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

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

Effects of carbonated natural mineral water baths and mofettes on peripheral arterial flow in rats

(1) Introduction. Disorders of peripheral blood circulation affect people all around the world. Balneotherapy, in the form of carbonated mineral water baths and mofettes, could be considered one of the treatment options. The current study aims to investigate, in an experimental study, the effects of carbonated natural mineral water, with a known composition, and natural mofettes from Băile Tușnad (Romania) on peripheral arterial blood flow. (2) Material and method. A total of 16 rat subjects were studied, divided equally into 4 groups, all evaluated at 2, 4 and 6 weeks after the intervention. Group 1 was considered the control-group, and no treatment was applied. Group 2 was taken to the mofettes daily, for 2 weeks, for exposure to carbon dioxide, dry gas, for 20 minutes/day. Group 3 performed daily mofettes and baths with carbonated mineral water, for two weeks, 20 minutes/day, each procedure. Group 4 took a daily bath with carbonated mineral water, for 2 weeks, 20 min/day. At the end of the two-week treatment, they were evaluated by doppler ultrasound at the femoral artery, respectively at 2 and 4 weeks, to evaluate the effect over time of these treatments. Femoral artery diameter (mm), peak systolic velocity (PVS, cm/s), heart rate (HR, bpm) were quantitatively determined in all 4 groups, at 2, 4 and 6 weeks respectively, and ultrasound images were captured. (3) Results and discussions. In the control group, there were no differences at 2 weeks vs. 4 weeks vs. 6 weeks regardless of the studied parameter. The diameter of the femoral artery increased significantly in group 3 (mofetta and carbonated mineral water, p=0.0183), respectively in group 4 (mineral water p=0.007). Heart rate changed significantly p=0.0183 in the mofette group, as well as in the one treated with carbonated mineral water p= 0.024. The results of the study suggest that carbonated mineral water and mofettes were responsible for the changes in femoral artery flow, compared to the data from the control group. (4) Conclusions. Carbonated mineral water baths and mofettes could increase the peripheral arterial blood flow, during repeated immersion, and the results were beneficial 2 weeks after the end of the treatment, and were maintained after treatment at 4 and 6 weeks, respectivel

Matrix Gla Protein – a new marker for colorectal cancer detection? A systematic review

Background. Colorectal cancer is a real public health issue, with high morbidity and severe impact on quality of life. Although mortality from this type of cancer is decreasing due to modern diagnostic and treatment methods, the understanding of its genetic and molecular mechanisms is important to develop a broader range of diagnostic and therapeutic approaches. Genetic therapy is an important strategy in cancer treatment, and the matrix Gla protein (MGP) gene expression has been described in numerous studies as increased in tumour pathology. In this article, we have summarized the currently available evidence on the connection between MGP and colorectal cancer. Materials and Methods. Following the PRISMA guidelines, we have searched the PubMed, ProQuest and ScienceDirect databases for relevant published works that studied the connection between colorectal cancer and MGP gene expression. Results. Three relevant works were included in this systematic review. Two of these studies have observed MGP gene overexpression in tumour cells, a result that contradicts the third study, where the MGP gene was underexpressed. Conclusions. The data provided by these articles is contradictory, and therefore more studies are needed on larger sets of subjects, to fully understand the connection between MGP and colorectal cancer. Materials and methods: Following the PRISMA guidelines, we have searched the PubMed, ProQuest and ScienceDirect databases for relevant published works that studied the connection between colorectal cancer and MGP gene expression. Results: Three relevant works were included in this systematic review. Two of these studies have observed MGP gene overexpression in tumour cells, a result that contradicts the third study, where the MGP gene was underexpressed. Conclusions: The data provided by these articles is contradictory, and therefore more studies are needed on larger sets of subjects, to fully understand the connection between MGP and colorectal cancer

