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Mihai VC, Gheorghe L, Rezuș II, Jucan AE, Andronic MC, Gavrilescu O, Dranga M, Andronic AM, Prelipcean CC, Rezuș C, Mihai C. Novelties and Perspectives of Intestinal Ultrasound in the Personalised Management of Patients with Inflammatory Bowel Diseases-A Systematic Review. Diagnostics (Basel) 2024; 14:812. [PMID: 38667458 PMCID: PMC11049436 DOI: 10.3390/diagnostics14080812] [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: 03/13/2024] [Revised: 03/29/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Inflammatory bowel diseases (IBDs) affect over 4.9 million individuals worldwide. Colonoscopy (CS) is the gold-standard technique for diagnosis. The remissive-recurrent pattern of evolution raises the need for non-invasive techniques to monitor disease activity. This review aims to present the advantages of intestinal ultrasound (IUS) in managing IBDs. Our search was conducted on the PubMed, Embase, and Cochrane (CENTRAL) databases, selecting original studies comparing IUS with other imaging and invasive monitoring methods. Our search yielded 8654 results, of which 107 met the inclusion criteria. Increased bowel wall thickness (BWT) and colour Doppler signal (CDS) are discriminative for disease activity. IUS can predict disease outcomes and detect response to treatment or postoperative recurrence. Contrast-enhanced ultrasound (CEUS) and elastography help differentiate fibrotic from inflammatory stenoses. The difficult rectal assessment limits the use of IUS in ulcerative colitis (UC). Transmural healing may develop as a therapeutic target as it is associated with better outcomes. Patients are compliant with this technique, and its results correlate well with CS and other imaging methods. In conclusion, IUS proves to be essential in assessing IBD activity and treatment response, predicting outcomes and detecting complications. CEUS and elastography are researched to improve the diagnostic values of IUS.
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Affiliation(s)
- Vasile-Claudiu Mihai
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Radiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Liliana Gheorghe
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Radiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Ioana-Irina Rezuș
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Radiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Alina Ecaterina Jucan
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Mihaela-Cristiana Andronic
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Otilia Gavrilescu
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Mihaela Dranga
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Andrei-Mihai Andronic
- Discipline of Medical Semiology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Cristina Cijevschi Prelipcean
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Ciprian Rezuș
- Discipline of Internal Medicine, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
- 3rd Internal Medicine Clinic, “Sf. Spiridon” Emergency County Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Cătălina Mihai
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
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Dranga M, Chiriac S, Stanciu C, Cijevschi Prelipcean C, Timofeiov S, Trifan A. The Rate of Burnout Syndrome in A Tertiary Gastroenterology University Center in Romania. J Gastrointestin Liver Dis 2024; 33:79-84. [PMID: 38554432 DOI: 10.15403/jgld-5282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/29/2023] [Indexed: 04/01/2024]
Abstract
BACKGROUND AND AIMS The burnout syndrome (BOS) is commonly seen in healthcare professionals, particularly in physicians who are exposed to a high level of stress at work and has a negative impact on the medical activity. Physicians with BOS manifest a negative attitude, a reduction in compassion at work, and suboptimal patient care experiences. These all can lead to absenteeism, poor performance and more frequent medical errors. We aimed to assess the level of BOS in a tertiary gastroenterology university center in Romania. METHODS This observational study involved 40 physicians from a tertiary gastroenterology university center. An online questionnaire assessed the presence of BOS using the Maslach Burnout Inventory. RESULTS A total of 40 physicians responded to the questionnaire. The prevalence of overall BOS of 87.5%. In terms of high burnout, 15 doctors (37.5%) had emotional exhaustion, 10 doctors (25%) had depersonalization, and 30 doctors (80%) scored low for personal achievement. Men presented more frequently emotional exhaustion and women lower personal achievement scores, but there was no significant statistical difference. No significant relationship was found between marital status or the number of children and BOS. We identified multiple risk factors associated to BOS, the most important one being strict internal regulations. CONCLUSIONS Physicians presented an increased risk for BOS. The high rate of BOS among physicians found in our study requires careful attention. Further studies aiming to identify other factors that contribute to BOS and to identify measures to combat this syndrome are necessary.
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Affiliation(s)
- Mihaela Dranga
- Grigore T. Popa University of Medicine and Pharmacy Iași; Institute of Gastroenterology and Hepatology, St. Spiridon Emergency Hospital, Iași, Romania. .
| | - Stefan Chiriac
- Grigore T. Popa University of Medicine and Pharmacy Iași; Institute of Gastroenterology and Hepatology, St. Spiridon Emergency Hospital, Iași, Romania. .
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, St. Spiridon Emergency Hospital, Iași, Romania.
| | | | - Sergiu Timofeiov
- Grigore T. Popa University of Medicine and Pharmacy Iași; 3rd Surgical Unit, St. Spiridon Emergency Hospital, Iasi, Romania.
| | - Anca Trifan
- Grigore T. Popa University of Medicine and Pharmacy Iași; Institute of Gastroenterology and Hepatology, St. Spiridon Emergency Hospital, Iași, Romania.
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Mateescu RB, Gheorghe C, Trifan AV, Saftoiu A, Seicean A, Diculescu MM, Banciu C, Gheorghe LS, Busuioc B, Goldis A, Dobru D, Fratila O, Eugen D, Bataga S, Constantinescu G, Gheonea D, Tantau A, Jinga M, Brisc C, Cijevschi Prelipcean C, Chira R, Fierbințeanu-Braticevici C, Dumitrascu D, State M, Voiosu T, Negreanu L. Safety, Efficacy and Persistence of Advanced Therapies in Inflammatory Bowel Disease: Results from ORIGINS. A Retrospective Observational Study. J Gastrointestin Liver Dis 2023; 32:444-451. [PMID: 38147607 DOI: 10.15403/jgld-5128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/21/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS Real-world assessments of efficacy and safety of advanced therapies used for inflammatory bowel disease (IBD) patients are limited. We aimed to report safety, efficacy and treatment persistence of new molecules (infliximab, adalimumab, vedolizumab, tofacitinib, ustekinumab) in a retrospective multicentric national Romanian analysis. METHODS We conducted a nationwide, retrospective observational multicentric study. Data were collected retrospectively from electronic and paper files. Patients who started on one of the five investigated molecules during December 2019-December 2021 were included. The main outcome measures were clinical remission, endoscopic healing, persistence on treatment and safety data. RESULTS A total of 678 adult patients from 24 Romanian IBD centers with a diagnosis of ulcerative colitis or Crohn's disease were included. Participants had previously failure to one (268, 39.5%), two (108, 15%) or more treatment lines and only 38% (259) were biologic naïve. In the 24 months study period, most patients were started on vedolizumab (192, 28%), followed by adalimumab, infliximab, ustekinumab and tofacitinib. In biologic-naïve patients, most physicians (72%) preferred anti-TNF treatment as first line biologic (93 patients started on infliximab, 92 on adalimumab), followed by vedolizumab, ustekinumab and tofacitinib. During follow-up, 71% (470, p=0.05) of patients achieved clinical remission and 36% (134, p=0.03) achieved mucosal healing. The 6 months milestone for persistence was reached in 78% (530) of cases. Almost half of patients (47%, 316 patients) persisted on their current treatment for over 12 months. Overall, an adverse reaction was reported for 67 (10.4%) patients, with no lethal events. CONCLUSIONS Population of biologic-experienced IBD patients in Romania is increasing and is becoming more difficult to achieve long-term disease control. Discontinuation rates for advanced therapies are high.
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Affiliation(s)
| | - Cristian Gheorghe
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute,Bucharest, Romania.
| | - Anca Victorita Trifan
- Gastroenterology Department, St. Spiridon Emergency Clinical County Hospital, Iasi, Romania.
| | - Adrian Saftoiu
- Gastroenterology Department, Elias Emergency Hospital, Bucharest, Romania.
| | - Andrada Seicean
- Gastroenterology Department, Prof. Dr. Octavian Fodor Gastroenterology Institute, Cluj-Napoca, Romania.
| | | | - Christian Banciu
- Gastroenterology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
| | | | - Bogdan Busuioc
- Gastroenterology Department, Ion Cantacuzino Clinical Hospital, Bucharest, Romania.
| | - Adrian Goldis
- Gastroenterology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.
| | - Daniela Dobru
- Gastroenterology Department , University of Medicine , Science and Tehnology G.E.Palade Targu-Mures.
| | - Ovidiu Fratila
- Third Internal Medicine Department, University of Oradea, Romania.
| | - Dumitru Eugen
- Gastroenterology Department, Emergency Clinical County Hospital, Constanta, Romania.
| | - Simona Bataga
- Gastroenterology Department, Emergency Clinical County Hospital, Targu-Mures, Romania.
| | | | - Dan Gheonea
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova.
| | - Alina Tantau
- Internal Medicine and Gastroenterology Department, Iuliu-Hatieganu University of Medicine and Pharmacy, Cluj- Napoca, Romania.
| | - Mariana Jinga
- Internal Medicine and Gastroenterology Department, Dr Carol Davila Central University Emergency Military Hospital, Bucharest, Romania.
| | - Ciprian Brisc
- Gastroenterology Department, Emergency Clinical County Hospital, Oradea, Romania.
| | | | - Romeo Chira
- Gastroenterology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
| | | | - Dan Dumitrascu
- Second Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.
| | - Monica State
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania.
| | - Lucian Negreanu
- Gastroenterology Department, Emergency University Hospital Bucharest, Romania.
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Jucan AE, Gavrilescu O, Dranga M, Popa IV, Mihai IR, Mihai VC, Stefanescu G, Drug VL, Prelipcean CC, Vulpoi RA, Barboi OB, Ciortescu I, Mihai C. Evaluation of Disease Activity in Inflammatory Bowel Disease: Diagnostic Tools in the Assessment of Histological Healing. Biomedicines 2023; 11:3090. [PMID: 38002090 PMCID: PMC10669373 DOI: 10.3390/biomedicines11113090] [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: 10/29/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Inflammatory bowel disease (IBD) comprises two types of chronic intestinal disorders: Crohn's disease and ulcerative colitis. In long-standing ulcerative colitis disease activity, histological persistent inflammation has been linked to an increased risk of relapse, and long-term corticosteroid use, even when endoscopic remission is reached. In Crohn's disease, the discontinuous nature of lesions and transmural inflammation have limited the standardized histological assessment. The current evidence from research proposes that besides clinical and endoscopic healing, the achievement of histological healing constitutes an endpoint to assess disease activity and remission in IBD patients concerning better long-term disease outcomes. Histological alterations may persist even in the absence of endoscopic lesions. For these reasons, new advanced techniques promise to revolutionize the field of IBD by improving the endoscopic and histologic assessment, disease characterization, and ultimately patient care, with an established role in daily practice for objective assessment of lesions. This review outlines the importance of including microscopic evaluation in IBD, highlighting the clinical benefits of a deep state of disease remission using validated diagnostic methods and scoring systems for daily clinical practice.
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Affiliation(s)
- Alina Ecaterina Jucan
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Otilia Gavrilescu
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Mihaela Dranga
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Iolanda Valentina Popa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Ioana-Ruxandra Mihai
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Vasile-Claudiu Mihai
- Department of Radiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Gabriela Stefanescu
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Vasile Liviu Drug
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Cristina Cijevschi Prelipcean
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
| | - Radu-Alexandru Vulpoi
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Oana-Bogdana Barboi
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Irina Ciortescu
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Catalina Mihai
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
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Vulpoi RA, Luca M, Ciobanu A, Olteanu A, Bărboi O, Iov DE, Nichita L, Ciortescu I, Cijevschi Prelipcean C, Ștefănescu G, Mihai C, Drug VL. The Potential Use of Artificial Intelligence in Irritable Bowel Syndrome Management. Diagnostics (Basel) 2023; 13:3336. [PMID: 37958232 PMCID: PMC10648815 DOI: 10.3390/diagnostics13213336] [Citation(s) in RCA: 1] [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: 09/21/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Irritable bowel syndrome (IBS) has a global prevalence of around 4.1% and is associated with a low quality of life and increased healthcare costs. Current guidelines recommend that IBS is diagnosed using the symptom-based Rome IV criteria. Despite this, when patients seek medical attention, they are usually over-investigated. This issue might be resolved by novel technologies in medicine, such as the use of Artificial Intelligence (AI). In this context, this paper aims to review AI applications in IBS. AI in colonoscopy proved to be useful in organic lesion detection and diagnosis and in objectively assessing the quality of the procedure. Only a recently published study talked about the potential of AI-colonoscopy in IBS. AI was also used to study biofilm characteristics in the large bowel and establish a potential relationship with IBS. Moreover, an AI algorithm was developed in order to correlate specific bowel sounds with IBS. In addition to that, AI-based smartphone applications have been developed to facilitate the monitoring of IBS symptoms. From a therapeutic standpoint, an AI system was created to recommend specific diets based on an individual's microbiota. In conclusion, future IBS diagnosis and treatment may benefit from AI.
