Romanian Journal of Internal Medicine最新文献

{"title":"Clinical risk scores for the prediction of incident atrial fibrillation: a modernized review.","authors":"Anna Maria Louka,&nbsp;Christos Tsagkaris,&nbsp;Alexandra Stoica","doi":"10.2478/rjim-2021-0018","DOIUrl":"https://doi.org/10.2478/rjim-2021-0018","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is considered the most common sustained arrhythmia. Major cardiovascular risk factors that have been identified to initiate and perpetuate AF include age, sex, arterial hypertension, heart failure, valvular heart disease and diabetes mellitus. In the literature, several studies aimed to formulate easily - applied and accurate risk stratification scores, based on antecedent cardiovascular events, comorbidities and biomarkers for the prediction of new-onset AF. The present narrative review addresses the most universally accepted and efficient clinical scores, with an extended applicability in different populations and ages, particularly scores derived from the Framingham Heart Study, the Atherosclerosis Risk in Communities, the Malmo Diet and Cancer Study, as well as the CHARGE-AF, the CHADS2, CHA2DS2-VASc, HATCH and CH2EST scores. Identification of incident AF can be challenging, thus dictating for utilization of validated clinical instruments in everyday clinical practice.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38951031","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":"Spontaneous bacterial peritonitis: update on diagnosis and treatment.","authors":"Roxana-Emanuela Popoiag,&nbsp;Carmen Fierbințeanu-Braticevici","doi":"10.2478/rjim-2021-0024","DOIUrl":"https://doi.org/10.2478/rjim-2021-0024","url":null,"abstract":"<p><p>Spontaneous bacterial peritonitis (SBP) is a common complication in patients with liver cirrhosis, with an increased risk of mortality. For this reason, a diagnostic paracentesis should be performed in all patients with ascites and clinical features with high diagnostic suspicion. Although literature data abound in identifying new diagnostic markers in serum or ascites, they have not yet been validated. The final diagnosis requires the analysis of ascites and the presence of > 250 mm³ neutrophil polymorphonuclear (PMN) in ascites. If previous data showed that the most common microorganisms identified were represented by gram-negative bacteria, we are currently facing an increase in gram-positive bacteria and multidrug-resistant bacteria. Although prompt and effective treatment is required to prevent outcomes, this becomes challenging as first-line therapies may become ineffective leading to worsening prognosis and increased in-hospital mortality. In this paper we will make a brief review of existing data on the diagnosis and treatment of SBP.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39035763","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":"Evaluation of oxidative stress markers in hospitalized patients with moderate and severe COVID-19.","authors":"Dragica Zendelovska,&nbsp;Emilija Atanasovska,&nbsp;Marija Petrushevska,&nbsp;Katerina Spasovska,&nbsp;Milena Stevanovikj,&nbsp;Ilir Demiri,&nbsp;Nikola Labachevski","doi":"10.2478/rjim-2021-0014","DOIUrl":"https://doi.org/10.2478/rjim-2021-0014","url":null,"abstract":"<p><p><b>Background.</b> Clinical evidence suggests increased oxidative stress in COVID-19 patients and this worsened redox status could potentially contribute to the progression of the disease. <b>Objectives.</b> To investigate the oxidative stress we have measured oxidative stress parameters, namely, PAT (total antioxidant power, iron reducing) and d-ROMs (plasma peroxides). Additionally we have investigated their correlation with the most frequently used clinical parameters CRP, LDH, and NLR in serum from moderate and severe COVID-19 patients hospitalized in a tertiary hospital. <b>Methods.</b> PAT and d-ROMs were determined by analytical photometric metric method in serum from 50 hospitalized patients. For each of them, two samples were collected and analyzed immediately after collection seven days apart. <b>Results.</b> All patients at admission had a much higher value for plasma peroxides and a significant correlation between oxidative stress parameters and CRP, LDH, and NLR. (p<0.05), except for OS index (OSI) vs CRP in the severe group. At discharge, plasma peroxides were reduced and OSI was improved in the moderate group. <b>Conclusion.</b> We consider that using OSI at the beginning of COVID-19 disease presents a valuable starting point for the general assessment of oxidative stress and hence enabling a better triage of the patients in terms of disease severity.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38837860","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":"New markers of oxidative stress in lichen planus and the influence of hepatitis C virus infection - a pilot study.","authors":"Madalina Irina Mitran,&nbsp;Mircea Tampa,&nbsp;Ilinca Nicolae,&nbsp;Cristina Iulia Mitran,&nbsp;Clara Matei,&nbsp;Simona Roxana Georgescu,&nbsp;Mircea Ioan Popa","doi":"10.2478/rjim-2021-0017","DOIUrl":"https://doi.org/10.2478/rjim-2021-0017","url":null,"abstract":"<p><p><b>Introduction.</b> Lichen planus (LP) is a mucocutaneous T-cell mediated disorder of unknown etiology. There is growing evidence that oxidative stress is an important player in the pathogenesis of LP. Therefore, we have investigated oxidative stress markers in LP and the influence of hepatitis C virus (HCV) infection, a frequently associated condition, on oxidative stress in LP patients. <b>Method.</b> We have determined the serum levels of 4- hydroxynonenal (4-HNE) and symmetric dimethylarginine (SDMA), as markers of oxidative stress, and total antioxidant capacity (TAC), as a marker of the antioxidant defence, in 4 groups: group A - HCV positive patients with LP (n=12), group B - HCV positive patients without LP (n=12), group C - HCV negative patients with LP (n=31) and group D - control group (n=26). <b>Results.</b> In LP patients, we have identified an increased level of lipid peroxidation (4-HNE - group A - 8.41±1.11 μg/mL, group B - 7.97±2.17 μg/mL, group C - 7.81±1.96 μg/mL and group D - 6.15±1.17 μg/mL) and alterations in arginine methylation (SDMA - group A - 1.10±0.24 μmol/L, group B - 1.03±0.16 μmol/L, group C - 0.84±0.19 μmol/L and group D - 0.50±0.06 μmol/L) associated with a diminished antioxidant defence (TAC - group A - 234.50±49.96, μmol/L group B - 255.83±41.41 μmol/L, group C - 269.83±43.33 μmol/L and group D - 316.46 ±29.33 μmol/L), processes augmented by the association with HCV infection. <b>Conclusion.</b> There is an imbalance between oxidants and antioxidants in patients with LP, an imbalance that is augmented by the presence of HCV infection. SDMA could be regarded as a novel biomarker of oxidative stress among these patients. To the best of our knowledge this is the first study to investigate the influence of HCV infection on oxidative stress in LP patients.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38950697","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":"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}