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Non-alcoholic fatty liver disease (NAFLD) represents a complex chronic condition, which in the absence of screening–monitoring markers and effective standardized treatment is one of the most important issues in pediatric pathology. In this study, we analyzed the role of vitamin D supplementation in obese children with/without NAFLD and the impact on the components of the associated metabolic syndrome (MS). The study included 22 children with simple obesity (SO) and 50 with NAFLD, aged between 6 and 14 years, who received regimen-based therapy or vitamin D supplementation in case of deficiency. Anthropometric and paraclinical data associated with MS were statistically compared before and after treatment. It was observed that there was a statistical association of NAFLD with MS components, which were present both in SO and in the 6–9 years group. Vitamin D deficiency was associated with the presence of obesity, NAFLD and MS components, and correction of the deficiency induced a tendency to normalize the associated parameters. In the case of a treatment strictly based on the regimen, we found decreases in vitamin D values and additional alteration of some parameters. Supplementation with vitamin D potentiates the effects of the specific regimen, and the effects seem to be dependent on the MS components.

Introduction Performing a colonoscopy allows the examination of the entire colon and the assessment of polyps. Patients, materials and methods We performed a retrospective analysis of prospectively collected data from January 2018 until February 2020 (two years), in which we enrolled a number of 210 patients performing colonoscopy in the Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania. We performed 326 polypectomies. Results We classified the polyps into diminutive (n=169), small (n=103) and large polyps (n=54). Regarding the polypectomy technique, our results indicated that 40 out of 48 (83.3%) polypectomies with the biopsy forceps were complete, as well as 27 out of 31 (87.1%) cold snare polypectomies and 12 out of 14 (85.7%) hot snare polypectomies. The differences were not statistically significant (p=0.116). Regarding the number of incomplete polypectomies, our data suggests that the high expertise endoscopist had two incomplete resections (5.1% of total), the medium expertise endoscopist 1 had also two incomplete resections (11.1% of total), the medium expertise endoscopist 2 had three incomplete resections (15% of total), the limited expertise endoscopist 1 had three incomplete resections (27.27% of total) and the limited expertise endoscopist 2 had four incomplete resections (30.76% of total). Analyzing the data, the differences were statistically significant (p=0.006). Conclusions Our study is able to suggest that high-definition white-light endoscopy (HD-WLE) macroscopic visualization of the polyp resection site is not enough to assess complete polyp resection and follow-up colonoscopy should be performed for cases with incomplete margins of resection.

Cholestatic jaundice is usually linked to a malignant disease when it is secondary to a mechanical obstruction of the bile duct or due to hepatic metastasis. As a paraneoplastic syndrome, cholestasis has been described in lymphoproliferative disorders, in prostate cancer and as the Stauffer syndrome with non-metastatic dysfunction in patients with renal cell carcinoma (RCC). We present the case of a 61 year old patient with a paraneoplastic manifestation with cholestatic jaundice due to RCC with kindney and lung metastases. Clinical characteristics of patients with RCC vary and sometimes manifest in a peculiar way. Cholestatic jaundice is a rare paraneoplastic syndrome associated with RCC and with the exclusion of more frequent causes, it should be taken into account in the differential diagnosis. This rare but possible association requires prompt recognition, as prognosis correlates with disease stage and influences patient’s overall survival, and an early recognition of this syndrome may improve, sometimes, patients’ outcome.

