Microbiota signatures in type-2 diabetic patients with chronic kidney disease - A Pilot Study

The human microbiota is paramount for normal host physiology. Altered host-microbiome interactions are part of the pathogenesis of numerous common ailments. Currently, much emphasis is placed on the involvement of the microbiome in the pathogenesis of type-2 diabetes mellitus (T2DM), impaired glucose tolerance, and other metabolic disorders (i.e. obesity). Several studies found highly significant correlations of specific intestinal bacteria with T2DM. A better understanding of the role of the microbiome in diabetes and its complications might provide new insights in the development of new therapeutic principles. Our pilot study investigates the microbiota patterns in Romanian type-2 diabetic patients with diabetic kidney disease. Fecal samples were collected from type 2-diabetic patients and healthy controls and further used for bacterial DNA isolation. Using 16 rDNA qRT-PCR, we analyzed phyla abundance (Bacteroidetes, Firmicutes) as well as the relative abundance of specific bacterial groups (Lactobacillus sp., Enterobacteriaceae, Ruminococus sp., Prevotella sp., Faecalibacterium sp., Clostridium coccoides, Clostridium leptum). Our study also investigates the diabetic fungal microbiome for the first time. Furthermore, we report significant correlations between the treatment regimen and microbiota composition in diabetic nephropathy

Problema fundamentalismului islamic şi stabilitatea politică

Ideologia nu poate fi distrusă prin cuvînt sau logică, cu atît mai mult nu poate fi distrusă cu arme. Ideologia moare singură, cînd se dovedeşte că nu prea corespunde realităţii. Reacţia Occidentului la ceea ce se întîmplă în Egipt, declaraţiile, că organizaţia „Fraţii musulmani‖ (Muslim Brotherhood)[1] sunt nişte băieţi paşnici cu care Ḥusnī Sayyid Mubārak speria Occidentul şi deaceea î-i numea terorişti, este neadecvată

The role of endothelium in covid-19

The 2019 novel coronavirus, known as severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) or coronavirus disease 2019 (COVID-19), is causing a global pandemic. The virus primarily affects the upper and lower respiratory tracts and raises the risk of a variety of non-pulmonary consequences, the most severe and possibly fatal of which are cardiovascular problems. Data show that almost one-third of the patients with a moderate or severe form of COVID-19 had preexisting cardiovascular comorbidities such as diabetes mellitus, obesity, hypertension, heart failure, or coronary artery disease. SARS-CoV2 causes hyper inflammation, hypoxia, apoptosis, and a renin–angiotensin system imbalance in a variety of cell types, primarily endothelial cells. Profound endothelial dysfunction associated with COVID-19 can be the cause of impaired organ perfusion that may generate acute myocardial injury, renal failure, and a procoagulant state resulting in thromboembolic events. We discuss the most recent results on the involvement of endothelial dysfunction in the pathogenesis of COVID-19 in patients with cardiometabolic diseases in this review. We also provide insights on treatments that may reduce the severity of this viral infection

Death by SARS-CoV 2: a Romanian COVID-19 multi-centre comorbidity study

Evidence regarding the relation between SARS-CoV-2 mortality and the underlying medical condition is scarce. We conducted an observational, retrospective study based on Romanian official data about location, age, gender and comorbidities for COVID-19 fatalities. Our findings indicate that males, hypertension, diabetes, obesity and chronic kidney disease were most frequent in the COVID-19 fatalities, that the burden of disease was low, and that the prognosis for 1-year survival probability was high in the sample. Evidence shows that age-dependent pairs of comorbidities could be a negative prognosis factor for the severity of disease for the SARS-CoV 2 infection

The role of Bosniak classification in the assessment of renal cystic masses and in the therapeutical protocol

