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Background: The ongoing COVID-19 pandemic has put a constant strain on hospital resources, so there is a dire need for investigation methods that are widely available and that can predict mortality and the need for critical care. Hematological indices, which can be easily calculated from a complete blood count (CBC), are useful in determining a patient’s inflammatory response to infectious diseases. Aim: This was a prospective cohort study that aimed to assess the prognostic value of scores based on CBCs in hospitalized patients with mild or moderate COVID-19 and medical comorbidities regarding the need for intensive care unit (ICU) therapy and short-term mortality. Methods: We included 607 patients with confirmed COVID-19, followed up for the need for ICU admission (15.5%) and 30 day mortality post-discharge (21.7%). CBC-derived scores were tested upon emergency department (ED) admission and after a median of 8 days. Results: In a multivariate model, elevated followed-up neutrophil-to-lymphocyte ratio (NLR) predicted increased odds for ICU admission (OR: 1.14 [95%CI: 1.06–1.22], p < 0.001) and short-term mortality (OR: 1.30 [95%CI: 1.09–1.57], p = 0.005). Monocyte-to-lymphocyte ratio (MLR) predicted 2.5-fold increased odds for ICU admission and 2.2-fold increased odds for mortality. Conclusion: NLR and MLR followed up 8 days post-admission are predictive for adverse outcomes in mild or moderate COVID-19 patients.

Serotonin syndrome (SS) is a clinical toxidrome with high variability in clinical practice. It develops due to increased serotonin levels in the central nervous system. With an underestimated frequency, SS can develop following an overdose, a therapeutic dose increase, or drug to drug interaction of at least one serotonergic agent. It can present with autonomic signs, neuromuscular changes and an altered mental status. However, history and clinical examination are key features to formulate the diagnosis. Treatment options consist of supportive measures, discontinuation of the offending agent and certain therapeutic agents previously reported to improve outcomes. Physicians have limited experience with SS, partially due to the lack of its identification in clinical practice. Therefore, we have integrated, in a narrative review, the case of a young male with SS following an atypical antipsychotic overdose superimposed on chronic treatment with agents previously known to produce SS.

The aim of this paper is to describe the temporal progression and clinical picture of a 2-year-old child with infantile Refsum disease, as well as the diagnostic procedures performed; this case presented multiple hematologic, metabolic, and developmental complications and progressive disabilities. Genetic testing revealed a mutation of the PEX6 (Peroxisomal Biogenesis Factor 6) gene, and the metabolic profile was consistent with the diagnosis. Particularly, the child also presented altered coagulation factors and developed a spontaneous brain hemorrhage. The clinical picture includes several neurological, ophthalmological, digestive, cutaneous, and endocrine disorders as a result of the very long chain fatty acid accumulation as well as secondary oxidative anomalies. The study of metabolic disorders occurring because of genetic mutations is a subject of core importance in the pathology of children today. The PEX mutations, difficult to identify antepartum, are linked to an array of cell anomalies with severe consequences on the patient’s status, afflicting multiple organs and systems. This is the reason for which our case history may be relevant, including a vast number of symptoms, as well as modified biological parameters.

Infective endocarditis is a severe infective heart disease, commonly involving native or prosthetic valves. It frequently presents with univalvular involvement and simultaneous double valve or multivalvular involvement is rarely described. The third leading cause of infective endocarditis worldwide is Enterococcus faecalis, which is associated with high mortality rates despite important advances in antimicrobial therapy. It develops secondary to enterococcal bacteremia, with its origin from the gastrointestinal or genitourinary tract and predominantly affecting the elderly population with multiple comorbidities. Clinical presentation is usually less typical, and the treatment is challenging. It can be marked by antibiotic resistance, side effects, and subsequent complications. Surgical treatment can be considered if deemed appropriate. To the best of our knowledge, we present the first case-based narrative review of Enterococcus faecalis double valve endocarditis involving both the aortic native and prosthetic mitral valve, highlighting the clinical characteristics, treatment, and complications of this condition.

Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated, fluid-overloaded patients. The pathophysiology of hyponatremia in patients with heart failure is complex, including numerous mechanisms: increased activity of the sympathetic nervous system and the renin–angiotensin–aldosterone system, high levels of arginine vasopressin and diuretic use. Symptoms are usually mild but hyponatremic encephalopathy can occur if there is an acute decrease in serum sodium levels. It is crucial to differentiate between dilutional hyponatremia, where free water excretion should be promoted, and depletional hyponatremia, where administration of saline is needed. An inappropriate correction of hyponatremia may lead to osmotic demyelination syndrome which can cause severe neurological symptoms. Treatment options for hyponatremia in heart failure, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The aim of this review is to summarize the principal mechanisms involved in the occurrence of hyponatremia, to present the main guidelines for the treatment of hyponatremia, and to collect and analyze data from studies which target new treatment options, such as vaptans.

The pathogeny of the metabolic syndrome (MetS ) is not fully elucidated, but a link between visceral obesity and the increase of the proinflammatory response was proven. Atherosclerosis, perceived as a metabolic complication, draws attention to the peroxisome proliferator-activated receptors- alpha (PPARα). PPARα receptors are transcription factors involved in lipid metabolism, inflammation and atheromatosis. Hence, it interferes in the pathogeny of cardiovascular diseases and other chronic diseases too (neurological, psychical, neoplasical). The study of the expression of PPARα and its modulation on different level may be beneficial in the treatment of metabolic syndrome, intervening in the modulation of another proinflammatory factors.

Background and Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, patients with chronic diseases suffering exacerbations have required acute medical care. The purpose of our study was to determine useful criteria for the differentiation of patients with acute clinical syndromes and suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Materials and Methods: This was an observational retrospective study, conducted in an internal medicine clinic from April to May 2020. We collected clinical, biological, and computed tomography (CT) data on patients with exacerbations of chronic diseases and clinical suspicion of SARS-CoV-2 infection. Patients with an already-positive real-time reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 on presentation at the emergency department were excluded from our study. Results: Of 253 suspected cases, 20 were laboratory-confirmed as having SARS-CoV-2 infection by RT-PCR, whereas COVID-19 diagnosis was ruled out in the remaining 233. Venous thromboembolism (VTE) correlated significantly with COVID-19 diagnosis in suspected patients, while laboratory markers were not significantly different between the two groups. Of the suspected patients, significantly higher percentages of dry cough, fever, myalgias, sore throat, loss of smell and appetite, and ground-glass opacities (GGOs) on CT were found in SARS-CoV-2-positive individuals. Conclusions: The study demonstrated that, until receiving the result of an RT-PCR test for SARS-CoV-2 (usually 12–24 h), association with VTE as a comorbidity, fever, dry cough, and myalgia as clinical features, and GGO on CT are the main markers for the identification of COVID-19 patients among those suspected with acute clinical syndromes. Our results also provide evidence for doctors not to rely solely on biological markers in the case of suspected SARS-CoV-2 infection in patients with exacerbations of chronic diseases. These data are useful for faster decision-making with regard to suspected COVID-19 patients before receiving RT-PCR test results, thus avoiding keeping patients in crowded emergency departments.

Objectif. L’objectif de notre étude est d’évaluer la pression artérielle et la pression différentielle chez les patients atteints du syndrome métabolique (SM), afin de déceler et de prévenir les complications cardiovasculaires qui peuvent survenir chez ces patients. Matériels et méthodes. L’analyse des cas‑témoin a été faite sur un total de 1528 patients, dans un cabinet de médecine familiale, les sujets étant répartis en deux groupes: le lot avec SM et le groupe témoin (sans SM). Le groupe avec SM se composait de 388 patients diagnostiqués selon les critères harmonisés. Le groupe témoin sans SM était composé de 1140 patients n’ayant pas présenté au moins trois critères diagnostiques du syndrome métabolique. Résultats. La pression différentielle, les valeurs calculées pour les patients atteints de syndrome métabolique ont été généralement plus élevées que le taux moyen escompté à 40 mmHg, avec une valeur moyenne de 47,86 ± 12,02 mmHg. Le groupe de contrôle a une valeur moyenne (40,28 ±12.20 mmHg) du pouls, une pression significativement plus faible (p

