Multiple endocrine neoplasias (MEN) represent a rare and intricate group of disorders with diverse endocrine and extra- endocrine manifestations. Among the five identified types of MEN syndromes, MEN 2 stands out due to its complexity, featuring medullary thyroid carcinoma (MTC), pheochromocytoma, and primary hyperparathyroidism (PHPT). MEN 2 is inherited in an autosomal dominant manner, with nearly a 100% lifetime risk of developing MTC, which can be fatal if not detected early. Comprehensive diagnostic protocols and timely interventions significantly mitigate morbidity. To guide surgical decisions, management strategies include regular imaging and biomarker monitoring (calcitonin, CEA, metanephrines/normetanephrines, and parathyroid hormone). Genetic screening of at-risk families and prophylactic thyroidectomy remain cornerstone preventive measures. Although tyrosine kinase inhibitors are generally reserved for specific cases of MTC and are not first-line therapies for MEN2-associated tumors, they hold the potential for mitigating tumor progression and recurrence despite the risk of endocrine dysfunction. This paper presents a narrative review focusing on multiple endocrine neoplasia type 2 (MEN2) syndrome, encompassing its genetic underpinnings, clinical presentations, diagnostic modalities, and therapeutic approaches. A total of 48 articles were included in this review.
Million people worldwide are affected by the hepatitis C virus (HCV). The highest incidence of illness was between 1945 and 1975. It was also estimated that 70% of those people were not tested for the disease. Most recent treatment concepts are safe, highly effective and have a vital public health influence by achieving a viral constant response in a significant proportion of treated patients. It helps reduce liver fibrosis, liver cancer risk and dissemination. With its increased population incidence, HCV becomes a serious public health problem. This review discusses the current literature in this field in terms of the importance of screening of HCV, follow-up, treatment and includes considerations in specific populations such as patients with cirrhosis, with HIV/HCV co-infection, patients with HBV/HCV co-infection and with renal damage.
Worldwide, adults and childhood obesity are increasing alarmingly, being a major health problem. Obesity is correlated with an increased incidence of various systemic diseases including cancer, heart diseases, and diabetes mellitus type 2. Risk factors for obesity are dysbiosis, genetic, socioeconomic, behavioural and environmental. The gut microbiota has beneficial effects on human health, like host immune system stimulation, being influenced by pH, or nutrient intake. Studies performed on humans and animal models reported differences regarding microbiota at lean and obese individuals. The consumption of probiotics and prebiotics may balance the microbiota with positive effects in obesity. The main aim of this review is to reveal the interaction between dysbiosis and obesity.
Multiple sclerosis is a chronic autoimmune disease, characterized by the appearance of demyelinating lesions with inflammatory character in the CNS. Given the unpredictable evolution of the disease, numerous attempts have been initiated to find some pathogenic factors and by default targeted treatment methods. The intestinal microbiota of these patients is often significantly altered compared to the healthy population and given the complex connections between the intestine and the central nervous system, the idea of causality between dysbiosis and this condition was launched. The intestinal mucosa represents the interface between the external environment and the organism, so that it is considered the starting point of some local immunological processes but with systemic resonance, especially neurological. The classic medication scheme widely used to treat MS nowadays can also affect the integrity of the intestinal mucosa by breaking the fine balance at this level. Data from recent studies around the subject open new treatment opportunities around preserving the intestinal microbiota and strategies like vitamin A intake and fat-soluble vitamin D supplementation, probiotic complexes or faecalis microbiota transplantation appear more promising and easier to apply in daily clinical practice.
Background and aim: Ombitasvir/Paritaprevir/Ritonavir+Dasabuvir in association with ribavirin was the only interferon-free regimen available in 2015 in Romania for compensated HCV cirrhosis. The aim of our study is to reveal our experience with interferon-free therapy in compensated HCV cirrhosis. Materials and methods: We conducted a multicenter prospective study including 90 patients with compensated (Child-Pugh A) HCV cirrhosis treated with Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir and Ribavirin regimen for twelve weeks. The HCV infection was diagnosed using clinical, biological, and FibroMax tests. Each patient had follow-up visits at four, eight, twelve and twenty-four weeks after the initiation of the treatment. Results: 44 (49% of) patients were female and 46 (51 % of) were male. The mean age of patients in the study was 61 years old. All the patients had HCV genotype 1b infection. 22 patients were naive and 68 had previous antiviral therapies based on pegylated IFN-α and ribavirin. At the initiation of treatment 64 (71%) of patients had cytolysis, 38 (42%) had thrombocytopenia, 19 (21%) patients had hyperbilirubinemia and 11 (12%) patients had anemia. It was noticed a decreasing of cytolysis, only 10% of 64 patients still having cytolysis after four weeks of treatment. One patient (1%) died after four weeks of treatment by complications of cirrhosis. 89 (99%) of patients had a virologic response (VR) at the end of treatment (EOT) and sustained virologic response (SVR) twelve weeks after the last dose administration. Conclusion: The most common side effect among the patients in the study group was anemia (47% cases). Cytolysis disappeared after four weeks of treatment in 61% of patients. The interferon-free combination treatment was safe and highly effective in compensated HCV cirrhosis.
