Adorata Coman - Academia.edu (original) (raw)
Papers by Adorata Coman
Family medicine and primary care. Open access, May 23, 2024
Recent research on Attention-Deficit/Hyperactivity Disorder (ADHD) underscores the significance o... more Recent research on Attention-Deficit/Hyperactivity Disorder (ADHD) underscores the significance of prenatal environmental factors alongside the well-documented genetic influences in the disorder's development. Studies have shown that approximately 5% of children and 2.5% of adults globally are affected by ADHD, with symptoms that severely impact various aspects of life. While genetics play a crucial role, accounting for 70% to 80% of ADHD's heritability, factors such as maternal diet, exposure to pollutants and teratogens, psychological stress, and prenatal inflammation are gaining attention for their potential impact on fetal brain development. These environmental factors could increase the risk of ADHD by altering critical developmental pathways, as evidenced by the association between maternal stress, dietary patterns during pregnancy, and increased ADHD symptoms in offspring. Furthermore, exposure to substances like alcohol and tobacco, as well as maternal inflammation, are linked to a higher risk of developing ADHD, highlighting the complex interplay between genetic predisposition and environmental exposures. This growing body of evidence calls for a comprehensive approach to prenatal care, emphasizing the importance of mitigating environmental and nutritional risks to prevent the development of ADHD and improve long-term outcomes for children.
The Medical-Surgical Journal, Jun 30, 2020
In Europe, approximately 25% of population are estimated to have metabolic syndrome (MS), with si... more In Europe, approximately 25% of population are estimated to have metabolic syndrome (MS), with similar prevalence values in Latin America. In general, the prevalence of the metabolic syndrome increases with age with nearly 40% of people aged 60 and older meeting the diagnostic criteria. Material and methods: The purpose of this study is to evaluate the prevalence of associations between metabolic syndrome components to find a pattern applicable to patients with this pathology. The study was conducted on a total of 1,528 patients over 18 months, from 01.06.2017 to 31.12.2018, within a general practitioner (GP) medical office, being an epidemiological case-control study. Results: Studying the distribution of Harmonized I diagnostic criteria in the research group, we obtained the following data: 15.7% of subjects were included into MS with three components (MS3); 6.9% of the participants fall into the MS with four components (MS4); 2.87% of the patients included in the study group all five components of the metabolic syndrome (MS5). Out of a total of 203 women diagnosed with MS, we identified the presence of five-component MS in 10.83% of MS patients, while 31.03% were diagnosed with MS4. Conclusions: Early diagnosis of MS by the family doctor may reduce the cardiometabolic risk, the costs it generates, and could increases patients’ quality of life.
Revista De Cercetare Si Interventie Sociala, 2015
Obesity is a major health problem by: a high incidence (especially in industrialized countries); ... more Obesity is a major health problem by: a high incidence (especially in industrialized countries); an impairment of life duration and quality; promote a large panel of cardiovascular, respiratory, rheumatologic, endocrine-metabolic disturbances (mortality of 1.5 to 4 times higher than in normal weight); increased surgical risk; huge psycho-social consequences. Integrative therapeutically attitude should act both on individual and population level, in order to avoid social isolation and better results. An intention to treat study was made, 12 month period of follow up, initial randomization of 6 month, 107 patients, from 287 selected. Synoptically we found: 10% good results with only lifestyle modifications and 87% good results with both lifestyle modification and medication, only 3% of failure. We obtained good results for all the anthropometrically parameter, after 1 year of treatment. The cornerstone was: high motivation and integrated treatment focused on both directions. Medication of the best choice is that which has dual effects: energy balance and eating disorders. We have to achieve a multifactor approach of treating obese persons as integrated treatment with a strong social component.
Medic.ro, Nov 20, 2019
Pelvic inflammatory disease (PID) is a frequent disease which occurs in the female genital tract,... more Pelvic inflammatory disease (PID) is a frequent disease which occurs in the female genital tract, being very often misdiagnosed or mistreated. PID and its complications, such as infertility, ectopic pregnancy or pelvic chronic pain, can be prevented through a screening of the sexually transmitted infections for the sexually active, non-symptomatic individuals who are at risk of developing these infections or through an efficient treatment for the females affected by PID.
