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Stoian M, Andone A, Boeriu A, Bândilă SR, Dobru D, Laszlo SȘ, Corău D, Arbănași EM, Russu E, Stoian A. COVID-19 and Clostridioides difficile Coinfection Analysis in the Intensive Care Unit. Antibiotics (Basel) 2024; 13:367. [PMID: 38667043 PMCID: PMC11047694 DOI: 10.3390/antibiotics13040367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
Since the emergence of SARS-CoV-2 in late 2019, the global mortality attributable to COVID-19 has reached 6,972,152 deaths according to the World Health Organization (WHO). The association between coinfection with Clostridioides difficile (CDI) and SARS-CoV-2 has limited data in the literature. This retrospective study, conducted at Mureș County Clinical Hospital in Romania, involved 3002 ICU patients. Following stringent inclusion and exclusion criteria, 63 patients were enrolled, with a division into two subgroups-SARS-CoV-2 + CDI patients and CDI patients. Throughout their hospitalization, the patients were closely monitored. Analysis revealed no significant correlation between comorbidities and invasive mechanical ventilation (IMV) or non-invasive mechanical ventilation (NIMV). However, statistically significant associations were noted between renal and hepatic comorbidties (p = 0.009), death and CDI-SARS-CoV-2 coinfection (p = 0.09), flourochinolone treatment and CDI-SARS-CoV-2 infection (p = 0.03), and an association between diabetes mellitus and SARS-CoV-2-CDI infection (p = 0.04), as well as the need for invasive mechanical ventilation (p = 0.04). The patients with CDI treatment were significantly younger and received immuno-modulator or corticotherapy treatment, which was a risk factor for opportunistic agents. Antibiotic and PPI (proton pump inhibitor) treatment were significant risk factors for CDI coinfection, as well as for death, with PPI treatment in combination with antibiotic treatment being a more significant risk factor.
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Affiliation(s)
- Mircea Stoian
- Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Adina Andone
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.B.); (D.D.)
| | - Alina Boeriu
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.B.); (D.D.)
| | - Sergio Rareș Bândilă
- Orthopedic Surgery and Traumatology Service, Marina Baixa Hospital, Av. Alcade En Jaume Botella Mayor, 03570 Villajoyosa, Spain;
| | - Daniela Dobru
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.B.); (D.D.)
| | - Sergiu Ștefan Laszlo
- Intensive Care Unit, Mures, County Hospital, Street Gheorghe Marinescu No 1, 540136 Targu Mures, Romania; (S.Ș.L.); (D.C.)
| | - Dragoș Corău
- Intensive Care Unit, Mures, County Hospital, Street Gheorghe Marinescu No 1, 540136 Targu Mures, Romania; (S.Ș.L.); (D.C.)
| | - Emil Marian Arbănași
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540136 Targu Mures, Romania;
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Mureșan AV, Florea E, Arbănași EM, Bartus R, Arbănași EM, Ion AP, Cordoș BA, Halatiu VB, Niculescu R, Stoian A, Ciucanu CC, Russu E. Elevated Leukocyte Glucose Index Is Associated with Long-Term Arteriovenous Fistula Failure in Dialysis Patients. J Clin Med 2024; 13:2037. [PMID: 38610802 PMCID: PMC11012331 DOI: 10.3390/jcm13072037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Arteriovenous fistula (AVF) is the preferred type of vascular access for dialysis in patients with end-stage kidney disease (ESKD). However, the primary patency of AVF at one year is under 70% due to several risk factors and comorbidities. Leukocyte glucose index (LGI), a new biomarker based on blood leukocytes and glucose values, has been found to be associated with poor outcomes in cardiovascular disease. The aim of this study is to analyze the impact of LGI on the long-term primary patency of AVF following dialysis initiation. (2) Methods: We conducted a retrospective observational study in which we initially enrolled 158 patients with ESKD admitted to the Vascular Surgery Department of the Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis between January 2020 and July 2023. The primary endpoint was AVF failure, defined as the impossibility of performing a chronic dialysis session due to severe restenosis or AVF thrombosis. After follow-up, we categorized patients into two groups based on their AVF status: "functional AVF" for those with a permeable AVF and "AVF failure" for those with vascular access dysfunction. (3) Results: Patients with AVF failure had a higher prevalence of atrial fibrillation (p = 0.013) and diabetes (p = 0.028), as well as a higher LGI value (1.12 vs. 0.79, p < 0.001). At ROC analysis, LGI had the strongest association with the outcome, with an AUC of 0.729, and an optimal cut-off value of 0.95 (72.4% sensitivity and 68% specificity). In Kaplan-Meier survival analyses, patients in the highest tertile (T3) of LGI had a significantly higher incidence of AVF failure compared to those in tertile 1 (p = 0.019). Moreover, we found that patients with higher baseline LGI values had a significantly higher risk of AVF failure during follow-up (HR: 1.48, p = 0.003). The association is independent of age and sex (HR: 1.65, p = 0.001), cardiovascular risk factors (HR: 1.63, p = 0.012), and pre-operative vascular mapping determinations (HR: 3.49, p = 0.037). (4) Conclusions: In conclusion, high preoperative values of LGI are positively associated with long-term AVF failure. The prognostic role of the biomarker was independent of age, sex, cardiovascular risk factors, and pre-operative vascular mapping determinations.
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Affiliation(s)
- Adrian Vasile Mureșan
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania; (A.V.M.); (E.R.)
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Elena Florea
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Emil-Marian Arbănași
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania; (A.V.M.); (E.R.)
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Regenerative Medicine Laboratory, Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Réka Bartus
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania; (A.V.M.); (E.R.)
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Eliza-Mihaela Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Alexandru Petru Ion
- Regenerative Medicine Laboratory, Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Bogdan Andrei Cordoș
- Regenerative Medicine Laboratory, Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Centre for Experimental Medical and Imaging Studies, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Vasile Bogdan Halatiu
- Department of Physiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Raluca Niculescu
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Claudiu Constantin Ciucanu
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania; (A.V.M.); (E.R.)
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Eliza Russu
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania; (A.V.M.); (E.R.)
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
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Moțățăianu A, Andone S, Stoian A, Bălașa R, Huțanu A, Sărmășan E. A Potential Role of Interleukin-5 in the Pathogenesis and Progression of Amyotrophic Lateral Sclerosis: A New Molecular Perspective. Int J Mol Sci 2024; 25:3782. [PMID: 38612591 PMCID: PMC11011909 DOI: 10.3390/ijms25073782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Cumulative data suggest that neuroinflammation plays a prominent role in amyotrophic lateral sclerosis (ALS) pathogenesis. The purpose of this work was to assess if patients with ALS present a specific peripheral cytokine profile and if it correlates with neurological disability assessed by ALSFRS-R, the rate of disease progression, and the pattern of disease progression (horizontal spreading [HSP] versus vertical spreading [VSP]). We determined the levels of 15 cytokines in the blood of 59 patients with ALS and 40 controls. We identified a positive correlation between levels of pro-inflammatory cytokines (interleukin [IL]-17F, IL-33, IL-31) and the age of ALS patients, as well as a positive correlation between IL-12p/70 and survival from ALS onset and ALS diagnosis. Additionally, there was a positive correlation between the ALSFRS-R score in the upper limb and respiratory domain and IL-5 levels. In our ALS cohort, the spreading pattern was 42% horizontal and 58% vertical, with patients with VSP showing a faster rate of ALS progression. Furthermore, we identified a negative correlation between IL-5 levels and the rate of disease progression, as well as a positive correlation between IL-5 and HSP of ALS. To the best of our knowledge, this is the first study reporting a "protective" role of IL-5 in ALS.
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Affiliation(s)
- Anca Moțățăianu
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (S.A.); (A.S.); (R.B.); (E.S.)
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Sebastian Andone
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (S.A.); (A.S.); (R.B.); (E.S.)
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Adina Stoian
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (S.A.); (A.S.); (R.B.); (E.S.)
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Rodica Bălașa
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (S.A.); (A.S.); (R.B.); (E.S.)
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Adina Huțanu
- Department of Laboratory Medicine, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania
- Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Emanuela Sărmășan
- 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.M.); (S.A.); (A.S.); (R.B.); (E.S.)
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Cocuz IG, Popelea MC, Niculescu R, Manea A, Sabău AH, Tinca AC, Szoke AR, Budin CE, Stoian A, Morariu SH, Cotoi TC, Cocuz ME, Cotoi OS. Pathophysiology, Histopathology, and Differential Diagnostics of Basal Cell Carcinoma and Cutaneous Squamous Cell Carcinoma-An Update from the Pathologist's Point of View. Int J Mol Sci 2024; 25:2220. [PMID: 38396897 PMCID: PMC10888641 DOI: 10.3390/ijms25042220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) are the most frequently occurring non-melanocytic skin cancers. The objective of our study is to present the pathophysiology of BCC and cSCC and its direct relationship with the histopathological diagnostics and the differential diagnostics of these types of cancer, based on the morphological characteristics, immunohistochemical profile, and genetic alterations. The qualitative study was based on emphasizing the morphological characteristics and immunohistochemistry profiles of BCC and cSCC and the differential diagnostics based on the tissue samples from the Clinical Pathology Department of Mures Clinical County Hospital between 2020 and 2022. We analyzed the histopathological appearances and immunohistochemical profiles of BCC and cSCC in comparison with those of Bowen disease, keratoacanthoma, hyperkeratotic squamous papilloma, metatypical carcinoma, pilomatricoma, trichoblastoma, Merkel cell carcinoma, pleomorphic dermal sarcoma (PDS), and melanoma. Our study showed the importance of the correct histopathological diagnosis, which has a direct impact on the appropriate treatment and outcome for each patient. The study highlighted the histopathological and morphological characteristics of NMSCs and the precursor lesions in HE and the immunohistochemical profile for lesions that may make the differential diagnosis difficult to establish.
