rss_2.0Romanian Journal of Internal Medicine FeedSciendo RSS Feed for Romanian Journal of Internal Medicine Journal of Internal Medicine 's Cover encounter of sarcoidosis and solid pseudopapillary tumor of the pancreas<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Objective</title> <p>Current literature indicates a connection between sarcoidosis and malignancy, prompting advanced screening in uncertain cases. Solid pseudopapillary tumors (SPT) of the pancreas are rare entities that can be confirmed by adding imaging results to immunohistochemistry staining. The aim of this article is to describe a rare association of sarcoidosis and SPT.</p> </sec> <sec><title style='display:none'>Materials and methods</title> <p>Case report.</p> </sec> <sec><title style='display:none'>Results</title> <p>A young female patient with no prior medical history presents with shortness of breath and fatigue. The diagnosis of pulmonary and hepatic sarcoidosis is placed upon laboratory and radiographic changes. Intermittent abdominal pain prompts an MRI that shows the presence of a tumoral mass in the tail of the pancreas. Surgical resection of the mass is performed and histological examination indicates a SPT, subsequently confirmed by immunohistochemistry.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>This is the third reported case of concomitant sarcoidosis and solid pseudopapillary tumor of the pancreas.</p> </sec> </abstract>ARTICLE2022-01-21T00:00:00.000+00:00New markers of oxidative stress in lichen planus and the influence of hepatitis C virus infection – a pilot study<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Lichen planus (LP) is a mucocutaneous T-cell mediated disorder of unknown etiology. There is growing evidence that oxidative stress is an important player in the pathogenesis of LP. Therefore, we have investigated oxidative stress markers in LP and the influence of hepatitis C virus (HCV) infection, a frequently associated condition, on oxidative stress in LP patients.</p> <p><bold>Method.</bold> We have determined the serum levels of 4- hydroxynonenal (4-HNE) and symmetric dimethylarginine (SDMA), as markers of oxidative stress, and total antioxidant capacity (TAC), as a marker of the antioxidant defence, in 4 groups: group A – HCV positive patients with LP (n=12), group B – HCV positive patients without LP (n=12), group C – HCV negative patients with LP (n=31) and group D – control group (n=26).</p> <p><bold>Results.</bold> In LP patients, we have identified an increased level of lipid peroxidation (4-HNE – group A – 8.41±1.11 μg/mL, group B - 7.97±2.17 μg/mL, group C – 7.81±1.96 μg/mL and group D – 6.15±1.17 μg/mL) and alterations in arginine methylation (SDMA – group A – 1.10±0.24 μmol/L, group B – 1.03±0.16 μmol/L, group C – 0.84±0.19 μmol/L and group D – 0.50±0.06 μmol/L) associated with a diminished antioxidant defence (TAC – group A – 234.50±49.96, μmol/L group B – 255.83±41.41 μmol/L, group C – 269.83±43.33 μmol/L and group D – 316.46 ±29.33 μmol/L), processes augmented by the association with HCV infection.</p> <p><bold>Conclusion.</bold> There is an imbalance between oxidants and antioxidants in patients with LP, an imbalance that is augmented by the presence of HCV infection. SDMA could be regarded as a novel biomarker of oxidative stress among these patients. To the best of our knowledge this is the first study to investigate the influence of HCV infection on oxidative stress in LP patients.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Carnitine palmitoyltransferase-II deficiency: case presentation and review of the literature<abstract> <title style='display:none'>Abstract</title> <p>Carnitine palmitoyltransferase-II deficiency, an autosomal recessive disorder, is the most common cause of recurrent rhabdomyolysis in adults. Recognition and avoidance of triggers, such as heavy exercise and stress, is key in prevention of further episodes; however, even with preventative measures, many patients will continue to experience periodic symptoms, including rhabdomyolysis. Avoidance of renal failure, correction of electrolyte disturbances and halting further muscle breakdown are the goals of treatment. It is essential for clinicians to recognize the signs and symptoms of acute disease in CPT-II deficiency. We present a case of recurrent rhabdomyolysis requiring hospitalization in a patient with CPT-II deficiency and review the literature for common clinical manifestations, diagnostics, and treatment strategies.