Abstract Asthma is a chronic obstructive disease with high morbidity and mortality despite modern diagnostic and treatment methods. Oral corticosteroid therapy has been the mainstay treatment for severe asthma for almost a century, improving the patient's quality of life by reducing the severity and frequency of asthma attacks. However, long-term systemic corticosteroid administration has disadvantages owing to the increased prevalence of adverse effects. In recent years, the use of targeted biological therapies has increased, prompting us to question the current role of corticosteroid therapy in the management of severe eosinophilic asthma. We present the case of a 49-year-old female patient, who smoked (25 pack-years) and was diagnosed with asthma 20 years ago based on clinical, biological, and spirometric criteria. The patient was treated with prednisone (10 mg/day). This study aimed to demonstrate the potential long-term effects of corticosteroid administration in smokers with severe asthma who had clear criteria for initiating biological therapy.
{"title":"Challenges in the Management of Long-Therm Corticotherapy Treatment at Smoker Pacient with Severe Asthma","authors":"Andreea-Dumitriţa Slabu, M. Catrangiu, A. Iorga","doi":"10.2478/inmed-2023-0252","DOIUrl":"https://doi.org/10.2478/inmed-2023-0252","url":null,"abstract":"Abstract Asthma is a chronic obstructive disease with high morbidity and mortality despite modern diagnostic and treatment methods. Oral corticosteroid therapy has been the mainstay treatment for severe asthma for almost a century, improving the patient's quality of life by reducing the severity and frequency of asthma attacks. However, long-term systemic corticosteroid administration has disadvantages owing to the increased prevalence of adverse effects. In recent years, the use of targeted biological therapies has increased, prompting us to question the current role of corticosteroid therapy in the management of severe eosinophilic asthma. We present the case of a 49-year-old female patient, who smoked (25 pack-years) and was diagnosed with asthma 20 years ago based on clinical, biological, and spirometric criteria. The patient was treated with prednisone (10 mg/day). This study aimed to demonstrate the potential long-term effects of corticosteroid administration in smokers with severe asthma who had clear criteria for initiating biological therapy.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"20 1","pages":"109 - 116"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44917855","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 Smoking is a chronic disease with a recurring character, one of the oldest habits on the globe but also a problem of modern society, which kills more than 8 million people each year. More than 50% of those deaths are the result of direct tobacco use, while around 1.2 million are the result of non-smokers being exposed to second-hand smoke(1). Nicotine addiction must be seen as a chronic disease, with numerous periods of relapse and remission, and is mandatory that the clinician must treat it properly. Smoking cessation is of critical importance to public health, various studies indicate that smoking is a major risk factor for a variety of serious health conditions, including cancer, heart disease, stroke, and chronic obstructive pulmonary disease (COPD). The risk of developing these conditions is directly related to the amount and the duration of smoking and is higher for those who start smoking at a younger age. While counseling is likely to be successful in helping individuals quit smoking, there are also other methods to reach the goal, including medication, nicotine replacement therapy, and lifestyle changes. However, these methods may not be as effective as counseling in helping individuals quit smoking. Otherwise, other methods, such as reducing the amount of smoking or switching to a less harmful form of tobacco, may reduce the risk of developing some of the conditions associated with smoking, but they do not reduce the risk to the same level as quitting smoking.
