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Universitatea de Medicina si Farmacie Grigore T. Popa Iasi | UMF Iasi · Department of Internal Medicine (Internal Medicine, Clinical Toxicology)

The link between venous thromboembolism (VTE) and cancer is well known. VTE could be the initial sign of an occult malignancy. There are more diagnoses of cancer after an unprovoked VTE compared to a provoked VTE, with a reported prevalence between 4.5% and 5.6% over 12 months, within the first 6 months of VTE diagnosis. There are no recommended gu...

This project proposed to study particularities of comorbidities in nonalcoholic fatty liver disease (NAFLD) according to gender groups.

Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of...

The paper aims to assess the eff ect of health care renunciation by pregnant women for fi nancial reasons on the health status of their new-borns. A sample of 512 women who gave birth at "Cuza-Voda" Maternity in Iasi was surveyed. The following methodological approach was used to reach the objectives of the study: assessment of the degree to which...

Importanța factorilor de risc în diagnosticul precoce al arteriopatiei obliterante a membrelor inferioare

Essential tests and maneuvers in internal medicine

Noțiuni practice fundamentale în medicina internă

Background Hashimoto’s encephalopathy (HE) is a controversial immunological neuropsychiatric disease, with a poorly understood pathogenesis. It is characterized by symptoms of acute or subacute encephalopathy which usually occur in the presence of elevated levels of antithyroid antibodies. Even though it is also known as steroid responsive encephal...

The Coronavirus Disease 2019 (COVID-19) pandemic was declared in early 2020 after several unexplained pneumonia cases were first reported in Wuhan, China, and subsequently in other parts of the world. Commonly, the disease comprises several clinical features, including high temperature, dry cough, shortness of breath, and hypoxia, associated with f...

Background: Upper gastrointestinal (GI) bleeding is a life-threatening condition with high mortality rates. Aim: To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes: In-hospital mortality, intervention (endoscopic or surgical) and length of admission (≥ 7 d). Methods: We performed a retrospecti...

Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during t...

Peripheral artery disease particularities in patients with type 2 diabetes mellitus

Cardiovascular risk in patients with nonalcoholic fatty liver disease

Myocardial ischemia is a pathophysiological state characterized by inadequate perfusion of the myocardium, resulting in an imbalance between myocardial oxygen demand and supply. It is most commonly caused by coronary artery disease, in which atherosclerotic plaques lead to luminal narrowing and reduced blood flow to the heart. Myocardial ischemia c...

Atunci, în 2019, când am elaborat prima ediție a acestei lucrări colective, efortul de sinteză, efortul explicativ și claritatea noțiunilor medicale prezentate în paginile acelei cărți medicale au fost răsplătite de interesul miilor de cititori care au considerat-o utilă. Lucrarea a avut o distribuție națională în librăriile de specialitate și a fo...

Infective endocarditis is a severe infective heart disease, commonly involving native or prosthetic valves. It frequently presents with univalvular involvement and simultaneous double valve or multivalvular involvement is rarely described. The third leading cause of infective endocarditis worldwide is Enterococcus faecalis, which is associated with...

Magnesium is the fourth most common mineral in the human body and the second richest intracellular cation. This element is necessary for many physiological reactions, especially in the cardiovascular and respiratory systems. COVID-19 is an infectious disease caused by SARS-CoV-2. The majority of people who become ill as a result of COVID-19 have mi...

Nontrombotic pulmonary embolism represents the embolization of different types of materials (cells, organisms, gas, foreign material) into pulmonary circulation. The disease is uncommon, and clinical presentation together with laboratory findings are nonspecific. Its pathology is usually misdiagnosed based on imaging findings as pulmonary thromboem...

In recent years, direct oral anticoagulants (DOAC) have accumulated evidence of efficacy and safety in various clinical scenarios and are approved for a wide spectrum of indications. Still, they are currently used off-label for left ventricular thrombus owing to a paucity of evidence. For the same reason, there is a lack of guideline indication as...

Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated, fluid-overloaded patients. The pathophysiology of hyponatremia in patients with heart failure is complex, including numerous mechanisms: increased activity of the sympathetic nervous system and the renin–angiotensin–aldosterone system, high levels of...

Serotonin syndrome (SS) is a clinical toxidrome with high variability in clinical practice. It develops due to increased serotonin levels in the central nervous system. With an underestimated frequency, SS can develop following an overdose, a therapeutic dose increase, or drug to drug interaction of at least one serotonergic agent. It can present w...

Background: The ongoing COVID-19 pandemic has put a constant strain on hospital resources, so there is a dire need for investigation methods that are widely available and that can predict mortality and the need for critical care. Hematological indices, which can be easily calculated from a complete blood count (CBC), are useful in determining a pa...