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Clinical risk scores for the prediction of incident atrial fibrillation: a modernized review<abstract> <title style='display:none'>Abstract</title> <p>Atrial fibrillation (AF) is considered the most common sustained arrhythmia. Major cardiovascular risk factors that have been identified to initiate and perpetuate AF include age, sex, arterial hypertension, heart failure, valvular heart disease and diabetes mellitus. In the literature, several studies aimed to formulate easily – applied and accurate risk stratification scores, based on antecedent cardiovascular events, comorbidities and biomarkers for the prediction of new-onset AF. The present narrative review addresses the most universally accepted and efficient clinical scores, with an extended applicability in different populations and ages, particularly scores derived from the Framingham Heart Study, the Atherosclerosis Risk in Communities, the Malmo Diet and Cancer Study, as well as the CHARGE-AF, the CHADS2, CHA2DS2-VASc, HATCH and CH2EST scores. Identification of incident AF can be challenging, thus dictating for utilization of validated clinical instruments in everyday clinical practice.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Imaging characteristics of nontuberculous mycobacterial pulmonary nodules<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Nontuberculous mycobacteriosis (NTM) of the lungs can develop nodules. In order to clarify some of the characteristics of lung NTM nodules, we examined volume doubling time (VDT) and maximum standardized uptake value (SUVmax) in positron emission tomography (PET) of pathologically diagnosed NTM nodules.</p> <p><bold>Methods</bold>. From November 2012 to August 2018, clinical and radiological information were retrospectively investigated in eight patients who were surgically resected and diagnosed as NTM. These eight patients were followed up until November 2020 and were confirmed to have no appearance of lung cancer or reappearance of lung NTM nodules. The VDT was calculated using the Schwartz formula.</p> <p><bold>Results.</bold> The median maximum diameter of the nodule at the time of the first CT scan was 16.0 (range: 9.9–20.0) mm. The median maximum diameter of the nodule on CT performed before the surgical biopsy was 18.8 (range: 10.4–32.8) mm. The median doubling time calculated from these results was 203 (range: 20–568) days. Caseous granulomas and acid-fast bacilli were histologically confirmed in all eight patients. Culture of excised nodules revealed <italic>Mycobacterium intracellulare</italic> in five patients and <italic>Mycobacterium avium</italic> in three patients. Six patients received PET, and median SUVmax was: 7.0 (range: 3.3–21.0). Median VDT was around 200 days. Some patients had irregular-shaped nodules.</p> <p><bold>Conclusions.</bold> CT/PET-CT characteristics of lung nodules are not reliable in differentiating lung NTM nodules from malignant ones. To avoid unnecessary resection, it may be better to collect various information on imaging findings in the nodule itself and in opacities other than the nodule.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Spontaneous bacterial peritonitis: update on diagnosis and treatment<abstract> <title style='display:none'>Abstract</title> <p>Spontaneous bacterial peritonitis (SBP) is a common complication in patients with liver cirrhosis, with an increased risk of mortality. For this reason, a diagnostic paracentesis should be performed in all patients with ascites and clinical features with high diagnostic suspicion. Although literature data abound in identifying new diagnostic markers in serum or ascites, they have not yet been validated. The final diagnosis requires the analysis of ascites and the presence of &gt; 250 mm<sup>3</sup> neutrophil polymorphonuclear (PMN) in ascites. If previous data showed that the most common microorganisms identified were represented by gram-negative bacteria, we are currently facing an increase in gram-positive bacteria and multidrug-resistant bacteria. Although prompt and effective treatment is required to prevent outcomes, this becomes challenging as first-line therapies may become ineffective leading to worsening prognosis and increased in-hospital mortality. In this paper we will make a brief review of existing data on the diagnosis and treatment of SBP.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00The relationship of vitamin D deficiency with severity and outcome of acute stroke<abstract> <title style='display:none'>Abstract</title> <p><bold>Background.</bold> There are currently conflicting results regarding the link between vitamin D deficiency and the increased risk for stroke and its poor prognosis. The present study aimed to assess the relationship between vitamin D deficiency and prognosis of acute stroke.