Successive Waves of the COVID-19 Pandemic Had an Increasing Impact on Chronic Cardiovascular Patients in a Western Region of Romania.

Three years since the COVID-19 pandemic started, there is still little information about patients with chronic medical conditions, such as cardiovascular diseases (CVDs), who become infected with SARS-CoV-2. A retrospective analysis was performed to evaluate the impact of the COVID-19 pandemic on patients with cardiovascular comorbidities hospitalized with positive RT-PCR results for SARS-CoV-2 during the highest peaks of the first three pandemic waves: April 2020, October 2020, and November 2021. The primary outcome was in-hospital mortality; the secondary outcomes were length of hospitalization and required mechanical ventilation to assess the disease severity. Data were extracted from the hospital electronic database system: 680 eligible cases were identified out of 2919 patients. Mortality was the highest in wave 3 (31.9%) compared to the previous waves (13.6% and 25.8%). Hospitalization was also significantly longer in wave 3 (11.58 ± 5.34 vs. 8.94 ± 4.74 and 10.19 ± 5.06; p < 0.001), and so was the need for mechanical ventilation (21.7% vs. 8.2% and 9%; p < 0.001). Older age and male gender were confirmed as highly significant predictors of unfavorable outcomes. Ischemic heart disease worsened the odds of patients' survival irrespective of the three pandemic waves (Breslow-Day test, p = 0.387), with a marginally significant Mantel-Haenszel common estimate for risk: OR = 1.604, 95% (0.996; 2.586). The significantly worse outcomes in wave 3 could have been influenced by a combination of factors: the low percentage of vaccinations in Romanian population, the more virulent delta strain, and pandemic attrition in the care provided to these patients with chronic CVDs.

The chronic coronary syndrome-Heart failure roundabout: A multimodality imaging workflow approach.

Heart failure (HF) is a complex syndrome of considerable burden with high mortality and hospitalization rates. Approximately two-thirds of patients with HF have ischemic etiology, which makes crucial the identification of relevant coronary artery disease (CAD). Moreover, patients with chronic coronary syndrome (CCS) can first show signs of dyspnea and left ventricular (LV) dysfunction. If establishing a diagnosis of HF and consequent management is clear enough, it will not be the same when it comes to recommendations for etiology assessment. Ischemic heart disease is the most studied disease by cardiac multimodality imaging with excellent diagnostic performance. Based on this aspect, the high prevalence of CAD, the worst outcome-HF patients should undergo a diagnostic work-up using these multimodality imaging techniques. The aim of this mini-review is to provide insights on multimodality imaging for diagnosing CCS in patients with new onset of HF and propose a diagnostic work-up based on current international studies and guidelines.

Mannose-binding lectin 2 gene polymorphisms and predisposition to allergic bronchial asthma in a western Romanian children population: an observational study.

OBJECTIVES: To analyse: (1) the associations between different mannose-binding lectin 2 (MBL2) genotypes and susceptibility to bronchial asthma (BA) in Romanian children; and (2) the correlations between several patient sociodemographic variables and MBL2 polymorphisms. METHODS: This prospective observational case-control study included paediatric patients with symptomatic BA and healthy controls. Participants were genotyped for two MBL2 single-nucleotide polymorphisms (SNPs): exon 1 codon 54 A/B variant rs1800450, and -550 promoter H/L variant rs11003125 (GenBank accession). Associations between MBL2 genotypes and susceptibility to BA were determined by calculated odds ratios, and Kendall Tau's correlations were used to investigate the associations between sociodemographic variables and SNPs. RESULTS: Among 59 patients with BA and 65 healthy controls, associations between MBL2 polymorphisms and susceptibility to BA were not found to be statistically significant. Statistically significant weak positive correlations were found between age at diagnosis and A/B genotype, and between the smoking status of biologically male and female parents. A statistically significant weak inverse association was found between male parent smoking status and family history of BA. CONCLUSION: These results may help guide future research into paediatric BA in Romania and Eastern Europe. Due to study limitations, the results require validation in future large-scale studies.

Nano Selenium-Enriched Probiotics as Functional Food Products against Cadmium Liver Toxicity.

