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Open access

Alexandru Predescu, Sorina Diaconu, Nicoleta Tiuca, Adina Purcareanu, Alina Tomescu, Denisa Cuciureanu, Filip Petruta, Palan Ana Maria, Calota Carmen and Corina Pop

Abstract

Leptospirosis is a spirochaetal zoonosis, with a broad spectrum of clinical manifestations, ranging from mild (febrile illness) to fulminant forms (systemic disease with jaundice and kidney failure – Weil's disease).

We present the case of a 62 year old patient, with no personal pathological incidents, brought to the emergency room for fever, chills, myalgia, nausea, vomiting, abdominal pain, for 14 days, with jaundice, shortness of breath, and confusion for 72 hours. Clinical examination revealed fever, confusion, jaundice, tachypnoea, tachycardia, irregular heart rhythm, hypotension, anuria, hepatomegaly, no clinical signs of liver cirrhosis or flapping tremor. Laboratory tests revealed leucocytosis with neutrophilia, hepatic cytolysis, renal failure, rhabdomyolysis, while the imagistic investigations were normal. Serological tests were performed for viral, drug induced hepatitis, autoimmune diseases, other infectious diseases (Elisa and ultramicroscopic agglutination tests were positive for leptospirosis). Later, the patient's condition worsened, resulting in intubation and mechanical ventilation, persistence of febrile syndrome and jaundice, bilateral lower limb petechiae with hepatic encephalopathy. Broad spectrum antibiotics (Ceftriaxone and Penicillin G), dialysis, hydroelectrolytic rebalancing, Dopamine support, antiarrhythmic drugs were administered, and the hepatic encephalopathy was also treated. The outcome was favourable (extubation, resolution of febrile syndrome, inflammation, jaundice and hepatic encephalopathy).

This case is an example of atypical, monophasic leptospirosis which is common in Weil's disease (the most severe form of leptospirosis), with onset as a febrile illness leading to multiple system organ failure.

Open access

Vlad Florin Anton and Polliana Mihaela Leru

Abstract

We report a case of a 69-year-old woman who is followed since seven years for persistent blood hypereosinophilia up to 5100/mmc. She has been extensively investigated for other diseases known to induce hypereosinophilia, including allergies, parasitic infections and neoplasia. No end-organ dysfunction could be confirmed. We considered a possible primary hypereosinophilic syndrome (HES) and determined the genetic mutation FIP1L1-PDGFRA characteristic for HES, which was negative.

Bone marrow showed reactive eosinophilia with no malignant cells and rare mast cells, less than 15 in aggregates, which is the major criterion for diagnosing mastocytosis. Knowing the association between HES and mastocytosis, we measured and found high serum tryptase levels and positive c-kit D816V genetic mutation, characteristic for systemic mastocytosis. The patient was closely monitored, with regular hematologic and clinical evaluation, mainly for cardiac and neurologic manifestations.

A short trial of high dose corticotherapy induced remission of hypereosinophilia, but this could not be maintained with lower doses. The clinical outcome during follow-up period was rather good, except mild cognitive decline and atrial fibrillation.The reported case is illustrative for versatile presentation and difficulties in management of hypereosinophilia in clinical practice.

Open access

Pașc Priscilla, Ioana Alexandra Coţe and Mircea Ioachim Popescu

Abstract

Cardiac myxoma is the most common adult cardiac tumor, with an incidence of 1: 1,000,000 in the general population. Usually occurring between 4-6 decades of life, especially in women, most of the myxomas appear sporadically and are of unknown etiology. Rare cases are genetically determined. Sudden death can occur in 15% of cases. While papillary tumors often complicate coronary or systemic thromboembolism, solid tumors, ovoids, cause heart failure by obstructing the mitral orifice. From a clinical point of view, the atrial myxoma may mimic a valvulopathy, heart failure, dilatation cardiomyopathy, bacterial endocarditis, and may cause heart rhythm disorders, syncope, myocardial infarction and systemic or pulmonary thromboembolism. I will present the case of a giant atrial myxoma, intermittent obstructive of the mitral orifice, evolving towards global heart failure. The lack of severe acute complications during the most likely long-lasting evolution represents an undiscovered curiosity.

