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The irritable bowel syndrome (IBS) is the most common chronic gastrointestinal disorder referred to gastroenterologists. One of the most common manifestations of IBS is bloating. Abdominal bloating is defined as subjective sensation of abdominal distension associated with girth increment. Therefore, it is described in the Rome IV criteria as bloating/abdominal distension. Bloating symptoms are reported by 10-30% of the general population and it was rated as the most bothersome symptom by 60% of IBS patients; the lack of specificity of this complaint prevented bloating to be included between the diagnostic criteria for IBS. Indeed, bloating may be reported also in healthy people or in other functional conditions. This paper looks to the evolutions of the concepts on bloating according to the Rome working groups from the beginning until now and it represents a comprehensive review on the prevalence and pathogenesis of bloating.

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Hepatitis C remains a major issue worldwide, both in mortality and morbidity. For certain genotypes, its treatment has stagnated in recent decades. The emergence of new drugs, Direct Acting Antiviral Agents (DAA) resulted in Sustained Viral Response rate (SVR) of over 90%. Of such treatment benefited more than 5,000 patients in Romania during 2016. The End of Treatment (EOT) rates are comparable to international studies. There were, however, included only patients with liver cirrhosis (Fibromax-stage F4) without signs of hepatic decompensation, but still remain many of those with chronic infection in moderate stages of fibrosis with good liver function. Studies on DAA approved today show that the early stages also benefit from new treatments with higher SVR and even progression stopping of liver fibrosis induced by the virus. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder, affecting about 10 to 20% of the population in developed countries. The mechanisms underlying the symptoms of this condition are poorly understood. Considered initially as the consequence of abnormal gut motility, visceral hypersensitivity, psychosocial factors and brain-gut axis dysfunction, IBS is now acknowledged as a multifactorial disorder. Specific peripheral mechanisms are involved, including mucosal immune activation, increased intestinal permeability, entero-endocrine cell products, an excess of bile acids, gut dysbiosis. A better understanding of these mechanisms could help develop new and specific therapeutic pathways in patients suffering from IBS. [ABSTRACT FROM AUTHOR]

True and false aneurysmas (pseudoaneurysmas) of veins are very rare conditions. We present the case of a 58 year old woman with a progressive spheric enlargement with pusatile character of the right laterocervical area. Ultrasonography established the diagnosis showing the vascular mass with turbulent flow belonging to the external jugular vein and the communication with the internal jugular vein. The particularities of this case are the absence of an obvious etiology and the particular variant of flow direction from internal towards the external jugular vein. To the best of our knowledge, this is the first case of pseudoaneurysma of the external jugular vein reported in literature. [ABSTRACT FROM AUTHOR]

The involvement of high values of iron in different diseases, such as nonalcoholic fatty liver disease (NAFLD), insulin resistance, diabetes mellitus, metabolic syndrome and cardiovascular diseases, created the so called dysmetabolic iron overload syndrome (DIOS). The molecular mechanism is not known exactly, but a possible pathogenesis might imply distrubances in oxidative stress and injury of the DNA-structure, in the cellular transport of iron (hepcidin), and in the defective release of adipokines. The target organs in DIOS and the induced disorders are: pancreas (insulin resistance, diabetes mellitus), liver (severe steatosis, progressive fibrosis and malignant transformation), heart (acute myocardial infarction) and arteries (atherogenesis). The typical histological location in hepatic iron overload is the sinusoidal space. Therapeutical response to dietary restriction and phlebotomy include decrease of hepatic and metabolic tests, lower risks of progressive fibrosis in liver and hepatocarcinoma and cardiovascular mortality. [ABSTRACT FROM AUTHOR]

Background and aims. Irritable bowel syndrome (IBS) is one of the most frequent functional gastrointestinal disorders, having its subtypes related to the predominant bowel pattern: IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), mixed IBS (IBS-M) or alternating IBS (IBS-A). Some patients alternate between subtypes (IBS-A). We looked for the prevalence of alternation between subtypes in patients with IBS. We also analyzed changes in pharmacological therapy specifically addressed to IBS. Methods. We performed a retrospective observational study that included 60 patients diagnosed with IBS according to Rome III criteria. Patients were asked using a detailed structured interview about their stool form changes regarding previous six months. Alternators were defined as patients that changed IBS subtype over time (previous six months). Results. Out of the 60 patients diagnosed with IBS, 18 patients (30%) were alternators. Of these, 8 patients (44%) changed twice the subtype. Two patients (66.66%) of the IBS-M subgroup shifted between subtypes. Eight patients (44.44%) changed medication over the six months. Four patients (22.2%) of the alternators were on double association of therapy (antispasmodics) addressed to IBS. Four patients (22.22%) discontinued medication. Conclusions. Patients with IBS often change between subtypes even within six months. Alternators in our pilot study represented 30% of IBS patients. IBS-M seems to be the least stable phenotype. The rarest change is the shift between IBS-C and IBS-D. Alternators also often change their pharmacological treatment (antispasmodics). [ABSTRACT FROM AUTHOR]