Since cadmium is a toxic metal that can cause serious health problems for humans, it is necessary to find bioremediation solutions to reduce its harmful effects. The main goal of our work was to develop a functional food based on elemental selenium nanoparticles (SeNPs) obtained by green synthesis using Lactobacillus casei and to validate their ability to annihilate the hepatic toxic effects induced by cadmium. The characterization of SeNPs was assessed by UV-Vis spectroscopy, FTIR, XRD, DLS and TEM. In order to investigate the dose-dependent protective effects of SeNPs on Cd liver toxicity, mice were assigned to eight experimental groups and fed by gavage, with 5 mg/kg b.w. cadmium, respectively, with co-administration with SeNPs or lacto-SeNPs (LSeNPs) in 3 doses (0.1, 0.2 and 0.4 mg/kg b.w.) for 30 days. The protective effect was demonstrated by the restoration of blood hepatic markers (AST, ALT, GGT and total bilirubin) and antioxidant enzymes, such as catalase (CAT) and glutathione peroxidase (GPx). Moreover, the antioxidant capacity of mice plasma by the FRAP assay, revealed the highest antioxidant capacity for the 0.2 mg/kg LSeNPs group. Histopathological analysis demonstrated the morphological alteration in the group that received only cadmium and was restored after the administration of SeNPs or LSeNPs, while the immunohistochemical analysis of the bcl family revealed anti-apoptotic effects; the Q-PCR analysis showed an upregulation of hepatic inflammatory markers for the group exposed to Cd and a decreased value for the groups receiving oral SeNPs/ LSeNPs in a dose-dependent manner. The best protective effects were obtained for LSeNPs. A functional food that includes both probiotic bacteria and elemental SeNPs could be successfully used to annihilate Cd-induced liver toxicity, and to improve both nutritional values and health benefits.

The Importance of a New Cardiovascular Risk Factor - Asymmetric Dimethylarginine.

In the past years, scientific research has highlighted the presence of a new cardiovascular risk factor, the implications of which have not been sufficiently studied so far. It is different from conventional risk factors because it acts independently at the endothelial level, having important proatherogenic properties. Through its action, this risk factor leads to increased oxidative stress and promotes the onset of atherosclerosis faster than other well-known risk factors so far. Asymmetric dimethylarginine (ADMA) is a methylprotein that arises from posttranslational methylation of proteins. Its importance has emerged in recent years, when the rate of cardiovascular mortality among patients with chronic kidney disease has been high. The distinctive element of this risk factor compared to other well-known ones is given by its ability to compete directly with nitric oxide synthase, being its strongest endogenous inhibitor, with strong proatherogenic attributions. Given that ADMA has tight correlations with atherogenesis and endothelial damage, its assessment should be taken into consideration for any patient who has been recently diagnosed with high blood pressure.

Genetic Polymorphism of MBL 2 in Patients with Allergic Bronchial Asthma.

Mannose-binding lectin (MBL) belongs to a family of glycoproteins called lectins or collectins, which possess many of the functional features of immunoglobulins. Mannose-binding lectin is a very important component of the innate immune system, which recognizes distinct pathogens and activates the classical path of the complement-fixation method. In humans, the serum levels of collectins vary widely, and their variability is correlated with susceptibility and resistance to infection and other diseases. Recent studys show that MBL gene polymorphism is involved in the pathogenesis of many diseases, including infectious and allergic illnesses. Our study aims to determine the role of MBL polymorphism in children diagnosed with allergic bronchial asthma, especially in acute episodes. We conclude that MBL2 gene polymorphism is associated with atopy, allergic diseases and acute respiratory tract infections with MBL deficiency in early childhood. In terms of genetic polymorphism, most of the studied alleles were type A, these being the most frequently present in the studied groups, while alleles B, C or D have been explored to a lesser extent. Studies are also required for adult patients with allergic and atopic conditions, because so far, most of the research has been done on pediatric population only.

Acute kidney injury: a clinical issue in hospitalized patients with heart failure with mid-range ejection fraction.