Electrocardiogram (ECG) still remains a very useful diagnostic method in modern cardiology. Its broad availability, noninvasiveness and good sensitivity explain why it plays a capital role in the very beginning of the process of diagnosis for every patient, with or without cardiac-related complaints. For the practitioner, good training in ECG inter...

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that can lead to ankylosis by secondary ossification of inflammatory lesions, with progressive disability and a significant impact on quality of life. It is also a risk factor for the occurrence of comorbidities, especially cardiovascular diseases (CVDs), mood disorders, osteoporosis...

Background: Data regarding the combined prognostic role of biomarkers and risk scores in relation with the history of atherosclerotic cardiovascular disease (ASCVD) in COVID-19 patients are lacking. Methods: The aim of this observational cohort study was to evaluate the combined prognostic value of N-terminal pro B-type natriuretic peptide (NT-p...

The association of gastric neuroendocrine tumour type I with macrocytic anaemia due to vitamin B12 deficiency is commonly encountered. The etiological cause of macrocytic anaemia must always be precisely established for the subsequent treatment guidance. We present the case of a 63-year-old patient admitted for marked physical asthenia, palpitation...

In cancer survivors, cardiac dysfunction is the main cause of mortality. Cardiotoxicity represents a decline in cardiac function associated with cancer therapy, and the risk factors include smoking, dyslipidemia, an age of over 60 years, obesity, and a history of coronary artery disease, diabetes, atrial fibrillation, or heart failure. Troponin is...

Acute coronary syndrome (ACS) is a spectrum of clinical and paraclinical disorders arising from an imbalance of oxygen demand and supply to the myocardium. The most common cause is atherosclerosis; however, other rare causes such as carbon monoxide (CO) poisoning should be considered. Through tissue hypoxia and direct cell injury, CO poisoning can...

Background: Biomarkers were correlated with mortality in critically ill COVID-19 patients. No prediction tools exist for noncritically ill COVID-19 patients. We aimed to compare the independent prognostic value of inflammation and cardiac biomarkers for post-acute COVID-19 patients and the 30-day mortality rate in noncritically ill COVID-19 patien...

Aim: The aim of this study is to evaluate the relationship between ferritin and iron concentrations, and ankle-brachial index values at 6-12 months dynamics for peripheral artery disease (PAD) evolution predictability. Methods: We examined a group of 216 patients admitted consecutively between January 2017-February 2018. At the initial and dynamic...

The Iași Medical School, created in 1879, within the first modern University in the country, operates since 1990 as the University of Medicine and Pharmacy and bears the name of a world-renowned Professor of Anatomy, Grigore T. Popa, exceptional personality in the fields of science, education and political attitude. A successful academic medical ca...

Chronic pruritus is a major and distressing symptom of many diseases of dermatological, neurological, psychogenic or systemic origin. Chronic itch could be a presenting sign of malignancy, therefore paraneoplastic pruritus has also been associated with neuroendocrine tumors (NETs). This article reviews a patient known with chronic pruritus for the...

Background: Systemic sclerosis (SSc) is a chronic multisystem autoimmune condition defined by a complex pathobiology, comprising excessive fibrosis of skin and internal organs, peripheral vasculopathy with endothelial cell dysfunction, inadequate vascular repair and neovascularization, and aberrant immunity. Vitamin D is a steroid hormone with ple...

We report the case of a 77-year-old patient admitted for worsening dyspnea, palpitations and dizziness. The electrocardiogram (ECG) showed atrial fibrillation (AF) and left bundle branch block (LBBB). Clinical examination showed hypoxemia (SaO2 87% room air), jugular venous distension, pitting edema, arrhythmic heart sounds, a splitting of the seco...

Patients poisoned with drugs and nonpharmaceutical substances are frequently admitted from the emergency department (ED) to a medical or ICU department. We hypothesized that biomarkers of inflammation and inflammation-related indexes based on the complete blood cell (CBC) count can identify acutely poisoned patients at increased risk for ICU hospit...

Acute antiarrhythmics poisoning represents a challenge in the Emergency Department (ED). These patients often develop malignant arrhythmias in need of exceptional therapeutic measures in the ICU. We report a 47-year-old patient admitted to the ED 5 h after the ingestion of a large dose of amiodarone and flecainide in a suicide attempt. During their...

Thank you for the opportunity to respond to the issues raised by Ferrés-Padró et al. in their recent letter to the editor [...]

New polymer-bioactive compound systems were obtained by immobilization of triazole derivatives onto grafted copolymers and grafted copolymers carrying betaine units based on gellan and N-vinylimidazole. For preparation of bioactive compound, two new types of heterocyclic thio-derivatives with different substituents were combined in a single molecul...