The increasing prevalence of the metabolic syndrome requires the identification of new risk factors associated with this syndrome. The aim of this study was to discover and analyze a possible relationship between psychosocial indicators like depression and the metabolic syndrome and to identify the level of depression for patients with metabolic abnormalities. A total of 134 participants aged 45-64 years (52% men and 48% women) have been submitted to physical measurements and laboratory tests. Metabolic syndrome was defined according to the NCEP/ATPIII criteria (National Cholesterol Education Program, Adult Treatment Panel III). Depression was assessed using a standardized depression questionnaire (Beck Depression Inventory). Statistical analysis of the collected data was performed. The Beck score has shown that 16% of the patients with metabolic syndrome presented minor depression, 17% severe depression and 27% moderate depression. At women, mean depression scores (25.8±15,29) were higher in comparison with men (15±8.35), p=0,018. Participants with metabolic syndrome had higher levels of depression than individuals without the metabolic syndrome. Women presented higher scores for depressive symptoms in comparison with men. Depression is a risk factor associated with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background. Oral health related quality of life (OHRQoL) represents a complex concept, which brings important insight into the patients' dental and oral self-perception. This field of research also targets young adult populations. Aims. The aim of the current study was to assess the OHRQoL self-perception differences in three study programs student samples: two dental medicine student samples and an economics student sample. Methods. After providing informed consent from the subjects, the OHIP-49 questionnaire was applied in three samples: a sample belonging to the Faculty of Dental Medicine, Romanian section, Cluj-Napoca (n = 63), a sample belonging to the English section of the same Faculty (n = 63) and a sample of students enrolled in the Faculty of Economics, Cluj-Napoca (n = 63). The dental Romanian and economics student samples completed the Romanian version of OHIP-49, while the dental English program students completed the English version of the same instrument. Mean subscale scores were calculated, followed by inferential statistical procedures: one-way and two-way analysis of variance and the t-test. The independent variables were gender and the study program. Results. For the complete sample, the subscales presenting the highest scores were functional limitation (8.05), physical pain (10.03) and psychological discomfort (6.05). Statistically significant differences in OHRQoL self-perception, using one-way ANOVA, were obtained between: economics students and English section dental students (p = 0.03) for the functional limitation subscale; economics and Romanian section dental students (p = 0.039) for the same subscale; economics students and English section dental students (p = 0.029) for the handicap subscale. In respect to the complete sample, the t-test revealed statistically significant differences between male and female subjects for the scores of the following subscales: functional limitation t (187) = -2.359, p = 0.019, physical pain t (187) = -2.172, p = 0.031, and psychological disability t (187) = -2.556, p = 0.11. Conclusions. The self-perception of OHRQoL statistically significantly varies in accordance with gender and the study program. The involved students tend to focus more on physical impacts of oral conditions. [ABSTRACT FROM AUTHOR]

Background. The autonomic nervous system is often imbalanced in patients with type 2 diabetes mellitus (DM) and this may be clinically inapparent. Cardiovascular autonomic neuropathy (CAN) is a common form of autonomic dysfunction in DM patients and associates abnormalities in heart rate control, as decreased heart rate variability (HRV) and in central and peripheral vascular dynamics. Subjects and methods. The study group consisted of 64 patients, diagnosed with type 2 diabetes mellitus. The control group consisted of 55 healthy subjects. Chronic heart failure and uremia was excluded. We created two study groups, with and without cardiovascular symptoms. Exercise tolerance was measured using rating of perceived exertion scale in correlation with a standard effort. HRV was measured using a 24-hour ECG monitoring system. Time domain parameters used are: SDNN, SDANN and pNN50 %; frequency domain parameters are: low frequency (LF), high frequency (HF) and LF/HF ratio. Results. There are significant differences between disease duration (and not age), in patients with cardiovascular symptoms. Orthostatic hypotension was found in 13 patients and heart rate increased over 100 at rest was found in 28 patients. HRV parameters are lower in DM group but differences are significant only for SDNN and LF, HF, and normalized units HF. From the total group, more than half had HRV parameters below the normal range (51%), and 72% of them had also cardiovascular symptom. Of the asymptomatic patients, 14 (51.85%) had abnormal HRV parameters. Conclusion. Subclinical autonomic neuropathy should be detected using autonomic function tests. Waiting for symptoms to appear is not recommended, as clinical signs and symptoms not always progress, so are not reliable tools in early diagnosis and risk stratification. [ABSTRACT FROM AUTHOR]

Background: Hepatic disease represents a significant complication in children with cystic fibrosis (CF), yet its relationship with specific genetic factors, including CFTR (Cystic fibrosis transmembrane conductance regulator) mutations and SERPINA1 alleles, is not well understood. This study aims to clarify these associations within a Romanian pediatric CF population., Methods: In this cross-sectional, prospective study, we examined 71 children with CF, comparing those with hepatic disease (n=25) to those without (n=46). We collected comprehensive clinical, biochemical, and genetic data, focusing on CFTR genotypes and SERPINA1 alleles. Key outcomes included the prevalence of hepatic disease in relation to specific genotypes, fibrosis markers, and liver function tests., Results: The DF508/DF508 genotype was the most prevalent, occurring in 49% of the cohort. No significant associations were found between hepatic disease and specific CFTR genotypes or SERPINA1 alleles. However, children with hepatic disease exhibited significantly higher fibrosis scores (APRI and FIB-4), suggesting more advanced liver involvement. Additionally, a slight delay in CF diagnosis was observed in those with hepatic disease, though this difference did not reach statistical significance., Conclusion: This pioneering study in Romania underscores the complexity of hepatic disease in CF. While specific CFTR genotypes and SERPINA1 alleles were not significantly associated with hepatic complications, the findings emphasize the importance of early diagnosis and monitoring using fibrosis markers to identify children at risk for liver involvement.