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Affiliation(s)
- Iuliu Gabriel Cocuz
- Pathophysiology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (I.G.C.); (R.N.); (A.-H.S.); (A.-C.T.); (A.R.S.); (C.E.B.); (A.S.); (O.S.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | | | - Raluca Niculescu
- Pathophysiology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (I.G.C.); (R.N.); (A.-H.S.); (A.-C.T.); (A.R.S.); (C.E.B.); (A.S.); (O.S.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Andrei Manea
- Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania;
| | - Adrian-Horațiu Sabău
- Pathophysiology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (I.G.C.); (R.N.); (A.-H.S.); (A.-C.T.); (A.R.S.); (C.E.B.); (A.S.); (O.S.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Andreea-Cătălina Tinca
- Pathophysiology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (I.G.C.); (R.N.); (A.-H.S.); (A.-C.T.); (A.R.S.); (C.E.B.); (A.S.); (O.S.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Andreea Raluca Szoke
- Pathophysiology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (I.G.C.); (R.N.); (A.-H.S.); (A.-C.T.); (A.R.S.); (C.E.B.); (A.S.); (O.S.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Corina Eugenia Budin
- Pathophysiology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (I.G.C.); (R.N.); (A.-H.S.); (A.-C.T.); (A.R.S.); (C.E.B.); (A.S.); (O.S.C.)
- Pneumology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Adina Stoian
- Pathophysiology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (I.G.C.); (R.N.); (A.-H.S.); (A.-C.T.); (A.R.S.); (C.E.B.); (A.S.); (O.S.C.)
- Neurology I Clinic, Targu Mures Emergency County Hospital, 540136 Targu Mures, Romania
| | - Silviu Horia Morariu
- Dermatology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Dermatology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Titiana Cornelia Cotoi
- Pharmaceutical Technique Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Pharmacy No. 2, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Maria-Elena Cocuz
- Fundamental Prophylactic and Clinical Disciplines Department, Faculty of Medicine, Transilvania University of Brasov, 500003 Brașov, Romania;
- Clinical Pneumology and Infectious Diseases Hospital of Brasov, 500174 Brasov, Romania
| | - Ovidiu Simion Cotoi
- Pathophysiology Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (I.G.C.); (R.N.); (A.-H.S.); (A.-C.T.); (A.R.S.); (C.E.B.); (A.S.); (O.S.C.)
- Pathology Department, Mures Clinical County Hospital, 540011 Targu Mures, Romania
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Stoian M, Roman A, Boeriu A, Onișor D, Bandila SR, Babă DF, Cocuz I, Niculescu R, Costan A, Laszlo SȘ, Corău D, Stoian A. Long-Term Radiological Pulmonary Changes in Mechanically Ventilated Patients with Respiratory Failure due to SARS-CoV-2 Infection. Biomedicines 2023; 11:2637. [PMID: 37893011 PMCID: PMC10604756 DOI: 10.3390/biomedicines11102637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023] Open
Abstract
From the first reports of SARS-CoV-2, at the end of 2019 to the present, the global mortality associated with COVID-19 has reached 6,952,522 deaths as reported by the World Health Organization (WHO). Early intubation and mechanical ventilation can increase the survival rate of critically ill patients. This prospective study was carried out on 885 patients in the ICU of Mureș County Clinical Hospital, Romania. After applying inclusion and exclusion criteria, a total of 54 patients were included. Patients were monitored during hospitalization and at 6-month follow-up. We analyzed the relationship between invasive mechanical ventilation (IMV) and non-invasive mechanical ventilation (NIMV) and radiological changes on thoracic CT scans performed at 6-month follow-up and found no significant association. Regarding paraclinical analysis, there was a statistically significant association between patients grouped by IMV and ferritin level on day 1 of admission (p = 0.034), and between patients grouped by PaO2/FiO2 ratio with metabolic syndrome (p = 0.03) and the level of procalcitonin (p = 0.01). A significant proportion of patients with COVID-19 admitted to the ICU developed pulmonary fibrosis as observed at a 6-month evaluation. Patients with oxygen supplementation or mechanical ventilation require dynamic monitoring and radiological investigations, as there is a possibility of long-term pulmonary fibrosis that requires pharmacological interventions and finding new therapeutic alternatives.
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Affiliation(s)
- Mircea Stoian
- Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540139 Targu Mures, Romania;
| | - Adina Roman
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania; (A.B.); (D.O.)
| | - Alina Boeriu
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania; (A.B.); (D.O.)
| | - Danusia Onișor
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania; (A.B.); (D.O.)
| | - Sergio Rareș Bandila
- Orthopedic Surgery and Traumatology Service, Marina Baixa Hospital, Av. Alcade En Jaume Botella Mayor, 03570 Villajoyosa, Spain;
| | - Dragoș Florin Babă
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania;
| | - Iuliu Cocuz
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Targu Mures, Romania; (I.C.); (R.N.); (A.S.)
| | - Raluca Niculescu
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Targu Mures, Romania; (I.C.); (R.N.); (A.S.)
| | - Anamaria Costan
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania;
| | - Sergiu Ștefan Laszlo
- Intensive Care Unit, Mureș County Hospital, Street Gheorghe Marinescu no 1, 540136 Targu Mures, Romania;
| | - Dragoș Corău
- Intensive Care Unit, Mureș County Hospital, Street Gheorghe Marinescu no 1, 540136 Targu Mures, Romania;
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Targu Mures, Romania; (I.C.); (R.N.); (A.S.)
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Mureșan AV, Tomac A, Opriș DR, Bandici BC, Coșarcă CM, Covalcic DC, Hălmaciu I, Akácsos-Szász OZ, Rădulescu F, Lázár K, Stoian A, Tilinca MC. Inflammatory Markers Used as Predictors of Subclinical Atherosclerosis in Patients with Diabetic Polyneuropathy. Life (Basel) 2023; 13:1861. [PMID: 37763265 PMCID: PMC10532684 DOI: 10.3390/life13091861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND peripheral arterial disease (PAD) is identified late in diabetic patients because, in the majority of cases, it is associated with diabetic peripheral neuropathy, resulting in little or no symptoms, or symptoms that are completely neglected. METHODS In this study were enrolled all patients over 18 years of age, with diabetes mellitus type II for more than a year with poor glycemic control, diagnosed with diabetic polyneuropathy admitted to the Diabetology Department, Emergency County Hospital of Targu Mures, Romania between January 2020 and March 2023. We divided the patients into two groups, based on the presence or absence of subclinical atherosclerosis in the lower limb, named "SA" and "non-SA". RESULTS Patients in the SA group were older (p = 0.01) and had a higher incidence of IHD (p = 0.03), history of MI (p = 0.02), and diabetic nephropathy (p = 0.01). Moreover, patients with subclinical atherosclerosis had a higher BMI (p < 0.0001) and a longer duration of diabetes (p < 0.0001). Among all patients, the systemic inflammatory markers, MLR (r = 0.331, p < 0.001), NLR (r = 0.517, p < 0.001), PLR (r = 0.296, p < 0.001), SII (r = 0.413, p < 0.001), as well as BMI (r = 0.241, p < 0.001) and HbA1C (r = 0.489, p < 0.001), demonstrated a strong positive correlation with the diabetes duration. The multivariate logistic regression analysis showed that older patients (OR: 2.58, p < 0.001), the male gender (OR: 2.30, p = 0.006), a higher baseline levels of BMI (OR: 7.71, p < 0.001), and the duration of diabetes (OR: 8.65, p < 0.001) are predictors of subclinical atherosclerosis in DN patients. Additionally, the high baseline levels of all systemic inflammatory markers (for all: p < 0.001) and poor diabetes management (OR: 10.4, p < 0.001 for HbA1C; OR: 10.78, p < 0.001 for admission glucose) are independent predictors of SA. CONCLUSIONS the inflammatory markers, NLR, MLR, PLR, and SII, being cheap and easy to collect in routine medical practice from the standard blood tests, could be an important step in predicting vascular outcomes in diabetic patients and the disease's progression, playing a key role in follow-up visits in type-2 diabetic patients and PAD patients.
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Affiliation(s)
- Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (A.V.M.); (C.M.C.)
