The Importance of Echocardiography Assessment in Coronary Patients Subject to Cardiovascular Recovery Programs

Cardiovascular diseases cause approximately one-third of deaths worldwide and an increasing number of individuals with non-fatal ischemic heart disease live with chronic disabilities and impaired quality of life. Cardiac rehabilitation is designed to limit the physiological and psychological effects of cardiac illness, reduce the risk for sudden death or re-infarction, control cardiac symptoms and enhance the psychosocial and vocational status of selected patients. The study group included a group of 78 patients who had a coronary event no more than 3 months ago and who are included in cardio-vascular recovery programs. The patients were echocardiographic evaluated at the first admission and later at 6 months. The evolution of the patients was a favorable one, being objectified an increase of both the ejection fraction of the left ventricle, as well as an improvement of MAPSE and TAPSE.

Therapeutic Perspectives in Sneddon’s Syndrome

Sneddon’s syndrome is a rare but severe progressive chronic disease, characterized by multiple discoloration skin patches called Livedo racemosa and recurrent cerebrovascular events. It mainly affects women aged around 40. Considering the two main forms, antiphospholipid (APS) positive and negative, the available treatments are directed at either one of them. The idiopathic form (APS negative) is associated with a more severe prognosis as chronic oral anticoagulant therapy (COA) is more difficult to manage. One therapeutic perspective in controlling disease progression in these patients is by understanding the protein Z deficiency in these patients as a deciding factor in the success of the COA therapy.

Adverse Drug Reactions and Atrioventricular Conduction Disorders - A Female Gender Related Aproach

Introduction. Although cardiovascular disease remains the leading cause of mortality regardless of gender, the female gender has remained an underrepresented population in studies in this field. Sustained initiatives by the European Society of Cardiology have brought to the fore the importance of studying gender differences regarding the safety profile of cardiovascular drugs in women. Common cardiovascular adverse drug reactions include atrioventricular conduction disorders. Materials and methods. The present study followed the clinical and paraclinical features of female patients with a primary diagnosis of bradycardia in relation to bradycardic medication. We included a group of 359 female patients, divided according to the presence or absence of bradycardia medication into a study group (n=206) and a control group (n=153). Results. Patients with associated bradycardic medication frequently required emergency admission (P < 0.001), with prolonged hospitalization (P < 0.001). The main atrioventricular conduction disorders identified were atrial fibrillation with slow ventricular response (P = 0.028), sinus bradycardia (P = 0.009) and sinus pauses (P = 0.009). Among comorbidities, heart failure (P<0.001) and chronic kidney disease (P<0.001), were common in the study group. Echocardiographic parameters of left ventricular (P=0.002) and biatrial (P<0.001) dilatation, as well as severe left ventricular systolic dysfunction (P=0.009), showed statistical significance in this group. The most used drugs were beta-blockers, amiodarone, and digoxin. Conclusions. Our results indicate, as factors associated with medication-related bradyarrhythmias in female gender: heart failure with severe systolic dysfunction, renal dysfunction, atrial fibrillation, and left ventricular dilatation.

The Profile of Romanian Patient with Central Sleep Apnea and Heart Failure

Sleep-related breathing disorders are highly prevalent in patients with established cardiovascular disease, especially Heart failure (HF). Central sleep apnea (CSAS) share several pathophysiological features with obstructive sleep apnea, but each with a unique pathology and specific treatment. There are considerably fewer published patient profile reports in association with CSAS-HF. The treatment for association CSAS-HF varies and depends on the etiology of respiratory disorder and leaves considerable room for improvement for future investigations. Despite progress over the last 3 decades, HF continues to have high morbidity and mortality rates. At this time, it is also uncertain whether CSAS is a consequence of HF with reduced ejection fraction or it is in fact a risk factor for the evolution of underlying cardiac pathology. Therefore, this retrospective study highlights the interaction between CSA and HF, with particular attention to age differences, a frequent reported risk factor, in a Romanian large cohort. Were included adults > 18 years old, with sleep apnea syndrome (apnea-hypopnea index-AHI>5 per hour of sleep with at least 50% of central on polygraphy-PG and after on polysomnographic-PSGsleep study) in the presence of sleep symptoms, with known HF with preserved LVEF (>40%) in a previous internal/cardiology department. Were excluded those < 18years old, with other sleep apneas (obstructive, mixed or complex), other sleep disorders (by PSG), inadequate PSG records,or patient refusal. Anthropometric data, clinical findings, vital parameters, comorbidities, treatments and investigations (see below) were analyzed in the population and also in subgroups. The majority of this study population (12 patients) were male, older, with normal weight, symptomatic and comorbidities. As many as 90% of the patients presented severe CSAS and 77.8% associated Cheyne–Stokes respiration (CSR). The comparative analysis of the subgroups in which according to the literature the associated pathologies manifest differently showed that there have not been noted major differences or statistically significant correlation between these two groups and cardiac outcomes.Still, in the group over 65 years we found that people were more predisposed to suffer from high BP, judging by the elevated level of the systolic blood pressure value, and another relevant comorbidities were atrial fibrillation, had more apneas and hypopneas during sleep and severe CSA were the most common. Following titration, AHI, central apnea index, desaturation index decreased with clinically significant. This study appeals to the importance of sleep health, an even more important aspect for Romania, where this associations underreported and even unrecognized, and thus the general condition of patients can worsen. Further research, based on other criteria of difference, is needed as the evidence is still lacking regarding the long-term consequences of CSA and long-term impact of current strategies in HF population.