</p> <p><bold>Methods.</bold> This bi-center cross-sectional study was performed on 140 consecutive patients who referred to two general hospitals in Iran with the diagnosis of acute stroke. The levels of 25-hydroxy vitamin D were evaluated by Electrochemiluminescence (ECL) technique. Clinical severity of stroke on admission as well as on discharge time were evaluated using the National Institutes of Health Stroke Scale (NIHSS) or Modified Rankin (mRS) tools.</p> <p><bold>Results.</bold> Mean serum level of vitamin D was 25.51 ± 18.87 ng/mL, ranging from 3.0 to 98.6 ng/ml. There was a significant difference between the two groups (with and without vitamin D deficiency) in terms of stroke severity and disability, as reflected by mRS (P=0.003) and NIHSS evaluation (14.24 ± 9.23 versus 9.73 ± 7.36, P=0.003). Also, regarding patients’ clinical condition, the mean NIHSS score in those with deficient and normal levels of vitamin D was 14.24 ± 9.23 and 9.73 ± 7.36, respectively with NIHSS score &gt; 5 in 76.1% and 61.5%, respectively (P = 0.003).</p> <p><bold>Conclusion.</bold> According to the results of study, vitamin D status can be related to the severity of stroke. However, considering the cross-sectional design of our study, it could not point out the causality between vitamin D deficiency and acute stroke and further studies are warranted. It is not possible to draw any conclusions in terms of causality. Further studies are required in order to assess the relationship between the serum vitamin D levels and stroke severity.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Acute heart failure in pregnancy: importance of a timely multidisciplinary approach to recognition and management<abstract> <title style='display:none'>Abstract</title> <p>Increased cardiovascular demands of pregnancy may unmask occult diseases, such as dilated cardiomyopathy or valvular stenosis, or precipitate peripartum cardiomyopathy. We report a case of the emergency management and delivery of a young pregnant woman who presented with acute decompensated heart failure that was not immediately recognized. An emergency transfer to a tertiary care institution was arranged. Once diagnosed, the patient received multidisciplinary care shared between cardiologists, obstetricians, cardiac anesthetists, a neonatologist, and a midwife, resulting in good maternal and fetal outcomes.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Evaluation of oxidative stress markers in hospitalized patients with moderate and severe COVID-19<abstract> <title style='display:none'>Abstract</title> <p><bold>Background.</bold> Clinical evidence suggests increased oxidative stress in COVID-19 patients and this worsened redox status could potentially contribute to the progression of the disease.</p> <p><bold>Objectives.</bold> To investigate the oxidative stress we have measured oxidative stress parameters, namely, PAT (total antioxidant power, iron reducing) and d-ROMs (plasma peroxides). Additionally we have investigated their correlation with the most frequently used clinical parameters CRP, LDH, and NLR in serum from moderate and severe COVID-19 patients hospitalized in a tertiary hospital.</p> <p><bold>Methods.</bold> PAT and d-ROMs were determined by analytical photometric metric method in serum from 50 hospitalized patients. For each of them, two samples were collected and analyzed immediately after collection seven days apart.</p> <p><bold>Results.</bold> All patients at admission had a much higher value for plasma peroxides and a significant correlation between oxidative stress parameters and CRP, LDH, and NLR. (p&lt;0.05), except for OS index (OSI) vs CRP in the severe group. At discharge, plasma peroxides were reduced and OSI was improved in the moderate group.</p> <p><bold>Conclusion.</bold> We consider that using OSI at the beginning of COVID-19 disease presents a valuable starting point for the general assessment of oxidative stress and hence enabling a better triage of the patients in terms of disease severity.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Hashimoto’s thyroiditis is associated with elevated serum uric acid to high density lipoprotein-cholesterol ratio<abstract> <title style='display:none'>Abstract</title> <p><bold>Background.</bold> Hashimoto’s thyroiditis (HT) is an auto-immune condition characterized with lymphocytic and fibroblastic infiltration of the thyroid gland. The rate of uric acid and HDL cholesterol – so called as uric acid to HDL ratio (UHR) has been shown to be elevated in inflammatory conditions diseases. We aimed to compare UHR and other laboratory parameters of the patients with HT to those values in healthy controls.