Carbamazepine-induced DRESS syndrome: a case report

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening, idiosyncratic, acute adverse drug reaction. Fever, morbilliform cutaneous eruption, and eosinophilia are essential features for the diagnosis of this syndrome, along with significant multisystem involvement, hepatitis being the most common, followed by nephritis. The pathogenesis of DRESS syndrome is not yet fully understood. Several hypotheses have been proposed which support the involvement of an intricate interplay of multiple factors. We report a clinical case of DRESS syndrome with renal injury, induced by carbamazepine, in a patient with alcohol abstinence syndrome. In order to define the case, the RegiSCAR score and the Japanese Group score, used in the diagnosis of drug-induced hypersensitivity, were applied. DRESS syndrome is a potentially fatal disease, with a mortality that can reach up to 40% of cases. This condition endangers the patient\u27s life by affecting the internal organs, mainly the liver, kidneys, heart, and lungs. Our case attempts to increase awareness among physicians about this serious disease and the importance of early diagnosis, especially since carbamazepine is a commonly used anticonvulsant drug

Neuroendocrine carcinoma of the breast: a case report

Neuroendocrine breast carcinomas represent a rare subtype of breast cancer. Their definition, prevalence and prognosis remain controversial in the literature. Regarding the presentation, there are no differences from other breast carcinomas and clinical syndromes related to hormone production are extremely rare. Refinement of the classification of neuroendocrine neoplasms of the breast is needed in order to improve the reproducibility of their diagnostic criteria and to define their clinical significance. This article presents the case of a 44-year-old female patient diagnosed with invasive breast carcinoma with neuroendocrine features, according to the 2012 World Health Organization (WHO) definition, with focus on presentation, clinical manifestations, diagnostic approach and differential diagnosis

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

Impact of the Defining Criteria and Components of Metabolic Syndrome on Arterial Stiffness Parameters

Background: Metabolic syndrome is associated with an increase in cardiovascular morbidity and mortality. Since the first description of MS, several definitions have been elaborated (IDF, AHA, Who, NCEP). Arterial stiffness is a strong independent predictor of cardiovascular events and cardiovascular mortality in various groups of patients. Aim: The purpose of present study was to investigate the impact of the different definitions of MS on arterial stiffness. Material and Methods: we investigated 214 patients, mean age 60.04±9.98 years. Arterial stiffness was evaluated using TensioMed TM Arteriograph. Results: Using the three definitions of the metabolic syndrome – IDF 2005, AHA, NCEP -, a proportion of 71.5% (153 patients), 72.9% (156 patients) and 62.1% (133 patients), respectively, had metabolic syndrome. Pulse wave velocity in the group of patients with metabolic syndrome was increased compared to those without metabolic syndrome, but the difference was not statistically significant (IDF - 10.37±2.13m/sec vs 10.04±2.21m/sec, AHA 10.40±2.14m/sec vs 9.93±2.19m/sec, NCEP 10.47±1.86m/sec vs 9.95±2.55m/sec). A statistically significant difference between pulse wave velocity in men with metabolic syndrome compared to those without metabolic syndrome was found, the relationship being not true in women. Conclusion: Patients with MS (especially men) have increased arterial stiffness parameters than those without metabolic syndrome. All the three definitions used have the same ability to identify patients with arterial stiffness. Arterial stiffness parameters are more altered as the number of criteria for the definition of metabolic syndrome increases, regardless of the definition used

The profile of cardiovascular risk factors in heart failure obese patients hospitalised in a rehabilitation romanian hospital

Despite all advanced evidence-based therapeutic opportunities, heart failure remains a major public health burden, with a dramatically increasing in prevalence. Moreover, the diagnosis of chronic heart failure in obese patients brings unique challenges. So, the aim of this study was to identify the cardiovascular risk factors profile in heart failure obese patients, admitted in rehabilitation programs. Material and methods. This study enrolled 80 obese (body mass index ≥30 kg/m2) patients, 56.2% men with average age ranged of 69.75 ± 9.12 years who were hospitalized for decompensated heart failure in the Rehabilitation Hospital, Cardiology-Department, Cluj-Napoca, Romania. Baseline characteristics, clinical presentation, NT-proBNP values, echocardiographic parameters and in-hospital therapies were evaluated. The lot was divided into three groups: obese heart failure patients with reduced (<40%), preserved (≥50%), and mid-range (40-49%) ejection fraction. Heart failure was defined according to 2016 ESC criteria. NT-pro-BNP values higher than 125 pg/ml were considered to be associated with heart failure development. Statistics were performed using SPSS 16.0 for Windows. Results. The mean age of the analyzed study population was 69.75 ± 9.12 years and 56.2% were men. The most frequent associated risk factor was smoking (45%), followed by diabetes mellitus (40%) and hypertension (25%). The mean ejection fraction value was 43.58±10.85% and the median value was 45%. The mean NT-pro-BNP registered levels were 2887.03±3157 pg/ml. An inverse relationship was found between NT-pro-BNP levels and plasma lipid fractions, total-cholesterol-r=-0.194, LDL-cholesterol-r=-0.0971, triglycerides-r=-0.155, HDL-cholesterol-r=-0.07. Also, NT-proBNP negatively correlated with left ventricular ejection fraction-r=-0.307, p=0.0086. In conclusion, obese heart failure patients presented particular characteristics, the most frequent observed cardiovascular risk factors were smoking, diabetes mellitus and arterial hypertension. Identifying the major comorbidities in this subgroup of patients is of major importance, especially for improving heart failure's prognosis and survival

