Influence of GSTM1, GSTT1 and GSTP1 gene polymorphisms on the appearance of microalbuminuria in type 2 diabetes mellitus patients

[Section: Letter to the Editor] This work was funded by an internal research grant from The University of Medicine and Pharmacy from of Târgu Mures, number 649/14.01.2016

STUDIUL MODIFICĂRILOR RENALE DUPĂ ANESTEZIA GENERALĂ CU SEVOFLURAN, FLUX SCĂZUT

INTRODUCTION. Proteinuria is the most common laboratory manifestation of renal disease; in the absence of clinical symptoms, it consists of a urinary excretion of more than 150 mg/day of protein. Glomerular membrane damage, decreased tubular reabsorption or destruction of kidney tissue causes proteinuria. The presence of increased amounts of protein in the urine can be an important indicator of kidney dysfunction. Among the side effects of Sevoflurane, is mentioned the glomerular toxicity effect, as a result of the contact of Sevoflurane with CO2 absorbents, that give rise to toxic compounds: Compound A, B, C, D.  Experience in repeated exposure to Sevoflurane is little known, which is why the use of Sevoflurane in patients with renal disease, diabetes and hypertension is not restrictive. In this study we aimed to analyze changes in serum urea and creatinine, post anesthesia in relation to glomerular permeability modification for proteins. MATERIAL AND METHOD. We performed medium and long-term anesthesia, with low flow (2l / min) Sevoflurane, to a total of 155 patients of the Department of Anesthesiology, from the Mures County Hospital in the period 01.10.2009-01.11.2014. We collected demographic data, biological samples of serum and urine preoperatively, 24 and 72 hours postoperatively RESULTS By applying statistical analysis tests Graph Pad Prisma 6 for repetitive data from the 3 intervals, we get the following results: For serum creatinine by Anova table operatively to 24 and 72 hours postoperatively, we obtained a value P = 0.054 by Bartlett test, and a PINTRODUCERE. Proteinuria este cea mai comună manifestare de laborator a afectării  renale, în absența simptomelor clinice, ea constă în excreția  prin urină  a peste 150 mg/zi proteine. Lezarea membranei glomerulare, scăderea reasorbției tubulare sau distrucția țesutului renal determină apariția proteinuriei. Printre efectele secundare ale Sevofluranului, este citat şi efectul toxic glomerular, ca urmare a contactului Sevofluranului cu absorbanţii de CO2, care duc la apariţia unor compuşi toxici: Compusul A, B, C, D. Experienţa în cazul expunerii repetate la Sevofluran este puţin cunoscută, motiv pentru care folosirea Sevofluranului, la pacienţii cu afectare renală, diabetici, hipertensivi nu este restrictivă. În cadrul acestui studiu ne-am  propus să analizăm modificările ureei şi creatininei serice, postanestezic în raport cu modificarea permeabiliţii glomerulare pentru proteine. MATERIAL SI METODA. Am efectuat anestezie de medie si lungă durată,  cu  low flow(2l/min) Sevofluran,  la  un numar  155 de pacienţi, din cadrul Departamentului de Anestezie, al Spitalului Judeţean Mureş,  în perioada 01.10.2009-01.11.2014. Am colectat date demografice, probe biologice de ser şi urină preoperator, la 24 şi 72 ore postoperator. REZULTATE: Prin aplicarea testelor de analiză statistică Graph Pad Prisma 6, pentru datele repetitive la cele 3 intervale stabilite, obţinem următoarele rezultate: Pentru creatinina serică, prin  Anova table, preoperator, la 24 de şi 72 de ore postoperator, am obţinut o valoare P= 0,054, prin Bartlett,s test, o valoare P< 0.0001. După analiza ureei serice, preoperator, la 24 şi 72 de ore postoperator,  prin Anova table obţinem o valoare P=0,0521, iar prin aplicarea Bartlett,s test o valoare P=0,0037. Prin analiza statistică a glicemiei serice, preanestezic, postanestezic la 24 şi 72 de ore, am obţinut următoarele date statistice: prin Anova table o valoare P< 0,0001, iar prin aplicarea Bartlett,s test o valoare P< 0,0001.   Prin analiza eşantioanelor de urină, în cele 3 momente, preanestezic, postanestezic la 24 şi 72 de ore, pentru proteinele totale/24 de ore, avem următoarele date: prin aplicarea testului Anova table, P<0,0001, prin aplicare Bartlett,s test P<0,0001. CONCLUZII Determinarea creatininei si ureei serice, este inadecvată pentru monitorizarea injuriei renale produse de compusul A. Analizând  datele parţiale şi finale, ale acestui studiu, am observat prezenţa semnificativă a proteinelor si glucidelor în urină postoperator, cu un maxim la 24 de ore postanestezic şi cu tendința de regresie spre 72 de ore, dar fară a reveni la valorile iniţiale, preanestezice. Menţinerea unor valori crescute de proteine şi glucide în urină, la 72 de ore la pacienţii cu Sepsis, Diabet Zaharat, Hipertensivi este un semn important, care subliniază încă o dată efectul nedorit pe care îl are Sevofluranul  asupra rinichiului.   Cuvinte cheie: sevofluran, proteinurie, creatinină, uree serică

