Biochemical Manifestations of Gastroesophageal Reflux Disease Progression in Children: A Single Center Case-Control Study

Gastroesophageal reflux disease (GERD) is a common digestive condition, representing one of the most frequent reasons for medical examination, especially in pediatric gastroenterology departments. GERD could be associated with biochemical alterations representing either its systemic manifestations or markers of complications. The aim of our paper was to evaluate biochemical parameters secondary to GERD in children. Two hundred and sixty-seven children of both genders aged between 1 month and 18 years who displayed suggestive symptoms for this condition were included in the study and were monitored for a period of 5 years. Depending on the range of symptoms and technical possibilities, the following procedures/investigations were performed: esophageal pH monitoring and imagistic or endoscopic examination, besides specific biochemical investigations. The cohort was sub-divided into two groups: one that included 213 children with confirmed GERD who represented the study group and 54 healthy children where GERD had been excluded, the control group. Out of all the investigated children, 39.0% displayed low hemoglobin values, 43.7% displayed low values of erythrocyte indices (MCH), and 68.5% had increased erythrocyte sedimentation rate (ESR) values, while increased eosinophil levels were recorded in 46.9% of the cases. Such parameters were proven to be a biomarker of suspected eosinophilic esophagitis, whereas 32.9% of the cases displayed high blood glucose values that could be correlated with gastroesophageal reflux symptoms. Other measured parameters (such as magnesium, aminotransferases and proteins) remained within the normal limits, without statistically significant differences compared to in the control group. This condition is diagnosed based on invasive investigations, which are often difficult to accept by the patients’ parents. The biochemical modifications correlated to the clinical manifestations can anticipate the progression of the disease, thus limiting the necessity of performing invasive diagnosis tests

Clinicopathological Characteristics of Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

Papillary thyroid microcarcinoma (PTMC) is a common malignant disease of the endocrine system, which has rapidly increased in incidence and prevalence in recent decades. The aim of our paper was to identify correlations between pathological and clinical features of cases of PTMC. A total of 612 patients of both genders, who were operated on for benign thyroid diseases in the 3rd Surgical Unit of St. Spiridon University Hospital of Iasi, were monitored for a period of 2 years. According to pathological reports, PTMC was diagnosed in 144 cases. Of those cases, 81.2% were female and 18.8% were male, with an overall mean age of 54.77 ± 11.9 years. The mean diameter of tumors was 3.04 ± 2.2 mm (75.7% were under 5 mm), and 35.4% were multifocal tumors. Of all tumors studied, 76.4% were the follicular variant, 13.2% were conventional, and 10.4% of cases included tall cell, hobnail, or columnar variants. The underlying diseases were multinodular goiters (73.6%), adenomas (25%), Hashimoto thyroiditis (17.4%), Basedow’s disease, and other types of hyperthyroidism (4.9%), primarily hyperparathyroidism (7.6%), with a small percentage presenting a combination thereof. Extracapsular invasion was present in 14.6% while 5.6% presented perineural invasion and 0.7% of cases had vascular invasion. Lymphatic emboli were found in 9% of cases and lymph node metastasis in 5.6% of cases. PTMC is not as innocent as believed, and further studies, performed on larger batches, would be necessary in order to identify high oncological risk cases and to determine when a more aggressive surgical approach is indicated

Biological and behavioral aspects regarding combined systemic management of alcohol dependence

Although there are numerous ideas on the management of alcohol dependence, ranging from various schemes of pharmacologic treatment to specific psychotherapeutic approaches, the reviews and meta-analyses reveal only modest effects of these approaches. Another approach regarding the problem of alcohol is based on the behavioral biology, specifying that consumption of alcohol is actually a type of behavior, a way of life. The results presented in this report provide evidence to support the idea that the systemic, ethological approach of alcohol-related and complex problems brings additional value when complementing the standard medicinal therapy, both in terms of achieving and maintaining abstinence, as well as in improving the quality of life for the patients

Balancing orbital volume reduction and redistribution for a tailored surgical treatment in Graves’ ophthalmopathy

Aim!#!The purpose of this study is to share our experience on the use of different orbital decompression techniques, as well as the principles followed for deciding the most case-appropriate procedure that ensured the most favorable outcomes.!##!Methods!#!We reviewed the Graves' ophthalmopathy cases operated over the course of 14 years, regarding the presenting signs, the imaging evaluation, the degree of exophthalmos, the type of surgical orbital decompression performed, and the postoperative outcomes.!##!Results!#!All 42 patients identified presented with proptosis, with 92.8% cases of bilateral proptosis. The main addressing concern was functional in 54.8% cases and aesthetic in 45.2% patients. CT was used for the preoperative evaluation in all cases. In total, 81 orbits were operated. The orbital decompression surgery involved only the orbital fat in 7.4% of orbits and associated fat and bone decompression in the other 92.6% of orbits. The postoperative results were favorable in all cases regarding both appearance and function, with minimal postoperative complications.!##!Conclusion!#!The adequate selection of the most suitable procedure based on the characteristics of each case is the prerequisite for a successful surgery. We found that the association of fat and bone decompression of various extents is most permissive in tailoring the degree of decompression to the existing requirements

The dynamics of some oxidative stress markers in 3, 6 and 12-months alcohol abstinent patients: possible relevance for the usage of antioxidants in alcohol withdrawal / Dinamica unor markeri ai stresului oxidativ la 3, 6 şi 12 luni de abstinenţă de la alcool: posibila relevanţă a utilizării de antioxidanţi