INTRODUCTION Acute kidney injury (AKI) during hospitalization is associated with increased mortality in patients with acute heart failure (AHF). In 2016, the European Society of Cardiology introduced the category of heart failure (HF) with mid­range ventricular ejection fraction (HFmrEF) as a distinct category from HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). OBJECTIVES The aim of this study was to evaluate in­hospital mortality risk associated with AKI in patients with AHF, with a focus on the HFmrEF group. PATIENTS AND METHODS A total of 365 health records of patients with a primary diagnosis of acute decompensated heart failure (ADHF) were reviewed. AKI was defined according to Acute Kidney Injury Network criteria. HF was diagnosed based on Framingham criteria. Patients with ADHF were evaluated as 3 separate groups, based on ventricular ejection fraction: HFpEF (≥50%), HFmrEF (40%-49%), and HFrEF (<40%). Risk and survival analyses were conducted on de­identified data. RESULTS The AKI­associated in­hospital mortality odds ratios for HFmrEF and HFrEF groups were 4.55 (95% CI, 1.46-14.18) and 2.59 (95% CI, 1.05-6.41), respectively, with a highly significant difference between the groups (P = 0.002; Mantel-Haenszel test). The hazard ratios in the Cox proportional hazards model were 4.79 (95% CI, 1.54-14.96) and 2.94 (95% CI, 1.27-6.80) for HFmrEF and HFrEF groups, respectively. CONCLUSIONS AKI was associated with a higher risk of mortality in patients with HFmrEF when compared with those with HFrEF, suggesting a stronger prognostic impact of AKI in patients with HFmrEF.

The association between HIV clinical disease severity and psychiatric disorders as seen in Western Romania.

HIV disease continues to be a serious health issue all over the world. By the end of 2016, 36.7 million people were living with HIV, 1.8 million people became newly infected and 1 million died of HIV-related causes/diseases. In order to develop effective treatment strategies, is important to assess the risk factors that affect negatively the HIV-positive patients. HIV-infected patients are at high risk of developing psychiatric disorders in every stage of the illness. Psychiatric disorders can negatively influence the treatment adherence, induce risk behavior and influence the quality of life. The purpose of this study is to determine if the severity of HIV disease is associated with increased frequency of psychiatric disorders. We evaluated 101 HIV-positive patients receiving antiretroviral therapy in Western Romania via Psychiatric Diagnostic Screening Questionnaire (PDSQ). We conducted a risk analysis in order to see if the patients have a higher risk of developing psychiatric disorders depending on HIV serostatus factor (HIV asymptomatic, symptomatic, AIDS converted). Our study shows that, the patients having AIDS and symptomatic HIV have a higher prevalence for the most common psychiatric disorders: major depressive disorder (OR = 5.81;p < 0.001), panic disorder (OR = 3.11; p = 0.016), agoraphobia (OR = 4.31; p = 0.024), social phobia (OR = 2.81; p = 0.038), generalized anxiety disorder (OR = 4.79; p = 0.006), somatization (OR = 8.72; p < 0.0010) and hypochondria (OR = 4.66; p = 0.0013). Symptomatic HIV and AIDS converted serostatus is also a risk factor for post-traumatic stress disorder, obsessive-compulsive disorder and psychosis. The main conclusion of this study is that the more severe HIV clinical disease was associated with increased frequency of psychiatric disorders. As a consequence, we conclude that psychiatric disorders and HIV/AIDS treatment should be addressed simultaneously, depending on the risk specific factors such as the HIV infection stage and, due to psychiatric repercussions of HIV is expected to become more relevant in the coming years.

Uterine Artery Doppler Flow Indices in Pregnant Women During the 11 Weeks + 0 Days and 13 Weeks + 6 Days Gestational Ages: a Study of 168 Patients.

