Drug Survival, Effectiveness and Safety of Secukinumab in Axial Spondyloarthritis up to 4 Years: A Real-Life Single Center Experience

(1) Objective: The main aims of our study were to explore the drug survival and effectiveness of secukinumab in patients with axial spondyloarthritis (axSpA). (2) Methods: We underwent a retrospective analysis of consecutive axSpA treated with secukinumab as a first line of biologics or at switch in a biologic-experienced population. Efficacy data, indicating improvement in inflammation parameters (such as C-reactive protein and erythrocyte sedimentation rate) and disease activity scores (such as Ankylosing Spondylitis Disease Activity Score [ASDAS-CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), and patient-reported outcomes (pain), were assessed at 6, 12, 24, 36 and 48 months. The drug survival rate, dropout rate and discontinuation reasons (efficacy versus safety) of secukinumab were assessed in subgroup analysis (axSpA with and without exposure to biologics). (3) Results: In total, 46 patients were exposed to the IL-17A inhibitor secukinumab. The drug survival for axSpA patients 59.7% at 12 months and 31.3% at 24 months. There were no statistically significant differences in the median drug survival between biologic-naïve versus biologic-experienced subgroups. (4) Conclusions: Secukinumab has demonstrated effectiveness and safety in treating a cohort of axSpA patients in real-world settings, with a notable retention rate of the drug.

The use of intravenous immunoglobulin in the treatment of Hashimoto's encephalopathy: case based review

Background

Hashimoto's encephalopathy (HE) is a controversial immunological neuropsychiatric disease, with a poorly understood pathogenesis. It is characterized by symptoms of acute or subacute encephalopathy which usually occur in the presence of elevated levels of antithyroid antibodies. Even though it is also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), some cases appear to be steroid-resistant. This review examined whether treatment of Hashimoto's encephalopathy with intravenous immunoglobulin (IVIG) is associated with better clinical outcomes than the standard therapy. Additionally, we presented a case of a 59-year-old man who presented with severe neurological manifestations and was successfully treated with intravenous immunoglobulin.

Methods

The online databases PubMed and EMBASE were searched.

Results

A total of 1,365 articles were identified. After the deletion of 112 duplicates, 1,253 studies were screened by evaluating the title and abstract, focusing on Hashimoto's encephalopathy cases where IVIG were used. 846 studies were excluded because they were not relevant to the topic or included pediatric population. Therefore, 407 full-text articles were assessed for eligibility. The final analysis included 14 eligible articles after 393 were excluded (irrelevant texts, not written in English, full-text not available). In the majority of the selected case-reports, IVIG was associated with a good outcome, sometimes even with dramatic improvements in patient's status.

Conclusion

In last years, intravenous immunoglobulin therapy proved its utility in Hashimoto's encephalopathy's treatment, being a well tolerated therapy associated with remarkable improvement in patient's status. Further research is still needed in order to define the optimal treatment protocol for Hashimoto's encephalopathy and to establish if intravenous immunoglobulin can also be used as a first-line therapy, alone or in combination with steroids.

The Beginning of an ECLS Center: First Successful ECPR in an Emergency Department in Romania-Case-Based Review

According to the latest international resuscitation guidelines, extracorporeal cardiopulmonary resuscitation (ECPR) involves the utilization of extracorporeal membrane oxygenation (ECMO) in specific patients experiencing cardiac arrest, and it can be considered in situations where standard cardiopulmonary resuscitation efforts fail if they have a potentially reversible underlying cause, among which we can also find hypothermia. In cases of cardiac arrest, both witnessed and unwitnessed, hypothermic patients have higher chances of survival and favorable neurological outcomes compared to normothermic patients. ECPR is a multifaceted procedure that requires a proficient team, specialized equipment, and comprehensive multidisciplinary support within a healthcare system. However, it also carries the risk of severe, life-threatening complications. With the increasing use of ECPR in recent years and the growing number of centers implementing this technique outside the intensive care units, significant uncertainties persist in both prehospital and emergency department (ED) settings. Proper organization is crucial for an ECPR program in emergency settings, especially given the challenges and complexities of these treatments, which were previously not commonly used in ED. Therefore, within a narrative review, we have incorporated the initial case of ECPR in an ED in Romania, featuring a successful resuscitation in the context of severe hypothermia (20 °C) and a favorable neurological outcome (CPC score of 1).

Severe Intentional Corrosive (Nitric Acid) Acute Poisoning: A Case Report and Literature Review

Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the evolution and possible complications of poisoning. Interventional and reconstructive surgical procedures may significantly improve the life expectancy and quality of life of patients following intoxication with corrosive substances.

Infective Endocarditis during Pregnancy-Keep It Safe and Simple!

The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike.

Role of Chemerin and Perivascular Adipose Tissue Characteristics on Cardiovascular Risk Assessment by Arterial Stiffness Markers in Patients with Morbid Obesity

BACKGROUND AND OBJECTIVE

The development of arterial stiffness (AS) in obesity is a multifactorial and complex process. The pleomorphic actions of adipokines and their local activity in perivascular adipose tissue (PVAT) are potential modulators of AS appearance and progression. We aimed to assess the correlations between two adipokines (chemerin, adiponectin), PVAT morphological changes (adipocyte size, blood vessel wall thickness) and AS parameters in the special subgroup of patients with morbid obesity.

