Carbohydrate Antigen 125 (CA 125): A Novel Biomarker in Acute Heart Failure.

BACKGROUND: Heart failure is a global major healthcare problem with millions of hospitalizations annually and with a very high mortality. There is an increased interest in finding new and reliable biomarkers for the diagnostic, prognostic and therapeutic guidance of patients hospitalized for acute heart failure; Our review aims to summarize in an easy-to-follow flow recent relevant research evaluating the possible use and the clinical value of measuring CA 125 serum levels in acute HF. METHODS: A thorough search in the main international databases identified a relevant pool of 170 articles, providing recently published data for this narrative review that used PRISMA guidelines. RESULTS: There are data to sustain the role of carbohydrate antigen 125 (CA 125), a worldwide used marker of ovarian cancer, in patients with heart failure. Several studies have shown links between CA 125 levels and congestion seen in acute heart failure, high mortality and readmission rates at 6 months follow-up after discharge from acute heart failure and also a role of CA 125 in the guidance of heart failure therapy. There are also clinical trials that showed that several particularities of CA 125 make it even better than N-terminal pro b-type natriuretic peptide (NT-pro BNP)-a classical and more utilized marker of heart failure) in several scenarios of acute heart failure. CONCLUSIONS: Although the mechanism behind the upregulation of serum CA 125 in patients with congestive HF has not been confirmed nor fully understood.

Thrombomodulin Serum Levels-A Predictable Biomarker for the Acute Onset of Ischemic Stroke.

The early diagnosis of acute ischemic stroke (AIS) can be challenging in cases presenting with a scarcity of clinical signs, normal cerebral imaging in early stages and a lack of specific serum markers. Thrombomodulin has been shown to be associated with cerebrovascular ischemic events and can be considered an important biomarker for the acute onset of ischemic stroke. In our study, we compared the serum levels of thrombomodulin (sTM) between a relevant patient group of 70 AIS patients and a control group of patients without AIS admitted into the neurology department between June 2022 and May 2023. sTM levels were measured at 24 h and 48 h after patients' admissions into the hospital. There was a significant difference between the two groups (AIS: 23.2 ± 9.17 ng/mL vs. controls: 3.64 ± 1.72 ng/mL; p-value < 0.001). sTM values were correlated with the score of neurological deficits, with gender and dyslipidemia. The association of sTM values with the acute onset of AIS as an end point was significant, which allows rapid therapeutic interventions, even in the absence of a well-defined clinical syndrome (AUC = 0.99). Reanalysis of the patients after propensity score matching increased the power of sTM as a biomarker (AUC = 1). sTM represents a potentially useful biomarker to diagnose the onset of an AIS, even in scarce clinical presentations, which makes thrombomodulin a valuable indicator for early treatment initiation.

The Contribution of Procalcitonin, C-Reactive Protein and Interleukin-6 in the Diagnosis and Prognosis of Surgical Sepsis: An Observational and Statistical Study.

Background: Sepsis affects over 30 million people worldwide each year, causing approximately 6 million deaths. Challenges in clinical diagnosis and the need for an early diagnosis to prevent mortality due to sepsis have led to dependence on inflammatory biomarkers like Procalcitonin (PCT), C-reactive protein (CRP), and Interleukin-6 (IL-6). Objective: This study was performed to observe the contribution of inflammatory biomarkers in the diagnosis and prognosis of patients with surgical sepsis. Methods: We performed a retrospective observational study in a Clinical Emergency Hospital, which included a number of 125 patients with surgical sepsis admitted between January 2020 and December 2021. The patients were included in the study based on the Sepsis-3 definition. PCT, CRP, IL-6, Sepsis-related Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index (CCI), the time up to surgery, the days of treatment in Intensive Care Unit (ICU) and the total days of hospitalization had been statistically analyzed. Results: The mean age of all patients was 65.14 years. The mean value in all patients for PCT was 20.08 ng/mL, for CRP was 175.42 mg/l, and for IL-6 was 799.6 pg/mL. The strongest correlation between biomarkers was between CRP and IL-6 (r = 0.425; p < 0.0001). Of all biomarkers, the CRP correlated the strongest with patient outcomes (r = 0.544; p < 0.0001). The area under curve (AUC) for the mean values of the inflammatory biomarkers was calculated and the best diagnostic performance was for CRP with 0.816 (95% CI: 0.744-0.887). Conclusion: CRP and IL-6 were the most efficient in sepsis diagnosis. The association of PCT, CRP and IL-6 has increased the range of certainty in sepsis diagnosis. CRP was the most efficient biomarker in the prognosis of sepsis.

