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Open access

Irina Ilea, Iulia Lupan, Daniel Corneliu Leucuta, Caius Romulus Duncea and Maria Dronca

Abstract

Objectives. The aim of this study was to examine the effects of single nucleotide polymorphisms (SNPs) of PON1 gene at the level of promoter region (‒909 and ‒832) and of first exon (+575, A20352G, resulting Q192R substitution) on paraoxonase-1 (PON1) activities in 53 patients with angiographycally proven coronary heart disease (CHD) and 17 free-CHD subjects. Methods and Results. Serum PON1 arylesterase (Ar-ase) and salt-stimulated paraoxonase (ssPO-ase) activities were assessed with manual spectrophotometric methods, by using phenyl acetate and paraoxon as substrates. Common serum biochemical markers were assayed by enzymatic methods using commercial kits, on a Roche/Hitachi 912 Auto Analyzer. PON1 genotypes were determined by PCR and nucleotide sequencing of the amplicons with an ABI PRISMTM 310 Genetic Analyzer and a BigDye® Terminator v3.1 Cycle Sequencing Kit. The severity of coronary artery stenosis was assessed and classified using the Gensini score. We found no significant differences in the PON1 activities and -909(G→C), -832(G→A) and +575(A→G) PON1 polymorphisms between CHD and CHD-free groups. Considering all investigated subjects, we found that -909(G→C) and +575(A→G) SNPs had statistically significant effects on Ar-ase activity and PO-ase activity, respectively. In a multiple regression model we found that diabetes, LDL-cholesterol and the number of mutant alleles were significant independent determinants of the Gensini score. A significant positive correlation was observed only between the Gensini score and the number of mutant alleles. Conclusions. There are no differences between CHD and CHD-free groups regarding PON1 genotypes and phenotypes but the increasing number of PON1 mutant alleles is an important factor in determining the severity of coronary damage.

Open access

Laszlo Mihaela, Oliviu Pascu, Daniel-Corneliu Leucuta and Vasile Andreica

Abstract

Introduction: The infection with Clostridium difficile has increased in incidence worldwide and it raises many problems with regard to therapy, resistance to treatment and especially recurrence. Recurrence is frequent in patients treated for Clostridium difficile infection, requiring vancomycin by mouth, with limited alternatives. The literature shows that one of the most efficient treatment methods in Clostridium difficile infection is the transplantation of gut microbiota, also known as fecal microbiota transplantation. Aim: We present our results following FMT performed in patients with recurrent Clostridium difficile infection, and propose a simple and effective protocol for fecal microbiota transplantation. Study design: The study was prospective. The phases of the FMT procedure: assessment of patient eligibility, patient’s consent, identification and screening of donors, discontinuation of antibiotics (vancomycin, metronidazole) 3 days prior to the procedure. Methods: Between 2013 and 2015, FMT was performed in 30 patients with recurrent Clostridium difficile infection, by direct infusion of extensively processed donor fecal matter via colonoscopy. We followed up the patients for 12 months. Results: Immediate post-transplantation outcome in what concerns stool frequency during the follow-up period (7 days) was encouraging in 93.33% of patients. The donors were healthy individuals (53% 1st degree relatives), previously screened for possible infections and infestations. This result was sustained at 6-month and 12-month follow-up. Post-transplantation recurrence occurred in 6.67% (2 patients), which responded well to treatment and did not require a new vancomycin course. Conclusions: Fecal microbiota transplantation via colonoscopy is effective, safe, easy to perform, it yields lasting results and is therefore a good option for recurrent or treatment-resistant Clostridium difficile infection.

Open access

Daniela Iacob, Angela Butnariu, Daniel-Corneliu Leucuţa, Gabriel Samaşca, Diana Deleanu and Iulia Lupan

Abstract

Introduction. Heart failure (HF) is characterized by neuroendocrine activation. The cardiac natriuretic hormones, including atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), together with their related pro-peptides (proANP and proBNP) represent a group of peptide hormones produced by the heart. A normal NT-proBNP level has a high negative predictive value for heart failure. The use of NT-proBNP testing is helpful in diagnosing acute HF in the emergency care setting, allowing an early and optimal treatment. The purpose of this study is to assess the prognostic value of NT-proBNP in heart failure in children younger than 3 years old and to establish whether it correlates with the NYHA/Ross functional class and left ventricle systolic function.