MATERIAL AND METHODS

We enrolled 25 patients with morbid obesity and 25 non-obese patients, who were age- and gender-matched, untreated for cardiovascular risk factors, and admitted to hospital for laparoscopic surgical procedures (bariatric surgery for morbid obesity and non-inflammatory benign pathology surgery for non-obese patients). Before the surgical procedures, we evaluated demographic and anthropometric data and biochemical parameters including the studied adipokines. Arterial stiffness was evaluated using a Medexpert ArteriographTM TL2 device. In both groups, adipocyte size and vascular wall thickness as well as local adiponectin activity were analyzed in PVAT from intraoperative biopsies.

RESULTS

In our study, adiponectin (p = 0.0003), chemerin (p = 0.0001) and their ratio (p = 0.005) had statistically significant higher mean values in patients with morbid obesity compared to normal-weight patients. In patients with morbid obesity there were significant correlations between chemerin and AS parameters such as aortic pulse wave velocity (p = 0.006) and subendocardial viability index (p = 0.009). In the same group adipocyte size was significantly correlated with another AS parameter, namely, aortic systolic blood pressure (p = 0.030). In normal-weight patients, blood vessel wall thickness positively correlated with AS parameters such as brachial (p = 0.023) and aortic augmentation index (p = 0.023). An important finding was the negative adipoR1 and adipoR2 immunoexpression in PVAT adipocytes of patients with morbid obesity. Additionally, we found significant correlations between blood vessel wall thickness and blood fasting glucose (p < 0.05) in both groups.

CONCLUSIONS

Chemerin and adipocyte size could be predictive biomarkers for AS in patients with morbid obesity. Given the small number of patients included, our results need further validation.

Corneal biomechanical properties in myopic and emmetropic children

OBJECTIVE

The purpose of this study was to investigate the relationship between corneal biomechanics and ocular morphology in myopic children and adolescents.

PATIENTS AND METHODS

The study included 170 right eyes, from 170 patients under the age of 18 years, who underwent a complete ophthalmologic examination, gathering the following data: spherical equivalent (SE) (under pharmacological cycloplegia), biomechanical parameters - corneal hysteresis (CH) and corneal resistance factor (CRF), structural parameters - axial length (AL) and central corneal thickness (CCT).

RESULTS

The average age of the patients was 15.26 years old (55.29% girls, 44.70% boys). Out of the 170 eyes, 111 were myopic eyes and 59 were emmetropic. Myopic eyes had a significantly lower CH (p=0.001), CRF (p=0.002) and CCT (p=0.009), and higher AL (p<0.001) than emmetropic eyes. The AL and CCT were significantly higher in myopic males, compared to myopic females (p<0.001 and 0.001). In myopes, we found statistically significant negative correlations between AL and CH (Pearson's r=-0.218), CRF (r=-0.226) and also SE (r=-0.539), and positive between SE and either CH (r=0.193) or CRF (r=0.201).

CONCLUSIONS

Corneal biomechanical properties are significantly related to myopia parameters in children.

Determinants of Arterial Stiffness in Patients with Morbid Obesity. The Role of Echocardiography and Carotid Ultrasound Imaging

Background and objective: Morbid obesity is accompanied by an increased cardiovascular (CV) risk, which justifies a multidisciplinary, integrative approach. Arterial stiffness has a well-defined additional role in refining individual CV risk. Given that echocardiography and carotid ultrasound are usual methods for CV risk characterization, we aimed to identify the imaging parameters with a predictive value for early-onset arterial stiffness. Material and methods: We conducted a study in which 50 patients (divided into two equal groups with morbid obesity and without obesity), age and gender matched, untreated for cardiovascular risk factors, were addressed to bariatric surgery or non-inflammatory benign pathology surgery. Before the surgical procedures, we evaluated demographics, anthropometric data and biochemical parameters including adipokines (chemerin, adiponectin). Arterial stiffness was evaluated using the Medexpert ArteriographTM TL2 device. Transthoracic echocardiography and carotid ultrasound were also performed. We also analyzed adipocyte size and vascular wall thickness in intraoperative biopsies. Results: Left ventricle (LV) mass index (p = 0.2851), LV ejection fraction (LVEF) (p = 0.0073), epicardial adipose tissue thickness (p = 0.0001) as echocardiographic parameters and carotid intima–media thickness (p = 0.0033), relative wall thickness (p = 0.0295), wall to lumen thickness ratio (p = 0.0930) and carotid cross-sectional area (p = 0.0042) as ultrasound parameters were significant measures in our groups and were assessed in relation to adipocyte size, blood vessel wall thickness and adipokines serum levels. Statistical analysis revealed directly proportional relationships between LV mass index (p = 0.008), carotid systolic thickness of the media (p = 0.009), diastolic thickness of the media (p = 0.007), cross-sectional area (p = 0.001) and blood vessel wall thickness. Carotid relative wall thickness positively correlates with adipocyte size (p = 0.023). In patients with morbid obesity, chemerin and adiponectin/chemerin ratio positively correlates with carotid intima–media thickness (p = 0.050), systolic thickness of the media (p = 0.015) and diastolic thickness of the media (p = 0.001). The multiple linear regression models revealed the role of epicardial adipose tissue thickness and carotid cross-sectional area in predicting adipocyte size which in turn is an independent factor for arterial stiffness parameters such as pulse wave velocity, subendocardial viability ratio and aortic augmentation index. Conclusions: Our results suggest that epicardial adipose tissue thickness, carotid intima–media thickness, relative wall thickness and carotid cross-sectional area might be useful imaging parameters for early prediction of arterial stiffness in patients with morbid obesity.