Archives of the Balkan Medical Union, Sep 12, 2018
Évaluation de la tension artérielle et de la pression du pouls dans le syndrome métabolique Objec... more Évaluation de la tension artérielle et de la pression du pouls dans le syndrome métabolique Objectif. L'objectif de notre étude est d'évaluer la pression artérielle et la pression différentielle chez les patients atteints du syndrome métabolique (SM), afin de déceler et de prévenir les complications cardiovasculaires qui peuvent survenir chez ces patients. Matériels et méthodes. L'analyse des cas-témoin a été faite sur un total de 1528 patients, dans un cabinet de médecine familiale, les sujets étant répartis en deux groupes: le lot avec SM et le groupe témoin (sans SM). Le groupe avec SM se composait de 388 patients diagnostiqués selon les critères harmonisés. Le groupe témoin sans SM était composé de 1140 patients n'ayant pas présenté au moins trois critères diagnostiques du syndrome métabolique. Résultats. La pression différentielle, les valeurs calculées pour les patients atteints de syndrome métabolique ont été généralement plus élevées que le taux moyen
Journal of Inflammation Research
The Coronavirus Disease 2019 (COVID-19) pandemic was declared in early 2020 after several unexpla... more The Coronavirus Disease 2019 (COVID-19) pandemic was declared in early 2020 after several unexplained pneumonia cases were first reported in Wuhan, China, and subsequently in other parts of the world. Commonly, the disease comprises several clinical features, including high temperature, dry cough, shortness of breath, and hypoxia, associated with findings of interstitial pneumonia on chest X-ray and computer tomography. Nevertheless, severe forms of acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) are not limited to the respiratory tract but also may be extended to other systems, including the cardiovascular system. The bi-directional relationship between atherosclerosis and COVID-19 is accompanied by poor prognosis. The immune response hyperactivation due to SARS-CoV-2 infection causes an increased secretion of cytokines, endothelial dysfunction, and arterial stiffness, which promotes the development of atherosclerosis. Also, due to the COVID-19 pandemic, access to healthcare amenities was reduced, resulting in increased morbidity and mortality in patients at risk. Furthermore, as lockdown measures were largely adopted worldwide, the sedentary lifestyle and the increased consumption of processed nutrients or unhealthy food increased, and in the consequence, we might observe even 70% of overweight and obese population. Altogether, with the relatively low ratio of vaccinated people in many countries, and important health debt appeared, which is now and will be for next decade a large healthcare challenge. However, the experience gained in the COVID-19 pandemic and the new methods of patients' approaching have helped the medical system to overcome this crisis and will hopefully help in the case of new possible epidemics.
Journal of Personalized Medicine
Despite being one of the most debilitating conditions encountered in the field of toxicology, the... more Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the...
Journal of Personalized Medicine
Infective endocarditis is a severe infective heart disease, commonly involving native or prosthet... more Infective endocarditis is a severe infective heart disease, commonly involving native or prosthetic valves. It frequently presents with univalvular involvement and simultaneous double valve or multivalvular involvement is rarely described. The third leading cause of infective endocarditis worldwide is Enterococcus faecalis, which is associated with high mortality rates despite important advances in antimicrobial therapy. It develops secondary to enterococcal bacteremia, with its origin from the gastrointestinal or genitourinary tract and predominantly affecting the elderly population with multiple comorbidities. Clinical presentation is usually less typical, and the treatment is challenging. It can be marked by antibiotic resistance, side effects, and subsequent complications. Surgical treatment can be considered if deemed appropriate. To the best of our knowledge, we present the first case-based narrative review of Enterococcus faecalis double valve endocarditis involving both the ...
In this report we will describe how alcohol played an important role throughout James Augustine A... more In this report we will describe how alcohol played an important role throughout James Augustine Aloysius Joyce's work, even though the Irishman has never been clinically diagnosed as being an alcoholic. In this way, while for some of his readers it might come as a shock to find out that he was a binge drinker, Joyce not only admitted to his drinking habits, but he claimed that drinking made for an excellent writing aid. He is also said to have believed that liquor heightened feelings and he could not write as well without the drinking process. Another link that brings its contribution to the chaining of alcohol to Joyce's work from a literary point of view is the presence of Irish nationalism. Thus, the nationalist fervour depicted in his literary work seems to always be accompanied by alcohol consumption, self-pity and the reminiscences of the greater times, all dominated by a sense of sarcasm conducted by the author.
