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Aorto-mesenteric Bypass for the Treatment of Chronic Mesenteric Ischemia

Abstract

Chronic mesenteric artery disease has a much lower incidence than the acute one, but it raises the same problems in terms of patient survival. The long-term outcomes for open surgery are crucial for the right choice of a particular technique. We present the case of a 39-year-old female patient with a history of total nephrectomy, chronic kidney failure, and hypertension, who presented in the Emergency Department with abdominal pain with high intensity, for which she was admitted to the General Surgery Department. Abdominal computed tomography angiography was performed, which indicated the diagnosis of partial upper mesenteric artery stenosis. The patient underwent surgery, during which a retrograde aorto-mesenteric bypass with a Gore-Tex 5 mm diameter prosthesis was performed. In situations where the endovascular approach fails or has no indication (multiple incidence lesions from the origin of the superior mesenteric artery), open surgery is the indication in chronic mesenteric ischemia.

Open access
Association between the Incidence of Sudden Cardiac Arrest and the Location of Culprit Lesions in STEMI Patients – Design of a Prospective Clinical Study

Abstract

Out-of-hospital cardiac arrest (OHCA) has a poor prognosis and is the most severe complication of any cardiac event. It is known from previous studies that the location of the culprit lesion in ST-segment elevation myocardial infarction (STEMI) patients with cardiac arrest may affect the post resuscitation survival rate. However, due to the low number of cases, the association between the localization of the culprit lesion within the coronary tree and the occurrence of cardiac arrest is not widely discussed, because resuscitated cardiac arrest patients are excluded from the vast majority of clinical trials. This is a prospective observational study that aims to develop a prediction model for OHCA in patients who present with STEMI, based on differences related to culprit lesion location. The primary objective of the study is to evaluate the differences related to the location of the culprit lesion in patients with STEMI who present OHCA versus patients without cardiac arrest.

Open access
Chemical or Surgical Treatment in Ingrown Toenails? Practical Issues from a Case Series

Abstract

Introduction: An ingrown toenail is a serious medical problem that cannot be overlooked, and the decision of choosing between conservative versus surgical treatment may be difficult in daily practice.

Case series presentation: We present the cases of two young men with a long history of ingrown toenails, previously treated by complete nail avulsion, numerous topical applications of antibiotics, and 5% silver nitrate, successfully treated with caustic chemical agents, compared to a 19-year-old athlete with debilitating pain, intense inflammatory changes, infection, granulation tissue induced by skin penetration of lateral nail edge by an incurved toenail, in whom surgical treatment was needed.

Conclusion: Chemical matricectomy in the absence of any surgical intervention, along with patience allowing the nail to grow, could be an option that is easy to perform in case of ingrown nails. However, the selection of cases is important, taking into balance the benefit-risk ratio.

Open access
Factors Associated with Sub-intimal Coronary Artery Dissection in MINOCA Patients with Delayed Washout at Coronary Angiography – Protocol for an Observational, OCT-based Study

Abstract

Background: Myocardial infarction (MI) with no obstructive coronary arteries (MINOCA) is a special form of the acute coronary syndrome. The heterogeneous pathophysiology of MINOCA is not well elucidated and includes cardiac and non-cardiac causes. Slow flow phenomenon on coronary angiography can be associated with several possible causes of MINOCA confirmed by optical coherence tomography (OCT). Therefore, the aim of this study is to assess the underlying mechanism of the delayed washout phenomenon on coronary angiography and the potential role of subintimal coronary artery dissection (SD) in the setting of an acute MI.

Methods and design: This clinical prospective, descriptive research will enroll patients diagnosed with acute MI (STEMI or NSTEMI) identified by coronary angiography, followed by OCT imaging of the coronary arteries at the Emergency Clinical County Hospital of Târgu Mureş, Romania. The enrolled patients will be separated into two groups based on OCT examination, patients with SD and patients with no SD.

Conclusion: The underlying mechanisms of MINOCA with delayed washout phenomenon on coronary angiography is still poorly understood. Modern invasive imaging techniques are capable to assess the microstructure of the coronary artery wall and are able to offer the much needed information to elucidate the pathophysiological changes which ultimately cause the acute event. The current study offers a new, complex – clinical, invasive and noninvasive imaging, as well as biomarker-based – approach, which may lead to a better understanding and treatment of this pathology.

Open access
Impact of Coronary Plaque Vulnerability on Acute Cardiovascular Events – Design of a CT-based 2-year Follow-up Study

Abstract

With coronary artery disease (CAD) projected to remain the leading cause of global mortality, prevention strategies seem to be the only effective approach able to reduce the burden and improve mortality and morbidity. At this moment, diagnostic strategies focus mainly on symptomatic patients, ignoring the occurrence of major cardiovascular events as the only manifestation of CAD. As two thirds of fatal myocardial infarction are resulting from plaque rupture, an approach based on the “vulnerable plaque” concept is mandatory in order to improve patient diagnosis, treatment, and, by default, prognosis. Given that the main studies focus on a plaque-centered approach, this is a prospective observational study that will perform a complex assessment of the features that characterize unstable coronary lesions, in terms of both local assessment via specific coronary computed tomography angiography markers of coronary plaque vulnerability and systemic approach based on serological markers of systemic inflammation in patients proved to be “vulnerable” by developing acute cardiovascular events.