One of the most frequent kidney pathologies encountered in daily practice is represented by the presence of renal cysts. Most of them are asymptomatic and are found accidentally during periodical check-ups because they don’t have clinical signs until they grow and compress the surrounding organs. We have reviewed the current data regarding this pathology, in order to underline the risk of malignant transformation and its impact on the patient’s life. It is estimated that the prevalence rate of renal cysts in the general population is approximately 10% and it increases with age.Imaging investigations, such as contrast tomography or magnetic resonance imaging, are essential for establishing the cysts characteristics, especially when ultrasonography raises the suspicion of a modified renal cyst, as well as in guiding the therapeutical protocol. The Bosniak classification is based on contrast tomography scans and has allowed the standardization of the kidney cysts, considering their characteristics. More attention should be given to Bosniak IIF and III cystic renal masses, which contain thickened walls and more septa, but no enhanced nodules/soft tissue components, because more than half of these cysts can have a malignant component

Discharge protocol in acute pancreatitis: an international survey and cohort analysis

There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients’ care

Modele de etici axate pe principiile grijii și dreptăţii

Existenţa diferitelor modele de etici pot fi diferenţiate în baza unor criterii concrete. Astfel, în funcţie de sfera prioritară de aplicare a valorilor morale, deosebim etică generală și etică profesională; din punct de vedere a diferenţei dintre metodele de justificare a datoriei morale distingem deontologia kantiană, etica virtuţii, etica teleologică a binelui. Un alt criteriu semnificativ în acest context, se referă la valorile în sine, la stabilirea priorităţii lor reciproce în cadrul alegerii morale. În acest caz se formează diverse modele de etică datorită faptului, că sistemul de norme morale care determină natura acţiunilor noastre și, într-o măsură, natura motivelor și experienţelor, poate fi orientat în primul rând către una sau alta din valorile morale de bază Cea mai semnificativă fiind opoziţia, dar și complementaritatea dintre etica dreptăţii și etica grijii. Modelele opuse de etică caracterizează moduri diferite de a relaţiona cu o altă persoană ca subiect moral. Perspectiva la care ne vom opri în acest articol este una inedită: vom delimita teoretic conceptele de dreptate și grijă, vor fi evidenţiate unele abordări ale acestor tipuri de etic

Upper endoscopy in patients with acute ST-elevation myocardial infarction (STEMI) and postthrombolysis upper gastrointestinal bleeding – results, therapeutic utility

Abstract Upper endoscopy is the “golden standard” for the diagnosis of upper gastrointestinal bleeding (UGB); it appreciates the persistence of bleeding in more than 90% of cases, it reveals the UGB lesion, gives prognostic information about re-bleeding risk and offers the possibility of endoscopic haemostasis. Uncomplicated STEMI by itself is not a contraindication for upper endoscopy [1,2]. The aim of our study was to observe the haemorrhagic lesions in STEMI patients with postthrombolysis UGB and to evaluate the safety and therapeutic utility of upper endoscopy in this category of patients. We performed upper endoscopy in STEMI patients with postthrombolytic UGB during a period of 4 years (1st of Jan 2008 - 31st of Dec 2011). Patients with systolic blood pressure (SBP) &lt;100 mmHg, with Killip class&gt;1, with unstable ECG and/or with severe associated conditions (respiratory distress, cerebrovascular stroke, consciousness disorders) were withdrawn from undergoing upper endoscopy, as well as patients who refused the investigation. During studied period, 618 STEMI patients underwent pharmacological coronary reperfusion. Postthrombolysis UGB occurred in 42 of them (6.79%). We could perform upper endoscopy in 30 patients (71.43%), the rest of 12 (28.57%) being withdrawn from endoscopy (6 patients with Killip class&gt;1, 4 patients with systolic blood pressure&lt;100mmHg, 2 patients refused the investigation). Incriminated haemorrhagic lesions were: erosive gastroduodenitis in 20 cases (66.67%) and duodenal ulcer in 10 cases (33.33%). As about therapeutic utility, amongst 30 patients investigated just 4 needed endoscopic treatment (haemoclips used in Forrest IB patients with duodenal ulcers). Endoscopy was a safe investigation in STEMI patients with postthrombolysis UGB. Erosive gastroduodenitis was incriminated as the source of bleeding in most of the cases. As it concerns the therapeutic utility of UE in STEMI patients with UGB, 13.33% of bleeding patients benefited from endoscopic treatment (mechanical haemmostasis). </jats:p