Journal of Hypertension, 2018
Objective: Aortic stenosis (AS) and arterial hypertension (HT) are two common disorders affecting... more Objective: Aortic stenosis (AS) and arterial hypertension (HT) are two common disorders affecting predominantly the ageing population, both negatively impacting morbidity and mortality, and their association should require more attention in terms of diagnosis and management. The aim of this study is to assess the distinctive features of AS concerning the clinical presentation and the paraclinical parameters between hypertensive and non-hypertensive patients. Design and method: The study was conducted by retrospective analysis of 144 cases of hospitalized patients, diagnosed with AS on a period of two years (01.01.2016–31.12.2017), with and without HT. We studied the differences between the two subgroups regarding the etiology, comorbidities, some echocardiographic parameters and laboratory findings. Results: Among the patients studied with AS, the average age of presentation was 77 years for both the hypertensive and non-hypertensive patients, but a significantly higher age was found for the degenerative AS comparing to the congenital AS (78.22 years vs 63.6 years, p < 0.05); 88.2% of the cases had systemic hypertension, most of them being treated by a combination of at least three anti-hypertensive drugs (83.3%). The leading cause of AS in both hypertensive and non-hypertensive patients was degenerative, accounting for 80.5% and 94.1 % of the cases respectively, followed by rheumatic fever and bicuspid aortic valve disease. In terms of echocardiographic measurements, we found that the HT had an effect of reduction of the aortic pressure gradients (43.11 mmHg vs 57 mmHg in the non-HT subgroup), which is consistent with the literature data, even if the threshold for statistical significance was not attained. The laboratory findings revealed that half of the hypertensive patients were found to have anemia, compared to 5.8% of the normotensive patients and almost half of the HT subgroup appeared to associate chronic kidney disease as opposed to only 23.5% in the non-HT patients. Conclusions: HT affects a high proportion of the patients admitted for AS, that is known to put population at risk for cardiovascular events, but the impact of their coexistence in terms of prognosis is yet to be clarified.
Atherosclerosis, 2018
aged 40-64; median age 54 (47-59) years) and named ATEROGEN-IVA-NOVO. 27.5% of individuals were m... more aged 40-64; median age 54 (47-59) years) and named ATEROGEN-IVA-NOVO. 27.5% of individuals were men. The frequency of statin treatment was 10.8%. Carotid and femoral arteries were analyzed for maximum stenosis (MS) and plaque number (PN) using Samsung MedisonMySonoU6. 2013 ESC clinical guidelines were used to verify CAD. The data are presented as a median (25th-75th percentile). Results: Plaques in carotid arteries were found in 74.5% of the men and 58.0% of the women (p¼0.000). Femoral atherosclerosis was detected in 51.8% of the men and 28.8% of the women (p¼0.000). The frequency of persons with greater than 50% stenosis was only 2.6% and 0.9% for carotid and femoral arteries, respectively. MS (20 (0-30)% vs. 0 (0-20)%, p¼0.000) and PN (1 (0-2) vs. 0 (0-1), p¼0.000) were higher for carotid arteries than for femoral ones. Multiple linear regression analysis (MLRA) of carotid MS showed relationships with age (b¼0.33, p¼0.000), male sex (b¼0.17, p¼0.028), LDL-cholesterol (b¼0.23, p¼0.002), and glucose (b¼0.15, p¼0.048). MLRA of femoral MS showed relationships with age (b¼0.29, p¼0.023), smoking (b¼0.18, p¼0.031), and CAD (b¼0.20, p¼0.000). Conclusions: Femoral atherosclerosis is less common than carotid one, but it is more strongly associated with CAD.
Atherosclerosis, 2018
Aim: Evaluate the efficacy of nebivolol therapy associated with ramipril vs nebivolol combined wi... more Aim: Evaluate the efficacy of nebivolol therapy associated with ramipril vs nebivolol combined with amlodipine and ramipril in patients with APS and EH undergoing PCI. Methods: The study included 89 patients who were divided into three groups: I group 13 patients who were administered nebivolol 5mg/day, the II group 57 patients who were administered nebivolol 5 mg/day combined with ramipril 10 mg/day, and the III group 19 patients who were administered nebivolol 5 mg/day with amlodipine 10 mg/day and ramipril 10 mg/day. In all groups was evaluated the blood pressure, the echocardiography was performed at the beginning of the study,at 6,12 months. The biomarker of endothelial dysfunction-NO was assessed in blood: prePCI, postPCI (24 hours) at 1,3,6,12 months. Results: At the end of study was recorded the BP level of<140/90 mmHg in all groups. Left ventricle mass index (LVMI) has reduced in comparison with the initial value in I group from 113.45±11.41 to 109.2±8.6 (at 12 months), p>0.05. In the II group, LVMI has significantly decreased from 129.15±4.9 to 115.6±4.5,p<0.01. In the III group, LVMI has reduced from 115.2±7.9 to 110.3±7 g/m2 p>0.05. Level of NO has increased compared to the initial value in the I group from 66.3±6.03 up to 93.8±2.2 (p>0.05); in the II group from 51.4±2.1 up to 97.7±1.5 (p<0.01), in the III group from 60.3±5.6 up to 95.8±2.98 (p>0.05). Conclusions: The combination of ramipril with nebivolol significantly decreased the LVMI by 10.5%. The association of nebivolol with ramipril favored a increase of the NO level with 90.1% vs the initial.
