Extragastric manifestations of Helicobacter Pylori infection in Romanian population

"luliu Hatieganu” University of Medicine and Pharmacy, Otorhinolaryngology Department, Cluj-Napoca, RomaniaIntroduction: Helicobacter pylori (H. pylori) is one of the most frequent causes of gastrointestinal infections worldwide. It is known that the immunological response evoked by the bacterium is an important determinant of gastric mucosal damage. Epidemiological studies have investigated H. Pylori as a pathogenic determinant of some extragastric disorders due tolow-grade inflammatory state, molecular mimicry mechanisms, interference with the absorbance of nutrients and drugs possibly influencing the occurrence or the evolution of many diseases. The main burden of infection is in the developing countries possibly reflecting the presence of geographical variability in the prevalence of both H. pylori infection and the considered extradigestive disorders. Purpose and objectives: The aim of this study is to determine the prevalence of systemic hypertension (HTA), ischemic cardiomyopathy (IC), dyslipidemia, type 2 diabetes mellitus (T2DM) and chronic obstructive pulmonary disease (COPD) in a series of patients with Helicobacter Pylori infection and explore the possible etiopathogenetic link between them. Materials and method: A total of 100 participants were divided into two groups according to the presence (n=45) or absence (n=55) of Helicobacter Pylori infection. The detection of bacteria was assessed by upper endoscopic gastric biopsies. The presence of HTA, IC, dyslipidemia, T2DM and COPD were investigated in the medical history of both groups. Results: One hundred patients (47 men, 53 women), aged 30-85 years (the mean 58.1) were included; 55% of patients were positive for H. pylori infection. Twenty-two (51%) of patients with H. Pylori infection presented HTA, compared to 24 (42%) subjects of H. Pylori negative, without semnificative difference between the two groups. (p=0.65). The presence of IC was significantly higher (46%) in H. Pylori positive group than (25%) of the group without infection (p=0.003). Nineteen patients (34%) H. pylori positive had T2DM, while 10 patients (23%) were found in the H. Pylori negative group, the difference being statistically insignificant (p=0.58). The most frequent extragastric manifestation for patients infected with H. Pylori was dyslipidemia (29.7%). The patients with H. Pylori had significantly higher levels of dyslipidemia (62%) compared with the non-infected group (25%) (p=0.002). Sixteen (25%) cases of COPD were found in H. Pylori positive group and 10 (26%) in the H. Pylori negative group without reaching statistically significant levels (p=0.71). Conclusion: The association between H. pylori infection and ischemic cardiomyopathy and dyslipidemia was revealed in this study. Although some authors found convincing evidence of the involvement of Helicobacter pylori as one possible cause of systemic hypertension, type 2 diabetes mellitus and chronic obstructive pulmonary disease, our results have failed to confirm the existence of this etiological association. Hence, the precise processes remain unclear and require further studies

Duodenal carcinoid tumour – a case report

Duodenal carcinoids are rare tumours of the small intestine with heterogenous clinical and pathological characteristics. The long-term prognosis is very good if discovered in the early stages. We present the case of a patient with a non-functional duodenal carcinoid tumour discovered incidentally during an upper gastrointestinal endoscopy. The diagnosis was confirmed through immunohistochemistry. Treatment consisted of the endoscopic resection of the tumour and the surveillance of the patient for the following 2 years, with no signs of recurrence. We have conducted a literature review regarding the clinical manifestations, diagnosis, treatment, and follow-up of patients with this type of tumours

Nanoparticles in the treatment of chronic lung diseases

Nanoparticles, although considered a topic of modern medicine, actually have an interesting history. Currently, advances in nanomedicine hold great promise as drug carrier systems for sustained release and targeted delivery of diverse therapeutic agents. Nanoparticles can be defined as complex drug carrier systems which incorporate and protect a certain drug or particle. Nanoparticles can be administered via different routes, such as intravenous injection, oral administration, or pulmonary inhalation. Even though the use of nano-carriers via pulmonary inhalation is heavily debated, this system represents an attractive alternative to the intravenous or oral routes, due to the unique anatomical and physiological features of the lungs and the minimal interactions between the targeted site and other organs. Some of the widely used nano-carriers for the treatment of chronic pulmonary diseases, via pulmonary route, are as follows: polymeric nanoparticles, liposomal nano-carriers, solid lipid nanoparticles, and submicron emulsions. Nano-carrier systems provide the advantage of sustained-drug release in the lung tissue resulting in reduced dosing frequency and improved patient compliance. Further studies focusing on understanding the mechanisms of action of nanoparticles and improving their chemical structure are required in order to better understand the potential long-term risk of excipient toxicity and nanoscale carriers

