A Cross Sectional Study on the Effect of Stress and Academic Stressors Among International Medical Students of a Romanian University

Medical students are exposed to increased stress due to academic, psycho-social and health-related factors. This study aimed to assess the levels of stress and the associations with socio-demographic characteristics and academic performance; the frequency of the major academic stressors; the most stressful factors as stated by the students themselves. A cross-sectional study including 110 international medical students of the 3rd-year was performed in the first two weeks of November 2019. A questionnaire including socio-demographic data, a list with potential academic stressors and an open question regarding the greatest stressors in student’s opinion as well as The Kessler Psychological Distress Scale, was administrated in pen-andpaper format. Mild, moderate and severe levels of stress were found in 36.73%, 22.44 %, and 13.26 % of students, respectively. Increased levels of stress were associated with poor academic performance and did not correlate with age or country of origin. The frequency of moderate and severe stress was 3-times greater in women than in men. The most stressful factors in students’ opinion were the academic stressors (88.77%) followed by psychosocial factors (25.51%) and health-related factors (9.18%). The frequency of examination was perceived as a stressor always present by more than 25% of the students. Most of the students showed elevated levels of stress. Academic factors were the most important stressors in students’ opinion. Further research is needed to identify the proper strategy to rectify academicrelated problems to decrease the levels of stress

Thrombophilia in Pregnancy

Pregnancy represents a physiologic hypercoagulable state. The presence of inherited thrombophilias (factor V Leiden, prothrombin G20210A mutation, deficiencies of protein C, protein S and antithrombin) or acquired thrombophilias (antiphospholipid syndrome) increases the risk for venous thromboembolism, which represents one of the most common causes of direct maternal death. The clinical diagnosis of thrombosis can be difficult because of the overlap of symptoms with pregnancy-related manifestations. Antiphospholipid syndrome is correlated with early and late pregnancy complications whereas the association between the inherited thrombophilias and adverse pregnancy outcomes is still controversial. The psychological impact of thrombophilia in pregnancy should be also taken into consideration to prevent the negative effects of anxiety and stress on mother’s health and on birth outcomes. Thrombophilia testing in pregnancy is recommended only in cases in which the result is likely to influence the therapeutic decision. Low-molecular-weight heparins are the preferred anticoagulant for prophylaxis and therapy of thromboembolic events in pregnancy, presenting a low incidence of side effects. Future research is required to establish the optimal therapeutic strategy in pregnant women with thrombophilia, based upon a better stratification, in order to prevent thromboembolism and to improve pregnancy outcomes

Methylenetetrahydrofolate reductase gene polymorphisms in cardiometabolic diseases

Although there is growing evidence that C677T polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene could be considered a risk factor for cardiometabolic diseases associated with elevated levels of homocysteine, the clinical impact and efficiency of therapy remain a matter of debate. The role of A1298C polymorphism of MTHFR in these diseases is still not clearly defined. Most of the studies have shown the correlations between homozygosity for the T677 allele of the MTHFR gene and homocysteine-related cardiometabolic diseases including the metabolic syndrome, diabetes mellitus, ischemic cardiopathy, stroke, and venous thromboembolism. The proposed pathological mechanism of hyperhomocysteinemia involves prothrombotic effects and endothelial dysfunction. Therapy with vitamins B may decrease the homocysteine level in cases with C677T polymorphism whereas the reducing effect on cardiovascular events is not significant.Biomedical Reviews 2008; 19: 49-52

The Importance of Homozygous Polymorphisms of Methylenetetrahydrofolate Reductase Gene in Romanian Patients with Idiopathic Venous Thromboembolism

Background: Methylenetetrahydrofolate reductase (MTHFR) polymorphisms have recently raised the interest as a possible thrombophilic factors. Aims: We aimed to assess the frequency of the methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms in idiopathic venous thromboembolism (VTE) in a Romanian population and the associated risk of VTE. Study Design: We performed a case-control transversal study including 90 patients diagnosed with VTE and 75 sex- and age-matched controls. Methods: MTHFR C677T and A1298C polymorphisms were detected using PCR-RFLP method. Results: The homozygous MTHFR 677TT genotype, present in 18.8% of patients with VTE versus 6.6% of controls, was significantly associated with VTE (p= 0.021, OR= 3.26, 95%CI (1.141-9.313)). The heterozygous MTHFR A1298C genotype, presenting the highest prevalence in the VTE group (34.4%) as well as in controls (37.3%), was not associated with VTE (p=0.7). No associations were found for heterozygous MTHFR C677T (with a frequency of 32.2% in VTE and 37.3% in controls, p=0.492), respective homozygous MTHFR A1298C genotype (with a frequency of 1.1% in VTE and 2.6% in controls, p=0.456). Conclusion: Among MTHFR polymorphisms, only homozygosity for MTHFR 677TT may be considered a risk factor for VTE; the MTHFR A1298C polymorphism is not significantly associated with an increased risk of VTE

Genetic determination of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. According to the Rome III criteria, IBS is defined as recurrent abdominal pain or discomfort for at least 3 d per month during the previous 3 mo associated with two or more of the following symptoms: improvement with defecation, onset associated with a change in the frequency of stool and/or onset associated with a change in form or appearance of stool. There is growing evidence regarding the genetic contribution in IBS, however the precise etiology of IBS is still unknown. The evaluation of the genetic influence is based on twin studies, familial aggregation and genetic epidemiological investigations. Most studies showed a concordance for IBS significantly greater in monozygotic than in dizygotic twins. The majority of the studies have shown that familial aggregation may represent exposures to a similar environment, as well as the influence of genetic factors. Whereas no specific gene has been identified in association with IBS, recent studies have noticed the importance of polymorphisms in the promoter region of the serotonin reuptake transporter gene, G-protein beta 3 subunit gene (C825T), cholecystokinin receptor (CCKAR gene 779T>C), and high-producer tumor necrosis factor genotype. Further studies are necessary to determine how genetic factors influence the clinical manifestations and therapeutical response in IBS patients