Use of Digital Healthcare Communication to Improve Urologists' Surveillance of Lithiasis Patients Treated with Internal Urinary Drainage Pre- and Post-COVID-19 Period

The COVID-19 pandemic has greatly affected lithiasis patients, which has led to an increase in the number of internal stents that have been installed. In this paper, two studies were carried out, a clinical study and a quantitative study. The aim of the first study was to evaluate the incidence and the prevalence of bacterial urinary colonization in patients with obstructive urolithiasis who needed internal stents implanted. In the second study, a multiple linear regression was created to identify the opinion of urologists regarding the importance of using digital technologies to improve the communication process. The result of the clinical study illustrates that the prevalence of urinary colonization in patients with internal stents carried out for obstructive urolithiasis was 35%, with this value being influenced by co-infection with COVID-19. The results of the quantitative study illustrated the fact that urologists are open to using new online technologies to facilitate communication with patients. The results have high importance for both doctors and patients, illustrating the main factors that have the ability to influence the communication process. The hospital managers should take into account the results obtained in this study when they choose to use certain online communication technologies with patients.

The Current State of Knowledge Regarding the Use of Double J Catheters in Treating Obstructive Urolithiasis

"Urinary lithiasis is a common pathology in the modern era. Its significance lies in the possible complications that may arise as well as in its potential for recurrence. The treatment and prevention of recurrences of urinary lithiasis often require the intervention of several specialists: urologists, nephrologists, endocrinologists, nutritionists, biochemists, etc. In the last 20 years, the treatment strategy for urinary lithiasis has changed, with minimally invasive methods replacing laparoscopic or open surgery. These are effective and have rare complications. Whichever treatment method is chosen, it may be necessary to temporarily divert the upper urinary tract by inserting double J catheters for preventive, curative, or palliative purposes. Ureteral catheters have had to be improved over time to avoid two major incidents: their migration and colonization. Various materials were used, varying the shape, size, length, guide as well as approaches. The urinary infection-urolithiasis association is frequent, without always being able to specify the cause-effect relationship. The rate of urinary colonization appears to be influenced by the presence of stent colonization as well as the time since the implant. The association of chronic diseases or emergency insertion is associated with an increased risk of urinary colonization. Complications induced by the time of the double J catheter being implanted are rare, and minor and disappear with its removal. In the case of failure to insert a double J ureteral catheter, the alternative would be to perform an ultrasound-guided percutaneous nephrostomy. Double J ureteral catheter insertion is an effective minimally invasive option in the treatment of obstructive urolithiasis. "

Contributi scientifici in memoria di Antonio Fusco

Come si leggerà nell'Introduzione della sezione propriamente scientifica del Volume, il presente testo nasce dalla volontà e, soprattutto, dall'esigenza culturale di omaggiare il fu Prof. Antonio Fusco. Un debito scientifico ed umano che trova il suo locus naturale in questa prima parte del testo stesso, cui farà poi seguito la parte propriamente scientifica. In siffatta parentesi dovuta per le ragioni appena menzionate, il lettore, l'amico o l'allievo dell'opera del Prof. Fusco potranno trovare un suo sintetico Curriculum Vitae, correlato da una specifica ed accurata prosa, svolta dal già Magnifico Rettore Carlo Cipolli; il quale, oltre che evidenziare, ricordando, i meriti del collega oramai scomparso, aggiunge alsuo scritto un elemento che sarebbe imprescindibile a non trasformare lo stesso in una mera sequenza di parole: l'amicizia e l'affetto per un amico che, oramai, non c'è più. A fine lettura, evidente risuonerà il fatto che la vita di ognuno, se mossa dalla passione per ciò per cui si è predisposti cognitivamente e psicologicamente, può essere ricca di riconoscimenti, riconoscenze e soddisfazioni che, lungi dal divenire un cuscino di allori su cui adagiarsi, per una mente creativa come quella del Prof. Fusco hanno funto solo da motivazioni ad agire instancabilmente guardando sempre al futuro. Il lavoro di una vita che, materialmente, è sancito da un supporto poco più di cm 25x15: una targa. Una materialità evidente che, con grande commozione e riconoscenza, è stata affissa il 25 ottobre 2019 sull'aula fronte l'Aula Magna del Campus "La Folcara", a testimonianza che quello spirito creativo in continua evoluzione non si ferma; non si arresta neppure con la fine biologica di chi lo ha "posseduto". Rimangono le opere ed il pensiero del Prof. Fusco e restano gli affetti. A tal proposito, il lettore troverà una breve e sentita sezione su Testimonianze; coloro i quali hanno avuto modo, nell'arco della vita accademica ed umana, personale, di Fusco di conoscerlo. Ecco, allora, che i ricordi saranno i veri protagonisti di questa parentesi. Dopo di ciò, prima dei contributi prettamente scientifici dei lavori, tenutisi in occasione del Convegno Internazionale Psicologia, Arte, Letteratura. Antiche e Nuove Tendenze, seguiranno i saluti delle autorità che in quei due giorni si sono succedute a rappresentare non solo l'istituzione affiliata, ma anche la relazione di stima e di affetto che le legava al compianto Professore. Si passerà, infine, al volume tradizionalmente inteso.

