Sleep apnea syndrome associated with gonadal hormone imbalance (Review).

Patients with obstructive sleep apnea exhibit an increased risk of developing gonadal disorders. Because a notable number of people worldwide have sleep respiratory and reproductive disorders, it is essential to recognize the association between local upper airway dysfunction and its gonadal effects. Repeated breathing pauses cause sleep fragmentation, disorganization of sleep cycles and stages, sympathetic activation, intermittent hypoxemia and systemic inflammation. Nocturnal intermittent hypoxemia has a direct central effect on neurotransmitters, with disturbances in the normal production of hypothalamic-pituitary hormones. Awakenings and micro-awakenings at the end of apneic episodes produce a central stress responsible for hormonal changes and subsequent endocrine imbalances. The aim of the present study was to investigate the impact of obstructive sleep apnea syndrome (OSAS) on gonadal hormonal homeostasis and its consequences. Recognizing and understanding how local upper airway dysfunction causes gonadal imbalance may facilitate better care for patients with OSAS. Although there may be a direct relationship between sleep-disordered breathing and gonadal function mediated by hormones via the hypothalamic-pituitary-gonadal axis, to date, current therapies have not been effective.

Role of the Renin-Angiotensin System in Long COVID's Cardiovascular Injuries.

The renin-angiotensin system (RAS) is one of the biggest challenges of cardiovascular medicine. The significance of the RAS in the chronic progression of SARS-CoV-2 infection and its consequences is one of the topics that are currently being mostly discussed. SARS-CoV-2 undermines the balance between beneficial and harmful RAS pathways. The level of soluble ACE2 and membrane-bound ACE2 are both upregulated by the endocytosis of the SARS-CoV-2/ACE2 complex and the tumor necrosis factor (TNF)-α-converting enzyme (ADAM17)-induced cleavage. Through the link between RAS and the processes of proliferation, the processes of fibrous remodelling of the myocardium are initiated from the acute phase of the disease, continuing into the long COVID stage. In the long term, RAS dysfunction may cause an impairment of its beneficial effects leading to thromboembolic processes and a reduction in perfusion of target organs. The main aspects of ACE2-a key pathogenic role in COVID-19 as well as the mechanisms of RAS involvement in COVID cardiovascular injuries are studied. Therapeutic directions that can be currently anticipated in relation to the various pathogenic pathways of progression of cardiovascular damage in patients with longCOVID have also been outlined.

Perspectives on Post-COVID-19 Pulmonary Fibrosis Treatment.

Pulmonary fibrosis, a critical outcome of chronic inflammatory diseases, has gained prominence in the context of post-coronavirus (post-COVID-19) complications. This review delves into the multifaceted landscape of post-COVID-19 pulmonary fibrosis, elucidating the intricate molecular mechanisms underlying its pathogenesis and highlighting promising therapeutic avenues. Examining the aftermath of severe acute respiratory syndrome-2 (SARS-CoV-2) infection, the review reveals key signaling pathways implicated in the fibrotic cascade. Drawing parallels with previous coronavirus outbreaks enhances our understanding of the distinctive features of post-COVID-19 fibrosis. Antifibrotic drugs, like pirfenidone and nintedanib, take center stage; their mechanisms of action and potential applications in post-COVID-19 cases are thoroughly explored. Beyond the established treatments, this review investigates emerging therapeutic modalities, including anti-interleukin agents, immunosuppressants, and experimental compounds, like buloxybutide, saracatinib, sirolimus, and resveratrol. Emphasizing the critical importance of early intervention, this review highlights the dynamic nature of post-COVID-19 pulmonary fibrosis research. In conclusion, the synthesis of current knowledge offers a foundation for advancing our approaches to the prevention and treatment of these consequential sequelae of COVID-19.

Health Risks During Ukrainian Humanitarian Crisis.

