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Background: The current review aims to present the beneficial effects of SGLT2 inhibitors (dapagliflozin and empagliflozin) on several hemodynamic parameters such as blood pressure, filtration pressure at the level of the glomerular capillaries, and the improvement of the preload and afterload of heart muscle. In order to stop chronic kidney disease (CKD) from progressing, SGLT2 inhibitors have become an important disease-modifying treatment. Materials and methods: Recent clinical studies have shown the success of these drugs in treating heart failure, reducing the risk of cardiovascular events, hospitalization, and mortality. Results: The hemodynamic effects of SGLT2 inhibitors include a diuretic effect, due to reduced sodium reabsorption. Also, at this level, numerous studies have confirmed the beneficial effect of dapagliflozin in patients with chronic kidney disease, associated with a 44% reduced risk of progression in this pathology. SGLT2 inhibitors are associated with a reduction in blood pressure and weight loss, because of their diuretic effect, especially empagliflozin, which can explain the beneficial effects in patients with heart failure. In addition, mainly empagliflozin reduces stiffness and arterial resistance. Conclusions: Although the exact mechanism of action is unknown, SGLT2 inhibitors reduce the interstitial volume by blocking the tubular reabsorption of glucose. This leads to reduced blood pressure and enhanced endothelial function. Consequently, there have been improvements in hospitalization and fatality rates. Because of their beneficial effects, these medications have been guidelines for managing heart failure and chronic kidney disease. [ABSTRACT FROM AUTHOR]

This review covers recent data on the relationship between major depressive disorder (MDD) and faecal microbiome and examines the co-relations between the use of probiotics and changes in psychiatric state. We conducted a thorough search of academic databases for articles published between 2018 and 2022, using specific keywords and previously established inclusion/exclusion criteria regarding faecal microbiota, depressive disorder, and probiotics. Of 192 eligible articles (reviews, original papers, and clinical trials), we selected 10 that fully met our criteria and performed a careful review to determine any correlation between microbiome, probiotic treatment, and depression. All patients were adults (mean age, 36.8), with at least one MDD episode and onset of depression during adolescence (duration of 31.39 years of depressive episodes). We found mixed but mostly positive results regarding the influence of probiotic/prebiotic/postbiotic effects on depression. We could not identify the precise mechanism of action that led to their improvement. Antidepressants did not alter the microbiota, according to studies that evaluated this aspect. Probiotic/prebiotic/postbiotic treatments were proven to be safe, with few and mild side effects. Probiotics seemingly could be beneficial in patients with depression, as evidenced by well-established depression scales. Based on this finding and the high tolerability and safety of probiotics, no caveats against their routine use can be made. Some unmet needs in this field include determination of the dominant type of microbiota in specific patients with depression; study of microbiome-directed/driven treatment regarding dose and duration adjustments; and multiple versus single strain treatments. [ABSTRACT FROM AUTHOR]

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 <3 meals/day was found in 58.89%, sedentary lifestyle in 53.33%, sleeping time <6 h/day in 44.22%, hypercaloric nutrition in 43.56%, excessive alcohol consumption in 42.89% and depression symptoms in 31.78%. Unhealthy lifestyle a composite risk factor was identified in 67.33% of individuals. Fast-food consumption increases the risk for adiposity by 1.85-fold while sedentary lifestyle by 1.79-fold. Risk factors for adiposity play an important role in increasing the prevalence of overweight and obesity. Public health measures are necessary in order to educate the general population regarding the importance of healthy nutrition and physical exercise. [ABSTRACT FROM AUTHOR]

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<0.01) higher values in the group of obese subjects, while adiponectin had statistically significant (P<0.01) lower values. The prevalence of metabolic syndrome was 35% in the obese group and 5% in the normal weight group. Adiponectin and HOMA-IR were the variables significantly associated with metabolic syndrome (P<0.01), adiponectin/HOMA-IR ratio and leptin/adiponectin ratio were also associated with metabolic syndrome (P<0.01). No relationship was found between metabolic syndrome and hsCRP. Adiponectin and adiponectin/HOMA-IR were associated with all the components of metabolic syndrome and they can be useful to identify patients with high risk of diabetes mellitus and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Botulinum toxin is a substance produced by Clostridium Botulinum and is responsible for human botulism. This substance is a poison, a neurotoxin, but used in limited quantities it can be a cure for some diseases. It is well connected to a large variety of medical applications. The mechanism of action relies on blocking the acetylcholine at the neuromuscular junction, which blocks the transmission of the nervous impulse with secondary flaccid paralysis. In urology, its role in idiopathic overactive bladder and neurogenic bladder is well known. We performed a thorough review using PubMed and other databases, revising the mechanisms of botulinum toxin action in urologic pathology, treatment procedures and other options. Botulinum toxin is a well-studied substance with a large number of applications in medicine. In urologic pathology, overactive bladder and neurogenic bladder are backed by robust studies that support the therapeutic role of this substance. The toxin has multiple effects, such as inhibition of the nerve growth factor, blocking the bladder sensory afferent pathway and apoptotic effect on the prostate tissue, by inhibiting the substance P, altering the nociceptive pathways. Interstitial cystitis and other rare pathologies show promising results, but further studies are needed. The role of botulinum toxin in benign prostatic hyperplasia is still not elucidated. [ABSTRACT FROM AUTHOR]