{"title":"Intensive Counseling of Smokers for Nicotine Addiction Cessation and Health Benefits of Smoking Cessation","authors":"Constantin Ancuţa, Sorin Bivolaru, F. Mihălțan","doi":"10.2478/inmed-2023-0244","DOIUrl":"https://doi.org/10.2478/inmed-2023-0244","url":null,"abstract":"Abstract Smoking is a chronic disease with a recurring character, one of the oldest habits on the globe but also a problem of modern society, which kills more than 8 million people each year. More than 50% of those deaths are the result of direct tobacco use, while around 1.2 million are the result of non-smokers being exposed to second-hand smoke(1). Nicotine addiction must be seen as a chronic disease, with numerous periods of relapse and remission, and is mandatory that the clinician must treat it properly. Smoking cessation is of critical importance to public health, various studies indicate that smoking is a major risk factor for a variety of serious health conditions, including cancer, heart disease, stroke, and chronic obstructive pulmonary disease (COPD). The risk of developing these conditions is directly related to the amount and the duration of smoking and is higher for those who start smoking at a younger age. While counseling is likely to be successful in helping individuals quit smoking, there are also other methods to reach the goal, including medication, nicotine replacement therapy, and lifestyle changes. However, these methods may not be as effective as counseling in helping individuals quit smoking. Otherwise, other methods, such as reducing the amount of smoking or switching to a less harmful form of tobacco, may reduce the risk of developing some of the conditions associated with smoking, but they do not reduce the risk to the same level as quitting smoking.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"20 1","pages":"7 - 26"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44515172","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}
{"title":"Cardiac Involvement in Kaposi Sarcoma, an Unexpected Finding","authors":"Magdalena Gurzun, D. Iancu, S. Stanciu","doi":"10.2478/inmed-2023-0253","DOIUrl":"https://doi.org/10.2478/inmed-2023-0253","url":null,"abstract":"","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"20 1","pages":"117 - 118"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49100305","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}
George Bogdan, Antonio Cotea, F. Mihălțan, A. A. Constantin
Abstract Bochdalek hernia (BH) represents the herniation of abdominal visceral components through a discontinuity between the lateral (costal) and posterior (crural) components of the diaphragm. With an incidence directly proportional to age, it is rare in adults, with reported frequencies in the specialized literature ranging from 0.17% to 6% of all diaphragmatic hernias, and it is the most common type of congenital diaphragmatic hernia, affecting the left hemidiaphragm in 85% of cases(1,2). The authors describe the case of an 83-year-old patient, a former nurse in a pneumology department, diagnosed with Bochdalek hernia, which mimicked a suspicious neoplastic lung mass. The patient's clinical context and conducted investigations established the benign etiology of the formation, without requiring further surgical intervention. Additionally, we provide a brief review of the medical literature on this topic, radiological approaches, and the importance of differential diagnosis.
{"title":"Bochdalek Hernia in an 83-Year-Old Ex-Pulmonology Nurse","authors":"George Bogdan, Antonio Cotea, F. Mihălțan, A. A. Constantin","doi":"10.2478/inmed-2023-0250","DOIUrl":"https://doi.org/10.2478/inmed-2023-0250","url":null,"abstract":"Abstract Bochdalek hernia (BH) represents the herniation of abdominal visceral components through a discontinuity between the lateral (costal) and posterior (crural) components of the diaphragm. With an incidence directly proportional to age, it is rare in adults, with reported frequencies in the specialized literature ranging from 0.17% to 6% of all diaphragmatic hernias, and it is the most common type of congenital diaphragmatic hernia, affecting the left hemidiaphragm in 85% of cases(1,2). The authors describe the case of an 83-year-old patient, a former nurse in a pneumology department, diagnosed with Bochdalek hernia, which mimicked a suspicious neoplastic lung mass. The patient's clinical context and conducted investigations established the benign etiology of the formation, without requiring further surgical intervention. Additionally, we provide a brief review of the medical literature on this topic, radiological approaches, and the importance of differential diagnosis.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"20 1","pages":"89 - 94"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47737703","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 Osteoporosis is a disease that affects over 40 percent of women over the age of 50. The diabetes-osteoporosis relationship is complex and still incompletely elucidated, despite numerous studies conducted in recent decades(1). The influence of diabetes on bone tissue differs, however, between the forms of type 1 and type 2 diabetes. The purpose of this paper is to highlight the main aspects of the physical therapy in the prophylaxis and treatment of diabetic osteoporosis in females, in the context of proper guidance and an appropriate exercise program. After 35 years of age, the bone continuously loses its substance, a normal and natural phenomenon with the aging. However, this loss can become a serious problem if the initial "bone reserve" was too low or if the bone loss is done too quickly, and especially after the menopause. The result is an increased risk of fracture, either by a normal fall, like in the wrist or hip, or by a moderate lifting effort, as in the case of the vertebrae. Insufficient physical activity, sedentarism, obesity or low body weight, metabolic disorders with absorption deficits lead to demineralization and bone marrow scarring. So, an appropriate exercise program under the auspices of: resistance, posture, balance, are targets that can activate osteoblast in the process of deposition and collagen construction in the bone matrix. A good exercise program in the prophylaxis and treatment of osteoporosis consists of exercise, posture and balance exercises designed for both upper and lower limbs, but also for abdominal and pelvic belts.
