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  • Author: Ioan Tilea x
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Abstract

Morganella morganii (M. morganii) is a Gram-negative aerobic and facultative anaerobic rod, belonging to the Enterobacteriaceae family. This pathogen is uncommon in community-acquired infections, most often being found in postoperative nosocomial and urinary tract infections. Infection of the central nervous system with this pathogen is rare. We present the case of a 66-year-old patient who underwent colon cancer surgery, chemotherapy and radiotherapy, had left iliac anus, type 2 diabetes and developed acute meningoencephalitis caused by M. morganii. Cerebrospinal fluid examination revealed increased number of polymorphonuclear neutrophils, modified biochemistry and AmpC beta-lactamase producing M. morganii strain. After initiation of antibiotic treatment, initially with empirical therapy represented by meropenem and vancomycin, afterwards adjusted to meropenem and ciprofloxacin, according to the stain’s susceptibility to antimicrobials the patient’s evolution was favourable, in spite of the existence of two immune suppressing conditions.

Abstract

Lyme borreliosis (LB) is the most frequent infection transmitted by ticks from the Ixodes genus, both in the United States of America (USA), and in Europe. The objectives of this study were the monitoring of the incidence and clinical manifestations of the disease in Mures County, Romania. Material and method. The study was conducted over a period of two years, January 1st 2010 -December 31st 2011, on a number of 120 consecutive patients. The definite or probable diagnosis of LB was established on the Centers for Disease Control and Prevention (CDC, Atlanta, USA) criteria, and on the European Union Concerted Action on Lyme borreliosis (EUCALB). ELISA and Western-Blot techniques were used for identification of IgM and IgG antiBb from the serum and CSF. Results. There were 44 cases in 2010 and 76 cases in 2011. According to the case definition, 106 cases were confirmed as LB and 14 were probable. LB was more frequently diagnosed in children, young adults and adults, compared to the over 60 years old age group. The incidence of disease was higher in women patients, 68 (56.66%) compared to men - 52 patients (43.33%), with a higher proportion in people coming from an urban setting, 78 patients (65%), compared to people coming from rural settings 42 patients (35%). Clinical manifestations were acute, like erythema migrans (EM) in 64.16% of the patients, neurological in 22.5% of the patients, joint related in 1.66% of the patients and cardiac in 0.83% of the cases. Conclusions. In Mures County we have observed an increased incidence of this disease in 2011 vs. 2010. The predominant clinical manifestations were the acute dermatological and neurological ones.

Abstract

Lyme neuroborreliosis is an infection of the nervous system caused by spirochetes of the Borrelia burgdorferi sensulato group. Neurological clinical manifestations usually present a steady evolution and are different in patients from Europe compared to those from America, possibly due to vector agents and different bacterial species. Various diagnostic markers were studied in consideration of a clear or possible diagnosis of the disease, because evolution and complications depend on early diagnosis and initiation of therapy. The isolation of the bacterium is difficult, microscopic examination and the bacterial dezoxiribonucleic acid amplification shows low sensitivity. However, the diagnosis of Lyme neuroborreliosis is mainly based on serological methods that have a satisfactory sensitivity and specificity. A correct diagnosis can be performed by strictly respecting clinical guidelines and protocols and carefully interpreting the serological tests. The presence of anti-borrelia burgdorferi antibodies in the cerebrospinal fluid with evidence of intrathecal antibody production is the gold standard diagnosis of Lyme neuroborreliosis. Early administration of antibiotic treatment (third generation cephalosporins, cyclins, aminopenicillins) can produce the remission of neurological symptoms, the eradication of spirochetes in acute phase of the disease, thus avoiding the development of the chronic disease.

Abstract

Colorectal cancer is an important health issue, both in terms of the number of people affected and the associated costs. Colonoscopy is an important screening method that has a positive impact on the survival of patients with colorectal cancer. The association of colonoscopy with computer-aided diagnostic tools is currently under researchers’ focus, as various methods have already been proposed and show great potential for a better management of this disease. We performed a review of the literature and present a series of aspects, such as the basics of machine learning algorithms, different computational models as well as their benchmarks expressed through measurements such as positive prediction value and accuracy of detection, and the classification of colorectal polyps. Introducing computer-aided diagnostic tools can help clinicians obtain results with a high degree of confidence when performing colonoscopies. The growing field of machine learning in medicine will have a big impact on patient management in the future.

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.

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.

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.

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.

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.

Abstract

The objective of this study was to find a link between the grade of left ventricular diastolic dysfunction (LVDD) and the progression to permanent non-valvular atrial fibrillation (AF), in a group of patients with left ventricular diastolic dysfunction and paroxysmal or persistent atrial fibrillation.

Methods: A bidirectional study on 57 patients meeting the inclusion criteria was conducted; each patient was admitted in a university-based hospital between January 1st - June, 30, 2013, with a follow up 3 and 6 months later. Permanent atrial fibrillation development was followed.

Results: Out of the 57 patients, 23 had paroxysmal AF and 34 were with persistent AF. After six months, 21 patients progressed to permanent AF, representing 36.84% of the total patients. Female patients with age over 65 had more often atrial fibrillation, but more men progressed to a sustained form of AF. No statistically significant difference regarding the grade of diastolic dysfunction, the left atrial size or volume, or the left ventricular ejection fraction was observed between the patients with progression, compared to those without progression.

Conclusions: The grade of left ventricular diastolic dysfunction did not prove to be a predictive factor for permanent atrial fibrillation, neither the left atrial size or volume, or the left ventricular ejection fraction.