Ethical aspects of smoking cessation among the population from Transylvania

Ethical aspects related to the approach of persons addicted to tobacco use are a particular concern of pneumologists. Considered for a long time ”an expression of the modern way of life”, smoking is viewed today as a pandemic disease, being at the same time an epidemic that can be completely prevented. We present the ethical aspects of the approach of persons addicted to tobacco use, the peculiarities of the medical approach in smoking cessation and implicitly, of the doctor-patient relationship and how to make patients responsible for their own health within this relationship. The final aim of the medical intervention was to restore patient’s autonomy in making decisions regarding smoking cessation, along with a change in lifestyle. In changing the patients’ attitude, the principles of autonomy and non-maleficence represented a strong motivation, the patients benefiting from the presence and implementation of a National Smoking Cessation Progra

The effect of mofettes and natural carbonated mineral water on accelerating bone healing in a femoral defect model in rats

(1) Background: The aim of the study was to investigate the effecs of mofettes and carbonated mineral water baths on bone healing using a rat femoral defect model; (2) Methods: A 2mm diameter unicortical defect in the left femoral diaphysis in 40 Wistar Rats was surgically creat-ed. Furthermore, the subjects were divided into 4 treatment-groups: control, mofette therapy, mofette therapy and carbonated mineral water bath, and carbonated mineral water bath. At the end of the 2-week treatment and at 4 and 6 weeks, the animals were evaluated through Mi-cro-CT analysis of the bone defect and histological analysis of bone tissue and skin; (3) Results: The processes of bone consolidation and repair are not completed at 6 weeks in all groups. However, comparing the proliferated bone tissue in the created orifice and the degree of thick-ening of the femoral wall, it can be affirmed that at 6 weeks, the best results are present in Group 4, treated with carbonated mineral water baths, followed by the combination of mofettes and carbonated water. (4) The use of these treatments could open a new possibility for shorten-ing the healing time in patients with bone defects, as it is non-invasive and accessible

Age-related trends in colorectal cancer diagnosis: focus on evaluation of prehabilitation and rehabilitation programs

The increase in the prevalence of both colon and rectal cancer in recent years poses challenges for the medical system in terms of patient management and indirectly incurs significant finan-cial burdens. Purpose: The aim of this paper is to track the changes in the prevalance of the co-lon and rectal cancer at a tertiary clinic in Romania over time and to identify complementary methods to improve the prognosis and quality of life of cancer patients. Material and methods: We conducted an observational, longitudinal, population-based study, including all patients newly diagnosed with colon or rectal neoplasia within the time frame from 1 January 2013 to 1 January 2024 in a tertiary medical clinic in Romania. For each case included in the study, we gathered demographic data (age at the time of cancer diagnosis, gender, place of origin), loca-tion of the tumor, duration until surgical intervention, alternative treatment methods em-ployed (such as radiation or chemotherapy, and immunotherapy), and the length of survival. We also assess the feasiblity of physical prehabilitation and rehabilitation programs for inpa-tients diagnosed with malignant neoplasms of the colon or rectum. Results: The study found significant differences in patient ages and the execution of prehabilitation and rehabilitation practices between those admitted for colon and rectal cancer during the periods 2013-2018 and 2019-2023, with a notable shift in the prevalence of colon versus rectal cancer over these peri-ods. Conclusions: Prehabilitation and rehabilitation practices for colorectal cancer patients are underdocumented or suboptimal, with recent improvements in documentation, especially for rectal cancer due to colostomy needs, and an observed increase in patient age due to COVID-19 pandemic protocols. Additional research and the development of standardized protocols are needed

The effect of carbonated mineral water and mofette treatment in Baile Tusnad after ischemic stroke – a case report