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Affiliation(s)
- Radu Alexandru Vulpoi
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Mihaela Luca
- Institute of Computer Science, Romanian Academy-Iasi Branch, 700481 Iasi, Romania; (M.L.); (A.C.)
| | - Adrian Ciobanu
- Institute of Computer Science, Romanian Academy-Iasi Branch, 700481 Iasi, Romania; (M.L.); (A.C.)
| | - Andrei Olteanu
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Oana Bărboi
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Diana-Elena Iov
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Loredana Nichita
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Irina Ciortescu
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Cristina Cijevschi Prelipcean
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Gabriela Ștefănescu
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Cătălina Mihai
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
| | - Vasile Liviu Drug
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700111 Iasi, Romania; (R.A.V.); (A.O.); (D.-E.I.); (L.N.); (I.C.); (C.C.P.); (G.Ș.); (C.M.); (V.L.D.)
- Emergency Clinical Hospital “Saint Spiridon”, Institute of Gastroenterology and Hepatology, 700111 Iasi, Romania
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Gavrilescu O, Popa IV, Dranga M, Mihai R, Cijevschi Prelipcean C, Mihai C. Laboratory Data and IBDQ-Effective Predictors for the Non-Invasive Machine-Learning-Based Prediction of Endoscopic Activity in Ulcerative Colitis. J Clin Med 2023; 12:jcm12113609. [PMID: 37297804 DOI: 10.3390/jcm12113609] [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: 03/19/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
A suitable, non-invasive biomarker for assessing endoscopic disease activity (EDA) in ulcerative colitis (UC) has yet to be identified. Our study aimed to develop a cost-effective and non-invasive machine learning (ML) method that utilizes the cost-free Inflammatory Bowel Disease Questionnaire (IBDQ) score and low-cost biological predictors to estimate EDA. Four random forest (RF) and four multilayer perceptron (MLP) classifiers were proposed. The results show that the inclusion of IBDQ in the list of predictors that were fed to the models improved accuracy and the AUC for both the RF and the MLP algorithms. Moreover, the RF technique performed noticeably better than the MLP method on unseen data (the independent patient cohort). This is the first study to propose the use of IBDQ as a predictor in an ML model to estimate UC EDA. The deployment of this ML model can furnish doctors and patients with valuable insights into EDA, a highly beneficial resource for individuals with UC who need long-term treatment.
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Affiliation(s)
- Otilia Gavrilescu
- Medicale I Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- "Saint Spiridon" County Hospital, 700111 Iasi, Romania
| | - Iolanda Valentina Popa
- Medicale II Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihaela Dranga
- Medicale I Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- "Saint Spiridon" County Hospital, 700111 Iasi, Romania
| | - Ruxandra Mihai
- Medicale II Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Cătălina Mihai
- Medicale I Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- "Saint Spiridon" County Hospital, 700111 Iasi, Romania
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Morosanu AM, Mihai IR, Rezus II, Gavrilescu O, Dranga M, Prelipcean CC, Mihai C. New onset severe ulcerative colitis following Ixekizumab therapy. Arch Clin Cases 2022; 9:173-176. [PMID: 36628163 PMCID: PMC9769074 DOI: 10.22551/2022.37.0904.10227] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Ixekizumab is one of the three biologic agents including Secukinumab and Brodalumab that targets the Interleukin-17 (IL-17) pathway to reduce inflammation in psoriasis and ankylosing spondylitis. In this report we present the case of 42-year-old woman, who was diagnosed with psoriasis and psoriatic arthritis. One week after first administration of Ixekizumab, she developed diffuse abdominal pain, bloody diarrhea (7-8 stools/day) and fever. Following imaging (colonoscopy, computed tomography) and laboratory investigations, she was diagnosed with acute severe ulcerative colitis complicated with toxic megacolon. The medical treatment (first corticotherapy, then infliximab) has failed and the patient needed emergency colectomy. Based on the immunological mechanisms and the observation from other studies, Ixekizumab should be considered an etiology for new-onset inflammatory bowel disease.
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Affiliation(s)
| | - Ioana Ruxandra Mihai
- “Grigore T. Popa” University of Medicine and Pharmacy, Clinical Rehabilitation Hospital, 1st Rheumatology Clinic, Iasi, Romania,Correspondence: Ioana Ruxandra Mihai, 1st Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Str., Iaşi 700661 Romania.
| | - Ioana Irina Rezus
- “Grigore T. Popa” University of Medicine and Pharmacy, Department of Dermatology, Iasi, Romania
| | - Otilia Gavrilescu
- “Grigore T. Popa” University of Medicine and Pharmacy, “Sf. Spiridon” County Clinical Emergency Hospital, Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Mihaela Dranga
- “Grigore T. Popa” University of Medicine and Pharmacy, “Sf. Spiridon” County Clinical Emergency Hospital, Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Cristina Cijevschi Prelipcean
- “Grigore T. Popa” University of Medicine and Pharmacy, “Sf. Spiridon” County Clinical Emergency Hospital, Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Catalina Mihai
- “Grigore T. Popa” University of Medicine and Pharmacy, “Sf. Spiridon” County Clinical Emergency Hospital, Institute of Gastroenterology and Hepatology, Iasi, Romania
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Gavrilescu O, Prelipcean CC, Dranga M, Popa IV, Mihai C. Impact of COVID-19 Pandemic on the Quality of Life of IBD Patients. Medicina (Kaunas) 2022; 58:medicina58050562. [PMID: 35629979 PMCID: PMC9146780 DOI: 10.3390/medicina58050562] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The COVID-19 pandemic has had a considerable impact on inflammatory bowel disease (IBD) patients by limiting their access to medical services due to restrictions and the reorganization of the healthcare systems, which affects their quality of life (QoL). We aimed to assess the impact of the COVID-19 pandemic on the QoL of patients with IBD. Materials and Methods: We conducted a descriptive observational study, which included 90 adult patients diagnosed with IBD. The study sample consisted of two subgroups: a retrospective-pre-pandemic group (group A) and a prospective-pandemic group (group B). Group A included 45 IBD patients who were evaluated in 2018. Group B included 45 patients with confirmed diagnosis of IBD, evaluated between June and December 2021—the period of the COVID-19 pandemic (prospective), consecutively recruited. All the patients filled in a QoL assessment questionnaire—IBDQ-32. Subsequently, the two samples were comparatively assessed. Results: The average values of the IBDQ scores were significantly lower in 2021 compared to those recorded in 2018: 145.56 vs. 128.3 (p < 0.05). We also we found significant differences between the subscores: IBDQ1 (p = 0.043), IBDQ2 (p = 0.034), IBDQ3 (p = 0.045), IBDQ4 (p = 0.025). Conclusions: IBDQ scores were significantly lower in 2021 compared to 2018 (p < 0.05), showing that during the COVID-19 pandemic, patients with IBD had a more influenced QoL.
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Affiliation(s)
- Otilia Gavrilescu
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.G.); (C.M.)
| | | | - Mihaela Dranga
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.G.); (C.M.)
- Correspondence:
| | - Iolanda Valentina Popa
- Medicale II Department “Grigore T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Cătălina Mihai
- Medicale I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.G.); (C.M.)
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Cucuteanu B, Negru D, Gavrilescu O, Popa IV, Floria M, Mihai C, Cijevschi Prelipcean C, Dranga M. Extrapancreatic necrosis volume: A new tool in acute pancreatitis severity assessment? World J Clin Cases 2021; 9:9395-9405. [PMID: 34877275 PMCID: PMC8610849 DOI: 10.12998/wjcc.v9.i31.9395] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/16/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many scores have been suggested to assess the severity of acute pancreatitis upon onset. The extrapancreatic necrosis volume is a novel, promising score that appears to be superior to other scores investigated so far.
AIM To evaluate the discriminatory power of extrapancreatic necrosis volume to identify severe cases of acute pancreatitis.
METHODS A total of 123 patients diagnosed with acute pancreatitis at Institute of Gastroenterology and Hepatology, St Spiridon Hospital between January 1, 2017 and December 31, 2019 were analyzed retrospectively. Pancreatitis was classified according to the revised Atlanta classification (rAC) as mild, moderate, or severe. Severity was also evaluated by computed tomography and classified according to the computed tomography severity index (CTSI) and the modified CTSI (mCTSI). The results were compared with the extrapancreatic volume necrosis to establish the sensitivity and specificity of each method.
RESULTS The CTSI and mCTSI imaging scores and the extrapancreatic necrosis volume were highly correlated with the severity of pancreatitis estimated by the rAC (r = 0.926, P < 0.001 and r = 0.950, P < 0.001; r = 0.784, P < 0.001, respectively). The correlation of C-reactive protein with severity was positive but not as strong, and was not significant (r = 0.133, P = 0.154). The best predictor for the assessment of severe pancreatitis was the extrapancreatic necrosis volume [area under the curve (AUC) = 0.993; 95% confidence interval (CI): 0.981-1.005], with a 99.5% sensitivity and 99.0% specificity at a cutoff value of 167 mL, followed by the mCTSI 2007 score (AUC = 0.972; 95%CI: 0.946-0.999), with a 98.0% sensitivity and 96.5% specificity, and the CTSI 1990 score (AUC = 0.969; 95%CI: 0.941-0.998), with a 97.0% sensitivity and 95.0% specificity.
CONCLUSION Radiological severity scores correlate strongly and positively with disease activity. Extrapancreatic necrosis volume shows the best diagnostic accuracy for severe cases.
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Affiliation(s)
- Bogdan Cucuteanu
- Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
| | - Dragoş Negru
- Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
| | - Otilia Gavrilescu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
| | - Iolanda Valentina Popa
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi City 700115, Romania
| | - Mariana Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi City 700115, Romania
| | - Cătălina Mihai
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
| | - Cristina Cijevschi Prelipcean
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
| | - Mihaela Dranga
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
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Popa IV, Burlacu A, Gavrilescu O, Dranga M, Prelipcean CC, Mihai C. A new approach to predict ulcerative colitis activity through standard clinical–biological parameters using a robust neural network model. Neural Comput Appl 2021. [DOI: 10.1007/s00521-021-06055-x] [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: 10/21/2022]
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Gavril OI, Arhire LI, Gavrilescu O, Dranga M, Barboi O, Gavril RS, Popescu R, Cijevschi Prelipcean C, Trifan AV, Mihai C. Role of PNPLA3 in the Assessment and Monitoring of Hepatic Steatosis and Fibrosis in Patients with Chronic Hepatitis C Infection Who Achieved a Sustained Virologic Response. Medicina (Kaunas) 2021; 57:medicina57111153. [PMID: 34833371 PMCID: PMC8618282 DOI: 10.3390/medicina57111153] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: Hepatic diseases are an important public health problem. All patients with chronic hepatitis C virus (HCV) infection receive treatment, regardless of hepatic fibrosis severity. However, evaluation of hepatic fibrosis and steatosis is still useful in assessing evolution, prognosis and monitoring of hepatic disease, especially after treatment with direct-acting antivirals (DAAs). The aim of this study was to assess the link between patatin-like phospholipase domain-containing 3 (PNPLA3) polymorphism and the degree of hepatic steatosis and fibrosis in patients with chronic HCV infection, as well as changes in steatosis and fibrosis three monthsafter obtaining a sustained viral response (SVR). Materials and Methods:Ourstudy included 100 patients with chronic hepatitis C (CHC) infection and compensated cirrhosis who received DAA treatment and who were evaluated using Fibromax prior to and 3 months after SVR. The influence of PNPLA3 (CC, CG, GG) genotype among these patients on the degree of post-treatment regression of steatosis and fibrosis was assessed. Results: Regression was noticed in the degree of both hepatic steatosis and hepatic fibrosis post-DAA treatment (three months after SVR). Analysis of the correlation between PNPLA3 genotype and fibrosis indicated that the average level of fibrosis (F) before DAA treatment was higher in patients with the GG genotype than in patients with the CC or CG genotype. Three months after SVR, the average level of fibrosis decreased; however, it remained significantly increased in GG subjects compared to that in CC or CG patients. The degree of hepatic steatosis before treatment was not significantly different among patients with different PNPLA3 genotypes, and no significant correlations were observed three months after SVR. Conclusions: The genetic variants of PNPLA3 influence the evolution of hepatic fibrosis. The GG subtype plays an important role in the degree of hepatic fibrosis both before and after treatment (three months after SVR)and could be a prognostic marker for assessment of post-SVR evolution.