Open access
Perception of Healthy Eating among Romanian Adults

Abstract

Background: Totaling about 60% of all causes of death, chronic illnesses are the main cause of global mortality. Unhealthy behaviors, such as unbalanced eating or insufficient physical activity, can trigger metabolic changes, manifested by hypertension, high blood sugar, hyperlipidemia, obesity. These changes are grouped into the category of metabolic risk factors. Over time, these factors can cause cardiovascular diseases associated with a high mortality rate.

Aim of the study: To evaluate the perception of healthy eating in a Romanian population.

Material and methods: We applied a validated online questionnaire aimed to investigate people’s attitude towards diet and their motivation regarding food consumption in ten countries, based on an international project. For the present paper, we evaluated a Romanian sample of 821 adult respondents.

Results: Most of the subjects (82.82%) were from an urban area, and 68.94% were women. Regarding the prevalence of chronic diseases, 3.53% of participants had cardiovascular disease, 6.69% had high cholesterol levels, 7.18% were obese, and 6.57% were suffering from high blood pressure. Significant correlations have been identified between calorie count, excessive sugar and salt consumption, gender variables, cardiovascular disease, obesity, and high blood pressure. Also, tradition is very important in relation to eating behaviors, being highly correlated with obesity. The general direction of answers was correct, even if half of the questionnaire items were formulated in a ‘negative’ way, and disagreement is needed for a consistent response with a correct perception of healthy diets. The overall perception of healthy eating was consistent with scientific information in the field.

Conclusion: Women are generally better informed than men regarding healthy eating. Also, there is a possible conflict between traditional food-related cultural values and modern nutritional guidelines based on scientific information.

Open access
The Relationship between Anxiety and Immunity in Pediatric Oncology Patients

Abstract

Background: Pediatric onco-hematology is not a frequently encountered medical specialty, and it influences everyday life, basic activities, and the immune system, mostly through psychosocial changes, which may affect every individual and their families differently. Anxiety is the most frequently encountered mental health disorder occurring during childhood and adolescence. The effect of stress and anxiety on the immune system is suggested by the fact that stress hormones elevate proinflammatory cytokines and subsequently lower the anti-inflammatory response.

Objective: Our main objective was to analyze the relationship between anxiety disturbance and cytokine levels in oncologic pediatric patients from Târgu Mureș in order to answer the following question: does anxiety influence immunity?

Material and methods: After testing pediatric oncology patients from the Pediatrics Clinic no. 2 of Târgu Mureș, Romania with the SCARED child test, we took blood samples from each participant. IL-6, IL-10, IL-1β, IL-12p40 and TNF-α levels were evaluated with a Human Cytokine Magnetic Panel using the xMAP technique on Flexmap 3D platform (Luminex Corporation, Austin, USA). C-reactive protein levels were determined with the BN Pro Spec nephelometer with CardioPhase hsCRP (Siemens Healthcare Diagnostics, GmbH, Marburg, Germany) reagent.

Results: The 46 pediatric oncology patients had 6 main diagnostic groups, the most frequent pathology was acute leukemia (58.7%) followed by malignant solid tumors (21.74%) and lymphomas (6.52%). In the anxious group (45.65%) we observed 4 of the 5 studied anxiety types: panic disorder, separation, social, and generalized anxiety. We measured the cytokine levels of all the participants from the two main groups: anxious/non-anxious. Statistical analysis (linear regression) showed statistically significant positive correlations in the anxious group related to the IL-1β and IL-6, a moderate/weak correlation related to IL-12p40, as well as a negative moderate correlation between IL-10 values in the anxious group and a positive trend in the non-anxious group.

Conclusions: Psycho-oncology is a relatively young specialty with few studies in the last two decades. IL-1β, IL-6, and TNF-α present high levels in anxious patients, while IL-10 and IL-12p40 have low serum levels in mental disorders. C-reactive protein levels are not influenced by anxiety.

Open access
Unilateral Palmar Post-traumatic Granuloma Annulare – Work-related?

Abstract

Granuloma annulare (GA) is a granulomatous skin condition that can present with a diversity of clinical manifestations and locations, with an unknown etiology and diagnosed on clinical-pathological grounds/correlations. Although many trigger factors have been described and several pathogenic mechanisms proposed, the etiology of GA remains unknown. We report a case of work-related, isolated, unilateral GA localized on the right palmar area of a young worker, possibly induced by work-related direct trauma.

Open access
Congenital Malalignment of the Nails

Abstract

Congenital malalignment of the toenail is characterized by the lateral (rarely medial) deviation of nail plates that affects mostly the great toes from one foot or both, but has also been described on other toes, even on the hands. This nail disease is still considered a rare entity, although it is not a rare clinical observation in daily practice. We present a few cases in children and adults, highlighting the diagnosis made by clinical observation, regardless of the different grades of severity of the nail disease. Conclusion: It is of great importance to clinically recognize this entity in young children and to make the correct recommendations.

Open access