{"title":"Physical Therapy Aspects on Diabetic Female Osteoporosis Complication","authors":"Adina Geambașu","doi":"10.2478/inmed-2023-0248","DOIUrl":"https://doi.org/10.2478/inmed-2023-0248","url":null,"abstract":"Abstract Osteoporosis is a disease that affects over 40 percent of women over the age of 50. The diabetes-osteoporosis relationship is complex and still incompletely elucidated, despite numerous studies conducted in recent decades(1). The influence of diabetes on bone tissue differs, however, between the forms of type 1 and type 2 diabetes. The purpose of this paper is to highlight the main aspects of the physical therapy in the prophylaxis and treatment of diabetic osteoporosis in females, in the context of proper guidance and an appropriate exercise program. After 35 years of age, the bone continuously loses its substance, a normal and natural phenomenon with the aging. However, this loss can become a serious problem if the initial \"bone reserve\" was too low or if the bone loss is done too quickly, and especially after the menopause. The result is an increased risk of fracture, either by a normal fall, like in the wrist or hip, or by a moderate lifting effort, as in the case of the vertebrae. Insufficient physical activity, sedentarism, obesity or low body weight, metabolic disorders with absorption deficits lead to demineralization and bone marrow scarring. So, an appropriate exercise program under the auspices of: resistance, posture, balance, are targets that can activate osteoblast in the process of deposition and collagen construction in the bone matrix. A good exercise program in the prophylaxis and treatment of osteoporosis consists of exercise, posture and balance exercises designed for both upper and lower limbs, but also for abdominal and pelvic belts.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"20 1","pages":"63 - 68"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42514830","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}
E. Marinescu, A. Vlădăreanu, H. Bumbea, C. Ciufu, M. Găman, D. Vasile, I. Voican, D. Cîșleanu, A. Nicolescu, E. Andrus, A. Neagu, M. Onisâi, M. Cârstoiu
Abstract The occurrence of acute leukemia during pregnancy is a rare pathologic situation and requires a multidisciplinary approach that includes at least a hematologist, gynecologist, neurologist, or psychotherapist and sometimes even intensive care unit care. The difficulties in caring for such a patient are many, from determining the risk associated with continuing the pregnancy, to choosing diagnostic tools and therapy appropriate for such a situation, to considering the patient's wishes and preferences. Below, we present the approach for cases of acute leukemia in pregnancy diagnosed and treated at the Emergency University Hospital of Bucharest (SUUB), Hematology Department, between January 1, 2017 and December 31, 2022, during a 6-year period.