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Affiliation(s)
- Oana Irina Gavril
- Department of Medical Specialties (I), Faculty of Medicine, “Grigore T. Popa” Universityof Medicine and Pharmacy, 700111 Iași, Romania; (O.I.G.); (O.G.); (M.D.); (O.B.); (C.C.P.); (A.-V.T.); (C.M.)
| | - Lidia Iuliana Arhire
- Department of Medical Specialties (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania;
| | - Otilia Gavrilescu
- Department of Medical Specialties (I), Faculty of Medicine, “Grigore T. Popa” Universityof Medicine and Pharmacy, 700111 Iași, Romania; (O.I.G.); (O.G.); (M.D.); (O.B.); (C.C.P.); (A.-V.T.); (C.M.)
| | - Mihaela Dranga
- Department of Medical Specialties (I), Faculty of Medicine, “Grigore T. Popa” Universityof Medicine and Pharmacy, 700111 Iași, Romania; (O.I.G.); (O.G.); (M.D.); (O.B.); (C.C.P.); (A.-V.T.); (C.M.)
| | - Oana Barboi
- Department of Medical Specialties (I), Faculty of Medicine, “Grigore T. Popa” Universityof Medicine and Pharmacy, 700111 Iași, Romania; (O.I.G.); (O.G.); (M.D.); (O.B.); (C.C.P.); (A.-V.T.); (C.M.)
| | - Radu Sebastian Gavril
- Department of Medical Specialties (I), Faculty of Medicine, “Grigore T. Popa” Universityof Medicine and Pharmacy, 700111 Iași, Romania; (O.I.G.); (O.G.); (M.D.); (O.B.); (C.C.P.); (A.-V.T.); (C.M.)
- Correspondence: ; Tel.: +40-74-040-4797
| | - Roxana Popescu
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iași, Romania;
| | - Cristina Cijevschi Prelipcean
- Department of Medical Specialties (I), Faculty of Medicine, “Grigore T. Popa” Universityof Medicine and Pharmacy, 700111 Iași, Romania; (O.I.G.); (O.G.); (M.D.); (O.B.); (C.C.P.); (A.-V.T.); (C.M.)
| | - Anca-Victorita Trifan
- Department of Medical Specialties (I), Faculty of Medicine, “Grigore T. Popa” Universityof Medicine and Pharmacy, 700111 Iași, Romania; (O.I.G.); (O.G.); (M.D.); (O.B.); (C.C.P.); (A.-V.T.); (C.M.)
| | - Catalina Mihai
- Department of Medical Specialties (I), Faculty of Medicine, “Grigore T. Popa” Universityof Medicine and Pharmacy, 700111 Iași, Romania; (O.I.G.); (O.G.); (M.D.); (O.B.); (C.C.P.); (A.-V.T.); (C.M.)
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Dranga M, Boiculese LV, Popa IV, Floria M, Gavril OI, Bărboi OB, Trifan A, Cijevschi Prelipcean C, Mihai C, Gavrilescu O. Anemia in Crohn's Disease-The Unseen Face of Inflammatory Bowel Disease. Medicina (Kaunas) 2021; 57:medicina57101046. [PMID: 34684083 PMCID: PMC8539193 DOI: 10.3390/medicina57101046] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: Anemia is the most frequent complication of inflammatory bowel diseases. Clinically, anemia can affect important quality-of-life (QoL) components, such as exercise capacity, cognitive function, and the ability to carry out social activities. The disease activity has a significant impact on QoL, mainly due to clinical manifestations, which are more severe during the periods of disease activity. Our aim was to estimate the impact of anemia on QoL in patients with Crohn's disease. Material and Methods. We made a prospective study on 134 patients with Crohn's disease (CD) in a Romanian tertiary center. The CD diagnosis was established by colonoscopy and histopathological examination. In particular cases, additional examinations were required (small bowel capsule endoscopy, computed tomography enterography, and magnetic resonance enterography). Anemia was defined according to the World Health Organization's definition, the activity of the disease was assessed by Crohn's disease activity index (CDAI) score, and the QoL was evaluated by Inflammatory Bowel Disease Questionnaire 32 (IBDQ 32). Results: 44.8% patient had anemia, statistically related to the activity of the disease and corticoids use. We found a strong association between QoL and disease activity on all four sub-scores: patients with more severe activity had a significantly lower IBDQ (260.38 ± 116.96 vs. 163.85 ± 87.20, p = 0.001) and the presence of anemia (127.03 vs. 148.38, p = 0.001). In multiple regression analyses, both disease activity and anemia had an impact on the QoL. Conclusions: Anemia has high prevalence in the CD in northeastern region of Romania. Anemia was more common in female patients, in patients undergoing corticosteroid treatment, and in those with active disease. Both anemia and disease activity had a strong negative and independent impact on QoL.
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Affiliation(s)
- Mihaela Dranga
- Medicale I Department “Grigore T. Popa”, University of Medicine and Pharmacy, 700111 Iasi, Romania; (M.D.); (M.F.); (O.I.G.); (O.-B.B.); (A.T.); (O.G.)
- Institute of Gastroenterology and Hepatology, St. Spiridon Emergency Hospital, 700111 Iasi, Romania;
| | - Lucian Vasile Boiculese
- Department of Medical Informatics, Biostatistics, Computer Science, Mathematics and Modelling Simulation “Grigore T. Popa”, University of Medicine and Pharmacy, 700111 Iasi, Romania;
| | - Iolanda Valentina Popa
- Medicale II Department “Grigore T. Popa”, University of Medicine and Pharmacy, 700111 Iasi, Romania;
| | - Mariana Floria
- Medicale I Department “Grigore T. Popa”, University of Medicine and Pharmacy, 700111 Iasi, Romania; (M.D.); (M.F.); (O.I.G.); (O.-B.B.); (A.T.); (O.G.)
- Department of Internal Medicine, Dr. Iacob Czihac Emergency Military Hospital, 700483 Iasi, Romania
| | - Oana Irina Gavril
- Medicale I Department “Grigore T. Popa”, University of Medicine and Pharmacy, 700111 Iasi, Romania; (M.D.); (M.F.); (O.I.G.); (O.-B.B.); (A.T.); (O.G.)
- Department of Internal Medicine, CF Hospital, 700506 Iasi, Romania
| | - Oana-Bogdana Bărboi
- Medicale I Department “Grigore T. Popa”, University of Medicine and Pharmacy, 700111 Iasi, Romania; (M.D.); (M.F.); (O.I.G.); (O.-B.B.); (A.T.); (O.G.)
- Institute of Gastroenterology and Hepatology, St. Spiridon Emergency Hospital, 700111 Iasi, Romania;
| | - Anca Trifan
- Medicale I Department “Grigore T. Popa”, University of Medicine and Pharmacy, 700111 Iasi, Romania; (M.D.); (M.F.); (O.I.G.); (O.-B.B.); (A.T.); (O.G.)
- Institute of Gastroenterology and Hepatology, St. Spiridon Emergency Hospital, 700111 Iasi, Romania;
| | | | - Cătălina Mihai
- Medicale I Department “Grigore T. Popa”, University of Medicine and Pharmacy, 700111 Iasi, Romania; (M.D.); (M.F.); (O.I.G.); (O.-B.B.); (A.T.); (O.G.)
- Institute of Gastroenterology and Hepatology, St. Spiridon Emergency Hospital, 700111 Iasi, Romania;
- Correspondence:
| | - Otilia Gavrilescu
- Medicale I Department “Grigore T. Popa”, University of Medicine and Pharmacy, 700111 Iasi, Romania; (M.D.); (M.F.); (O.I.G.); (O.-B.B.); (A.T.); (O.G.)
- Institute of Gastroenterology and Hepatology, St. Spiridon Emergency Hospital, 700111 Iasi, Romania;
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Singeap AM, Girleanu I, Diculescu M, Gheorghe L, Ciocîrlan M, Gheorghe C, Costache A, Tanțău A, Zaharie R, Goldis A, Gheonea D, Dobru D, Dumitru E, Prelipcean CC, Gîlcă-Blanariu GE, Moscalu M, Stanciu C, Trifan A. Risk Factors for Extraintestinal Manifestations in Inflammatory Bowel Diseases - Data from the Romanian National Registry. J Gastrointestin Liver Dis 2021; 30:346-357. [PMID: 34375380 DOI: 10.15403/jgld-3818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Identifying the risk factors for extraintestinal manifestations (EIMs) in inflammatory bowel diseases (IBD) may optimize the therapeutic decision. We aimed to assess the prevalence of EIMs in IBD patients in Romania and to determine the risk factors. METHODS We analyzed 2,626 patients registered in the Romanian IBD Prospect National Registry. We performed a descriptive cross-sectional study to assess the point prevalence of EIMs, calculating global prevalence and analyzing the different types of EIMs and their respective frequencies were carried out. Demographic and clinical risk factors were researched as possible predictors for EIMs development, based on the results of the univariate and multivariate logistic regression analysis. RESULTS The overall point prevalence of EIMs was 16.3%. A significantly higher frequency of EIMs in Crohn's disease (CD) was noted in comparison to ulcerative colitis (UC) and IBD unclassified (IBDU) (23.2% vs 11.3% and 16.3%, respectively, p<0.001). The most frequent type of EIM was peripheral arthropathy (8.3%), significantly associated with CD (p<0.001). Univariate analysis highlighted the significant independent common predictive risk factors for EIMs, in both CD and UC patients: female gender, patient's urban area of origin, anemia, hypoalbuminemia, and high level of C-reactive protein (CRP), while significant independent IBD phenotype-related risk factors were ileocolonic location and concomitant involvement of upper gastrointestinal tract for CD, non-smoker status and both moderate and severe disease activity for UC (p<0.05). Multivariate analysis determined that female CD patients with moderate or severe disease activity, with other than isolated ileal disease, and female UC patients with moderate or severe extensive colitis are the most likely to develop EIMs. CONCLUSIONS IBD patients are experiencing EIMs in a large proportion, with higher rates for CD. As EIMs negatively affect patient outcomes, foreseeing the risk by identifying independent and associated predictive factors could be a first step to optimal work-up and treatment.
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Affiliation(s)
- Ana-Maria Singeap
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania. .
| | - Irina Girleanu
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
| | - Mircea Diculescu
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Liana Gheorghe
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Maria Ciocîrlan
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Cristian Gheorghe
- Carol Davila UMF, Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Inst., Bucharest, Romania.
| | - Adrian Costache
- Carol Davila UMF, Dr. I. Cantacuzino Clinical Hospital, Bucharest.
| | - Alina Tanțău
- Iuliu Hațieganu University of Medicine and Pharmacy, 4th Medical Clinic, Cluj- Napoca, Romania.
| | - Roxana Zaharie
- Iuliu Hatieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Adrian Goldis
- Victor Babeș University of Medicine and Pharmacy, Municipal Emergency Hospital, Department of Gastroenterology and Hepatology, Timișoara, Romania.
| | - Dan Gheonea
- University of Medicine and Pharmacy, Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania.
| | - Daniela Dobru
- University of Medicine and Pharmacy, Tg Mures, Emergency County Hospital, Department of Gastroenterology, Târgu-Mureș, Romania.
| | - Eugen Dumitru
- Faculty of Medicine, Ovidius University of Constanța, Emergency County Hospital, Department of Gastroenterology, Constanta, Romania.
| | | | | | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.
| | - Carol Stanciu
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
| | - Anca Trifan
- Grigore T. Popa UMF, Inst. of Gastroenterol. and Hepatol., Emergency County Hospital Saint Spiridon, Iasi, Romania.
