SEVERE AMIODARONE-INDUCED BRADICARDIA CONCEALES SICK SINUS SYNDROME: CASE REPORT.

Sinus node dysfunction is one of the most common arrhythmias in elderly patients; it is usually associated with intermittent and variable symptoms, thus making it difficult to diagnose. We present the case of an elderly female patient with a personal history of atrial fibrillation treated for the last three years with amiodarone; she was admitted to the Geriatric Clinic for non-specific symptoms with onset two months previously for which she had already sought care in different medical services. Clinical examination showed severe bradycardia; ECG and Holter ECG on admission confirmed severe bradycardia, with a heart rate between 29 and 50 beats/min (bpm). Given her long-term treatment with amiodarone we looked for and found hyperthyroidism; the endocrine examination led to the diagnosis of mixed type Amiodarone-induced thyrotoxicosis and initiation of corticosteroid and antithyroid treatment. The evolution of cardiac arrhythmia was monitored with the help of several Holter ECGs performed after amiodarone washout and return to the euthyroid state, which revealed a tachycardia-bradycardia syndrome initially masked by the side effects of the unsupervised therapy with amiodarone, and properly treated by the implantation of a pacemaker.

New Developments in the Approach and Diagnosis of Sarcopenia.

Sarcopenia, the key point of frailty syndrome, leads to decreased physical activity, with important consequences upon the quality of life in elderly. The prevalence of sarcopenia is still uncertain because of the lack of homogeneity of the studied populations, and also because of the variety of techniques. The development of biological markers that can be used in a cost effective manner to guide diagnosis and facilitate monitoring patients with sarcopenia, would mark an important step in managing the care of geriatric patients. Nutrition combined with physical activity is the key component of the management of sarcopenia, with a synergistic effect that helps combat malnutrition and improve the quality of life.

THE EFFECTS OF RIBOFLAVIN AND METHYLENE BLUE ON NOCICEPTION AND VISCERAL PAIN.

BACKGROUND: Methylene Blue (MB) can prevent electron leaking, increase mitochondrial oxidative phosphorylation, and reduce ROS overproduction under pathological conditions, currently being trace evidence that it can alter pain perception in humans by local administration during certain surgical procedures. Riboflavin or vitamin B2 (B2) constitutes a part of the vitamin B group, which in recent studies shows a growing implication in the treatment of some pathology that imply pain management. AIM: To investigate the effect of one dose of Riboflavin and Methylene Blue on nociception and visceral pain in mice. METHODS: A total of 48 BALB/c male mice were divided into 3 groups: MB Group, B2 Group and C Group. MB (5 mg/kg b.w.), B2 (100 mg/kg b.w.) or an equivalent volume of saline was administered intraperitoneally. Mice were tested before (baseline) and after drugs administration over a 4h period. Nociception was evaluated by means of Hot Plate Test (HPT) and TFT (Tail Flick Test). Visceral pain was evaluated 2h after administration. RESULTS: Four hours after MB administration we recorded an analgesic effect on the hot plate test (p < 0.05 at 30, 60 and 240 min). No significant effect on the TFT was noticed. B2 vitamin had an antinociceptive effect as compared to control group only for HPT that persisted for 2h but had no effect on TFT. Both MB and B2 vitamin have shown an analgesic effect (p < 0.01) on visceral pain when compared to the control group but the pain inhibition was more important after riboflavin administration. CONCLUSIONS: Even if the exact mechanisms are not clarified by our study, we demonstrated that both ATP modulators (MB & B2 vitamin) have analgesic effect on visceral pain and nociception.

A case of severe hypoalbuminemia associated with chronic congestive heart failure: the role of the tricuspid regurgitation.

Hypoalbuminemia is considered an independent predictor of mortality, especially in elderly patients. It is common in patients with congestive heart failure, when is due to several mechanisms: increased volume of distribution, significant stasis in the mesenteric circulation and altered protein metabolism in the liver. These alterations are even more pregnant when tricuspid regurgitation is associated or aggravated by different risk factors (recent infections, anemia, hyperthyroidism). We present the case of an elderly patient with severe hypoproteinemia and important hypoalbuminemia associated with congestive heart failure and aggravation of tricuspid regurgitation. The differential diagnosis concluded that hypoalbuminemia was influenced by tricuspid regurgitation as it enhanced liver dysfunction and enteral protein absorption due to increased stasis in mesenteric system. On the other hand, hypoalbuminemia contributed to the progression of heart failure by favoring myocardial edema, volume overload, and diuretic resistance. This is why correct management of this situation should include removal of subclinical excess of fluid and renutrition. A multidisciplinary approach is needed in order to achieve a good control of the symptoms and a significant improvement of quality of life.