Petrica Popa,1,* Sevastita Iordache,1,* Dan Nicolae Florescu,1,* Vlad Florin Iovanescu,1,* Alexandru Vieru,2 Valentin Barbu,2 Maria-Cristina Bezna,3,* Dragos Ovidiu Alexandru,4,* Bogdan Silviu Ungureanu,1,* Sergiu Marian Cazacu1,* 1Gastroenterology Department, University of Medicine and Pharmacy Craiova, Craiova, Dolj County, Romania; 2Gastroenterology Department, Clinical Emergency County Hospital Craiova, Craiova, Dolj County, Romania; 3Cardiology Department, Clinical Emergency County Hospital Craiova, Craiova, Romania; 4Department of Medical Informatics and Statistics, University of Medicine and Pharmacy Craiova, Craiova, Dolj County, Romania*These authors contributed equally to this workCorrespondence: Dan Nicolae Florescu, University of Medicine and Pharmacy Craiova, Gastroenterology Department, Petru Rares Street No. 2-4, Craiova, Dolj County, 200349, Romania, Tel +40723377004, Fax +40251426688, Email nicku.dan@gmail.comIntroduction: During the last few years, a progressive higher proportion of patients have had upper gastrointestinal bleeding (UGIB) related to antithrombotic therapy. The introduction of direct oral anticoagulant (DOAC) and COVID-19 pandemic may change the incidence, mortality, and follow-up, especially in patients at high risk of bleeding.Patients and Methods: We studied the use of anti-thrombotic therapy (AT) in patients with upper gastrointestinal bleeding for 5 years (January 2017–December 2021) including Covid-19 pandemic period (March 2020–December 2021). We analyzed mortality rate, rebleeding rate and need for transfusion in patients with AT therapy compared with those without AT therapy and risk factors for mortality, and also the incidence of gastrointestinal bleeding in patients admitted for COVID-19 infection.Results: A total of 824 patients were admitted during Covid-19 pandemic period and 1631 before pandemic period; a total of 426 cases of bleeding were recorded in patients taking antithrombotic therapy and the frequency of antithrombotic therapy in patients with UGIB was higher in pandemic period (24.39% versus 13.8%). Unadjusted mortality was 12.21%, similar with patients with no antithrombotic treatment but age-adjusted mortality was 9.62% (28% lower). The rate of endoscopy was similar but fewer therapeutic procedures were required. Mean Hb level was 10% lower, and more than 60% of patients required blood transfusion.Conclusion: Mortality was similar compared with patients with no antithrombotic therapy, fewer therapeutic endoscopies were performed and similar rebleeding rate and emergency surgery were noted. Hb level was 10% lower and a higher proportion of patients required blood transfusions. Mortality was higher in DOAC treatment group compared with VKA patients but with no statistical significance. The rate of upper gastrointestinal bleeding in Covid-19 positive hospitalized cases was 0.58%. The mortality risk in multivariate analysis was associated with GB score, with no endoscopy performed, with obscure and variceal bleeding and with LMWH versus VKA therapy.Keywords: Covid-19, direct oral anticoagulant therapy, acenocoumarol, antithrombotic therapy, upper gastrointestinal bleeding

Introduction Amongst all malignant tumors, cancers of the digestive tract rank first in terms of yearly deaths. Patients above 60 years of age are the most affected, as the diagnosis is frequently made in advanced stages of the disease when therapy is less effective. Our study aimed to evaluate the efficiency of narrow-band imaging (NBI) endoscopy and probe-based confocal laser endomicroscopy (pCLE) in the correct diagnosis of preneoplastic lesions in the upper and lower digestive tract. Patients, materials and methods We included 46 patients with digestive preneoplastic lesions, who underwent either upper or lower digestive endoscopy, followed by NBI and pCLE. We recorded 5-10 frames per each lesion, from different angles and distances during white-light endoscopy and selected frames from full recordings of NBI and pCLE. Usual preparation was used for the endoscopic procedures; pCLE required in vivo administration of 10% Sodium Fluorescein as a contrast agent. Pathology was performed in case of solid tumors. Three medical professionals with different levels of training, blinded to the results, interpreted the data. Results The experienced physician correlated very well the NBI findings with pathology (0.93, p=0.05), while the resident physician and the experienced nurse obtain lower, albeit still statistically significant, values (0.73 and 0.62, respectively). For pCLE, the experienced physician obtained near-perfect correlation with pathology (0.96), followed closely by the resident physician (0.93). The nurse obtained a modest correlation (0.42). All examiners obtained approximately equal performances in discerning between malignant and benign lesions. Conclusions Digestive endoscopy in NBI mode proved its effectiveness. Even less experienced endoscopists can achieve good results, while an experienced nurse can positively influence the diagnosis. In the case of pCLE, when available, it can greatly reduce diagnostic times, while requiring higher expertise and specialty training.

Thrombocytopenia is defined as a platelet count below 150,000/mm3 for adults. There is still controversy about whether individuals with platelet counts of 100,000/mm3 to 150,000/mm3 should be classified as having genuine thrombocytopenia or borderline thrombocytopenia. Thrombocytopenia is considered mild when the platelet count is between 70,000 and 150,000/mm3 and severe if the count is less than 20,000/mm3. Thrombocytopenia in rheumatoid arthritis is a rare complication, with an incidence estimated between 3 and 10%. The main etiological aspects include drug-induced thrombocytopenia and immune thrombocytopenic purpura. The most common hematological abnormalities in SARS-CoV-2 infection are lymphopenia and thrombocytopenia. It has been observed that the severity of thrombocytopenia correlates with the severity of the infection, being a poor prognosis indicator and a risk factor for mortality. COVID-19 can stimulate the immune system to destroy platelets by increasing the production of autoantibodies and immune complexes. Autoimmunity induced by viral infections can be related to molecular mimicry, cryptic antigen expression and also spreading of the epitope. During the COVID-19 pandemic, it is of great importance to include the SARS-CoV-2 infection in differential diagnoses, due to the increased variability in forms of presentation of this pathology. In this review, our aim is to present one of the most recently discovered causes of thrombocytopenia, which is the SARS-CoV-2 infection and the therapeutic challenges it poses in association with an autoimmune disease such as rheumatoid arthritis.