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Dumitrascu DL, Baban A, Bancila I, Barboi O, Bataga S, Chira A, Chirila I, Cijevschi Prelipcean C, Ciobanu L, Cozma-Petrut A, David L, Diculescu M, Dobru D, Dimitriu A, Dumitru E, Fadgyas-Stanculete M, Gheorghe C, Gilca-Blanariu GE, Goldis A, Grad S, Macarie M, Marica-Sabo C, Miere D, Nedelcu L, Negovan A, Pojoga C, Pop AV, Popa SL, Porr PJ, Rusu F, Seicean A, Sporea I, Stroie T, Blaga-Surdea T, Tocia C, Trifan A, Brisc C, Drug V. Romanian Guidelines for Nonpharmacological Therapy of IBS. J Gastrointestin Liver Dis 2021; 30:291-306. [PMID: 33951120 DOI: 10.15403/jgld-3581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS The nonpharmacological therapy in irritable bowel syndrome (IBS) is expanding rapidly. Practitioners and medical educators need to be aware of progress and changes in knowledge of this topic. The Romanian Society of Neurogastroenterology aimed to create guidelines based on best evidence on the use of nonpharmacological therapy in IBS. METHODS A group of experts was constituted. This was divided in eleven subgroups dedicated to eleven categories of nonpharmacological therapy. The subgroups searched the literature and formulated statements and recommendations. These were submitted to vote in order to obtain consensus. RESULTS The outcome of this activity is represented by the guidelines of the Romanian Society of Neurogastroenterology, presented in this paper. The recommendations are seen as complementary to the pharmacological therapy and are not intended to recommend avoiding pharmacological drugs. CONCLUSIONS These guidelines were elaborated by a Delphi process and represent a useful tool for physicians managing patients with IBS.
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Affiliation(s)
- Dan L Dumitrascu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Department of Internal Medicine, Cluj-Napoca, Romania. .
| | - Adriana Baban
- Dept. of Psychology; Babes-Bolyai University, Cluj-Napoca, Romania.
| | - Ion Bancila
- Center of Gastroenterology and Hepatology Fundeni Clinical Institute, Bucharest, Romania.
| | - Oana Barboi
- Institute of Gastroenterology and Hepatology, Iasi; Grrigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
| | - Simona Bataga
- George E. Palade University of Medicine, Pharmacy, Sciences and Tehnology, Tg. Mures, Romania.
| | - Alexandra Chira
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Department of Internal Medicine, Cluj-Napoca, Romania.
| | - Ioan Chirila
- Gheorghe T. Popa University of Medicine and Pharmacy, Iasi; Deptartment of Environmental Health, National Institute of Public Health - RCoPH Iasi, Romania.
| | - Cristina Cijevschi Prelipcean
- Institute of Gastroenterology and Hepatology, Iasi; Grrigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
| | - Lidia Ciobanu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Anamaria Cozma-Petrut
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Deptartment of Bromatol, Hygiene, Nutrition, Romania.
| | - Liliana David
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Deptartment of Nursing, Romania.
| | - Mircea Diculescu
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy Bucharest, Romania.
| | - Daniela Dobru
- George E. Palade University of Medicine, Pharmacy, Sciences and Tehnology, Tg. Mures, Romania.
| | - Anca Dimitriu
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy Bucharest, Romania.
| | - Eugen Dumitru
- Research Center for the Morphological and Genetic Study in Malignant Pathology; Faculty of Medicine, Ovidius University Constanța, Romania.
| | - Mihaela Fadgyas-Stanculete
- Iuliu Hatieganu Univeristy of Medicine and Pharmacy, Cluj-Napoca; Department of Neurosciences, Cluj-Napoca, Romania.
| | - Cristian Gheorghe
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy Bucharest, Romania.
| | | | - Adrian Goldis
- Department of Gastroenterology and Hepatology Victor Babeș University of Medicine and Pharmacy, Academy of Medicale Science, Research Center, Timișoara, Romania.
| | - Simona Grad
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Department of Internal Medicine, Cluj-Napoca, Romania.
| | - Melania Macarie
- George E. Palade University of Medicine, Pharmacy, Sciences and Tehnology, Tg. Mures, Romania.
| | - Cristina Marica-Sabo
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Dept. of Internal Medicine, Cluj-Napoca, Romania.
| | - Doina Miere
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Deptartment of Bromatol, Hygiene, Nutrition, Romania.
| | | | - Anca Negovan
- George E. Palade University of Medicine, Pharmacy, Sciences and Tehnology, Tg. Mures, Romania.
| | - Cristina Pojoga
- Babes-Bolyai University, Cluj-Napoca; Regional Institute of Gastroenterol and Hepatol, Cluj-Napoca; Department of Clinical Psychology and Psychotherapy, International Institute for Advanced Study of Psychotherapy and Applied Mental Health, Cluj-Napoca; Romania.
| | - Andrei Vasile Pop
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Department of Internal Medicine, Cluj-Napoca, Romania.
| | - Stefan-Lucian Popa
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Department of Internal Medicine, Cluj-Napoca, Romania.
| | | | - Flaviu Rusu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Department of Internal Medicine, Cluj-Napoca, Romania.
| | - Andrada Seicean
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Academy of Medical Science, Research Center, Timișoara, Romania.
| | - Tudor Stroie
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy Bucharest, Romania.
| | - Teodora Blaga-Surdea
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; 2nd Department of Internal Medicine, Cluj-Napoca, Romania.
| | - Cristina Tocia
- Faculty of Medicine, Ovidius University Constanța, Romania.
| | - Anca Trifan
- Institute of Gastroenterology and Hepatology, Iasi; Grrigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
| | - Ciprian Brisc
- Faculty of Medicine and Pharmacy, University of Oradea, Romania.
| | - Vasile Drug
- Institute of Gastroenterology and Hepatology, Iasi; Grrigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
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Popa IV, Diculescu M, Mihai C, Prelipcean CC, Burlacu A. Developing a Neural Network Model for a Non-invasive Prediction of Histologic Activity in Inflammatory Bowel Diseases. Turk J Gastroenterol 2021; 32:276-286. [PMID: 34160357 DOI: 10.5152/tjg.2021.20420] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Colonoscopy with biopsy is the "gold" standard for evaluating disease activity in inflammatory bowel diseases (IBD). Current research is geared toward finding non-invasive, cost-efficient methods that estimate disease activity. We aimed to develop a neural network (NN) model for the non-invasive prediction of histologic activity in IBD using routinely available clinical-biological parameters. METHODS Standard clinical-biological parameters and histologic activity from 371 ulcerative colitis (UC) and 115 Crohn's disease (CD) patient records were collected. A training set, a test set, and a validation set were used for building/validating 2 models for each disease. All models had binary output predicting the active/inactive histologic disease status. For both diseases, the first model used both clinical and biological inputs, while the second used only biological data. RESULTS First UC model obtained an accuracy of 95.59% on the test set and 96.67% on the validation set. The second UC model achieved accuracies of 88.24% and 86.67% on the test and validation sets, respectively. The First CD classifier resulted in 90.48% accuracy on the test set and 91.67% on the validation set. Finally, the second CD classifier obtained an accuracy of 85.71% on the test set and 91.67% on the validation set. CONCLUSIONS An accurate and non-invasive artificial intelligence system to predict histologic disease activity in IBD is designed. Our models achieved similar or better results compared to the documented performance of fecal calprotectin (the best non-invasive IBD biomarker to date). Given these favorable results, we anticipate the future utility in the clinical setting of a non-invasive disease activity prediction.
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Affiliation(s)
- Iolanda Valentina Popa
- University of Medicine and Pharmacy "Gr. T. Popa", Iași, Romania;Institute of Gastroenterology and Hepatology, Iași, Romania
| | - Mircea Diculescu
- Department of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania;Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Catalina Mihai
- University of Medicine and Pharmacy "Gr. T. Popa", Iași, Romania;Institute of Gastroenterology and Hepatology, Iași, Romania
| | - Cristina Cijevschi Prelipcean
- University of Medicine and Pharmacy "Gr. T. Popa", Iași, Romania;Institute of Gastroenterology and Hepatology, Iași, Romania
| | - Alexandru Burlacu
- University of Medicine and Pharmacy "Gr. T. Popa", Iași, Romania; Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iași, Romania;Romanian Academy of Medical Sciences, Bucharest, Romania
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16
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Cardoneanu A, Mihai C, Rezus E, Burlui A, Popa I, Cijevschi Prelipcean C. Gut microbiota changes in inflammatory bowel diseases and ankylosing spondilytis. J Gastrointestin Liver Dis 2021; 30:46-54. [PMID: 33548121 DOI: 10.15403/jgld-2823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Both inflammatory bowel diseases (IBD) and ankylosing spondylitis (AS) can be considered chronic immune disorders sharing common etiopathogenetic mechanisms. Changes in the composition of the intestinal microbiota, which can lead to an abnormal mucosal response, could be the missing link between these two diseases. Our study evaluate the composition of intestinal microbiota and to characterize gut dysbiosis in patients with IBD and AS. METHODS We conducted a prospective case-control study that enrolled 124 patients [20 Crohn's disease (CD), 27 ulcerative colitis (UC), 28 AS, 17 IBD + AS and 32 controls). Intestinal microbiota analysis was performed by real-time polymerase chain reaction in stool samples. RESULTS The total quantity of bacteria was decreased in all investigated groups compared to the control group. In studied groups, we noticed an increased percentage of Bacteroides and Escherichia coli (E.coli) and a decreased percentage of Clostridium coccoides, Clostridium leptum, and Faecalibacterium prausnitzii compared to the control group. The percentages of Bifidobacterium (p=0.010) as well as Lactobacillus group (p=0.023) were higher in the L3 form of CD patients. In the E2 form of UC, the quantity of Bacteroides was much higher compared to the E3 form (p=0.004). In AS patients, significant correlations were observed only for the Bifidobacterium species, significantly increased in the axial form compared to peripheral disease (p=0.035). Statistically significant correlations were demonstrated between the Crohn Disease Activity Index score and the total bacterial group (p=0.023, r=-0.507), respectively Bacteroides (p=0.021, r=-0.511) and between the Mayo score and Lactobacillus (p=0.001), respectively E. coli (p=0.001). In IBD + AS group, the Crohn Disease Activity Index score was inversely correlated with the total bacterial group (p=0.010) and directly correlated with Lactobacillus (p=0.047). CONCLUSIONS Intestinal dysbiosis is associated with both IBD and AS. In the association of IBD with AS, dysbiosis is intermediate, but it is associated with the more severe articular disease. Bifidobacterium and Lactobacillus (commonly used as probiotics!) were found to be increased in the association between active IBD and active AS. Further studies are needed to understand how dysbiosis regulates the gut immune system and contributes to intestinal and articular inflammation.
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Affiliation(s)
- Anca Cardoneanu
- Grigore T. Popa University of Medicine and Pharmacy, Rehabilitation Clinical Hospital, Iasi, Romania. .
| | - Catalina Mihai
- Grigore T. Popa University of Medicine and Pharmacy, Sf. Spiridon Emergency Hospital, Institute of Gastroenterology and Hepatology, Iasi, Romania. .
| | - Elena Rezus
- Grigore T. Popa University of Medicine and Pharmacy, Rehabilitation Clinical Hospital, Iasi, Romania.
| | - Alexandra Burlui
- Grigore T. Popa University of Medicine and Pharmacy, Rehabilitation Clinical Hospital, Iasi, Romania.
| | - Iolanda Popa
- Grigore T. Popa University of Medicine and Pharmacy, Sf. Spiridon Emergency Hospital, Institute of Gastroenterology and Hepatology, Iasi, Romania.
| | - Cristina Cijevschi Prelipcean
- Grigore T. Popa University of Medicine and Pharmacy, Sf. Spiridon Emergency Hospital, Institute of Gastroenterology and Hepatology, Iasi, Romania.