OBJECTIVES: Uterine artery Doppler flow studies during the 11th and 14th week of pregnancy are important in the prediction of preeclampsia and intrauterine growth restriction in pregnant women as well as in the prevention thereof. METHODS: Our study on Doppler flow indices of the uterine arteries involved 168 patients examined in our clinic, with pregnancies ranging from 11 weeks + 0 days to 13 weeks + 6 days. RESULTS: There were 72 patients from 11 weeks + 0 days to 11 weeks + 6 days (42.86%), 43 from 12 weeks + 0 days to 12 weeks + 6 days (25.60%), and 53 from 13 weeks + 0 days to 13 weeks + 6 days (31.55%). The mean values of the Doppler indices were PI 1.75±0.79, 1.88± 0.81, 1.71±0.81, and 1.58±0.72 and RI 0.72±0.14, 0.75±0.14, 0.71±0.14, and 0.70±0.14 for the entire group and for the three intervals, respectively. There were 71 (42.26%), 33 (19.64%, with 18 cases or 54.55% on the right side), and 64 (38.10%) patients with bilateral, unilateral and absent uterine artery notching, respectively. The mean Doppler indices for the three aforementioned groups were 2.18±0.79, 1.63±0.72, and 1.33±0.57 for the PI, and 0.79±0.11, 0.71±0.14, and 0.66±0.14 for the RI, respectively. The indices for the 175 arteries with and 161 without notching, taken separately, in all patients, as well as for the uterine arteries with and without notching in patients with unilateral notching only were 2.16±0.76, 1.30±0.54, 2.08±0.66, and 1.17±0.43 for the PI, and 0.79±0.11, 0.65±0.14, 0.79±0.11, and 0.63±0.12 for the RI, respectively. CONCLUSIONS: The mean uterine artery PI and RI decrease from 11 weeks + 0 days-11 weeks + 6 days to 13 weeks + 0 days-13 weeks + 6 days. They also decrease from patients with bilateral uterine artery notching to those without notching. The frequency of uterine artery notching decreases with increasing gestational age. Our results are similar to those in literature.

Galectin-3: A Link between Myocardial and Arterial Stiffening in Patients with Acute Decompensated Heart Failure? / Galectina-3: Ligação entre Rigidez Miocárdica e Arterial em Pacientes com Insuficiência Cardíaca Descompensada?

Abstract Background: Heart failure is accompanied by abnormalities in ventricular-vascular interaction due to increased myocardial and arterial stiffness. Galectin-3 is a recently discovered biomarker that plays an important role in myocardial and vascular fibrosis and heart failure progression. Objectives: The aim of this study was to determine whether galectin-3 is correlated with arterial stiffening markers and impaired ventricular-arterial coupling in decompensated heart failure patients. Methods: A total of 79 inpatients with acute decompensated heart failure were evaluated. Serum galectin-3 was determined at baseline, and during admission, transthoracic echocardiography and measurements of vascular indices by Doppler ultrasonography were performed. Results: Elevated pulse wave velocity and low arterial carotid distensibility are associated with heart failure in patients with preserved ejection fraction (p = 0.04, p = 0.009). Pulse wave velocity, carotid distensibility and Young’s modulus did not correlate with serum galectin-3 levels. Conversely, raised galectin-3 levels correlated with an increased ventricular-arterial coupling ratio (Ea/Elv) p = 0.047, OR = 1.9, 95% CI (1.0‑3.6). Increased galectin-3 levels were associated with lower rates of left ventricular pressure rise in early systole (dp/dt) (p=0.018) and raised pulmonary artery pressure (p = 0.046). High galectin-3 levels (p = 0.038, HR = 3.07) and arterial pulmonary pressure (p = 0.007, HR = 1.06) were found to be independent risk factors for all-cause mortality and readmissions. Conclusions: This study showed no significant correlation between serum galectin-3 levels and arterial stiffening markers. Instead, high galectin-3 levels predicted impaired ventricular-arterial coupling. Galectin-3 may be predictive of raised pulmonary artery pressures. Elevated galectin-3 levels correlate with severe systolic dysfunction and together with pulmonary hypertension are independent markers of outcome.

