Romanian Journal of Internal Medicine最新文献

{"title":"Hashimoto's thyroiditis is associated with elevated serum uric acid to high density lipoprotein-cholesterol ratio.","authors":"Ozge Kurtkulagi,&nbsp;Burcin Meryem Atak Tel,&nbsp;Gizem Kahveci,&nbsp;Satilmis Bilgin,&nbsp;Tuba Taslamacioglu Duman,&nbsp;Asli Ertürk,&nbsp;Buse Balci,&nbsp;Gulali Aktas","doi":"10.2478/rjim-2021-0023","DOIUrl":"https://doi.org/10.2478/rjim-2021-0023","url":null,"abstract":"<p><p><b>Background.</b> Hashimoto's thyroiditis (HT) is an auto-immune condition characterized with lymphocytic and fibroblastic infiltration of the thyroid gland. The rate of uric acid and HDL cholesterol - so called as uric acid to HDL ratio (UHR) has been shown to be elevated in inflammatory conditions diseases. We aimed to compare UHR and other laboratory parameters of the patients with HT to those values in healthy controls. <b>Methods.</b> The patients diagnosed with HT by medical history, physical examination, elevated thyroid autoantibodies in serum and characteristic sonographic findings in outpatient internal medicine clinics of our institution were enrolled to the present retrospective study. Age and sex matched healthy volunteers were enrolled as controls. UHR of the HT patients and control subjects were compared. <b>Results.</b> The mean UHR of the HT group was 11% ± 4 %, while UHR of the control group was 8% ± 2% (p<0.001). UHR was significantly and positively correlated with thyroid stimulating hormone (TSH) (r=0.26, p=0.01) and negatively correlated with free T4 (FT4) (r=-0.22, p=0.04) levels. The sensitivity and specificity of the UHR level were greater than 8.3%: were 74% and 52%, respectively (AUC: 0.74, p<0.001, 95% CI: 0.64-0.84). <b>Conclusion.</b> We suggest that UHR is a reliable and useful marker for HT. Therefore, it may be helpful in establishing the diagnosis of HT in addition to other diagnostic tools.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 4","pages":"403-408"},"PeriodicalIF":1.9,"publicationDate":"2021-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39244277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute heart failure in pregnancy: importance of a timely multidisciplinary approach to recognition and management.","authors":"Sanoj Chacko,&nbsp;Joseph De Bono,&nbsp;Howard Marshall,&nbsp;Yumna B Haseeb,&nbsp;Sohaib Haseeb,&nbsp;Katie Morris,&nbsp;Sara Thorne","doi":"10.2478/rjim-2021-0019","DOIUrl":"https://doi.org/10.2478/rjim-2021-0019","url":null,"abstract":"Abstract Increased cardiovascular demands of pregnancy may unmask occult diseases, such as dilated cardiomyopathy or valvular stenosis, or precipitate peripartum cardiomyopathy. We report a case of the emergency management and delivery of a young pregnant woman who presented with acute decompensated heart failure that was not immediately recognized. An emergency transfer to a tertiary care institution was arranged. Once diagnosed, the patient received multidisciplinary care shared between cardiologists, obstetricians, cardiac anesthetists, a neonatologist, and a midwife, resulting in good maternal and fetal outcomes.","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 4","pages":"416-419"},"PeriodicalIF":1.9,"publicationDate":"2021-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39022458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence and the impact of sarcopenia in digestive cancers. A systematic review.","authors":"Carmen Haiducu,&nbsp;Adrian Buzea,&nbsp;Liliana Elena Mirea,&nbsp;Gheorghe Andrei Dan","doi":"10.2478/rjim-2021-0026","DOIUrl":"https://doi.org/10.2478/rjim-2021-0026","url":null,"abstract":"<p><p><b>Introduction:</b> Sarcopenia is characterized by a decrease in skeletal muscle mass, associated with low muscle strength and/or poor physical performance. Assessing the prevalence of sarcopenia among digestive cancers and establishing the impact that sarcopenia has on the postoperative evolution of digestive tumors may be a central pillar in improving postoperative outcomes by caring for perioperative sarcopenia. This brief review aimed to evaluate the prevalence of sarcopenia in digestive cancer patients. <b>Method and materials:</b> PubMed database was searched for \"sarcopenia\" AND \"digestive cancers\" from January 1st, 2010, through September 30th, 2020. PRISMA guideline was used for this systematic review. After the selection process, 31 complete studies were included in our review. Assessment of sarcopenia diagnosis for the studies included in this systematic review was based on a computed tomographic calculation of the skeletal muscle index at the third lumbar vertebra. <b>Results:</b> Among