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17
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Gavrilescu O, Prelipcean CC, Dranga M, Soponaru C, Mihai C. The specialized educational and psychological counseling in inflammatory bowel disease patients - a target or a challenge? Turk J Gastroenterol 2020; 31:760-766. [PMID: 33361038 DOI: 10.5152/tjg.2020.19669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/AIMS Stress, in its various forms, plays an important role in the development and evolution of inflammatory bowel disease (IBD). For patients with IBD, the evidence related to the effects of various types of psychological therapies remains inconclusive. This study aimed to evaluate whether cognitive behavioral therapy, in combination with educational counseling, influenced disease activity and quality of life (QoL) among patients with IBD. MATERIALS AND METHODS We conducted a randomized controlled trial with 60 patients diagnosed with IBD. All patients completed the IBD questionnaire-32 (IBDQ-32) and the Big Five Inventory. Group A (experimental group) received specialized educational and psychological counseling (SEPC), and group B (control group) was treated according to the current medical practice. All patients were reassessed after 12 months. RESULTS After the SEPC, there was no improvement in disease activity as estimated by fecal calprotectin levels. However, the QoL of patients in group A was significantly improved. The highest mean difference between the initial and final IBDQ scores was found among patients whose main personality trait was openness to experience (48.58±28.80), and the lowest mean difference between these 2 scores was found among patients whose main personality trait was closedness to experience (3.33±2.97, p=0.009). CONCLUSION Although there was no improvement in disease activity after the SEPC, this therapy improved patients' QoL in terms of both emotional and social functions, especially among patients whose dominant personality trait was openness to experience or neuroticism.
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Affiliation(s)
- Otilia Gavrilescu
- Department of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy Iasi, "Sf. Spiridon" Emergency University Hospital Iasi, Iasi, Romania
| | - Cristina Cijevschi Prelipcean
- Department of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy Iasi, "Sf. Spiridon" Emergency University Hospital Iasi, Iasi, Romania
| | - Mihaela Dranga
- Department of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy Iasi, "Sf. Spiridon" Emergency University Hospital Iasi, Iasi, Romania
| | - Camelia Soponaru
- Alexandru Ioan Cuza University, School of Psychology and Education Sciences, Iasi, Romania
| | - Catalina Mihai
- Department of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy Iasi, "Sf. Spiridon" Emergency University Hospital Iasi, Iasi, Romania
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Mihai C, Floria M, Vulpoi R, Nichita L, Cijevschi Prelipcean C, Drug V, Scripcariu V. Pancreatico-Pleural Fistula - from Diagnosis to Management. A Case Report. J Gastrointestin Liver Dis 2019; 27:465-469. [PMID: 30574630 DOI: 10.15403/jgld.2014.1121.274.ple] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Pancreatic pseudocysts are frequent complications of both acute and chronic pancreatitis. By contrast, pancreatico-pleural fistula is rare. Here we report a case of massive pleural effusion secondary to a fistula in the left hemi-diaphragm, between a pancreatic pseudocyst and the left pleura, in a patient with a right kidney tumor and bilateral massive pulmonary thromboembolism. This fistula developed after several episodes of un-investigated acute pancreatitis. The pleural effusion was treated by three thoracocenteses, without recurrence.
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Affiliation(s)
- Catalina Mihai
- Grigore T. Popa University of Medicine and Pharmacy Iași; Gastroenterology and Hepatology Institute, Sf. Spiridon Emergency Hospital Iași, Romania
| | - Mariana Floria
- Grigore T. Popa University of Medicine and Pharmacy Iași;III Medical Clinic, Sf. Spiridon Emergency Hospital Iași, Romania.
| | - Radu Vulpoi
- Grigore T. Popa University of Medicine and Pharmacy Iași; Gastroenterology and Hepatology Institute, Sf. Spiridon Emergency Hospital Iași, Romania
| | - Loredana Nichita
- Grigore T. Popa University of Medicine and Pharmacy Iași; Gastroenterology and Hepatology Institute, Sf. Spiridon Emergency Hospital Iași, Romania
| | - Cristina Cijevschi Prelipcean
- Grigore T. Popa University of Medicine and Pharmacy Iași; Gastroenterology and Hepatology Institute, Sf. Spiridon Emergency Hospital Iași, Romania
| | - Vasile Drug
- Grigore T. Popa University of Medicine and Pharmacy Iași; Gastroenterology and Hepatology Institute, Sf. Spiridon Emergency Hospital Iași, Romania
| | - Viorel Scripcariu
- Grigore T. Popa University of Medicine and Pharmacy Iași;Regional Institute of Oncology, Iași, Romania
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Mihai C, Mihai BM, Dranga M, Drug VL, Covic A, Cijevschi Prelipcean C. Severe hyponatremia after direct-acting antiviral treatment in a patient with virus C compensated liver cirrhosis and kidney transplant. J Gastrointestin Liver Dis 2018; 27:203-204. [PMID: 29922767 DOI: 10.15403/jgld.2014.1121.272.hyp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Cătălina Mihai
- Institute of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy, "Sf. Spiridon" Clinical Hospital, Iași, Romania
| | - Bogdan Mircea Mihai
- Clinical Centre of Diabetes, Nutrition and Metabolic Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, "Sf. Spiridon" Clinical Hospital, Iași, Romania.
| | - Mihaela Dranga
- Institute of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy, "Sf. Spiridon" Clinical Hospital, Iași, Romania
| | - Vasile Liviu Drug
- Institute of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy, "Sf. Spiridon" Clinical Hospital, Iași, Romania
| | - Adrian Covic
- Nephrology Department, Dialysis and Renal Transplant Center, "Grigore T. Popa" University of Medicine and Pharmacy, "Dr. C.I. Parhon" University Hospital Iasi, Romania
| | - Cristina Cijevschi Prelipcean
- Institute of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy, "Sf. Spiridon" Clinical Hospital, Iași, Romania
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Dranga M, Mihai C, Gavrilescu O, Cardoneanu A, Floria M, Mihai B, Cijevschi Prelipcean C. The Role of Combining Biochemical Markers in Assessing the Endoscopic Activity in Ulcerative Colitis. Rev Chim 2018. [DOI: 10.37358/rc.18.5.6305] [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: 11/20/2022]
Abstract
Ulcerative colitis (UC) isa chronic, idiopathic and recurrent inflammatory bowel disease (IBD), characterized by periods of activity and remissionwhose monitoring requires invasive explorations associated with discomfort for the patient and important costs. Mucosal healing became one of the most important therapeutic targets in UC. The aim of our study was to identify a score, made up of noninvasive, available, used in current clinical practice biochemical markers, which should correlate with endoscopic activity in UC. We conducted a prospective study on 114 patients with UC. All patients were assessed both for biological inflammatory markers: erythrocyte sedimentation rate (ESR),C- reactive protein (CRP), fibrinogen, platelets, albumin, fecal calprotectin (FC) and by colonoscopy to estimate the endoscopic activity using Mayo score. By linear regression, we tried to identify a biochemical score correlated with endoscopic activity. Out of the serological markers,ESR (p=0.014), CRP(p= 0.021) and fibrinogen (p=0.035) correlated with the endoscopic activity of the disease. The best sensitivity to determine the endoscopic activity was given by FC (96.05%) with a predictable negative value of 91.1% (p=0.001). The score determined by linear regression: 1 (ESR]15mm/1h) x 0.305 + 1(fibrinogen]340.5mg/dL) x 0.309+1 (CRP] 5 mg/L) + 1 (calprotectin]200 μg/g) had an increased positive predictive value compared to each and one biomarker, nevertheless, with a sensitivity and specificity inferior to that of FC. Up to now, it is the first attempt to achieve a score made up exclusively of biological markers. The obtained score, although with an increased accuracy, has proven to have a lower predictability in comparison with FC used individually and cannot entirely replace colonoscopy.
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Mihai C, Cijevschi Prelipcean C, Dranga M, Gavrilescu O, Cardoneanu A, Lacatusu C, Mihai BM. Correlations Between Inflammatory Biomarkers and Activity in Inflammatory Bowel Diseases. Rev Chim 2018. [DOI: 10.37358/rc.18.3.6181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is an increasing interest in non-invasive methods to assess gut inflammation. The data regarding the correlations between inflammatory markers and activity of inflammatory bowel disease (IBD) are still controversial. In the last years faecal calprotectin became the most widely used biomarker in diagnosis and monitoring the IBD activity. We prospectively studied the correlation between the serological inflammatory markers (platelets, erythrocyte sedimentation rate - ESR, fibrinogen, C Reactive Protein -CRP, ferritin, albumin), faecal calprotectin and severity of IBD in a tertiary referral centre in North-East Romania. Our study demonstrated that is a good correlation between serologic inflammatory markers (platelets, fibrinogen and ferritin, not ESR and albumin) and severity of IBD. CRP is a good marker in Crohn�s disease (CD) but not in ulcerative colitis (UC). Faecal calprotectin (FC) is the best inflammatory biomarker which correlates with activity both in UC and CD. Inflammatory biomarkers, especially FC are an important tool to evaluate patients with IBD.
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Cardoneanu A, Cijevschi Prelipcean C, Danciu M, Mihai C, Dranga M, Gavrilescu O, Rezuş E. Looking beyond gut inflammation in inflammatory bowel disease. Rom J Morphol Embryol 2018; 59:1097-1105. [PMID: 30845290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Patients diagnosed with inflammatory bowel disease (IBD) often develop one or more extraintestinal manifestations (EIM). We performed a prospective study that included 517 patients with IBD (Crohn's disease - CD, ulcerative colitis - UC or undifferentiated colitis - CN) diagnosed between 1975 and 2016 in the Northeastern region of Romania. The patients were extracted from the national database (IBD Prospect). UC cases predominated compared to CD cases (n=368 vs. n=135). Only 10 patients were diagnosed with CN. In the study group, 51 cases with IBD and EIM were identified, having a prevalence of 9.9%. Musculoskeletal manifestations were the most common EIM. Peripheral involvement - arthritis (n=26, 68.42%) predominated, followed by axial damage - sacroiliitis/ankylosing spondylitis (SI∕AS) (n=12, 31.58%) (p=0.001). Patients with CD had a 3.48-fold greater risk of developing joint manifestations [p<0.001, odds ratio (OR)=3.478, 95% confidence interval (CI) 1.779-6.801]. In both CD and UC patients, arthritis cases were the most frequent observed (68.42% vs. 31.58%). Patients with CD had a 5-fold higher risk of developing arthritis (p<0.001, OR=5.009, 95% CI 2.21-11.34). Neither CD, nor UC patients, had a confirmed risk of developing SI∕AS (p=0.468, OR=1.565, 95% CI 0.463-5.293 for CD) (p=0.586, OR=0.714, 95% CI 0.211-2.413 for UC). Cases of arthritis and CD (n=16) mainly correlated with the colonic localization of inflammation (n=7, p=0.723) followed by ileo-colonic form of CD (n=7, p=0.321). Patients with arthritis and UC (n=10) initially correlated with pancolitis (n=5, p=0.072, OR=3.023, 95% CI 0.855-10.69) then with proctitis (n=3, p=0.392) and left-sided colitis (n=2, p=0.024, OR=0.196, 95% CI 0.041-0.938).
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Affiliation(s)
- Anca Cardoneanu
- Department of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania; ; Department of Morphopathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania;
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Trifan A, Stanciu C, Gheorghe L, Iacob S, Curescu M, Cijevschi Prelipcean C, Stefanescu G, Girleanu I, Chiriac S, Mihai C, Brisc C, Goldis A, Sporea I, Miftode E, Bataga S, Rogoveanu I, Preda C, Caruntu FA, Singeap AM. Efficacy and safety of paritaprevir/ritonavir, ombitasvir, and dasabuvir with ribavirin for the treatment of HCV genotype 1b compensated cirrhosis in patients aged 70 years or older. Medicine (Baltimore) 2017; 96:e9271. [PMID: 29390377 PMCID: PMC5815789 DOI: 10.1097/md.0000000000009271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 02/05/2023] Open
Abstract
Advanced age has been a major limitation of interferon-based treatment for chronic hepatitis C virus (HCV) infection because of its poor response and tolerability. Direct-acting antiviral (DAA) drug regimens are safe and highly effective, allowing administration of treatment also in elderly. This study aims to assess the efficacy and safety of paritaprevir/ritonavir, ombitasvir, and dasabuvir (PrOD) with ribavirin for the treatment of patients aged ≥70 years with HCV genotype 1b compensated cirrhosis.A total of 1008 patients with HCV genotype 1b compensated cirrhosis were prospectively treated with PrOD + ribavirin for 12 weeks, between December 2015 and July 2016. Sustained virologic response 12 weeks after the end of treatment (SVR12), adverse effects (AEs), comorbidities, discontinuation, and death rates were recorded. Efficacy and safety of therapy were assessed in patients aged ≥70 years and compared with data from patients <70 years.There were 117 patients aged ≥70 years, preponderantly females (58.9%), mean age 73.3 ± 2.8 years (range 70-82), and 37 (31.6%) were treatment-experienced. Comorbidities were reported in 60.6% of patients ≥70 years and in 39.8% of those <70 years (P < .001). SVR12 rates based on intention-to-treat and per-protocol analyses were 97.4% and 100%, respectively, in patients ≥70 years, compared to 97.8% and 99.6%, respectively, in patients <70 years (P = ns and P = ns). Severe AEs were reported in 4 (3.4%) patients ≥70 years, compared to 23 (2.6%) in those <70 years (P = ns). One death was recorded in a patient aged 79 years (0.9%) and 6 deaths (0.8%) in those <70 years (P = ns).Treatment with PrOD + ribavirin in patients 70 years of age or older with HCV genotype 1b compensated cirrhosis proved as effective, safe, and well tolerated, as it did in younger patients.
