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Open access

Szakacs Xantus Timea, Varga Andreea, Bocicor Andreea Elena, R Tatar and I Tilea

Abstract

Background: Left non-compaction cardiomyopathy (LVNC) or “spongy myocardium” is a relatively rare primary genetic cardiomyopathy, characterized by prominent wall trabeculations and intertrabecular recesses which communicate with the ventricular cavity. It appears in isolated form or coexists with other congenital heart diseases and/or systemic abnormalities. Material and method: A 28-year-old woman was admitted with exertional dyspnoea, palpitations, non-specific chest pain and progressive fatigue on exertion. In her family history sudden cardiac-related deaths at young age are present. Cardiovascular system examination revealed tachycardia, intermittent extrabeats. The rest EKG showed sinusal tachycardia (105 bpm), negative T-waves in DII, DIII, aVF, V4-V6. Consecutive 24 hours Holter EKG monitoring revealed nonsustained ventricular tachycardia, paroxysmal atrial fibrillation, isolated ventricular extrasystoles. Echocardiography showed left ventricular systolic dysfunction (LVEF:30-35%), slight LV enlargement, normal right ventricle and small left ventricle (LV) trabeculae in the apical area. Cardiac MRI demonstrated dilated LV and the presence of the trabeculations of LV walls suggestive for non-compaction cardiomyopathy. A combined treatment for heart failure and cardiac arrhythmias was initiated with good clinical results. Patient was scheduled for an implantable cardioverter defibrillator “life-saving”. Conclusions: The symptoms of heart failure and cardiac arrhythmias should be considered important in apparently healthy young patients. Besides intensive medical treatment is indicated the implantation of an ICD “life-saving” and in advanced cases heart transplantation. Even if the electrocardiographic findings are non specific for noncompaction, a complete diagnostic evaluation is important, including sophisticated imaging techniques, a screening of first-degree relatives, and an extensive clinical, and genetic appreciation by a multidisciplinary team.

Open access

Ioan Ţilea, Elena Andreea Bocicor, Codruţa Maria Gal and Andreea Varga

Abstract

Background: Pulmonary hypertension (PH), defined by mean pulmonary arterial pressure (PAPm) ≥25 mm Hg, can lead to increasing pulmonary vascular resistance, which eventually results in right ventricle failure. Scleroderma, as an autoimmune connective tissue disease, is associated with PH as a sub-group according to the 2015 ESC/ERS PH classification. Pulmonary arterial hypertension (PAH) associated with scleroderma (SSc-PAH) can often result in poor prognosis with increased mortality. Early diagnosis and specific treatment of PH can significantly improve the prognosis of these patients.

Case report: We present the case of a 50 year-old male, with no relevant family history, with a 2-year history of echocardiography-based diagnosis of PH (PAPm 78 mmHg). Physical examination revealed limited hand and forearm areas of non-folding thick skin, vital signs in the normal range and peripheral oxygen saturation of 96%. Severity and risk assessment were performed based on clinical and imaging tests, and hemodynamics. 12-lead rest ECG revealed sinus tachycardia and right bundle branch block, the six-minute walk test confirmed limited exertion capacity, Borg scale 9. Transthoracic echocardiography pointed to dilated right heart cavities and moderate pericardial effusion. Right heart catheterization confirmed the PAH (PAPm: 36 mmHg), and pulmonary CT angiography excluded massive pulmonary embolism. Rheumatologic examination and immune serology identified a scleroderma subset, limited cutaneous sclerosis form (lcSSc) with early onset PH. Combined specific PH drug therapy was initiated, followed by clinical and functional improvement in clinical status, prognosis and life quality.

Conclusions: In clinical group 1 of PH, the subgroup etiology of PAH associated with connective tissue disease (1.4.1) often goes undiagnosed, mainly due to the diminish of lung involvement symptoms in early CTD stages. Multidisciplinary approach is essential in order to refine the diagnosis and set out the treatment algorithm.