În prezentul articol am fost interesaţi să studiem relevanţa stresului oxidativ în cadrul proceselor legate de abstinenţa de la alcool, având în vedere în special faptul că literatura de specialitate este extrem de controversată în acest domeniu de cercetare. Astfel, am determinat nivelul unor markeri specifici ai stresului oxidativ la pacienţii selectaţi după 3, 6 şi 12 luni de abstinenţă de la alcool. 62 de pacienţi de sex masculin au fost selectaţi pentru studiu. În cadrul studiului s-au prezentat 33 de pacienţi pentru determinările bazale, 14 pacienţi la 3 luni, 14 pacienţi la 6 luni şi 15 pacienţi la 12 luni de abstinenţa de la alcool, în timp ce lotul control a inclus 32 de persoane sănătoase, potrivite ca vârstă si sex-ratio cu celelalte grupuri de studiu. Astfel, în ceea ce priveşte rezultatele, în cazul superoxid dismutazei (SOD) am observat o diferenţă semnificativă între cele trei loturi de studiu (p<0.0001), precum şi o creştere semnificativă din punct de vedere statistic a valorilor SOD la pacienţii aflaţi la 3 luni (p<0.0001), 6 luni (p<0.0001) şi respectiv 12 luni (p<0.0001) de abstinenţa de la alcool, faţă de determinările bazale. De asemenea, în cazul glutation peroxidazei, am observat o diferenţă semnificativă din punct de vedere statistic între grupuri (p=0.0003), plus creşteri importante la 6 luni (p=0.03) şi 12 luni (p=0.006), faţă de determinările bazale. În ceea ce priveşte malondialdehida (MDA), ca şi principal marker al proceselor de peroxidare lipidică, am putut observa de asemenea diferenţe semnificative între grupurile de studiu (p<0.0001). Mai mult, în cazul tuturor celor 3 grupe de pacienţi s-au putut observa scăderi semnificative ale concentraţiei de MDA, în comparaţie cu determinările bazale (p=0.003 pentru 3 luni, p=0.01 pentru 6 luni şi p=0.0002 pentru 12 luni). În concluzie, aceste date confirmă un stress oxidativ crescut la pacienţii consumatori cronici de alcool şi, mai important decât atât, demonstrează o scădere semnificativă şi progresivă a statusului stresului oxidativ la 3, 6 şi 12 luni de abstinenţa de la alcool, aşa cum am putut observa din creşterea progresivă a activităţii specifice a enzimelor antioxidante determinate şi scăderea nivelelor de peroxidare lipidică

The Renin-Angiotensin System: The Challenge behind Autoimmune Dermatological Diseases

Autoimmune dermatological diseases (AIDD) encompass a diverse group of disorders characterized by aberrant immune responses targeting the skin and its associated structures. In recent years, emerging evidence suggests a potential involvement of the renin–angiotensin system (RAS) in the pathogenesis and progression of these conditions. RAS is a multicomponent cascade, primarily known for its role in regulating blood pressure and fluid balance. All of the RAS components play an important role in controlling inflammation and other immune responses. Angiotensin II, the main effector, acts on two essential receptors: Angiotensin Receptor 1 and 2 (AT1R and AT2R). A disturbance in the axis can lead to many pathological processes, including autoimmune (AI) diseases. AT1R activation triggers diverse signaling cascades involved in inflammation, fibrosis and tissue remodeling. Experimental studies have demonstrated the presence of AT1R in various cutaneous cells and immune cells, further emphasizing its potential contribution to the AI processes in the skin. Furthermore, recent investigations have highlighted the role of other RAS components, beyond angiotensin-converting enzyme (ACE) and Ang II, that may contribute to the pathophysiology of AIDD. Alternative pathways involving ACE2, Ang receptors and Ang-(1-7) have been implicated in regulating immune responses and tissue homeostasis within the skin microenvironment. Understanding the intricate involvement of the RAS in AIDD may provide novel therapeutic opportunities. Targeting specific components of the RAS, such as angiotensin receptor blockers (ARBs), ACE inhibitors (ACEIs) or alternative RAS pathway modulators, could potentially ameliorate inflammatory responses, reduce tissue damage and lessen disease manifestations. Further research is warranted to outline the exact mechanisms underlying RAS-mediated immune dysregulation in AIDD. This abstract aims to provide a concise overview of the intricate interplay between the RAS and AIDD. Therefore, we elaborate a systematic review of the potential challenge of RAS in the AIDD, including psoriasis, systemic sclerosis, vitiligo, lupus erythematosus and many more

Atrial Fibrillation and Chronic Coronary Ischemia: A Challenging Vicious Circle

Atrial fibrillation, the most frequent arrhythmia in clinical practice and chronic coronary syndrome, is one of the forms of coronary ischemia to have a strong dual relationship. Atrial fibrillation may accelerate atherosclerosis and may increase oxygen consumption in the myocardium, creating a mismatch between supply and demand, thus promoting the development or worsening of coronary ischemia. Chronic coronary syndrome alters the structure and function of gap junction proteins, affecting the conduction of action potential and leading to ischemic necrosis of cardiomyocytes and their replacement with fibrous tissue, in this way sustaining the focal ectopic activity in atrial myocardium. They have many risk factors in common, such as hypertension, obesity, type 2 diabetes mellitus, and dyslipidemia. It is vital for the prognosis of patients to break this vicious circle by controlling risk factors, drug therapies, of which antithrombotic therapy may sometimes be challenging in terms of prothrombotic and bleeding risk, and interventional therapies (revascularization and catheter ablation)