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Affiliation(s)
- Anca Trifan
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
- Institute of Gastroenterology and Hepatology, Iasi
| | | | - Liana Gheorghe
- Gastroenterology, “Carol Davila” University of Medicine and Pharmacy
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest
| | - Speranta Iacob
- Gastroenterology, “Carol Davila” University of Medicine and Pharmacy
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest
| | - Manuela Curescu
- Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy
- Department of Infectious Diseases, “Victor Babes” Hospital for Infectious and Lung Diseases, Timisoara
| | | | - Gabriela Stefanescu
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
- Institute of Gastroenterology and Hepatology, Iasi
| | - Irina Girleanu
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
- Institute of Gastroenterology and Hepatology, Iasi
| | - Stefan Chiriac
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
| | - Catalina Mihai
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
- Institute of Gastroenterology and Hepatology, Iasi
| | - Ciprian Brisc
- Gastroenterology, Oradea University of Medicine and Pharmacy
- Department of Gastroenterology, County Clinical Hospital, Oradea
| | - Adrian Goldis
- Gastroenterology, “Victor Babes” University of Medicine and Pharmacy
- Department of Gastroenterology and Hepatology Timisoara, The County Hospital Timisoara
| | - Ioan Sporea
- Gastroenterology, “Victor Babes” University of Medicine and Pharmacy
- Department of Gastroenterology and Hepatology Timisoara, The County Hospital Timisoara
| | - Egidia Miftode
- Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy
- “Sf. Parascheva” Infectious Diseases Clinical Hospital, Iasi
| | - Simona Bataga
- Gastroenterology, Targu Mures University of Medicine and Pharmacy, Targu Mures
- Department of Gastroenterology, Targu Mures Emergency County Hospital
| | - Ion Rogoveanu
- Internal Medicine, Craiova University of Medicine and Pharmacy
- Internal Medicine Department, Emergency Clinical County Hospital Craiova
| | - Carmen Preda
- Gastroenterology, “Carol Davila” University of Medicine and Pharmacy
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest
| | - Florin Alexandru Caruntu
- Infectious Diseases, “Carol Davila” University of Medicine and Pharmacy
- “Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania
| | - Ana-Maria Singeap
- “Grigore T. Popa” University of Medicine and Pharmacy Iasi
- Institute of Gastroenterology and Hepatology, Iasi
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Floria M, Bărboi O, Grecu M, Cijevschi Prelipcean C, Balan G, Drug VL. Atrial fibrillation and sympathovagal balance in patients with gastroesophageal reflux disease. Turk J Gastroenterol 2017; 28:88-93. [PMID: 28134128 DOI: 10.5152/tjg.2017.16540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Similar autonomic innervation of the esophagus and left atrium with sympathovagal imbalance seems to explain the association between non-valvular atrial fibrillation (AF) and gastroesophageal reflux disease (GERD). We aimed to assess this association via parameters of heart rate variability in time (SDNN) and frequency (low-frequency (LF)/high-frequency (HF) ratio) domains by 24-hour electrocardiographic (ECG) Holter monitoring. MATERIALS AND METHODS One hundred thirty-five patients were prospectively included by a joint team consisting of a gastroenterologist and a cardiologist on the basis of the patients' complaints. A diagnosis of GERD was assessed by the gastroenterologist clinically. All patients also underwent upper gastrointestinal endoscopy. RESULTS The patients were included in two groups: 61 patients with GERD (group I) and 74 patients without GERD (group II), with demographic data of 41% male, age 61.5±9 years, and body mass index (BMI) 28.8±4 kg/m2 versus 46% male, age 58±9 years, and BMI 29±4 kg/m2 (all p>0.05). In groups I and II the percentages of patients with AF were 33% and 39%, respectively (p=0.52). Patients with GERD had a relative risk of AF of 1.17 (95% confidence interval [CI] 0.78-1.75; p=0.34). Heart rate variability in terms of the time-domain parameter (SDNN) was statistically significantly lower in the GERD group (97.6±13.7 ms versus 139.9±44.6 ms; p=0.001). The mean value of the frequency-domain parameter (LF/HF ratio) was also lower in the GERD group (0.75±0.17 ms versus 0.76±0.24 ms), but without statistical significance (p=0.930). CONCLUSION Sympathovagal balance seems to be disrupted in patients with GERD, with dominance of the parasympathetic system and an increased risk of arrhythmias, although AF was not significantly more frequent in these patients.
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Affiliation(s)
- Mariana Floria
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania; III Medical Clinic of Sf. Spiridon University Hospital, Iași, Romania.
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Dranga M, Mihai C, Drug V, Dumitrescu G, Prelipcean CC. A rapid test for assessing disease activity in ulcerative colitis. Turk J Gastroenterol 2016; 27:149-55. [PMID: 27015620 DOI: 10.5152/tjg.2016.15408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Direct assessment by endoscopic examination has become a "gold standard" in monitoring patients with ulcerative colitis. However, it is an invasive method, with risks and discomfort for the patients. The aim is therefore to identify a less invasive method of assessing ulcerative colitis activity compared to colonoscopy. MATERIALS AND METHODS A prospective study was conducted among 103 patients with ulcerative colitis. Calprotectin was measured by a semi-quantitative rapid test. For each patient, a complete blood count was performed; liver and kidney functions, glycaemia, serum proteins, and inflammatory markers were also evaluated. RESULTS The Mayo score showed direct correlations with fecal calprotectin, C-reactive protein, and the erythrocyte sedimentation rate (p<0.05) and indirect correlations with hemoglobin (p=0.139). The sensitivity and specificity of calprotectin were 98.0% and 76.7%, respectively. Subsequently, combined analysis of the markers' sensitivity/specificity was conducted. CONCLUSION The semi-quantitative rapid test proved to be a good predictor for differentiating the endoscopic active disease from the inactive one. The individual use of fecal calprotectin presents the highest sensitivity in determining the endoscopic activity. Nevertheless, in monitoring patients, combined determination of the three inflammatory markers studied [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), calprotectin] is more useful in reducing unnecessary colonoscopies.
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Affiliation(s)
- Mihaela Dranga
- University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania; Institute of Gastroenterology and Hepatology, Iasi, Romania.
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Cijevschi Prelipcean C, Mihai C. Mucosal Healing In Ulcerative Colitis-The Fountain of Youth? Rev Med Chir Soc Med Nat Iasi 2016; 120:747-749. [PMID: 30137701] [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: 06/08/2023]
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Palaghia M, Mihai C, Perianu L, Furnica C, Lozneanu L, Tarcoveanu E, Cijevschi Prelipcean C. What Can We Find Behind a Parietal Abscess? Case Report. Rev Med Chir Soc Med Nat Iasi 2016; 120:623-627. [PMID: 30142261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We report a rare case of a 71-year-old female who presented to the First Clinic of Surgery from “Sf. Spiridon” Hospital Iasi, Romania with a mass in the left iliac fossa that started to discharge a feculent secretion five days prior to presentation. The patient had a history of constipation, several episodes of hematochezia associated with significant weight loss over the past 6 months. Following evaluation, a diagnosis of enter cutaneous fistula secondary to a locally advanced sigmoid cancer was made. The patient underwent semi-elective resection of the sigmoid tumor (measuring 20 cm) with 10 cm safe margins, and of the involved lymph nodes and abdominal wall. A termino-terminal colo-rectal anastomosis was performed. The patient was discharged the 10th postoperative day after an uneventful evolution for oncological evaluation. The authors presented this case in order to illustrate the challenges associated with diagnostic and therapeutic management of advanced colorectal cancer that has been discovered through a parietal abscess.
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Iacob T, Ţăţulescu DF, Cijevschi Prelipcean C, Dumitraşcu DL. Pathogenic Factors in Postinfectious Irritable Bowel Syndrome - An Update. Rev Med Chir Soc Med Nat Iasi 2016; 120:515-521. [PMID: 30044574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
After acute infectious gastroenteritis, up to thirty percent of patients present prolonged gastrointestinal symptoms and a part of those affected patients can have the diagnostic criteria for postinfectious irritable bowel syndrome. The main diagnosis of a patient with postinfectious irritable bowel syndrome was till this summer, clinically based on Roma III criteria. The Rome IV criteria brought some changes that involve also the post infectious irritable bowel syndrome, recognizing further the postinfectious IBS as a specific entity according to the multidimensional clinical chronic mucosal inflammation triggered by enteric infection, may underlie persistent bowel symptoms in patients who develop postinfectious irritable bowel syndrome.
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Bărboi OB, Prelipcean CC, Mihai C, Floria M, Chirilă I, Darie AM, Drug VL, Bălan G. EXTRADIGESTIVE MANIFESTATIONS OF GASTROESOPHAGEAL REFLUX DISEASE: DEMOGRAPHIC, CLINICAL, BIOLOGICAL AND ENDOSCOPIC FEATURES. Rev Med Chir Soc Med Nat Iasi 2016; 120:282-287. [PMID: 27483705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Gastroesophageal reflux disease (GERD) with extradigestive manifestations is a disorder increasingly recognized both by gastroenterologists, pneumologists, otolaryngologists and cardiologists. AIM To evaluate the demographical, clinical, biological and endoscopic features of the patients with gastroesophageal reflux disease and extradigestive manifestations (chronic laryngitis, asthma, pseudoangina). MATERIAL AND METHODS Prospective case-control study, including 137 patients selected from patients referred to the Iasi Institute of Gastroenterology and Hepatology between July 2014-September 2015. In the presence of typical GERD symptoms (heartburn or regurgitation), the patients were assessed by upper digestive endoscopy for the detection or exclusion of esophagitis. Despite the absence of esophageal lesions, the patients were further assessed by impedance-pHmetry. RESULTS Depending on the dominant extradigestive manifestation, the patients were assigned into 3 groups: 94 chronic laryngitis patients, 24 asthma patients and 19 pseudoangina patients. Females were more frequent among pseudoangina patients (68.4%). Mean age of the male patients with dysphonia or asthma was lower (p=0.002), the majority (78.1%) living in urban areas. Obesity was predominant in pseudoangina group (52.6%), as compared to dysphonia group (16%) the differences being statistically significant (p=0.002). A share of 57.9% of pseudoangina patients were dyslipidemic, in contrast to dysphonia (24.5%) or asthma group (37.5%) (p=0.013). Esophagitis was also more frequent at pseudoangina group (84.2%), but with no significant statistical difference between the study groups (79.8% and 75%, respectively) (p=0.115). It seems that Helicobacterpylori infection tends to be protective in patients with GERD and pseudoangina (RR=0.61), but it can not be extrapolated to the general population (p=0.459). CONCLUSION GERD with extradigestive manifestations is a prevalent and heterogeneous disease. There are demographic, clinical, biological and endoscopic differences between patiens with extradigestive GERD.
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Cucuteanu B, Prelipcean CC, Mihai C, Dranga M, Negru D. SCORING IN ACUTE PANCREATITIS: WHEN IMAGING IS APPROPRIATE? Rev Med Chir Soc Med Nat Iasi 2016; 120:233-238. [PMID: 27483698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Acute pancreatitis (AP) is a frequent presentation to the emergency departments with a rising incidence and a great variability in clinical severity and outcome. The aim of this review is to offer a succinct presentation on acute pancreatitis scoring systems and the use of different imaging methods in severity prediction: Ranson criteria, Glasgow criteria, Hong Kong Score, Acute Physiology and Chronic Health Evaluation II (APACHE II), computed tomography scoring systems, Bedside Index of Severity in Acute Pancreatitis (BISAP) score, Panc 3, Japanese Severity Score (JSS), Harmless Acute Pancreatitis Score (HAPS), Pancreatitis Outcome Prediction (POP), Sequential Organ Failure Assessment (SOFA). This article also describes the Revised Atlanta Classification of AP (2012) and the correlation with computed tomography.
