Romanian Journal of Internal Medicine最新文献

Background: Ulcerative colitis (UC) is characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. This work aimed to assess the prevalence of defecatory disorders in patients with quiescent UC using high-resolution anorectal manometry.

Methods: This study included 50 UC patients who have documented UC remission or in mild activity (clinically and endoscopically using Mayo score) for the last 6 months, and had persistent symptoms of defecatory disorder (Constipation, faecal incontinence, urgency, rectal pain, and/or sense of incomplete evacuation). All patients were subjected to detailed history taking, systemic physical examination, laboratory investigations, colonoscopy, and high-resolution anorectal manometry. The patient or their relatives provided written consent that was informed. The study was conducted with the approval of the Ethical Committee.

Results: There were statistically significant differences regarding the relation between fecal incontinence and with duration of the disease (P= 0.008), while no significant differences were observed with the UC extension or the treatment used. Regarding constipation, urgency, incomplete evacuation, and proctalgia defecatory disorders; it had no statistical significance with the duration of the disease, the UC extension, and the treatment used.

Conclusion: UC patients still experience defecatory disorders even at the quiescent stage, and we recommend their evaluation by anorectal manometry.

Background: Colorectal cancer (CRC) is a global health concern, including in Indonesia. Genetic factors, particularly those affecting immune regulation and tumor immune evasion, contribute significantly to CRC pathogenesis The cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) gene, which encodes an immune checkpoint receptor, influences T-cell activation and immune response. Certain CTLA4 gene polymorphism has been associated with altered immune function and increased risk of CRC.

Objectives: This study aims to explore the potential role of CTLA4-658C>T as a genetic marker for CRC susceptibility.

Methods: This case-control study included 60 colorectal cancer (CRC) patients and 60 non-CRC patients from January 2023 to December 2024 at Universitas Sumatera Utara Hospital and its network hospitals. CRC patients aged 18 years or older were included in the case group, while patients with non-CRC findings after colonoscopy served as controls. Patients with systemic diseases (e.g., diabetes, heart or kidney failure, other cancers) were excluded. Data on demographics and CRC characteristics were collected from medical records. Participants were interviewed to complete missing data and provided blood samples for CTLA4-658C>T polymorphism analysis.

Results: The CTLA4-658T>C polymorphism was significantly associated with colorectal cancer (CRC). Individuals with the CC+CT genotype had a 2.69-fold higher risk of developing CRC than those with the TT genotype (p=0.022). Additionally, carriers of the C allele had a 2.26-fold higher risk of CRC than those with the T allele (p=0.015).

Conclusion: These findings suggest that CTLA4-658C>T may serve as a potential genetic marker for CRC susceptibility, highlighting the role of immune regulation in CRC development.

Background: In individuals with type 2 diabetes mellitus (T2DM), impairments in aortic elastic functions due to vascular remodeling and changes in cardiac morphology and function are observed from the time of diagnosis.

Objective: This study investigated alterations in aortic elastic functions in newly diagnosed T2DM patients using transthoracic echocardiography (TTE) and explored their association with various body composition parameters.

Materials and methods: A total of 273 newly diagnosed diabetic patients (144 females; mean age: 50.7±12.2 years) and 139 control subjects without any detected diseases (90 females; mean age: 47.1±8.5 years) were included in the study. Echocardiographic parameters and aortic elastic properties were evaluated using TTE. Body composition indices, including Body Mass Index, Waist-to-Hip Ratio, Tri-Ponderal Mass Index (TMI), Visceral Adiposity Index, Body Shape Index, Body Roundness Index, Body Adiposity Index, and Cardiometabolic Index were calculated for all participants.

Results: When aortic elastic parameters were evaluated, aortic strain and aortic distensibility were significantly lower in Group 1 compared to Group 2, while the aortic stiffness index was significantly higher in Group 1. Aortic elastic parameters were significantly correlated with most of all body composition indices except for BSI, with the highest correlation observed with TMI (AS; rho=0.490, ASI; rho=0.456, AD; 0.516; p<0.001).

Conclusion: In newly diagnosed T2DM patients, aortic elastic functions are impaired at the time of diagnosis compared to the normal population. Among body composition indices; the most significant association was found with TMI. TMI may be considered a potential screening tool not only for evaluating aortic elastic functions but also for identifying other atherosclerotic processes.