Irritable bowel syndrome (IBS) is one of the most common diseases of gastro-enterology, associating abdominal pain, transit disorders and changes in the consistency of the stools. Material and method. The study included 200 patients suffering from IBS, selected from a total of 2,300 patients of a family medicine practice in urban area. For diagnosis and classification, Rome III criteria and Bristol scale were used. For a subgroup was applied a questionnaire for the evaluation of quality of life, QoL. Treatment was initiated on three levels. Results. The incidence of the disease during the 3 years of study (2013-2016) was 2.9%. The type of IBS most often encountered was the one with dominance of constipation (IBS-C 32.5%), followed by the alternating form (IBS-A 26%), mixed (IBS-M-24%) and the dominance of diarrhea (IBS-D 18.5%). Form with more severe impact on the quality of life is IBS-C – 52.24 score, and most easily tolerated IBS-A – 69 score. Treatment was initiated at the on level I at 33% of the patients at the on level II to 36 %, and on level III to 31% of the patients. Maximum efficiency of treatment scores were obtained from patients on treatment level III. Complete remission of symptoms is obtained only in 9.5% of total patients. Conclusions. SII is a common condition in family medicine practice, due to changes in the modern diet. The diagnosis can be facilitated by the application of questionnaires, and treatment is based on changes in lifestyle and on pharmacological agents.

This descriptive epidemiological study included 615 subjects investigated by their family doctor in the interval October 2011- August 2012.Patients were selected according to 2012 IDF diagnostic criteria resulting 304 patients.There was a Gaussian distribution of waist circumference (WC) with a maximum in age-group 70-80 years (46.3%), followed by age- groups 50-60 years (37.8%) and 60-70 years (41.6%). Waist circumference measurement showed an average of 100.76 +/- 11.59 cm, ranges 72 cm - 134 cm, without statistical significance. Mean body mass index (BMI) was 28.25 +/- 4.72 kg/m2 vs. 27.79 +/- 4.48 kg/m2. The difference is statistically significant (p = 0.05). Considering categorical the patients with hypertension (AHT) according to the definition, we found that only 7 cases did not have AHT (4.4%) as compared to a prevalence of AHT of 13.7% in the MS (metabolic syndrome) group. Mean serum triglyceride level was 123.11 +/- 68.55 mg/dl versus 113.75 +/- 65.62 mg/dl in the MS group, significantly higher (p0.003). Mean HDL cholesterol was 57.58 +/- 17.11 mg/dl versus 58.54 +/- 15.02 mg/dl, statistically significant difference (p0.05).The prevalence of glucoregulation disorders is higher in the MS group. Proportional relationships were found between BMI, WC, and SBP and high blood glucose. Comparison of blood glucose levels at baseline and at 1 year follow up showed significant differences.

To identify the specific risk factors for chronic hepatitis B/C virus infections in the correctional system in Moldova (Romania).The study included 533 subjects imprisoned in three correctional facilities located in the Northern region of Moldova. The subjects were divided into 2 groups: HBV/HBC group--108; Control group--425.The risk factor for transfusion-contracted HBV/HCV was 3.73; the empirical treatment of the HBV/HBC group resulted in a relative infection risk of 2.62; syringe sharing in the HBV/HBC group accounted for a risk factor of over 4 (OR = 4.33); tattooing induced a relative risk factor of 1.25, and piercing was a risk factor of approximately 2 (OR = 1.97); sharing personal care items represented a risk factor of over 2 (OR = 2.02). Injection drugs induced a relative risk of over 4 (OR = 4.33). In the HBV/HCV group, self-aggression represented a risk factor of 1.65.Prison environment, by its specific and nonspecific contamination modalities (shared with the rest of the population but more common) causes that inmates to be 2-4 times more exposed to hepatitis B/C infection.