The risk of carcinoma increases in patients with a 10-year or longer duration of ulcerative colitis (UC). To search for a more objective parameter to assess epithelial dysplasia. The study comprised 25 cases of longstanding UC: 7 cases with regenerative atypia, 7 with low grade dysplasia, 7 with high grade dysplasia, and 4 cases indefinite for dysplasia. The colonic biopsies obtained during endoscopy were stained with H&E to identify the aforementioned categories. Seventy-five sections from biopsy specimens were stained immunohistochemically to detect differences in the frequency and pattern of nuclei positive for the proliferation marker Ki67 and p53. In high grade dysplasia, the distribution of Ki67 positive cells was diffuse throughout the full length of the crypt, whereas low grade dysplasia and epithelium indefinite for dysplasia, as well as regenerative epithelium, showed an expanded basal zone. None of the regenerative atypia cases showed strong intensity p53 staining compared to dysplasia cases. None of the high grade dysplasia cases showed restricted p53 staining to the lower two thirds of the crypt. All the cases of HGD showed extension of Ki67 and p53 staining above the basal two thirds of the crypt. Ki67 and p53 immunostained cell assessment combined with routine histological evaluation of colorectal mucosa can improve the diagnostic accuracy, as well as the assessment of malignant transformation risk. [ABSTRACT FROM AUTHOR]

Background: Infliximab is a monoclonal anti-TNF-alpha antibody that has been shown to be effective in Crohn's disease therapy. However, data are scarce about the mechanism of action and its efficacy in ulcerative colitis (UC). Aim: To assess intracellular changes of the colonic mucosa in patients with UC before and after infliximab treatment. Methods: 7 patients (18-65 years, 4 men) with active, refractory, moderate to severe UC (Lichtiger's Clinical Activity Index >6, Endoscopic Index >4) underwent colonoscopy before and 4 weeks after the initial infusion of infliximab 5mg/kg of body weight. Endoscopically obtained biopsy specimens were processed specifically, stained with uranyl-acetate and lead citrate and examined with a JEOL-1010 transmission electron microscope. Results: Before treatment we noticed severe alterations of the epithelium: microvilli depletion, shattering of the epithelial junctions, cytoplasmic vacuolization, dilatation of the endoplasmic reticulum, pycnotic nuclei, altered structure of mitochondria and Golgi complexes. Rarefaction of the goblet cells, and abnormal mucus formation and secretion were also observed. The corresponding chorion showed structural alteration of component cells, obstructed capillaries, erythrocyte extravasation, and many plasmocytes and neutrophils. After infliximab, improvement in morphology and function of the epithelial organelles, rich mucus secretion and recovery of the chorionic components were noticed. Conclusions: Our study revealed important intracellular alterations of the UC mucosa that were restored after infliximab therapy. These features may contribute to a better understanding of UC pathogenesis and mechanism of action of the anti-TNF-alpha therapies. [ABSTRACT FROM AUTHOR]

