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Open access

Alexandr Ceasovschih, Victoriţa Șorodoc, Viviana Aursulesei, Dan Tesloianu, Irina M. Jaba, Corina Dima Cozma, Bogdan M. Mihai, Cristian Stătescu, Oana Sîrbu, Alexandra Stoica, Cristina Tuchiluș, Ecaterina Anisie, Elena D. Grigorescu, Lilia Simionov, Maria Obreja and Laurenţiu Șorodoc

Abstract

Objectives. This study aimed to examine peripheral artery disease severity impact on psychological profile of arteriopathy patients.

Material and methods. The prospective study included consecutive PAD patients admitted to the 2nd Department of Internal Medicine and the Department of Cardiology of the Emergency Clinical Hospital “Sf. Spiridon” Iasi, between January and September, 2017.

Rezults. The group included 139 PAD patients, 80.6% male and 19.4% female, with an average age of 63.23±9.44 years. PAD stages have a very strong association with level of quality of life (p<0.0001). All Leriche-Fontaine classification categories were significantly associated with the depressive symptoms (p<0.0001). The stress level was moderate in stages IIA, IIB and III and extremely severe in the terminal stage. The prevalence of anxiety was lowest in incipient PADstages with the highest value in stage III.

Conclusions. The fragment of the PhD study presented the psychological profile in the PAD staging and advocates a personalized, wide-ranging approach to the arteriopathy patient including pain and depressive-anxiety management, with amajor impact on the quality of life at terminal stages.

Open access

Mădălina Moisi, Adriana Ardelean, Larisa Roşan, Cosmin Mihai Vesa, Alexandra Cozma, Livia Mihelea, Marius Rus and Mircea Ioachim Popescu

Abstract

Atrial myxomas are common benign tumors localized in the left atrium (85%). The diagnosis is often made during routine examination due to the fact that they are usually asymptomatic. Sometimes the complications of these benign tumors, consisting in embolic events and obstructive valvular disfunction, may be alarm signs that reveal the underlying pathological condition.

We report the case of a 63-years-old female presenting with non-specific symptoms, the echocardiography was the one that showed the left atrial mass. The particularity that made this case special was the fact that the anticoagulation indication for the atrial fibrillation discovered on the ECG was correlated with the presence of the thrombocytopenia, so the final decision was to postpone it till the surgery. After the removal of the atrial tumor the sinusal rhythm was restored and the combination of beta-blockers and antiplatelet was the best therapeutic choice.

Open access

Traian Constantin Panciu, Bianca Masgras, Catrinel Ciuca, Raluca Ciomag, Anca Mihăilescu and Adriana Gurghean

Abstract

Introduction. The treatment of neoplasia has advanced due to targeted molecular therapies. Erlotinib, a tyrosine kinase inhibitor that acts by blocking epidermal growth factor receptor (EGFR), is used to treat advanced or metastatic chemotherapy-resistant non-small cell lung cancers (NSCLC).

Erlotinib is a safe and well tolerated medication. Although the most common adverse effects are cutaneous or gastrointestinal, its cardiotoxicity is an important topic in the treatment and follow-up of neoplastic patients.

Clinical case. A 76-year-old male patient with 40 Pack Year history of smoking that has quitted 20 years ago, was admitted in 2009 for night sweats, dry cough and weight loss. He is diagnosed with lung cancer in the right upper lobe (T4N2M1), with the histopathological diagnosis of clear cell adenocarcinoma. The patient performs radiotherapy and chemotherapy with 6 series of Gemcitabine and Cisplatin with partial response, followed by Erlotinib treatment with favorable progression with regression of tumor size.

In December 2017, he presents recurrent episodes of atypical angina lasting about 2 weeks. The electrocardiographic examination reveals ST segment elevation, with tall T waves and Q waves are present in the lower branches, associated with the increase of myocardial necrosis enzymes. Echocardiography highlights inferior hypokinesia with left ventricle ejection rate estimated at 45%. The patient has a favorable evolution during admission without recurrence of pain. Coronary angiography is performed at distance with evidence of vascular atherosclerotic lesions and the installation of active pharmacodynamic stents.

Discussions. Tyrosine kinase inhibitors may be the cause of acute coronary events both by affecting myocardiocytes following EGFR inhibition, but also by increasing atheromatic plaque instability and by prolonging theQT segment.

In conclusion a systemic cardiologic assessment of Erlotinib-treated patients may be recommended throughout the course of therapy.

Open access

Andrei Popescu, Andrei Haidar and Rodica Maricela Anghel

Abstract

Recent years have brought major advances in the treatment of malignant melanoma. One such an advance is the treatment with BRAF tyrosine-kinase inhibitors in metastatic malignant melanomas that harbor mutations in the BRAF gene. The trials that have been performed in this setting have demonstrated superior response rates and increased overall survival, however, they mostly included patients with melanomas carrying the more common V600E and V600K mutations, not being able to assess the benefit of these treatments in situations where more rare mutations of the BRAF gene are present. We present the evolution of a patient with malignant melanoma with a rare V600M mutation in the BRAF gene, that was eventually treated with vemurafenib. Also we present a brief review of the major phase III trials that showed benefit with tyrosine-kinase inhibitors in BRAF mutated melanoma, with respect to the BRAF mutations included.