Background: The unprecedented exodus in the history of the European Union of more than 6 million Ukrainian refugees (May 13, 2022) is a cause for concern and could lead to a new difficult situation in terms of infectious disease control. Following the SARS-CoV-2 pandemic, Europe is facing a new challenge that could lead to a new wave of COVID-19 and an increase in the number of cases of tuberculosis or eradicated diseases, such as polio. Aim: The purpose of this analysis was to provide an overview of lung diseases and health risks that could be encountered in refugees from Ukraine and translated to European Union`countries. Methods: A systematic review was conducted in PubMed, World Health Organization, the UN Refugee Agency and the government's websites. Selected publications investigated the health problems arising from Ukrainian population migration from conflict areas and their impact on the public health system in the adoptive countries. The main potentially contagious diseases in Ukraine have also been reviewed. Results: The population of Ukraine has serious public health problems such as SARS-CoV-2 infection, multidrug-resistant tuberculosis, high levels of drug resistance and difficulties with an effective vaccination program, so there are significant risks of developing epidemics in transit or host countries. The current crisis has major peculiarities because the migrants were not concentrated in the camps but there was a dispersion of them on large territories of European countries. Conclusion: In order to meet the health needs of refugees, it is necessary to adapt health systems culturally and linguistically, to train health workers on the particularities of existing diseases in the countries of refugee origin, and to facilitate collection of medical data on migrants' health.

Clinical challenges of SARS-CoV-2 variants (Review).

Since the first cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there have been challenges recognizing the clinical features of SARS-CoV-2 and identifying therapeutic options. This has been compounded by viral mutations that affect clinical response and primary epidemiological indicators. Multiple variants of SARS-CoV-2 have been identified and classified on the basis of nomenclature implemented by scientific organizations and the World Health Organisation (WHO). A total of five variants of concern (VOCs) have been identified to date. The present study aimed to analyse clinical and epidemiological features of each variant. Based on these characteristics, predictions were made about potential future evolution. Considering the time and location of SARS-CoV-2 VOC emergence, it was hypothesised that mutations were not due to pressure caused by the vaccines introduced in December 2020 but were dependent on natural characteristics of the virus. In the process of adapting to the human body, SARS-CoV-2 is expected to undergo evolution to become more contagious but less deadly. SARS-CoV-2 was hypothesized to continue spread through isolated epidemic outbreaks due to the unimmunized population, mostly unvaccinated children and adults, and for coronaviruses to continue to present a public health problem.

NiCoCrAlX (X = Y, Hf and Si) Bond Coats by Cold Spray for High Temperature Applications.

MCrAlX powder compositions (M = Ni,Co and X = Y, Hf, Si or combination) are often thermally sprayed via vacuum plasma spray (VPS), low pressure plasma spray (LPPS) or high velocity oxy-fuel to produce high temperature oxidation and hot corrosion resistant bond coats for thermal barrier coatings (TBCs). Cold spray technology is currently considered as a promising alternative to the traditional thermal spray solutions, having the advantage of delivering oxide-free and very dense metallic coatings at relatively lower costs compared to VPS and LPPS. NiCoCrAlY and NiCoCrAlYHfSi bond coats were deposited using a high pressure cold spray system and the influence of feedstock properties on the deposited bond coats were investigated. To improve NiCoCrAlYHfSi bond coat deposition, laser assisted cold spray (LACS) was employed. The results show that LACS can be successfully used to deposit this particular powder while eliminating nozzle erosion and low deposition efficiency disadvantages observed with conventional cold spray. To identify the optimal LACS setup for deposition of dense and uniform coatings, different laser/spray jet configurations were examined. TBCs with bond coats sprayed at the optimal configuration were assessed isothermally at 1150 °C in air for up to 500 h, and the results showed formation of a thermally grown oxide layer composed of predominantly Al2O3 with embedded small clusters of Hf-Y-rich oxides.

Inhaled interferons beta and SARS-COV2 infection: a preliminary therapeutic perspective.

INTRODUCTION: SARS-COV2 infection represents a therapeutic challenge due to the limited number of effective therapies available and due to the fact that it is not clear which host response in terms of inflammation pattern is the most predictive for an optimal (and rapid) recovery. Interferon ß pathway is impaired in SARS-COV2 infection and this is associated with a bigger disease burden. Exogenous inhaled interferon might be beneficial in this setting. AREAS COVERED: Nebulized interferon-ß is currently investigated as a potential therapy for SARS-COV2 because the available data from a phase II study demonstrate that this medication is able to accelerate the recovery from disease. EXPERT OPINION: Further clinical studies are needed in order to better document the efficacy of this therapy especially in severe forms of COVID-19, the optimal duration of therapy and if such a medication is appropriate for domiciliary use. Also combined regimens with antivirals or with compounds which are able to enhance the endogenous production of interferon might be of promise.

COPD and Anticoagulation Therapy: Time for a New Approach?