a total of 11,651 patients with digestive cancers, the prevalence of sarcopenia was 43.68%. The highest prevalence of sarcopenic patients was in esophageal (70.4%) and hepatic (60.3%) cancer, following by biliary tract (49.3%), pancreatic (45.70%), colorectal (42.83%) cancer, and gastric cancer (32.05%) with the lowest prevalence. The results of the studies conducted by now regarding the prevalence of sarcopenia in digestive cancers and its relevance in the evolution of these cancers are discordant and uneven. Some studies show that the presence of sarcopenia in patients with digestive cancers is associated with an increased rate of postoperative complications, increased toxicity of chemotherapeutics and increased mortality. Other studies do not find sarcopenia as an independent risk factor associated with negative consequences in the course of patients with digestive cancers. <b>Conclusions:</b> Sarcopenia is prevalent in digestive cancers. There is still no consensus about the impact of sarcopenia on the treatment of digestive cancers. Further studies are needed to evaluate the real consequences of sarcopenia in digestive cancers..</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 4","pages":"328-344"},"PeriodicalIF":1.9,"publicationDate":"2021-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39148126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carnitine palmitoyltransferase-II deficiency: case presentation and review of the literature.","authors":"Benjamin J Mccormick,&nbsp;Razvan M Chirila","doi":"10.2478/rjim-2021-0021","DOIUrl":"https://doi.org/10.2478/rjim-2021-0021","url":null,"abstract":"Abstract Carnitine palmitoyltransferase-II deficiency, an autosomal recessive disorder, is the most common cause of recurrent rhabdomyolysis in adults. Recognition and avoidance of triggers, such as heavy exercise and stress, is key in prevention of further episodes; however, even with preventative measures, many patients will continue to experience periodic symptoms, including rhabdomyolysis. Avoidance of renal failure, correction of electrolyte disturbances and halting further muscle breakdown are the goals of treatment. It is essential for clinicians to recognize the signs and symptoms of acute disease in CPT-II deficiency. We present a case of recurrent rhabdomyolysis requiring hospitalization in a patient with CPT-II deficiency and review the literature for common clinical manifestations, diagnostics, and treatment strategies.","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 4","pages":"420-424"},"PeriodicalIF":1.9,"publicationDate":"2021-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39087543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmet needs in the diagnosis and treatment of Romanian patients with bilio-pancreatic tumors: results of a prospective observational multicentric study.","authors":"Theodor Voiosu,&nbsp;Andrei Voiosu,&nbsp;Cella Danielescu,&nbsp;Daniela Popescu,&nbsp;Claudia Puscasu,&nbsp;Monica State,&nbsp;Aurelia Chiricuţă,&nbsp;Mara Mardare,&nbsp;Andrada Spanu,&nbsp;Andreea Bengus,&nbsp;Bogdan Busuioc,&nbsp;Marius Zamfir,&nbsp;Octav Ginghina,&nbsp;Maria Barbu,&nbsp;Cornelia Nitipir,&nbsp;Bogdan Mateescu","doi":"10.2478/rjim-2021-0009","DOIUrl":"https://doi.org/10.2478/rjim-2021-0009","url":null,"abstract":"<p><p><b>Background.</b> Biliopancreatic tumors (BPT) are among the most aggressive solid malignancies, and their incidence is rising. Good patient outcome relies heavily on a multidisciplinary approach to therapy, including timely access to endoscopy, surgery and chemo/radiotherapy. We aimed to evaluate current practices as reflected in the management and outcome of patients diagnosed with BPT in the setting of a low-resource medical system in order to identify areas suitable for improvement. <b>Material and methods.</b> We conducted a prospective observational study of patients with pancreatic cancers and extrahepatic cholangiocarcinomas evaluated in 4 referral centers in Romania. We collected data on the pathology of the tumors, staging at diagnosis, ECOG status, surgical interventions, chemo/radiotherapy and endoscopic drainage where applicable. A telephonic follow-up visit at 3 months after the enrollment visit collected additional data regarding evolution, subsequent treatment, performance status and disease-related events and outcomes. <b>Results and conclusions.</b> One hundred seventy-two patients were included in the study during a one-year period at the four participating centers. 