Leishmaniasis--an unusual cause of splenomegaly in Romania.

Leishmaniasis is a parasitic infection caused by protozoans classified as Leishmania species. Romania is not considered an endemic country and there are only few reports of sporadic cases in the last 100 years. However, studies suggest that the disease is spreading north. We present the case of a 44 year old female that presented with asthenia, perspirations, vertigo, weight loss and menometrorhagias in small to medium quantity. Clinical exam revealed the presence of splenomegaly and her blood tests indicated she had pancitopenia; differential diagnosis included myeloproliferative or lymphoproliferative disorders, infections that evolve with spleen enlargement, autoimmune-related splenomegaly and hepatic--all tests were negative. She refused the bone marrow aspiration. Three months later, her condition worsened and the menometrorragias became more severe. Bone marrow aspiration revealed the presence of numerous intra and extracellular Leishmania spp. amastigotes. A detailed anamnesis showed that she had worked for six months in Italy as a care-giver nine months ago. She was transferred to Bucharest where she received optimal treatment. However, due to the continuous bleeding, the evolution was unfavourable. This is an alarm sign for physicians that should take into account the fact that, due to population migration and global warming, tropical infectious diseases are becoming more and more common. The signs and symptoms, as well as the treatment in leishmaniasis are reviewed, as well as a brief history of leishmaniasis in Romania.

Study of school fatigue on a group of teenagers studying at "dimitrie cantemir" highschool, iasi.

Purpose. Fatigue is a physiological phenomenon which is permanently present at students because of the scholar demands. Excessive demands can cause pathological fatigue phenomenon, which should be avoided. Subjects and method. The study included a group of 203 students from Dimitrie Cantemir Highschool in Iasi. The teenagers were questioned about the presence of the fatigue phenomenon. Results. Fatigue is rarely present at 62.6% of the questioned students. During the week, this phenomenon appears especially at the beginning (22.2%) or in the middle of the week (34.5%). In a few cases it appears at the end of the week, as it should. Night sleep is only of 6-7 hours (37.4%) or 7-8 hours (36.9%), which is not enough.The insufficient number of sleeping hours can be paid by day sleep, but most of the responses are "rarely" (50.7%). Active rest is represented by sport or other activities of choice. Sport is the only less attractive option - in most cases children allocate only 15-30 minutes a day for it (33.5%). They stay in front of the TV between 0.5 and 1 hour (42.9%) and of the computer between 2-3 hours (44.3%) daily. Conclusions. Children's daily schedule isn't balanced, so the risk of excessive fatigue really exists.

Macro-creatine kinase syndrome as an underdiagnosed cause of ck-mb increase in the absence of myocardial infarction: two case reports.

When assessing an acute coronary syndrome (ACS) by means of high serum levels of creatine kinase (CK) and its MB fraction (CK-MB), one must keep in mind that there are several other causes for an increase of these markers, such as myocarditis, pericarditis, heart failure, severe aortic stenosis, stroke, renal failure, malignant hyperthermia, Reye syndrome, polymyositis, and borreliosis (1). Also, there are cases when CK-MB is falsely increased due to certain abnormalities that occur in the CK isoenzymes. One such example is the formation of the so-called macro-creatine kinase complexes (macro-CK) that give a false increase of the CK-MB fraction. We report two clinical cases where macro-CK was the cause of apparent increase in serum CK and CK-MB: in a 79-year old male with a history of coronary disease and a 82-year old female with permanent atrial fibrillation.

[Food intake--family income in a group of teenagers from Iasi "Dimitrie Cantemir" High School]. / Corelatia alimentatie--venit pe membru de familie la un lot de adolescenti de la Liceul "Dimitrie Cantemir" din Iasi.

UNLABELLED: Food intake is influenced by a series of factors, including family, income, school and mass-media. MATERIAL AND METHOD: A group of 78 teenagers were investigated using a food intake questionary, correlating the results with family income. RESULTS: Our results show that the food intake is influenced more by family dietary habits rather than family income, with no significant differences between families with different socio-economic status. CONCLUSION: Educational programs for changing the nutritional habits must be implemented.