To evaluate the presence and role of stress in causing diseases.We conducted a 6-month study in patients who presented for the first time with a series of symptom and tried to look for an organic cause of those symptoms. We wanted to see the impact of stress in everyday life and its role in causing various diseases.The obtained results showed a female predominance in terms of seeking medical advice and that the most affected age group was 20-30 years, accounted for by the start of socio-professional issues. The psycho-behavioural symptoms were the most prevalent, followed by the gastro-intestinal ones. The presence of stress had left its mark on these events, fact proven by the lower rate of organic pathology.Stress awareness must guide us in medical practice as to avoid under- or over-diagnosis.

Introduction. Metabolic syndrome (MS) is a cluster of distinct metabolic alterations with an increased cardiovascular risk. Peroxisome Proliferator-Activated Receptor - Alpha (PPARα), member of the nuclear receptor superfamily of transcription factors, is critically involved in the management of lipid metabolism during homeostasis or inflammatory stresses in various cell types and represents one of the therapeutic targets in MS. We analysed the PPARα expression in leukocytes of pacients with MS, in order to address PPARα involvement in these group of diseases. Material and method. Our study included 57 adult patients recruited under informed voluntary consent, investigated in order to establish whether they present MS, according to International Diabetes Federation (IDF) European guidelines and grouped in 2 lots: the MS Lot (26 patients) and control group, non-MS Lot (31 subjects). Common clinical and laboratory parameters targeted in MS evaluation were determined for all the studied cases. The expression levels of 2 molecules, PPARα and CD36 were evaluated in various circulating leukocyte populations of these patients by an optimized flow cytometry method. Statistic analysis clarifying the significance of value differences for various parameters measured was performed under SPSS and simple statistical tests (Pearson, t-Student, Chi -test). Results and discussion. The fluorescence staining for PPARα were significantly dimmer when comparing the cellular expression in eosinophils (p

What does obesity mean? One of the people's health markers is the nutritional steady-state, the mean ponderal equilibrium. The normal weight means the longest life expectancy assuring body weight, from all points of view. The body weight increasing means adipose tissue accumulation and the onset of obesity. Obesity quantification could be made by BMI (body mass index)--normal range 22-24 kg/m2- waist to hip ratio--normal range 0.8-0.9--and abdominal perimeter--normal range up to 80 cm. Why should we do obesity prevention? Because obesity means a high risk factor for cardio-vascular disease, cancer, bone diseases, general mortality. By 10 kg weight loss, real benefits are achieved: left ventricle hypertrophy reduction, decreasing of cardio-vascular risk, pulmonary function improve, reducing of atherosclerotic symptoms by 91%, of arterial pressure by 10-20 mmHg, of diabetes mortality by 30%, cancer by 40% and general mortality by 20%. In our country, 53% of population is overweight and obese, predominantly urban population. Obesity costs are high: about 4-8% of health budget are spent for screening, diagnosis and obesity management, including economical losses. When should we do obesity prevention? Primary care physicians must control all health indexes. If the patient passes over normal ranges of body weight, we should take account and intervene efficiently, by specific and non-specific therapeutic methods. How could we do obesity prevention? General care physicians and specialists could prevent efficiently this disease by taking apart obesity causes and risk factors: genetics, life-style, drug intake, smoking, professional and endocrine factors. Primary and secondary care physicians have to screen high risk persons, to analyze professional, familial and social conditions, to appreciate educational and economical status. All these realize an integral obesity management, together with the psychologist and the sociologist. Secondary prevention means obesity treatment, in order to prevent complications and, in the same time, to maintain normal body weight after ponderal excess loss. Obesity prevention is an important and complex social problem to debate. We have to mobilize political and economical factors, food industry, education. Obesity control means protection against one of the most aggressive health risk factors.

