Alexandra Crișan, Elena Guluţă, Alexandra Mincă, Dragoș Mincă, Adina Rusu, Radu Costea, Dana Galieta Mincă, Valeriu Gheorghiţă, Amalia Loredana Călinoiu
Abstract Background and aims. According to the Centers for Disease Control and Prevention (CDCP) 2020 National Diabetes Statistics Report, 13% of American adults have diabetes and 34.5% meet the criteria for prediabetes. The prevalence of prediabetes increases with age. The purpose of this study was to emphasize the importance of implementing nutritional education programs for the prevention of diabetes on prediabetic population. Material and method. The study was interventional, prospective and randomized, including 218 patients with prediabetes, a representative sample for a population at risk of developing diabetes, followed and treated in a specialized center. We included patients diagnosed with prediabetes, to whom principles of nutritional education were applied. After 6 months they were reevaluated by dosing glycosylated hemoglobin. Results. 218 patients were included, with an average age of 64.6 years, of which 56.9% were female. The average body mass index was 31.8 kg/m 2 , with a prevalence of obesity of 61.5% of the studied population (obesity was diagnosed and staged according to WHO). Six months after the implementation of the nutritional education program, a statistically significant decrease (p=0.005) of glycosylated hemoglobin was observed, by −0.12%. This difference was maintained 12 months after enrollment (p=0.009). Conclusions Nutritional education has a major importance in the prevention of diabetes, a fact that can reduce the worldwide incidence of this pathology together with the complications that can appear related to prolonged exposure to hyperglycemia.
{"title":"Efficiency of a Nutrition Education Program in the Prediabetic Population: Is it Necessary?","authors":"Alexandra Crișan, Elena Guluţă, Alexandra Mincă, Dragoș Mincă, Adina Rusu, Radu Costea, Dana Galieta Mincă, Valeriu Gheorghiţă, Amalia Loredana Călinoiu","doi":"10.2478/inmed-2023-0254","DOIUrl":"https://doi.org/10.2478/inmed-2023-0254","url":null,"abstract":"Abstract Background and aims. According to the Centers for Disease Control and Prevention (CDCP) 2020 National Diabetes Statistics Report, 13% of American adults have diabetes and 34.5% meet the criteria for prediabetes. The prevalence of prediabetes increases with age. The purpose of this study was to emphasize the importance of implementing nutritional education programs for the prevention of diabetes on prediabetic population. Material and method. The study was interventional, prospective and randomized, including 218 patients with prediabetes, a representative sample for a population at risk of developing diabetes, followed and treated in a specialized center. We included patients diagnosed with prediabetes, to whom principles of nutritional education were applied. After 6 months they were reevaluated by dosing glycosylated hemoglobin. Results. 218 patients were included, with an average age of 64.6 years, of which 56.9% were female. The average body mass index was 31.8 kg/m 2 , with a prevalence of obesity of 61.5% of the studied population (obesity was diagnosed and staged according to WHO). Six months after the implementation of the nutritional education program, a statistically significant decrease (p=0.005) of glycosylated hemoglobin was observed, by −0.12%. This difference was maintained 12 months after enrollment (p=0.009). Conclusions Nutritional education has a major importance in the prevention of diabetes, a fact that can reduce the worldwide incidence of this pathology together with the complications that can appear related to prolonged exposure to hyperglycemia.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ancuţa Alina Constantin, Andrei Antonio Cotea, Florin Dumitru Mihălţan
Abstract Lung cancer dominates the current picture of malignancies worldwide, remaining a tragic first place in mortality statistics. Despite the continuous improvements in lung cancer screening, the refinement of surgical techniques, and innovations in oncological treatments, lung cancer remains the main contributor to fatalities among all forms of neoplastic conditions. (1,2) Lung adenocarcinoma is not just one of the most common histological types of lung cancer but also one of the deadliest high heterogeneity. Smoking worldwide due to its late diagnosis and tobacco is one of the main risk factors for any lung cancer, including adenocarcinoma, but there are also other factors that can increase the risk, such as family history of lung cancer and professional exposure to noxious agents such as silica, asbestos, radon, heavy metals, and diesel fumes . (3) Therefore, through this case series report the authors attempt to present their experience with three cases with a broad range of differences such as past medical history, living and work conditions, and other vicious habits such as smoking. This paper strives to establish the potential faces that lung adenocarcinoma can adopt, disguising itself under the umbrella of many other lung parenchymal syndromes, mimicking non-malignant processes, often displaying features very similar to an infection, and misdiagnosed as pneumonia, thereby delaying the diagnosis. Additionally, we provide a brief synthesis of the best resources available in lung adenocarcinoma-specific literature, including the importance of distinguishing early signs and symptoms, medical imaging, differential diagnosis, and early treatment.
