Therapeutic alternatives with CPAP in obstructive sleep apnea

Obstructive Sleep Apnea (OSA), characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causes frequent disruption of sleep and hypoxic events. The condition is linked to many adverse health related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome. OSA is a chronic condition requiring long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA. However, its effectiveness is influenced by patients’ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients, but for the majority, lifestyle changes such as exercise and dietary control may prove useful. However, exercise training remains under-utilized by many clinicians as an alternative treatment for OSA. Other interventions such as oral appliance (OA), upper way stimulation, and oropharyngeal exercises are used in OSA. Because the benefit of all these techniques is heterogeneous, the major challenge is to associate specific OSA therapies with the maximum efficacy and the best patient compliance

Unhealthy lifestyle and the risk of metabolic syndrome- the Romanian experience

Background. Metabolic syndrome (MetS) represents a clustering of metabolic risk factors for cardiovascular disease. Many studies have shown the influence of an unhealthy lifestyle on the risk of MetS, yet some aspects remain controversial. Aim of the study: to investigate the relationship between an unhealthy lifestyle and the risk of MetS. Materials and Methods. The study was conducted using a sample of 181 patients, 54 (29.8%) males and 127 (70.2%) females, aged 59.95±10.8 years. The baseline survey involved the completion of structured questionnaires and clinical examination. Results. Rural environment, lower education level, past smoking, the absence of fruit/vegetables in the diet, carbonated soft drinks, and the consumption of significant amounts of alcohol were risk factors for the MetS. Conclusion. A precise etiology for the MetS remains unclear, but it is known to result from a complex interaction of genetic, metabolic, and socio-economic and environmental factors

Hepatocarcinoma with tumor thrombus occupying the right atrium and portal vein in a patient with hereditary hemochromatosis and liver cirrhosis

We present the case of a 46-year old patient with Child-Pugh class C cirrhosis with MEDL-Score 16, and hepatocellular carcinoma invading the inferior vena cava and the right atrium. The etiology of cirrhosis is type 1 hereditary hemochromatosis with positive HFE C282Y/C282Y and H63D/H63D mutations. A systematic review of the literature was performed and only 30 cases of hepatocellular carcinoma with tumor thrombosis extending into the right atrium have been described. To our knowledge, this is the first case that evidences the presence in hereditary hemochromatosis of hepatocellular carcinoma with atypical invasion into the right atrium. Screening of patients with a family history of hereditary hemochromatosis allows detection of the disease in the asymptomatic phase, allowing initiation of early therapy and improved prognosis

Immune and Inflammatory Pathways in Non-Alcoholic Steatohepatitis (NASH). An update

Non-alcoholic steatohepatitis (NASH), also known as fatty liver disease (FLD), is a major public health problem. It is considered to be the hepatic manifestation of the metabolic syndrome. Chronic inflammation of the liver is an essential key in the progression from simple hepatic steatosis to steatohepatitis, the evolutionary stage of fatty liver disease. Moreover, the innate immune system plays a crucial role in the progression of hepatic inflammation. For this reason, it is of utmost importance to elucidate the connections between immune mechanisms, Toll-like receptor cytokine signalling, in order to find new effective treatments. Further studies are necessary to test theories presented in this paper. The elucidation of mechanisms underlying the progression of hepatic steatosis towards steatohepatitis is essential for the development of useful diagnosis and treatment for medical practice

Imatinib-induced interstitial pneumonitis – a literature review and case report

Imatinib is generally well tolerated, with mild common side effects such as nausea and vomiting, diarrhea, muscle cramps, fatigue, skin rash and edema; however, pulmonary complications are uncommon. A 73-year-old woman undergoing one month treatment with Imatinib for chronic myeloid neoplasm associated with eosinophilia was admitted for sudden alteration of her performance status, dyspnea at rest and productive cough. On clinical examination, the patient was hypoxic (oxygen saturation on room air was 87%), and auscultation of her lungs revealed diffuse bilateral fine crackles. Computed tomography showed bilateral pulmonary interstitial syndrome. Imatinib was discontinued and the patient received systemic corticosteroid therapy and oxygen therapy. After one month, the symptoms and radiological findings were resolved. When Imatinib therapy was resumed, respiratory symptoms reappeared, which is why treatment with Imatinib was interrupted. Imatinib-induced pneumonitis should take into consideration when patients develop respiratory symptoms or abnormal pulmonary radiological features

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

Thrombocytopenia in end-stage renal disease and chronic viral hepatitis B or C

Objectives. We evaluated platelet counts in end-stage renal disease and chronic viral hepatitis. Materials and Methods. We studied 70 patients with end-stage renal disease and chronic viral hepatitis and compared them to a control group of 45 patients without hepatitis. Results. The presence of viral hepatitis was associated with a higher prevalence of thrombocytopenia. Correlations between age, C-reactive protein, liver stiffness measurement, and platelet count were observed. C-reactive protein levels \u3e 10 mg/dl were associated with a lower risk of thrombocytopenia in patients with end-stage renal disease and chronic viral hepatitis, yet age \u3e 60 years, dialysis vintage \u3e 10 years, aspartate and alanine aminotransferase levels \u3e 20 IU/L, albumin levels \u3c 3.5 g/dl, and fibrosis stage ≥ 3 were not related. Conclusions. Chronic viral hepatitis leads to a higher prevalence of thrombocytopenia. Platelet counts in these patients begin to decrease significantly once liver fibrosis reaches stage III

The evaluation of liver fibrosis regression in chronic hepatitis C patients after the treatment with direct-acting antiviral agents – A review of the literature

The second-generation of direct-acting antiviral agents are the current treatment for chronic viral hepatitis C infection. To evaluate the regression of liver fibrosis in patients receiving this therapy, liver biopsy remains the most accurate method, but the invasiveness of this procedure is its major drawback. Different non-invasive tests have been used to study changes in the stage of liver fibrosis in patients with chronic viral hepatitis treated with the second-generation of direct-acting antiviral agents: liver stiffness measurements (with transient elastography or acoustic radiation force impulse elastography) or different scores that use serum markers to calculate a fibrosis score. We prepared a literature review of the available data regarding the long-term evolution of liver fibrosis after the treatment with direct-acting antiviral agents for chronic viral hepatitis C

Therapeutic alternatives with CPAP in obstructive sleep apnea

Obstructive Sleep Apnea (OSA), characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causes frequent disruption of sleep and hypoxic events. The condition is linked to many adverse health related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome. OSA is a chronic condition requiring long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA. However, its effectiveness is influenced by patients’ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients, but for the majority, lifestyle changes such as exercise and dietary control may prove useful. However, exercise training remains under-utilized by many clinicians as an alternative treatment for OSA. Other interventions such as oral appliance (OA), upper way stimulation, and oropharyngeal exercises are used in OSA. Because the benefit of all these techniques is heterogeneous, the major challenge is to associate specific OSA therapies with the maximum efficacy and the best patient compliance