Organophosphate pesticide (OP) poisoning is quite common and can cause cardiovascular complications and even direct myocardial injury. However, no guideline has included an acute poisoning as a potential cause for a type 2 myocardial infarction (MI) so far. Here we present a case of a 61-year-old woman brought by ambulance to emergency department o...

Am conceput această carte de cazuri clinice de medicină internă pentru a fi un instrument de învățare pentru toți profesioniștii acestei specialități. Indiferent de grade sau vârstă ne perfecționăm continuu dacă reușim să asimilăm ceva din experiența colegilor. Cazul real îl găsim în spital nu în ghiduri sau în tratate de specialitate. Medicina int...

The prognostic value of multiple glycemic parameters in poisoned patients was never assessed. We aim to explore the effects of glucose variability on short-term outcomes in nondiabetic and diabetic patients acutely poisoned with undifferentiated xenobiotics. We performed a prospective observational study in a tertiary center for toxicology in north...

Background and Objectives: During the coronavirus disease 2019 (COVID-19) pandemic, patients with chronic diseases suffering exacerbations have required acute medical care. The purpose of our study was to determine useful criteria for the differentiation of patients with acute clinical syndromes and suspicion of severe acute respiratory syndrome co...

New grafted copolymers possessing structural units of 1-vinyl-3-(1-carboxymethyl) imidazolium betaine were obtained by graft copolymerization of N-vinylimidazole onto gellan gum followed by the polymer-analogous reactions on grafted polymer with the highest grafting percentage using sodium chloroacetate as the betainization agent. The grafted copol...

INTRODUCERE: Ansamblului de efecte negative conferite consumului cronic de etanol i se alătură o serie de studii prospective observaţionale ce documentează efectele benefice ale consumului moderat de alcool asupra funcţiei renale (prevenţia declinului asociat vârstei/încetinirea progresiei bolii renale cronice). SCOPUL LUCRĂRII: Profilul renal al...

Objective: This study was performed to determine whether a dual-biomarker approach using N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and galectin-3 optimizes the diagnosis and risk stratification of acute cardiac dyspnea. Atypical clinical manifestations and overlapping pathologies require objective and effective diagnostic meth...

LINKING THEORY TO PRACTICE: UNDERUSE OF CHRONIC ORAL ANTI-COAGULATION IN ATRIAL FIBRILLATION (Abstract): The effectiveness of chronic oral anticoagulation in preventing thromboembolic events related to atrial fibrillation has a l-ready been proven. Nevertheless, a suboptimal use of oral anticoagulants is documented in real-world practice. Aim: To c...

SCOPUL LUCRĂRII Spectrul larg al patologiilor ce pot avea ca expresie clinică dispneea acută necesită un triaj rapid și-o conduită terapeutică specifică în situaţiile ameninţătoare de viaţă. Dispneea de cauza cardiacă este diagnosticată, în mod eronat, în aproximativ 15-20 % dintre cazuri datorită manifestărilor atipice, terapiei diuretice asociate...

BACKGROUND In emergency settings, clinical manifestations of acute heart failure are often misinterpreted due to the presence of comorbities, mainly respiratory pathologies, chronic administration of cardiovascular medication (e.g. diuretics) and reduced specificity for cardiovascular symptoms. Existing data sustain the utility of a multimarker ana...

INTRODUCERE Fibrilaţia atrială, tulburarea de ritm supraventricular atât de frecvent întâlnită în practica medicală, continuă să ridice probleme în ceea ce privește asigurarea unui tratament de prevenţie tromboembolică. În pofida unui interes medical permanent de creștere a acceptanţei anticoagulantelor orale, datele actuale continuă să indice că d...

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A case of respiratory failure in a domestic fire victim presenting with 1-3-degree skin burns on 10% of the total body surface, is reported. Forty-eight hours after admission to hospital, the patient developed severe respiratory failure that did not respond to mechanical ventilation. Severe obstruction of the airway had resulted from secretions and...

Acute exposure to systemic poisons represents an important challenge in clinical toxicology. We aimed to analyze the potential role of cardiac biomarkers, routine laboratory tests, and clinical scores as morbidity and in-hospital mortality predictors in patients intoxicated with various systemic poisons. We conducted a prospective study on adults a...

The direct pharmacological properties of amino acids and the possibility of using them as carriers for other active pharmacological substances are well known. Methionine, being able to yield the methyl group, is very important in the treatment of hepatic diseases. Paracetamol acute poisoning causes liver injury in both humans and animals. The study...