Native and Prosthetic Simultaneously Double Valve Infective Endocarditis with Enterococcus faecalis-Case-Based Review

Infective endocarditis is a severe infective heart disease, commonly involving native or prosthetic valves. It frequently presents with univalvular involvement and simultaneous double valve or multivalvular involvement is rarely described. The third leading cause of infective endocarditis worldwide is Enterococcus faecalis, which is associated with high mortality rates despite important advances in antimicrobial therapy. It develops secondary to enterococcal bacteremia, with its origin from the gastrointestinal or genitourinary tract and predominantly affecting the elderly population with multiple comorbidities. Clinical presentation is usually less typical, and the treatment is challenging. It can be marked by antibiotic resistance, side effects, and subsequent complications. Surgical treatment can be considered if deemed appropriate. To the best of our knowledge, we present the first case-based narrative review of Enterococcus faecalis double valve endocarditis involving both the aortic native and prosthetic mitral valve, highlighting the clinical characteristics, treatment, and complications of this condition.

Management of Hyponatremia in Heart Failure: Practical Considerations

Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated, fluid-overloaded patients. The pathophysiology of hyponatremia in patients with heart failure is complex, including numerous mechanisms: increased activity of the sympathetic nervous system and the renin-angiotensin-aldosterone system, high levels of arginine vasopressin and diuretic use. Symptoms are usually mild but hyponatremic encephalopathy can occur if there is an acute decrease in serum sodium levels. It is crucial to differentiate between dilutional hyponatremia, where free water excretion should be promoted, and depletional hyponatremia, where administration of saline is needed. An inappropriate correction of hyponatremia may lead to osmotic demyelination syndrome which can cause severe neurological symptoms. Treatment options for hyponatremia in heart failure, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The aim of this review is to summarize the principal mechanisms involved in the occurrence of hyponatremia, to present the main guidelines for the treatment of hyponatremia, and to collect and analyze data from studies which target new treatment options, such as vaptans.

The Value of Early and Follow-Up Elevated Scores Based on Peripheral Complete Blood Cell Count for Predicting Adverse Outcomes in COVID-19 Patients

Background: The ongoing COVID-19 pandemic has put a constant strain on hospital resources, so there is a dire need for investigation methods that are widely available and that can predict mortality and the need for critical care. Hematological indices, which can be easily calculated from a complete blood count (CBC), are useful in determining a patient’s inflammatory response to infectious diseases. Aim: This was a prospective cohort study that aimed to assess the prognostic value of scores based on CBCs in hospitalized patients with mild or moderate COVID-19 and medical comorbidities regarding the need for intensive care unit (ICU) therapy and short-term mortality. Methods: We included 607 patients with confirmed COVID-19, followed up for the need for ICU admission (15.5%) and 30 day mortality post-discharge (21.7%). CBC-derived scores were tested upon emergency department (ED) admission and after a median of 8 days. Results: In a multivariate model, elevated followed-up neutrophil-to-lymphocyte ratio (NLR) predicted increased odds for ICU admission (OR: 1.14 [95%CI: 1.06−1.22], p < 0.001) and short-term mortality (OR: 1.30 [95%CI: 1.09−1.57], p = 0.005). Monocyte-to-lymphocyte ratio (MLR) predicted 2.5-fold increased odds for ICU admission and 2.2-fold increased odds for mortality. Conclusion: NLR and MLR followed up 8 days post-admission are predictive for adverse outcomes in mild or moderate COVID-19 patients.

The Value of Troponin as a Biomarker of Chemotherapy-Induced Cardiotoxicity

In cancer survivors, cardiac dysfunction is the main cause of mortality. Cardiotoxicity represents a decline in cardiac function associated with cancer therapy, and the risk factors include smoking, dyslipidemia, an age of over 60 years, obesity, and a history of coronary artery disease, diabetes, atrial fibrillation, or heart failure. Troponin is a biomarker that is widely used in the detection of acute coronary syndromes. It has a high specificity, although it is not exclusively associated with myocardial ischemia. The aim of this paper is to summarize published studies and to establish the role of troponin assays in the diagnosis of cardiotoxicity associated with various chemotherapeutic agents. Troponin has been shown to be a significant biomarker in the diagnosis of the cardiac dysfunction associated with several types of chemotherapeutic drugs: anthracyclines, anti-human epidermal growth factor receptor 2 treatment, and anti-vascular endothelial growth factor therapy. Based on the data available at this moment, troponin is useful for baseline risk assessment, the diagnosis of cardiotoxicity, and as a guide for the initiation of cardioprotective treatment. There are currently clear regulations regarding the timing of troponin surveillance depending on the patient’s risk of cardiotoxicity and the type of medication administered, but data on the cut-off values of this biomarker are still under investigation.