Comptes rendus de la Société française de gynécologie, 1957
Journal of the American Academy of Dermatology, 2009
Background and Aims: Sizeable proportion of patients have discordant low density lipoprotein chol... more Background and Aims: Sizeable proportion of patients have discordant low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (NHDL-C). We assessed whether this discordance have impact on mortality in patients with acute coronary syndrome (ACS). Methods: We retrospectively evaluated the data of 198 consecutive patients with ACS. Fasting serum lipid profiles were recorded, GRACE and TIMI scores were calculated. Mortality and cardiovascular events (heart failure, non-fatal myocardial infarction and angina) at sixth months were recorded. Percentile distributions of LDL-C and NHDL-C were calculated. Patients were divided into 3 groups according to percentiles : Discordant group : LDL-C<NHDL-C(n¼38), concordant group: LDL-C¼NHDL-C(n¼112) and discordant group LDL-C>NHDL-C(n¼48). Results: TIMI risk score didn't differ among discordant or concordant groups. Mean GRACE score was higher in group with LDL-C<NHDL-C than with LDL-C¼NHDL-C and LDL-C>NHDL-C (p¼0,029). There wasn't significant difference between LDL¼NHDL-C and LDL-C>NHDL-C regarding to GRACE score (p¼0.723). Percentage of cardiovascular events and mortality at sixth months were not different among groups (p¼0,473 and p¼0,176). Conclusions: There is no difference regarding mortality rates and cardiovascular events after ACS between LDL-C and NHDL-C concordant and discordant groups.
International Journal of Pharmacology, Phytochemistry and Ethnomedicine, Feb 1, 2019
The pathogeny of the metabolic syndrome (MetS) is not fully elucidated, but a link between viscer... more The pathogeny of the metabolic syndrome (MetS) is not fully elucidated, but a link between visceral obesity and the increase of the proinflammatory response was proven. Atherosclerosis, perceived as a metabolic complication, draws attention to the peroxisome proliferator-activated receptors-alpha (PPARα). PPARα receptors are transcription factors involved in lipid metabolism, inflammation and atheromatosis. Hence, it interferes in the pathogeny of cardiovascular diseases and other chronic diseases too (neurological, psychical, neoplasical). The study of the expression of PPARα and its modulation on different level may be beneficial in the treatment of metabolic syndrome, intervening in the modulation of another proinflammatory factors.
Children
The aim of this paper is to describe the temporal progression and clinical picture of a 2-year-ol... more The aim of this paper is to describe the temporal progression and clinical picture of a 2-year-old child with infantile Refsum disease, as well as the diagnostic procedures performed; this case presented multiple hematologic, metabolic, and developmental complications and progressive disabilities. Genetic testing revealed a mutation of the PEX6 (Peroxisomal Biogenesis Factor 6) gene, and the metabolic profile was consistent with the diagnosis. Particularly, the child also presented altered coagulation factors and developed a spontaneous brain hemorrhage. The clinical picture includes several neurological, ophthalmological, digestive, cutaneous, and endocrine disorders as a result of the very long chain fatty acid accumulation as well as secondary oxidative anomalies. The study of metabolic disorders occurring because of genetic mutations is a subject of core importance in the pathology of children today. The PEX mutations, difficult to identify antepartum, are linked to an array of ...
Journal of Personalized Medicine
Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated... more Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated, fluid-overloaded patients. The pathophysiology of hyponatremia in patients with heart failure is complex, including numerous mechanisms: increased activity of the sympathetic nervous system and the renin–angiotensin–aldosterone system, high levels of arginine vasopressin and diuretic use. Symptoms are usually mild but hyponatremic encephalopathy can occur if there is an acute decrease in serum sodium levels. It is crucial to differentiate between dilutional hyponatremia, where free water excretion should be promoted, and depletional hyponatremia, where administration of saline is needed. An inappropriate correction of hyponatremia may lead to osmotic demyelination syndrome which can cause severe neurological symptoms. Treatment options for hyponatremia in heart failure, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The aim of this...
Journal of Personalized Medicine
Serotonin syndrome (SS) is a clinical toxidrome with high variability in clinical practice. It de... more Serotonin syndrome (SS) is a clinical toxidrome with high variability in clinical practice. It develops due to increased serotonin levels in the central nervous system. With an underestimated frequency, SS can develop following an overdose, a therapeutic dose increase, or drug to drug interaction of at least one serotonergic agent. It can present with autonomic signs, neuromuscular changes and an altered mental status. However, history and clinical examination are key features to formulate the diagnosis. Treatment options consist of supportive measures, discontinuation of the offending agent and certain therapeutic agents previously reported to improve outcomes. Physicians have limited experience with SS, partially due to the lack of its identification in clinical practice. Therefore, we have integrated, in a narrative review, the case of a young male with SS following an atypical antipsychotic overdose superimposed on chronic treatment with agents previously known to produce SS.