The Role of IL-6 and ET-1 in the Diagnosis of Coronary MicroVascular Disease in Women

Background: Microvascular angina is a common clinical entity, with about a three-fold higher frequency in women. The pathogenesis of microvascular angina has not been much studied, but inflammation and endothelial dysfunction have been incriminated as the main mechanisms of this disease. Methoss: Our purpose was to analyze whether certain inflammatory markers, i.e., interleukin 6 (IL-6) and endothelin 1 (ET-1), can play a role in the diagnosis of microvascular angina in women. Results: Ninety women with ischemic heart disease were divided into two groups, based on their affliction with either microvascular or macrovascular disease. In general, the levels of IL6 and ET1 were similar between the two groups. Analyzing these marker levels according to the number of coronary lesions, we obtained an increased IL6 value that was similar for patients with microvascular angina, one-vessel, and two-vessel coronary disease, but significantly lower than in women with three-vessel coronary lesions. Also, in microvascular angina, IL6 level was correlated with the NYHA IV functional class. Unexpectedly, the level of ET1 was correlated with left ventricular systolic dysfunction. Conclusions: In women with an increased suspicion of microvascular angina, in whom microvascular dysfunction cannot be tested invasively, IL-6 level, unlike the ET-1 level, might be considered a diagnostic marker of this disease

DNA Methylation and Micro-RNAs: The Most Recent and Relevant Biomarkers in the Early Diagnosis of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a frequently encountered cancer type, and its alarming incidence is explained by genetic and epigenetic alterations. Epigenetic changes may represent diagnostic and prognostic biomarkers of HCC. In this review we discussed deoxyribonucleic acid (DNA) hypomethylation, DNA hypermethylation, and aberrant expression of small non-coding ribonucleic acid (RNA), which could be useful new biomarkers in the early diagnosis of HCC. We selected the articles on human subjects published in English over the past two years involving diagnostic markers detected in body fluids, cancer diagnosis made on histopathological exam, and a control group of those with benign liver disease or without liver disease. These biomarkers need further investigation in clinical trials to develop clinical applications for early diagnosis and management of HCC

Cardiac Changes in Overweight and Obese Patients

Background. Obesity and overweight are two pathologies that are more and more frequent in the XXIst century diagnosis and are causing high morbidity and mortality rates in the general population, especially through cardiovascular complications

Particularities of Catheter Ablation in Women with Atrial Fibrillation and Associated Ischemic Heart Disease

Background: Atrial fibrillation is more common in men, but in the presence of ischemic heart disease, this arrhythmia is more frequent in women. However, like in coronary heart disease, women with atrial fibrillation are suboptimally treated. Methods: To identify particularities of ablation, in women with atrial fibrillation and ischemic heart disease. Results: 29 women and 26 men, with documented ischemic heart disease and atrial fibrillation, who underwent catheter ablation, were admitted in the study. No significant differences were registered regarding the heart rate control treatment. Electrical cardioversion was significantly higher in men, while pharmacological cardioversion was predominantly recommended in women. The ablation was performed later in women, after 2.55 &plusmn; 1.84 years versus 1.80 &plusmn; 1.05 in men (p = 0.05). The time elapsed until the ablation was performed was statistically correlated with atypical symptomatology and with the number of antiarrhythmics used prior to the ablation. There were no significant differences for the relapse of atrial fibrillation at 3 months. Quality of life at 3 months after ablation was increased in both groups. Conclusion: Catheter ablation is performed much later in women, and the causes responsible for this delay would be more atypical symptoms and a greater number of antiarrhythmics tried before the ablation