From chronic pruritus to neuroendocrine tumor: A case report

Chronic pruritus is a major and distressing symptom of many diseases of dermatological, neurological, psychogenic or systemic origin. This chronic itch could be a presenting sign of malignancy; therefore, paraneoplastic pruritus has also been associated with neuroendocrine tumors (NETs). This article focuses on a patient presenting with chronic pruritus for the past 12 months and who received numerous treatment schemes with very poor clinical improvement, that presented in the hospital for worsening of the chronic pruritus associated with skin rash and significant weight loss (approximately 6 kg over a 2-month period). The laboratory tests showed iron deficiency anemia, eosinophilia and negative tumor markers. In order to investigate the hypoanabolic and anemic syndromes, upper gastrointestinal endoscopy and colonoscopy, which showed no lesions or tumors, were employed. Skin biopsy was performed and antihistaminic and local steroid treatment was initiated. The patient's status worsened within a week and the patient was started on systemic steroid treatment with poor results. Computer tomography was performed to identify any tumor(s) located either in the pelvis or abdomen. A lesion was found in the terminal ileum, identified as a hypervascularized associating bulky lymphadenopathy. The patient was transferred to the surgical ward where right hemicolectomy with manual ileotransverse anastomosis L-L was performed. The histopathological result confirmed NET G2. The patient clinically improved, the skin lesions resolved and the itchiness disappeared. The general status improved significantly. NET G2 diagnosing was possible due to the atypic paraneoplastic sign: chronic pruritus. This case study highlights the association between itch and malignancy and presents an atypical way of NET presentation when all tumor markers remain negative.

A 3D high resolution MRI method for the visualization of cardiac fibro-fatty infiltrations

Modifications of the myocardial architecture can cause abnormal electrical activity of the heart. Fibro-fatty infiltrations have been implicated in various cardiac pathologies associated with arrhythmias and sudden cardiac death, such as arrhythmogenic right ventricular cardiomyopathy (ARVC). Here, we report the development of an MRI protocol to observe these modifications at 9.4 T. Two fixed ex vivo human hearts, one healthy and one ARVC, were imaged with an Iterative decomposition with echo asymmetry and least-square estimations (IDEAL) and a magnetization transfer (MT) 3D sequences. The resulting fat fraction and MT ratio (MTR) were analyzed and compared to histological analysis of the three regions (“ARVC triangle”) primarily involved in ARVC structural remodeling. In the ARVC heart, high fat content was observed in the “ARVC triangle” and the superimposition of the MTR and fat fraction allowed the identification of fibrotic regions in areas without the presence of fat. The healthy heart exhibited twice less fat than the ARVC heart (31.9%, 28.7% and 1.3% of fat in the same regions, respectively). Localization of fat and fibrosis were confirmed by means of histology. This non-destructive approach allows the investigation of structural remodeling in human pathologies where fibrosis and/or fatty tissue infiltrations are expected to occur.

Difficulties in maintaining electroconvulsive treatment (ECT) in a psychiatric hospital during covid19 pandemic

Introduction

ECT is an effective care with high level of recommendation. During the COVID19, new recommendations to protect patients and caregivers combined with the increasing use of medicines and medical devices (MD) for anesthesia, caused greater difficulties of supply. Even if vital for patients, it is challenging to maintain ECT in this environment.

Objectives

The aim of this study is to resume the measures implemented in order to maintain ECT during COVID19.

Methods

Retrospective analysis of measures implemented to maintain the ECT during COVID19.

Results

As FFP2 masks were restricted to intensive care units, our hospital were not supplied. After negotiations, the regional health agency (ARS) has granted us an allocation of 100 masks to maintain ECT. Our efficient stock management of personal protective equipment as well as our transparency on these stocks with ARS and sharing with other hospitals out of stock played a role in this agreement.We had to adapt our MDs references according to breaks of many ones and new recommendations. The university hospital helping us in supplying certain missing references. Considering the difficulties in supplying drugs and MDs, and limited availability of anesthetists, we have reduced the number of ECT. Prioritization of patients with vital indications had to be achieved.

Conclusions

The prioritization of some services by the regulatory agency causes many supply difficulties for the others. It would be important to reassess the priority of ECT in such crisis because most of the time other caregivers and regulatory agencies are not aware how they are vital for patients.