Solid Pseudopapillary Neoplasm of the Pancreas -Raising Awareness of a Rare Tumor

Solid pseudopapillary neoplasm (SPN) is a rare clinical entity. One third of the patients are asymptomatic and the diagnostic is based on imaging studies (abdominal ultrasound, computed tomography, magnetic resonance imaging) and histological examination of biopsies obtained most frequently by endoscopic ultrasound-guided fine-needle aspiration. In this article we made a short review of the literature and present the imaging and histological aspects found in our patients with SNP.

The Role of Myocardial Perfusion Imaging in Patients with Diabetes Mellitus

Diabetes mellitus is a complex pathology with increasing incidence, associated with an increased risk of coronary heart disease. Myocardial perfusion imaging (MPI) is an important diagnostic tool for the evaluation of coronary artery disease (CAD), with a high prognostic value. Objective. The aim of this study was to evaluate the role of stress-rest MPI in the assessment of patients with DM and suspected or confirmed CAD. Method. We performed a retrospective analysis of 128 patients who underwent stress-rest MPI in our department, all of them with coronary angiography (CA) available. All patients underwent stress rest myocardial perfusion SPECT using a 1-day or 2-day protocol. The radiopharmaceuticals used were 99m-Tc-MIBI or tetrofosmin. The study was performed with a gated protocol SPECT, synchronous with the ECG, using a dual-head gamma camera. Patients were divided in 4 subgroups based on the presence of DM and of significant CA changes. Results. In the group of patients with significant coronary disease on CA and previously diagnosed DM, number of perfusion defects on the stress-rest MPI were higher and also the presence of systolic disfunction and the severity of defects. Our results support the idea that the severity and extent of myocardial perfusion defects are greater in diabetic patients than in non-diabetic patients. Conclusions. We can consider myocardial perfusion SPECT with 99mTc-labeled agents as a feasible method for the diagnosis and evaluation of CAD and for the management of diabetic patients.

Peripheral Neuropathy: A Practical Guide for Internists

Diagnosing peripheral neuropathy is essential for the majority of clinical specialties, as it often reveals systemic underlying diseases that are rarely purely neurological. The patient’s history and thorough clinical examination represent the foundation of an early diagnosis. For internal medicine practitioners, it is important to consider common causes at first and search for diabetes, alcoholism or vitamin B12 deficiency, whilst following a diagnosis algorithm that encompasses cues to less popular aetiologies such as systemic vasculitis or paraproteinemia. Prior to requesting nerve conduction studies or further investigations, a few characteristics of peripheral neuropathy should be sought: onset, symmetry, distribution and function impairment (either sensory or motor). Given its interdisciplinary nature, peripheral neuropathies are managed via tight collaboration between the specialist and the internist. Although symptomatic treatment for painful neuropathy is available, treating the underlying disease is fundamental.

Atomic Force Microscopy Applied to Atopic Dermatitis Study

Atopic dermatitis (AD)-the commonest inflammatory skin disease affects up to 25% of children and 2% to 5% of adults. Methods of the diagnostic provide expanded recommendations founded on available evidence. Morphological evaluation remains a principal feature of clinical investigation and the main criteria of diagnosis. Methods. We collected normal and affected skin from a 6-month child patient who was diagnosed through dermatologic examination. Clinical characteristics and the diagnosis of atopic dermatitis were in accordance with Hanifin and Rajka criteria. Morphology and structural integrity were investigated by Atomic Force Microscopy. Results. Optical and topography images indicate that in the case of AD skin lesions the cuticle structure was severely damaged and distorted with the flattening and grading of the plates, which have an irregular appearance. From the surface morphologies of the samples, we demonstrate that the shape of the corneocytes, with granular and elongated appearance, specific to normal skin is transformed by AD into broken and collapsed plates with discontinuous appearance. Conclusions. In the initial diagnosis of AD changes of the skin properties can be an indicator. Hanifin and Rajka criteria together with Atomic Force Microscopy can be a useful and necessary technique diagnosing cases of atopic dermatitis.

Shoulder Involvement in Daily Practice – Ultrasonographic Approach

Shoulder involvement is one of the most frequent findings in rheumatology and many of the rheumatic diseases can determine inflammatory lesions, as well as degenerative ones. Due to the non-specificity of clinical symptoms, imaging methods are emerging into the daily practice in order to establish an accurate diagnosis. Objectives. The aim of the study was to determine the presence of different pathologic changes in patients with shoulder pain, depending on the concurrent disease and associated risk factors. Material and methods. We included in our retrospective study 40 consecutive patients that presented with shoulder pain, during the past 6 months, in the Department of Rheumatology. All those patients underwent ultrasound evaluation according to EULAR Guidelines for musculoskeletal Ultrasound in Rheumatology. Results. Rotator cuff lesions, which most commonly underlie non traumatic pain in adults, were detected with frequencies similar to the ones described by the literature. It seems that comorbidities, as the presence of diabetes, may influence tendon degeneration or rupture. Conclusions. Although it included a relatively low number of subjects, our paper reveals data similar to the ones previously published and underlines the necessity of applying an algorithm for managing shoulder pathology, that should mandatory include ultrasonography examination, in order to obtain an accurate diagnosis and individualize each patient's therapeutic approach and improve their life quality.