Family medicine and primary care. Open access, May 23, 2024
Recent research on Attention-Deficit/Hyperactivity Disorder (ADHD) underscores the significance o... more Recent research on Attention-Deficit/Hyperactivity Disorder (ADHD) underscores the significance of prenatal environmental factors alongside the well-documented genetic influences in the disorder's development. Studies have shown that approximately 5% of children and 2.5% of adults globally are affected by ADHD, with symptoms that severely impact various aspects of life. While genetics play a crucial role, accounting for 70% to 80% of ADHD's heritability, factors such as maternal diet, exposure to pollutants and teratogens, psychological stress, and prenatal inflammation are gaining attention for their potential impact on fetal brain development. These environmental factors could increase the risk of ADHD by altering critical developmental pathways, as evidenced by the association between maternal stress, dietary patterns during pregnancy, and increased ADHD symptoms in offspring. Furthermore, exposure to substances like alcohol and tobacco, as well as maternal inflammation, are linked to a higher risk of developing ADHD, highlighting the complex interplay between genetic predisposition and environmental exposures. This growing body of evidence calls for a comprehensive approach to prenatal care, emphasizing the importance of mitigating environmental and nutritional risks to prevent the development of ADHD and improve long-term outcomes for children.
The Medical-Surgical Journal, Jun 30, 2020
In Europe, approximately 25% of population are estimated to have metabolic syndrome (MS), with si... more In Europe, approximately 25% of population are estimated to have metabolic syndrome (MS), with similar prevalence values in Latin America. In general, the prevalence of the metabolic syndrome increases with age with nearly 40% of people aged 60 and older meeting the diagnostic criteria. Material and methods: The purpose of this study is to evaluate the prevalence of associations between metabolic syndrome components to find a pattern applicable to patients with this pathology. The study was conducted on a total of 1,528 patients over 18 months, from 01.06.2017 to 31.12.2018, within a general practitioner (GP) medical office, being an epidemiological case-control study. Results: Studying the distribution of Harmonized I diagnostic criteria in the research group, we obtained the following data: 15.7% of subjects were included into MS with three components (MS3); 6.9% of the participants fall into the MS with four components (MS4); 2.87% of the patients included in the study group all five components of the metabolic syndrome (MS5). Out of a total of 203 women diagnosed with MS, we identified the presence of five-component MS in 10.83% of MS patients, while 31.03% were diagnosed with MS4. Conclusions: Early diagnosis of MS by the family doctor may reduce the cardiometabolic risk, the costs it generates, and could increases patients’ quality of life.
Revista De Cercetare Si Interventie Sociala, 2015
Obesity is a major health problem by: a high incidence (especially in industrialized countries); ... more Obesity is a major health problem by: a high incidence (especially in industrialized countries); an impairment of life duration and quality; promote a large panel of cardiovascular, respiratory, rheumatologic, endocrine-metabolic disturbances (mortality of 1.5 to 4 times higher than in normal weight); increased surgical risk; huge psycho-social consequences. Integrative therapeutically attitude should act both on individual and population level, in order to avoid social isolation and better results. An intention to treat study was made, 12 month period of follow up, initial randomization of 6 month, 107 patients, from 287 selected. Synoptically we found: 10% good results with only lifestyle modifications and 87% good results with both lifestyle modification and medication, only 3% of failure. We obtained good results for all the anthropometrically parameter, after 1 year of treatment. The cornerstone was: high motivation and integrated treatment focused on both directions. Medication of the best choice is that which has dual effects: energy balance and eating disorders. We have to achieve a multifactor approach of treating obese persons as integrated treatment with a strong social component.
Medic.ro, Nov 20, 2019
Pelvic inflammatory disease (PID) is a frequent disease which occurs in the female genital tract,... more Pelvic inflammatory disease (PID) is a frequent disease which occurs in the female genital tract, being very often misdiagnosed or mistreated. PID and its complications, such as infertility, ectopic pregnancy or pelvic chronic pain, can be prevented through a screening of the sexually transmitted infections for the sexually active, non-symptomatic individuals who are at risk of developing these infections or through an efficient treatment for the females affected by PID.