Acute Clinical Syndromes and Suspicion of SARS-CoV-2 Infection: The Experience of a Single Romanian Center in the Early Pandemic Period

Background and Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, patients with chronic diseases suffering exacerbations have required acute medical care. The purpose of our study was to determine useful criteria for the differentiation of patients with acute clinical syndromes and suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Materials and Methods: This was an observational retrospective study, conducted in an internal medicine clinic from April to May 2020. We collected clinical, biological, and computed tomography (CT) data on patients with exacerbations of chronic diseases and clinical suspicion of SARS-CoV-2 infection. Patients with an already-positive real-time reverse-transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 on presentation at the emergency department were excluded from our study. Results: Of 253 suspected cases, 20 were laboratory-confirmed as having SARS-CoV-2 infection by RT-PCR, whereas COVID-19 diagnosis was ruled out in the remaining 233. Venous thromboembolism (VTE) correlated significantly with COVID-19 diagnosis in suspected patients, while laboratory markers were not significantly different between the two groups. Of the suspected patients, significantly higher percentages of dry cough, fever, myalgias, sore throat, loss of smell and appetite, and ground-glass opacities (GGOs) on CT were found in SARS-CoV-2-positive individuals. Conclusions: The study demonstrated that, until receiving the result of an RT-PCR test for SARS-CoV-2 (usually 12-24 h), association with VTE as a comorbidity, fever, dry cough, and myalgia as clinical features, and GGO on CT are the main markers for the identification of COVID-19 patients among those suspected with acute clinical syndromes. Our results also provide evidence for doctors not to rely solely on biological markers in the case of suspected SARS-CoV-2 infection in patients with exacerbations of chronic diseases. These data are useful for faster decision-making with regard to suspected COVID-19 patients before receiving RT-PCR test results, thus avoiding keeping patients in crowded emergency departments.

The Role of Chemical Agents in the Microbial Flora with Major Risk of Interventios in Maxilo-facial Surgery

The pathology of the oro-maxilo-facial territory comprises a vast chapter of diseases with primary or secondary infectious etiology, the mouth being the natural cavity of the organism with the most varied and variable flora of bacterial contamination. By the continuity solutions created by the mechanical act of mastication, decubitus of defective prosthetic works, local dento-periodontal infectious processes, but especially of dental or small-scale interventions, open gates and possibilities of penetration into the blood circulation of the microorganisms, which cause the transient bacteria. The study included 243 randomly selected patients, with the address of the Oral and Maxillofacial Surgery Clinic in the period 2016-2018. The inoculation of microorganisms in the oral cavity in circulating blood as a result of oral surgery or dental care procedures is much more common than in other areas of the body. Aggressive dental maneuvers that create solutions of continuity of oral mucosa, gingiva, periodontal surgery, periodontal surgery techniques can cause bacteria.

QRISK2 Score in CABG Patients Correlated with Risk Factors

Guidelines for primary prevention suggested using any risk score, among those QRISK2, identifying the high-risk populations. The purpose of this study was to determine whether the QRISK2 Score would register changes in patients with coronary artery disease demanding acute or postponed CABG intervention. The QRISK2 Score was performed the day of admission after the clinical examination and blood test results, and immediately after CABG surgery (in the first week post-CABG, in an interval of 24 hours to 7 days) having another blood test evaluation. The 120 patients admitted in the Clinic of Cardiovascular Surgery of the Institute of Cardiovascular Disease met the inclusion criteria: CABG patients (less than 1 week), aged 40-85 years old, BMI ] 25 kg/m�, and mixed dyslipidemia. In both phases, for every patient, it was performed a clinical examination, a set of hematological, biochemical, lipid, coagulation and inflammatory profile, and ECG and echocardiography. Our research on hospitalized patients undergoing CABG, by comparing the Phase I and Phase III results, revealed that the median 10-year QRISK2 cardiovascular risk score was approximately 47.88 % lower (p=0.000) in the first week after cardiac surgery. QRISK2 score gives a more appropriate risk estimation based on the social component, thus identifying high risk patients associating social deprivation. Comparative to Framingham risk score, QRISK2 score, by including additional variables, proves the efficacy of lifestyle changes and management decisions, and sustaines the treatment directed towards modifying variables or risk factors.

The Importance of Risk Factors and the Chemistry of Anestetics in the Occurence of Medical Emergencies in Dental Surgery

In the dental practice or in the ambulatory of oral and maxillo-facial surgery, there may be real medical emergencies, emergencies in which the speed of effective measures is essential. A good knowledge of the things to be done in the practice, as first representatives of the medical shield in defence against the inexorable secures the winning of precious seconds. Medical care in dentistry and dentoalveolar surgery involves two seemingly different aspects: a well-defined technical one, of strict specialty, and another less well defined, which practically includes all the particularities of the patient coming to the dental practice. However precise the dental technique and the practitioner�s skill are, if the specific conditions of each patient are not taken into account, the medical benefit cannot rise to a high level, and the final result may be compromised by complications with unforeseen risks. The study included 7,996 patients resolved in the Oral and Maxillo-facial Surgery Clinic (Ambulatory), in the period from 1.02.2014 to 31.12.2018. The superficiality of a seemingly healthy patient approach may lead to the disregard of some important aspects with a predictive role in the triggering of a medical emergency, as an informational history must be more than an orderly list of symptoms. You always gain something by listening to patients and observing the way they talk about their symptoms. The crossed statistical deductions on the explored data revealed, based on the majority percentages obtained on each studied index, that the following have an extremely important aspect for the dental practice and dentoalveolar surgery: the dental anxiety level as well as the patient�s general status are the landmarks that require the greatest attention from the practitioner for the purpose of preventing medical emergencies.