Duodenal carcinoid tumour – a case report

Duodenal carcinoids are rare tumours of the small intestine with heterogenous clinical and pathological characteristics. The long-term prognosis is very good if discovered in the early stages. We present the case of a patient with a non-functional duodenal carcinoid tumour discovered incidentally during an upper gastrointestinal endoscopy. The diagnosis was confirmed through immunohistochemistry. Treatment consisted of the endoscopic resection of the tumour and the surveillance of the patient for the following 2 years, with no signs of recurrence. We have conducted a literature review regarding the clinical manifestations, diagnosis, treatment, and follow-up of patients with this type of tumours

Rehabilitation therapies in stable chronic obstructive pulmonary disease

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease. The pulmonary rehabilitation (PR) is a mutidisciplinary and comprehensive intervention in symptomatic patients with COPD. Objective. This review aims to synthesize evidence from available studies on the relative efficacies of different methods of rehabilitation therapies in patients with stable COPD. Material and Methods. A search was performed on the databases Pubmed, Embase, ResearchGate. Of the 410 articles retrieved from databases, only 20 met the inclusion criteria. Two reviewers independently reviewed selected eligible studies. Results. Rehabilitation is a multidisciplinary intervention in symptomatic patients with COPD, including speleotherapy, halotherapy, muscular training, soft tissue manual therapy and neuromuscular electrostimulation. All of the case-control studies using speleotherapy reported improved respiratory function to varying degrees and there were improvements in lung functional tests including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1), oxygen saturation, partial pressure of oxygen in arterial blood, and partial pressure of carbon dioxide in arterial blood. In addition, halotherapy has been associated with relief of respiratory conditions such as COPD, asthma and cystic fibrosis by its bactericidal effect, improvement of immunity and rheological properties of secretions. Respiratory muscle training is a part of rehabilitation for COPD subjects. In patients who can not perform physical activity, neuromuscular electrostimulation (NMES) increased 6 minute walking distance and time to symptom limitation exercising at a submaximal intensity and reduced the severity of leg fatigue on completion of exercise testing. Conclusion. The management of COPD should include a multidisciplinary therapy, including rehabilitation therapies as an adjuvant to the medical treatment, especially because due to the high prevalence, mortality, and morbidity, COPD will be one of the biggest public health challenges in the next century

Renal damage induced by non-steroidal anti-inflammatory drug treatment

Non-steroidal anti-inflammatory drugs (NSAIDs) are extensively used worldwide due to their analgesic, antipyretic and antiinflammatory effects. NSAIDs (both non-selective NSAIDs and selective cyclooxygenase-2 inhibitors) have nephrotoxic potential, particularly when used chronically.The principal mechanism of action of NSAIDs is cyclooxygenase inhibition, which prevents the conversion of arachidonic acid to prostaglandins, prostacyclins and thromboxanes. In the kidney, prostaglandins induce vasodilation and counter the action of the renin-angiotensin-aldosterone system and the sympathetic nervous system, ensuring optimal renal perfusion. Inhibition of this mechanism by NSAIDs can result in renal damage: acute kidney injury through hemodynamic mechanism, acute interstitial nephritis, glomerular disease, papillary necrosis, water and electrolyte imbalances, HTN. Chronic NSAID use may lead to chronic kidney disease.The nephrotoxic effect is reduced in young patients without renal disease or other comorbidities, but increases significantly in elderly patients with pre-existing kidney disease, nephrotic syndrome, diabetes mellitus, severe congestive heart failure, volume depletion, cirrhosis with ascites, HTN, atherosclerosis, or in patients under treatment with diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor inhibitors