{"title":"The Multiple Faces of Lung Adenocarcinoma: Challenges in Diagnosis","authors":"Ancuţa Alina Constantin, Andrei Antonio Cotea, Florin Dumitru Mihălţan","doi":"10.2478/inmed-2023-0261","DOIUrl":"https://doi.org/10.2478/inmed-2023-0261","url":null,"abstract":"Abstract Lung cancer dominates the current picture of malignancies worldwide, remaining a tragic first place in mortality statistics. Despite the continuous improvements in lung cancer screening, the refinement of surgical techniques, and innovations in oncological treatments, lung cancer remains the main contributor to fatalities among all forms of neoplastic conditions. (1,2) Lung adenocarcinoma is not just one of the most common histological types of lung cancer but also one of the deadliest high heterogeneity. Smoking worldwide due to its late diagnosis and tobacco is one of the main risk factors for any lung cancer, including adenocarcinoma, but there are also other factors that can increase the risk, such as family history of lung cancer and professional exposure to noxious agents such as silica, asbestos, radon, heavy metals, and diesel fumes . (3) Therefore, through this case series report the authors attempt to present their experience with three cases with a broad range of differences such as past medical history, living and work conditions, and other vicious habits such as smoking. This paper strives to establish the potential faces that lung adenocarcinoma can adopt, disguising itself under the umbrella of many other lung parenchymal syndromes, mimicking non-malignant processes, often displaying features very similar to an infection, and misdiagnosed as pneumonia, thereby delaying the diagnosis. Additionally, we provide a brief synthesis of the best resources available in lung adenocarcinoma-specific literature, including the importance of distinguishing early signs and symptoms, medical imaging, differential diagnosis, and early treatment.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Chronic obstructive pulmonary disease (COPD) is a preventable and treatable heterogeneous lung disease characterized by chronic respiratory symptoms such as dyspnea, cough, sputum production. The main pathophysiological changes occur in the airways, lung parenchyma, pulmonary blood vessels and are represented by chronic inflammation and structural changes. The inflammatory response is initiated by exposure to chronic irritants and amplifies with the severity of airflow. Smoking remains the most important risk factor, but chronic airflow limitation can also be objectified in non-smokers. Oxidative stress, the excess of pulmonary proteinases, the alteration of the lung microbiome and the presence of inflammatory mediators can contribute to the amplification of the inflammatory process. Lung inflammation that develops in patients with COPD leads to an increase in biomarkers that are associated with neutrophilic inflammation, such as MMP9, elastase, neutrophils in the bronchoalveolar lavage fluid, and proinflammatory cytokines in peripheral blood. Also, interleukin-8 (IL-8) contributes to neutrophil activation, but further research is needed to identify the role of IL-8, the benefits of anti-inflammatory therapy, also emphasizing the importance of progression in medicine.