The Role of Chemical Factors in the Inflammation and Infection of Cervico-facial Actinomicosis

Inflammation is a reflex reaction of the body to the action of some harmful agents, a reaction that manifests itself as a complex of functional and structural modifications of a vasculo-tisular nature, this reaction has occurred in the process of evolution. The intensity of the inflammatory reaction depends on the reactive properties of the body, the location of the inflammatory process, the anatomo-physiological particularities of the damaged tissue, and the conditions in which the inflammation develops. As accurate as dental technique and the practitioner�s skill, if the specific conditions of each patient are not taken into account, the benefit medical cannot rise to a higher level, with the final result being compromised by complications with unpredictable risks. Actinomycosis is a specific infection with subacute or chronic evolution, common to humans or animals, caused by microorganisms of the actinomycete family. The location of the affection in the cervico-facial sphere is four times bigger than the rest of the body; the disease is manifested by rough nodules, red in the cheek or sub-maxillary region, fistulas and scars on which new lesions appear. In order to achieve the proposed objectives, we conducted a study on a representative human sample of 158 patients, from the Oral and Maxillofacial Clinic, between 1.01.2013-31.12.2017. Risk factors (gender, age, area, dental anxiety score), our findings are unlikely to define separately the potential for the risk of installing actinomycosis. The level of dental anxiety as well as the general status of the patient are the markers that require the greatest attention from the practitioner in order to prevent a dental problem.

Conjunctival Benign Fibrous Histiocytoma in a 57-year-old man

Purpose. To report a case of benign fibrous histiocytoma of the conjunctiva involving the cornea, an uncommon ocular surface tumor. Methods. A 57-year-old patient came in our service complaining of a progressively enlarging conjunctival mass temporally to the limbus and invading the adjacent cornea of the left eye. Results. The approach consisted in surgical excision followed by cryotherapy on the edges and on the base of the excision site and amniotic membrane patch reconstruction of the ocular surface defect. Pathologic examination and immunohistochemistry were performed in order to establish the diagnosis. No recurrences appeared in 8 months of follow up. Conclusions. Fibrous histiocytoma might be easily misdiagnosed as it is exceedingly rare. Complete resection with careful inspection of edges is advised. Cryotherapy at the base and borders of the resection site is recommended as both benign and malignant tumors can show recurrence. Amniotic membrane should always be regarded as an efficient option in reconstruction of broad surface defects after tumor resection. Abbreviations: FH = fibrous histiocytoma, CIN = corneal intraepithelial neoplasia, SSCA = squamous cell carcinoma, AM = amniotic membrane, MMC = topical mitomycin-C, 5-FU = 5-fluorouracil, BCVA = best corrected visual acuity.

Oral Tumors Having the Origins in Multiple Tissues, Non-differentiated or Differentiated

The lesions in the oral cavity must be seen in the light of pathological and correlated system processeswith systemic illnesses because systemic illnesses cause oral manifestations and inversely - oral affections(Alvin Gardner). Many times, when symptoms and signs occur, the disease is in an advanced phase, the interest of the oral cavity being the expression of a generalized illness. Extremely varied tumors in shape and evolution come from multiple tissues undifferentiated or differentiated, often in a complication of different structures, which imparts to them a histological polymorphism. They can be found and traced in their evolution during a dental examination, more easily than those developed at the organs. An early detection of precancerous states and neoplasia can be made, and clinical and paraclinical data are corroborated in the dynamics of the evolutionary process, with the observation that, in the presence of benign histological aspects, evolution may be serious due to functional turbulence lymphangioma of the tongue with muscle fiber atrophy, epithelial ulceration and superadded inflammation with oral phlegmon), haemorrhages (oral mucosal hemangioma). We studied 120 patients with oral tumors originating in multiple non-differentiated tissues or differentiated, over a 5-year period, January 2012-December 2016. Malignant ganglion involvement includes a broad pathology requiring rigorous, clinical, paraclinical, histological and immunohistochemical examination to achieve effective therapeutic management. The degree of malignancy should be specified in all cases where this is possible with the help of available systems as it is of prognostic and predictive importance.

Heart-Type Fatty Acid-Binding Protein (H-FABP) in Patients with Type 2 Diabetes Beneficiaries of Rehabilitation Program Post Coronary Artery Bypass Grafting

Heart-type fatty acid-binding protein (H-FABP) is a non-invasive bio-marker, with high sensitivity and specificity, being capable to point out the myocardial injury and to predict major adverse cardiovascular events (MACE). Cardiac rehabilitation program, through a complex and sustained post-interventional management plays an important role in reducing the plasma levels of H-FABP. In the study, which included 120 post-coronary artery bypass (CABG) patients, we analyzed the link between low levels of general post-surgical health status and the presence of cardiovascular risk factors, common biochemical markers, and especially the role played by diabetic status in lowering the plasma H-FABP levels. From the group, 65 patients had been diagnosed with type 2 Diabetes Mellitus (T2DM). The H-FABP values decreased both in diabetics and in non-diabetics between the two phases of CR, 6 months away from CABG. More than half of the patients had important reduction of H-FABP, at 6 months after the onset of CR program. Half of the group registered a smaller reduction of H-FABP, but more noticeable in diabetics. Ischemic lesion during open heart surgery is linked to high levels of H-FABP and with an occurence risk of postoperative atrial fibrillation, that can be also triggered and sustained by multiple endocrine conditions related to aging. Thus, metabolic control should always remain a target of the complex management in cardiac rehabilitation.