Archives of the Balkan Medical Union, Sep 12, 2018
Évaluation de la tension artérielle et de la pression du pouls dans le syndrome métabolique Objec... more Évaluation de la tension artérielle et de la pression du pouls dans le syndrome métabolique Objectif. L'objectif de notre étude est d'évaluer la pression artérielle et la pression différentielle chez les patients atteints du syndrome métabolique (SM), afin de déceler et de prévenir les complications cardiovasculaires qui peuvent survenir chez ces patients. Matériels et méthodes. L'analyse des cas-témoin a été faite sur un total de 1528 patients, dans un cabinet de médecine familiale, les sujets étant répartis en deux groupes: le lot avec SM et le groupe témoin (sans SM). Le groupe avec SM se composait de 388 patients diagnostiqués selon les critères harmonisés. Le groupe témoin sans SM était composé de 1140 patients n'ayant pas présenté au moins trois critères diagnostiques du syndrome métabolique. Résultats. La pression différentielle, les valeurs calculées pour les patients atteints de syndrome métabolique ont été généralement plus élevées que le taux moyen
Journal of Inflammation Research
The Coronavirus Disease 2019 (COVID-19) pandemic was declared in early 2020 after several unexpla... more The Coronavirus Disease 2019 (COVID-19) pandemic was declared in early 2020 after several unexplained pneumonia cases were first reported in Wuhan, China, and subsequently in other parts of the world. Commonly, the disease comprises several clinical features, including high temperature, dry cough, shortness of breath, and hypoxia, associated with findings of interstitial pneumonia on chest X-ray and computer tomography. Nevertheless, severe forms of acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) are not limited to the respiratory tract but also may be extended to other systems, including the cardiovascular system. The bi-directional relationship between atherosclerosis and COVID-19 is accompanied by poor prognosis. The immune response hyperactivation due to SARS-CoV-2 infection causes an increased secretion of cytokines, endothelial dysfunction, and arterial stiffness, which promotes the development of atherosclerosis. Also, due to the COVID-19 pandemic, access to healthcare amenities was reduced, resulting in increased morbidity and mortality in patients at risk. Furthermore, as lockdown measures were largely adopted worldwide, the sedentary lifestyle and the increased consumption of processed nutrients or unhealthy food increased, and in the consequence, we might observe even 70% of overweight and obese population. Altogether, with the relatively low ratio of vaccinated people in many countries, and important health debt appeared, which is now and will be for next decade a large healthcare challenge. However, the experience gained in the COVID-19 pandemic and the new methods of patients' approaching have helped the medical system to overcome this crisis and will hopefully help in the case of new possible epidemics.
Journal of Personalized Medicine
Despite being one of the most debilitating conditions encountered in the field of toxicology, the... more Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the...
Journal of Personalized Medicine
Infective endocarditis is a severe infective heart disease, commonly involving native or prosthet... more Infective endocarditis is a severe infective heart disease, commonly involving native or prosthetic valves. It frequently presents with univalvular involvement and simultaneous double valve or multivalvular involvement is rarely described. The third leading cause of infective endocarditis worldwide is Enterococcus faecalis, which is associated with high mortality rates despite important advances in antimicrobial therapy. It develops secondary to enterococcal bacteremia, with its origin from the gastrointestinal or genitourinary tract and predominantly affecting the elderly population with multiple comorbidities. Clinical presentation is usually less typical, and the treatment is challenging. It can be marked by antibiotic resistance, side effects, and subsequent complications. Surgical treatment can be considered if deemed appropriate. To the best of our knowledge, we present the first case-based narrative review of Enterococcus faecalis double valve endocarditis involving both the ...
In this report we will describe how alcohol played an important role throughout James Augustine A... more In this report we will describe how alcohol played an important role throughout James Augustine Aloysius Joyce's work, even though the Irishman has never been clinically diagnosed as being an alcoholic. In this way, while for some of his readers it might come as a shock to find out that he was a binge drinker, Joyce not only admitted to his drinking habits, but he claimed that drinking made for an excellent writing aid. He is also said to have believed that liquor heightened feelings and he could not write as well without the drinking process. Another link that brings its contribution to the chaining of alcohol to Joyce's work from a literary point of view is the presence of Irish nationalism. Thus, the nationalist fervour depicted in his literary work seems to always be accompanied by alcohol consumption, self-pity and the reminiscences of the greater times, all dominated by a sense of sarcasm conducted by the author.