Resumo Fundamento: A insuficiência cardíaca é acompanhada por anormalidades na interação ventrículo-vascular devido à rigidez miocárdica e arterial aumentada. A galectina-3 é um biomarcador recentemente descoberto que exerce um importante papel na fibrose miocárdica e vascular, e na progressão da insuficiência cardíaca. Objetivos: O objetivo deste estudo foi determinar se a galectina-3 está correlacionada com marcadores de rigidez arterial e acoplamento ventriculoarterial deficiente em pacientes com insuficiência cardíaca descompensada. Métodos: Um total de 79 pacientes internados com insuficiência cardíaca descompensada foi avaliado. Galectina-3 sérica basal foi determinada e, durante a admissão hospitalar, foram realizadas ecocardiografia transtorácica e medidas de índices vasculares por ultrassonografia Doppler. Resultados: Velocidade de onda de pulso elevada e baixa distensibilidade da artéria carótida estão associadas com insuficiência cardíaca em pacientes com fração de ejeção preservada (p = 0,04, p = 0,009). Velocidade de pulso, distensibilidade da artéria carótida e módulo de Young não se correlacionaram com níveis séricos de galectina-3. Por outro lado, níveis elevados de galectina-3 correlacionaram com razão de acoplamento ventriculoarterial aumentada (Ea/Elv) p = 0,047, OR = 1,9, IC 95% (1,0-3,6). Níveis aumentados de galectina-3 estavam associados com taxas mais baixas de pressão ventricular esquerda na fase inicial da sístole (dp/dt) (p = 0,018), e pressão arterial pulmonar aumentada (p = 0,046). Os resultados mostraram que níveis elevados de galectina-3 (p = 0,038, HR = 3,07) e pressão pulmonar arterial (p = 0,007, HR = 1,06) são fatores de risco independentes para mortalidade de todas as causas e reinternações hospitalares. Conclusões: O estudo mostrou que não houve correlação significativa entre níveis séricos de galectina-3 e marcadores de rigidez arterial. Altos níveis de galectina-3, por outro lado, foi um preditor de acoplamento ventriculoarterial deficiente. A galectina-3 pode ser um preditor de pressões arteriais pulmonares aumentadas. Níveis elevados de galectina-3 correlacionam-se com disfunção sistólica grave e, juntamente com hipertensão pulmonar, é um marcador independente de desfecho.

Galectin-3: A Link between Myocardial and Arterial Stiffening in Patients with Acute Decompensated Heart Failure?

BACKGROUND: Heart failure is accompanied by abnormalities in ventricular-vascular interaction due to increased myocardial and arterial stiffness. Galectin-3 is a recently discovered biomarker that plays an important role in myocardial and vascular fibrosis and heart failure progression. OBJECTIVES: The aim of this study was to determine whether galectin-3 is correlated with arterial stiffening markers and impaired ventricular-arterial coupling in decompensated heart failure patients. METHODS: A total of 79 inpatients with acute decompensated heart failure were evaluated. Serum galectin-3 was determined at baseline, and during admission, transthoracic echocardiography and measurements of vascular indices by Doppler ultrasonography were performed. RESULTS: Elevated pulse wave velocity and low arterial carotid distensibility are associated with heart failure in patients with preserved ejection fraction (p = 0.04, p = 0.009). Pulse wave velocity, carotid distensibility and Young's modulus did not correlate with serum galectin-3 levels. Conversely, raised galectin-3 levels correlated with an increased ventricular-arterial coupling ratio (Ea/Elv) p = 0.047, OR = 1.9, 95% CI (1.0­3.6). Increased galectin-3 levels were associated with lower rates of left ventricular pressure rise in early systole (dp/dt) (p=0.018) and raised pulmonary artery pressure (p = 0.046). High galectin-3 levels (p = 0.038, HR = 3.07) and arterial pulmonary pressure (p = 0.007, HR = 1.06) were found to be independent risk factors for all-cause mortality and readmissions. CONCLUSIONS: This study showed no significant correlation between serum galectin-3 levels and arterial stiffening markers. Instead, high galectin-3 levels predicted impaired ventricular-arterial coupling. Galectin-3 may be predictive of raised pulmonary artery pressures. Elevated galectin-3 levels correlate with severe systolic dysfunction and together with pulmonary hypertension are independent markers of outcome.

The Harmfulness of Alcohol and Tobacco Smoking in Cardiovascular Pathology and the Perspective of Spiritual Therapy.

A holistic approach to the human person, from a somatic, psychological and spiritual point of view, with reference to the harmfulness of alcoholism and smoking in cardiovascular pathology, highlights several therapeutic variants over time. Among them are: the current somatic therapy, which could not offer optimal solution in eradicating this vice, and psychiatry which, using will power, could not solve man's contradiction with himself, caused by a tempting and treacherous irrationality of senses, instinctive-affective desires, turned into vices, as a "Quasi altera natura", devoid of any bright and creative horizon. As such we propose an alternative that entails changing one's lifestyle to eliminate the harmful effect of alcoholism and smoking on cardiovascular pathology, through the perspective of spiritual therapy, accessible to contemporary society, at no cost and with no adverse events.

Galectin-3 in heart failure pathology--"another brick in the wall"?