{"title":"The Importance of the Interleukin-8 Study in Chronic Obstructive Pulmonary Disease","authors":"Elena-Andreea Moaleș, Adriana Chetran, Ioana Mădălina Zota, Corina Dima Cozma, Florin Mitu","doi":"10.2478/inmed-2023-0255","DOIUrl":"https://doi.org/10.2478/inmed-2023-0255","url":null,"abstract":"Abstract Chronic obstructive pulmonary disease (COPD) is a preventable and treatable heterogeneous lung disease characterized by chronic respiratory symptoms such as dyspnea, cough, sputum production. The main pathophysiological changes occur in the airways, lung parenchyma, pulmonary blood vessels and are represented by chronic inflammation and structural changes. The inflammatory response is initiated by exposure to chronic irritants and amplifies with the severity of airflow. Smoking remains the most important risk factor, but chronic airflow limitation can also be objectified in non-smokers. Oxidative stress, the excess of pulmonary proteinases, the alteration of the lung microbiome and the presence of inflammatory mediators can contribute to the amplification of the inflammatory process. Lung inflammation that develops in patients with COPD leads to an increase in biomarkers that are associated with neutrophilic inflammation, such as MMP9, elastase, neutrophils in the bronchoalveolar lavage fluid, and proinflammatory cytokines in peripheral blood. Also, interleukin-8 (IL-8) contributes to neutrophil activation, but further research is needed to identify the role of IL-8, the benefits of anti-inflammatory therapy, also emphasizing the importance of progression in medicine.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"253 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract We present the case of a 61-year-old male patient, with no medical history, who was presenting for an anterior chest pain, which appeared suddenly during an effort, accompanied by palpitations, fatigue and dyspnea Physical examination revealed the presence of a 4/6 systolic murmur with maximal auscultation at the apex and radiation in the left axilla. Echocardiographic evaluation revealed diagnostically suggestive elements for severe posterior mitral valve prolapse without any rupture, color Doppler showing severe mitral regurgitation, a tricuspid valve prolapse, tricuspid regurgitation grade III and pulmonary hypertension. Coronary angiography revealed coronary arteries without hemodynamically significant lesions, and Holter ECG/24-hour monitoring detected atrial fibrillation in 44% of the monitoring time. In this context, the possible causes of the anterior chest pain were: microvascular angina, traction on the chordae or pulmonary hypertension. The patient had a surgical indication for mitral valve replacement or reconstruction. The department of cardiac surgery undergoes mitral valve replacement with a mechanical prosthesis with a favorable outcome.
{"title":"Mitral Valve Prolapse, Not Always an Easy Diagnosis","authors":"Adriana Chetran, Ştefania Teodora Duca, Ana Nicolae, Andreea Moaleş, Alexandru-Dan Costache, Corina Dima-Cozma, Ovidiu Mitu, Florin Mitu, Irina-Iuliana Costache","doi":"10.2478/inmed-2023-0263","DOIUrl":"https://doi.org/10.2478/inmed-2023-0263","url":null,"abstract":"Abstract We present the case of a 61-year-old male patient, with no medical history, who was presenting for an anterior chest pain, which appeared suddenly during an effort, accompanied by palpitations, fatigue and dyspnea Physical examination revealed the presence of a 4/6 systolic murmur with maximal auscultation at the apex and radiation in the left axilla. Echocardiographic evaluation revealed diagnostically suggestive elements for severe posterior mitral valve prolapse without any rupture, color Doppler showing severe mitral regurgitation, a tricuspid valve prolapse, tricuspid regurgitation grade III and pulmonary hypertension. Coronary angiography revealed coronary arteries without hemodynamically significant lesions, and Holter ECG/24-hour monitoring detected atrial fibrillation in 44% of the monitoring time. In this context, the possible causes of the anterior chest pain were: microvascular angina, traction on the chordae or pulmonary hypertension. The patient had a surgical indication for mitral valve replacement or reconstruction. The department of cardiac surgery undergoes mitral valve replacement with a mechanical prosthesis with a favorable outcome.