The current case report presents a patient diagnosed with Behcet disease in concurrence with psoriatic arthritis, leading to a complex treatment, difficult management and challenging approach of both rheumatic disorders. After treatment with synthetic disease-modifying drugs and three different TNF inhibitors, the patient developed pulmonary tuberculosis, followed by tuberculosis spondylodiscitis, even after proper anti-tuberculosis therapy.

The majority of studies concerning Helicobacter pylori (H. pylori) are oriented towards the implication of infection with H. pylori in processes that end in the formation of neoplasia, without assessing the impact of the bacterium in triggering acute gastroduodenal hemorrhagic episodes. The present study includes 166 patients with upper digestive hemorrhage, admitted to the ATI Clinic, the Gastroenterology Clinic or to the Surgery II Clinic of the County Emergency Clinical Hospital in Craiova, Romania between 2017 and 2019. All patients were monitored for evolution and received treatment according to current guidelines, and hemorrhagic lesions were biopsied. In the study group, 56.8% of the patients with upper gastrointestinal bleeding (UGIB) were positive for H. pylori and 43.2% were negative. In patients less than 50 years of age, non-steroidal anti-inflammatory drug (NSAID) use and H. pylori infection had a cumulative effect in causing bleeding lesions, but in patients older than 50 years of age, the use of NSAIDs was replaced by therapies with oral antiplatelet or anticoagulant agents. The need for hemostasis surgery was more common in patients who exhibited H. pylori-positive UGIB compared to H. pylori-negative (16 vs. 9.7%). In patients with H. pylori-positive hemorrhagic lesions, gastric resection was frequently required to obtain hemostasis. Persistence of H. pylori infection in patients with a history of gastric resection (4.1%) still predisposes to a hemorrhagic or neoplastic complication.

The majority of studies concerning Helicobacter pylori (H. pylori) are oriented towards the implication of infection with H. pylori in processes that end in the formation of neoplasia, without assessing the impact of the bacterium in triggering acute gastroduodenal hemorrhagic episodes. The present study includes 166 patients with upper digestive hemorrhage, admitted to the ATI Clinic, the Gastroenterology Clinic or to the Surgery II Clinic of the County Emergency Clinical Hospital in Craiova, Romania between 2017 and 2019. All patients were monitored for evolution and received treatment according to current guidelines, and hemorrhagic lesions were biopsied. In the study group, 56.8% of the patients with upper gastrointestinal bleeding (UGIB) were positive for H. pylori and 43.2% were negative. In patients less than 50 years of age, non-steroidal anti-inflammatory drug (NSAID) use and H. pylori infection had a cumulative effect in causing bleeding lesions, but in patients older than 50 years of age, the use of NSAIDs was replaced by therapies with oral antiplatelet or anticoagulant agents. The need for hemostasis surgery was more common in patients who exhibited H. pylori-positive UGIB compared to H. pylori-negative (16 vs. 9.7%). In patients with H. pylori-positive hemorrhagic lesions, gastric resection was frequently required to obtain hemostasis. Persistence of H. pylori infection in patients with a history of gastric resection (4.1%) still predisposes to a hemorrhagic or neoplastic complication.

Clostridioides difficile infection (CDI) stands as the leading cause of nosocomial infection with high morbidity and mortality rates, causing a major burden on the healthcare system. Driven by antibiotics, it usually affects older patients with chronic disease or immunosuppressed or oncologic management. Variceal bleeding secondary to cirrhosis requires antibiotics to prevent bacterial translocation, and thus patients become susceptible to CDI. We aimed to investigate the risk factors for CDI in cirrhotic patients with variceal bleeding following ceftriaxone and the mortality risk in this patient’s population. We retrospectively screened 367 cirrhotic patients with variceal bleeding, from which 25 patients were confirmed with CDI, from 1 January 2017 to 31 December 2019. We found MELD to be the only multivariate predictor for mortality (odds ratio, OR = 1.281, 95% confidence interval, CI: 0.098–1.643, p = 0.042). A model of four predictors (age, days of admission, Charlson index, Child–Pugh score) was generated (area under the receiver operating characteristics curve, AUC = 0.840, 95% CI: 0.758–0.921, p &lt, 0.0001) to assess the risk of CDI exposure. Determining the probability of getting CDI for cirrhotic patients with variceal bleeding could be a tool for doctors in taking decisions, which could be integrated in sustainable public health programs.