Heart failure is a disease affecting millions of patients each year, and is responsible for burdening the world with high mortality rates. More concerns come from its numerous hospital readmissions (with an estimated number of 2.6 million per year which makes it one of the leading diseases responsible for national healthcare expenditures). Despite drastic improvement of therapies in recent years, heart failure remains a progressive disease. Thus, more attention has been given to finding potential biomarkers involved in the pathological mechanisms of this disease that would potentially lead to faster diagnosis and improved prognosis. One of the emerging biomarkers that has just recently come into the spotlight is galectin-3. It was associated in recent clinical trials with both the progression and severity of heart failure. Ventricular remodelling and myocardial fibrosis are essential for heart failure development and are linked to poor outcomes. An ever-growing body of evidence places galectin-3 as an important link between inflammation and fibrosis, which play a prominent role in cardiac remodelling.This review sums up the most relevant experimental and clinical studies about galectin-3 and its potential prognostic value in heart failure. The article also provides a better understanding of this molecule's involvement in heart failure pathology by modulating cardiac fibrosis. It also weighs whether the available data on galectin-3 are consistent enough to reduce readmissions and mortality while improving diagnosis and future therapies for heart failure, versus the possibility that it is simply"another brick in the wall?"

Correlations between the surface ECG and the intracavitary electrocardiogram in typical atrial flutter.

UNLABELLED: Typical atrial flutter (cavo-tricuspid isthmus-dependent) has as an electrophysiological substrate a macro-reentry circuit localized in the right atrium. Depending on the right atrial depolarization sequence, the rotation of the macro-reentry circuit can be counterclockwise (with an inferior to superior activation of the right atrium free wall and superior to inferior activation of the interatrial septum), characterized by negative F waves in inferior leads (DII, DIII, aVF) and V6, and positive in V1 on the surface electrogram (ECG), or clockwise (with a superior to inferior activation of the right atrium free wall and inferior to superior activation of the interatrial septum) characterized by positive F waves in inferior leads (DII, DIII, aVF) and V6, and negative in V1. Nevertheless, it is considered that for the diagnosis of the typical or atypical nature of this arrhythmia, the surface ECG has limited value. The purpose of this study was to compare the relationship between the flutter rotation sequence determined by the intracavitary electrogram and the morphology of the F waves on the surface ECG. METHODS: The study included 387 patients admitted to the Cardiology - Rehabilitation Hospital from Cluj-Napoca between January 2007 and May 2010, diagnosed with typical atrial flutter during an electrophysiological study. Using the intracavitary electrograms the flutter rotation sequence was determined (clockwise or counterclockwise). The F waves' aspect on the surface ECG in leads DII, DIII, aVF, aVL, V1 and V6 was then analyzed. RESULTS: One hundred and fifty two patients (39.3%) were diagnosed with clockwise atrial flutter and 235 patients (60.7%) with counterclockwise atrial flutter. The positive predictive value (PPV) of negative F waves in inferior leads and positive in V1 was, in the case of counterclockwise atrial flutter 98%; the negative predictive value (NPV) was 79%; sensitivity (Se) was 83% and specificity (Sp) was 97%. For typical clockwise atrial flutter, the PPV of the positive F waves in the inferior leads and negative in V1 was 94% (p < 0.001); the NPV was 85%; Se was 73% and Sp was 97%. CONCLUSION: The surface ECG has a high value in determining the macroreentry circuit rotation sequence in the case of typical atrial flutter.

RANKL/RANK/OPG molecular complex--control factors in bone remodeling in psoriatic arthritis.

AIM: To investigate the blood levels of bone remodeling factors (RANKL, OPG and Bone-ALP) in psoriatic arthritis patients. MATERIAL AND METHODS: Included in this study were 27 patients with psoriatic arthritis (CASPAR classification criteria) and 20 healthy subjects. The RANKL , OPG and Bone-ALP levels have been quantified by ELISA method. RESULTS: Peripheral blood concentrations were higher in psoriatic arthritis than in the healthy subjects, and a strong negative correlation between RANKL and OPG and between RANKL and Bone-ALP was also found. CONCLUSIONS: The increase in OPG and Bone-ALP serum level is strongly related to the increase in RANKL serum level in patients with psoriatic arthritis. The increase in OPG and Bone-ALP serum level induces the production of bone matrix parallel to the bone destruction mediated by RANKL. The follow up of the patients with psoriatic arthritis by early RANKL, OPG and Bone-ALP serum level determinations, and of bone metabolism markers (with specific role in bone remodeling), allows an accurate evaluation of disease activity and, in the future, could be a criterion for the initiation of specific, targeted treatment.

