Marlena Pascu, Ruxandra Miulescu and C. Ionescu-Tîrgoviste
Fetal Macrosomia in the Diabetic Woman
Diabetes mellitus complicates up to 10% of pregnancies, while in Romania the incidence is this under 5%. In most of the cases we are talking about gestational diabetes, while only in 0.1 - 0.3% of the cases, the diabetes was pregestational (mainly Type 1 diabetes and rarely Type 2 diabetes or Mody). The study we conducted concerned the incidence of macrosomia in the general population; in the study we investigated 3,000 pregnant patients who gave birth in the Unit of Obstetrics & Gynecology of ‘Dr Cantacuzino’ Hospital from 13th January 2007 to 30th March 2010. The 7.1% of incidence of diabetes mellitus highlighted by the study which aimed to trace gestational diabetes conducted in 2007-2010 period with the assistance of the ‘Dr Cantacuzino’ Hospital, represents just the tip of the iceberg. The positive diagnosis of gestational diabetes identified not only women who had diabetes mellitus pre-existing the pregnancy, without their being aware of it, but also women with a pathology of carbohydrate metabolism who will in the future run a higher risk of developing type 2 diabetes mellitus.
Doiniţa Oprea, Elena Valentina Ionescu, Liliana Elena Stanciu, Carmen Oprea, Ruxandra Badiu and Mădălina Gabriela Iliescu
Background. Rheumatoid arthritis (RA), met in the literature also as chronic evolving polyarthritis, is a chronic inflammatory disease, which typically involves the small and medium joints, with a symmetric distribution. Clinical studies shown that a proportion of patients with RA, without measurable rheumatoid factors are a distinct entity from those patients with seropositive RA. Around one third of patients with RA are seronegative for those two serological markers, the rheumatoid factors (RF) and anti-citrullinated peptide antibodies (Anti-CCP). Hands are the most frequently affected in both seropositive and seronegative RA and the first joints involved in the inflammatory process are the metacarpo-phalangeal joints, IFP joints and the radiocarpian joint. The big joints become later symptomatic, after the small joints are affected. Materials and methods: 66 patients files and the personal records of the patients consecutively admitted in the Rheumatology Department of the Clinical Emergency County Hospital Constanta. Patients from county Constanta were included in the study, with diagnosis of rheumatoid arthritis (diagnosis confirmed at least 2 years ago), including both forms (seropositive and seronegative) of the disease. The complete clinical exam was done for the patients included in the study, following the identification of the active joint disease. The mechanical status of the joint was observed by a single evaluator for each of those 66 patients with RA, with special focus on the presence of the deformities / ankyloses of the hands joints. Therefore, there were evaluated: the mobility (the number of the joints with limited movements), deformities, ankyloses (the number of the joints without mobility). The joint mobility was assessed by counting the hand joints with limited movements and the worsening of the prehension function. The presence of the following hand deformities was followed: fingers in “swan neck”, “fusiform fingers”, the thumb “in Z”, and the aspect of “hand in the shape of a camel back”. For evaluating the painful or swollen joints we used: the 28 joint index, the overall evaluation of the disease activity - by the patient (Patient Global Assessment-PGA) and by the doctor (Medical Doctor Global Assessment- MDGA), the score of disease activity DAS 28 (DAS28 - Disease Activity Score 28), the index of the clinical activity of the disease (Clinical Disease Activity Index- CDAI), as well as the simplified index of activity of the disease (Simplified Disease Activity Index-SDAI). It was determined for each patient the plasma RF and anticitrullinated peptide antibodies. Results and discussion. As expected, there is a bigger frequency of female patients in both forms of the disease (seropositive and seronegative) and regarding males the recurrence is approximate equal between those two groups. By comparing the frequency of the joint deformities at hand level between the 2 groups of patients included in the study (seropositive PR and seronegative PR), we saw a superiority of these (with all their forms) in the patients with seropositive polyarthritis. Conclusions. The clinical study done in this work is completing the data offered by the studies of some dedicated authors, who analysed the characteristic elements of rheumatoid arthritis depending on seropositivity. Our results confirm the idea that seronegative rheumatoid arthritis has a more gentle clinical evolution and is a less destructive form of disease.
C. Popescu, Violeta Bojincă, Daniela Opriş and Ruxandra Ionescu
Aim. Rheumatoid arthritis (RA) may influence not only abdominal fat, but also whole body adiposity, since it is associated with chronic inflammation and disability. The study aims to evaluate the whole body adiposity of RA patients and to assess potential influences of disease specific measures.
Methods. The study was designed to include Caucasian postmenopausal female RA patients and age-matched postmenopausal female controls. Each subject underwent on the same day clinical examination, laboratory tests, whole body dual X-ray absorptiometry (DXA) composition and physical activity estimation using a self-administered questionnaire.
Results. A total of 107 RA women and 104 matched controls were included. Compared to controls, the RA group had less physical activity and a higher prevalence of normal weight obesity. Overfat RA women had a significantly higher toll of inflammation, disease activity, glucocorticoid treatment and sedentary behavior. RA women with inflammation, glucocorticoid treatment and higher disease activity class had higher whole body and trunk adipose tissue indices and higher prevalence of overfat status. Glucocorticoid treatment, inflammation, disease duration and severity correlated with whole body adipose tissue and significantly predicted high adiposity content and overfat phenotypes.