</p> <p><bold>Methods.</bold> The patients diagnosed with HT by medical history, physical examination, elevated thyroid autoantibodies in serum and characteristic sonographic findings in outpatient internal medicine clinics of our institution were enrolled to the present retrospective study. Age and sex matched healthy volunteers were enrolled as controls. UHR of the HT patients and control subjects were compared.</p> <p><bold>Results.</bold> The mean UHR of the HT group was 11% ± 4 %, while UHR of the control group was 8% ± 2% (p&lt;0.001). UHR was significantly and positively correlated with thyroid stimulating hormone (TSH) (r=0.26, p=0.01) and negatively correlated with free T4 (FT4) (r=−0.22, p=0.04) levels. The sensitivity and specificity of the UHR level were greater than 8.3%: were 74% and 52%, respectively (AUC: 0.74, p&lt;0.001, 95% CI: 0.64–0.84).</p> <p><bold>Conclusion.</bold> We suggest that UHR is a reliable and useful marker for HT. Therefore, it may be helpful in establishing the diagnosis of HT in addition to other diagnostic tools.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Healthcare-associated infection during the COVID-19 pandemic in a tertiary care hospital in Romania<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Information on healthcare-associated <italic>C.difficile</italic> infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic.</p> <p><bold>Methods.</bold> We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017–2018.</p> <p><bold>Results.</bold> We found 51 cases during 2020–2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017–2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days).</p> <p>Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment – mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group.</p> <p><bold>Conclusions.</bold> The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017–2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Evaluation of severity scoring systems in patients with severe community acquired pneumonia<abstract> <title style='display:none'>Abstract</title> <p><bold>Background.</bold> The aim of this study was to evaluate the ability of severity scoring systems to predict 30-day mortality in patients with severe community-acquired pneumonia.</p> <p><bold>Methods.</bold> The study included 98 patients aged ≥18 years with community acquired pneumonia hospitalized at the Intensive Care Unit of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia, during a 3-year period. We recorded demographic, clinical and common biochemical parameters. Five severity scores were calculated at admission: CURB 65 (Confusion, Urea, Respiratory Rate, Blood pressure, Age ≥65 years), SCAP (Severe Community Acquired Pneumonia score), SAPS II (Simplified Acute Physiology Score), SOFA (Sequential Organ Failure Assessment Score) and MPM (Mortality Prediction Model). Primary outcome variable was 30-day in-hospital mortality.</p> <p><bold>Results.</bold> The mean age of the patients was 59.08 ± 15.76 years, predominantly males (68%). The overall 30-day mortality was 52%. Charlson Comorbidity index was increased in non-survivors (3.72 ± 2.33) and was associated with the outcome. All severity indexes had higher values in patients who died, that showed statistical significance between the analysed groups. The areas under curve (AUC) values of the five scores for 30-day mortality were 0.670, 0.732, 0,726, 0.785 and 0.777, respectively.</p> <p><bold>Conclusion.</bold> Widely used severity scores accurately detected patients with pneumonia that had increased risk for poor outcome, but none of them individually demonstrated any advantage over the others.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00The prevalence and the impact of sarcopenia in digestive cancers. A systematic review<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction:</bold> Sarcopenia is characterized by a decrease in skeletal muscle mass, associated with low muscle strength and/or poor physical performance. Assessing the prevalence of sarcopenia among digestive cancers and establishing the impact that sarcopenia has on the postoperative evolution of digestive tumors may be a central pillar in improving postoperative outcomes by caring for perioperative sarcopenia.</p> <p>This brief review aimed to evaluate the prevalence of sarcopenia in digestive cancer patients.</p> <p><bold>Method and materials:</bold> PubMed database was searched for “sarcopenia” AND “digestive cancers” from January 1st, 2010, through September 30th, 2020. PRISMA guideline was used for this systematic review. After the selection process, 31 complete studies were included in our review.