was found between E-cadherin expression and hormonal status, tumor size, histologic type, tumor grade and molecular subtype. Most of the luminal A and B tumors were E-cadherin positive, while more than half of non-luminal tumors were E-cadherin negative. Survival rates are different in the negative and positive E-cadherin tumor groups respectively and between luminal and non-luminal groups. E-cadherin expression may be a useful prognostic marker for classifying other subgroups of breast cancer.