Carbon dioxide baths might represent an effective therapeutic method in the rehabilitation of coronary heart disease, myocardial infarction and stroke, as well as in the treatment of chronic venous insufficiency, inflammatory diseases and functional disorders. According to the World Health Organization, 5.5 million deaths from stroke were recorded in 2001, and about 15 million people survive stroke every year. Mortality from stroke is 11% for women and 8.4% for men. According to the European Association for Cardiovascular Prevention Rehabilitation, phase II and III cardiovascular rehabilitation is performed in Romania only in a proportion of 10%. The therapeutic effects of carbonated mineral waters are due to the action of carbon dioxide. This induces cutaneous vasodilation, with a decrease in blood pressure values. It also causes an increase of cardiac output, while reducing blood pressure and heart rate. Mofettes are natural emanations along the Harghita volcanic massif, which contain CO2 in concentrations of 90-98% with cutaneous vasodilator effects, increasing cerebral and muscle blood flow. The natural therapeutic factors in Baile Tusnad, consisting of carbonated mineral water baths, mofettes, climate therapy, along with medical physical culture, indicated in the rehabilitation treatment of post-stroke patients had a beneficial effect on clinical and functional symptomatology, improving the quality of gait and balance, functionality and exercise capacity in a patient who suffered stroke five years before and was followed up for three years, while she attended an annual medical rehabilitation program in Baile Tusnad. Continuing medical rehabilitation programs, in the absence of contraindications, in Romanian spa resorts for cardiovascular treatment, as well as conducting randomized clinical studies on the efficiency of these treatments is important

The effect of carbonated mineral water and mofette treatment in Baile Tusnad after ischemic stroke – a case report

Carbon dioxide baths might represent an effective therapeutic method in the rehabilitation of coronary heart disease, myocardial infarction and stroke, as well as in the treatment of chronic venous insufficiency, inflammatory diseases and functional disorders. According to the World Health Organization, 5.5 million deaths from stroke were recorded in 2001, and about 15 million people survive stroke every year. Mortality from stroke is 11% for women and 8.4% for men. According to the European Association for Cardiovascular Prevention  Rehabilitation, phase II and III cardiovascular rehabilitation is performed in Romania only in a proportion of 10%. The therapeutic effects of carbonated mineral waters are due to the action of carbon dioxide. This induces cutaneous vasodilation, with a decrease in blood pressure values. It also causes an increase of cardiac output, while reducing blood pressure and heart rate. Mofettes are natural emanations along the Harghita volcanic massif, which contain CO2 in concentrations of 90-98% with cutaneous vasodilator effects, increasing cerebral and muscle blood flow. The natural therapeutic factors in Baile Tusnad, consisting of carbonated mineral water baths, mofettes, climate therapy, along with medical physical culture, indicated in the rehabilitation treatment of post-stroke patients had a beneficial effect on clinical and functional symptomatology, improving the quality of gait and balance, functionality and exercise capacity in a patient who suffered stroke five years before and was followed up for three years, while she attended an annual medical rehabilitation program in Baile Tusnad. Continuing medical rehabilitation programs, in the absence of contraindications, in Romanian spa resorts for cardiovascular treatment, as well as conducting randomized clinical studies on the efficiency of these treatments is important

Diagnostic difficulties in chronic kidney disease – Is it or is it not Fabry disease?

Introduction. Renal impairment and neurological symptoms are common manifestations of Fabry disease. Although rare, Fabry disease should be taken into consideration when consulting a patient who presents with neurological and renal impairment, acroparesthesia and fatigue. The aim of this paper is to discuss the case of a female patient presenting with mild systemic symptoms and consequent renal impairment. Case report. The female patient, aged 64, presented for a painful ankle swelling, acroparesthesias, nycturia and fatigue. We diagnosed a gout attack, but found that she had biological signs of renal impairment, aggravated by the use of non-steroidian anti-inflammatory drugs. The search for an etiology of her renal failure proved difficult because she refused the kidney biopsy. The positivity of pANCA antibodies added another potential cause of kidney disease. The mild deficiency of alpha-galactosidase could not fully support the diagnosis of Fabry disease. Discussions and conclusions. In women, Fabry disease should be suspected even if the symptomatology is not typical and as severe as in men. It is difficult to diagnose the Fabry disease in a female patient with chronic kidney disease, because of its polymorphic manifestations and association with other comorbidities, in our case, pANCA vasculitis