Metachronous mucinous breast carcinoma and mucinous pancreatic cystadenoma in a patient with metabolic comorbidities; case report and a literature review

Mucinous breast carcinoma is a rare subtype of mammary neoplasm encountered in medical practice. It represents approximately 1-6% of all breast cancers and is more common in postmenopausal women. There are two subtypes of mucinous breast carcinoma: pure and mixed. We report the case of a 73-year-old Caucasian woman diagnosed with mucinous pancreatic cystadenoma in 2007. She underwent a surgical procedure involving pancreatectomy of the body and tail, along with multiple known cardiovascular and metabolic comorbidities. In November 2019, during a clinical-biological evaluation for associated diseases, a mucinous carcinoma of the right breast was accidentally detected and later confirmed through further investigations. For treatment, a surgical procedure was performed involving lower right quadrantectomy with right axillary lymph node dissection. The postoperative clinical course was favorable. In conclusion, we present the case of a patient diagnosed with mixed mucinous breast carcinoma, without axillary lymph node invasion. Postmenopausal women with diabetes, overweight, and obesity have an increased susceptibility to breast cancer, with our patient having all these risk factors. To date, no study has demonstrated the genetic or radiation implication in the occurrence of mucinous carcinomas, nor the possible development of mucinous carcinomas in series in the same patient. Yet, current data are insufficient to provide recommendations for the screening of malignant mucinous tumors in subjects with significant cardiometabolic risk factors

The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature

The second-generation of direct-acting antiviral agents are the current treatment for chronic viral hepatitis C infection. To evaluate the regression of liver fibrosis in patients receiving this therapy, liver biopsy remains the most accurate method, but the invasiveness of this procedure is its major drawback. Different non-invasive tests have been used to study changes in the stage of liver fibrosis in patients with chronic viral hepatitis treated with the second-generation of direct-acting antiviral agents: liver stiffness measurements (with transient elastography or acoustic radiation force impulse elastography) or different scores that use serum markers to calculate a fibrosis score. We prepared a literature review of the available data regarding the long-term evolution of liver fibrosis after the treatment with direct-acting antiviral agents for chronic viral hepatitis C

Composition and modification of the lung microbiome in patients with idiopathic pulmonary fibrosis

Lungs have long been considered sterile, but recent research has shown that a large number of microbiological organisms exist in the lungs of healthy subjects (including bacteria, fungi, and viruses), collectively known as the microbiome. It undergoes changes in patients with respiratory pathology. Studies in idiopathic pulmonary fibrosis show that a large number of bacteria or the abundant presence of potentially pathogenic bacteria can cause disease progression and exacerbation, and can implicitly increase mortality. There seems to be a quantitative balance, a well-established proportion between the components of this microbiome, which is disturbed during a disease and can reach a state of pulmonary dysbiosis . Evidence suggests that the microbiome may be used as a prognostic biomarker and may also explain the pathogenesis of interstitial fibrosis

Smoking during pregnancy; an epidemiologic study of knowledge and behavior in Caucasian women

Introduction. Although it is an easily avoidable lifestyle, tobacco use during pregnancy is an important chronic health care problem, potentially leading to severe pregnancy complications for both mother and infant. Objectives. The purpose of this study was to evaluate the level of knowledge regarding the effects of tobacco smoking during pregnancy. Methods. An online self-report questionnaire was administered using social networks and websites to women who were pregnant or who had recently given birth. Results. 1357 women were eligible to be included in the study. 919 women smoked during their pregnancy, 105 smoked but stopped before pregnancy (former smoker) and 333 never smoked cigarettes in their life. Comorbidities were found in 11.4% of active smokers group, 10.5 % (p=0.758) in the former smokers’ group and 8.1% (p=0.224) in the never smokers’ group. In addition, 33.8% of active smokers, 42.9% among former smokers and 31.5 % of never smokers had a good knowledge about smoking effects. Unfortunately, about 67% of them continued to smoke, even though they knew that nicotine passes into breast milk. The other women reduced the number of cigarettes or even quit smoking, usually with the encouragement and support of close people. Conclusions. Both passive and active smoking during pregnancy is a serious health problem that must be addressed through rigorous health programs, which must include (but not necessarily be limited to) behavioral therapy