Case Report. Diagnostic Challenges: Liver Metastases from Mammary Gland Origin or Cholangiocarcinoma?

Liver metastases are secondary malignant tumor formations due to the dissemination of primary malignant tumors, which are often the first clinical manifestation of mammary cancer. We present the case of a 52-year-old female patient from an urban area who came to the walk-in service at the "Sf. Ap. Andrei" Emergency County Hospital, Galati, for laboratory investigations. These revealed a significant increase in CA 15-3 tumor markers and a slight increase in CA 125 and CA 19-9 markers; however, clinical examination did not reveal tumors in the breast and there were no axillary adenopathies. CT exam revealed a large tumor formation in the hepatic right lobe and, close to it, a smaller one. The mammograph showed millimetric lesions at the level of the left mammary gland and bilateral axillary adenopathies. Subsequently, the patient underwent two liver biopsies in two different hospitals, which produced different histological and immunohistochemical results. PET-CT drew attention to a lung tumor and disclosed a different origin of metastases. In the end, correlating all investigations, the final diagnosis was cholangiocarcinoma with liver metastases and lung tumor with lung and bone metastases.

Basal Cell Carcinoma Perineural Invasion and Suggestive Signs of Perineural Invasion-Findings and Perspectives.

Basal cell carcinoma (BCC) is a malignant tumor with a rising incidence and is the beneficiary of several innovative evaluation techniques. Histopathology remains the gold standard for assessment, having the possibility of addressing multiple high-risk factors such as perineural invasion (PNI). The current study included a number of 244 BCC patients and targeted the identification of positive PNI and its suggestive signs, and whether they correlated or not with other high-risk tumor signs. PNI was found in 20.1% of patients, with 30.7% of patients having perineural chronic inflammation (PCI), which is a suggestive sign of PNI. PNI was also found in larger tumors, with deeper Clark levels, in high-risk BCCs and high-grade tumors. PNI and PCI are both important for pathology reporting, aiding in treatment choice and further patient management, with possibly positive outcomes concerning morbidity and mortality.

Correlation Between Serum Procalcitonin Levels and 28-Day Mortality in Patients with Surgical Sepsis and Septic Shock.

Background: Sepsis is a major medical emergency accounting for approximately 48.9 million cases and 11 million deaths worldwide, representing 19.7% of all global deaths. This study was conducted to evaluate the correlation between procalcitonin values and 28-day mortality. Methods: A retrospective study was conducted that included patients with sepsis and septic shock, treated in the surgical departments of the Sf. Apostol Andrei Galati County Emergency Clinical Hospital between January 2020 and December 2021. Results: 125 patients (mean age 65 years), mostly men (56%, n=70) were included. The mean procalcitonin value at admission in the sepsis group (28%, n=35) was 5.98 ng/mL, and in the septic shock group (72%, n=90) was 40.09 ng/mL. The most significant correlation was between procalcitonin at discharge, 28-day mortality (r = 0.437; p 0.0001) and SOFA score (r = 0.356; p 0.0001). Conclusions: Procalcitonin at discharge was positively correlated with 28-day mortality and SOFA score. The procalcitonin value at discharge can be used in the prognosis of the patient with surgical sepsis, but for better results the association between procalcitonin, SOFA score and the clinical status of the patient is recommended.

The Use of Brain Natriuretic Peptide in the Evaluation of Heart Failure in Geriatric Patients.

Heart failure is one of the main morbidity and mortality factors in the general population and especially in elderly patients. Thus, at the European level, the prevalence of heart failure is 1% in people under 55 years of age but increases to over 10% in people over 70 years of age. The particularities of the elderly patient, which make the management of heart failure difficult, are the presence of comorbidities, frailty, cognitive impairment and polypharmacy. However, elderly patients are under-represented in clinical trials on the diagnosis and treatment of heart failure. The need for complementary methods (biomarkers) for differential and early diagnosis of heart failure is becoming more and more evident, even in its subclinical stages. These methods need to have increased specificity and sensitivity and be widely available. Natriuretic peptides, in particular B-type natriuretic peptide (BNP) and its fraction NTproBNP, have gained an increasingly important role in the screening, diagnosis and treatment of heart failure in recent years.

Sweet Syndrome Associated with Myelodysplastic Syndrome-A Review of a Multidisciplinary Approach.