Background: Opera singers are at risk to develop gastroesophageal reflux, because of the vocational challenges during singing. The singers are reluctant to be submitted to pH-metry fearing throat injuries. We evaluated the gastroesophageal reflux in vocal opera students using a non-invasive salivary test., Design and Setting: A prospective, case-control study was carried out in 30 vocal opera students from the Music Academy of the city Cluj-Napoca, Romania, enrolled in the "canto" section., Methods: For control, 20 medical students and residents were enrolled. Each subject filled in a questionnaire and gave saliva samples for the salivary test Peptest™ (RD Biomed). The statistical analysis was made using program R version 3.2.1 (2015-06-18)., Results: According to salivary Peptest, vocal opera students had a higher prevalence of gastro-esophageal reflux than the control group (96.67% versus 30%; 29 from 30 vs 14 from 20), P<0.001. Only 50% (15 of 30) of the vocal opera students reported reflux symptoms., Conclusions: Salivary Peptest confirmed a higher prevalence of gastroesophageal reflux in vocal opera students, although not all of them reported reflux symptoms.

Background and Aims: The interest in the research of both Oral Health Related Quality Of Life and dental aesthetics has increased in the recent years. The aim of the current study consists in the evaluation of the perception of oral-health, dental aesthetics and self-esteem in a general population., Methods: A group of students of the Faculty of Dental Medicine, Cluj-Napoca, were trained in the field of questionnaire interviewing. The students were asked to apply the following questionnaires to a number of maximum five close persons: the OHIP-14Aesthetic questionnaire, the Rosenberg self-esteem scale and a questionnaire evaluating demographic data. Each interviewed subject provided informed consent. The sample included 97 subjects with an age range of 18-75 years. For each of the three applied questionnaires overall scores were computed and used for the calculation of Pearson correlations and inferential statistical procedures: the t-test., Results: Related to the complete sample (N=97), the highest OHIP-14Aesthetic scores were obtained for the functional limitation (mean score of 2.22), physical pain (mean score of 2.72) and psychological discomfort (mean score of 1.37) subscales. The highest Rosenberg self-esteem scale scores were obtained for the following questions: "I think I am no good at all" (mean score of 3.50), "feel useless at times" (mean score of 3.53), "inclined to feel that I am a failure" (mean score 3.77), "positive attitude toward myself" (mean score of 3.50). Statistically significant correlations were registered between the overall Rosenberg self-esteem scale score and the scores of the following OHIP-14Aesthetic subscales: psychological discomfort (r = -0.201, p = 0.49), physical disability (r = -0.219, p = 0.031), psychological disability (r = -0.218, p = 0.032), social disability (r = -0.203, p = 0.046). The t-test revealed statistically significant gender differences, in regard to the OHIP-14Aesthetic overall score t(95) = -2.820, p = 0.006., Conclusions: The current study indicates the existence of statistically significant gender differences in the perception of oral health and a series of dental aesthetics elements in a general population. Moreover, statistically significant correlations were obtained between the perception of oral health and the perception of self-esteem.

The gastric environment has been long time considered bacteria-free, but the discovery of Helicobacter pylori (H. pylori) in 1982 superseded this conception. Over the last decades new diagnostic methods have been developed, starting with culture-dependent and advancing to culture-independent ones. These modern techniques provide new insight into the composition and influence of this ecosystem on the entire gastrointestinal tract. H. pylori is no longer considered the only microorganism in the stomach, other non-H. pylori microbial species may populate the same environment and exercise their role. Current knowledge suggests possible links of these bacteria with gastroduodenal diseases, such as peptic ulcer and gastric cancer but most of them need further scientific evidence. This review summarizes current information on these complex interrelations between gastric microbial communities and host in health and disease.

Background and Aims: Anger is strongly associated with the coping style, personality, interpersonal conflicts and quality of life. Increased research is being focused on the negative impact of anger on irritable bowel syndrome (IBS). Certain psychological areas such as anger have not been investigated in Romanian patients. The present study aims to determine the basal differences in experiencing anger between IBS patients and controls., Method: We examined the State-Trait anger in 60 subjects with IBS and 45 controls. The socio-demographic data and the State-Trait Anger Inventory were administered in individual sessions., Results: evidenced that the IBS group had high mean scores for trait anger. No significant differences between the groups were detected on state anger., Conclusion: Higher levels of trait anger characterize IBS patients when compared to controls and this may be associated with symptoms. These findings are discussed within the context of other data suggesting that trait anger contributes to development and evolution of IBS, perhaps through modulation of the colonic motor activity.