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Alexandru Tomac
- Clinic of Plastic Surgery, Emergency Clinical Hospital Saint Spiridon, 700111 Iasi, Romania;
| | - Diana Roxana Opriș
- Emergency Institute for Cardiovascular Diseases and Transplantation (IUBCVT) of Targu Mures, 540136 Targu Mures, Romania
| | - Bogdan Corneliu Bandici
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (A.V.M.); (C.M.C.)
| | - Cătălin Mircea Coșarcă
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (A.V.M.); (C.M.C.)
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Diana Carina Covalcic
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (A.V.M.); (C.M.C.)
| | - Ioana Hălmaciu
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
| | - Orsolya-Zsuzsa Akácsos-Szász
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Flavia Rădulescu
- Clinical Department of Endocrinology, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (F.R.)
- Department of Scientific Research Methodology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Krisztina Lázár
- Clinical Department of Endocrinology, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (F.R.)
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Mariana Cornelia Tilinca
- Department of Diabetes, Nutrition and Metabolic Diseases, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
- Department of Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
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Stoian A, Bajko Z, Stoian M, Cioflinc RA, Niculescu R, Arbănași EM, Russu E, Botoncea M, Bălașa R. The Occurrence of Acute Disseminated Encephalomyelitis in SARS-CoV-2 Infection/Vaccination: Our Experience and a Systematic Review of the Literature. Vaccines (Basel) 2023; 11:1225. [PMID: 37515041 PMCID: PMC10385010 DOI: 10.3390/vaccines11071225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The neurological complications of coronavirus disease 2019 (COVID-19) infection and the side effects of vaccination include immune-mediated diseases of the central nervous system (CNS) such as acute disseminated encephalomyelitis (ADEM). It is an acute-onset demyelinating disease that involves a rapid evolution and multifocal neurological deficits that develops following a viral or bacterial infection or, less frequently, following vaccination. Acute hemorrhagic leukoencephalitis (AHLE) is the hemorrhagic variant of ADEM that presents a more severe evolution which can be followed by coma and death. The objectives of this study consist in evaluating the diagnosis, clinical characteristics, imaging and laboratory features, evolution, and treatment of ADEM and AHLE following COVID-19 infection or vaccination. METHODS We performed a systematic review of the medical literature according to PRISMA guidelines that included ADEM cases published between 1 January 2020 and 30 November 2022 following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination and also included our own clinical experience regarding this pathology. RESULTS A total number of 74 patients were diagnosed with ADEM, 45 following COVID-19 infection and 29 after a SARS-CoV-2 vaccine. A total of 13 patients (17.33%) presented AHLE. The moderate form of COVID-19 presented a positive correlation with AHLE (r = 0.691, p < 0.001). The existence of coma and AHLE was correlated with poor outcomes. The following more aggressive immunomodulatory therapies applied in severe cases were correlated with poor outcomes (major sequelae and death): therapeutic plasma exchange (TPE) treatment (r = 382, p = 0.01) and combined therapy with corticosteroids and TPE (r = 0.337, p = 0.03). CONCLUSIONS Vaccinations are essential to reduce the spread of the COVID-19 pandemic, and the monitoring of adverse events is an important part of the strategic fight against SARS-CoV-2. The general benefits and the overall good evolution outweigh the risks, and prompt diagnosis is associated with a better prognosis in these patients.
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Affiliation(s)
- Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Zoltan Bajko
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Mircea Stoian
- Department Anesthesiology and Critical Care Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | | | - Raluca Niculescu
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Emil Marian Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Eliza Russu
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Marian Botoncea
- Department of General Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Rodica Bălașa
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
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8
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Niculescu R, Russu E, Arbănași EM, Kaller R, Arbănași EM, Melinte RM, Coșarcă CM, Cocuz IG, Sabău AH, Tinca AC, Stoian A, Vunvulea V, Mureșan AV, Cotoi OS. Carotid Plaque Features and Inflammatory Biomarkers as Predictors of Restenosis and Mortality Following Carotid Endarterectomy. Int J Environ Res Public Health 2022; 19:ijerph192113934. [PMID: 36360814 PMCID: PMC9654888 DOI: 10.3390/ijerph192113934] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is the first-line surgical intervention for cases of severe carotid stenoses. Unfortunately, the restenosis rate is high after CEA. This study aims to demonstrate the predictive role of carotid plaque features and inflammatory biomarkers (monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)) in carotid restenosis and mortality at 12 months following CEA. METHODS The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with a minimum of 70% carotid stenosis and surgical indications for CEA admitted to the Vascular Surgery Clinic, Emergency County Hospital of Targu Mures, Romania between 2018 and 2021. RESULTS According to our results, the high pre-operative values of inflammatory biomarkers-MLR (OR: 10.37 and OR: 6.11; p < 0.001), NLR (OR: 34.22 and OR: 37.62; p < 0.001), PLR (OR: 12.02 and OR: 16.06; p < 0.001), SII (OR: 18.11 and OR: 31.70; p < 0.001), SIRI (OR: 16.64 and OR: 9.89; p < 0.001), and AISI (OR: 16.80 and OR: 8.24; p < 0.001)-are strong independent factors predicting the risk of 12-month restenosis and mortality following CEA. Moreover, unstable plaque (OR: 2.83, p < 0.001 and OR: 2.40, p = 0.04) and MI (OR: 3.16, p < 0.001 and OR: 2.83, p = 0.005) were independent predictors of all outcomes. Furthermore, AH (OR: 2.30; p = 0.006), AF (OR: 1.74; p = 0.02), tobacco (OR: 2.25; p < 0.001), obesity (OR: 1.90; p = 0.02), and thrombotic plaques (OR: 2.77; p < 0.001) were all independent predictors of restenosis, but not for mortality in all patients. In contrast, antiplatelet (OR: 0.46; p = 0.004), statin (OR: 0.59; p = 0.04), and ezetimibe (OR:0.45; p = 0.03) therapy were protective factors against restenosis, but not for mortality. CONCLUSIONS Our data revealed that higher preoperative inflammatory biomarker values highly predict 12-month restenosis and mortality following CEA. Furthermore, age above 70, unstable plaque, cardiovascular disease, and dyslipidemia were risk factors for all outcomes. Additionally, AH, AF, smoking, and obesity were all independent predictors of restenosis but not of mortality in all patients. Antiplatelet and statin medication, on the other hand, were protective against restenosis but not against mortality.
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Affiliation(s)
- Raluca Niculescu
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139, Targu Mures, Romania
| | - Emil Marian Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Réka Kaller
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Răzvan Marian Melinte
- Department of Orthopedics, Regina Maria Health Network, 540098 Targu Mures, Romania
- Department of Orthopedics, Humanitas MedLife Hospital, 400664 Cluj Napoca, Romania
| | - Cătălin Mircea Coșarcă
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Iuliu Gabriel Cocuz
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Adrian Horațiu Sabău
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Andreea Cătălina Tinca
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Vlad Vunvulea
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139, Targu Mures, Romania
| | - Ovidiu Simion Cotoi
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
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Bajko Z, Maier S, Motataianu A, Filep RC, Stoian A, Andone S, Balasa R. Rivaroxaban for the treatment of cerebral venous thrombosis: a single-center experience. Acta Neurol Belg 2022; 122:105-111. [PMID: 33733345 DOI: 10.1007/s13760-021-01651-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
The mainstay of cerebral venous thrombosis (CVT) treatment according to current guidelines is parenteral anticoagulation with unfractionated heparin or low-molecular-weight heparin followed by long-term oral anticoagulation with vitamin K antagonists. Direct oral anticoagulants (DOACs), including the factor Xa inhibitor rivaroxaban, are used occasionally off-label for CVT based on individual treatment plans. This publication sought to report our experience with rivaroxaban for the indication of CVT and to review the relevant literature data concerning this topic. We performed a single-center retrospective analysis including patients from our institution with the diagnosis of cerebral venous thrombosis treated with rivaroxaban. Among 12,500 stroke patients over an 11-year period, we identified 87 cases with a diagnosis of CVT (0.7%). As long-term anticoagulation, 80 of these patients were receiving vitamin K antagonists and seven were receiving DOACs, including six receiving rivaroxaban and one receiving apixaban. Of the six patients receiving rivaroxaban, at least 6 months of clinical follow-up data were available for five of them. Excellent clinical outcomes were obtained in four of these five cases (modified Rankin scale score: 0-1 points). No hemorrhagic events, recurrent thrombosis, or other relevant complications were recorded during the follow-up period. Despite our small study sample size, our positive results support that rivaroxaban may be a safe and effective treatment option for patients with CVT. Hopefully, ongoing randomized clinical trials will better clarify the role of rivaroxaban in the treatment of CVT so as to provide a more convenient and safer alternative to vitamin K antagonists in this context.