Open access

Lucia Mazur-Nicorici, Victoria Sadovici-Bobeica, Maria Garabajiu and Minodora Mazur

Abstract

Introduction. The aim of the research was the study of the adherence to treatment in patients with systemic lupus erythematosus.

Methods. Cross-sectional study including 132 consecutive patients with systemic lupus erythematosus (SLICC, 2012 classification criteria). We collected clinical and socio-demographic data, socio-economic status; we assessed SLEDAI-2k disease activity, and estimated the adherence to treatment by Morisky questionnaire.

Results. Our results demonstrated that low adherence to treatment in patients with systemic lupus erythematosus was in only 11.36% of patients, while 43.18% and 45.46% of the patients were scored as moderate and high adherence, respectively. A moderate/high adherence to treatment was associated to a high level of education (r = −0.51, p < 0.05, 95% CI = −0.25 to −0.66), low disease activity (r = 0.38, p < 0.05, 95% CI = 0.25 to 0.53) and low indices of physician global assessment (r = −0.31, p<0.05, 95% CI = −0.23 to −0.71). The sub-analysis of the adherence to each drug demonstrated that the highest adherence was to treatment with glucocorticosteroids – 92.85%, followed by hydroxychloroquine and aspirin – 92.15% and 89.79%, respectively.

Conclusion. In our cohort, the adherence to treatment was high in 45.46%, moderate in 43.18% and low in only 11.36% cases. High adherence to treatment was associated to low disease activity. The adherence was positively influenced by the age at the onset of the disease and a high educational level.

Open access

Meral Çeliker, Mustafa Yavuz Selçuk and Serdar Olt

Abstract

Objective. To investigate the relationship between sarcopenia and diabetic nephropathy.

Methods. 56 diabetic patients without complications, 50 diabetic patients with nephropathy, 53 healthy controls included in this present study. Demographic characteristics such as sex, age, anthropometric measurements such as weight, body mass index [BMI], hip circumference, waist circumference and upper arm circumference were measured. Sarcopenia diagnosis was based on European Working Group on Sarcopenia in Older People [EWGSOP] criteria which consist of hand grip strength, 6-meter walking test and muscle mass.

Results. The frequency of sarcopenia increased gradually from 15.1% in healthy control group to 21.4% in the diabetes group, and 34% in diabetic nephropathy group (X2 for trend, p = 0.029). The frequency of sarcopenia was similar in diabetes and diabetic nephropathy group. However, the frequency of sarcopenia was higher in diabetic nephropathy than healthy controls (OR = 2.89, CI [1.11-7.51] in logistic regression).

Conclusion: In the present study, the prevalence of sarcopenia was higher in patients with diabetic nephropathy compared to healthy controls.

Open access

Gianfranco E. Umeres-Francia, María V. Rojas-Fernández and Vicente A. Benites-Zapata

Open access

Natsuki Aoyama-Maeda, Taro Horino, Osamu Ichii and Yoshio Terada

Abstract

Macrophage activation syndrome (MAS), a variant of secondary hemophagocyticlymphohistiocytosis, is a potentially life-threatening complication of inflammatory and autoimmune diseases. We present a case of MAS as a rare manifestation of systemic lupus erythematosus. Although initial treatment with corticosteroid, with or without cyclosporine A, is justified in patients with MAS, evidence regarding the effectiveness of this treatment protocol remains to be clarified. Our patient was successfully treated with a combination of intravenous immunoglobulin therapy and intravenous methyl predonisolone pulse therapy, which was followed by a course of oral prednisolone and oral tacrolimus. Based on our experience, we propose tacrolimus to provide a more useful adjuvant treatment to corticosteroid therapy than cyclosporine A.

Open access

Rahmatollah Rafiei, Mahboobeh Bemanian, Fereshteh Rafiei, Mahmood Bahrami, Lotfollah Fooladi, Giti Ebrahimi, Ahmadreza Hemmat and Zahra Torabi

Abstract

Introduction. It seems that there is a relationship between small intestinal bacterial overgrowth (SIBO) and non-alcoholic fatty liver disease (NAFLD). The main objective of this study was to evaluate the prevalence of SIBO among NAFLD patients.

Methods. In this descriptive-analytical cross-sectional study, 98 eligible NAFLD patients were evaluated for SIBO using hydrogen breath test (HBT). They were divided into SIBO-positive and SIBO-negative groups. Demographic, clinical, and laboratory data were obtained.

Results. Based on the HBT, 38 patients (39%) had bacteria overgrowth. There were no significant differences between SIBO-positive and SIBO-negative regarding demographic data and BMI classification (P > 0.05). Biochemical variables, the results of abdominal ultrasound, and liver elastography did not show any significant difference between SIBO-positive and SIBO-negative patients (P > 0.05). Patients with SIBO were found to have higher rates of bloating, while abdominal pain was more prevalent in SIBO-negative patients (P < 0.001).

Conclusions. SIBO is prevalent in NAFLD and associated with bloating in these patients. Further studies are necessary to elucidate if therapeutic manipulation of gut microbiota reduces the risk of NAFLD, fibrosis, and liver cirrhosis.