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"203 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract We present the case of a 60-year-old female patient, dyslipidemic, obese, diabetic and hypertensive, with a history of resected right adrenal pheochromocytoma (1999 - no subsequent surgical or endocrinological re-evaluation), presenting for increased blood pressure values and the recurrence of symptoms (headaches, palpitations, sweating), with progressive accentuation in the last months. The patient associates pain in the right costovertebral angle and weight loss. The clinical examination revealed facial erythrosis, excessive sweating, tachycardic heart sounds, increased blood pressure and orthostatic hypotension. Electrocardiography reveals sinus tachycardia, signs of left ventricular hypertrophy, with repolarization abnormalities, morphological aspect confirmed by the transthoracic echocardiography. An ultrasound of the abdomen and pelvis ultrasound objectified a large tumor formation at the level of the right adrenal gland and a liver nodule. In the context of the symptoms, the suspicion of recurrent pheochromocytoma was raised, confirmed biochemically by the increase in urinary normetanephrines and through imagistic methods (CT scan of the abdomen and pelvis), the patient having an indication for curative surgical treatment. After completing the preoperative assessment (ECG Holter monitor, ABPM), during the hospitalization period, the antihypertensive regimen was adjusted by combining 4 antihypertensive drugs, episodes of orthostatic hypotension being managed by administering glucocorticoids and colloidal solutions for volume repletion. The patient was referred to the general surgery clinic for resection of the tumor, following the antihypertensive preparation protocol. Although the post-procedural evolution was favorable, the patient presents a high risk of tumor recurrence, requiring annual evaluation for a period of 10 years. Also, due to the association of cardiovascular risk factors and target organ damage, the patient requires periodic cardiological evaluation.
{"title":"Pheochromocytoma: Intricate Cardiovascular Manifestations","authors":"Andreea Timofte, Mirela Claudia Nechita, Alexandru-Dan Costache, Silvia Chiriac, Ovidiu Mitu, Florin Mitu, Voichiţa Mogoș, Irina-Iuliana Costache","doi":"10.2478/inmed-2023-0259","DOIUrl":"https://doi.org/10.2478/inmed-2023-0259","url":null,"abstract":"Abstract We present the case of a 60-year-old female patient, dyslipidemic, obese, diabetic and hypertensive, with a history of resected right adrenal pheochromocytoma (1999 - no subsequent surgical or endocrinological re-evaluation), presenting for increased blood pressure values and the recurrence of symptoms (headaches, palpitations, sweating), with progressive accentuation in the last months. The patient associates pain in the right costovertebral angle and weight loss. The clinical examination revealed facial erythrosis, excessive sweating, tachycardic heart sounds, increased blood pressure and orthostatic hypotension. Electrocardiography reveals sinus tachycardia, signs of left ventricular hypertrophy, with repolarization abnormalities, morphological aspect confirmed by the transthoracic echocardiography. An ultrasound of the abdomen and pelvis ultrasound objectified a large tumor formation at the level of the right adrenal gland and a liver nodule. In the context of the symptoms, the suspicion of recurrent pheochromocytoma was raised, confirmed biochemically by the increase in urinary normetanephrines and through imagistic methods (CT scan of the abdomen and pelvis), the patient having an indication for curative surgical treatment. After completing