{"title":"Acute Leukemia in Pregnancy: From the Experience of the Suub Hematology Center","authors":"E. Marinescu, A. Vlădăreanu, H. Bumbea, C. Ciufu, M. Găman, D. Vasile, I. Voican, D. Cîșleanu, A. Nicolescu, E. Andrus, A. Neagu, M. Onisâi, M. Cârstoiu","doi":"10.2478/inmed-2023-0245","DOIUrl":"https://doi.org/10.2478/inmed-2023-0245","url":null,"abstract":"Abstract The occurrence of acute leukemia during pregnancy is a rare pathologic situation and requires a multidisciplinary approach that includes at least a hematologist, gynecologist, neurologist, or psychotherapist and sometimes even intensive care unit care. The difficulties in caring for such a patient are many, from determining the risk associated with continuing the pregnancy, to choosing diagnostic tools and therapy appropriate for such a situation, to considering the patient's wishes and preferences. Below, we present the approach for cases of acute leukemia in pregnancy diagnosed and treated at the Emergency University Hospital of Bucharest (SUUB), Hematology Department, between January 1, 2017 and December 31, 2022, during a 6-year period.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"20 1","pages":"27 - 34"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46603267","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 young patient, known to have COPD and DZ, who presented to the emergency room for dyspnea and sudden onset right laterobasal pain. From the patient's recent history we note episode of right total pneumothorax five days prior to presentation to our unit, for which pleural drainage was fitted. Clinical examination and standard chest X-ray performed in the emergency department established the diagnosis of recurrent total pneumothorax. Given the medical history and recent history of pneumothorax in a young heavy smoker patient with two episodes of right pneumothorax, one of which was recent, known with diabetes mellitus and COPD, with imaging changes such as "reticulo-nodular lesions with cystic appearance and interstitial fibrosis on the left lung area", the diagnosis of COPD was questioned and the suspicion of pulmonary histiocytosis X was raised, which is why, together with the radiologist and thoracic surgeon, the decision was made to perform a surgical treatment and a lung biopsy to establish a definite diagnosis. The result of the lung biopsy confirmed the suspicion of pulmonary histiocytosis X. Since in histiocytosis X the damage is multi-organ, one month postoperatively the patient underwent a complex biological, functional and imaging evaluation to identify or exclude other affected organs. Imaging and functional investigations performed, collaborated with the patient's history, age and medical history refuted the diagnosis of COPD. Therapeutically for pulmonary histiocytosis X it was recommended to stop smoking urgently and monitor respiratory function at 6 months in the first year after diagnosis.
{"title":"How Real is the Diagnosis of Copd in a Young Patient?","authors":"Sorin Bivolaru, A. A. Constantin, M. Marinescu","doi":"10.2478/inmed-2023-0251","DOIUrl":"https://doi.org/10.2478/inmed-2023-0251","url":null,"abstract":"Abstract We present the case of a young patient, known to have COPD and DZ, who presented to the emergency room for dyspnea and sudden onset right laterobasal pain. From the patient's recent history we note episode of right total pneumothorax five days prior to presentation to our unit, for which pleural drainage was fitted. Clinical examination and standard chest X-ray performed in the emergency department established the diagnosis of recurrent total pneumothorax. Given the medical history and recent history of pneumothorax in a young heavy smoker patient with two episodes of right pneumothorax, one of which was recent, known with diabetes mellitus and COPD, with imaging changes such as \"reticulo-nodular lesions with cystic appearance and interstitial fibrosis on the left lung area\", the diagnosis of COPD was questioned and the suspicion of pulmonary histiocytosis X was raised, which is why, together with the radiologist and thoracic surgeon, the decision was made to perform a surgical treatment and a lung biopsy to establish a definite diagnosis. The result of the lung biopsy confirmed the suspicion of pulmonary histiocytosis X. Since in histiocytosis X the damage is multi-organ, one month postoperatively the patient underwent a complex biological, functional and imaging evaluation to identify or exclude other affected organs. Imaging and functional investigations performed, collaborated with the patient's history, age and medical history refuted the diagnosis of COPD. Therapeutically for pulmonary histiocytosis X it was recommended to stop smoking urgently and monitor respiratory function at 6 months in the first year after diagnosis.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"20 1","pages":"95 - 107"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45825953","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}
Oana Irina Gavril, I. Eșanu, I. Zota, I. Popa, L. Arhire, Diana Tatarciuc, A. Maștaleru, Andrei Drugescu, R. Gavril, M. Graur, F. Mitu
Abstract Hepatic steatosis is a frequent pathological finding in patients with chronic viral C infection (HCV) and can be independently associated with increased alcohol consumption, type 2 diabetes, obesity and hyperlipidemia. All these factors can lead to the development of hepatic steatosis in patients with HCV. There are several noninvasive techniques and scores used for diagnosing and quantifying liver steatosis. Successful eradication of HCV with interferon-free treatment regimens has been suggested to improve the level of hepatic steatosis. The precise mechanisms responsible for these beneficial effects are currently under investigation, but it is thought that the decrease in hepatic inflammation and viral replication contribute to the resolution of hepatic steatosis. Moreover, the overall enhancement in liver health and metabolic factors may also have a significant impact.