Introduction. The ingestion of caustic substances represents a medical/surgical emergency, the severity of the lesions usually depends on the nature and quantity of the ingested product, and the treatment requires a multidisciplinary approach. Aim and methods. to retrospectively analyze the profile of the patients with caustics ingestion from Bihor Emergency Clinical County Hospital between 1st of January 2013 and 31st of December 2023. We carefully analyzed the files of the aforementioned patients for clinical, biological, endoscopic, therapeutic as well as the evolving patterns. Results. We included 42 patients, with a clear male predominance, M/F ratio of 1.62. The mean age was 34.6 years ±14.2, rural/urban ratio 24/18. From the studied group, 12 patients (28.5%) were known and followed-up with a psychiatric illness. Accidental ingestions were less frequent n=13 (31%) than voluntary ingestions n=29(69%). Among the substances, HCl/bleach was the most used n=20 (47.6%), followed by ethylene glycol n=12 (28.6%), NaOH n=5 (11.9%), H2SO4 n=2 (4.8%), unknown substance n=3 (7.1%). At admission, 23 (54.8%) patients presented oropharyngeal lesions, vomiting in 32 cases (76.2%), epigastric pain in 32 cases (76.2%), esophageal syndrome in 10 cases (23.8%), hematemesis in 4 cases (9.5%), peritoneal syndrome in 3 cases (7.1%), acute renal failure in 7 cases (16.7%). After excluding a surgical emergency, the UGIE performed in the first 24 hours after admission, showed according to the Zargar classification: grade I esophageal lesions -7 cases (16.7%), grade II -18 cases (42.9%), grade III - 6 cases (14.3%) and grade IV -3 (7.1%). Grade I gastric lesions were observed in 18 patients (42.8%), grade II in 4 patients (9.5%), grade III in 13 patients (31%), grade IV in 2 (4.8%). All patients received medical treatment (PPI, metoclopramide) and parenteral nutrition according to severity. Early pneumomediastinum after UGIE was observed in 3 patients (7.1%). The in-hospital mortality rate was (16.7%). A predictive factor for unfavourable prognosis is hyperleukocytosis (p=0.018). There is no significant correlation between the amount ingested (p=0.8) or age (p=0.6) and the evolution of the patients or between the product ingested and the severity of esophageal/gastric involvement at admission. Conclusion. In our study, the epidemiological profile of caustic ingestion was dominated by the voluntary ingestion of HCL/bleach, the symptomatology was mainly digestive, and hyperleukocytosis represented an unfavourable prognostic factor. [ABSTRACT FROM AUTHOR]

Introduction. Wild mushroom poisoning provoked by the consumption of mushrooms from uncontrolled sources (personal harvesting from woods) is still a frequently encountered emergency in our country, especially in rainy seasons and with dominant digestive manifestations. Aim and methods. we performed a retrospective study between 1st of January 2019 and 31st of December 2022, with the purpose of identifying and characterizing all the mushroom poisoning cases that sought medical care in Bihor Emergency Clinical County Hospital. All the medical files of the patients were carefully analyzed for epidemiological and personal data, clinical manifestations, blood tests disturbances and mortality rate. Results. between the aforementioned periods we identified 103 cases with mushroom poisoning, 51.4 in women (of which 1.94% were pregnant) and 48.5 in men, most of them coming from rural areas (69.9%). The dominant age decades were 50-59 and 60-69 years, each with 24.7%. Regarding clinical manifestations, most of the patients expressed digestive complaints comprising nausea (71.84), vomiting (61.1%), abdominal pain (23.3%) and diarrhea (15.5%). The nervous system manifestations came second in place, dominated by vertigo (20.3%) and hallucinations (16.5%). Regarding laboratory parameters, 50% of the patients had normal routine blood analysis, the rest of the patients presenting with high levels of the liver tests and creatinine (29.1% and respectively 20.3%). The medium hospital admission period was 2.47 days. From 103 cases of poisoning there were 3 deaths, 2 induced by respiratory failure secondary to aspiration pneumonia caused by vomiting, and 1 case of multiple organ failure, leading to a general mortality of 2.91%. Conclusions. Wild mushroom poisoning in our region is mostly dominated by digestive symptoms and abnormal liver tests. Despite the fact that mushroom poisoning seems to bear a relative low mortality rate it still has a high incidence in our region/hospital suggesting that ancestral habits are still present especially in rural areas and in people of adult age (50-70 years), thus indicating the need of more sanitary education measures from young ages. [ABSTRACT FROM AUTHOR]