Open access

Andreea Elena Bocicor, Gabriela Buicu, Daniela Sabau, Andreea Varga, I Tilea and I Gabos-Grecu

Abstract

Introduction and objectives. Obesity is a public health issue, with increasing prevalence and incidence all over the world. Diet and exercise applied in obesity treatment are not always as effective as expected, as there are many other determining factors which can lead to obesity. One of these modifiable factors seem to be sleep disorder. The objective of our study was to test the positive association between the presence of sleep disorder and increased body mass index (BMI).

Material and method. 84 patients were screened in a descriptive cross-sectional study. Each patient completed the adjusted 7 items University of Toronto Sleep Assessment Questionnaire (SAQ©). Each affirmative answer was accounted 1 point. The total score was calculated. Mild sleep disorder was considered at 4-5 points, severe sleep disorder at 6 - 7 points. Body mass index (BMI) was calculated for each patient by the formula weight (Kg)/squared height (m2). We considered increased BMI values greater than 25 kg/m2. The association between the sleep disorder and increased BMI was statistically tested.

Results. We interviewed 84 patients, 32 (38%) men (average age 54 +/− 6.63) and 52 (62%) women (average age 50 +/− 5.26). Mild sleep disorder was present in 36 patients, and severe sleep disorder in 25 patients. We noticed association between sleep disorder and increased BMI (p=0.0064, RR=2.925, 95% CI 1.16-7.36). We observed the risk for increased BMI dependent on the sleep disorder severity.

Conclusions. Sleep disorder is a potentially modifiable risk factor which can be included in obesity therapeutic approach and management. Early diagnosis and treatment of sleep disorder is important in obesity prevention.

Open access

Bocicor Andreea Elena, Buicu Gabriela, Varga Andreea, R Tatar, Sabau Daniela, I Tilea and I Gabos-Grecu

Abstract

Introduction: Abdominal adiposity assessed by increased waist circumference and depression have both a high incidence and prevalence and are associated with increased general mortality and cardiovascular risk. Several studies showed a significant association between abdominal obesity, metabolic syndrome and depression. Early detection of these associations is important for for prevention and treatment of this disease.

Material and method: Eighty patients were enrolled in a cross-sectional descriptive study. Waist circumference was measured in all patients and an increased waist circumference was considered for subjects with values higher than 80 cm in women and higher than 94 cm in men as. Patients completed standardized questionnaires HADS for assessment of depression and anxiety. A depression (D) score higher than 10 points showed a trend to depression while an anxiety (A) score higher than 10 indicated a tendency to anxiety. The association between increased waist circumference, depression and anxiety was studied.

Results: We interviewed 80 patients, 34 (43%) men (mean age 62+/−6.43) and 46 (57%) women (mean age 59+/−5.16). Increased waist circumference was recorded in 22 men, and in 30 women. We noticed a good association between increased waist circumference and both depression (p=0.0006, RR=2.007, 95%CI 1.24-3.24) and anxiety (p=0.017, RR=2.046, 95%CI 1.21-3.45). We found both anxiety and depression risks rather equal in men, while in women we observed a higher depression risk.

Conclusions: Increased waist circumference is associated to depression and anxiety tendency in both genders. Depression trend is more powerful in women, while in men both depression and anxiety seen to have an equal frequency. Psychotherapy should be added to lifestyle changes in patients with abdominal adiposity.

Open access

Ioan Țilea, Codruța Gal, Andreea Varga and Roxana Rudzik

Abstract

Left ventricular non-compaction (LVNC) is a cardiomyopathy that can either result from arrested or abnormal myocardial morphogenesis during heart development, or can be acquired later in life. Current practice guidelines recommend different strategies for the management of patients with LVNC. Common clinical features of this disease include cardiac failure, thromboembolism, life-threatening arrhythmia or sudden cardiac death, which could indicate a worse prognosis. The disease may occur alone or in association with other congenital cardiac, neuromuscular, mitochondrial or metabolic disorders. The association of left ventricular non-compaction with other structural cardiac congenital diseases (such as atrial or ventricular septal defect, patent ductus arteriosus, obstruction of ventricular outflow tract) is rare. As clinical manifestations of LVNC are non-specific, particular imaging modalities (echocardiography, cardiovascular magnetic resonance imaging or ECG gated computed tomography) should be used in order to establish the diagnosis of LVNC. Antiarrhythmic drugs and implantable cardioverter defibrillators may be considered for the management of ventricular arrhythmias in patients with ventricular non-compaction. We report the presentation, diagnosis and management of a 46 year-old female with refractory severe cardiac failure, repeated syncope due to LVNC and atrial septal defect, requiring medical therapy and an implantable cardioverter defibrillator as a "life bridge" to heart transplantation.