The COVID-19 pandemic is currently delaying the process of chronic hepatitis C (HCV) eradication, since most of the chronic diseases are neglected. Thus, there is a need for alternative programs for HCV therapy implementation and disease monitoring. Our aim was to provide a multidisciplinary approach, so that HCV-infected patients from distant locations may benefit from HCV antivirals during the COVID-19 outbreak and within the lockdown period in Romania. Previously diagnosed HCV patients willing to participate in this telemedicine pilot study were included. Patient characteristics and medical adherence were assessed and compared to the year preceding the pandemic. We proposed a multidisciplinary approach by using a telemedicine program for HCV therapy monitoring. Patients also received a satisfaction questionnaire after delivering the sustained virologic response (SVR) result. A total of 41 patients agreed to participate in this study. The medication adherence was 100% for patients included in the telemedicine group, with a statistically significant difference from the medication adherence of the patients treated in 2019. The satisfaction item score was 4.92 out of 5 and our results (r = −0.94, p &lt, 0.0001) suggested that older patients embraced the telemedicine program less, but with the same success in terms of SVR (100%) and medication adherence (100%). Our pilot study offers the first example of a telemedicine program in Romania for HCV therapeutic management. During the lockdown period, telemedicine has served as a reliable tool and novel alternative for conventional monitoring of patients treated with direct antiviral agents and should be further considered even following the pandemic.

The 2016 Surviving Sepsis Campaign guidelines define sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. This study had the objective of assessing the efficacy of presepsin in the prognosis of sepsis. This was a single-center prospective study, performed in Craiova Emergency Hospital, that included 114 patients admitted in the Intensive Care Unit (ICU) department between 2018 and 2019 fulfilling the sepsis criteria. Including criteria were: age &ge, 18, sepsis diagnosed by the Sequential Organ Failure Assessment (SOFA) score of pulmonary, abdominal, urinary, surgical or unknown origin, as well as lactate levels &ge, 2 mmol/l and need of vasopressors for mean arterial pressure (MAP) &ge, 65 mmHg, despite adequate volume resuscitations for patients with septic shock. Patients younger than 18, pregnant, immunocompromised, or with terminal illnesses were excluded. Based on disease severity, patients were distributed into two study groups: sepsis&mdash, 76 patients and septic shock&mdash, 38 patients. As expected, SOFA score and most of its components (PaO2/FiO2, platelets, and Glasgow Coma Score (GCS)) were significantly modified for patients with septic shock compared to those in the sepsis group and for survivors versus non-survivors. Overall death rate was 34.2%, with a significantly higher value for patients with septic shock (55.3% vs. 23.7%, p = 0.035). Sepsis marker presepsin was significantly elevated in all patients (2047 ng/mL) and significantly increased for the septic shock patients (2538 ng/mL, p &lt, 0.001) and non-survivors (3138 ng/mL, p &lt, 0.001). A significant correlation was identified between the SOFA score and presepsin (r = 0.883, p &lt, 0.001). The receiver operating characteristics (ROC)-Area Under Curve (AUC) analysis showed significant prognostic values for presepsin regarding both sepsis severity (AUC = 0.726, 95% confidence interval CI = 0.635&ndash, 0.806) and mortality risk (AUC = 0.861, 95%CI = 0.784&ndash, 0.919). In conclusion, under the revised definition of sepsis, presepsin could be a useful marker for prognosis of sepsis severity and mortality risk. Additional data are required to confirm the value of presepsin in sepsis prognosis.