The role of radiofrequency ablation as a first line therapy in the treatment of atrial flutter.

UNLABELLED: Cavo-tricuspid isthmus radiofrequency (RF) ablation is an efficient option in the treatment of atrial flutter. In the case of a well-tolerated, first episode of atrial flutter, it has a class II indication, level of evidence B, the current first-line therapeutic option being electrical cardioversion, pharmacological cardioversion or atrial overdrive pacing followed by long-term antiarrhythmic therapy. The purpose of this study was to evaluate, in a prospective manner, the recurrence rate of these two different therapeutic options after the treatment of a first episode of atrial flutter. MATERIAL AND METHODS: Between January 2007 and May 2009, for 99 patients admitted to the hospital for a first episode of atrial flutter, cardioversion was attempted either by RF ablation (group 1-42 patients), or by electrical cardioversion, pharmacological cardioversion or atrial overdrive pacing followed by long-term Amiodarone therapy (group 21-57 patients). We compared the recurrence rate of atrial flutter in the 2 groups after a follow-up period of one year. RESULTS: In group 1, sinus rhythm was achieved in all patients, with bidirectional isthmic block being obtained for 37 patients (88.1%). In group 2, conversion to sinus rhythm was obtained in all cases. The recurrence rate was 6 times higher in group 2 vs group 1 (57.9% = 33 patients vs 9.5% = 4 patients) (p = 0.01). CONCLUSION: RF ablation should be considered as a therapeutic option in the treatment of the first episode of atrial flutter, due to its significant efficiency in maintaining sinus rhythm and to its low recurrence rate.

[The myocardial performance index (Tei-Index): correlation with seric NTproBNP levels in patients with dilated cardiomyopathy]. / Indexul de performanta miocardica globala (Tei): corelatia cu nivelul seric al NtproBNP in cardiomiopatia dilatativa.

UNLABELLED: A combined myocardial performance index (isovolumic contraction time plus isovolumic relaxation time divided by ejection time, 'Tei-Index') has been applied in the echocardiographic evaluation of patients with dilated cardiomyopathy (DCM). N-terminal pro brain natriuretic peptide (NTproBNP) is released from the left ventricular (LV) in response tomyocite stretch and is a powerful prognostic marker for heart failure. AIM: To assess the correlation between Tei index and NTproBNP level in patients with DCM. METHODS: Conventional echocardiography were performed in 50 consecutive patients with DCM, in sinus rhythm, concomitant with NTproBNP determination. Patients with paced rhythm and creatinine clearance < 40 mL/min were not included. Tei index was calculated. RESULTS: Simple regression analysis demonstrated a statistically significant linear correlation between NTproBNP and Tei index (r = 0.70, p < 0,001). NTproBNP had weaker relationship with pulmonary artery systolic pressure, indexed left atrial (LA) volume, LA volume, LV ejection fraction, early diastolic transmitral velocity (E) and no relationship with LA diameter, mitral E deceleration time, LV end-diastolic diameter. The area under the ROC curve for prediction of NTproBNP levels > 900 pg/mL was maxinal (0.76) for Tei index. The optimal Tei index cut-off for prediction of NTproBNP levels > 900 pg/mL was 0.77 (sensitivity = 84%, specificity = 82%). CONCLUSIONS: Tei index strongly correlates with NTproBNP in patients with DCM in sinus rhythm, and can be a simple and accurate predictor of the serum NTproBNP level.

[Bone turnover markers evaluation in psoriatic arthritis]. / Evaluarea anumitor mediatori ai turnover-ului osos din artrita psoriazica.