Conclusions. RA disease duration and severity are associated with higher whole body and regional adiposity. Low-dose glucocorticoid treatment seems to contribute to adiposity gain and redistribution. Clinicians may need to assess body composition and physical activity in RA patients in order to fully manage cardiovascular outcomes and quality of life.
Cristian Moise, Denisa Predeţeanu, Andra Bălănescu, Violeta Bojincă, Grigorie Baloșin and Ruxandra Ionescu
We present the case of a 34-year-old male who suddenly experienced upper right quadrant abdominal pain of medium-high intensity that radiated towards his right lumbar area and right testicle, accompanied by nausea and vomiting. His personal history was significant for having an eye prosthesis implanted when he was three years old, due to structural degradation of undetermined cause in his left eye.
He was first seen by a surgeon who recommended an abdominal CT scan and an urology consultation. In the urology clinic, renal and testicular ultrasounds were normal and he was prescribed symptomatic medication.
Due to the pain escalating, the patient underwent a contrast CT scan of the abdomen and pelvis that revealed two renal infarction lesions in the middle and inferior thirds of the right kidney.
The patient was admitted and anticoagulants and pain medication were started. A full body CT scan did not reveal any other abnormalities. Tumour markers and genetic thrombophilia markers were sent for analysis. He was referred to a nephrology clinic, where he underwent screening for multiple myeloma and vasculitic/autoimmune causes, with negative results. A contrast renal vascular ultrasound of the right kidney identified the obstructions as being in the middle and inferior interlobar veins.
Afterwards, the genetic tests revealed three thrombophilic mutations – factor V Leiden positive homozygote, MTHFR C677T and A1298C both positive heterozygote. This might have also been the cause of the childhood ocular surgery. The patient continued anticoagulation with apixaban, with no further significant medical events to this day.
Introduction: Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) are poor prognostic factors in rheumatoid arthritis (RA). The therapeutic implication of antinuclear antibody (ANA) positivity in RA is still debated. The study aims to evaluate ANA positivity as a prognostic factor for the therapeutic response to biologics in RA.
Methods: observational study; data were gathered from the Romanian Registry of Rheumatic Diseases which comprises all biological-treated RA patients in Romania. We included only RA patients who were tested for ANA before initiating biologics.
Results: A number of 740 RA patients were included (72.4% treated with TNF-α blockers, 27.6% with rituximab). Compared to ANA-negative patients, ANA-positive patients (26.9%) had: a higher disease activity score (DAS28) prior to biologics, at the time of treatment switch and after the observation period; lower drug persistence (p < 0.001 for all tests). Multiple linear regressions showed that ANA positivity is a significant predictor of the current value of DAS28, independently of the presence of RF and/or ACPA (p < 0.05).
Conclusion: ANA positivity in RA patients before starting biologics may be a poor prognosis factor for efficacy and drug persistence. Further studies are needed to confirm these observations.
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, Codruta Minerva Badescu, Simona Daniela Ionescu, Elena Mitrea, Gabriel Rosu, Georgeta Daniela Ionescu, Ana Maria Visinescu, Gabriela Mihailescu, Rozalina Lapadatu, Emilia Oprisan, Stefan Zeh, Isabelle Scholl and Martin Härter
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.
Paula Ionilă, Ruxandra Jurcuţ, Nicoleta Ferariu, Monica Roşca, Monica Chivulescu, Adriana Mursă, Sebastian Militaru, Alin A. Ionescu, Cristina Căldăraru, Ana G. Fruntelată, Silvia F. Goanţă, Simina Crişan, Adina Ionac, Ana-Maria Avram, Attila Frigy, Radu Sascău, Cătălina Arsenescu-Georgescu, Ioan M. Coman, Bogdan A. Popescu, Carmen Ginghină and Eduard Apetrei
Introduction. Hypertrophic cardiomyopathy (HCM) is a disease with increased left ventricular (LV) wall thickness not solely explained by abnormal loading conditions, with great heterogeneity regarding clinical expression and prognosis. The aim of the present study was to collect data on HCM patients from different centres across the country, in order to assess the general characteristics and therapeutic choices in this population.
Methods. Between December 2014 and April 2017, 210 patients from 11 Romanian Cardiology centres were enrolled in the National Registry of HCM. All patients had to fulfil the diagnosis criteria for HCM according to the European Society of Cardiology guidelines. Clinical, electrocardiographic, imaging and therapeutic characteristics were included in a predesigned online file.
Results. Median age at enrolment was 55 ± 15 years with male predominance (60%). 43.6% of the patients had obstructive HCM, 50% non-obstructive HCM, while 6.4% had an apical pattern. Maximal wall thickness was 20.3 ± 4.8 mm (limits 15-37 mm) while LV ejection fraction was 60 ± 8%. Heart failure symptoms dominated the clinical picture, mainly NYHA functional class II (51.4%). Most frequent arrhythmias were atrial fibrillation (28.1%) and non-sustained ventricular tachycardia (19.9%). Mean sudden cardiac death risk score (SCD-RS) was 3.0 ± 2.3%, with 10.4% of the patients with high risk of SCD. However, only 5.7% received an ICD. Patients were mainly treated with beta-blockers (72.9%), diuretics (28.1%) and oral anticoagulants (28.6%). Invasive treatment of LVOT obstruction was performed in a small number of patients: 22 received myomectomy and 13 septal ablation. Cardiac magnetic resonance was reported in only 14 patients (6.6%).
Conclusions. The Romanian registry of HCM illustrates patient characteristics at a national level as well as the gaps in management which need improvement – accessibility to high-end diagnostic tests and invasive methods of treatment.