The etiological factors involved in acute pancreatitis are multiple, both pancreatic and extra-pancreatic, having a predisposing or triggering role. The purpose of our study was to evaluate the role of BMI (body mass index) in the evolution of acute pancreatitis. The study was performed between January 2018-October 2020 on a lot of 110 patients diagnosed with acute pancreatitis and admitted to the 1stSurgery Clinic and the 2ndMedical Clinic of the Craiova Emergency County Clinical Hospital, the study was prospective. The control lot consisted of patients who were not diagnosed with acute pancreatitis (n=232).Comparing the distributions according to the body mass index of the two groups by the Chi square test, a statistically significant difference is observed (p

Secondary hemochromatosis is a condition generated by defects in the iron metabolism such as elevated intestinal iron absorption and increased iron stores in tissues and organs. The current case report presents a 35-year-old female admitted for inflammatory pain of the left ankle, second and third right MCP joints and right sternoclavicular joint associated with Celsian clinical signs, subcutaneous edema and loss of articular function. The patient is known with beta thalassemia major, secondary hemochromatosis and chronic hepatitis C as a consequence of repeated blood transfusions. We pleaded for the existence of a HC-A associated with microcrystalline calcium pyrophosphate dehydrate crystal deposition (CPPD) disease associated with secondary osteoarthritic changes.

Secondary hemochromatosis is a condition generated by defects in the iron metabolism such as elevated intestinal iron absorption and increased iron stores in tissues and organs. The current case report presents a 35-year-old female admitted for inflammatory pain of the left ankle, second and third right MCP joints and right sternoclavicular joint associated with Celsian clinical signs, subcutaneous edema and loss of articular function. The patient is known with beta thalassemia major, secondary hemochromatosis and chronic hepatitis C as a consequence of repeated blood transfusions. We pleaded for the existence of a HC-A associated with microcrystalline calcium pyrophosphate dehydrate crystal deposition (CPPD) disease associated with secondary osteoarthritic changes.

Cholangiocarcinoma is an extremely rare and highly aggressive primary malignancy of the biliary tract. The current report illustrates a rare case of distal common bile duct adenocarcinoma encountered in a 65-year-old male patient who was thoroughly investigated after presenting with a two weeks history of pain in the right hypochondrium, jaundice and unintentional weight loss (6 kg in two weeks). The medical team opted for a pancreaticoduodenectomy (Whipple procedure) managing to obtain negative resection margins of the tumor with a favorable immediate postoperative evolution. However, the surgical team was forced to reintervene twice due to complications caused mainly by the patient's disregard.

Calcium fructoborate (CF), a natural sugar-borate ester found in fresh fruits and vegetables, is a source of soluble boron. CF contains three forms of borate (diester, monoester, and boric acid) and all are biologically active, both at the intracellular (as free boric acid) and extracellular level (as fructose-borate diester and monoester). At the cellular and molecular level, CF is superior to the boric acid/borate, exhibiting a complex “protective” effect against inflammatory response. CF is commercially available in the USA as a “nature-identical” complex, an active compound for dietary supplements. It provides effective and safe support against the discomfort and lack of flexibility associated with osteoarticular conditions (arthritis and joint degeneration), and improves Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and McGill indexes. In addition, orally administered CF is effective in ameliorating symptoms of physiological response to stress, including inflammation of the mucous membranes, discomfort associated with osteoarthritis disorders, and bone loss, and also for supporting cardiovascular health. Clinical studies have exhibited the ability of CF to significantly modulate molecular markers associated with inflammatory mechanisms, mainly on the elevated serum levels of C-reactive protein (CRP).

Gastric cancer (GC) is an important health problem despite the advances in surgery and chemotherapy and although the incidence is decreasing, GC is still considered the second most common cause of deceases produced by cancer. Survival rates in gastric cancer are low, mainly because most patients are often diagnosed in late stages. The current interest in the diagnostic of GC is the detection of early gastric cancer. Advances in high-resolution endoscopic techniques such as narrow band imaging (NBI) allow the detection of early precancerous lesions like polyps or metaplastic mucosa. Performing only white light imaging endoscopy in order to detect gastric cancer can lead to omission or misdiagnose of a considerable number of early gastric cancers. NBI endoscopy associated with other high-resolution examinations is viable in detecting early gastric cancer, though few studies also indicate that the endoscopist's expertise plays an important factor as well.

Conventional white light endoscopy is far from being an ideal tool to detect, characterize, and confirm the nature of colorectal lesions in order to indicate targeted biopsies or polyp resections only when necessary. Minimally invasive imaging techniques have gradually emerged to reveal previously unseen abnormalities to the operator during endoscopic examination. In this respect, technology and applications of narrow band imaging (NBI) are rapidly evolving. Magnification using NBI with near-focus mode has been introduced recently to enable closer examination under the control of a single button. The aim of this article is to offer an in-depth overview of this topic with emphasis on colorectal polyps through a literature review by using PubMed search tools including full-text articles, up-to-date guidelines and recent abstracts with obvious conclusions.