the preoperative assessment (ECG Holter monitor, ABPM), during the hospitalization period, the antihypertensive regimen was adjusted by combining 4 antihypertensive drugs, episodes of orthostatic hypotension being managed by administering glucocorticoids and colloidal solutions for volume repletion. The patient was referred to the general surgery clinic for resection of the tumor, following the antihypertensive preparation protocol. Although the post-procedural evolution was favorable, the patient presents a high risk of tumor recurrence, requiring annual evaluation for a period of 10 years. Also, due to the association of cardiovascular risk factors and target organ damage, the patient requires periodic cardiological evaluation.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Charcot–Marie–Tooth disease (CMT) is one of the hereditary motor and sensory neuropathies, a group of varied inherited disorders of the peripheral nervous system characterized by progressive loss of muscle tissue and touch sensation across various parts of the body. Currently incurable, this disease is the most commonly inherited neurological disorder, and affects about one in 2,500 people. A CMT diagnosis involves clinical evaluation of muscle function and atrophy, testing of sensory responses, and electromyography and nerve conduction studies. Often, the most important goal for patients with CMT is to maintain movement, muscle strength, and flexibility. Therefore, an interprofessional team approach with occupational therapy, physical therapy, orthotics, podiatrist, and orthopedic surgeon is recommended. Physical therapy should be involved in designing an exercise program that fits a person’s personal strengths and flexibility, but also in a god evaluation podoscopic assessment. Due to the lack of good sensory reception in the feet, CMT patients need to see a physical therapist in order to stabilize their feet or correct progressive problems by rebalancing the biomechanics of the foot. The procedure involves a computerized assessment, the realization of the plant footprint in the foam and the creation of plantatory therapeutics on the mold. These plantar orthoses help control foot drop and ankle instability and often provide a better sense of balance for patient. Appropriate footwear is also very important for CMT case, but often with difficulty finding well-fitting shoes because of their high arched feet and hammer toes. The patient will use these plantatory proponents in the right shoes in order to: increase of planting support surface, reduction of varus, slowing down the retraction tendency of plant aponeurosis
腓骨肌萎缩病(charcott - marie - tooth disease, CMT)是一种遗传性运动和感觉神经病变，是一组以身体各部位肌肉组织和触觉进行性丧失为特征的周围神经系统遗传性疾病。目前无法治愈，这种疾病是最常见的遗传性神经系统疾病，大约每2500人中就有一人受到影响。CMT诊断包括对肌肉功能和萎缩的临床评估、感觉反应测试、肌电图和神经传导研究。通常，CMT患者最重要的目标是保持运动、肌肉力量和灵活性。因此，建议由职业治疗、物理治疗、矫形科、足科医生和骨科医生组成一个跨专业的团队。物理治疗应该包括设计一个适合一个人的个人力量和灵活性的锻炼计划，但也在一个良好的评估足镜评估。由于足部缺乏良好的感觉接收，CMT患者需要去看物理治疗师，以稳定他们的足部或通过重新平衡足部的生物力学来纠正进行性问题。该程序包括计算机化评估，实现泡沫中的植物足迹以及在模具上创建种植疗法。这些足底矫形器有助于控制足下垂和踝关节不稳定，通常为患者提供更好的平衡感。合适的鞋子对CMT病例也很重要，但由于他们的高弓足和锤状脚趾，通常很难找到合适的鞋子。患者将在右鞋中使用这些植支，以增加植支面，减少内翻，减缓植腱膜的收缩倾向
{"title":"The Importance of Rebalancing Foot Biomechanics by Computerized Podoscopic Assessment - Study in Charcot Marie Tooth Syndroms","authors":"Adina Geambașu, Cosmin Marin, Remus Relu Glogojeanu","doi":"10.2478/inmed-2023-0258","DOIUrl":"https://doi.org/10.2478/inmed-2023-0258","url":null,"abstract":"Abstract Charcot–Marie–Tooth disease (CMT) is one of the hereditary motor and sensory neuropathies, a group of varied inherited disorders of the peripheral nervous system characterized by progressive loss of muscle tissue and touch sensation across various parts of the body. Currently incurable, this disease is the most commonly inherited neurological disorder, and affects about one in 2,500 people. A CMT diagnosis involves clinical evaluation of muscle function and atrophy, testing of sensory responses, and electromyography and nerve conduction studies. Often, the most important goal for patients with CMT