Increased copeptin levels in metabolic syndrome from a Romanian population

Rationale: Arginine vasopressin (AVP) is secreted under conditions of water deprivation. Since AVP has a low half-life in the plasma, the C-terminal fragment of AVP-precursor (copeptin) was used to estimate the AVP levels. High copeptin levels increase the risk for the development of diabetes mellitus. Aim: This study was aimed to measure copeptin levels in the metabolic syndrome (MetS) in Romanians using a competitive enzyme immunoassay. Methods and results: Patients prone to present MetS (n = 63) were compared to controls (n = 42). In the MetS group, the syndrome was confirmed in 93.6%. Affected patients displayed 85.7% obesity and insulin resistance (HOMAIR of 4.9 ± 0.4 versus 1.1 ± 0.8 in controls). Low HDL-cholesterol was less represented (47.5%). Copeptin levels were 0.6 ± 0.0 in MetS versus 0.42 ± 0.0 ng/ mL in controls (P < 0.004). Higher copeptin (0.79 to 1.83 ng/ mL) was associated with MetS, P < 0.0018, OR 20, 95%CI [3.03 - 131.7]. In ANOVA, high copeptin was equally explained by MetS or obesity (P < 0.05,α = 3.8). The best correlation was found with high triglyceride levels (P < 0.013,α = 6.3) while the correlation with HOMAIR remained not significant. Discussion: These data indicated a concordant correlation between increased copeptin and MetS or its components. In the light of epidemiological data, indicating that more than 50% of the European population has a lower daily water intake and a fraction of 25% displaying high copeptin, our data further sustained that copeptin may be a good biomarker for MetS and/ or obesity, which should be further investigated with other members of the osmoregulation pathway at both pathogenesis and genetic levels.

Aldosterone and cardiovascular pathology: from bench to bedside

Thirty years ago, aldosterone was an unidimensional hormone considered responsible for salt and water homeostasis. The current role of aldosterone in pathology is very complex. Recognition of mineralocorticoid receptors throughout the body has raised the importance of aldosterone in understanding the pathophysiology of previously unknown cardiovascular effects. This came from the first documentation of aldosterone receptors outside the kidney, making it not only an endocrine hormone, but a paracrine one, too. Aldosterone is contemporary appreciated to play an important role as a cardiac and vascular risk hormone. Aldosterone-mediated actions include the expression of several genes: collagen genes; genes controlling tissue growth factors and plasminogen activator inhibitor type 1; genes mediating inflammation. Aldosterone receptor blocking agents improve cardiovascular structure, function, and prognosis. They appear to provide additive benefit when used in conjunction with either an ACE inhibitor or an angiotensin receptor blocker.