Journal of Hypertension, 2018
Objective: Aortic stenosis (AS) and arterial hypertension (HT) are two common disorders affecting... more Objective: Aortic stenosis (AS) and arterial hypertension (HT) are two common disorders affecting predominantly the ageing population, both negatively impacting morbidity and mortality, and their association should require more attention in terms of diagnosis and management. The aim of this study is to assess the distinctive features of AS concerning the clinical presentation and the paraclinical parameters between hypertensive and non-hypertensive patients. Design and method: The study was conducted by retrospective analysis of 144 cases of hospitalized patients, diagnosed with AS on a period of two years (01.01.2016–31.12.2017), with and without HT. We studied the differences between the two subgroups regarding the etiology, comorbidities, some echocardiographic parameters and laboratory findings. Results: Among the patients studied with AS, the average age of presentation was 77 years for both the hypertensive and non-hypertensive patients, but a significantly higher age was found for the degenerative AS comparing to the congenital AS (78.22 years vs 63.6 years, p < 0.05); 88.2% of the cases had systemic hypertension, most of them being treated by a combination of at least three anti-hypertensive drugs (83.3%). The leading cause of AS in both hypertensive and non-hypertensive patients was degenerative, accounting for 80.5% and 94.1 % of the cases respectively, followed by rheumatic fever and bicuspid aortic valve disease. In terms of echocardiographic measurements, we found that the HT had an effect of reduction of the aortic pressure gradients (43.11 mmHg vs 57 mmHg in the non-HT subgroup), which is consistent with the literature data, even if the threshold for statistical significance was not attained. The laboratory findings revealed that half of the hypertensive patients were found to have anemia, compared to 5.8% of the normotensive patients and almost half of the HT subgroup appeared to associate chronic kidney disease as opposed to only 23.5% in the non-HT patients. Conclusions: HT affects a high proportion of the patients admitted for AS, that is known to put population at risk for cardiovascular events, but the impact of their coexistence in terms of prognosis is yet to be clarified.
Atherosclerosis, 2018
aged 40-64; median age 54 (47-59) years) and named ATEROGEN-IVA-NOVO. 27.5% of individuals were m... more aged 40-64; median age 54 (47-59) years) and named ATEROGEN-IVA-NOVO. 27.5% of individuals were men. The frequency of statin treatment was 10.8%. Carotid and femoral arteries were analyzed for maximum stenosis (MS) and plaque number (PN) using Samsung MedisonMySonoU6. 2013 ESC clinical guidelines were used to verify CAD. The data are presented as a median (25th-75th percentile). Results: Plaques in carotid arteries were found in 74.5% of the men and 58.0% of the women (p¼0.000). Femoral atherosclerosis was detected in 51.8% of the men and 28.8% of the women (p¼0.000). The frequency of persons with greater than 50% stenosis was only 2.6% and 0.9% for carotid and femoral arteries, respectively. MS (20 (0-30)% vs. 0 (0-20)%, p¼0.000) and PN (1 (0-2) vs. 0 (0-1), p¼0.000) were higher for carotid arteries than for femoral ones. Multiple linear regression analysis (MLRA) of carotid MS showed relationships with age (b¼0.33, p¼0.000), male sex (b¼0.17, p¼0.028), LDL-cholesterol (b¼0.23, p¼0.002), and glucose (b¼0.15, p¼0.048). MLRA of femoral MS showed relationships with age (b¼0.29, p¼0.023), smoking (b¼0.18, p¼0.031), and CAD (b¼0.20, p¼0.000). Conclusions: Femoral atherosclerosis is less common than carotid one, but it is more strongly associated with CAD.
Atherosclerosis, 2018
Aim: Evaluate the efficacy of nebivolol therapy associated with ramipril vs nebivolol combined wi... more Aim: Evaluate the efficacy of nebivolol therapy associated with ramipril vs nebivolol combined with amlodipine and ramipril in patients with APS and EH undergoing PCI. Methods: The study included 89 patients who were divided into three groups: I group 13 patients who were administered nebivolol 5mg/day, the II group 57 patients who were administered nebivolol 5 mg/day combined with ramipril 10 mg/day, and the III group 19 patients who were administered nebivolol 5 mg/day with amlodipine 10 mg/day and ramipril 10 mg/day. In all groups was evaluated the blood pressure, the echocardiography was performed at the beginning of the study,at 6,12 months. The biomarker of endothelial dysfunction-NO was assessed in blood: prePCI, postPCI (24 hours) at 1,3,6,12 months. Results: At the end of study was recorded the BP level of<140/90 mmHg in all groups. Left ventricle mass index (LVMI) has reduced in comparison with the initial value in I group from 113.45±11.41 to 109.2±8.6 (at 12 months), p>0.05. In the II group, LVMI has significantly decreased from 129.15±4.9 to 115.6±4.5,p<0.01. In the III group, LVMI has reduced from 115.2±7.9 to 110.3±7 g/m2 p>0.05. Level of NO has increased compared to the initial value in the I group from 66.3±6.03 up to 93.8±2.2 (p>0.05); in the II group from 51.4±2.1 up to 97.7±1.5 (p<0.01), in the III group from 60.3±5.6 up to 95.8±2.98 (p>0.05). Conclusions: The combination of ramipril with nebivolol significantly decreased the LVMI by 10.5%. The association of nebivolol with ramipril favored a increase of the NO level with 90.1% vs the initial.
