Aldolase A and carbonic anhydrase III, two new candidate biomarkers versus acknowledged parameters in the context of crushing syndrome

Introduction. Crushing syndrome can affect all structures of a limb and can cause unique or complex injuries. The clinical picture of the injuries is nonspecific and extremely varied, and is not characteristic of the mechanism that generated it. The aim of our study was to correlate the changes of ALD A (aldolase A) and CAIII (carbonic anhydrase III) in the appearance and evolution of the crushing syndrome. Material and methods. The present study included 22 patients with crushing syndrome. The control group consisted of 20 healthy subjects. IL-6 (interleukin-6), CK (creatine kinase), ALD A and CAIII blood levels were determined simultaneously from all the participants to the study. Statistical analysis was performed using IBM SPSS Statistics 25 and Microsoft Office Excel / Word 2013. Results. Our results showed significantly increased levels of ALD A, CAIII, IL-6 and CK in patients with crushing syndrome. However, no statistically significant correlations could be found between the studied biomarkers. Discussions. So far, in the medical literature, very few studies focused on the correlation between the occurrence of crushing syndrome and changes in ALD A and CA III levels. Conclusions. Our study showed that ALD A and CAIII may become important biomarkers for the rapid diagnosis of crushing syndrome in the future.

The role of the family doctor in the early diagnosis of colorectal cancer

The incidence of colorectal cancer is increasing. It is currently the third most common cancer, after lung and breast cancer. Despite the increased incidence, recent advances in early detection, performing the screening according to the recommendations and treatment options have reduced colorectal cancer mortality. The role of the family doctor is to advise and to identify non-modifiable risk factors (age, male sex, race, family history, inflammatory bowel disease) as well as modifiable ones (tobacco consumption, low-fiber, high-fat and high carbohydrate diet, a sedentary lifestyle, obesity), in order to avoid these risk factors by developing a personalized plan for the prevention and early detection of colorectal cancer depending on the individual risk. Genetic testing and a more comprehensive family history documentation by the family doctor can enable those with a hereditary predisposition for the colorectal cancer to take preventive measures. Applying evidence-based prevention strategies reduces the prognosis of colorectal cancer and reduces mortality. Colorectal cancer has an increased survival rate if diagnosed early and treated properly.

Non-syndromic pheochromocytoma: From post-operatory scores to lifetime follow-up

We introduce a case report of an adult male diagnosed with non-syndromic pheochromocytoma with a first pathological post-operatory report of malignant type with further re-considerations during follow-up for a 6-year period of time. This is 46 - year old male admitted for: post-adrenalectomy status reassessment. In 2013 he was diagnosed with high blood pressure requiring a complex regime of anti-hypertensive drugs to control it. In 2015 he was referred for an endocrine check-up which revealed a pheochromocytoma (noradrenaline type). Computed tomography imaging of the abdomen showed a right adrenal tumor of 28/38 mm, a mass that was clearly contoured, with heterogeneous pattern, and with moderate caption of intravenous contrast. Laparoscopic right adrenalectomy is performed with normalization of high pre-operatory normetanephrines and a dose reduction of anti-hypertensive medication which was still necessary. Pathological report suggested a malignant pheochromocytoma; the initial PASS score of 8 was later re-calculated, and a GAPP score of 5 was achieved showing a moderately differentiated tumor. No genetic backup was identified. Within the first year after tumor removal, the patient suffered a stroke, proving the higher cardiovascular risk than general population even after hormonal imbalance is restored. Lifelong surveillance is the rule.

Creatine supplementation and muscles: From metabolism to medical practice

Creatine has become the most popular dietary supplement in sport and exercise physiology. In humans creatine is synthesized by the kidneys, pancreas and liver and transported mainly into brain, skeletal and cardiac muscle. Phosphocreatine is a high-energy content molecule, essential for the ADP to ATP conversion during intensive physical activity. Creatine and phosphocreatine are crucial in the energy shuttle system of high-energy phosphates between the mitochondrial ATP production and the cytosolic ATP consumption. Creatine supplementation increases lean body mass acting on myogenic regulatory factors. During muscular recovery, creatine supplementation regulates the regeneration process by reduction of muscle damage-induced inflammation and oxidative stress, activation and proliferation of satellite cells and regulation of calcium transport in muscle. The effects of creatine supplementation on muscle physiology are beneficial in anaerobic/aerobic exercises. In several muscle disorders (muscular dystrophies, in idiopathic inflammatory myopathies) creatine improved functional performance, but apparently not in metabolic myopathies; in McArdle diseases it may even have paradoxical effects. More research is warranted to better understand the short and long-term effects and safety of creatine supplementation among adolescents or elderly, as well as in different types of muscle diseases; for the two enzymatic genetic defects of creatine biosynthesis – arginine: glycine amidinotransferase (AGAT) and guanidinoacetate methyltransferase (GAMT), respectively – normal neurodevelopment has been achieved in early initiation of creatine therapy.