Functional diseases of digestive tract are an ubiquitary problem of diagnosis and treatment for ambulatory care services. Its evolution is chronicle but there are no organic lesions for the beginning. Nevertheless, it impairs quality of life and creates many days of incapacity of work.We studied 1118 cases with digestive malfunctions, selected from the patients consulted on Ambulatory Care Unit--Internal Medicine, 2007-2008.Basal clinical and laboratory explorations classified the type of digestive malfunctions according to international criteria. So we found these types of anomalies: gastro-oesofagial reflux--788 cases; peptic-like syndrome--752 cases; pyloric functional spasm--385 cases; helicobacter pyloridi positive--632 cases; gallblader dysfunction--767 cases; irritable bowel syndrome--872 cases. The treatment was applied pursued the pathological status. Most of cases had un diagnosticated diseases as peptic ulcer, gastritis, gallbladder diseases.Our conclusions are that the whole tract has continuity and the site of dysfunction is difficult to diagnose from the beginning. Pro-kinetic drugs and inhibitory of gastric secretion have very good results. The same time we must treat the "background"--extra digestive factors (i.e., Helicobacter pylori infection).

Lipid metabolism disorders--breast cancer risk association in postmenopausal women was searched in many studies; the HDL-cholesterol value triggered most of controversies. Some authors plead for increased breast cancer risk in overweight/obese postmenopausal women if HDL is higher while others plead for higher risk if HDL is lower then in general population.We studied a 110 subjects female population aged between 41 and 69, and determined height, weight, body mass index (BMI), abdominal perimeter (AP), lipid parameters (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides). All women performed mammography and breast echography. Imagery divided the subjects in three groups: 30 breast cancer patients (first diagnosis)--group 1, 50 breast dysplasia women--group 2, and normal breast patients--group 3.HDL-cholesterol proved significantly higher in group 2 compared to group 3 (control group), by the third and the fourth quartile; the same when it came to overweight/obese post-menopausal women. Nevertheless, more lipid disorders clustered in group 1 obese/overweight postmenopausal women.High HDL in breast dysplasia women is reported in international studies too. High menopause prevalence in group 3, implying abdominal obesity and lipid disorders may explain the small difference between group 1 (breast cancer patients) and group 3 (control group). High clustering in group 1 pleads for increased breast cancer risk in metabolic syndrome postmenopausal women. Comparing HDL values and the clustering phenomenon in group 1 to the other two groups considered as a control population (as done in international published studies), we can conclude that low HDL--abdominal obesity association increases breast cancer risk after the menopausal age.

The 1998 report on the occasion of the 4th anniversary of International obesity Task Force emphasized that overweight (BMI25) is also linked to the increasing incidence of some neoplasias--breast, colon, endometer, prostate or kidney. Carmichael and Bates showed an inverse relationship between BMI and perimenopausal breast cancer.We studied a group of 110 patients divided in three subgroups--30 patients who had just been diagnosed with breast cancer; 50 patients with breast dysplasia diagnosed by mammography and mammary echography; 30 patients with no modifications on mammography or breast echography. Height, weight, abdominal and hip perimeter have been measured. All have performed complete lipidogramme as well as serum estradiol.15 of the 30 breast cancer patients (50%) were obese with a WHR0.8 compared to 23 (46%) in the mastosis group and 20 (66%) in the reference group. The prevalence differences were not significant, but the association between abdominal obesity and increased serum estradiol is highly significant for group I compared to the other groups (p0.01).Our study confirms that android obesity and estrogens are linked to breast carcinogenesis promotion by synergic or common pathways.