Open access

Stan Florentina-Mirela, Loredana Benea, Marian Forminte, Razvan Vasilescu and Simona Caraiola

Abstract

Introduction. Diabetes mellitus is one the most frequent pathologies that affect the general population in the modern era, infections being one of the main reasons why the diabetic patient will present to an emergency room. The diabetic patient can develop infections with various germs and locations, that have a tendency to reoccur and have an unfavourable evolution compared to the general population.

Case report. A 71 year old female patient, diabetic and with significant cardiovascular pathology is admitted with a persistent febrile syndrome after 7 days on antibiotic treatment for respiratory infection. She had recently had a neurosurgical evaluation for lumbar pain; radiology had shown a compression of the T12-L1 vertebral bodies, the neurosurgeon stating that surgery was not recommended because of the associated pathologies. Clinical examination reveals a poor general state, fever, pulmonary: bilateral basal subcrepitant rales, BP = 100/60 mmHg, AV = 100 BPM irregular. Blood work showed: leucocytosis with neutrophilia, inflammatory syndrome with high procalcitonin levels, hyperglycinaemia, nitrogen retention; chest X-ray shows stasis and the echocardiography EF 25%. The complete clinical examination detected a right inguinal abscess, that had a slow, favourable evolution after drainage and antibiotic therapy according to the antimicrobial susceptibility testing (AST) (blood culture with staph, wound culture with E.Coli). After 2 weeks, the antibiotic therapy was discontinued because of the favourable clinical and lab work evolution; after 24 hours the patient is febrile again, the leucocytosis and inflammatory syndrome reappear without any other clinical changes. The infectious assessment was redone: sterile wound cultures, sterile urine cultures, no valvular vegetation on echocardiography, a CT of the chest, abdomen and pelvic area suggestive for T12-L1 spondylodiscitis.

Conclusions. The etiological diagnosis of the febrile syndrome in a diabetic patient can be extremely difficult in practice. In our case, the patient had not noticed the inguinal abscess and the lumbar pain (that restrained her to bed) represented an important sign, easily ignored in the obvious infectious context.

Open access

Bondar Andrei Cristian and Popa Amorin Remus

Abstract

Alpha lipoic acid is an antioxidant substance used for the pathogenic treatment of diabetic neuropathy, oxidative stress being a central mechanism in diabetic microvascular complications. Our study included 24 diabetes mellitus patients with diabetic neuropathy and 20 healthy subjects. Diabetes patients were given alpha lipoic acid 600 mg intravenously for 10 days and then per os for 30 days.

Significant improvements were observed concerning oxidative stress evaluated by measuring serum malondyaldehide and ceruloplasmin. The clinical characteristic of neuropathy improved, both the level of pain decreased and the vibration perception threshold increased. Our study demonstrated a two times higher level of oxidative stress in patients with diabetes compared to healthy subjects, and that by influencing oxidative stress we could influence the clinical aspects of neuropathy. Further investigations need to be done to explore the pleiotropic effects of alpha lipoic acid on other mechanisms that are implicated in the pathogenies of diabetic neuropathy.

Open access

Anna-Boróka Tusa, Annamária Magdás, Réka-Júlia Tusa and Al. Incze

Summary

Objective. In lower limb peripheral artery disease the most commonly used method for the assessment of the main arterial system is represented by the determination of ankle-brachial index (ABI). The post-occlusive reactive hyperaemia (PORH) is a controversial method used for the evaluation of primary collateral circulation. The follow-up of these patients has an underestimated part, their quality of life. The aim of this study is to evaluate this and highlight the importance of the PORH in the sight of optimal treatment.

Method. 34 patients diagnosed with lower extremity artery disease, receiving conservative treatment, the ankle-brachial index was defined with a Doppler Bistos BT-200, 8 MHz device, the PORH was evaluated with a Bidop ES-100V, an instrument which sends information for a Smart-V-Link software. To assess the quality of life we used the VascuQol-6 test.

Results. The age (mean ± SD) of the patients was 67.24±9.51, 52.92% were active smokers. A significant positive correlation was found between PORH and the results of VascuQol-6 test (p=0.02, r=0.38) and an inverse correlation between ABI <0.5 and VascuQol-6 >12. We noticed a significant difference between the VascuQol-6 result at smokers and non-smokers (p=0.02).