Guillain–Barré and Acute Transverse Myelitis Overlap Syndrome Following Obstetric Surgery

There are rare reports of the occurrence of acute transverse myelitis and Guillain–Barré syndrome after various surgical procedures and general/epidural anaesthesia. The concomitant occurrence of these pathologies is very rare and is called Guillain–Barré and acute transverse myelitis overlap syndrome. In this article, we present the case of a second trimester pregnant patient who developed Guillain–Barré and acute transverse myelitis overlap syndrome

COVID-19 and <i>Clostridioides difficile</i> Coinfection Analysis in the Intensive Care Unit

Since the emergence of SARS-CoV-2 in late 2019, the global mortality attributable to COVID-19 has reached 6,972,152 deaths according to the World Health Organization (WHO). The association between coinfection with Clostridioides difficile (CDI) and SARS-CoV-2 has limited data in the literature. This retrospective study, conducted at Mureș County Clinical Hospital in Romania, involved 3002 ICU patients. Following stringent inclusion and exclusion criteria, 63 patients were enrolled, with a division into two subgroups—SARS-CoV-2 + CDI patients and CDI patients. Throughout their hospitalization, the patients were closely monitored. Analysis revealed no significant correlation between comorbidities and invasive mechanical ventilation (IMV) or non-invasive mechanical ventilation (NIMV). However, statistically significant associations were noted between renal and hepatic comorbidties (p = 0.009), death and CDI-SARS-CoV-2 coinfection (p = 0.09), flourochinolone treatment and CDI-SARS-CoV-2 infection (p = 0.03), and an association between diabetes mellitus and SARS-CoV-2-CDI infection (p = 0.04), as well as the need for invasive mechanical ventilation (p = 0.04). The patients with CDI treatment were significantly younger and received immuno-modulator or corticotherapy treatment, which was a risk factor for opportunistic agents. Antibiotic and PPI (proton pump inhibitor) treatment were significant risk factors for CDI coinfection, as well as for death, with PPI treatment in combination with antibiotic treatment being a more significant risk factor

Characteristics of Developmental and Epileptic Encephalopathy Associated with <i>PACS2</i> p.Glu209Lys Pathogenic Variant—Our Experience and Systematic Review of the Literature