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Diabetes accelerates the progression of atherosclerosis through key mechanisms such as insulin resistance, hyperglycemia, dyslipidemia, chronic inflammation, and oxidative stress, significantly increasing the risk of coronary artery disease, stroke, and heart failure. Traditional risk assessment models and treatment strategies often fall short in fully addressing these complexities, leaving a substantial residual cardiovascular risk in diabetic patients. This review focuses on the need for enhanced screening protocols in diabetic populations, examining advanced risk scoring models and detection techniques aimed at improving early identification and management of ASCVD. Also, this study examines the pathophysiological links between diabetes and atherosclerosis, emphasizing the need for enhanced screening protocols. Emerging tools, such as non-invasive imaging techniques (e.g., coronary artery calcium scoring, CCTA) and biomarkers (e.g., polygenic risk scores), offer promise for improved early detection and risk stratification. Additionally, newer therapeutic strategies targeting inflammation and insulin resistance are being explored to mitigate cardiovascular risks in this population. Given the significant cardiovascular risk associated with diabetes, particularly T2DM, these advancements are crucial in reducing morbidity and mortality related to atherosclerotic events.

Background: Endoscopic ultrasound (EUS) is gaining ground in today's diagnostic routine due to its ability to provide dynamic, accurate representations, but mostly because it facilitates tissue sampling amenable to histopathologic studies. Our main objective was to assess the accuracy of sampling pancreatic malignancies through EUS-fine-needle aspiration (FNA) compared to EUS-fine-needle biopsy (FNB) at a tertiary referral center, where rapid on-site evaluation (ROSE) for EUS-FNA is not available.

Material and methods: A retrospective, 5-year analysis of all EUS-guided tissue acquisitions of pancreatic masses suggestive of neoplasia was performed. Out of the 484 patients who initially underwent non-invasive imaging studies, 401 subjects were ultimately confirmed as malignant using EUS-FNA/FNB or surgery.

Results: Overall, the accuracy of EUS-guided sampling was 91%. There were 36 patients (9%) with false-negative results after EUS, who were further addressed to surgery and confirmed with pancreatic malignancy. Cytological and histological examinations found that FNB was significantly higher than FNA regarding the diagnostic yield (91.3% vs. 84.1%; p-value<0.05). Moreover, FNB required fewer needle punctures than FNA to achieve a definitive diagnosis (1.63 vs. 1.99; p-value<0.05).

Conclusions: Diagnostic management of pancreatic malignancies is unequivocally improved by FNB needles, rendering an improved tissue acquisition at a lower number of passes.

Alcohol-related liver disease (ALD) is still to this date one of the leading causes of chronic liver disease globally. ALD comprises a wide disease spectrum, from the benign liver steatosis, to the life-threatening inflammatory acute phenotype of alcoholic hepatitis (AH) and ultimately, advanced liver fibrosis and cirrhosis. AH represents an acute inflammatory liver condition caused by prolonged high quantities of alcohol intake. Disease outcome varies from mild to severe, with systemic implication and high mortality. Although the pathogenesis has been extensively studied over the years, little progress has been made regarding therapeutic options. In over 50 years, steroid treatment is still the cornerstone therapeutic option, albeit having multiple limitations and a low success rate. On the other hand, important progress has been made regarding disease management and severity stratification with the implementation of different prognostic score. Although highly prevalent, AH still has many unmet needs, with a growing necessity for novel non-invasive diagnosis, prognosis biomarkers and impactful treatment options.

Introduction: Heart failure (HF) is a significant global health issue associated with high morbidity and mortality. Accurate biomarkers are crucial for predicting adverse outcomes and informing management. High-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI) are important prognostic indicators in HF, though their predictive value can be affected by comorbidities, particularly renal dysfunction.

Objectives: This review evaluates the prognostic significance of troponin adjusted for renal function in patients with HF.

Methods: A comprehensive literature search was performed in PubMed, including studies from 2011 to September 2024, using specific MeSH terms related to HF, troponin, and prognosis.

Results: Thirty-two studies met the inclusion criteria, all indicating an association between troponin levels adjusted for renal function and cardiovascular mortality in HF patients (HR 1.67-3.22). High-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI) are independent predictors of cardiovascular mortality in acute heart failure (AHF). Increasing hs-cTnI levels, with a baseline threshold of 0.03 ng/mL, significantly correlate with mortality risk (P = .0011). Patients with hs-cTnT > 14 ng/L, > 21.5 ng/L, and > 26.5 ng/L exhibit increased all-cause mortality after adjusting for renal function. Despite these associations, the role of troponin in predicting heart failure readmissions remains inconsistent, indicating that elevated troponin levels do not reliably predict rehospitalization risk, particularly in those with advanced renal impairment.

Conclusions: High-sensitivity troponins (hs-cTnT and hs-cTnI) are independent predictors of mortality in heart failure, even after accounting for renal function, while their role in predicting hospitalizations is weaker.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are common cause of acute kidney injury, but chronic kidney disease (CKD) risk of NSAIDs is controversial. Prior systematic reviews are outdated with some methodological flaws. We conducted this systematic review to clarify the association between chronic NSAIDs use and occurrence and/or progression of CKD.