</p> <p>Assessment of sarcopenia diagnosis for the studies included in this systematic review was based on a computed tomographic calculation of the skeletal muscle index at the third lumbar vertebra.</p> <p><bold>Results:</bold> Among a total of 11,651 patients with digestive cancers, the prevalence of sarcopenia was 43.68%.</p> <p>The highest prevalence of sarcopenic patients was in esophageal (70.4%) and hepatic (60.3%) cancer, following by biliary tract (49.3%), pancreatic (45.70%), colorectal (42.83%) cancer, and gastric cancer (32.05%) with the lowest prevalence.</p> <p>The results of the studies conducted by now regarding the prevalence of sarcopenia in digestive cancers and its relevance in the evolution of these cancers are discordant and uneven.</p> <p>Some studies show that the presence of sarcopenia in patients with digestive cancers is associated with an increased rate of postoperative complications, increased toxicity of chemotherapeutics and increased mortality. Other studies do not find sarcopenia as an independent risk factor associated with negative consequences in the course of patients with digestive cancers.</p> <p><bold>Conclusions:</bold> Sarcopenia is prevalent in digestive cancers. There is still no consensus about the impact of sarcopenia on the treatment of digestive cancers. Further studies are needed to evaluate the real consequences of sarcopenia in digestive cancers..</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Pharmacogenomics: introduction and use in clinical practice<abstract><title style='display:none'>Abstract</title><p>Pharmacogenomics describes the link between the genetic code and variations in drug response or adverse effects. It is rapidly gaining in both interest and accessibility. The knowledge of the gene-drug pairing for a wide range of medications will allow the clinician to select drugs with the best efficacy, appropriate dose and lowest likelihood of serious side effects.</p><p>In order to apply this knowledge, practitioners need to be familiar with the basic principles of pharmacodynamics and pharmacokinetics and how these relate to drug response. Once these are understood, so can be the genetic variations that lead to different phenotypes. Our review explains these concepts and uses examples of commonly prescribed medications and their gene pairings. At the present time, the Food and Drug Administration (FDA) guidelines remain sparse in regards to pharmacogenomic testing but, despite this, direct-to-consumer testing is widely available. In this context, we detail how to interpret a pharmacogenomic report, we review the indications for testing, as well as its limitations.</p><p>This information is a step ahead towards invidualized medicine, in the hope that tailoring medications and doses to an individual’s genetic make-up will predict a safe and effective response.</p></abstract>ARTICLE2020-06-02T00:00:00.000+00:00Insulin resistance and testosterone level in Indonesian young adult males<abstract><title style='display:none'>Abstract</title><p><bold>Introduction.</bold> Central obesity is characterized by the accumulation of abdominal fat which may lead to several diseases including insulin resistance. The prevalence of central obesity is higher in male and the incidence in young adult males is increased. Central obesity is also related to low testosterone levels. The research aimed to assess the relationship between the testosterone levels and insulin resistance of young adult males with central obesity.</p><p><bold>Methods.</bold> This was a <italic>cross-sectional</italic> study, the subjects were young adult males of 18 to 25 years old. The central obesity consisted of 50 samples and non-central obesity comprised 70 samples. The examination of testosterone and insulin was performed by the ECLIA method, glucose used the enzymatic method, the insulin resistance was calculated by using the HOMA-IR index.</p><p><bold>Results.</bold> The mean of the testosterone level in central obesity was lower than non-central obesity (5.24 + 1.17 vs 7.18 + 1.54 ng/mL, p &lt; 0.001). HOMA-IR index in central obesity was higher than non-central obesity (4.29 + 2.23 vs 2.46 + 1.72, p &lt; 0.001). Testosterone levels had negative correlation with HOMA-IR (r = –0.470, p &lt; 0.001). There was significant difference in HOMA-IR among the quartiles of testosterone levels.</p><p><bold>Conclusion.</bold> There is negative correlation between testosterone level with HOMA-IR, the lower the testosterone level the higher the insulin resistance in young adult males.