Chemical Study of Antibiotics in Treatment of Non-secfic Perimaxial Suppurations in Pregnancy

Physiological changes caused by pregnancy favor the onset or aggravation of preexisting buccal dental lesions, which, untreated, may evolve into infectious complications. Perimaxilation should be treated immediately due to the risk of infection spread or disseminated at a distance. Pain relief is an important reason for immediate treatment, as the particular state of nervousness can trigger a neuro-hormonal reflex followed by a break in pregnancy. The treatment of perimaxial suppositions involves two main aspects: surgical management and medical management. Surgical management will apply as well as outside the pregnancy, recommending local or loco-regional anesthesia with 2% xylin and vasoconstrictor at very low doses. In medical management, it should be noted that the upcoming mother�s ingestion of various drug substances is a matter of maximum responsibility. Drug administration during pregnancy should be an exceptional attitude, but strict application of this principle could deprive pregnant women of the use of useful drugs resulting in maternal complications and embryo-fetal suffering. The study is a retrospective and was performed on a batch of 70 pregnant women who presented themselves in the Oral and Maxillofacial Surgery Clinic during 2014-2017, presenting perimaxial suppurations.Surgical treatment (opening and evacuation of the purulent collection), performed in all patients, was preceded by anesthesia, local or loco-regional. Preventive dental care should prevail over curative care in the case of dental treatments of women pregnant women, because all physiological changes caused by pregnancy aggravate the pre-existing oro-dental lesions. Prophylactic attitude will not allow the emergence of infectious complications of dental origin.

The Relation of Body Mass Index to Biochemical Parameters and Profile of Heart Failure

The bidirectional relation between body mass index (BMI) and heart failure (HF) is complex and not fully understood. The obesity paradox phenomena is controversial and related to patient selection, parameters used for defining abnormal weight, characteristics of HF. Our study sustain the importance of controlling risk factors, in particular plasma glucose, lipid levels, as well as hypertension in patients with HF and BMI over 25 kg/m2. Also, in contrast to the randomized control studies our results can only partially support data related to obesity paradox phenomena.

Biochemical Markers in Patients with Readmission for Congestive Heart Failure

Repetitive or recurrent hospitalizations are a general major health issue in patients with chronic disease. Congestive heart failure, is associated with a high incidence and presence of early rehospitalization, but variables in order to identify patients at increased risk and also an analysis of potentially remediable factors contributing to readmission have not been previously reported and it remains still a difficult problem. We retrospectively assessed 100 patients aged between 48-85 years old, of which 75% were men, who had been hospitalized with documentation of congestive heart failure in St. Spiridon County Emergency Hospital. They were hospitalized between 2010-2017. Even if recurrent heart failure was the most common cause for readmission or rehospitalization, other cardiac disorders and noncardiac illnesses were also accounted for readmission. Predictive factors of an increased probability of readmission included prior patient�s medical heart failure history, heart failure decompensation precipitated or accelerated by an ischaemic episode, atrial fibrillation or uncontrolled hypertension. Factors contributing to preventable readmissions included noncompliance with medications or diet, inadequate discharge planning or follow-up, failure of both social support system and the seek of a promp medical attention when symptoms reappeared. We also identified an inappropriate colaboration with family doctors especially for the patients from rural areas. Patients were more likely to cite side effects of prescribed medications rather than nonadherence as a precipitating factor for readmission. Thus, we can appreciate that early rehospitalization in patients with congestive heart failure may be avoidable in up to 50% of cases. Identification of high risk patients is possible and also necessary shortly after admission in order to identify nonpharmacological interventions designed to decrease readmission frequency.

Chemical composition and seasonal changes in the fatty acid profile of Uruguayan “Colonia” Cheeses

The basic chemical composition and the fatty acid (FA) profile of Uruguayan Colonia cheese, consumed in the Mercosur region, were determined. 24 cheeses from different dairy farms: 10 elaborated in autumn and 14 in spring, were analyzed. Those cheeses are made from cow´s milk, whose diet was composed of 50% pasture system, 25% concentrate, and 25% silage reserves. The cheese making and ripening time were similar. Seasonal differences emerged in the profiles of saturated FA (SFA), unsaturated FA (UFA) and polyunsaturated FA (PUFA). The seasonal comparation of polyunsaturated FA (PUFA) as well as the CLA isomer such as C18:2 t10c12 showed significant differences (p < 0.05). CLA isomer such as C18:2 c9t11, showed no differences (p > 0.05). The atherogenesis index (AI) = 2.21 and thrombogenicity (IT) = 2.84, were calculated and discussed.