Renin-Angiotensin-Aldosterone system inhibition in prevention of diabetes mellitus

The number of people with diabetes grows worldwide. The complications resulting from this disease are a significant cause of morbidity and mortality. World Health Organization estimates that, while in the year 2000 the number of people with diabetes was about 177 million, by 2025, this will increase to at least 300 million. The diabetes epidemic, without primary prevention, will continue to grow. Individuals with type 2 diabetes are at a significantly higher risk for coronary heart disease, peripheral vascular disease, and stroke, and they have a greater probability of having hypertension, dyslipidemia, and obesity. A number of clinical trials provide evidences that RAAS inhibition could be helpful at preventing new onset of type 2 diabetes mellitus. Pharmacologic treatment that antagonize the renin-angiotensin system (RAS) provide more benefits, not only in patients after myocardial infarction and in congestive heart failure, but also in persons with hypertension and type 2 diabetes mellitus.

Is cardiac involvement in collagen diseases important? A clinical study in 917 patients

Cardiac involvement in collagen diseases was studied in 917 patients representing all the cases of collagen diseases diagnosed in the "N. Gh. Lupu" Institute of Internal Medicine between 1985 and 1987. The prevalence of the various cardiac disorders was studied within every disease or group of diseases diagnosed according to clinical, ECG, radiologic and when necessary echocardiographic data. Collagen heart disease was diagnosed in 38.2% of the patients. In the case of systemic lupus erythematosus, of polyarteritis nodosa and of progressive systemic sclerosis this proportion exceeds 50%. The most frequent cardiac disorders were the rhythm and conduction disturbances, detected in 112 patients (12.2%). The cardiomyopathies and myocarditis, not infrequent (7.4%) represented an element of severity influencing the evolution and prognosis of disease. Myocardial ischemia secondary to coronary vasculitis syndromes has proved to be an important pathogenic mechanism of cardiac disorders. By their frequency and severity, the cardiac involvements in collagen diseases have proved important, becoming sometimes a central diagnostic, therapeutic and prognostic problem.

Cardiac involvement in progressive systemic sclerosis and polymyositis: a comparative study in 116 patients

A comparative study was carried out in 116 patients-51 with progressive systemic sclerosis (PSS) and 65 with polymyositis (PM) to detect the cardiac involvements secondary to these two collagen diseases. Different forms of cardiac involvement could be detected in 51% of the patients with PSS and in 18.5% of those with PM. The most frequent cardiac dysfunctions were disturbances of rhythm and conduction probably due to the coronary vascular changes in PSS and to processes of fibrosis and degenerescence of the specific myocardial fibers in PM. Myocardial lesions expressed by myocarditis and cardiomyopathies are not infrequent and have important prognostic implications. In the group of patients studied the valvular cardiopathies and clinically evident pericardites were rare. Cardiac involvement clearly proved more frequent in PSS - in which the pathogenic mechanism is mainly vascular - than in PM. This emphasizes the great importance of coronary circulation disturbances in the pathogenesis of collagen heart diseases.

Pacemaker therapy in a group of 132 patients with sick sinus syndrome--indications and results

Of the 132 patients with sick sinus syndrome (SSS) studied, 62 (47.8%) required pacemaker implantation thus showing the severity of the arrhythmic syndrome. The pacing requirement varied according to the SSS arrhythmic form with a maximum in the tachy-brady syndrome (53.5%) and in major sinus bradyarrhythmias--S--A block and sinus arrest (54.1%). The presence of syncopes (in 32.6% of the patients) represented the main indication for pacing. Very good results (100% efficiency) were obtained in the bradycardic forms. In the tachy-brady syndrome electrostimulation solved completely the bradycardic component and was able, alone, to suppress the tachyarrhythmic episodes in 18.4% of the patients. By associating pacing with antiarrhythmic drugs favourable results were obtained in an additional proportion of 65.8% of the patients. In the rest of 15.8% of the cases the results were partial.

The relationship between systemic lupus erythematosus and tuberculosis

Investigation of 280 cases of systemic lupus erythematosus (SLE) admitted during 15 consecutive years to the "N. Gh. Lupu" Institute of Internal Medicine, Bucharest, revealed association of this disease with tuberculosis (tb) in 51 cases (19%). In most of these patients, tb onset preceded that of SLE; in the others it was either concomitant or it occurred later, in the course of SLE evolution. It is assumed that tb is favouring SLE development, probably by antigenic oversollicitation in patients with genetic immune deficiencies. When it occurs in the late stages of SLE, association of tb is of severe prognosis.