{"title":"Hepatic Steatosis in Patients with Chronic Viral Hepatitis C Treated with Direct Acting Antivirals","authors":"Oana Irina Gavril, I. Eșanu, I. Zota, I. Popa, L. Arhire, Diana Tatarciuc, A. Maștaleru, Andrei Drugescu, R. Gavril, M. Graur, F. Mitu","doi":"10.2478/inmed-2023-0247","DOIUrl":"https://doi.org/10.2478/inmed-2023-0247","url":null,"abstract":"Abstract Hepatic steatosis is a frequent pathological finding in patients with chronic viral C infection (HCV) and can be independently associated with increased alcohol consumption, type 2 diabetes, obesity and hyperlipidemia. All these factors can lead to the development of hepatic steatosis in patients with HCV. There are several noninvasive techniques and scores used for diagnosing and quantifying liver steatosis. Successful eradication of HCV with interferon-free treatment regimens has been suggested to improve the level of hepatic steatosis. The precise mechanisms responsible for these beneficial effects are currently under investigation, but it is thought that the decrease in hepatic inflammation and viral replication contribute to the resolution of hepatic steatosis. Moreover, the overall enhancement in liver health and metabolic factors may also have a significant impact.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"20 1","pages":"55 - 60"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44092230","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}
C. Achim, Daniela-Gabriela Florescu, Bogdan-Mihai Ditu, Catalina Voicu Titere, Rares-Vasilica Moisa, G. Ismail
Abstract Chronic kidney disease (CKD) affects over 10% of the global population and is more prevalent in the elderly, females, patients with diabetes or hypertension, and certain racial minorities. CKD is a leading cause of mortality, especially in CKD stage G5 and End-Stage Renal Disease (ESRD). Left ventricular hypertrophy (LVH) is common in CKD patients, predicting mortality even in early stages. CKD patients face a higher risk of bleeding, with a 3.5 times higher risk in hemodialysis patients. Atrial fibrillation (AF) and acute coronary syndrome are more prevalent in patients with eGFR <60 ml/min, and the risk of pulmonary embolism increases by 25-30% regardless of CKD stage. Antithrombotic treatment is crucial for CKD patients with cardiovascular diseases. In early stages (G1-G3), both warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) can be used, with NOACs preferred due to their safety profile. In advanced stages (G4-G5) and ESRD (G5D), warfarin is commonly used, with reduced NOAC doses as an option. NOACs require careful monitoring of renal function, and hemodialysis can remove a significant portion of plasma dabigatran. Monitoring renal function is vital for CKD patients receiving NOACs. Some studies suggest NOACs may have a lower risk of cardiovascular events compared to warfarin, but conflicting data exist regarding bleeding risk. Individualized treatment decisions should consider the patient's renal function.
{"title":"Antithrombotic Therapy in Chronic Kidney Disease","authors":"C. Achim, Daniela-Gabriela Florescu, Bogdan-Mihai Ditu, Catalina Voicu Titere, Rares-Vasilica Moisa, G. Ismail","doi":"10.2478/inmed-2023-0249","DOIUrl":"https://doi.org/10.2478/inmed-2023-0249","url":null,"abstract":"Abstract Chronic kidney disease (CKD) affects over 10% of the global population and is more prevalent in the elderly, females, patients with diabetes or hypertension, and certain racial minorities. CKD is a leading cause of mortality, especially in CKD stage G5 and End-Stage Renal Disease (ESRD). Left ventricular hypertrophy (LVH) is common in CKD patients, predicting mortality even in early stages. CKD patients face a higher risk of bleeding, with a 3.5 times higher risk in hemodialysis patients. Atrial fibrillation (AF) and acute coronary syndrome are more prevalent in patients with eGFR <60 ml/min, and the risk of pulmonary embolism increases by 25-30% regardless of CKD stage. Antithrombotic treatment is crucial for CKD patients with cardiovascular diseases. In early stages (G1-G3), both warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) can be used, with NOACs preferred due to their safety profile. In advanced stages (G4-G5) and ESRD (G5D), warfarin is commonly used, with reduced NOAC doses as an option. NOACs require careful monitoring of renal function, and hemodialysis can remove a significant portion of plasma dabigatran. Monitoring renal function is vital for CKD patients receiving NOACs. Some studies suggest NOACs may have a lower risk of cardiovascular events compared to warfarin, but conflicting data exist regarding bleeding risk. Individualized treatment decisions should consider the patient's renal function.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"20 1","pages":"69 - 86"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41913737","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}