Efficacy of communication-based interventions on physicians and patients’ outcome: A meta-analysis of randomised controlled trials

Communication-based intervention on physicians are strongly linked to patient health improvement. We proceeded examine the efficiency of these programs interventions for relevant outcomes in patients life, along with study quality, publication bias and potential moderators. For this meta-analysis, we searched 2 databases, including: Web of Science and PubMed, using a comprehensive search strategy to identify the efficacy of the physician interventions on patient’s outcome studies in the literature, published from inception of 1965. Studies reporting means of health-related outcome in patients were included in the analyses. Studies quality was assessed with risk of bias tool. Meta-regression was used to explore heterogeneity of the year of published studies moderator and subgroup analysis was used to explore the medical specialty moderator. Of the 3,470 studies initially identified, 14 were eligible for inclusion. These studies had a large diversity of program interventions. The mean effect size representing the impact of communication intervention on patients physical and psychological health was not significant. The only significant mean effect was represented by psychological outcome. Significant associations were found between year of studies and general medicine specialization. In conclusion the impact of physicians’ intervention in not efficient on patients’ communication and medical outcome but it improves psychological health

Digestive disorders induced by the accumulation of arsenic in the human body

Exposure to arsenic is common, but unconscious, inducing major imbalances especially in the digestive tract, lungs, skin. Contamination is achieved by exposure to arsenic in the air, soil, groundwater, food. It is noted the use of arsenic in pesticides, herbicides, paints, wood preservatives, drinking water, various foods with a wide range of consumption (seafood, rice – including rice milk, rice bran, rice cereals, rice syrup rice, rice crackers). The diagnosis of arsenic poisoning is an important step in establishing the diet and detoxification treatment, focusing on the cause, not the symptoms. We present the case of a 45-year-old patient with symptoms manifested in the digestive tract for 4 years: abdominal bloating, cramps, vomiting, weekly episodes of acute diarrhea. During these period the patient received multiple treatments depending on the symptoms, without a significant improvement, without performing specific investigations of arsenic poisoning. The personalized diet and treatment plan, used in the case of this patient, for a period of 4 months was distinguished by a total solution of the manifestations presented in the anamnesis stage.

Electrical injuries in adult patients – 3 years overview

Electrocutions are a particular type of trauma, usually affecting young active people, leading to high morbidity and mortality rates in extensive injured patients. Those patients require complex, multidisciplinary treatment in specialized burn centers. We conducted a three-year retrospective study in the Burn Unit of the Clinical Emergency Hospital Bucharest, Romania, aiming to identify different factors that characterize electrical injuries, with the goal to improve our clinical practice, in order to decrease overall complications, the morbidity and mortality rates and obtain an optimal functional prognosis for those severely injured patients. Patient-related and injury-related parameters were analyzed, and particularities observed in our burn unit were noted. A clear understanding of the physiopathology of those injuries and their complications is essential for providing an optimal therapeutic strategy. Rapid initiation of systemic supportive measures, accurate diagnostic and an adequate surgical treatment, correctly conducted, are essential for improving the vital and functional prognostic of patients who suffer electric injuries.

The management of a patient with multiple infarcts with different etiologies

72 yo male, presents for abdominal pain and motor deficiency of the left upper limb. Clinical examination reveal severe general condition, left brachial hemiparesis, right arm blood pressure (BP) 240/120 mmHg, left arm BP 210/100 mmHg, heart rate (HR) 110 bpm, arrhythmic, abdominal pain at superficial palpation, without other abnormalities. Biological: negative hs troponin I, positive D-dimers, positive CRP, GFR 38 ml/min/m2, potassium 2.97 mmol/l. ECG: Atrial fibrillation. Abdominal ultrasound: abdominal dilated aorta, dissection flap. Abdominal and pelvic CT scan: right renal infarction, multiple splenic infarction, abdominal aortic aneurysm with dissection. Underwent interventional treatment of the abdominal aortic dissection (EVAR). Particularity of the case: concomitant diagnosis of multiple infarction with different etiologies, for which therapeutic decision was challenging.

Utility of topic agents in post cervical uterine fibroids removal

Uterine fibroids represent the most commonly encountered uterine tumors in women worldwide which can develop at the level of any segment of the uterus and can pose different problems in regard to the most appropriate therapeutic strategy especially in young women which deserve fertility preservation. Meanwhile in certain cases they can impede the development of a normal pregnancy due to their location or can show significant enlargement in volume during pregnancy due to the increased blow flow at this level. In all cases in which they induce the apparition of symptoms or impede the apparition or development of a normal pregnancy they should be removed. In cases in which the fibroids are located at the level of the uterine cervix attention should be focused on providing a correct and efficient postoperative healing. The aim of this paper is to review the most important aspects related to uterine cervix fibroid symptoms, treatment and postoperative healing, particular attention being given to Cerviron, a topic agent which seems to provide an efficient healing at this level.

The role of topic vaginal products as part of the therapeutic strategy in uterine cervix lesions

It has been widely demonstrated so far that lactobacilli represent probably the most important microorganisms which are developed at the level of the vaginal cavity and which are responsible for the maintenance of an adequate environment and pH at this level. Once the number of these microorganisms decrease the pH value increase leading to the apparition of a basic medium, which favors the development of certain microorganisms such as human papilloma virus. Meanwhile it is widely known that the presence of this virus is associated with an increased risk of developing premalignant and even malignant conditions. The aim of the current paper is to investigate the correlation between the vaginal pH, the risk of human papilloma virus infection and, in the meantime, to explore the possible benefits of local application of Cerviron, a topic, vaginal product which seems to significantly influence the risk of cervical lesions development.