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Affiliation(s)
- Zoltan Bajko
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, Targu-Mures, Romania
| | - Smaranda Maier
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, Targu-Mures, Romania
| | - Anca Motataianu
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, Targu-Mures, Romania
| | - Rares Cristian Filep
- Department of Interventional Radiology, Mures County Clinical Emergency Hospital, Targu-Mures, Romania
| | - Adina Stoian
- Department of Patophysiology, University of Medicine, Pharmacy, Science and Technology Targu Mures, Marinescu Gh 50, 540136, Targu-Mures, Romania.
| | - Sebastian Andone
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, Targu-Mures, Romania
| | - Rodica Balasa
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, Targu-Mures, Romania
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Bajko Z, Maier S, Motataianu A, Filep RC, Stoian A, Barcutean L, Andone S, Balasa R. Immunological mechanisms in multiple spontaneous cervical artery dissection: An illustrative case and review of the literature. Ro J Neurol 2021. [DOI: 10.37897/rjn.2021.4.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dissection of the cervical arteries is the leading cause of stroke in young adults, yet the etiology and pathogenesis of this event remain unclear. However, a growing number of data in the literature support the potential implications of immunological mechanisms in the pathogenesis. Several large patient groups and multicentre cohorts have reported significant associations with recent infections and elevated inflammatory markers. There are also several case reports and case series suggesting an association with various autoimmune disorders and viral infections. Some case reports have also detailed cervical artery dissections linked to the use of biological therapies for other pathologies. In the present case, a 38-year-old female patient with triple spontaneous cervical artery dissection presented multiple potential trigger factors as recent infection, autoimmune thyroid disease, primary thrombophilia and hyperhomocysteinemia. This report sought first presents this case, and then reviews the existing relevant literature data regarding the potential immunological mechanisms implicated in the pathogenesis of cervical artery dissection.
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Motataianu A, Barcutean L, Bajko Z, Stoian A, Maier S, Voidazan S, Balasa R. Autonomic and Somatic Nerve Functions in Type 2 Diabetes Mellitus Patients: Electrophysiological Aspects. Diagnostics (Basel) 2021; 11:diagnostics11112005. [PMID: 34829352 PMCID: PMC8621884 DOI: 10.3390/diagnostics11112005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives: To investigate the relationship between neurophysiological sensory and motor nerve function parameters, assessed by nerve conduction studies (NCS) with parasympathetic autonomic function and by heart rate variability (HRV) tests in patients with type 2 diabetes mellitus (T2DM). Material and Methods: A total of 161 T2DM patients underwent NCS. Cardiac autonomic response was assessed by HRV tests to deep breathing (HRV DB), to Valsalva manoeuvre, and during postural change from lying to standing. Results: The amplitude of motor response in the median nerve, tibial nerve, and peroneal nerve was associated with reduced HRV DB (p = 0.0001). The amplitude of motor response in the median nerve, tibial nerve, and peroneal nerve was associated with reduced HRV Valsalva (p = 0.0001). The correlation between the amplitude of response in all sensory nerves (sural, median, and ulnar) and HRV DB was statistically significant (p = 0.0001). Conclusion: The results indicate that there is a correlation in T2DM patients between the damage of small myelinated and unmyelinated nerve fibres from cardiac autonomic nerves, assessed by HRV tests and damage of large motor and sensory fibres, assessed by NCS. Based on the above results, a combination of NCS and HRV tests should be considered in the neurophysiological approach to diabetic neuropathy.
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Affiliation(s)
- Anca Motataianu
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
| | - Laura Barcutean
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
- Correspondence: ; Tel.: +40-7453-73947
| | - Zoltan Bajko
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
| | - Adina Stoian
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Pathophysiology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
| | - Smaranda Maier
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
| | - Septimiu Voidazan
- Department of Epidemiology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania;
| | - Rodica Balasa
- Neurology 1 Clinic, Emergency Clinical County Hospital Mureș, Gh. Marinescu Str., No. 50, 540136 Târgu Mureș, Romania; (A.M.); (Z.B.); (A.S.); (S.M.); (R.B.)
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureș, Gh. Marinescu Str., No. 38, 540139 Târgu Mureș, Romania
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Stoian A, Bajko Z, Maier S, Cioflinc RA, Grigorescu BL, Moțățăianu A, Bărcuțean L, Balașa R, Stoian M. High-dose intravenous immunoglobulins as a therapeutic option in critical illness polyneuropathy accompanying SARS-CoV-2 infection: A case-based review of the literature (Review). Exp Ther Med 2021; 22:1182. [PMID: 34475972 PMCID: PMC8406741 DOI: 10.3892/etm.2021.10616] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
The still ongoing COVID-19 pandemic has exposed the medical community to a number of major challenges. A significant number of patients require admission to intensive care unit (ICU) services due to severe respiratory, thrombotic and septic complications and require long-term hospitalization. Neuromuscular weakness is a common complication in critically ill patients who are treated in ICUs and are mechanically ventilated. This complication is frequently caused by critical illness myopathy (CIM) or critical illness polyneuropathy (CIP) and leads to difficulty in weaning from the ventilator. It is thought to represent an important neurologic manifestation of the systemic inflammatory response syndrome (SIRS). COVID-19 infection is known to trigger strong immune dysregulation, with an intense cytokine storm, as a result, the frequency of CIP is expected to be higher in this setting. The mainstay in the diagnosis of this entity beside the high level of clinical awareness is the electrophysiological examination that provides evidence of axonal motor and sensory polyneuropathy. The present article presents the case of a 54-year-old woman with severe COVID 19 infection who developed neuromuscular weakness, which turned out to be secondary to CIP and was treated successfully with a high dose of human intravenous immunoglobulins. Related to this case, we reviewed the relevant literature data regarding the epidemiology, pathophysiology and clinical features of this important complication and discussed also the treatment options and prognosis.
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Affiliation(s)
- Adina Stoian
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Zoltan Bajko
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Smaranda Maier
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | | | - Bianca Liana Grigorescu
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Anca Moțățăianu
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Laura Bărcuțean
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Rodica Balașa
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Mircea Stoian
- Department of Anesthesiology and Intensive Therapy, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
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Filep RC, Marginean L, Stoian A, Bajko Z. Diagnostic and prognostic computed tomography imaging markers in basilar artery occlusion (Review). Exp Ther Med 2021; 22:954. [PMID: 34335896 PMCID: PMC8290397 DOI: 10.3892/etm.2021.10386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023] Open
Abstract
Acute ischemic stroke treatment has been revolutionized by the addition of mechanical and aspiration thrombectomy. Randomized controlled trials have proven beyond doubt, the substantial clinical impact of endovascular interventions in anterior circulation territory strokes. Unfortunately, patients with vertebrobasilar ischemic stroke could not be included in these early trials due to inherent clinical, radiological, and prognostic particularities of posterior circulation ischemia; thus, indications for the treatment of posterior fossa strokes and basilar artery occlusion (BAO) are mainly based on retrospective studies and registries. BAO carries high morbidity and mortality, despite the new improvements in endovascular therapy. Identifying patients who will likely benefit from invasive treatment and have a good clinical outcome resides in discovering clinical, biological, or imaging markers, that have prognostic implications. Such imaging markers have been described, especially in the last decade. Hyperdense Basilar Artery Sign (HDBA), Posterior Circulations-Alberta Stroke Program Early CT Score (pc-ASPECTS), Pons-Midbrain Index (PMI), Posterior Circulation Collateral Score (pc-CS), Posterior Circulation CT Angiography Score (pc-CTA), and Basilar Artery on CT Prognostic Score (BATMAN), are computed tomography (CT) markers with properties that can aid the diagnosis of BAO and can independently predict clinical outcome. This paper aims to present a comprehensive review of these imaging signs to have a thorough understanding of their diagnostic and prognostic attributes.
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Affiliation(s)
- Rares Cristian Filep
- PhD School of Medicine, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
| | - Lucian Marginean
- PhD School of Medicine, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
| | - Adina Stoian
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
| | - Zoltan Bajko
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
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Stoian A, Bălașa R, Grigorescu BL, Maier S, Andone S, Cocuz IG, Bajko Z, Filep CR, Stoian M. Guillain-Barré syndrome associated with Covid-19: A close relationship or just a coincidence? (Review). Exp Ther Med 2021; 22:916. [PMID: 34306190 PMCID: PMC8281479 DOI: 10.3892/etm.2021.10348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
Several neurological complications affecting the central and peripheral nervous system were described secondary to COVID-19 infection such as hyposmia, headache, nausea, impaired consciousness, psychosis, neurocognitive syndromes and even cerebrovascular accidents. The mechanism of these complications is not fully understood, but heterogenous mechanisms such as cytokine storm, secondary hypercoagulability and direct neurotropism of the virus are thought to be involved. Guillain-Barré syndrome is a heterogeneous disease that frequently follows a bacterial or viral infection. During the ongoing SARS-CoV-2 pandemic, several isolated case reports and case series have suggested an association between this viral infection and the occurrence of Guillain-Barré syndrome. The main mechanism of Guillain-Barré syndrome is probably post-viral dysregulation of the immune system generated by SARS-CoV-2. The clinical characteristics and disease evolution seem to be similar to those observed in Guillain-Barré syndrome secondary to other etiologies. The aim of the present review is to summarize the relevant literature regarding SARS-CoV-2-related Guillain-Barré syndrome.
