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

Non-dental oral cavity findings in gastroesophageal reflux disease: a systematic review and meta-analysis

Gastroesophageal reflux disease (GERD) is known as the most prevalent gastrointestinal disorder in the United States, leading to substantial morbidity, although associated mortality is rare. Based on the appearance of esophageal mucosa on upper endoscopy, GERD is divided into erosive esophagitis (ERD) and nonerosive reflux disease (NERD). Heartburn and acid regurgitation are the typical symptoms of the disease, although some patients may present atypical manifestations such as epigastric pain, nausea, asthma, chronic cough, pharyngitis, laryngitis, sleep disturbances, otitis, and sinusitis. Other signs, such as oral mucosal lesions may result from GERD by direct acid or acidic vapor contact in the oral cavity. Oral manifestations such as tooth erosion, periodontitis, gingivitis, palatal erythema, ulceration, glossitis, oral acid burning sensation, halitosis, xerostomia have recently been reported in GERD patients. A considerable percentage of the patients are affected by oral manifestations before the onset of gastrointestinal symptoms, although in most cases the gastrointestinal signs and symptoms dominate the clinical picture. The injured oral mucosa negatively impacts the quality of life, especially functional limitation, physical inability and psychological disabilities, thus leading to social isolation. There is plenty of non-standardized information on the oral mucosal changes in GERD. In this context, we aimed at synthesizing and analyzing the current available evidence on non-dental oral cavity lesions and complaints that are present in patients diagnosed with GERD

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

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

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

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

Non-cardiometabolic comorbidities of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) comprises a spectrum of disorders which affect the liver, but were proven to have implications in many other organs and systems. It is now widely accepted that NAFLD has many comorbidities, mainly metabolic and cardio-vascular. Even if much comorbidity are well-explained, there are many other diseases associated with NAFLD in which the pathophysiological pathways are not completely understood. Research is conducted nowadays with the goal of completely elucidate the pathogenesis of NAFLD and its comorbidities, in order to eventually find a targeted cure for this "epidemic" liver disease. The purpose of this review is to present the non-cardiometabolic comorbidities of NAFLD, by using epidemiological and, physiopathological data, and to bring updated information on their treatment

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

Chronic Inflammation—A Link between Nonalcoholic Fatty Liver Disease (NAFLD) and Dysfunctional Adipose Tissue

Nonalcoholic fatty liver disease (NAFLD) is a new challenge in modern medicine, due to its high prevalence in the world. The pathogenesis of NAFLD is a complex dysmetabolic process, following the “multiple-hit” hypothesis that involves hepatocytes excessive accumulation of triglycerides, insulin resistance (IR), increased oxidative stress, chronic low-grade inflammatory response and lipotoxicity. In this review, we provide an overview of the interrelation of these processes, the link between systemic and local inflammation and the role of dysfunctional adipose tissue (AT) in the NAFLD development. Multiple extrahepatic triggers of the pathophysiological mechanisms of NAFLD are described: nutritional deficiency or malnutrition, unhealthy food intake, the dysfunction of the liver–gut axis, the involvement of the mesenteric adipose tissue, the role of adipokines such as adiponectin, of food intake hormone, the leptin and leptin resistance (LR) and adipose tissue’s hormone, the resistin. In addition, a wide range of intrahepatic players are involved: oxidative stress, fatty acid oxidation, endoplasmic reticulum stress, mitochondrial dysfunction, resident macrophages (Kupffer cells), neutrophils, dendritic cells (DCs), B and T lymphocytes contributing to the potential evolution of NAFLD to nonalcoholic steatohepatitis (NASH). This interdependent approach to complex dysmetabolic imbalance in NAFLD, integrating relevant studies, could contribute to a better clarification of pathogenesis and consequently the development of new personalized treatments, targeting de novo lipogenesis, chronic inflammation and fibrosis. Further studies are needed to focus not only on treatment, but also on prevention strategy in NAFLD