C. Șchiopu, R. Gavril, C. Ștefănescu, I. Eșanu, F. Mitu
Abstract Modern medicine tends to evolve towards interdiciplinary collaboration and case management. A strong example in that direction is represented by neurogastroenterology, a field that developed arround the concept of gut-brain axis. Still, research in this field determend the multisystemic role of the gut microbiome, beyond it's regulatory function within the gut-brain axis. The purpose of this review is to focus on the current knowledge in medical literature regarding gut microbiome and its possible invovlvement in medical areas, such as cardiology, rheumatology, pneumology, neurology and psychiatry, bringing these domains closer then ever. We researched Google Scholar, Scopus, PubMed and Wiley Library for articles containing the following key words: “microbiota”, “intestinal bacteria”, “disbiosis”, “probiotics”, “prebiotics”, “rheumatology”, “cardiology”, “diabetes”, “metabolic disease”, “clinical medicine” “cardiology”, “cardiovascular”. Articles were selected by number of acceses, citations, results and by being published between 2015 and 2023. Both animal and clinical studies were considered as well as literature reviews and systematic reviews. Although many studies are still in preclinical phase, and some of them still have uneven results, the road for research has contured theories, especially regarding physiologic and pathophysiologic functions that involve the microbiome and have multisystemic consequences. Conclusions. The gut microbiome may be the key of understanding multi-organic pathophysiologic mechanisms and may have the potential to act as a preventive clinical instrument and raising the effectiveness of therapeutic management in multiple medical fields, not only in gastroenterology and neuropsychiatry.
{"title":"The Gut Microbiome, a Possible Key to Multidisciplinary Clinical Practice - Literature Review","authors":"C. Șchiopu, R. Gavril, C. Ștefănescu, I. Eșanu, F. Mitu","doi":"10.2478/inmed-2023-0246","DOIUrl":"https://doi.org/10.2478/inmed-2023-0246","url":null,"abstract":"Abstract Modern medicine tends to evolve towards interdiciplinary collaboration and case management. A strong example in that direction is represented by neurogastroenterology, a field that developed arround the concept of gut-brain axis. Still, research in this field determend the multisystemic role of the gut microbiome, beyond it's regulatory function within the gut-brain axis. The purpose of this review is to focus on the current knowledge in medical literature regarding gut microbiome and its possible invovlvement in medical areas, such as cardiology, rheumatology, pneumology, neurology and psychiatry, bringing these domains closer then ever. We researched Google Scholar, Scopus, PubMed and Wiley Library for articles containing the following key words: “microbiota”, “intestinal bacteria”, “disbiosis”, “probiotics”, “prebiotics”, “rheumatology”, “cardiology”, “diabetes”, “metabolic disease”, “clinical medicine” “cardiology”, “cardiovascular”. Articles were selected by number of acceses, citations, results and by being published between 2015 and 2023. Both animal and clinical studies were considered as well as literature reviews and systematic reviews. Although many studies are still in preclinical phase, and some of them still have uneven results, the road for research has contured theories, especially regarding physiologic and pathophysiologic functions that involve the microbiome and have multisystemic consequences. Conclusions. The gut microbiome may be the key of understanding multi-organic pathophysiologic mechanisms and may have the potential to act as a preventive clinical instrument and raising the effectiveness of therapeutic management in multiple medical fields, not only in gastroenterology and neuropsychiatry.","PeriodicalId":77259,"journal":{"name":"Medicina interna (Bucharest, Romania : 1991)","volume":"20 1","pages":"35 - 54"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43925859","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}
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