Introduction. Since the start of the COVID-19 pandemic, many patients reported persistent symptoms and/or complications lasting beyond 4 weeks, now referred to as the post COVID-19 syndrome. Although SARS-CoV-2 is a virus with an essentially respiratory tropism, the extra-pulmonary manifestations of this pathogen are currently described. Aim and methods: to assess the digestive manifestations of the post COVID-19 syndrome. We conducted a single-center retrospective study (between January 2021-February 2023) including all the patients that suffered from a SarsCov2 infection and who later (after at least 4 weeks since the infection) addressed to the outpatient unit of Bihor Emergency Clinical County Hospital. We collected and analyzed demographic, clinical complaints and biological data. Results. We identified a number of 312 patients with a positive SarsCov2 PCR test, with a male/female ratio of 1.2 and a mean age of 51±14.2. Fifty four patients (17.3%) presented for a gastroenterological consultation in our unit for persistent digestive symptoms dating back at least 4 weeks since the Covid-19 infection. Among these patients, 7 (12.9%) had a personal history of inflammatory bowel disease (IBD), 9 (16.6%) had liver cirrhosis, 5 (9.3%) had chronic hepatitis and 4 (7.4%) patients had gastro-esophageal reflux disease. In addition, 21 patients (38.9%) had functional digestive disorders. The mean time between the SarsCov2 infection episode and the gastroenterology consultation was 3±2.4 months. The major clinical complaints regarding digestive system in our patients were: bowel movement disturbances (33.3%), unspecific dyspepsia (29.6%), abdominal bloating (16.6%), heartburn (14.8%), rectal bleeding (11.1%), vomiting (7.4%), upper gastrointestinal bleeding (3.7%) and anal pain (3.7%). Eighteen (85.7%) of the patients already known with functional diseases expressed a worsening of the chronic symptoms. Four (44.4%) of the patients with liver cirrhosis presented with a decompensation of the disease (edema and ascitis) and we were not able to identify and other decompensating factor except for the recent Covid-19 infection. Two patients with IBD had a moderate flare of the disease and 12 cases (22.2%) had transient increase of the liver function tests (up to 3xUNL) and cholestasis. Conclusions. Digestive symptoms, widely found as manifestations of SarsCov2 active infection, seem to be also part of the post COVID-19 syndrome. Though the exact causality link is hard to establish, it seems that these symptoms can be the first manifestation of a functional digestive disorder, aggravate a known functional pathology or complicate an evolving organic digestive disease. [ABSTRACT FROM AUTHOR]

Introduction. Esophageal cancer (EC) is a significant public health concern, as it remains one of the leading causes of cancer-related death worldwide. Oncological, surgical and palliative treatments are the management options. Aim and methods. to analyze the epidemiological, personal data, clinical characteristics, investigations and treatment approach for patients with EC. We retrospectively studied the files of patients diagnosed with EC between 1st of January 2021 and 31st of December 2022 in Bihor Emergency Clinical County Hospital (surgical and non-surgical wards). Results. In the above mentioned period, we identified 83 cases of EC, with a mean age of 65.66 years, with a predominance of male gender (81.92%) and rural geographic background (50.60%). The clinical picture was dominated by dysphagia in 73 patients (87.95%), followed by loss of appetite, in 38 patients (45.78%) and weight loss in 35 patients (42.16%). Other symptoms included vomiting, hoarseness and nausea in a smaller subset of patients. Only 69 patients (83.13%) had an upper gastrointestinal endoscopy (UGIE), 59 patients (71.08%) underwent CT scan examination and the rest of the patients being diagnosed and evaluated directly during surgery. Regarding the localization of the tumors, most of them were found in the lower esophagus (37.14%), followed by the medium part (36.14%) and superior region (26.50%). Based on the UGIE, most cases were already obstructive (53.01%). Histologically 62 patients (74.69%) had squamous carcinoma followed by adenocarcinoma (14.45%) of mainly moderate differentiation G2 (20.48%). Management strategies included: 41 surgeries (49.39%) of which 28 (33.73%) ended up in the placement of a feeding gastrostomy, 21 patients (25.30%) had an esophageal stent placement, 42 patients (50.60%) received chemotherapy and 38 (45.78%) had radiotherapy. During the 2 years of our study, 18 patients (21.68%) died. Conclusions. Our study revealed that unfortunately most cases of EC were diagnosed in an advanced stage of the disease when mostly palliative treatment options remained available. We also want to emphasize the need of an early diagnosis with a standardized workup and staging approach to avoid unnecessary surgery and provide best outcomes for the patients. Rising awareness of these aspects must become a flagship of our daily practice. [ABSTRACT FROM AUTHOR]

Background/aims: Today, there is no ideal treatment for nonalcoholic steatohepatitis. The present study intended to make a multicentric prospective study about the efficiency of lovastatin and pentoxyphyllin administered in patients with nonalcoholic steatohepatitis., Methodology: 87 patients were included in the present study. The patients diagnosed with nonalcoholic steatohepatitis and dislypidemia were treated for 4 months with lovastatin 10 mg/day and those without dislypidemia with pentoxyphyllin, 400 mg x 3/day. The patients were evaluated clinically and biochemically monthly., Results: Regarding the lovastatin-treated group, transaminases significantly decreased (p < 0.05), after the first and second month, as well as cholesterolemia (p < 0.001), and the APRI score after 2 months (p = 0.03). In the pentoxyphyllin-treated group, transaminases significantly decreased after 1 month (p < 0.05), and the Forns index after 2 months (p < 0.05)., Conclusions: Both drugs significantly decreased the transaminases. Lovastatin reduced the cholesterolemia in the dislipidemic patients. The decrease of the APRI score suggests that both medicines have benefic effects on the hepatic histology, too.