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Open access

Cristian Baicus, Paul Balanescu, Adriana Gurghean, Camelia Georgeta Badea, Vlad Padureanu, Ciprian Rezus, Florin Mitu, Ruxandra Jurcut, Andra Rodica Balanescu, Ioana Daha, Eugenia Balanescu, Mihai Bojinca, Larisa Pinte, Alexandru Marian Constantin, Nicoleta Dima, Mariana Floria, Maria Magdalena Leon-Constantin, Mihai Roca, Magda Mitu, Silvia Chiriac, Mariana Floria, Codruta Minerva Badescu, Simona Daniela Ionescu, Elena Mitrea, Gabriel Rosu, Georgeta Daniela Ionescu, Ana Maria Visinescu, Gabriela Mihailescu, Emilia Oprisan, Stefan Zeh, Isabelle Scholl and Martin Härter

Abstract

Background: Shared decision making (SDM) is becoming more and more important for the patient-physician interaction. There has not been a study in Romania evaluating patients’ point of view in the SDM process yet. Therefore, the present study aims to evaluate the psychometric parameters of the translated Romanian version of SDM-Q-9.

Material and methods: A multicentric cross-sectional study was performed comprising eight recruitment centers. The sample consisted of in- and outpatients who referred to Hospital Units for treatment for atrial fibrillation or collagen diseases. Furthermore, patients who were members of Autoimmune Disease Patient Society were able to participate via an online survey. All participants completed the Romanian translated SDM-Q-9.

Results: Altogether, 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n= 341; 51.3%). The Romanian version had good internal consistency (Cronbach α coefficient of 0.96.) Corrected item correlations were good ranging from 0.64 to 0.89 with low corrected item correlations for item 1 and item 7. PCA found a one-factorial solution (similar with previous reports) but the first item had the lowest loading.

Conclusion: SDM-Q-9 is a useful tool for evaluation and improvement in health care that was validated in Romania and can be used in clinical setting in this country.

Open access

Ho So, Victor Tak Lung Wong, Hin Ting Pang, Virginia Wen Nga Lao and Ronald Man Lung Yip

Abstract

We report a male patient who had refractory idiopathic inflammatory myopathy (IIM) presented with antisynthetase syndrome, being treated by potent immunosuppressants for years, developed Epstein-Barr virus (EBV)-associated lymphoma. Despite the stepping down of the immunosuppressives and active lymphoma therapy, the patient died. On top of the typical association of IIM and malignancy, rare EBV-associated tumors related to EBV infection secondary to the use of potent immunosuppressive therapies could occur. Further investigations are advisable if there are new symptoms and signs or in refractory IIM cases. This report serves as a diagnostic alert that the causation by EBV infection in unusual tumors found in patients with IIM should be considered, as both the treatment and prognosis may differ. A balance between the risks and benefits of immunosuppressive therapies should always be achieved.

Open access

Caterina Delcea, Camelia Badea, Ciprian Jurcut, Adrian Purcarea, Silvia Sovaila, Emma Weiss, Elena Alistar, Horia Balan and Cristian Baicus

Abstract

Quality of care in medicine is not necessarily proportional to quantity of care and excess is often useless or even more, potentially detrimental to our patients. Adhering to the European Federation of Internal Medicine’s initiative, the Romanian Society of Internal Medicine (SRMI) launched the Choosing Wisely in Internal Medicine Campaign, aiming to cut down diagnostic procedures or therapeutics overused in our country. A Working Group was formed and from 200 published recommendations from previous international campaigns, 36 were voted as most important. These were submitted for voting to the members of the SRMI and posted on a social media platform. After the two voting rounds, the top six recommendations were established.

Open access

Cheuk Man Ho and Chi Chiu Mok

Abstract

The development of immunotherapy has revolutionized the cancer treatment in the recent years. Immune checkpoint inhibitors (ICPis) such as anti-cytotoxic T-lymphocyte-associated antigen 4 (anti-CTLA-4) and anti-programmed cell death protein (anti-PD1) and its ligand (anti-PDL1) have become part of the standard treatment of various malignancies. Immune-related adverse events (irAEs) were common in patients treated with ICPis. Rheumatologists should be aware of the upcoming challenges in the management of irAEs in a patient receiving treatment with ICPis.

Open access

Chiu Sum Chu, Chi Hung To and Chi Chiu Mok

Abstract

Takayasu’s arteritis (TAK) is a systemic vasculitis mainly affecting the aorta and its first branches. The initial presentation can be very non-specific while its sequelae can be debilitating and fatal. Apart from clinical and biochemical tests, imaging studies remain pivotal for the diagnosis of this rare disease. Delay in treatment may result in vascular stenosis, leading to morbidity and mortality. We report a case of a young woman who presented with anemia with no obvious causes. Subsequently she developed ischemic symptoms and the diagnosis of TAK was established with magnetic resonance angiography (MRA). Our case illustrates the importance of recognition of the possibility of TAK in young women who presented with non-specific systemic upset and anemia of chronic inflammation. A high index of suspicion is needed and imaging studies should be considered early. The treatment of TAK will also be briefly reviewed.