Chronic obstructive pulmonary disease (COPD) is one of the most challenging chronic disease nowadays due to increased morbidity and mortality, despite the multiple new therapies included in the therapeutic scheme. A possible cause may be insufficient approach to thromboembolic risk in these patients, scientific data being so far insufficient and relatively controversial. Areas covered: anticoagulant therapy is used mainly during severe exacerbations. There are data that have shown that therapy with low weight heparins injectable anticoagulants causes not only a reduction in thromboembolic risk but also an improvement in respiratory function parameters. Expert opinion: a number of COPD phenotypes are more prone to procoagulant status and thrombus formation. A layered approach to COPD patients in terms of antithrombotic prophylaxis is needed. Although current published clinical data have not provided irrefutable evidence, possibly due to the relatively heterogeneous approach to inclusion criteria, the frequent identification of autopsy holes in patients with COPD suggests that the high risk of mortality is due to specific bronchopulmonary changes and pulmonary embolism.

Bronchiectasis in cystic fibrosis and pregnancy.

Cystic fibrosis is an autosomal recessive disease with a prognosis determined by the extent of pulmonary lesions. Here we present a rare case of a patient diagnosed with cystic fibrosis in the pediatric service, but who came for the first time to the Pneumology Hospital of Iasi. Respiratory failure, recurrent pulmonary infections and associated metabolic modifications generate a high vital risk during pregnancy.

Fatigue and serum testosterone in obstructive sleep apnea patients.

INTRODUCTION: Obstructive sleep apnea (OSA)-related fatigue is a common understudied symptom. Fatigue is associated with low serum testosterone level in non-OSA patients. No data are available about this association in OSA patients. OBJECTIVES: To investigate in adult obese males affected by OSA, the relationship between fatigue and serum testosterone in order to identify predictors for OSA-related fatigue. METHODS: Fifteen OSA patients and 15 control subjects participated. The parameters analyzed were serum testosterone morning concentration, polysomnography parameters, daytime sleepiness (Epworth Sleepiness Scale) and fatigue (Multidimensional Fatigue Inventory). Regression test was applied in order to show predictors of fatigue. Kruskal-Wallis test followed by post-hoc analysis was performed to test for differences between controls and OSA subgroups for testosterone, fatigue components and sleepiness. RESULTS: Mean testosterone level was 3.55 ± 0.7 ng/mL in the OSA group, significantly lower than in controls (4.26 ± 1.1 ng/mL, P = 0.049). An inverse correlation was found between testosterone and fatigue scores (P < 0.01). Furthermore, a statistically significant difference was found between the control group and the severe OSA subgroup for general fatigue, physical fatigue, reduced activity and mental fatigue. However, no significant differences were found between controls and mild OSA. Among all variables, testosterone was the only independent significant predictor of physical fatigue (t = -2.56, P = 0.033, R = 0.978, R(2) = 0.958) and reduced activity (t = -4.41, P = 0.002, R = 0.966, R(2) = 0.934) in the OSA patients. CONCLUSIONS: OSA-related fatigue was strongly associated with serum testosterone, together with OSA severity.

[Quality of sleep in students]. / Calitatea somnului la studenti.

Sleep quality is an important factor involved in students' learning process. Using different methods, actual studies suggest that complaints about sleep problems are common in young medical students. The aim of this study was to evaluate if is any relation between factors like medium and lifestyle among students of the University of Medicine and Pharmacy "Grigore T Popa" from Iasi. The study group included 30 students (2 of them were excluded) who performed a polisomnography, self reported Epworth questionnaire and two weeks sleep diary. Coffee, energy drinks, green and black tea and alcohol intake were recorded. In our evaluation it was used sleep disturbance index (SDI), for sleep quality description. In those two weeks, the mean sleep hours was 7.8 (95% CI 7.6-8), greater in female than in male. The results suggest a significant correlation between psychical excitants and sleep fragmentation. More, excessive daytime somnolence declared is not in concordance with sleep quality observed in sleep recorded with polysomnography. It looks to be in correlation with bad sleep habits and psychical excitants intake.

Body composition in obstructive sleep apneahypopnea syndrome bio-impedance reflects the severity of sleep apnea.