Open access

Andreea R. Zsigmond, Krisztina Varga, Sándor Harangi, Edina Baranyai and István Urák

Abstract

We determined the elemental profile of 16 edible mushroom species from the Făget Forest, near Cluj-Napoca, and of 12 species from the Apuseni Mountains. One-way ANOVA showed no difference in the elemental content of mushrooms when the two regions were compared. Some species accumulated high amounts of trace elements, i.e. Boletus edulis (Ag, S, Zn), Macrolepiota procera (Cu), Lactarius volemus (Co), Russula emetica (Mn), Armillariella mellea, and Chantarellus cibarius (Cr). The cadmium content was the highest in the case of Leccinum scabrum and Boletus edulis. These two species presented elevated risk levels for all age-groups when they are consumed regularly.

Open access

Ioan Tilea, Dorina Petra, Elena Ardeleanu, Adina Hutanu and Andreea Varga

Abstract

Hypertension remains one of the primary causes of premature cardiovascular mortality representing a major independent risk factor.

The importance of ambulatory blood pressure monitoring in clinical evaluation of hypertensive patients, beyond diagnosis, is the identification of circadian dipping/non-dipping profile. The non-dipper pattern in hypertensive and normotensive patients is associated with significant target organ damage and worse outcomes, as an increased cardiovascular risk condition. Non-dipping pattern has been found to be associated with specific clinical conditions. Obesity, diabetes mellitus, metabolic syndrome, obstructive sleep apnea syndrome, chronic kidney disease, autonomic and baroreflex dysfunctions, salt sensitivity, hormonal changes, gender and age were extensively studied. Research efforts are focused on recognizing and exploring predictive markers of abnormal blood pressure circadian pattern. Previous studies acknowledge that red cell distribution width, mean platelet volume, fibrinogen level, C-reactive protein, serum uric acid and gamma-glutamyltransferase, are independently significant and positive associated to non-dipping pattern. Moreover, research on new biomarkers are conducted: Chitinase 3-Like-Protein 1, atrial and B-type natriuretic peptide, brain-derived neurotrophic factor, chemerin, sphingomyelin and the G972R polymorphism of the insulin receptor substrate-1 gene. This review summarizes the current knowledge of different clinical conditions and biomarkers associated with the non-dipper profile in hypertensive patients.

Open access

Ioan Ţilea, Andreea Varga, Septimiu Voidăzan and Adina Huţanu

Abstract

Background: Twenty-four hours dynamic blood pressure (BP) behaviour displays dipper profile defined as nocturnal systolic BP (SBP) reduction>10% compared to daytime. Non-dipper profile, nocturnal absence of SBP fall, associates an increased cardiovascular risk. We investigated the concomitant association of inflammatory bio-markers - high-sensitivity- C-reactive protein (hs-CRP), Human Chitinase3-like1 (YKL-40) and autonomic nervous system (total brain-derived neurotrophic factor, BDNF) with respect to non-dipping blood pressure status.

Material and method: Using 24h automatic BP measurements, 80 known hypertensive patients were divided into two groups: dipper group included fifty-one dipper patients (age 55.6 ±13.5 years) and non-dipper group consisted of 29 non-dipper subjects (62.07±12.03 years). Serum levels of hs-CRP were evaluated with enhanced immunoturbidimetric assay. Plasma levels of YKL-40 were measured by commercial sandwich ELISA using microplate coated with a monoclonal antibody for CHI3L1. Plasma levels of total BDNF were determined using quantitative sandwich enzyme-linked immunoassay. Statistical analysis of obtained data was performed.