is to maintain movement, muscle strength, and flexibility. Therefore, an interprofessional team approach with occupational therapy, physical therapy, orthotics, podiatrist, and orthopedic surgeon is recommended. Physical therapy should be involved in designing an exercise program that fits a person’s personal strengths and flexibility, but also in a god evaluation podoscopic assessment. Due to the lack of good sensory reception in the feet, CMT patients need to see a physical therapist in order to stabilize their feet or correct progressive problems by rebalancing the biomechanics of the foot. The procedure involves a computerized assessment, the realization of the plant footprint in the foam and the creation of plantatory therapeutics on the mold. These plantar orthoses help control foot drop and ankle instability and often provide a better sense of balance for patient. Appropriate footwear is also very important for CMT case, but often with difficulty finding well-fitting shoes because of their high arched feet and hammer toes. The patient will use these plantatory proponents in the right shoes in order to: increase of planting support surface, reduction of varus, slowing down the retraction tendency of plant aponeurosis","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Is any specific organ protection by blocking the renin-angiotensin system? What is the role of the renin-angiotensin system (RAS) in progressive renal disease? The renoprotective effect of ACE-inhibitors and angiotensin II (Ang II) receptor blockers is not only mediated via their renal hemodynamic effects, but also through non-hemodynamic mechanisms? What is the clinical evidence for the importance of local renin-angiotensin system (RAS)? These are several questions of a medical reality: that pharmacological blockade of reninangiotensin system (RAS) is paradoxically effective although circulating plasma renin activity (PRA) is low. An overview of the normal function of the system, as well as ramifications of its dysfunction (overactivity) and potentials for therapeutic blockade, is provided below.
{"title":"Paradoxically Effects of Renin-Angiotensin System Suppression","authors":"Marilena Stoian","doi":"10.2478/inmed-2023-0256","DOIUrl":"https://doi.org/10.2478/inmed-2023-0256","url":null,"abstract":"Abstract Is any specific organ protection by blocking the renin-angiotensin system? What is the role of the renin-angiotensin system (RAS) in progressive renal disease? The renoprotective effect of ACE-inhibitors and angiotensin II (Ang II) receptor blockers is not only mediated via their renal hemodynamic effects, but also through non-hemodynamic mechanisms? What is the clinical evidence for the importance of local renin-angiotensin system (RAS)? These are several questions of a medical reality: that pharmacological blockade of reninangiotensin system (RAS) is paradoxically effective although circulating plasma renin activity (PRA) is low. An overview of the normal function of the system, as well as ramifications of its dysfunction (overactivity) and potentials for therapeutic blockade, is provided below.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandra-Maria-Vanessa Latiș, Alexandru-Dan Costache, Cristina Adam, Magda-Valeria Mitu, Florin Mitu
Abstract Treatment of supraventricular tachycardia with narrow QRS complexes (SVT) includes different therapeutic strategies such as: cardioversion, drug therapy or vagal maneuvers, depending on the patient’s condition, especially if they are hemodynamically stable or unstable. Vagal maneuvers are used to treat SVT during the acute presentation, if the patient is stable. They are recommended by the 2019 European Society of Cardiology guidelines for management of SVT with narrow QRS complexes. These include the Valsalva maneuver (enhanced or not) and carotid sinus massage. They have multiple advantages: they do not require medical equipment, can be performed anywhere (at the bedside or in an outpatient setting), have minimal risk and high effectiveness (19-54 % rate of success).