Background: Developmental and epileptic encephalopathies (DEE) encompass a group of rare diseases with hereditary and genetic causes as well as acquired causes such as brain injuries or metabolic abnormalities. The phosphofurin acidic cluster sorting protein 2 (PACS2) is a multifunctional protein with nuclear gene expression. The first cases of the recurrent c.625G>A pathogenic variant of PACS2 gene were reported in 2018 by Olson et al. Since then, several case reports and case series have been published. Methods: We performed a systematic review of the PUBMED and SCOPUS databases using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Our search parameters included DEE66 with a pathogenic PACS2 gene p.Glu209Lys mutation published cases to which we added our own clinical experience regarding this pathology. Results: A total of 11 articles and 29 patients were included in this review, to which we added our own experience for a total of 30 patients. There was not a significant difference between sexes regarding the incidence of this pathology (M/F: 16/14). The most common neurological and psychiatric symptoms presented by the patients were: early onset epileptic seizures, delayed global development (including motor and speech delays), behavioral disturbances, limited intellectual capacity, nystagmus, hypotonia, and a wide-based gait. Facial dysmorphism and other organs’ involvement were also frequently reported. Brain MRIs evidenced anomalies of the posterior cerebellar fossa, foliar distortion of the cerebellum, vermis hypoplasia, white matter reduction, and lateral ventricles enlargement. Genetic testing is more frequent in children. Only 4 cases have been reported in adults to date. Conclusions: It is important to maintain a high suspicion of new pathogenic gene variants in adult patients presenting with a characteristic clinical picture correlated with radiologic changes. The neurologist must gradually recognize the distinct evolving phenotype of DEE66 in adult patients, and genetic testing must become a scenario with which the neurologist attending adult patients should be familiar. Accurate diagnosis is required for adequate treatment, genetic counseling, and an improved long-term prognosis

Vascular Endothelial Growth Factor Insertion/Deletion gene polymorphism in patients with type 2 diabetes and diabetic peripheral polyneuropathy

Scopul acestei lucrări constă în studierea pentru prima dată în România a polimorfismului I/D al genei VEGF la un grup de pacienți cu diabet zaharat tip 2 și polineuropatie diabetică periferică comparativ cu un grup de control

The direct deleterious effect of Th17 cells in the nervous system compartment in multiple sclerosis and experimental autoimmune encephalomyelitis: one possible link between neuroinflammation and neurodegeneration

The processes of demyelination and neurodegeneration in the central nervous system (CNS) of multiple sclerosis (MS) patients and experimental autoimmune encephalomyelitis (EAE) are secondary to numerous pathophysiological mechanisms. One of the main cellular players is the Th17 lymphocyte. One of the major functions described for Th17 cells is the upregulation of pro-inflammatory cytokines, such as IL-17 at the level of peripheral and CNS inflammation. This review will focus on the newly described and unexpected, direct role played by the Th17 cells in the CNS of MS patients and EAE models. Th17 and their main cytokine, IL-17, are actively involved in the onset and maintenance of the immune cascade in the CNS compartment as Th17 were found to achieve brain-homing potential. Direct interaction of myelin oligodendrocyte glycoprotein - specific Th17 with the neuronal cells firstly induces demyelination and secondly, extensive axonal damage. The Th17 cells promote an inflammatory B cell response beyond the BBB through the presence of infiltrating Th follicles. Due to their role in preventing remyelination and direct neurotoxic effect, Th17 cells might stand for an important connection between neuroinflammation and neurodegeneration in a devastating disease like MS. The Th17 cell populations have different mechanisms of provoking an autoimmune attack not only in the periphery but also in the CNS of MS patients

Autoimmune Encephalitis in COVID-19 Infection: Our Experience and Systematic Review of the Literature

The neurologic complications of COVID-19 infection are frequent in hospitalized patients; a high percentage of them present neurologic manifestations at some point during the course of their disease. Headache, muscle pain, encephalopathy and dizziness are among the most common complications. Encephalitis is an inflammatory condition with many etiologies. There are several forms of encephalitis associated with antibodies against intracellular neuronal proteins, cell surfaces or synaptic proteins, referred to as autoimmune encephalitis. Several case reports published in the literature document autoimmune encephalitis cases triggered by COVID-19 infection. Our paper first presents our experience in this issue and then systematically reviews the literature on autoimmune encephalitis that developed in the background of SARS-CoV-2 infections and also discusses the possible pathophysiological mechanisms of auto-immune-mediated damage to the nervous system. This review contributes to improve the management and prognosis of COVID-19-related autoimmune encephalitis