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Affiliation(s)
- Adina Stoian
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Rodica Bălașa
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Bianca Liana Grigorescu
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Smaranda Maier
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Sebastian Andone
- Department of Neurology, 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania
| | - Iuliu Gabriel Cocuz
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Zoltan Bajko
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Cristian Rares Filep
- Department of Interventional Radiology, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania
| | - Mircea Stoian
- Department of Anesthesiology and Intensive Therapy, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
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Bajko Z, Balasa R, Maier S, Motataianu A, Barcutean L, Andone S, Stoian A, Filep RC. Stroke secondary to giant-cell arteritis: A literature review. Exp Ther Med 2021; 22:876. [PMID: 34194554 PMCID: PMC8237390 DOI: 10.3892/etm.2021.10308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/31/2021] [Indexed: 11/06/2022] Open
Abstract
Stroke is a leading cause of death and disability worldwide. In addition to the classical etiologies of stroke as atherosclerosis and cardioembolism there are many unusual, rare causes, which require a high level of clinical suspicion and further investigations for correct and early diagnosis and adequate treatment. Giant-cell arteritis or temporal arteritis, the most frequent vasculitis in the elderly population is one of the uncommon causes of stroke. In the setting of giant-cell arteritis, stroke more likely affects the vertebrobasilar territory and is the main cause of mortality. Duplex ultrasound examination is a routine investigation for stroke patients and may be key to the diagnosis if the classical hypoechoic ‘halo sign’ is recognized at the level of vertebral arteries. In this situation the ultrasound evaluation of temporal arteries and temporal artery biopsy are mandatory. The Giant-cell arteritis-related stroke is a rare condition; therefore, there are no evidence-based guidelines or standard recommendations for the treatment. In the present review, the main characteristics of giant-cell arteritis-related stroke are discussed.
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Affiliation(s)
- Zoltan Bajko
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Rodica Balasa
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Smaranda Maier
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Anca Motataianu
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Laura Barcutean
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Sebastian Andone
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Adina Stoian
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Rares Cristian Filep
- Department of Interventional Radiology, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania
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Bajko Z, Motataianu A, Stoian A, Barcutean L, Andone S, Maier S, Drăghici IA, Balasa R. Postpartum Cerebral Venous Thrombosis-A Single-Center Experience. Brain Sci 2021; 11:brainsci11030327. [PMID: 33806706 PMCID: PMC7998769 DOI: 10.3390/brainsci11030327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Cerebral venous thrombosis (CVT) is a rare variant of stroke in the general population, but an important subtype among pregnancy- and puerperium-related cases. Studies describing its risk factors and clinical characteristics are limited. The aim of our study is to disclose these aspects and compare with cases unrelated to pregnancy and puerperium. Materials and Methods: We performed a retrospective analysis including 88 consecutive cases from a tertiary neurology clinic with a diagnosis of CVT. Ten of the 88 cases (11.3%) appeared during the postpartum period. Results: The mean age of the puerperal CVT cases was 26.5 years. The main pregnancy-related risk factors besides puerperium were cesarean delivery (5/10), preeclampsia (2/10), and stillbirth (1/10). General risk factors for thrombosis, i.e., infection, smoking, and primary hypercoagulability, were identified in 50% of cases. Onset was in the first 3 weeks after delivery, with a mean value of 9.6 ± 5.6 days. Headache was present in 90% of postpartum CVT cases and in 76.1% of non-postpartum female cases. Seizures were more frequent in the postpartum group (60% vs. 34.8%). Onset was acute (<48 h) in 50% of postpartum cases and in 30.4% of the non-postpartum female group. The Rankin score at discharge was significantly lower in the postpartum group (0.22 vs. 0.7, p = 0.02), suggesting a more favorable short-term outcome. Conclusions: The early postpartum period represents an important risk for the development of CVT. Cesarean delivery and preeclampsia, besides general risk factors such as infection, smoking, and primary thrombophilia, contribute to enhanced risk. Puerperium-related CVT presents a more favorable outcome compared with CVT with other etiologies.
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Affiliation(s)
- Zoltan Bajko
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania; (Z.B.); (A.M.); (L.B.); (R.B.)
- Ist Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.S.); (S.A.); (I.-A.D.)
| | - Anca Motataianu
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania; (Z.B.); (A.M.); (L.B.); (R.B.)
- Ist Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.S.); (S.A.); (I.-A.D.)
| | - Adina Stoian
- Ist Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.S.); (S.A.); (I.-A.D.)
- Department of Patophysiology, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania
| | - Laura Barcutean
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania; (Z.B.); (A.M.); (L.B.); (R.B.)
- Ist Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.S.); (S.A.); (I.-A.D.)
| | - Sebastian Andone
- Ist Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.S.); (S.A.); (I.-A.D.)
| | - Smaranda Maier
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania; (Z.B.); (A.M.); (L.B.); (R.B.)
- Ist Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.S.); (S.A.); (I.-A.D.)
- Correspondence:
| | - Iulia-Adela Drăghici
- Ist Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.S.); (S.A.); (I.-A.D.)
| | - Rodica Balasa
- Department of Neurology, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania; (Z.B.); (A.M.); (L.B.); (R.B.)
- Ist Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania; (A.S.); (S.A.); (I.-A.D.)
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Stoian A, Șerban G, Bajko Z, Andone S, Mosora O, Bălașa A. Therapeutic plasma exchange as a first-choice therapy for axonal Guillain-Barré syndrome: A case-based review of the literature (Review). Exp Ther Med 2021; 21:265. [PMID: 33603872 PMCID: PMC7851665 DOI: 10.3892/etm.2021.9696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/04/2020] [Indexed: 12/04/2022] Open
Abstract
Guillain-Barré syndrome is an acute immune-mediated disease that affects the peripheral nervous system, with progressive motor deficit in the limbs, sometimes involvement of the cranial nerves and possible impairment of the autonomic nervous system. Due to the respiratory and autonomic nervous dysfunction, the disease has the potential to be fatal. Although modern methods of treatment have significantly improved patient prognosis, many patients nevertheless experience significant neurological sequelae. The practical applicability of plasmapheresis was illustrated in our case report. We report the case of a 27-year-old man who had a mild viral respiratory tract infection 1 week prior to the onset of disease with gradual development of a motor deficit, urinary retention, slight swallowing difficulties and mild respiratory dysfunction. Nerve conduction studies were performed and the diagnosis of acute motor axonal neuropathy phenotypic variant of Guillain-Barré syndrome was established. Autoimmune and inflammatory diseases, infectious diseases, endocrinopathies, neoplastic diseases, intoxications, metabolic diseases and vitamin deficiencies were ruled out. Our patient attended four sessions of therapeutic plasma exchange performed using peripheral venous approach with two needles with significant recovery of the motor deficit. The patient was discharged 1 week later on maintenance kinetotherapy with further favorable evolution. In conclusion, we report a good evolution as a result of therapeutic plasma exchange in a patient with acute motor axonal neuropathy phenotypic variant of Guillain-Barré syndrome. The procedure is well-tolerated and can be performed safely by peripheral approach not only in the intensive care unit but also in a neurology clinic.
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Affiliation(s)
- Adina Stoian
- Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Pathophysiology, University of Medicine and Pharmacy Targu Mures, 540136 Targu Mures, Romania
| | - Georgiana Șerban
- Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
| | - Zoltan Bajko
- Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurology, University of Medicine and Pharmacy Targu Mures, 540136 Targu Mures, Romania
| | - Sebastian Andone
- Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
| | - Oana Mosora
- Neurology Clinic I, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
| | - Adrian Bălașa
- Neurosurgery Clinic, Mures County Clinical Emergency Hospital Targu Mures, 540136 Targu Mures, Romania
- Department of Neurosurgery, University of Medicine and Pharmacy Targu Mures, 540136 Targu Mures, Romania
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Filep RC, Bajko Z, Simu IP, Stoian A. Pseudo-dissection of the internal carotid artery in acute ischemic stroke. Acta Neurol Belg 2020; 120:469-472. [PMID: 30251236 DOI: 10.1007/s13760-018-1025-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
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Campos-Gomez S, Antone N, Pacheco-Cuéllar G, Pop L, Campos Gomez K, Stoian A, Eniu R, Valdes-Andrade J, Dronca E, Matei R, Ligtenberg M, Ouchene H, Onisim A, Rotaru O, Eniu AE. Abstract P5-09-14: Prevalence and type of BRCA mutations in young breast cancer patients undergoing genetic cancer risk assessment in two developing countries: Analysis of two cohorts from Romania and Mexico. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: a previous study found significant clinicopathological differences between young Breast Cancer BrCA patients (pts) from Romania (Ro) and from Mexico (Mx). Here, we provide a molecular and clinical description of pts carrying BRCA mutations of both cohorts.
Methods: in this retrospective study, we analyzed 2 cohorts of BRCA1/2 mutations carriers tested in COEI from Mx between 2014-2017 and IOCN from Ro between 2015 to 2016. Ro pts were selected according to NCCN criteria, while Mx pts were selected based on risk evaluation models. NGS analysis and MLPA for BRCA1&2 were performed in all pts. We compared demographic, clinicopathological and molecular data.
