Adiponectin - stratification biomarker in diastolic cardiac dysfunction

This study does not propose to elucidate how adiponectin secretion is regulated, but how its adiponectin concentration is an indicator of heart disease. About adiponectin, it is not known whether it is functionally an enzyme, or very likely a cytokine/chemokine/hormone, secreted by fat cells/adipocytes in the abdomen. Abdominal fat secretes 67 hormones, and all of which cause disease. For example, adiponectin generates diabetes and ischaemic heart disease via dyslipidemia. Based on clinical symptoms, electrocardiographic and echocardiographic parameters, a group of 208 patients with diastolic cardiac dysfunction with or without preserved systolic function, developed on a background of painful chronic ischaemic heart disease, stable angina on exertion, was constituted. The serum levels of adiponectin, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were measured. Using the identified values, it was appreciated whether adiponectin correlates with the type of any of the two conditions, so that it can be recognised as a diagnostic and risk stratification marker.

Systemic inflammation factors as survival prognosis markers in ovarian neoplasm and the relationship with cancer-associated inflammatory mediators-a review

At the level of the genital system, ovarian neoplasm is the most frequent cause of morbidity and mortality. In the specialized literature, the coexistence of an inflammatory process is admitted from the early stages of the evolution of this pathology. Starting from the importance of this process, both in determinism and in the evolution of carcinogenesis and summarizing the field of knowledge, for this study we considered two objectives: the first was the presentation of the pathogenic mechanism, through which chronic +ovarian inflammation is involved in the process of carcinogenesis, and the second is the justification of the clinical utility of the three parameters, accepted as biomarkers of systemic inflammation: neutrophil-lymphocyte ratio, platelet lymphocyte ratio, and lymphocyte-monocyte ratio in the assessment of prognosis. The study highlights the acceptance of these hematological parameters, with practical utility, as prognostic biomarkers in ovarian cancer, based on the intrinsic link with cancer-associated inflammatory mediators. Based on the data from the specialized literature, the conclusion is that in ovarian cancer, the inflammatory process induced by the presence of the tumor, induces changes in the types of circulating leukocytes, with immediate effects on the markers of systemic inflammation.

The impact of COVID-19 on right ventricular function in chronic kidney disease patients

Introduction

In chronic kidney disease (CKD) patients, the case fatality rate caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is higher than in the general population [1]. In patients hospitalised with COVID 19, right heart dysfunction is present in 20% of the cases, associated with an increased risk of all-cause death [2].

Purpose

CARDIO-SCARS in CKD is a currently ongoing multi-center observational match controlled trial that aims to assess the cardiovascular (CV) risk in a CKD (stages 3 to 5), dialysis and kidney transplant population, following SARS-CoV-2 infection, by using clinical evaluation, various techniques and novel biomarkers (ClinicalTrials.gov Identifier NCT05125913). We hereby report the main baseline echocardiographic parameters that assess the right ventricular (RV) function.

Methods

We conducted a cross-sectional study that included 263 patients with CKD (dialysis, transplantation or eGFR <60 ml/min/1.73 m²). For assessing RV function, 5 parameters were measured: fractional area change (FAC, %), tricuspid annular plane systolic excursion (TAPSE, mm), tricuspid S' wave (S tric, cm/s), Tei index and right ventricular free wall longitudinal strain (RVFWLS, %). Patients in atrial fibrillation, with a permanent pacemaker or with a poor acoustic window were excluded.

Results

Our study included 263 patients with CKD, divided in two groups: 168 patients post COVID-19 (94 in dialysis, 38 post kidney transplantation and 36 with CKD) and 95 patients in the control group (57 in dialysis, 30 post kidney transplantation and 8 with CKD).The mean age was 57.3±15.4 years (median 60 years old), 55.2% of the patients were males, 24% were diabetic and 9.5% were smokers. The mean duration of dialysis in the COVID-19 group was 63.8 months vs. 62.6 months in the control group. In the COVID group, the echocardiography was performed at a mean distance of 2.2±2.1 months after testing positive for SARS-CoV-2.All the parameters of RV function were better in the control group (FAC (%): 43.6±11 vs. 41.3±11; TAPSE (mm): 23.2±6.9 vs. 21.4±4.9; S tric (cm/s): 13.4±3.4 vs. 13±3.1; Tei index: 0.5±0.2 vs. 0.6±0.2; RVFWLS (%): −20.1±3.8 vs. −18.6±5.1. After performing a two-sample t-Test, statistical significance was reached only for TAPSE, Tei index and RVFWLS (0.008, 0.0001 and 0.006, respectively).