Background: This topic is aimed to review the treatment approach in adult patients diagnosed with urosespsis, in order to decrease mortality and to maximize the outcome of the antibiotic stewardship efforts. Methods: We present an approach of antibiotic therapy in urosepsis from an infectious diseases physician perspective, based on the recently published data integrating the epidemiology of the urinary tract infections in a multidisciplinary hospital from Romania. Results: The principles of therapy in urosepsis should have five goals, but not limited to rapid diagnosis, specific intensive care unit treatment, obtaining urine and blood cultures, anti-infective treatment and identifying and correction of underlying risk factors. Due to the higher prognostic value, the antimicrobial therapy in urosepsis should consist in “two steps” regimen: initial antimicrobial therapy, based on “empirical” approach for the first 48 - 72 hours and directed or “definitive” antimicrobial therapy adapted to the susceptibility profile of the isolated pathogens, the penetration into the urinary tract and the patient clinical response. Clinicians should be aware of the different antibiotic susceptibility profile of the bacteria from the hospital compared to the community. Thus, the initial choice of antimicrobial agents depends on several criteria like the severity of illness and the risk factors for multidrug resistant pathogens: the immune status of the patient (age, debilitating chronic illnesses, immunosuppressive treatment or uncontrolled malignancies), broad-spectrum antimicrobial use and health care environment exposures in the previous 3 to 6 months, susceptibility of prior urinary isolates, and local community resistance prevalence of bacteria. Conclusions: Our important messages highlighted the need of a holistic approach of urosepsis, in a multidisciplinary team, with integration of risk factors for AMR, focusing on the first phase of antibiotic treatment as the main driven of the survival rate.
Background and aim. Adverse drug reactions (ADRs) are common events in medical practice, representing a matter of concern for both outpatient and in hospital care. Understanding and management of ADRs depend on their mechanism and clinical picture, which are complex and highly heterogeneous. Drug hypersensitivity reactions (DHRs) are immunologically-mediated ADRs, which are considered allergies after demonstrating evidence of either drug-specific antibodies or T-cells. The correct diagnosis of a drug allergy in hospital setting is essential for the outcome of treated disease and for the patient future in terms of therapeutic needs. Patients may be labeled as being drug allergic, based on their history and vague symptoms that do not correspond to a true allergic reaction. The aim of our study was to evaluate consequences of drug allergy labelling of female patients hospitalized in the department of obstetrics and gynecology from a university hospital during one year, in terms of medical attitude and therapeutic approach. Method and Results. We found that 159 out of 2395 patients hospitalized in the obstetrics-gynecology department declared a history of drug allergy on admission, but only 3 patients had medical documents and adequate recommendations from the allergist. Hospital medical attitude was significantly influenced in all declared allergic patients, mainly in terms of antimicrobial and anti-inflammatory therapy. Conclusion. We concluded that overestimation of drug allergies in hospital care has important consequences in terms of current and future recommended therapy that should be based on standardized allergist evaluation.
Zika virus, the etiological agent of Zika fever, is transmitted by mosquitoes and has been affecting the South American continent starting with 2015. It was reported in several European countries, carried by the people who returned from Latin America, as reported by the health authorities in those countries. Today, according to the World Health Organization (WHO), the virus suspected to cause serious birth defects in the fetus has also been confirmed in 21 of the 55 countries of South America, but also in other states from Europe and North America. Zika virus is a single stranded positive sense RNA virus belonging to Flavivirus genus (family Flaviviridae) and was first identified in 1947 in Uganda rainforest Zika. The increased number of cases of microcephaly, in children from northern Brazil, suggested a connection with Zika virus, but it has not yet been proven. Also, the virus can be transmitted sexually and through blood or blood products. Diagnosis of the infection is made using Polymerase Chain Reaction (PCR). So far, there is no specific antiviral treatment or vaccine against the infection with Zika virus. The best form of prevention is to avoid mosquito bites. WHO has estimated that the spread of Zika virus, transmitted through mosquito bite, is “a global public health emergency”. The priority is to protect pregnant women and to control the mosquitoes.
Introduction: Tuberculosis (TB) is still one of the most frequent infectious diseases, causing 2 million deaths a year worldwide. The prevalence of TB has increased in both immunocompetent and immunocompromised and virtually, it can affect any organ. Up to 25% of tuberculosis cases present extra-pulmonary involvement. The diagnosis of extra-pulmonary TB (EPTB) is difficult, often requiring biopsy. Material and methods: We present two cases of EPTB in immunocompetent young women. The first case is about a 15-years old female who presented with persistent high fever, ascites and an increased CA-125 serum level. Biochemical analysis of ascites fluid revealed a high value of adenosine deaminase (ADA), negative Ziehl-Neelsen stain and undetectable Mycobacterium tuberculosis at PCR assay. The peritoneal biopsy confirmed the diagnosis of peritoneal TB. The second case, a 29-years old female with a seven-month history of cervical lymph nodes swelling, with drainage and excision biopsy performed, misdiagnosed as cats-scratch disease based on the histological description as granulomatous lymphadenitis, which turned out to be tuberculous lymphadenitis at the second histopathological opinion. In conclusion, these cases highlight the need for tuberculosis consideration in the differential diagnosis of extra-pulmonary involvement, even in immunocompetent individuals, in order to decrease the misdiagnoses and complications rates.