Results: 65 pts, 21 (32.7%) from Mx and 44(67.7%) from Ro carried a BRCA mutation. 66.7% of Mx pts and 65.9% of Ro pts carried a BRCA1 mutation. We found clinical similarities: Mean age was 44.5y for Mx and 40.59y for Ro pts. IDC was the most frequent type of BrCa in both series (90.5 vs 90.9%). TNBC was seen in 13 Mx vs 27 Ro pts (61.9% vs 61.4%), HR positive was seen in 7 (33.3%) and 12 (27.3%) cases. Grading 3 was more frequently seen in Ro, while grading 2 was mainly noted in MX pts(p=<0.020). BRCA1/2 pathogenic mutations were different between the 2 cohorts and no BRCA 1/2 identical mutation was identified. 15 different mutations in 21 Mx pts, and 16 different mutations in 44 Ro pts were found. Mutations were different between 2 cohorts. Notably for the Ro cohort, 4 founder mutations (c.181T>G, c.3607C>T, c.5266dupC in BRCA1,and c.9928A>G[GPC1] in BRCA2) were found in 31/44 pts, while the Mx cohort, c.5123C>A and del 9-12del ex in BRCA1 were found in 6/21 mutations. Three Large rearrangements (LR) were exclusively seen in the Mx pts (5/21).
Conclusions Both cohorts didn't share any mutation, but the clinical features are similar. BRCA1 del 9-12del is a Mexican founder mutation, we found it in 14% of Mx pts, LR have been described more frequently in Latin American Populations, we found it in 30% of the MX cohort, while for Ro cohort four recurrent mutations qualify as founder mutations.
Citation Format: Campos-Gomez S, Antone N, Pacheco-Cuéllar G, Pop L, Campos Gomez K, Stoian A, Eniu R, Valdes-Andrade J, Dronca E, Matei R, Ligtenberg M, Ouchene H, Onisim A, Rotaru O, Eniu AE. Prevalence and type of BRCA mutations in young breast cancer patients undergoing genetic cancer risk assessment in two developing countries: Analysis of two cohorts from Romania and Mexico [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-14.
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Affiliation(s)
- S Campos-Gomez
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - N Antone
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - G Pacheco-Cuéllar
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - L Pop
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - K Campos Gomez
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - A Stoian
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - R Eniu
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - J Valdes-Andrade
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - E Dronca
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - R Matei
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - M Ligtenberg
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - H Ouchene
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - A Onisim
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - O Rotaru
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
| | - AE Eniu
- Centro Oncologico Estatal ISSEMyM, Toluca, Mexico; Ion Chiricuta Oncology Institute Cluj-Napoca, Romania, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Romania, Romania; Cardiff University School of Medicine, Cardiff, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands
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Dumitru L, Stoian A, Ionescu D, Dutu G, Ciobotaru E. Comparative study betwen lesions inflicted by bear and wolf. J Comp Pathol 2019. [DOI: 10.1016/j.jcpa.2018.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bajkó Z, Andone S, Maier S, Motataianu A, Copotoiu M, Romaniuc A, Barcutean L, Stoian A, Balasa R. Infarction of the posterior limb of the internal capsule: the first clinical manifestation of lupus. Ro J Neurol 2018. [DOI: 10.37897/rjn.2018.3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Moţăţăianu A, Maier S, Bajko Z, Voidazan S, Bălaşa R, Stoian A. Cardiac autonomic neuropathy in type 1 and type 2 diabetes patients. BMC Neurol 2018; 18:126. [PMID: 30149797 PMCID: PMC6112121 DOI: 10.1186/s12883-018-1125-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 08/14/2018] [Indexed: 01/28/2023] Open
Abstract
Background Cardiac autonomic neuropathy (CAN) in diabetes is among the strongest risk markers for future global and cardiovascular mortality. The aim of this study was to analyse CAN prevalence and to compare the associations between CAN, the glycaemic control, cardiovascular risk factors, peripheral neuropathy, retinopathy and macroangiopathy in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Methods One hundred ninety-five diabetic patients were included in this study. All patients were evaluated for detection of CAN (with standardised cardiovascular reflex tests), diabetes-related microvascular complications (polyneuropathy, retinopathy), common carotid artery intima-media thickness (IMT) and ankle-brachial index (ABI). Results The prevalence of CAN was 39.1% in T2DM and 61.8% in T1DM patients. Multivariate logistic regression analysis demonstrated that in T2DM, the odds [OR (95% confidence intervals)] of CAN increased with diabetes duration [1.67(1.42–1.92)], HbA1c [1.74(1.34–2.27)], cholesterol [1.01(1.00–1.01)], triglycerides [1.01(0.99–1.00)], smoking [2.35(1.23–4.49)], systolic blood pressure [1.01(1.00–1.03)], BMI [1.16(1.08–1.24)], glomerular filtration rate [0.91(0.88–0.93)], peripheral neuropathy [25.94(11.04–44.25)], retinopathy [13.13(3.03–84.73)] and IMT [10.12 (7.21–15.32)]. In T1DM, the odds of CAN increased with diabetes duration [1.62(1.13–2.31)], HbA1c [4.49(1.27–15.9)], age of patients [1.14(1.03–1.27)], glomerular filtration rate [0.94(0.89–0.99)], peripheral neuropathy [31.6(4.5–45.8)] and IMT [5.5(2.3–8.3)]. Conclusion This study indicated that CAN is a more frequent complication in T1DM. Apart from glycaemic control, the existence of CAN is associated with potentially modifiable cardiovascular risk only in T2DM patients. The presence of other micro- and macrovascular complications increases the probability of having CAN in both types of DM (but more pronounced in T2DM).
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Affiliation(s)
- Anca Moţăţăianu
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Gh Marinescu 50, 540136, Târgu Mureş, Romania.
| | - Smaranda Maier
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Gh Marinescu 50, 540136, Târgu Mureş, Romania
| | - Zoltan Bajko
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Gh Marinescu 50, 540136, Târgu Mureş, Romania
| | - Septimiu Voidazan
- Department of Epidemiology, University of Medicine and Pharmacy Târgu Mureş, Târgu Mureş, Romania
| | - Rodica Bălaşa
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Gh Marinescu 50, 540136, Târgu Mureş, Romania
| | - Adina Stoian
- Department of Pathophysiology, University of Medicine and Pharmacy Târgu Mureş, Târgu Mureş, Romania
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Eniu A, Pop L, Stoian A, Dronca E, Matei R, Ligtenberg M, Ouchene H, Onisim A, Rotaru O, Eniu R, Antone N. Abstract P4-06-11: Is myriad a reliable genetic risk model for prediction BRCA1/2 mutations in Romanian high-risk breast cancer patients? Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-06-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aim: To assess the predictive efficacies of genetic risk model Myriad for BRCA1/2 mutations in high-risk Romanian breast cancer patients (pts).
Methods: This prospective study evaluated the validity of Myriad risk assessment model for 250 high-risk breast cancer pts tested for BRCA1/2 mutations between 02.2015-12.2016 at IOCN. Inclusion criteria selected pts diagnosed with triple negative breast cancer under the age of 50, or having conventional family history criteria. All pts signed an informed consent. Myriad calculator software was utilized in order to assess the score for all 250 patients. BRCA testing was performed using an AmpliSeq-based sequencing analysis, on the Ion Torrent Personal Genome Machine at RCFG. Pathogenic mutations were validated using Sanger technology. MLPA was performed for all pts.
Results:The mean Myriad scores for all patients was 8.09% (2.2-26.6%) and the mean Myriad score for BRCA1/2 mutated pts was 11.56% (2.2-26.6%). The majority of pts, 166 (66,4%) presented a Myriad score between 2.2-4.8%, out of which 18 pts (40.9%) were BRCA1/2 mutated. Considering a higher score and the presence of deleterious BRCA1/2 mutations, 12 (27.27%) pts presented a score of 10.3-10.4%, 9 (20.45%) pts a score of 21.2-21.9%, and respectively 5 (11.36%)pts had a score of 26.6%. The subgroup analyzes revealed that the prediction of Myriad genetic risk model in high-risk breast cancer pts was statistical significant when the groups present scores between 10.3 and 26.2%. Other subgroup analysis failed to demonstrate statistical significance.
Table 1: Frequency analysis according to Myriad genetic risk model scores and BRCA1/2 mutational status.Myriad genetic risk model scores* (n=250)BRCA 1/2 mutated (n=44)No BRCA1/2 mutation (n= 191)Variants of unknown significance # (n=18)2.2-4.8% (n=166)18(40.9%)136(71.20%)12(66.66%)6.9%-8% (n=8)08(4.18%)010.3-10.4% (n=45)12(27.27%)29(15.18%)4(22.22%)15.9%(n=1)01(0.52%)021.2%-21.9% (n=14)9(20.45%)4(2.09%)1(5.55%)26.6% (n=16)5(11.36%)10(5.23%)1(5.55%)* The risk was calculated using BRCA risk calculator available at http://www.myriadpro.com/brca-risk-calculator/calc.html # Number of VUS results includes 3 pts that presented BRCA mutations positive results.