72.1% were diagnosed with pancreatic cancer while 27.9% had extrahepatic cholangiocarcinoma. We identified several unmet needs in the current practices of treatment for these malignancies: a lack of pathological confirmation in 25.6% of the cases, a very low percentage of resectable lesions (only 18% of the patients operated with curative intent), and suboptimal choice of drainage in patients who required palliative drainage at their first endoscopic intervention. Significant effort is required to ensure standard-of-care treatment for patient with BPT in low-resource medical systems, including comprehensive auditing and protocol surveillance.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 3","pages":"286-295"},"PeriodicalIF":1.9,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25426062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A single center experience: physician related diagnostic delay and demographic and clinical differences between patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis.","authors":"Firdevs Ulutaş,&nbsp;Veli Çobankara,&nbsp;Hande Şenol,&nbsp;Uğur Karasu,&nbsp;Serdar Kaymaz,&nbsp;Canan Albayrak Yaşar,&nbsp;Zeynep Dündar Ök,&nbsp;Murat Yiğit","doi":"10.2478/rjim-2021-0004","DOIUrl":"https://doi.org/10.2478/rjim-2021-0004","url":null,"abstract":"<p><p><b>Background.</b> A large number of comparative studies have been conducted for ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA), including disease burden, treatment modalities and patient characteristics. The aim of this study was to compare physician related diagnostic delay time between patients with AS and nr-axSpA. <b>Methods.</b> In our retrospective study we included 266 patients with axSpA. Patients were classified into two subgroups, AS and nr-axSpA. The time from back pain onset until diagnosis of axSpA was defined as the diagnostic delay. The first specialist referred to and the first diagnosis for each patient was noted in detail. Patient characteristics, clinical manifestations and laboratory and imaging results at diagnosis were also compared between subgroups. <b>Results.</b> The diagnostic delay time was significantly longer for AS patients [6 ± 8.14 years vs 1.62 ± 2.54 years]. 40.9% of all patients were initially consulted by specialists in physical therapy and rehabilitation, followed by 29.7% consulted by a neurosurgeon and 19.9% by a rheumatologist. The most common initial diagnosis was fibromyalgia, 52.6% (140), followed by ankylosing spondylitis, 28.9% (77), and lumbar disc hernia, 12.7% (34). <b>Conclusion.</b> The vast majority of patients were initially evaluated by healthcare providers other than rheumatologists and mostly diagnosed with fibromyalgia. Efforts to increase awareness and to educate first healthcare providers may shorten the diagnostic delay time.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 3","pages":"278-285"},"PeriodicalIF":1.9,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25334897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A plea for a unified approach to sedation in gastrointestinal endoscopy in Romania: results from a prospective multicentric trial.","authors":"Theodor Voiosu,&nbsp;Tudor Moga,&nbsp;Cristian Nedelcu,&nbsp;Cristina Tocia,&nbsp;Monica State,&nbsp;Claudia Puscasu,&nbsp;Andreea Bengus,&nbsp;Andrei Voiosu,&nbsp;Lucian Negreanu,&nbsp;Eugen Dumitru,&nbsp;Gabriel Constantinescu,&nbsp;Bogdan Mateescu,&nbsp;Ioan Sporea","doi":"10.2478/rjim-2021-0011","DOIUrl":"https://doi.org/10.2478/rjim-2021-0011","url":null,"abstract":"<p><p><b>Background.</b> Adequate sedation is a prerequisite for quality endoscopic examination of the digestive tract. We aimed to evaluate the current practices and safety profile of sedation for gastrointestinal endoscopy in Romania and its impact on the technical success of the procedure and procedure-related adverse events. <b>Methods.</b> We conducted a prospective, multicentric, observational study including all patients undergoing digestive endoscopic procedures under various degrees of sedation. We collected data regarding the endoscopic procedure, type and degree of sedation, drug regimens, personnel in charge of sedation, and relevant patient related information. The main study outcome was the rate of sedation-related adverse events; secondary study outcomes included procedure-related adverse events and the impact of sedation on procedure success. <b>Results.