Open access

Hüseyin Avni Findikli, Ayşe Şahin Tutak and Hakan Aydin

Abstract

Introduction: Changes in thyroid hormone level can affect the cardiovascular system. The aim of this study was to show how the Tpeak -Tend (Tpe) interval, which is a new marker of ventricular arrythmia, is affected in patients who have become euthyroid following Levothyroxine treatment for hypothyroidism, as this has not been examined previously in literature. Materials and Methods: This, cross-sectional study included a total of 119 females aged 18-45 years, separated into 3 groups as hypothyroid, euthyroid and control groups. For evaluation of the QTc and Tpe intervals, examination on precordial V5 lead was made of all the ECGs taken routinely on presentation of the patients. Results: The Tpe and QTc intervals of the hypothyroid group were determined to be significantly prolonged compared to those of the euthyroid and control groups (p<0.001) and the values of the euthyroid and control groups were similar. A positive correlation was determined between TSH levels and Tpe and QTc intervals. Tpe interval AUC= 0.801,(%95 CI: 0,719 - 0,884) was higher than that of QTc AUC= 0.689, (%95 CI: 0,591 - 0,786) Conclussions: The Tpe duration was evaluated in respect of the risk of arrythmia in hypothyroid patients. In patients who had become euthyroid, the Tpe interval was found to be similar to that of healthy individuals and was more predictive than QTc. In the light of these findings it can be recommended that measurement of the Tpe interval should be preferred to QTc as a marker of the arrythmogenic effect in hypothyroid patients.

Open access

Sara Machado, Rui Marques, Edite Nascimento, Ana Matos and Carla Henriques

Abstract

Introduction: Diabetes Control and Complications Trial has established the importance of glycemic control in reducing the progression of retinopathy, nephropathy, and neuropathy in type 1 diabetics. There is little literature linking the frequency of glycemic monitoring with glycated hemoglobin A (HbA1c) in type 2 diabetics. The objectives were to assess the influence of glycemic self-monitoring on HbA1c in three groups of patients with type 2 diabetes (with insulin, with oral antidiabetics and with combination therapy). Methods: The glucometer capillary surveys of 117 patients were counted in the 30 days prior to the visit to the Integrated Diabetes Unit at Centro Hospitalar Tondela-Viseu. In the three groups considered, sociodemographic characteristics (age, gender, area of residence, household and schooling) were evaluated and compared. Results: There was no statistically significant association between HbA1c and the frequency of capillary glucose in any of the groups. In the evaluation of sociodemographic data, contrary to what was expected, the area of residence and schooling did not influence the value of HbA1c. Conclusion: These results question the role of glycemic monitoring in the metabolic control of type 2 diabetics, highlighting the need to implement therapeutic education programs so that these patients can adequately intervene in the therapeutic adjustment as a function of the information obtained by capillary glycemia.

Open access

Mujgan Tek, Mehmet Serkan Çetin, Erdem Diker, Savaş Çelebi, Basri Amasyali and Berkten Berkalp

Abstract

BACKGROUND: Platelet to lymphocyte ratio (PLR) has been demonstrated as an risk and prognostic marker in many of cardiovascular diseases. Relationship between PLR and severity of carotid stenosis has been shown. The aim of our study was to investigate the relationship between PLR and all cause mortality in patients with carotid arterial disease. METODS: This retrospective study included 146 patients who had been performed selective carotid angiography. Carotid stenosis were graded by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Platelet to lymphocyte ratio was calculated as the ratio of plateletes to lymphocytes. The end point of the study was all-cause mortality. RESULTS: During median follow-up of 16 months (0-65 months) 15 (10.3%) patients suffered all-cause mortality. 50 patients(34.2%) underwent carotid endarterectomy and 69 patients (47.3%) had non-carotid cardiac surgery. 38 patients (26.02%) had cerebrovascular events (stroke/transient ischemic attack) at admission. NASCET grades were not different between survivors and non-survivors. Non-survivors had significantly lower hemoglobin (Hb) levels (12.7±1.6 g/dl vs. 13.7±1.7 g/dl , p= 0.031) and they were older than survivors (74.2±8.4 years vs. 68.6±8.5 years, p=0.029). Non-survivors had significantly higher PLR values compared with survivors (190.3±85.6 and 126.8±53.8, p=0.017). In multivariate analysis, only PLR predicted all-cause mortality in patients with carotid artery stenosis. CONCLUSİON: In our study, higher PLR was associated with increased all-cause mortality.

Open access

Serghei Covantev

Abstract

Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. The attention towards the PD has grown significantly since there are reports that this condition may cause acute relapsing pancreatitis, chronic pancreatitis and chronic abdominal pain syndrome. Furthermore, over the years, there have been multiple reports of PD associated with different types of tumors. There is evidence that PD can be associated with pancreatic tumors (up to 12.5% of cases). The golden standard for diagnosing PD is endoscopic retrograde cholangiopancreatography, but since it is an invasive procedure magnetic resonance cholangiopancreatography with secretin is a good alternative. In case the patient is symptomatic, endoscopic or surgical treatment should be performed. This review describes the key points of the pathophysiology, diagnostic modalities, risks of pancreatitis and tumors, as well as treatment options of PD.