Methods: MEDLINE, Cochrane Library, Web of Science and Science direct were searched for observational and interventional studies from inception to May 2023. Qualitative synthesis was performed. The meta-analysis used pooled odds ratios (OR) and hazard ratios (HR) to estimate the association between chronic NSAID use and CKD occurrence or progression.

Results: Forty studies with a total of 1757118 participants were included in the systematic review; of them 39 studies were suitable for meta-analysis. 56% of our included studies were recent, published within the last 10 years. The meta-analysis revealed a significant association between chronic NSAIDs use and CKD occurrence and progression. The pooled odds ratio was 1.24 (95% CI: 1.11-1.39, p <0.001, I² = 91.21%), and the pooled hazard ratio was 1.50 (95% CI: 1.31-1.7, p <0.001, I² = 90.77%). The pooled hazard ratio (HR) for individuals with no CKD at baseline was 1.31 (95% CI, 1.26-1.40), while for those with preexisting CKD, the HR was significantly higher at 1.67 (95% CI, 1.38-2.02). The HR for individuals with no specific chronic disease was 1.6 (95% CI, 1.32-1.94). For populations with diabetes mellitus (DM) and/or hypertension (HTN), the HR was 1.35 (95% CI, 1.27-1.43), and for those with rheumatic disease, the HR was 1.36 (95% CI, 0.88-2.10).

Conclusions: Long-term NSAID use increases the risk of chronic kidney disease (CKD) occurrence and progression, especially in individuals with pre-existing CKD, who have a 67% risk compared to the general population's 60%. A patient-centered approach for safe and effective pain management is crucial, with special caution for those with pre-existing CKD.

Introduction: The mortality rate of hemodialysis patients is extremely high and it is significantly affected by vascular access dysfunction. Our research aimed to determine predictive parameters of arteriovenous fistula functioning and survival in a one-year follow-up period.

Methods: The research was organized as a prospective, one-year study, which included 120 dialysis patients who were followed for one year. We recorded the demographic and gender structure, clinical parameters, and laboratory findings significant for the survival and functioning of arteriovenous fistulas. Laboratory findings are presented as the mean values of the analysis at the beginning and the end of the one-year control period.

Results: Univariable regression analysis confirmed the predictive significance of anastomosis positioning, type of vascular access, length of hemodialysis treatment, hemoglobin, Kt/V index values, and creatinine concentration for one-year survival, but multivariable regression analysis confirmed predictive significance only for length of treatment. Univariable regression analysis revealed significant predictors of vascular access function for the length of hemodialysis treatment, diastolic blood pressure, leukocytes, platelets, hemoglobin, creation of an arteriovenous fistula by a nephrologist, starting hemodialysis with a fistula and not with a central venous catheter, multivariable regression analysis confirmed predictive significance for the length of dialysis treatment and creation of an arteriovenous fistula by a nephrologist.

Conclusion: A prognostically important parameter for the one-year survival of a patient on hemodialysis is the length of dialysis treatment. In contrast, predictive parameters for the functioning of an arteriovenous fistula are the length of dialysis and the creation of a fistula by a nephrologist.

Background: Systemic sclerosis (SSc) is a complex connective tissue disease characterized by microangiopathy, immune dysregulation, and fibrosis. Early detection of microvascular abnormalities using nailfold videocapillaroscopy (NVC) is crucial in assessing disease progression and associated disease's involvement such as interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH).

Objective: This study aims to explore the relationships correlation between NVC patterns, clinical manifestations, and systemic complications in SSc.

Methods: We analyzed the data of 63 patients, predominantly female (95%), with a mean age of 49 years and an average disease duration of 42 months. Patients were categorized into early, active, and late patterns based on NVC findings. Clinical features, including digital ulcers (DU), ILD, and PAH, were assessed. Pearson correlation analyses were performed to evaluate the relationships between capillary loss, neoangiogenesis, ILD, and PAH.

Results: The early pattern group (mean mRSS 2.36) exhibited minimal microvascular damage and systemic involvement, with no DUs. In the active pattern group (mean mRSS 10.40), 34.38% had diffuse cutaneous SSc (dcSSc), with 15.63% presenting DUs, 65.63% ILD, and 37.5% PAH. The late pattern group (mean mRSS 18.00) showed the most severe disease, with 80% having DUs, 70% dcSSc, 90% ILD, and 70% PAH. Pearson correlation analyses revealed strong correlations between capillary loss and ILD (r = 0.7255) and PAH (r = 0.6369). A moderate correlation was found between neoangiogenesis and PAH (r = 0.5592).

Conclusion: The study demonstrates that progressive microvascular damage in SSc, as visualized by NVC, correlates strongly with the severity of systemic complications. Early detection of capillary loss and neoangiogenesis using NVC is critical for timely interventions, which could improve patient outcomes by mitigating the progression of ILD and PAH.