The Role of Chemical Substances in Classic and Modern Sialography Technique and applications

The purpose of this study was to assess the role of a chemical contrast medium used in plain x ray and CBCT (cone beam computed tomography) sialography imaging in the detection of different changes associated with lesions of salivary glands. 20 subjects were recruited into this prospective clinical study over a 1 year time period. Sialography was performed by an oral and maxillofacial surgeon. A lateral skull plain image was then made and a three-dimensional scanning using a CBCT machine. The imaging volume was centred on the gland of interest. The lateral skull plain images represented the two-dimensional part of the study, and these were used for comparison with the three-dimensional investigation, the CBCT images.

Lipid Profiles and Framingham Risk Score in Patients with Coronary Artery Bypass Graft Surgery undergoing Cardiac Rehabilitation Program

Coronary artery disease (CAD) is one of the major predictors of future cardiovascular events (CVEs). In addition, biomarkers such as high-sensitivity C-Reactive Protein (hsCRP), fibrinogen, homocysteine, and free fatty acid (FFA) correlate well with a future CVE. The Framingham Risk Score is a gender-specific algorithm used to estimate the 10-year cardiovascular risk of an individual. Cardiac rehabilitation is an instrument of medical management in cardiovascular diseases; beyond prevention, it can improve heart and muscle functioning in patients that were undergoing CABG, and cardiac and vascular adaptation. Over a 2-year period, 120 subjects were randomized and comprehensively evaluated. The mean age of the patients under study was 65.70 � 9.91 years old. For the Framingham cardiovascular risk score, the mean value in the Phase I was 16.5, while the mean value in Phase III was 10.6. The difference registered after cardiac surgery and the value in 6 months after the onset of cardiac rehabilitation program was important and statistically significant, as p [ 0.05. Fibrinogen showed significant phase-to-phase reductions of plasmatic values. Lipid profile values showed a statistically significant decrease. The renal filtration function evaluated by plasma creatinine showed statistically significant improvement and, in terms of absolute values, creatinine level was reduced in a range between 0.2-0.4 mg/dL. Also, it was recorded a significantly lower level of blood urea. By comparing the Phase I and Phase III results, we observed that the median 10-year Framingham cardiovascular risk score was approximately 6% lower (p [0.05), reflecting the survival benefit gained by patients under the intensive cardiovascular recovery program.

Chemical Reactions of Iodoform in the Study of Post-Extraction Alveolites

Post-operative alveolitis is a topical issue in dental practice, which is also reflected by the etiopathogenic aspects. The conservative principle requires the maintenance of dento-periodontal units in the arch for as long as possible, but there are situations where dental extraction is required. The healing process of the post-surgical wound is complex and involves processes of gingival mucosal regeneration and bone reshaping, involving several local factors: wound size, presence of infection, alveolar vascularization, intraalveolar foreign bodies, and general factors, especially general condition, age and body reactivity. The quality, structure, maintenance, and retraction of the clot are key factors in the formation of connective tissue during the healing of the post-extraction would. At the Oral and Maxillofacial Surgery Clinic of Gala�i, during a 2-year period between January 2015 and December 30, 2016, 2780 patients that required surgery - dental extraction were consulted and diagnosed. We found that among those 2780 patients with dental extractions 105 (3.77%) had post-treatment alveolitis. No post-surgical alveolitis from the case study was complicated by osteomyelitis of the jaws or by suppurations of the superficial or deep compartments of the face. The prophylactic measures in each dental extraction, together with the correct and timely curative treatment, combined with the dentist�s competence and responsibility, can shorten the time of suffering, actively combating the risk factor and accelerating the social reintegration of the patient with post-treatment alveolitis.

Heart-Type Fatty Acid-Binding Protein (H-FABP) in Patients with Coronary Artery Bypass Graft Surgery Undergoing Cardiac Rehabilitation Program

Heart-type Fatty Acid-Binding Protein (H-FABP), compared with classical biomarkers, proved to have high sensitivity for myocardial damage size in patients undergoing cardiac surgery. High H-FABP levels are strongly associated in case of death, post-operatively acute kidney injury and atrial fibrillation. Cardiac rehabilitation is an instrument of medical management in cardiovascular diseases; beyond prevention, it can improve heart and muscle functioning in patients that were undergoing CABG, and cardiac and vascular adaptation. Over a 2-year period, 110 subjects were randomized and comprehensively evaluated. The mean age of the patients under study was 65.70 � 9.91 years old. For the H-FABP, the mean value in the Phase I was 67.40 � 9.81 ng/mL, while the mean value in Phase III was 4.80 � 2.30 ng/mL. The difference registered between the plasma H-FABP value in the first 24 h after cardiac surgery and the value in 6 months after the onset of cardiac rehabilitation program was important and statistically significant, as p [ 0.05. Fibrinogen showed significant phase-to-phase reductions of plasmatic values. Lipid profile values showed a statistically significant decrease. The renal filtration function evaluated by plasma creatinine showed statistically significant improvement and, in terms of absolute values, creatinine level was reduced in a range between 0.2-0.4 mg/dL. Also, it was recorded a significantly lower level of blood urea. The reduction of plasma H-FABP values were registered between the first phase (the first 24 h) after cardiac surgery and the third phase of the cardiac rehabilitation program. H-FABP protein had a higher sensitivity and specificity when compared to other enzymes of myocardial cytolysis.