Table 2: Myriad genetic risk model stratified by 10.3 and 21.2% scores and BRCA test results.Data analyzedBRCA 1/2 mutatedNo BRCA1/2 mutationTotalP valueMyriad score 10.3%1229410.0100Myriad score 21.2%9413 Total213354
Conclusions: The Myriad genetic risk model can be an acceptable risk assessment tool for determining the risk of carrying BRCA mutations in Romanian population if the score is between 10-20%. The inaccuracy in carrier prediction using Myriad model represents a challenge worthy of additional investigation and comparison with other genetic models. Genetic counselors should recognize this limitation when using Myriad model and recommending genetic testing for Romanian high-risk breast cancer pts.ClinicalTrials.gov Identifier: NCT02317120.
Citation Format: Eniu A, Pop L, Stoian A, Dronca E, Matei R, Ligtenberg M, Ouchene H, Onisim A, Rotaru O, Eniu R, Antone N. Is myriad a reliable genetic risk model for prediction BRCA1/2 mutations in Romanian high-risk breast cancer patients? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-11.
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Affiliation(s)
- A Eniu
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
| | - L Pop
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
| | - A Stoian
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
| | - E Dronca
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
| | - R Matei
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
| | - M Ligtenberg
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
| | - H Ouchene
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
| | - A Onisim
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
| | - O Rotaru
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
| | - R Eniu
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
| | - N Antone
- Institute of Oncology "Prof Dr Ion Chiricuta", Cluj-Napoca, Romania; Research Center for Functional Genomics (RCFG), Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicina and Pharmacy, Cluj-Napoca, Romania; Radboud University Medical Center, Nijmegen, Netherlands; Cardiff University School of Medicine, Cardiff, United Kingdom; County Hospital Dej, Dej, Romania
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Bajkó Z, Maier S, Moţăţăianu A, Bălaşa R, Vasiu S, Stoian A, Andone S. Stroke Secondary to Traumatic Carotid Artery Injury - A Case Report. J Crit Care Med (Targu Mures) 2018; 4:23-28. [PMID: 29967897 DOI: 10.1515/jccm-2018-0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/26/2018] [Indexed: 12/19/2022]
Abstract
Introduction Lesions of the carotid and vertebral arteries secondary to direct trauma, called blunt cerebrovascular injuries (BCVI) are relatively rare and are markedly different from spontaneous dissections. Ischaemic stroke is a significant complication, with high morbidity and mortality rates. The basis of a diagnosis relies on appropriate, high sensitivity imaging screening. Case report We present the case of a 31 years old male patient with polytraumatism secondary to a motor vehicle accident, who was admitted to an orthopaedic clinic for multiple lower extremity fractures. His fractures were treated surgically. He developed in the 3rd day after the admission left sided hemiparesis secondary to ischaemic stroke. The diagnosis of traumatic carotid artery injury (TCAI) was based on duplex ultrasound and angio CT scans. The outcome was favourable despite the severe carotid lesions presenting with occlusion secondary to dissection. Conclusions In the majority of BCVI cases there is a variable latent period between the time of injury and the development of stroke. The management of cases is challenging because in the majority of cases there are multiple associated injuries. Although antithrombotics are widely used in the treatment, there is no consensus regarding the type of agent, the optimal dose or treatment duration.
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Affiliation(s)
- Zoltán Bajkó
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Târgu Mureş, Romania.,Mureş County Clinical Emergency Hospital, Târgu Mureş, Romania
| | - Smaranda Maier
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Târgu Mureş, Romania.,Mureş County Clinical Emergency Hospital, Târgu Mureş, Romania
| | - Anca Moţăţăianu
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Târgu Mureş, Romania.,Mureş County Clinical Emergency Hospital, Târgu Mureş, Romania
| | - Rodica Bălaşa
- Department of Neurology, University of Medicine and Pharmacy Târgu Mureş, Târgu Mureş, Romania.,Mureş County Clinical Emergency Hospital, Târgu Mureş, Romania
| | - Smaranda Vasiu
- Mureş County Clinical Emergency Hospital, Târgu Mureş, Romania
| | - Adina Stoian
- Mureş County Clinical Emergency Hospital, Târgu Mureş, Romania.,Department of Pathophysiology, University of Medicine and Pharmacy Târgu Mureş, Târgu Mureş, Romania
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Maier S, Bajko Z, Moţăţăianu A, Stoian A, Şchiopu B, Bălaşa R. Late Onset Tay-Sachs Disease in a Non-Jewish Patient: Case Report. Acta Medica Marisiensis 2017. [DOI: 10.1515/amma-2017-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Tay-Sachs disease (TSD) is a rare, inherited, autosomal rececessive lysosomal storage disease. The late-onset form is an uncommon condition among non-Jewish population.
We present the case of a 32 years old male patient without Jewish origins, in whom the disease began in adolescence and was initially diagnosed with spinal muscular atrophy. He developed progressively protean neurological symptomatology, including tetraparesis, cerebellar and extrapyramidal syndromes. The diagnosis was based on the cerebral MRI, showing severe cerebellar atrophy and the determination of the Hexosaminidase A activity, revealing low level.
In patients showing signs of lower motor neuron involvement, cerebellar and pyramidal signs and marked cerebellar atrophy the late-onset TSD should be suspected, and the first step in establishing the diagnosis should be to determine the serum activity of Hexosaminidase A.
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Affiliation(s)
- Smaranda Maier
- University of Medicine and Pharmacy Targu Mures , Department of Neurology
| | - Zoltan Bajko
- University of Medicine and Pharmacy Targu Mures , Department of Neurology
| | - Anca Moţăţăianu
- University of Medicine and Pharmacy Targu Mures , Department of Neurology
| | - Adina Stoian
- University of Medicine and Pharmacy Targu Mures , Department of Patophysiology
| | | | - Rodica Bălaşa
- University of Medicine and Pharmacy Targu Mures , Department of Neurology
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Antone N, Pop L, Dronca E, Stoian A, Matei R, Ligtenberg M, Ouchene H, Onisim A, Rotaru O, Eniu R, Eniu A. Is there a link between BRCA1 and BRCA2 mutations and obesity, high blood pressure and diabetes mellitus in Romanian high-risk breast cancer cases? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx652.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Andone S, Petrutiu S, Bajko Z, Motataianu A, Maier S, Macavei I, Stoian A, Balasa A, Balasa R. SPORADIC CREUTZFELDT-JAKOB DISEASE: A CLINICAL APPROACH OF A SMALL CASE SERIES AND LITERATURE REVIEW. Ro J Neurol 2017. [DOI: 10.37897/rjn.2017.3.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction. Creutzfeldt-Jakob Disease (CJD) is a very rare neurodegenerative disease with no cure that always leads to death. It is the most frequent prion disease and has multiple recognized forms, from which the sporadic form (sCJD) is the most common. The defining histological characteristic of CJD is the accumulation of the abnormal prion protein (PrPSc) along with neuronal loss and spongiform vacuolation. Typical neurological signs found in sCJD are rapidly progressive dementia, myoclonus, visual disturbances, pyramidal signs, extrapyramidal signs, behavioral changes and akinetic mutism. Material and method. We performed a retrospective study over the 2007-2017 period that included five cases of patients diagnosed with probable sCJD from our department. Results. The most common findings in the patients’ MRI were cerebral atrophy and ventricular enlargement, but we also found typical MRI changes such as increased T2 and FLAIR signal intensity in the head of the caudate nucleus, putamen and cerebral cortex. Repeated electroencephalograms showed typical sCJD patterns like periodic sharp wave complexes, mostly with biphasic or triphasic aspect. A complex differential diagnosis and numerous routine investigations (CBC, biochemical analysis, autoimmune panel, HIV antibodies, VDRL, anti-Borrelia antibodies, anti-TPO antibodies, anti-neuronal antibodies, B12 vitamin) were performed, without indicating an alternative diagnosis. All the patients died several months after the onset of symptoms. Conclusions. Given the rarity of the disease and the broad differential diagnosis, CJD proves to be a diagnostic challenge. In the absence of an alternative diagnosis, the association of rapidly progressive dementia, myoclonus, visual and cerebellar signs are highly suggestive for sCJD.
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Eniu A, Pop L, Stoian A, Dronca E, Matei R, Ligtenberg M, Ouchene H, Onisim A, Rotaru O, Eniu R, Antone N. Understanding BRCA1 and BRCA2 mutated breast cancer cases in Romania: First report on founder mutations in Romanians. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pop L, Stoian A, Dronca N, Matei R, Ligtenberg M, Ouchene H, Antone N, Eniu A. Are BRCA1/2 next generation sequencing results comparable across platforms in Europe? A validation study of BRCA testing in Romanian high-risk breast cancer patients. Breast 2017. [DOI: 10.1016/s0960-9776(17)30129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bajkó Z, Maier S, Moțățăianu A, Stoian A, Bărcuțean L, Bălașa R. Repetitive Transient Ischaemic Attacks Secondary to a Floating Carotid Artery Thrombus in a Young Patient with Essential Thrombocythemia. Journal Of Cardiovascular Emergencies 2016. [DOI: 10.1515/jce-2016-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
A free-floating carotid artery thrombus is a very rare ultrasonographical finding in patients with acute ischemic cerebrovascular events. One of the main causes of this presentation is represented by the hypercoagulability status of the patients. We report the case of a young male patient who presented with several transient ischaemic attacks secondary to a mobile thrombus in the left carotid sinus. Two hematological abnormalities, essential thrombocytosis and methylene tetrahydrofolate reductase mutation were found to be related to the thrombus formation. The role of the latter in the pathogenesis of ischemic stroke is not well documented in the literature. Following antiplatelet and anticoagulant medication, there was a fast dissolution of the thrombus, followed by a favorable clinical outcome. Neurologists should be aware that young patients with stroke require extensive imagistic and laboratory screening for an accurate etiological diagnosis.