{"title":"Vagal Maneuvers in Treating Acute Supraventricular Tachycardia with Narrow QRS","authors":"Sandra-Maria-Vanessa Latiș, Alexandru-Dan Costache, Cristina Adam, Magda-Valeria Mitu, Florin Mitu","doi":"10.2478/inmed-2023-0257","DOIUrl":"https://doi.org/10.2478/inmed-2023-0257","url":null,"abstract":"Abstract Treatment of supraventricular tachycardia with narrow QRS complexes (SVT) includes different therapeutic strategies such as: cardioversion, drug therapy or vagal maneuvers, depending on the patient’s condition, especially if they are hemodynamically stable or unstable. Vagal maneuvers are used to treat SVT during the acute presentation, if the patient is stable. They are recommended by the 2019 European Society of Cardiology guidelines for management of SVT with narrow QRS complexes. These include the Valsalva maneuver (enhanced or not) and carotid sinus massage. They have multiple advantages: they do not require medical equipment, can be performed anywhere (at the bedside or in an outpatient setting), have minimal risk and high effectiveness (19-54 % rate of success).","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Sarcoidosis is a multisystem, granulomatous, inflammatory disease, of uncertain aetiology, ubiquitous, much more common in the female population. The age at onset is usually between 30 and 50 years, also having a second peak of incidence in the immediate post-menopausal period. Respiratory system or lymphatic system involvement is present in about 90% of sarcoidosis cases, usually being short-lived and self-limiting, but sometimes the disease can become chronic and less often it can progress to irreversible pulmonary fibrosis, complicated with pulmonary hypertension followed by chronic pulmonary heart disease with cardio-respiratory failure and death. We present the case of a patient presenting a rare, nodular form of sarcoidosis, in which multiple calcifications, both parenchymal and lymphatic, were identified by imaging, most likely with a long-term evolution of the disease beforehand, but with a completely preserved pulmonary function.
{"title":"An Atypical Case of Pulmonary Sarcoidosis","authors":"Iris-Andreea Negoescu, Mădălina Moșteanu, Dragoș Băiceanu, Silviu Dumitru, Athir Eddan, Adrian Tudor, Beatrice Mahler","doi":"10.2478/inmed-2023-0262","DOIUrl":"https://doi.org/10.2478/inmed-2023-0262","url":null,"abstract":"Abstract Sarcoidosis is a multisystem, granulomatous, inflammatory disease, of uncertain aetiology, ubiquitous, much more common in the female population. The age at onset is usually between 30 and 50 years, also having a second peak of incidence in the immediate post-menopausal period. Respiratory system or lymphatic system involvement is present in about 90% of sarcoidosis cases, usually being short-lived and self-limiting, but sometimes the disease can become chronic and less often it can progress to irreversible pulmonary fibrosis, complicated with pulmonary hypertension followed by chronic pulmonary heart disease with cardio-respiratory failure and death. We present the case of a patient presenting a rare, nodular form of sarcoidosis, in which multiple calcifications, both parenchymal and lymphatic, were identified by imaging, most likely with a long-term evolution of the disease beforehand, but with a completely preserved pulmonary function.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adelina Maria Radu, Elena Munteanu, Raluca Totoiu, Irina Talposi, Violeta Melinte, Adina Rusu, Alexandra Minca, Amalia Calinoiu, Valeriu Gheorghita
Abstract We present two cases of liver abscess caused by Klebsiella pneumoniae with different management, one of them resolved under antibiotherapy without theraputic drainage. Klebsiella pneumoniae is a gram-negative, lactose-fermenting, rod-shaped bacterium that is part of natural intestinal flora and one of the common causes of nosocomial infections. The liver is one of the viscera in which abscesses frequently occur and is associated with intraabdominal or hepatobiliary diseases. The first patient was admitted to „Prof. Dr. Agrippa Ionescu” Hospital with sepsis due to liver abcess. The CT examination revealed a liver lesion in segments VI-VII, limited by a hypodense margin with fluid-parafluid content (with maximal axial diameters 54/32 mm), without any other focal hepatic lesions. Laboratory workup revealed neutrophilia and lymphopenia, anemia, trombocytopenia, increased inflammatory syndrome, a high level of procalcitonin and blood cultures positives with Klebsiella pneumoniae sensitive. Based on the information presented, the diagnosis established was liver abscess caused by Klebsiella pneumoniae with favorable outcome under initial empirical antibiotherapy with Vancomycin and Meropenem, de-escalated later to I.V. Ceftriaxone, due to the result of the antibiogram. At the 14 day mark, an abdominal CT reveals a slight dimentional progression. Percutaneous ecographic guided drainage was considered but the patient denied it.The patient was released with the antibiotherapy recomandation of 14 more days of orally administered Cefixime. After 4 weeks of antibiotherapy treatment, the patient is ecographically reassesed. The liver abscess is observed to have achieved complete remission without drainage, despite the classical literature recommended protocol. The second case, a male patient admitted with sepsis due to multiple liver abscess (the largest one 100/50 mm with negative blood cultures and unfavorable outcome, despite maximal empirical therapy. Percutaneous ecographic guided drainage was performed and Klebsiella pneumoniae was isolated from the drainage samples .Under target antibiotherapy with Ertapenem for 4 weeks the outcome was very good with complete resolution of the hepatic lesions. Hepatic abscess is associated with a high mortality rate and several complications, despite its low incidence. Prompt recognition is important for effective management and achieving good outcomes. Usually, the liver abscess is treated by either percutaneous drainage or surgical drainage in combination with antibiotics.The key to succesful outcomes is early diagnosis, institution of appropriate therapy and attentive evolution monitoring.More prospective trials with large cohorts are needed to refine our understanding of this serious condition.