UNLABELLED: The aim of this study was to investigate the blood level of bone turnover markers: osteoprotegerin (OPG), bone alkaline phosphatase (Bone-ALP), and receptor activator of NF-kappa B ligand (RANKL) of patients with psoriatic arthritis. METHODS: Twenty-four patients with psoriatic arthritis (CASPAR classification criteria) and twenty healthy controls were included. The OPG, Bone-ALP and RANKL levels were quantified by using ELISA method. RESULTS: Peripheral blood levels of bone turnover markers were higher in psoriatic arthritis than martors and there was a strong negative correlation between OPG-RANKL and Bone-ALP- RANKL. CONCLUSION: The OPG and Bone-ALP serum level is strongly negative related to the increase in RANKL serum level in patients with psoriatic arthritis. The increase in OPG and Bone-ALP serum level induces the production of bone matrix parallel to the bone destruction mediated by RANKL. Follow up of patients with psoriatic arthritis, by use of early determination of RANKL, OPG and Bone-ALP serum levels, and also of bone metabolism markers (they have specific role in bone remodeling), allows a precise evaluation of disease activity and, in future, could be a criteria for the initiation of specific, targeting treatment.

[Multidisciplinary approach in pyomyositis early diagnosis]. / Abordare multidisciplinara în diagnosticul precoce al piomiozitei.

Pyomyositis is a disease characterized by primary bacterial infection of the skeletal muscles of lower limbs and thorax. It is a very rare disease (100 cases in USA in the last 20 years) but with an increasing occurrence especially among patients with AIDS in an advanced stage or in association with other pathologic conditions like diabetes mellitus, cancer, connective tissue diseases or hematological disorders, long usage of corticosteroid drugs. We are hereby showing the case of a 46-year-old female who presented difficult problems of differential diagnosis until final diagnosis was established. Her life was saved due to an exemplary interdisciplinary collaboration and by using an extremely useful imaging method for musculoskeletal pathology--IRM. The IRM protocol: coronal and axial T2 weighted SE, coronal and axial T1 weighted SE, axial and coronal T2 weighted + Fat Sat was comprehensive and conclusive. The imaging diagnosis established the presence and extension of the muscle abscess, leading to an efficient drainage. After the surgery, the repeated IRM confirmed the drainage efficiency. Unlike the French literature which claims that the muscle abscesses are secondary to a primary center, in this case, and in accordance with Anglo-Saxon literature, the muscle abscess was primary, in absence of any other center of infection.

[The correlation between NT-proBNP plasma levels and heart failure syndrome]. / Corelatii intre nivelul plasmatic al NT-proBNP si sindromul de insuficienta cardiaca.

UNLABELLED: proBNP represents the precursor of the brain natriuretic peptide (BNP) and is released by the cardio-myocytes as a result of the myocardial stretch. It is fractioned into two components, BNP and NT-proBNP. We use more often the determination of NT-proBNP levels in laboratory tests because of its prolonged biological half-time (60-120 minutes, much longer than the BNP half-life). AIM: To determine a link between the plasmatic levels of NT-proBNP and heart failure syndrome (HFS). MATERIAL AND METHOD: We studied 40 patients admitted in the Internal Medicine Clinic of the Western University "Vasile Goldis" Arad, during a two years period (2004-2005). Every patient had a clinical examination, an echocardiography and the determination of NT-proBNP levels. For the determination of the BNP plasmatic levels we used a special kit Elecsys proBNP, which is now largely available. The NT-proBNP levels were correlated with the HFS diagnosis (the presence of dyspnea and the ejection fraction). RESULTS: In 29 patients the NT-proBNP levels were above the upper limit of 125 pg/ml, 86% of them being clinically diagnosed with HFS. 11 patients had BNP levels in the normal values range and 4 of them were clinically diagnosed with HFS. Correlating the NT-proBNP plasma levels and NYHA class of HF we could establish some guidelines regarding the critical BNP values upon which the diagnostic of HFS is almost certain. The minimum level of BNP at which a patient was diagnosed with HF was 89.9 pg/ml. Levels above 125 pg/ml predicts o risk six times higher for HFS. DISCUSSIONS: The BNP plasma values may be modified in hepatic or renal failure, which can cause false high levels of hormone. These situation should be considered possible error sources of diagnosis if the HFS is evaluated only by the means of NT-proBNP plasma levels. CONCLUSIONS: The dosage of plasma levels of NT-proBNP is useful into patients with suspected HFS, if the other methods of diagnosis are not reliable. There is a link between the NT-proBNP plasma levels and the NYHA HFS class. However only the dosage of BNP is not sufficient for a correct diagnosis of HFS.