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Palaghia M, Mihai C, Lozneanu L, Ciobanu D, Trofin AM, Rotariu A, Târcoveanu F, Cijevschi Prelipcean C. E-cadherin expression in primary colorectal cancer and metastatic lymph nodes. Rom J Morphol Embryol 2016; 57:205-209. [PMID: 27151709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Colorectal cancer (CRC) is one of the most prevalent malignancies and fourth cause of cancer death worldwide but the current TNM staging system together with clinicopathological characteristics are not sufficient to identify cases that have a poor prognosis. The aim of the current study was to compare E-cadherin expression in primary CRC and lymph node metastases with the one exhibited by normal colic mucosa and normal lymph nodes, and to evaluate its association with disease severity. The authors retrospectively analyzed 65 patients that underwent colectomy for CRC at the First Surgical Clinic, "Sf. Spiridon" Emergency Hospital from Iassy, Romania, over a 10 years period, from January 2004 to December 2013. In all cases, immunohistochemical staining against E-cadherin was performed on primary CRC and associated lymph nodes slices. Primary CRC presented a higher rate (64.62%) of abnormal E-cadherin expression (no staining, cytoplasmic or mixed staining) compared to normal colic mucosa (16.67%) (p<0.001). Both primary CRC and corresponding metastatic lymph nodes displayed a predominantly membranous expression (pure or mixed) of E-cadherin (67.69% and 89.23%, respectively). Well and moderately differentiated tumors displayed an increased E-cadherin expression (44 of 56 cases) compared to poorly differentiated tumors that lacked E-cadherin expression in six out of nine cases. In conclusion, E-cadherin expression abnormalities in CRC are rather qualitative than quantitative and E-cadherin is an important marker of tumor aggressiveness and spreading potential.
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Affiliation(s)
- Mădălina Palaghia
- Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, Iassy, Romania;
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Bărboi OB, Prelipcean CC, Cobzeanu MD, Palade D, Albu-Soda A, Floria M, Chirilă I, Drug VL, Bălan G. THE TRIBES AND TRIBULATIONS OF LARYNGOPHARYNGEAL REFLUX: A REVIEW OF RECENT STUDIES WITH IMPLICATIONS FOR INTERDISCIPLINARY COLLABORATIONS BETWEEN OTOLARYNGOLOGISTS AND GASTROENTEROLOGISTS. Rev Med Chir Soc Med Nat Iasi 2015; 119:967-973. [PMID: 26793836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Laryngopharyngeal reflux has been recognized since 2006 (Montreal Consensus) as an extradigestive manifestation of gastroesophageal reflux disease. However, despite numerous research studies, the relationship between these two pathologies is yet to be fully understood. The aim of this paper is to review the literature of the last five years available via the PubMed database, looking at the controversies about the prevalence, pathophysiology and diagnosis of laryngopharyngeal reflux.
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Badea MA, Prelipcean CC, Mihai C, Drug V. Current concepts in minimal hepatic encephalopathy. Rev Med Chir Soc Med Nat Iasi 2015; 119:9-17. [PMID: 25970936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Minimal hepatic encephalopathy (MHE) defines the presence of neurocognitive impairments in patients with cirrhosis or portal-systemic shunting that show a normal neurologic and psychiatric status on clinical examination. Although ammonia has the central role in MHE pathogenesis, factors such as infection, oxidative stress, manganese or intestinal bacterial overgrowth contribute to the development of the neurocognitive deficits associated with this disease. Many methods have proven useful in identifying MHE but because of the major drawbacks (standardization requirements, high price, sophisticated equipment, and limited access) a gold-standard test is still missing. Although beneficial, the treatment of MHE is not routinely recommended and should be taken into consideration in patients at risk for accidents and in those with cognitive complaints or decline in work performance.
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Negreanu L, Bataga S, Cijevschi Prelipcean C, Dobru D, Diculescu M, Dumitru E, Gheonea DI, Gheorghe L, Gheorghe C, Goldis A, Mateescu BR, Tantau M, Trifan A. Excellence Centers in Inammatory Bowel Disease in Romania: a Measure of the Quality of Care. JGLD 2014; 23:333-337. [DOI: 10.15403/jgld.2014.1121.233.ln1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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Prelipcean CC, Gogălniceanu P, Mihai C. Viral hepatitis C in 2014--the beginning of the end? Rev Med Chir Soc Med Nat Iasi 2014; 118:272-278. [PMID: 25076687] [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: 06/03/2023]
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Marineaţă A, Rezuş E, Mihai C, Prelipcean CC. Extra intestinal manifestations and complications in inflammatory bowel disease. Rev Med Chir Soc Med Nat Iasi 2014; 118:279-288. [PMID: 25076688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), doesn't affect only the intestinal tract, but also involve other organs such as: eyes, skin, joints, liver and biliary tracts, kidneys, lungs, vascular system. It is difficult to differentiate the true extraintestinal manifestations from secondary extraintestinal complications. The pathogenetic autoimmune mechanisms include genetic susceptibility, antigenic display of autoantigen, aberrant self-recognition and immunopathogenetic autoantibodies against organ-specific cellular antigens shared by colon and extra-colonic organs. An important role is owned by microbes due to molecular mimicry. This paper reviews the frequency, clinical presentation and therapeutic implications of extraintestinal symptoms in inflammatory bowel diseases.
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Dumitrescu G, Mihai C, Dranga M, Prelipcean CC. Serum 25-hydroxyvitamin D concentration and inflammatory bowel disease characteristics in Romania. World J Gastroenterol 2014; 20:2392-2396. [PMID: 24605037 PMCID: PMC3942843 DOI: 10.3748/wjg.v20.i9.2392] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/19/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe the relationship between vitamin D levels and inflammatory bowel disease (IBD) characteristics in northeastern Romanian patients.
METHODS: This was a prospective study of 47 consecutive IBD patients admitted to The Institute of Gastroenterology and Hepatology in Iasi, Romania between March 2011 and June 2012. The diagnosis of IBD was established based on endoscopic, histologic and radiologic findings. Demographic data, disease characteristics, ongoing treatments and biological parameters of patients (including markers of inflammation: C-reactive protein level, fibrinogen level, and erythrocyte sedimentation rate) were recorded. Serum vitamin D levels were measured and compared with age- and sex-matched healthy volunteers from the same geographic area. Vitamin D levels were defined as sufficient (> 30 ng/mL), insufficient (20-30 ng/mL), or severely deficient (< 20 ng/mL).
RESULTS: Thirty-three of the IBD patients included in this study had ulcerative colitis (UC) and 14 had Crohn’s disease (CD). Only 24% of the UC patients and 21% of the CD patients had sufficient vitamin D levels. The vitamin D levels were significantly lower in the CD patients with moderate to severe disease activity compared to the CD patients in remission or with mild disease activity (16 ± 6 ng/mL vs 26 ± 7 ng/mL; 16 ± 6 ng/mL vs 31 ± 9 ng/mL, respectively, P < 0.05). Vitamin D levels in the UC patients were not influenced by disease activity and no correlation was observed with the inflammation markers tested (C-reactive protein, fibrinogen, and erythrocyte sedimentation rate). No association was observed between vitamin D levels and smoking status or ongoing medication (5ASA, steroids, and anti-TNFα). Newly diagnosed IBD patients had lower vitamin D levels than patients with established cases, though these differences were not significant (UC: 22 ± 9 ng/mL vs 26 ± 12 ng/mL; CD: 18 ± 6 ng/mL vs 27 ± 11 ng/mL, respectively). Although no association was found between the season during which the visit was scheduled and vitamin D levels, the UC patients assessed during the winter tended to have lower levels than those assessed during the summer (22 ± 9 ng/mL vs 28 ± 13 ng/mL, respectively).
CONCLUSION: Vitamin D levels are significantly reduced in IBD patients in northeastern Romania, with the lowest levels occurring in CD patients with moderate to severe disease activity.
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Mihai C, Prelipcean CC, Pintilie I, Nedelciuc O, Jigaranu AO, Dranga M, Mihai B. Nutrition in inflammatory bowel diseases. Rev Med Chir Soc Med Nat Iasi 2013; 117:662-669. [PMID: 24502032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The relationship between nutrition and inflammatory bowel disease (IBD) is a complex one, the evaluation and correction of nutritional deficits being integral part of therapy in these patients. The diet that consists in excessive consumption of meat, sugar, fats (with a higher 0 6 /o) 3 polyunsaturated fatty acids ratio) are factors involved in the epidemiology and pathogenesis of IBD. Malnutrition is present among most IBD patients, being the result of multiple mechanisms from digestive symptoms to inflammatory process, intestinal resection and administration of medications. Oral diet is high-calorie, high protein at correcting the vitamin and mineral deficiencies. Enteral diet has both an adjuvant role and that of inducing and maintaining remission as single treatment, particularly in children. Parenteral nutrition is reserved for patients with obstruction, fistula, toxic megacolon, short bowel syndrome, severe malabsorption, and other conditions that make enteral nutrition impossible or inefficient.
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Affiliation(s)
- Cătălina Mihai
- Discipline of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Grigore T. Popa", Iasi
| | | | - Iulia Pintilie
- Discipline of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Grigore T. Popa", Iasi
| | - Otilia Nedelciuc
- Discipline of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Grigore T. Popa", Iasi
| | - Anca-Olivia Jigaranu
- Discipline of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Grigore T. Popa", Iasi
| | - Mihaela Dranga
- Discipline of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Grigore T. Popa", Iasi
| | - B Mihai
- Discipline of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy, Grigore T. Popa", Iasi
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Mihai C, Mihai B, Drug V, Cijevschi Prelipcean C. Gastric bezoars--diagnostic and therapeutic challenges. J Gastrointestin Liver Dis 2013; 224:111. [PMID: 23539409] [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: 06/02/2023]
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Prelipcean CC, Mihai C. Chronic hepatitis C virus infection in 2013--quo vadis? Rev Med Chir Soc Med Nat Iasi 2013; 117:7-10. [PMID: 24505885] [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: 06/03/2023]
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Dumitrescu G, Mihai C, Dranga M, Prelipcean CC. Bone mineral density in patients with inflammatory bowel disease from north-eastern Romania. Rev Med Chir Soc Med Nat Iasi 2013; 117:23-28. [PMID: 24505888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Inflammatory bowel disease (IBD) is associated with increased prevalence of bone demineralization. One of the risk factors for low bone density is the inadequate level of 25-OH vitamin D. AIM To determine the degree of bone demineralization in patients with IBD and the main causes leading to this condition. MATERIAL AND METHODS A prospective study was carried out between April, 2011 and October, 2012 in 143 patients diagnosed with IBD at the Gastroenterology and Hepatology Centre of Iaşi.The IBD diagnosis was made on clinical, biological, and endoscopic criteria and confirmed histologically. The diagnosis of osteopenia/osteoporosis was based on World Health Organization criteria. RESULTS Osteopenia was found in 48.07% of the patients with ulcerative colits (UC) and in 56.41% of the patients with Crohn's disease (CD); osteoporosis was present in 18.26% of the patients with UC and 15.38% of those with CD. The main causes identified were inadequate vitamin D level, extended high-dose corticotherapy in patients with CD, BMI < 18.5 kg/m2, and smoking, especially in the patients with UC. CONCLUSIONS Bone demineralization and hypovitaminosis D are frequently associated with IBD and require specific treatment.