Sweet syndrome (SS) is a rare disease described as a febrile neutrophilic dermatosis with acute onset, the pathogenesis of which has not yet been elucidated. The syndrome is characterized by the sudden onset of erythematous infiltrated papules or plaques located on the upper body and is associated with fever, leukocytosis and neutrophilia. The lesions show a dense dermal infiltration with mature neutrophils. The condition is responsive to systemic steroids. The central nervous system, bones, muscles, eyes, ears, mouth, heart, lung, liver, kidneys, intestines, and spleen may be affected by SS as extracutaneous manifestations. More and more cases have been found to be associated with malignancies, particularly myelodysplastic syndrome, and, less frequently, other hematologic malignancies or solid tumors. Approximately 21% of patients with SS have an associated malignancy and up to 80% of MASS cases are associated with hematological diseases, predominantly myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Myelodysplastic syndrome is a clonal disease of the bone marrow characterized by inefficient hematopoiesis, dysplasia of the bone marrow and peripheral cytopenias. Affected patients have a high risk of leukemic transformation. After analyzing later studies and current practical aspects regarding MDS-related SS, we suggest an algorithm for evaluating these patients.

The role of vitamin D in the onset and progression of diabetic retinopathy.

Having a classical role in the regulation of calcium homeostasis in skeletal system, vitamin D has also been recognized as being involved in the activity of the immune system, as well as in the pathology of the visual analyzer. Thus, regarding the function of vitamin D in the eye, this is supported by the identification of vitamin D receptors (VDR) in several structures of the eyeball, such as corneal epithelial and endothelial cells, ciliary body and retinal cells. One of the ophthalmological pathologies in which vitamin D plays an important role is diabetic retinopathy, both through its effects on the immune system (reduction of the pro-inflammatory cytokines - IL-1, IL-6, IL-012, TNF alpha, and stimulation of anti-inflammatory cytokines IL-10), as well as by reducing the level of vascular endothelial growth factor (VEGF) and thus inhibiting retinal neovascularization. Vitamin D demonstrates a protective role on the development and progression of diabetic retinopathy by reducing blood sugar, hypertension and atherosclerosis, but randomized studies are still needed to establish the direct causal relationship between the development of diabetic retinopathy and vitamin D levels.

Antibacterial and Photocatalytic Coatings Based on Cu-Doped ZnO Nanoparticles into Microcellulose Matrix.

The paper presents a successful, simple method for the preparation and deposition of new hybrid Cu-doped ZnO/microcellulose coatings on textile fibers, directly from cellulose aqueous solution. The morphological, compositional, and structural properties of the obtained materials were investigated using different characterization methods, such as SEM-EDX, XRD, Raman and FTIR, as well as BET surface area measurements. The successful doping of ZnO NPs with Cu was confirmed by the EDX and Raman analysis. As a result of Cu doping, the hybrid NPs experienced a phase change from ZnO to (Zn0.9Cu0.1)O, as shown by the XRD results. All the hybrid NPs exhibited a high degree of crystallinity, as revealed by the very sharp reflections in XRD patterns and suggested also by the Raman results. The evaluation of the very low copper-doping (0.1-1 at.%) effect has shown different behavior trends of the hybrid coatings compared with the starting oxide NPs, for MB and MO photodegradation. Continuous increases up to 92% and 60% for MB and MO degradation, respectively, were obtained at maximum 1 at.%-Cu doping coatings. Strong antibacterial activity against S. aureus and E. coli were observed.

Particularities of diagnosis in an elderly patient with neglected peritonitis: a case report.

Acute peritonitis accounts for 1% of inpatient surgical emergencies and is the second leading cause of sepsis in patients in intensive care departments. Diagnosis through laboratory analysis in bacterial peritonitis focuses mainly on the biomarkers, procalcitonin and C-reactive protein. A 73-year-old male patient presented with meteorism, diarrhea, vomiting, fever, and hypotension. Laboratory investigations showed very high procalcitonin and C-reactive protein values, and abdominal radiography revealed paraumbilical hydroaerial levels, which suggested septic shock of intra-abdominal origin. Emergency laparotomy was performed, which revealed agglutinated intestinal loops in the right iliac fossa with false membranes, purulent fluid, overdistended jejunum and ileum with an occlusive appearance, acute gangrenous appendicitis with perforation, and suppurative omentitis. The intraoperative diagnosis was acute neglected peritonitis in the occlusive phase owing to acute gangrenous appendicitis with perforation and suppurative omentitis. Laboratory analysis in conjunction with imaging provides important information in the early diagnosis of infectious pathology in elderly patients, even if these methods do not accurately identify the cause. The combination of procalcitonin and C-reactive protein biomarker levels successfully contributed to the diagnosis in this case. Notably, the patient's white blood cell counts were inconsistent with the severity of the infection.