{"title":"Liver Abscess Caused by Klebsiella Pneumoniae, Series of Cases with Different Management","authors":"Adelina Maria Radu, Elena Munteanu, Raluca Totoiu, Irina Talposi, Violeta Melinte, Adina Rusu, Alexandra Minca, Amalia Calinoiu, Valeriu Gheorghita","doi":"10.2478/inmed-2023-0260","DOIUrl":"https://doi.org/10.2478/inmed-2023-0260","url":null,"abstract":"Abstract We present two cases of liver abscess caused by Klebsiella pneumoniae with different management, one of them resolved under antibiotherapy without theraputic drainage. Klebsiella pneumoniae is a gram-negative, lactose-fermenting, rod-shaped bacterium that is part of natural intestinal flora and one of the common causes of nosocomial infections. The liver is one of the viscera in which abscesses frequently occur and is associated with intraabdominal or hepatobiliary diseases. The first patient was admitted to „Prof. Dr. Agrippa Ionescu” Hospital with sepsis due to liver abcess. The CT examination revealed a liver lesion in segments VI-VII, limited by a hypodense margin with fluid-parafluid content (with maximal axial diameters 54/32 mm), without any other focal hepatic lesions. Laboratory workup revealed neutrophilia and lymphopenia, anemia, trombocytopenia, increased inflammatory syndrome, a high level of procalcitonin and blood cultures positives with Klebsiella pneumoniae sensitive. Based on the information presented, the diagnosis established was liver abscess caused by Klebsiella pneumoniae with favorable outcome under initial empirical antibiotherapy with Vancomycin and Meropenem, de-escalated later to I.V. Ceftriaxone, due to the result of the antibiogram. At the 14 day mark, an abdominal CT reveals a slight dimentional progression. Percutaneous ecographic guided drainage was considered but the patient denied it.The patient was released with the antibiotherapy recomandation of 14 more days of orally administered Cefixime. After 4 weeks of antibiotherapy treatment, the patient is ecographically reassesed. The liver abscess is observed to have achieved complete remission without drainage, despite the classical literature recommended protocol. The second case, a male patient admitted with sepsis due to multiple liver abscess (the largest one 100/50 mm with negative blood cultures and unfavorable outcome, despite maximal empirical therapy. Percutaneous ecographic guided drainage was performed and Klebsiella pneumoniae was isolated from the drainage samples .Under target antibiotherapy with Ertapenem for 4 weeks the outcome was very good with complete resolution of the hepatic lesions. Hepatic abscess is associated with a high mortality rate and several complications, despite its low incidence. Prompt recognition is important for effective management and achieving good outcomes. Usually, the liver abscess is treated by either percutaneous drainage or surgical drainage in combination with antibiotics.The key to succesful outcomes is early diagnosis, institution of appropriate therapy and attentive evolution monitoring.More prospective trials with large cohorts are needed to refine our understanding of this serious condition.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：