</b> 1,043 consecutive endoscopic procedures from eight Romanian endoscopy units were included in our study. Sedation regimens were highly variable between participating centers, with 566 (54%) of procedures being performed under sedation provided by an anaesthesiologist. Sedation-related adverse events occurred in 40 cases (3.8%), most of them were mild respiratory and cardiovascular events and all reversed spontaneously. On multivariate analysis, male gender, procedure type (endoscopic ultrasound and endoscopic retrograde cholangiopancreatography) and deep sedation were risk factors for complications. The endoscopy unit, ASA status, age and type of sedative did not influence the complication rate. <b>Conclusion.</b> In conclusion, sedation for endoscopic procedures is generally safe, despite a high variability in sedation practices between centers in Romania. Establishing a national guideline on sedation for gastrointestinal endoscopy will ensure consistent and safe practice for these procedures.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 3","pages":"303-311"},"PeriodicalIF":1.9,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25471178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Clostridioides difficile</i> infection: a comprehensive review for primary providers.","authors":"Pedro Cortés,&nbsp;Yan Bi,&nbsp;Fernando Stancampiano,&nbsp;Jose R Valery,&nbsp;Jane H Cooper,&nbsp;Dana M Harris","doi":"10.2478/rjim-2021-0010","DOIUrl":"https://doi.org/10.2478/rjim-2021-0010","url":null,"abstract":"<p><p><i>Clostridioides difficile</i> infection (CDI) is an issue of great concern due to its rising incidence, recurrence, morbidity and impact on healthcare spending. Treatment guidelines have changed in the last few years, and new therapies are being considered. This is a practical review for the primary care practitioner of the latest guidelines for CDI diagnosis, treatment, and emerging therapies.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 3","pages":"262-269"},"PeriodicalIF":1.9,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25471179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ibrutinib in patients with atrial fibrillation - the challenge of thromboembolic prophylaxis.","authors":"Denisa-Corina Ciuculete,&nbsp;Raluca Alexandra Popescu,&nbsp;Gheorghe-Andrei Dan","doi":"10.2478/rjim-2021-0015","DOIUrl":"https://doi.org/10.2478/rjim-2021-0015","url":null,"abstract":"<p><p>Ibrutinib is a novel drug used in haematological malignancies. Its use is associated with an increased risk of atrial fibrillation (AF), which, in turn, exposes patients to embolic risk, including stroke. Reducing this risk requires anticoagulant therapy which is a matter of concern in the context of the increased bleeding risk of patients with haematological malignancies. In this context the presence of thrombocytopenia related to haematological disorder, ibrutinib-anticoagulants and ibrutinib-platelets interactions contribute to the amplification of the problem. The correct assessment of the thrombosis vs. haemorrhage balance represents a significant challenge for the clinician. In this paper we discuss practical issues related to anticoagulation in patients treated with ibrutinib and incident AF.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 3","pages":"270-277"},"PeriodicalIF":1.9,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38852713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis and the muscle tissue. A narrative review.","authors":"Eleousa Oikonomou,&nbsp;Themistoklis Paraskevas,&nbsp;Dimitris Velissaris","doi":"10.2478/rjim-2021-0005","DOIUrl":"https://doi.org/10.2478/rjim-2021-0005","url":null,"abstract":"<p><p>Sepsis and septic shock are considered major factors in the development of myopathy in critically ill patients, which is correlated with increased morbidity rates and ICU length of stay. The underlying pathophysiology is complex, involving mitochondrial dysfunction, increased protein breakdown and muscle inexcitability. Sepsis induced myopathy is characterized by several electrophysiological and histopathological abnormalities of the muscle, also has clinical consequences such as flaccid weakness and failure to wean from ventilator. In order to reach definite diagnosis, clinical assessment, electrophysiological studies and muscle biopsy must be performed, which can be challenging in daily practice. Ultrasonography as a screening tool can be a promising alternative, especially in the ICU setting. Sepsis and mechanical ventilation have additive effects leading to diaphragm dysfunction thus complicating the patient's clinical course and recovery. Here, we summarize the effects of the septic syndrome on the muscle tissue based on the existing literature.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"59 3","pages":"218-226"},"PeriodicalIF":1.9,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25334903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}