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Affiliation(s)
- Gabriela Dumitrescu
- Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iasi
| | - Cătălina Mihai
- Discipline of Medical Semiology, IGH, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iasi
| | - Mihaela Dranga
- Discipline of Medical Semiology, IGH, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iasi
| | - Cristina Cijevschi Prelipcean
- Discipline of Medical Semiology, IGH, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iasi
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Dumitrescu G, Dranga M, Pintilie IA, Nedelciuc O, Mihai C, Prelipcean CC. The prevalence of anaemia in patients with inflammatory bowel diseases in North-Eastern Romania. Rev Med Chir Soc Med Nat Iasi 2012; 116:968-974. [PMID: 23700874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED Anemia is a frequent complication of inflammatory bowel diseases (IBD). The main incriminated mechanisms are the iron deficiency and the chronic inflammation. The aim of this study was to determine the prevalence of anemia in IBD patients and to identify the main causes. MATERIAL AND METHODS A prospective study was carried out between April 1st 2011 and April 30th 2012 on a batch of 144 IBD patients diagnosed in the Gastroenterology and Hepatology Center of lasi. The IBD diagnosis was based on clinical, biological, endoscopic and histological criteria. The anemia diagnosis was based on the World Health Organization criteria. RESULTS Anemia was present in 40.27 % of IBD patients. The main cause identified was mixed type anemia, followed by iron deficiency and inflammation. Iron deficiency anemia was present especially in patients with ulcerative colitis with long evolution, frequent activity spurts and extended forms of diseases; an inflammatory anemia emerged mainly in patients with exterided and moderate-severe forms of the diseases. CONCLUSIONS Anemia remains a frequently associated pathology to the inflammatory bowel disease that requires specific management.
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Affiliation(s)
- Gabriela Dumitrescu
- University of Medicine and Pharmacy Grigore T Popa Iasi, Faculty of Medicine
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Sporea I, Popescu A, Gheorghe L, Cijevschi Prelipcean C, Spârchez Z, Voiosu R. "Quo vadis" liver biopsy? A multi-centre Romanian study regarding the number of liver biopsies performed for chronic viral hepatitis. J Gastrointestin Liver Dis 2012; 21:326. [PMID: 23012678] [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: 06/01/2023]
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Dranga M, Dumitrescu G, Badea M, Blaj A, Mihai C, Prelipcean CC. The semi-quantitative calprotectin rapid test--is it useful in inflammatory bowel disease? Rev Med Chir Soc Med Nat Iasi 2012; 116:761-765. [PMID: 23272524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To assess the efficiency of the dosage of the semi-quantitative calprotectin rapid test in evaluating the activity of inflammatory bowel diseases. MATERIAL AND METHODS The prospective study included 87 patients with BII (50 with ulcerative colitis, 37 with Crohn disease) hospitalized between January 2011 - May 2012. The diagnosis was confirmed by colonoscopy and histological examination. Fecal calprotectin was measured by means of a semi-quantitative rapid test. RESULTS There were 50 patients with UC and 37 with BC. 96% of the UC patients were evaluated during the active disease. 21 of them had a severe episode of active disease, 16 had a moderate one, while 10 had a mild activity episode. The correlation between the calprotectin values and lesions localization was analyzed, without finding any statistical differences. The data have shown a very strong correlation between the severity of the active disease, assessed through the UCDAI (Mayo) score, and the calprotectin value. Patients with CD manifested a linear correlation between the severity of the active disease and the calprotectin value. CONCLUSIONS The rapid test for assessing calprotectin could be a useful non-invasive marker in appreciating the severity of clinical and biological disease activity.
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Affiliation(s)
- Mihaela Dranga
- University of Medicine and Pharmacy Grigore T. Popa-Iaşi School of Medicine
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Nedelciuc O, Pintilie I, Dranga M, Mihai C, Prelipcean CC. Quality of life in patients with ulcerative colitis. Rev Med Chir Soc Med Nat Iasi 2012; 116:756-760. [PMID: 23272523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED Patients with inflammatory bowel disease (IBD) have to live with the perspective of a potential disability, which may lead in time to impaired quality of life (QoL). In order to fully understand the impact of IBD on patients and their careers we need to quantify the QoL. AIM To evaluate HRQol in ulcerative colitis patients as opposed to the general population and to identify the significant changes of HRQoL in accordance with the specific progression of UC. METHODS The prospective study (January 2010 - December 2012), included 105 patients with ulcerative colitis (UC). Disease activity was quantified by means of the Truelove and Witts score (mild, moderate and severe). All patients were administered a self-completed IBD questionnaire (IBDQ). Lower scores were related to a worse QoL. Statistical analysis was performed and di fferences were considered significant when p < or = 0.05. RESULTS Ninety-one percent (91%) were admitted with a flare, while they were asked to fill in the IBDQ. Proctitis was met in 2.94% of the cases, left-sided colitis in 71.1% and pancolitis in 26%. There were 32 patients with mild activity, 62 with moderate activity and only 3 with severe activity. The range score for QoL was 90-180. In proctitis: 80-190, in left-side colitis: 120-200, in pancolitis: 70-160 (p>0.05). The patients with severe form had a lower score (50-140) than patients in remission (130-180) (p<0.01). CONCLUSION Patients with UC have significantly influenced the QoL as compared to the general population. We found no significant differences regarding the extension of the lesions. The severity of the flare had a significant impact on the QoL.
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Affiliation(s)
- Otilia Nedelciuc
- University of Medicine and Pharmacy, Grigore T. Popa-Iaşi School of Medicine
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Prelipcean CC, Mihai C, Gogălniceanu P, Mihai B. Extrahepatic complications of chronic cholestasis: current diagnosis and treatment. Rev Med Chir Soc Med Nat Iasi 2012; 116:490-499. [PMID: 23077943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pruritus, fatigue and osteoporosis are the main symptoms of the extra hepatic manifestations of chronic cholestasis that affect patients' quality of life. Pruritus affects more often female patients, varies as intensity during a day and for longer period of time, typically can be localized on the palms of hands and soles of feet or can be generalized. Pruritus can be treated with anions resines exchange--cholestiramine, the pregnanne X receptor agonist Rifampicine, Naltrexone. Liver transplantation can be considered if severe pruritus remains refractory to all medical treatments. Fatigue is the most disabling complain in chronic colestasis. No specific therapies are available for fatigue and liver transplantation doesn't improve it. Osteoporosis and the risk of fractures are more severe with the duration and severity of hepatic disease. For treatment are recommended regular physical exercise, vitamin D and Ca supplimentation and bisphosphonates (Alendronate 70 mg/week) in severe cases. Only patients with atherosclerotic risk and hyperlipemia can be treated with statines. Fat soluble vitamin supplementation can be administrated only in symptomatic and proved vitamin deficiency.
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Affiliation(s)
- Cristina Cijevschi Prelipcean
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa"--Iaşi
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Prelipcean CC, Fierbinteanu-Braticevici C, Drug VL, Lăcătuşu C, Mihai B, Mihai C. [Liver cirrhosis--procoagulant stasis]. Rev Med Chir Soc Med Nat Iasi 2011; 115:678-685. [PMID: 22046771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Abnormal hemostasis tests and bleeding are often associated in liver cirrhosis. In these patients the balance between hypo- and hypercoagulation status is more fragile than in healthy people. In the hemostatic abnormalities associated with chronic liver disease are two main chategory factors: favoring hemorrage and favoring thrombosis. The main factors that favoring hemorrage are: low platelet count, impaired platelet function, decreased levels coagulation factors (II, V, VII, IX, X, XI), quantitative and qualitative abnormalities of fibrinogen, vitamin K defiency, low levels of trombin activable fibrinolisis inhibitor, activat plasminogenic tisular. The factors favoring thrombosis are elevated levels of factors VIII and von Willebrand, decreased levels of protein C, protein S, antithrombin, decreased levels of plasminogen. Traditionally it was thought that arterial and venous thrombosis is rare events in cirrhotic patients but recent studies have indicated that thrombotic complications can paradoxically occur even if clinically an increased risk of hemorrhage is considered. Treatment of venous thrombosis in patients with cirrhosis using routine anticoagulation with heparin and vitamin K antagonists has been described but with a high level of bleeding complications. So, based on the limited data available, AASLD guidelines stated no recommendations for or against the use of anticoagulation in cirrhotic patients with portal thrombosis. Although abnormal hemostasis tests and bleeding are often associated in patients with chronic liver disease it is a relatively poor correlation between hemorrhagic risk and routine diagnostic tests of hemostasis. Management of bleeding complications in liver cirrhosis varies and no general guidelines are available. The main therapeutic strategies are: red cell concentrate, plasma, platelet concentrate, recombinant factor VIIa, factor concentrates, desmopressin, antifibrynolitic agents, thrombopoietin receptor agonists, antibiotics. Clinical studies examining safety and efficacy of the various products for the different bleedeing or trombotic complications of liver cirrhosis need to be initiaded.
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Mihai C, Mihai B, Crumpei F, Barr C, Ferariu D, Gergescu S, Cijevschi Prelipcean C. Multiple focal liver lesions - diagnosis challenges. Case report. Med Ultrason 2011; 13:72-75. [PMID: 21390346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Multiple focal liver lesions can generate diagnosis difficulties in daily practice. This paper present the case of a 53 years old patient with multiple hyperechoic liver lesions suggestive for hepatic hemangiomas, detected during the ultrasonographic exam. Contrast enhanced ultrasonography indicated focal hepatic steatosis, while computed tomography proposed possible liver metastasis. The histological diagnosis was focal nodular hyperplasia associated with hepatic steatosis. The peculiarity of the case was the association of multiple focal nodular hyperplasia lesions with hepatic steatosis and atypical imaging findings that required histological confirmation.
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Affiliation(s)
- Cătălina Mihai
- Gr. T. Popa University of Medicine and Pharmacy, Bd. Independenţei, nr. 1, 700111, Iaşi, Romania.
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Burcă P, Mihai B, Mihai C, Drug VL, Dranga M, Lăcătuşu C, Prelipcean CC. [Cardiomyopathy in liver cirrhosis--an undiagnosed entity?]. Rev Med Chir Soc Med Nat Iasi 2010; 114:319-326. [PMID: 20700961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Cirrhotic cardiomyopathy is a condition recently known in liver cirrhosis consisting of systolic dysfunction to stress factors, diastolic dysfunction and electrophysiological abnormalities in the absence of cardiac disease. The prevalence of cirrhotic cardiomyopathy remains unknown until now. It can be diagnosed by using a combination of electrocardiograph, 2-dimensional echocardiography, and various serum markers (brain natriuretic factor--BNP, proBNP, TnI). Pathogenic mechanisms underlying cirrhotic cardiomyopathy development include abnormal signaling betaadrenergic, cardiomyocites membrane fluidity changes, interstitial fibrosis, myocardial hypertrophy, altered transmembrane ion channels as intervention with negative inotropic effect of different substances whose concentration is increased in cirrhosis. Major stresses on the cardiovasculary system such as liver transplantations, infections, insertion of transjugular portosystemic stent-shunt (TIPSS) have been demonstrated to put in evidence the presence of cirrhotic cardiomyopathy. Heart failure is a significant cause of mortality after liver transplantation but the improvement of liver function determines cardiac abnormalities reversal. Current management recommendations include empirical, nonspecific and mainly supportive measures, no specific treatment can be recommended, and cardiac failure should be treated as in non-cirrhotic patients with sodium restriction, diuretics, and oxygen therapy when necessary. The exact prognosis remains unclear. The extent of cirrhotic cardiomyopathy generally correlates to the degree of liver insufficiency. Reversibility is possible (either pharmacological or after liver transplantation), but further studies are needed.
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Affiliation(s)
- Paula Burcă
- Universitatea de Medicină şi Farmacie Gr.T. Popa, Facultatea de Medicinaă, Institutul de Gastroenterologie şi Hepatologie Iaşi
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Gherasim S, Dranga M, Mihai C, Prelipcean CC. [Clinical characteristics of gastritis due to excessive alcohol drinking. Observation of 117 patients at Dorohoi Hospital]. Rev Med Chir Soc Med Nat Iasi 2009; 113:1066-1069. [PMID: 20191875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED The aim of the study was to assess the symptoms manifested in patients with gastritis (gastropathies) due to excessive alcohol consumption. MATERIAL AND METHOD The study sample consisted of 117 cases admitted in the Town Hospital Dorohoi, Botoşani County, between 2002-2006. RESULTS Data were collected using special epidemiological questionnaires and statistical records of the hospital and Public Health Office. Anamnesis, clinical examination, following by endoscopy and histological and radiological examination completed the diagnosis. Although interventions regarding prevention methods were permanently applied, their efficiency was suboptimal for most of the patients suffering from chronic gastritis and excessive alcohol consumption.
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Affiliation(s)
- S Gherasim
- Secţia Medicină internă, Spitalul Municipal Dorohoi
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