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repeated breathing pauses during sleep and is closely associated with obesity. Body fat is known to be a predictive factor for OSAHS and its severity. AIM: To study the correlation between the severity of OSAHS and body composition measurements. METHODS: 30 patients with OSAHS (21 men, 9 women, mean age 45.1 years, mean apnea-hypopnea index = 29.6/hour) were included in the study after full polysomnography. They were divided into 3 groups according to the apnea-hypopnea index (AHI): mild OSAHS (mean AHI 10.9/h), moderate OSAHS (mean AHI 23.9/h) and severe OSAHS (mean AHI 53.9/h). Body composition (body fat, body water and dry lean mass) was assessed using bioelectric impedance assay (BIA). Other measurements included neck and abdominal circumferences and body mass index (BMI). Pearson's coefficient (r) was used to express correlations between AHI and the following parameters: BMI, neck and abdominal circumferences, body fat, dry lean mass, and body water. Wilcoxon Sum-of-Ranks (Mann-Whitney) test for comparing unmatched samples was used to compare anthropometric and body composition measurements between groups. RESULTS: The correlation between AHI and BMI was weak (r = 0.38). AHI correlated moderately with neck circumference (r = 0.54), with neck circumference corrected by height (r = 0.60), and more strongly with body fat (r = 0.67), with body water (r = 0.69) and with abdominal circumference (r = 0.75). There was a strong negative correlation between AHI and dry lean mass (r = - 0.92). There were significant differences in body fat, body water, neck circumference corrected by height and abdominal circumference (Wilcoxon Sum-of-Ranks, p < 0.01), between mild and severe OSASH groups, but not in BMI (Wilcoxon Sumof-Ranks, W = 86.5; p = 0.17). CONCLUSIONS: In our study, the severity of OSAHS correlated with body fat and with body water more strongly than with general and cervical obesity. Abdominal adiposity may predict OSAHS severity better than neck circumference.

Comparative study using tuberculin from Cantacuzino Institute versus Statens Serum Institute.

SETTING: Iasi County, Romania. OBJECTIVE: To evaluate the efficiency of the tuberculin produced by Cantacuzino Institute (ICB) compared to Statens Serum Institute (SSI) tuberculin in a group of high school students. DESIGN: 36 subjects were tested simultaneously with two tuberculin tipes. For each student, the left arm was tested with ICB tuberculin, while the right arm was tested with SSI tuberculin. All tests were single blind, and the subjects did not know which tuberculin type was used for each arm. The tuberculin administration sequence was random. RESULTS: No significant discrepancies were observed in results of both tuberculin reactions. The correlation coefficient was significant (0.95) between both tests (p<0.0001, CI 0.9111-0.9765). Positive results for the tuberculin test were found in 11.1% of the subjects when we used SSI tuberculin. The pain was almost absent at ICB tuberculin injection, comparatively at SSI tuberculin. CONCLUSION: Tuberculin 2u PPD made by Cantacuzino Institute has the same efficiency as tuberculin PPD RT 23 SSI. The findings of present study recommend, in absence of SSI tuberculin, to use Cantacuzino Institute tuberculin for identification of infections with Mycobacterium tuberculosis complex.

[Comparative evaluation between MB/BacT system and Löwenstein-Jensen solid culture media for mycobacterial isolation]. / Evaluare comparativa a sistemului MB/BacT cu mediul Löwenstein-Jensen pentru izolarea micobacteriilor.

Tuberculosis is a public health issue in both developed and developing countries. Success of the treatment depend on the identification of patients with positive sputum smears, rapid confirmation of diagnosis in patients with negative microscopy and identification of mycobacterial strains with altered drug susceptibility. Data from the literature show that liquid culture media have a higher sensitivity for isolation mycobacteria than solid culture media as Löwenstein-Jensen. In our series inoculation on liquid media resulted in retrieval of a significant higher number of mycobacterial strains than on solid media (435 vs 250). The time needed to obtain a positive culture was also lower for liquid media (15.89 +/- 9 days, mean +/- standard deviation) than for solid media (27.77 +/- 10.13 days), p < 0.001. These differences were seen in both smear negative and smear positive cases. Culture in liquid media isolated more strains with altered drug susceptibility but this difference was not statistically significant.

[Capture-recapture method--an instrument for estimating TB prevalence]. / Metoda capture-recapture--instrument de estimare a prevalentei tuberculozei.

Capture-recapture is a statistical method for determining, by means of a probabilistic calculation, the number of individuals with a certain characteristic in a population. Underestimation of the incidence of different diseases is currently an important epidemiological issue. In these circumstances, any disease monitoring system should be formally evaluated under the aspect of accuracy. Capture-recapture can match such a request. It is important to estimate the degree of incidence underestimation and the proportion of non-registered cases. This method can be applied virtually in any situation where there are two incomplete data sources. In epidemiology, the sources can vary: hospital charts, laboratory results, medical prescriptions, etc. Even with incomplete lists, the number of non-registered cases can be estimated by combining the data.