Methods. We enrolled 24 consecutive children with HF due to congenital heart diseases and dilated cardiomyopathy. The serum levels of NT-proBNP were measured, all patients underwent echocardiography and left ventricle ejection fraction was calculated.

Results. The highest median value of NT-proBNP was recorded in patients with cyanotic heart diseases (248.0 fmol/mL), p = 0.610. NT-proBNP had a negative correlation with the ejection fraction of the left ventricle: Spearman's rank correlation coefficient was −0.165.

Conclusions. NT-proBNP levels correlate with the severity of HF in infants and small children younger than 3 years old with heart failure due to congenital heart diseases and dilated cardiomyopathy.

Open access

Cerasela Mihaela Goidescu, Florin Petru Anton, Daniel Corneliu Leucuța, Petru Adrian Mircea and Luminița Animarie Vida-Simiti

Abstract

Background: Apelin is a potent endogenous inotropic peptide with a major role in counteracting the aldosterone and angiotensin II and their negative effects on the cardiovascular system. The exact role of apelin in the patho-physiology of this disease is not well understood. We aimed to investigate the possible associations of apelin-13 with clinical and paraclinical characteristics in HF patients as well as studying its dynamics during the course of the heart failure.

Method: We performed a prospective observational cohort single-center study. We compared the baseline serum levels of apelin-13 and NT-proBNP level in 53 heart failure patients (acute heart failure, chronic compensated heart failure and chronic decompensated heart failure). We divided the patients according to the apelin-13 level: above and below the median, and we analyzed the relationship between serum apelin-13 and the clinical, echocardiographic, electrocardiographic and biological parameters. Twenty patients were followed-up (after an average time interval of 9 months), investigating the same parameters.

Results: The median of apelin-13 was 495pg/mL (IQR 276-845pg/mL). We found strong, negative correlation between the serum levels of apelin-13 and NT-proBNP (Spearman rho= −0.83, p<0.001). For the reassessed patients the median apelin level was significantly higher at follow-up (460 pg/mL, IQR 342-871 pg/mL) as compared with the baseline level (395 pg/mL, IQR 270-603 pg/mL), p=0.019, and maintained the negative correlation with NT-proBNP level (Spearman’s rho −0.7, p<0.001. The Low Apelin-13 group have higher NT-proBNP levels and also contains all the patients in NYHA IV class heart failure, 71% of the acute HF patients, and 7 of 8 patients who died before follow-up.

Conclusion: Apelin-13 was negatively correlated with NT-proBNP. The Low Apelin-13 group contained the majority of the patients with a negative outcome (death before follow-up), most of the patients who presented with acute HF and all the patients in NYHA IV class.

Open access

Monica Goia-Socol, Ileana Duncea, Gabriela Roman, Mihai-Andrei Goia-Socol, Daniel-Corneliu Leucuţa and Carmen Emanuela Georgescu

Abstract

Background and aims: Type 1 diabetes mellitus (T1DM) represents a secondary cause of osteoporosis. Our aim was to determine bone mineral density (BMD) changes in a group of young Romanian adults with T1DM and to analyze the factors related to this disease that could have had an impact on bone mass. Material and Methods: Fifty-two young patients with T1DM were compared to 37 healthy volunteers matched for body mass index (BMI). All subjects had their BMD measured at the hip and lumbar spine. Results: We found no statistically significant differences in BMD between T1DM patients and controls (p=0.618 for lumbar spine, p=0.974 for femoral neck and p=0.883 for total hip). Multiple linear regression models detected BMI (p =0.043), smoking (p=0.001) and milk intake (p=0.004 for lumbar spine) as significant BMD determinants. In contrast, no associations were found between BMD and metabolic control, daily insulin dose or presence of diabetic retinopathy and/or neuropathy. Long diabetes duration was negatively associated with BMD in femoral neck (p=0.012). Conclusions: Although we couldn’t find differences between BMD in T1DM patients and controls, the link between diabetes duration and BMD that we found suggests that even young patients with long standing T1DM should have their BMD measured