To analyse obesity and metabolical complications (cardiovascular disease) in an obese population, Iasi county compared to the nonobese population of the same locality.Cross-sectional study on two groups: group 1--the witness group--48 cases normal weight and group 2--the study group--50 obese patients.High values of abdominal perimeter (AP) associate with high glycemia, high triglycerides and low HDL-col in obese patients; higher evidence of X syndrome elements association in the obese population; higher global risk for the obesity in modern life conditions; teenagers obesity trigger are small birthweight and perinatal malnutrition in 30% of cases.

The body mass index (BMI) shows a rate of 17.4% patients suffering from first degree fatness and 56.5% from second degree fatness. The frequency of the illness increases with age, the differences established being statistically important for a p of 0.001. 45.6% persons were diagnosed with HTA, with differences statistically important at a p of 0.01, so the number of cases increases with age. The same situation is to be found in cardiovascular illnesses (angina pectoris, ischaemic cardiopathy). The high level of cholesterol is more frequent at older people, and still the differences established are statistically not significant. In these conditions, the diet must be adapted to the patient's condition. A comparative study was made on groups of age, using the following groups of food: cereal derivatives, vegetables, fruits, dairy product, meat, fish. In most of the cases, the differences established are statistically not significant. So, even if the diagnosis is known, the patient doesn't give up his eating habits.

The aim of our study was to correlate "medium" dyslipidemias with cardio-vascular diseases, especially essential hypertension (EHT). We selected 488 cases using randomization, from a population of hypertensive people. About 210 cases benefited by lipidograms and risk assessment, using special diagrams. When cholesterol was 200-250 mg/dl, 72% of cases had EHT and over 300 mg/dl, 57% had EHT. Comparing LDL chol with EHT, we obtained that arterial tension over 160 mmHg is correlated with LDL over 190 mg/dl on 12%, when LDL was less than 190 mg/dl but more than 150 mg/dl, we found EHT on 16% cases. EHT was very strong correlated with HDL40 mg/dl, 88%. On 5% of cases the only one dyslipidemia was marked by low HDL chol and all this cases had EHT. A particular risk was represented by the dyslipidemia with low HDL chol and high triglycerides (28% of cases). We concluded that the highest prevalence was for medium hypercholesterolemia with/or low HDL chol and, the same time, extreme values had comparable prevalences with medium values.

Our study is a part of a national study initiated by ARSO (Romanian Association for Study of Obesity). We selected a statistically representative sample (1500 cases). Study was built upon a questionnaire, made by primary care physicians. Anthropometrical data evaluated the obesity (weight, waist circumference and body mass index, BMI) and we considered associated risk factors (cholesterol levels, diabetes, and hypertension). BMI, more than 25 and 30, defines overweight and obesity. Waist more than 80 cm, for women and 94 cm for men, was considered abdominal obesity. Prevalence of obesity was globally 28.69%, by BMI and abdominal obesity, 57.87%. Non-obese cases are mostly on 20-29 years (2:1), both sex and 30-39 years, mostly on women. After these decades, percents for overweight and obesity are, constantly, more on women (48%) than men (31.03%). Abdominal obesity rises constantly with age, between 42.8% and 73.04%. A lot of patient didn't know theirs cholesterol values, over 25%. The highest percent of high cholesterol is located on 50-59 years (42%) and 35.63% on previous decade. High number of menopausal women can explain this.1. We consider a high prevalence of obesity, 28.69%, predominant on women and aged persons. 2. Abdominal obesity has higher prevalence, 57.87%. 3. There are multiple risk factors, especially on 50-59 years decades but are not searched sufficiently.

We present a case of diltiazem overdose in which the patient ingested 5.6 g in an apparent suicide attempt. She was admitted in the emergency department 2 hours postingestion with cardiodepressive syndrome. She was treated with gastric lavage, activated charcoal, intravenous fluids, calcium, and epinephrine, without improvement in vital signs. We gave her an infusion of 20% intralipid, leading to a favorable evolution. The patient was stable hemodynamically and metabolic in the following 24 hours. She was alert and oriented and was extubated in the second day. She was discharged after 4 days in a good state and without any neurologic deficits.