Conclusions

Our study is the first to describe echocardiographic alterations post-COVID in a CKD population. All CKD patients had lower values of RV parameters than those reported in the general population. Still, the CKD COVID group had lower values than CKD control group, with the same magnitude as the changes reported in the general population [3,4]. The evolution of these parameters and their prognostic significance is of interest, regarding long-term CV sequelae of COVID-19.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Ministry of Research and Innovation, CNCS-UEFISCDI

Myeloperoxidase (MPO) - possible diagnosis biomarker and risk stratification in myocardial inotropism deficit induced by chronic ischemic heart disease

The myeloperoxidase levels of 208 patients with ischemic heart disease hospitalized for congestive heart failure were tested at admission, and discharge after 14 days. The calculations for the serum average concentration/lot/date, were made, subsequent, using the values of the tested parameters regarding MPO (admission and discharge) the mean concentration/lot was made, regardless of time of determination. The calculated average values analyses of the three MPO serum parameters were constantly elevated and permanently matched the myocardial contractility deficiency class. The integrated data of the study, allows us to propose the MPO’s circulating concentration as a diagnosis and risk assessment biomarker in the etiology of myocardial ischemia for chronic cardiac failure.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) - possible diagnostic and risk biomarker in chronic ischaemic heart disease

In a group of 208 patients with chronic ischaemic heart disease, the variation of A₂-associated-LDL phosphatase (Lp-PLA₂) serum concentration values was analysed in dynamics at a two-week interval. The conclusion of the study is that the values of serum concentration of Lp-PLA₂ can be accepted as a biomarker with diagnostic specificity for chronic ischaemic heart disease, a parameter of real utility in medical practice, both in situations where the patient, although clinically reporting the existence of angina pectoris, does not show specific changes on an EKG, and for the assessment of the response to personalised therapy.

TNF-alpha releasing capacity of the whole blood drops after open total splenectomy, but increases after partial/subtotal or minimally invasive splenectomy

BACKGROUND

The mechanisms that induce immunodeficiency after splenectomy remain unknown. The aim of this study was to measure the cytokine releasing capacity of the whole blood as an expression of the innate immunity after total (TS) and subtotal/partial splenectomy (S/PS) in order to assess the impact of splenectomy on the individual cytokine reactivity.

METHODS

We prospectively collected blood before (D0) and at multiple time points after splenectomy (7 days - D7, 30 days - D30, 90 days - D90, 180 days - D180, and 360 days - D360) and measured the cytokines releasing capacity of IL-6, TNF-alpha and IL-10 from whole blood under LPS stimulation which we normalized to the monocytes number.

RESULTS

When analyzing all splenectomies at D0, D7 and D30, normalized ΔTNF-alpha significantly dropped after splenectomy (p = .0038) and normalized ΔIL-6 and ΔIL-10 did not significantly change. More specifically, normalized ΔTNF-alpha dropped after TS (p = .0568) and significantly increased after S/PS (p = .0388). Open surgery induced a decrease in normalized ΔTNF-alpha (p = .0970), whereas minimally invasive (MI) surgery significantly increased the normalized ΔTNF-alpha releasing capacity (p = .0178). The cytokine levels were heterogenous between pathologies at D0, and ΔIL-6 dropped mainly in cirrhotic patients after splenectomy (all underwent TS), ΔTNF-alpha dropped in immune thrombocytopenic purpura patients (all underwent TS), but increased in spherocytosis (91% underwent S/PS) after splenectomy.

CONCLUSIONS

Splenectomy induces a decrease of the pro-inflammatory cytokine TNF-alpha and if splenic parenchyma is spared and the surgery is performed MI, this change is hindered.