Comptes rendus de la Société française de gynécologie, 1957
Journal of the American Academy of Dermatology, 2009
Background and Aims: Sizeable proportion of patients have discordant low density lipoprotein chol... more Background and Aims: Sizeable proportion of patients have discordant low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (NHDL-C). We assessed whether this discordance have impact on mortality in patients with acute coronary syndrome (ACS). Methods: We retrospectively evaluated the data of 198 consecutive patients with ACS. Fasting serum lipid profiles were recorded, GRACE and TIMI scores were calculated. Mortality and cardiovascular events (heart failure, non-fatal myocardial infarction and angina) at sixth months were recorded. Percentile distributions of LDL-C and NHDL-C were calculated. Patients were divided into 3 groups according to percentiles : Discordant group : LDL-C<NHDL-C(n¼38), concordant group: LDL-C¼NHDL-C(n¼112) and discordant group LDL-C>NHDL-C(n¼48). Results: TIMI risk score didn't differ among discordant or concordant groups. Mean GRACE score was higher in group with LDL-C<NHDL-C than with LDL-C¼NHDL-C and LDL-C>NHDL-C (p¼0,029). There wasn't significant difference between LDL¼NHDL-C and LDL-C>NHDL-C regarding to GRACE score (p¼0.723). Percentage of cardiovascular events and mortality at sixth months were not different among groups (p¼0,473 and p¼0,176). Conclusions: There is no difference regarding mortality rates and cardiovascular events after ACS between LDL-C and NHDL-C concordant and discordant groups.
International Journal of Pharmacology, Phytochemistry and Ethnomedicine, Feb 1, 2019
The pathogeny of the metabolic syndrome (MetS) is not fully elucidated, but a link between viscer... more The pathogeny of the metabolic syndrome (MetS) is not fully elucidated, but a link between visceral obesity and the increase of the proinflammatory response was proven. Atherosclerosis, perceived as a metabolic complication, draws attention to the peroxisome proliferator-activated receptors-alpha (PPARα). PPARα receptors are transcription factors involved in lipid metabolism, inflammation and atheromatosis. Hence, it interferes in the pathogeny of cardiovascular diseases and other chronic diseases too (neurological, psychical, neoplasical). The study of the expression of PPARα and its modulation on different level may be beneficial in the treatment of metabolic syndrome, intervening in the modulation of another proinflammatory factors.
Children
The aim of this paper is to describe the temporal progression and clinical picture of a 2-year-ol... more The aim of this paper is to describe the temporal progression and clinical picture of a 2-year-old child with infantile Refsum disease, as well as the diagnostic procedures performed; this case presented multiple hematologic, metabolic, and developmental complications and progressive disabilities. Genetic testing revealed a mutation of the PEX6 (Peroxisomal Biogenesis Factor 6) gene, and the metabolic profile was consistent with the diagnosis. Particularly, the child also presented altered coagulation factors and developed a spontaneous brain hemorrhage. The clinical picture includes several neurological, ophthalmological, digestive, cutaneous, and endocrine disorders as a result of the very long chain fatty acid accumulation as well as secondary oxidative anomalies. The study of metabolic disorders occurring because of genetic mutations is a subject of core importance in the pathology of children today. The PEX mutations, difficult to identify antepartum, are linked to an array of ...
Journal of Personalized Medicine
Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated... more Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated, fluid-overloaded patients. The pathophysiology of hyponatremia in patients with heart failure is complex, including numerous mechanisms: increased activity of the sympathetic nervous system and the renin–angiotensin–aldosterone system, high levels of arginine vasopressin and diuretic use. Symptoms are usually mild but hyponatremic encephalopathy can occur if there is an acute decrease in serum sodium levels. It is crucial to differentiate between dilutional hyponatremia, where free water excretion should be promoted, and depletional hyponatremia, where administration of saline is needed. An inappropriate correction of hyponatremia may lead to osmotic demyelination syndrome which can cause severe neurological symptoms. Treatment options for hyponatremia in heart failure, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The aim of this...
Journal of Personalized Medicine
Serotonin syndrome (SS) is a clinical toxidrome with high variability in clinical practice. It de... more Serotonin syndrome (SS) is a clinical toxidrome with high variability in clinical practice. It develops due to increased serotonin levels in the central nervous system. With an underestimated frequency, SS can develop following an overdose, a therapeutic dose increase, or drug to drug interaction of at least one serotonergic agent. It can present with autonomic signs, neuromuscular changes and an altered mental status. However, history and clinical examination are key features to formulate the diagnosis. Treatment options consist of supportive measures, discontinuation of the offending agent and certain therapeutic agents previously reported to improve outcomes. Physicians have limited experience with SS, partially due to the lack of its identification in clinical practice. Therefore, we have integrated, in a narrative review, the case of a young male with SS following an atypical antipsychotic overdose superimposed on chronic treatment with agents previously known to produce SS.