</p></abstract>ARTICLE2020-06-02T00:00:00.000+00:00A new approach to cardiac fat volume assessment and the correlation with coronary artery calcification<abstract><title style='display:none'>Abstract</title><p><bold>Background.</bold> Coronary artery disease (CAD) is the foremost cause of death in the most developed societies. Plaque formation in epicardial coronary arteries and ensuing inflammation are a known pathophysiologic factor of CAD.</p><p><bold>Objectives.</bold> We aimed to separately and simultaneously evaluate the correlation between pericardial fat pad volume and overall peri-coronary epicardial adipose tissue (EAT) thickness with coronary calcium score (CCS) to improve risk stratification of CAD.</p><p><bold>Methods.</bold> We retrospectively reviewed patients who underwent a non-invasive contrast-enhanced coronary multidetector CT (MDCT) angiography. Peri-coronary EAT thickness, pericardial fat pad volume and CCS were obtained by an expert radiologist from the patients coronary multidetector CT (MDCT) angiography.</p><p><bold>Results.</bold> We included 141 symptomatic patients (86 men, 55 women) with an average age of 53.53 ± 12.92. An increment of overall peri-coronary EAT thickness (1/3 × (left anterior descending artery (LAD) + left circumflex artery (LCx) + right coronary artery (RCA)) was associated with a 49% increase in the odds for the presence of coronary artery calcification (CAC) (P = 0.004). Significant predictability of peri-coronary EAT-average was seen in diagnosing calcified plaque. Pericardial fat pad volume was positively correlated with overall peri-coronary EAT thickness in age and body mass index (BMI)-adjusted linear regression models, (P &lt; 0.001).</p><p><bold>Conclusion.</bold> Our results amplify previous idea that peri-coronary EAT and pericardial fat pad volume might act as useful markers and better indicators of CCS based on Agatston score in comparison with BMI or body weight in order to reveal subsequent CADs.</p></abstract>ARTICLE2020-06-02T00:00:00.000+00:00Assessment of severity of acute pancreatitis over time<abstract><title style='display:none'>Abstract</title><p>In recent years there has been an increase in the incidence of acute pancreatitis worldwide. In spite of efforts to improve the treatment and care of patients with acute pancreatitis, to develop imaging investigations and interventional diagnostic and treatment techniques and to facilitate patients’ access to them, acute pancreatitis continues to be associated with significant mortality and morbidity, and the treatment of patients suffering from this disease entails significant costs for healthcare systems.</p><p>Researchers are in a permanent quest to get to a global consensus for stratifying the severity of acute pancreatitis. We need this in order to offer the proper management for each patient diagnosed with this condition and to improve hospital and health system strategies.</p><p>Over the years, it has been attempted to develop algorithms to support a swift assessment of patients with acute pancreatitis with a prediction of disease severity as close to reality as possible for optimal management. This has led to the development of classifications of severity and severity scores. These require a permanent updating to keep up with the technical and technological developments involved in investigating and treating the patient and encompassing the most recent studies.</p><p>The goal of this paper is to go through these classifications and scores, emphasizing factors that should be taken into account, and reflecting upon their utility and upon the necessity of improving them.</p></abstract>ARTICLE2020-06-02T00:00:00.000+00:00Efficacy of 4-hour rescue therapeutic plasma exchange in severe septic shock patients<abstract><title style='display:none'>Abstract</title><p><bold>Background</bold>.Early intervention for septic shock is crucial to reduce mortality and improve outcome. There is still a great debate over the exact time of therapeutic plasma exchange (TPE) administration in septic shock patients. This study aims to investigate the effect of early initiation (within 4 hours) of TPE in severe septic shock on hemodynamics &amp; outcome.</p><p><bold>Methods.</bold> We conducted a prospective, before-after case series study on 16 septic shock patients requiring high doses of vasopressors admitted in two ICUs from Cairo, Egypt. All of our patients received TPE within 4 hours of ICU admission. The fresh frozen plasma exchange volume = 1.5 × plasma volume.</p><p><bold>Results.