Investigation of the magnetic field effect upon interpolymeric complexes formation based on bovine serum albumin and poly(aspartic acid)

The study presents a novel strategy for obtaining highly ordered interpolymeric complexes based on a protein, bovine serum albumin and a synthetic polymer, poly(aspartic acid). In this approach, experimental tests were carried out in the presence of a magnetic field of different intensities, namely 0.11 T and 0.3 T produced by permanent magnets. The influence of the magnetic force on the complexation process and the resulted self-assembled structures were studied by means of FTIR spectroscopy, X-ray diffraction, DLS, SEM microscopy and in vitro assay. The changes in the FTIR spectra acquired after 24 h of exposure were connected with conformational changes in the secondary structure and increased interactions between polymers, particularly when a higher intensity field was used. Due to a large anisotropy of magnetic susceptibility characteristic to both proteins and polypeptides, the magnetic field generated ordered assemblies consisting in globular structures of nanometric dimensions. This assembly strategy using magnets, along with remote manipulation capability can provide a versatile, contact-free, and inexpensive tool to create new, complex materials with tailorable characteristics.

A cross-sectional analysis of joint status and quality of life in children and adolescents with haemophilia in Romania

BACKGROUND

Haemophilia is a congenital disorder of coagulation with high economic burden due to its requirement for an expensive, lifelong replacement therapy, with additional costs for the frequent complications and for the severe handicapping consequences. The objective of this cross-sectional study aimed at giving an insight into the health condition of young haemophiliacs in the absence of a regular prophylactic therapy.

METHODS

It was conducted on a heterogeneous group of 37 children and adolescents (4-24 years of age), with similar on demand therapeutic regimen, coming from the whole country, focusing on the joint status by using the Haemophila Joint Health Score (HJHS) system and on quality of life (QoL) by using the EQ-5D-3L-Y questionnaire.

RESULTS

The results revealed an impressive situation: 70.3 % with chronic arthropathy, 19 % with target joints, 69 % with multiple joint involvement, mainly elbow (41 %) and knee (34 %), joint damage starting in the age group 6-12 years (18.18 % arthropathy vs. 96 % in the age group above 12 years). Joint score (6.67 ± 7.92), gait score (0.75 ± 1.14) and HJHS (7.43 ± 8.78) were highly correlated (r = 0.7, p = 0.001) with the annualised bleeding rate ABR (16.2 ± 12.1). They impacted the QoL in all domains, also expressed by a VAS of 68.39 ± 21.6.

CONCLUSION

We concluded that in the situation of an international consensus that prophylactic replacement can prevent cost-effectively and cost-efficiently the deleterious joint damages, our study is supporting the introduction even of secondary and tertiary prophylaxis in young patients in our country.

Prenatal Diagnosis in Great Artery Trasposition and Implications in Postnatal Outcome

Great artery transposition, one of the most frequent and severe cyanotic heart malformations, represented the subject of many studies and research up to this moment. Although postnatal period is critical in this pathology, with correct management patients can benefit from complete surgical correction - arterial switch operation with good long term evolution. Prenatal diagnosis of Great Artery Transposition has an important contribution in choosing the appropriate treatment at the right time in postnatal period so that specific complications resulting from delaying the initiation of specific therapies can be avoided. This article proposes a review of existing data at this moment related to the importance of prenatal diagnosis in Great Artery Transposition and underlines how an accurate fetal diagnosis influences the decision of establishing the appropriate treatment in postnatal life for the children with this type of malformation and the complications that can be avoided.