Conclusions. The quality of life can be acceptable at patients with significant stenosis on the main artery and decreased ankle-brachial index due to presence of the collateral artery system with a maintained ability of vasodilatation represented by PORH. The efficiency of the treatmet is based on quitting smoking, starting programs which are helping patients to quit smoking would be useful.

Open access

Vesa Cosmin Mihai and Popa Amorin Remus

Abstract

Diabetes mellitus represents a public health problem because of its growing prevalence and the enormous costs for its treatment and complications. There are numerous risk factors for diabetes mellitus development but the most important ones are the modifiable factors. In Bihor County the prevalence of obesity and sedentary behaviour in the population of newly diagnosed patients are increased compared to their prevalence in the population without diabetes. Promotion of healthy eating habits and increased physical effort are the most important measures to prevent diabetes mellitus type 2, which accounts for 90-95% of total diabetes cases. Public health programs that bring together physicians, nutritionists, teachers and target groups (children, young people, obese and overweight people)must be initiated in general population from an early age and maintained in order to promote the adherence to a healthy lifestyle.

Open access

Vesa Cosmin Mihai, Daina Lucia Georgeta, Popa Loredana, Moisi Mădălina, Zaha Carmen Dana and Popa Amorin Remus

Abstract

Diabetes incidence in Bihor County in 2016 was 0.55% or 558/100.000 and in 2017 was 0.43% or 437/100.000. The prevalence of diabetes was 5.24% in 2016 and 5.48% in 2017. Age adjusted prevalence was 7.20% in 2016 and 7.66% in 2017, in the 20-79 age group. This prevalence is lower than the national prevalence from PREDATORR study of 11.6%. Data from diabetes registers underestimate diabetes prevalence. As a consequence it is mandatory to effectuate a screening of diabetes mellitus in Bihor County.

Open access

Mariana Dobrescu, Diana Păun, Daniel Grigorie and Cătălina Poiană

Summary

Subclinical hypothyroidism (HSC) is a relatively common thyroid dysfunction, characterized by the increase of the thyroid stimulating hormone (TSH) in the presence of normal free thyroxine values. Thyroid hormones are known for the cardiovascular effects, and the consequences of HSC on the cardiovascular system have become the focus of many studies lately. There are clear indications of the relationship between HSC and cardiovascular risk factors such as hypertension, dyslipidemia and atherosclerosis; also, HSC is associated with metabolic syndrome, BMI increase and cardiac insufficiency. Therefore, many clinical trials investigate the benefits and risks of HSC treatment with L-thyroxine.

Open access

M. Ababei, A. Câmpeanu, D. Nistorescu, O. Zaharia, P Portelli, M. Dobroiu and T. Nanea

Abstract

Background. CA-125 is a tumor antigen expressed on the surface of ovarian cells, used to monitor the treatment of ovarian cancer (normal upper limit is 35U/mL), but it seems also to have a role as biomarker in heart failure (HF).

Aim. To determine CA-125 changes in acute-decompensated HF (ADHF) patients.

Method. The study group included 110 patients (mean age 72±10 years, 63% men) with ADHF caused by ischemic cardiomyopathy. The subjects were clinically, ecocardiographically and biologically (NT-proBNP, PCR, serum uric acid (sUA), CA-125) evaluated.

Results. CA-125 at admission was 53±33 U/mL and decreased at discharge to 34±17 U/mL, without any difference between males and females. The mean level of CA-125 was significantly higher in patients with pleural effusion.

There was a significant difference between NT-proBNP at admission in obese versus normoponderal patients, which was maintained at discharge. In the same time, the CA-125 did not show significant differences between obese and normoponderal subjects at admission and discharge. The mean level of CA-125 was significantly higher for subjects with reduced ejection fraction and with elevated left ventricular filling pressures versus subjects with preserved ejection fraction and normal left ventricular filling pressures.

The CA-125 correlated with LVEF (R=-0.221, p=0.02), with NT-proBNP (R=0.371, p<0.001), with the inflammation marker - PCR (R=0.284, p=0.003) and oxidative stress marker - sUA (R=0.234, p=0.015).

Conclusions. The wide availability of CA-125, its relatively low cost, its correlation with known prognostic markers in HF and the additional information provided make it a valuable biomarker that can be used in monitoring ADHF patients.