Acute poisoning with drugs and nonpharmaceutical agents represents an important challenge in the emergency department (ED). The objective is to create and validate a risk-prediction nomogram for use in the ED to predict the risk of in-hospital mortality in adults from acute poisoning with drugs and nonpharmaceutical agents. This was a prospective c...

In recent decades, lifestyle and increase of life duration in developed countries predetermined the appearence of atherosclerotic ,,epidemy". Peripheral artery disease (PAD) is a disease with high incidence, as well as an indirect status indicator of coronary and cerebral arteries. PAD outcome, including the subclinical stage, can be improved by de...

The aim of this research was the synthesis of novel 2,3-disubstituted 1,3 thiazolidines, derived from 5- nitroindazole with antimicrobial activity and their encapsulation into polymer nanocapsules. Starting from previously synthesised hydrazones, there have been obtained novel thiazolidines by reaction with thioglycolic acid. The envisaged chemical...

The case of an 84 years old woman with uncharacteristic neurologic and cognitive symptoms, suspected of ischemic stroke is presented. Following an extensive assessment in the departments of neurology and internal medicine, the unusual aetiology of stroke was identified as meningovascular neurosyphilis. The patient fully recovered after antibiotic t...

lntroduction. ldiopathic polymyositis (PMl) is the main acquired myopathy, characterized by inflammatory and degenerative changes in the skeletal muscle. The incidence is 2-10 cases/1,000,000 people. Clinical case. A 63-year-old woman was found at home in confusion and was brought to the "Sf. Spiridon" Hospital Emergency Unit. Upon admission, labor...

Purpose: Acute exposure to a systemic poison represents an important segment of medical emergencies. We aimed to estimate the likelihood of systemic poison-induced morbidity in a population admitted in a tertiary referral center from North East Romania, based on the determinant factors. Methodology: This was a prospective observational cohort study...

Acute poisonings represent a common cause of morbidity and mortality worldwide. The prognostic utility of the transthoracic echocardiography (TTE) parameters combined with brain natriuretic peptide (BNP) in acute poisoning with different xenobiotics, upon admission in the hospital was not evaluated. This prospective observational cohort study inclu...

Digitalis poisoning is still frequently encountered in medical practice, either as acute or chronic overdosage. Toxic mechanism is represented by Na+/K+ ATP-ase blockade, followed by an increase in intracellular Na+ and hiperkalemia. Hiperkalemia increases mortality in digitalis poisoning, having a complementary effect to digitalis toxicity. Calciu...

Objectives The objective of this study was to assess the pattern and outcome of acute cholinesterase inhibitors substances (CIS) poisoning cases, in a cohort from a regional tertiary care hospital. Methods cases admitted in the Toxicology Clinic of ?Sf. Spiridon? Emergency Clinic Hospital Iasi, Romania between 1983 and 2013 were studied. Results...

Neutralization represents an important goal in toxicology, reducing exposure to poison being crucial in any management plan of any intoxication. Controversial data actually exists in the literature regarding activated charcoal capacity to bind organophosphates. To determine and compare organophosphate binding capabilities for different hydrophobic...

Rhabdomyolysis is a rare phenomenon that may be challanging to recognize in an emergency setting. Drugs are one of the common causes. Trimethoprim-Sulfamethoxazole (TMP-SMX) is a commonly used antibiotic effective in the treatment of upper and lower respiratory tract infections, as well as renal, urinary and gastrointestinal tract infections. It ha...

Organophosphate substances, although known to exert their toxic effects mainly by inhibiting cholinesterase enzymes, associate a cardiac toxicity with pathogenic mechanisms that are not only limited to this anticholinergic effect. The aim is to discover the most reliable explanation for the late cardiac toxic effect of organophosphates in acute int...

Novel drug-polymer conjugates were prepared by chemical immobilization of hydrazides on poly (N-vinyl pyrrolidone-alt-itaconic anhydride) support. Hydrazides with tuberculostatic activity were synthesized as derivatives of N-(p-nitrobenzoyl)-L-glutamine. Elemental and spectral analysis confirmed the chemical structure of the newly synthesized compo...

We present a case of diltiazem overdose in which the patient ingested 5.6 g in an apparent suicide attempt. She was admitted in the emergency department 2 hours postingestion with cardiodepressive syndrome. She was treated with gastric lavage, activated charcoal, intravenous fluids, calcium, and epinephrine, without improvement in vital signs. We g...

The conditions in which the obtaining reactions of some N-[p-(R)-Benzoyl]-L-Glutamine derivatives are made with the highest yield were established in this paper. Due to their antitumoral effects, the action of glutamine derivatives on the digestive enzymes has been evaluated. (Received March 10, 2013; Accepted May 8, 2013)