DIAGNOSTICUL PRENATAL AL TETRALOGIEI FALLOT ŞI IMPLICAŢIILE POSTNATALE

În ultimii ani, diagnosticul prenatal al malformaţiilor de cord a cunoscut o dezvoltare importantă. Supravietuirea globală a pacienţilor cu malformaţii congenitale de cord s-a îmbunătăţit în ultima decadă, datorită diversificării atât a metodelor de diagnostic, cât şi a celor de chirurgie cardiovasculară pe această arie de interes. Ca urmare a creşterii semnificative a supravieţuirii pe termen lung, în prezent, în majoritatea ţărilor dezvoltate există departamente dedicate monitorizării adulţilor cu malformaţii congenitale de cord, datorită particularităţilor şi nevoilor speciale ale acestui tip de pacienţi, în comparaţie cu patologia cardiacă dobândită a adultului. Articolul de faţă îşi propune o trecere în revistă a datelor existente până la acest moment legate de diagnosticul prenatal şi impactul acestuia asupra evoluţiei postnatale în ceea ce priveşte cea mai frecventă malformaţie congenitală cianogenă, şi anume Tetralogia Fallot. În cele ce urmează, reiterăm importanţa cunoaşterii cu exactitate a patologiei fetale prenatale pentru stabilirea din timp a conduitei medicale postnatale pentru copiii cu acest tip de malformaţie.

POSTNATAL IMPLICATIONS FOR PRENATAL DIAGNOSED TETRALOGY OF FALLOT

Over the last few years, prenatal diagnosis of congenital heart diseases experienced an important development. Overall survival of patients with congenital heart disease was improved in the last decade due to the advanced diagnostic methods and progression of cardiovascular surgical procedures in this field. Due to the significant increase of the long-term survival rate, currently, in most developed countries, there are departments dedicated to monitoring the adults with congenital heart malformation due to the particularities and special needs of this type of patients, compared with the regular cardiac pathology of adults. This article proposes a review of existing data at this moment related to the prenatal and postnatal diagnosis and their impact on the evolution regarding the most common cyanotic congenital malformation – Tetralogy of Fallot. In the following pages, we is emphasize the importance of knowing the precise fetal pathology for early determination of medical behavior in the postnatal period for the best care of these children.

Giant Cardiac Mass Detected to an Infant with Normal Fetal Echography and No Systolic Murmur in Early Postnatal Evolution

Infective endocarditis is rare in children and is rarer on a normal structural heart in an infant without any surgical intervention. Most cases are related to a pre-existing congenital lesion, the most frequent etiology are Gram-positive cocci and the most feared are fungal agents. This report presents a 7-monthold infant with fungal endocarditis on a normal structural heart. The diagnosis was suspected on clinical examination and was confirmed by echocardiography and positive blood cultures. His particular clinical evolution after medical and surgical treatment illustrates a severe disease with poor prognosis which may be a complication of neonatal intensive care procedures. Unusual cause of fungal endocarditis in a previously healthy infant: neonatal hospitalization in intensive care unit.

HIV and AIDS, among knowledge, responsibility and ignorance; a study on medical students at the end of their first universitary year

Despite the global effort to control the spread of HIV and AIDS, the number of HIV-infected people continues to increase worldwide. The failure of present prevention strategies, which rely principally on the modification of behavioral practices that put individuals at risk of getting the infection, and the lack of effective anti-HIV drugs have given an impetus to the search for a better way in the prevention and control of the epidemic. It was observed and scientifically documented that efforts related to prevention have to be adapted, constantly monitored and readapted in relation to results from periodical surveys. They also have to be well sustained over a sufficiently long period of time (years). Under these assumptions, in order to evaluate the knowledge and perception/attitudes of the students in the University of Medicine, we developed a questionnaire that we presented for completion, for example, to medical students at the end of their first year of study. The gathered data conducted us to the assumption that information regarding HIV transmission is not yet internalized in order to determine specific practices, and attitudes are more related to perceptions and beliefs than to facts. An active, responsible, adult day to day responsibility could increase the protection against HIV transmission. A limitation of our study was represented by the reduced number of participants (96) and the lack of correlation between attitudes and knowledge, between students in different years of study and over time. It is our intention to continue this research and provide more complete data in the nearest future.

[Studies of the influenza epidemic of January-March, 1974]

In an epidemiologic, clinical and viral study of several influenza foci in some urban districts of Romania during January-March 1974, 23 influenza virus B Hong-Kong 8/73 strains were isolated. The dynamics of HAI serum antibodies confirmed the viral diagnosis. The epidemic ran a slow course, affecting especially the 14-25 years age group and had an evident benign clinical aspect.