</bold> In the 16 patients included in the study, mean arterial pressure was significantly improved after the initial TPE (p &lt; 0.002) and norepinephrine dose which significantly reduced post TPE (p &lt; 0.001). In addition, norepinephrine dose to mean arterial pressure significantly improved (p &lt; 0.001). There was reduction of a net 6 hours fluid balances following the first TPE were observed in all the patients (p &lt; 0.03) by a mean of 757 ml. Systemic vascular resistance index was markedly improved post-TPE along with statistically improved cardiac index (p &lt; 0.01). Stroke volume variance was also significantly decreased after the TPE sessions (p &lt; 0.01). C-reactive protein significantly improved after TPE (P &lt; 0.01).</p><p><bold>Conclusion.</bold> Early initiation of TPE in severe septic shock patients might improve hemodynamic measures.</p></abstract>ARTICLE2020-06-02T00:00:00.000+00:00Antibiotics administration during last trimester of pregnancy is associated with atopic dermatitis – a cross-sectional study<abstract><title style='display:none'>Abstract</title><p><bold><italic>Introduction.</italic></bold> Studies regarding antibiotics administration during pregnancy and atopic dermatitis (AD) in children are only few. In this context, the objective of our study was to investigate the potential association between the timing of intrauterine exposure to antibiotics or prenatal antibiotic administration in general and AD occurrence in children.</p><p><bold><italic>Methods.</italic></bold> This was a cross-sectional study in 1046 subjects. The exposure to antibiotics during pregnancy was initially evaluated using simple logistic regressions. Then, each period of antibiotics administration was adjusted with the other periods of antibiotics exposure (model 1) and with the other variables associated with AD in our database (model 2).</p><p><bold><italic>Results.</italic></bold> In simple logistic regression analysis, the administration of antibiotics during pregnancy, as a whole period, presented a trend of association with AD (OR = 1.28, %CI: 0.99 – 1.65). When we analyzed antibiotic administration during each trimester of pregnancy, only antibiotherapy during the 3<sup>rd</sup> trimester was associated with AD (OR = 2.94, %CI: 1.21 – 7.12). After adjusting with all the other important risk factors associated with AD in the database, antibiotics administration during the 3<sup>rd</sup> trimester of pregnancy was still independently associated with AD (OR=2.64, %CI: 1.01 – 6.91).</p><p><bold><italic>Conclusion.</italic></bold> Antibiotic administration during the 3<sup>rd</sup> trimester of pregnancy was independently associated with AD in children.</p></abstract>ARTICLE2020-06-02T00:00:00.000+00:00In-hospital screening for diabetes mellitus with HbA1c in an internal medicine department was not useful; a prospective pilot study<abstract><title style='display:none'>Abstract</title><p><bold>Background.</bold> Screening inpatients for diabetes mellitus may be a good opportunity to detect undiagnosed cases and several studies have demonstrated the feasibility and usefulness of this practice. HbA1c has been suggested as the method of choice due to the effects of acute illness on glucose. The aim of this study was to evaluate a screening protocol based on HbA1c to identify inpatients with undiagnosed diabetes mellitus in an internal medicine department.</p><p><bold>Methods.</bold> We conducted a prospective study of all admissions in the internal medicine department of a 412-bed community hospital in Greece during a 6-month period. Candidates for screening based on the American Diabetes Association’s recommendations were screened with HbA1c. Patients with very poor health status and patients with conditions that may interfere with HbA1c measurement or interpretation were excluded.</p><p><bold>Results.</bold> Of 463 patients (median age 74) only a small proportion (14.9%) were candidates for screening with HbA1c. Known diabetes mellitus, a low admission glucose, severe anemia or blood loss and poor health status were the most common reasons of exclusion. Among the 55 screened patients, 7 had diabetes (based on HbA1c ≥ 6.5%). However, in only 1 of them HbA1c was above target considering the patients’ health status. Categorical agreement (no diabetes, prediabetes, diabetes) between morning glucose and HbA1c was low. However, the concordance between a morning glucose &lt; 125 mg/dl and HbA1c &lt; 6.5% was &gt; 90%.</p><p><bold>Conclusions.</bold> In settings similar to ours (very elderly patients, high rate of conditions that confound the use of HbA1c and high rate of patients with poor health status), untargeted screening of inpatients with HbA1c is unlikely to be cost-effective. A morning glucose during hospitalization may be a better first step for screening.</p></abstract>ARTICLE2019-12-16T00:00:00.000+00:00en-us-1