Results: In the non-dipper group, a significant positive association with age over 60 years, hs-CRP values above 1.90 mg/dl was observed along with increased mean values of YKL-40. Non-dipper status is independently and statistically significantly associated with elevated levels of hs-CRP (OR: 3.248, 95% CI: 1.022-10.317, p=0.046) in multivariate odds ratio analysis. No statistically significant positive association between a median total BDNF plasma level of 1430 pg/ml and the non-dipper hypertension profile was identified.

Conclusion: Our study demonstrated that patients over 60 years, in particular, have a higher probability to present a non-dipping pattern of hypertension. hs-CRP and YKL-40 values are more likely to increase in the non-dipping hypertensive patients, and hs-CRP values above 1.9 mg/dl can identify the presence of a non-dipper blood pressure profile.

Open access

Varga Andreea, Szakacs Xantus Timea, Gliga Mirela, Podoleanu Cristian Gheorghe Calin, Bocicor Andreea Elena, Carasca Emilian and Tilea Ioan

Abstract

Background: Young adults meeting hypertension diagnostic criteria have a lower prevalence of a hypertension diagnosis. Headache is a rather common symptom among young people. Fibromuscular dysplasia (FMD) is an idiopathic, segmental, nonatherosclerotic and noninflammatory disease of the muscular tunica of arterial walls, leading to stenosis of small and medium-sized arteries. Fibromuscular dysplasia is much more common than previously thought and is a treatable cause of secondary hypertension.

Case presentation: We present the case of an 18 y.o. young woman, with headache and high blood pressure. “White coat hypertension” was suspected. Clinical history with abrupt onset and increasingly difficult to treat hypertension especially in women, were suggestive for renal artery stenosis. Renal ultrasound and digital subtraction angiography confirmed the aspect of FMD. Sequential percutaneous renal artery angioplasty was later performed with improved evolution both from the clinical point of view and controlled blood pressure below 140/90 mmHg with minimal antihypertensive regimen. Angio CT exam of neck and brain arteries was performed, no other FMD typical lesions were identified.

Conclusions: Medical treatment is first indicated for the hypertensive patient. In this particular case percutaneous renal artery angioplasty showed significant improvement in reduction of antihypertensive treatment in a young patient with secondary hypertension. Further monitoring and management of this patient will include blood pressure measurements at 3-month intervals and renal function measurements annual, as well as non-invasive duplex ultrasonography at 12-month intervals, follow-up is indefinite. It remains challenging whether the patient can be medically managed on antihypertensive medication alone.

Open access

Ioan Țilea, Daniela Saveta Popa, Timea Szakács Xantus, Daniela Primejdie, Bianca Grigorescu, Brîndușa Țilea, Andreea Elena Bocicor and Andreea Varga

Abstract

A high-throughput liquid chromatography method with detection by tandem mass spectrometry (LC-MS/MS) was developed and validated for the quantification of apixaban in human plasma. The separation was performed on a Gemini-NX column under isocratic conditions using a 33:67 (v/v) mixture of acetonitrile and 1 mM ammonium formate in water at 40 ºC with a flow rate of 0.5 mL/min. The detection of apixaban was performed in multiple reaction monitoring mode (m/z 417.2 from m/z 460.2) with electrospray positive ionization. A single-step protein precipitation with methanol was used for plasma sample preparation. The method was validated with respect to selectivity, linearity (r > 0.994), intra-day and inter-day precision (CV < 14.4 %) and accuracy (bias < 9.5 %) over the range of 9.70 - 970.00 ng/mL plasma. The lower limit of quantification (LLOQ) was 9.70 ng/mL and the recovery was between 97.4 - 104.5 %. The method is fast, efficient, requires the processing of a small volume of plasma (50 μL), a short run-time (1 min) for chromatographic analysis, and a simple and rapid preparation of samples. It is very well suited for clinical therapeutic drug monitoring and pharmacokinetic studies.