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Affiliation(s)
- Zoltán Bajkó
- University of Medicine and Pharmacy, Tîrgu Mureş, Romania
- Department of Neurology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
| | - Smaranda Maier
- University of Medicine and Pharmacy, Tîrgu Mureş, Romania
- Department of Neurology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
| | - Anca Moțățăianu
- University of Medicine and Pharmacy, Tîrgu Mureş, Romania
- Department of Neurology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
| | - Adina Stoian
- University of Medicine and Pharmacy, Tîrgu Mureş, Romania
- Department of Neurology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
| | - Laura Bărcuțean
- University of Medicine and Pharmacy, Tîrgu Mureş, Romania
- Department of Neurology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
| | - Rodica Bălașa
- University of Medicine and Pharmacy, Tîrgu Mureş, Romania
- Department of Neurology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
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Bajkó Z, Bălaşa R, Moţăţăianu A, Bărcuţean L, Stoian A, Stirbu N, Maier S. Malignant Middle Cerebral Artery Infarction Secondary to Traumatic Bilateral Internal Carotid Artery Dissection. A Case Report. ACTA ACUST UNITED AC 2016; 2:135-141. [PMID: 29967852 DOI: 10.1515/jccm-2016-0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/30/2016] [Indexed: 01/18/2023]
Abstract
Traumatic bilateral dissection of the carotid arteries is a rare condition with potentially life-threatening complications. The case of a 57-year-old male patient with acute onset left sided hemiparesis, twelve hours after a blunt head injury, caused by a horse kick, is reported. A cerebral CT scan revealed right middle cerebral artery (MCA) territory infarction. Based on Duplex ultrasound and Angio CT scan findings, a diagnosis of bilateral ICA dissection was established. Despite antithrombotic treatment, the patient presented with a progressive worsening of his neurological status. The control CT scan evidenced malignant right MCA territory infarction that required decompressive craniotomy. The patient was discharged with significant neurological deficits. Together with this case, the aetiologies, clinical manifestations, diagnostic and therapeutical options and outcome of carotid artery dissection are discussed.
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Affiliation(s)
- Zoltán Bajkó
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, Romania
| | - Rodica Bălaşa
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, Romania
| | - Anca Moţăţăianu
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, Romania
| | - Laura Bărcuţean
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, Romania
| | - Adina Stoian
- University of Medicine and Pharmacy Târgu Mureş, Department of Pathophysiology, Târgu Mureş, Romania
| | | | - Smaranda Maier
- University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Târgu Mureş, Romania
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Motataianu A, Bajko Z, Maier S, Stoian A, Barcutean L, Balasa R. CORRELATIONS BETWEEN THE SEVERITY OF CARDIOVASCULAR AUTONOMIC NEUROPATHY AND OTHER COMPLICATIONS IN TYPE 2 DIABETES MELLITUS. Ro J Neurol 2016. [DOI: 10.37897/rjn.2016.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction. Cardiovascular Autonomic Neuropathy (CAN), also known as the “silent killer”, represents a serious complication of diabetes mellitus and is most of the times ignored. This is a highly topical issue, given the increased number of patients diagnosed with type 2 diabetes mellitus (T2DM). The purpose of this study was to determine the association between the severity of CAN and the severity of other microvascular complications, such as diabetic sensory-motor polyneuropathy (DSMP), diabetic retinopathy (DR) and macrovascular complications (carotid and peripheral vascular atherosclerosis) in patients with T2DM. Methods. A total of 149 patients with T2DM were assessed for CAN using the Ewing’s battery of cardiovascular autonomic function tests. The patients were evaluated for diabetic microvascular complications (DSMP, RD), respectively macrovascular complications (carotid atherosclerosis by intima media thickness and peripheral vascular atherosclerosis by ankle-brachial index). Results. Of the 45 patients with intermediate CAN, 35.55% were without DR, 51.11% had non-proliferative DR and 13.33% had proliferative DR. From the 13 patients with severe CAN, 76.92% had non-proliferative DR and 23.07% had proliferative DR. From the 56 patients with subclinical CAN, 26.7% had no DSMP, 48.2% had subclinical DSMP and 25% had clinical DSMP. Of the 45 patients with intermediate CAN, 11.2% had subclinical DSMP and 80% had clinical DSMP. Conclusion. In T2DM we demonstrated that an increase in the severity of cardiovascular autonomic injury is associated with an increase in the prevalence and severity of DSMP and DR, respectively carotid and peripheral atherosclerosis.
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Baboi L, Penet H, Stoian A, Yonis H, Gobert F, Bayle F, Leray V, Tapponnier R, Richard JC, Guérin C. Resistance of endotracheal tubes measured after extubation in ICU patients. Intensive Care Med Exp 2015. [PMCID: PMC4796960 DOI: 10.1186/2197-425x-3-s1-a385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Baboi L, Penet H, Stoian A, Yonis H, Gobert F, Tapponnier R, Bayle F, Leray V, Richard JC, Guérin C. Bench study of automated tube compensation versus pressure support after extubation in icu patients. Intensive Care Med Exp 2015. [PMCID: PMC4797976 DOI: 10.1186/2197-425x-3-s1-a278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Desgranges FP, Steghens A, Rosay H, Méeus P, Stoian A, Daunizeau AL, Pouderoux-Martin S, Piriou V. [Epidural analgesia for surgical treatment of peritoneal carcinomatosis: a risky technique?]. ACTA ACUST UNITED AC 2011; 31:53-9. [PMID: 22154448 DOI: 10.1016/j.annfar.2011.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 08/25/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND To study the risks of haemodynamic instability, and the possible occurrence of spinal haematoma, meningitis and epidural abscess when epidural analgesia is performed for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS We retrospectively analyzed the data of 35 patients treated by HIPEC with oxaliplatin or cisplatin. An epidural catheter was inserted before induction of general anaesthesia. Postoperatively, a continuous epidural infusion of ropivacain, then a patient-controlled epidural analgesia were started. RESULTS The epidural catheter was used peroperatively before HIPEC in 12 subjects (34%), and after HIPEC in 23 subjects (66%). The median dose of ropivacain given peroperatively in the epidural catheter was 40 mg (30-75). Norepinephrin was used in two subjects (6%) peroperatively (median infusion rate 0.325 μg/kg per minute [0.32-0.33]), and in four subjects (11%) in the postoperative 24 hours. No spinal haematoma, meningitis or epidural abscess were noted. Five subjects (14%) had a thrombopenia or a prothrombin time less than 60% before catheter removal. Two subjects (6%) had a leukopenia before catheter removal. No thrombopenia or blood coagulation disorders were recorded the day of catheter removal. CONCLUSION In this series of 35 patients, the use of epidural analgesia for HIPEC does not seem to be associated with a worse risk of haemodynamic instability, spinal haematoma, meningitis or epidural abscess. HIPEC with platinum salt is not incompatible with the safety of epidural analgesia, with an optimized fluid management peroperatively and the following of perimedullary anesthesia practice guidelines.
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Affiliation(s)
- F-P Desgranges
- Département d'anesthésie-réanimation, centre régional de lutte contre le cancer Léon-Bérard, Lyon, France.
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Bouvet L, Stoian A, Rimmelé T, Allaouchiche B, Chassard D, Boselli E. Optimal remifentanil dosage for providing excellent intubating conditions when co-administered with a single standard dose of propofol. Anaesthesia 2009; 64:719-26. [PMID: 19624626 DOI: 10.1111/j.1365-2044.2009.05916.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L Bouvet
- Claude Bernard University, University of Lyon, Lyon, France.
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Abstract
A patient with mitral stenosis and systemic thromboemboli is presented. Two-dimensional echocardiography demonstrated a spherical thrombus floating freely within the left atrium which was corroborated by postmortem examination. This case is unique in its clinical outcome and provides insight into the pathogenesis of such left atrial thrombi.
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Cernea P, Ionescu M, Stoian A. [Retinal detachment in the aphakic eye]. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Oftalmol 1984; 28:93-8. [PMID: 6236489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mînecan N, Nour V, Olaru C, Stoian A. [Renal insufficiency in acute pancreatitis]. Rev Med Chir Soc Med Nat Iasi 1980; 84:463-6. [PMID: 7244469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Mînecan N, Nour V, Olaru C, Stoian A. [The kidney in patients with multiple injuries]. Rev Med Chir Soc Med Nat Iasi 1978; 82:249-53. [PMID: 705122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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