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The role of cytomegalovirus (CMV) in the flare-up of ulcerative colitis (UC) is not clearly understood. CMV can cause similar symptoms in different clinical contexts, which may be attributed to the natural evolution of the viral infection, the patient's immune status, or its association with inflammatory bowel disease (IBD). This study aims to delineate the diverse manifestations of CMV-related lesions from clinical, endoscopic, and histopathological perspectives, alongside a brief narrative review of the literature. In managing IBD patients, it is crucial to be vigilant for signs of CMV reactivation, especially before the initiation of more intensive therapies. [ABSTRACT FROM AUTHOR]

(1) Elucidating the role of miRNAs (miRs) in ulcerative colitis may provide new insights into disease pathogenesis, diagnosis, treatment, and monitoring We aimed to investigate whether plasma levels of miR-21-5p and miR-155-5p may be used to differentiate between patients with organic disease such as ulcerative colitis (UC) and Clostridioides difficile infection (CDI), and patients with functional disease such as irritable bowel syndrome with diarrhea (IBS-D). (2) Serological samples were collected to quantify miR-155 and -21 expression, which was carried out through quantitative real-time polymerase chain reaction (qRT-PCR), from 84 patients: 34 with acute UC (group 1), 17 with CDI (group 2), and 33 with IBS-D (control group). (3) In this study, we found that the expression levels of miR-155-5p were almost the same for the two conditions and the control group (UC: 4.22 ± 1.61, CDI: 3.94 ± 1.62, IBS-D: 4.26 ± 1.26), with no significant differences either for ΔCt- or for ΔΔCt-derived parameters (p = 0.74 and p = 0.73, respectively). For miR-21, ΔCt levels presented significantly higher values among the ulcerative colitis group (p < 0.01), but the most important expression fold change was noticed in patients with CDI (UC:4.11 ± 8,46, CDI: 4.94 ± 9.68, IBS-D: 2.83 ± 5.41). (4) Circulating miR-155 and miR-21 were upregulated in UC, CDI, and IBS-D, but differentiation was not possible among them. But their involvement in the pathogenesis of the three diseases makes them suitable for improving the accuracy of diagnosis and facilitating the development of personalized treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: Inflammatory bowel disease (IBD) is a chronic idiopathic inflammation involving the gastrointestinal tract. Its two main components are ulcerative colitis (UC) and Crohn disease (CD). The immunological pathogenic substrate interacts with the microbiota and environmental factors in genetically susceptible individuals, with a peak incidence in patients aged 25-35. Lesions in UC only involve the colon, usually the left side, with continuous inflammation limited to the mucosa. Associated extraintestinal manifestations such as arthropathies, erythema nodosum or cholangitis are not uncommon. Case Report: We present the case of a 27-year-old woman who was diagnosed in 2020 with left sided ulcerative colitis and is on biologic therapy with an anti TNF alpha agent (Infliximab) since 2023. This patient comes into our clinic having lost 5-6 kg of weight in the previous month, 2-3 bloody stools a day and spontaneous rectal bleeding. Additionally we found pretibial lesions, oral cavity erosions and knee discomfort. Her medical history reveals multiple Clostridium difficile infections in 2022 treated with different combinations of Vancomycin and Metronidazole. Discussions : When managing an IBD patient, the current guidelines agree that "step up therapy" is preferred to "step down therapy". First line agents used for inducing remission include 5 -ASA drugs and corticosteroid medication. Due to clinical progression treatment with the immunomodulator Azathioprine is started following the eradication of Clostridium difficile. In March 2023, erythema nodosum, joint damage, clinical decline, and fecal calprotectin levels of 731 mcg/g led to the introduction of anti TNF alpha biologic therapy. Our patient returns a year later with a deteriorated clinical presentation, higher inflammatory markers (CRP 3.15 mg/Dl, ESR 164mm/h) and fecal calprotectin values of 1680 mcg/g. We conducted stool tests to rule out the potential causes of infectious colitis, and every test produced a negative result. To assess the extent of the colitis we performed a colonoscopy that described continuous colonic lesions, from the caecum to the rectum, congested, friable mucosa exhibiting bleeding upon air insufflation, multiple erosions and a few inflammatory polyps. After increasing corticosteroid doses and managing to improve the general state, the decision to intensify the biologic treatment is considered, to induce remission. Conclusions: The significance of this case lies in the detrimental evolution despite vigorous therapies, without development of antibodies against Infliximab. The burden this disease imposes especially among young people who have to shape their lives around their illness is something to remember when encountering such cases. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) are two closely related diseases, that consist mainly in excess fat accumulation in the liver. They share many risk factors and pathophysiological mechanisms. Metabolic risk factors include obesity, altered glucose metabolism, hypertension and dyslipidemia. Objective: The aim of the study was to compare risk factors of metabolic syndrome and non- alcoholic fatty liver disease in our clinic. Material and methods: A retrospective observational study was performed, including 60 patients diagnosed with NAFLD. The patients were admitted to the gastroenterology department of the "Mures County Clinical Hospital" in Targu Mures, Romania, from January 2023 to December 2023. Included were patients with a secured NAFLD diagnosis above the age of eighteen. The patients were grouped into two study groups: positive for NAFLD and positive for NAFLD and MetS. Excel and Jamovi were used for the statistical analysis. Results: No statistically significant differences were found in the demographic comparison of the study groups (age, gender, environment). The presence of metabolic risk factors was significantly higher in the group including MetS diagnosis, compared to the NAFLD only group: overweight/obesity (92,9% vs 58,7%, p=0.01), diabetes mellitus (78,6% vs 4,3%) or impaired fasting glucose (21,4% vs 4,3%) with p<0.001 and hypertension (100% vs 58,7%, p<0.01). Patients with NAFLD and metabolic syndrome either had three (57,1%) or all four (42,9%) of the risk variables listed (p=<0.001). 8,7% of the NAFLD group showed three risk factors, 45,7% showed two, 34,8% showed one, and 10,9% showed no metabolic risk factor (p<0.001). No significant differences were found in the analysis of various laboratory values and when comparing pulmonary, renal, neurological, oncological comorbidities. Conclusions: In addition to having an impact on the diagnosis of MetS, metabolic risk factors also typically influence, albeit to a lower degree, the development of NAFLD. [ABSTRACT FROM AUTHOR]

Background: Liver cirrhosis is a result of chronic damage to the liver which will cause scaring and fibrosis, ultimately leading to irreversible damage if it is not resolved or treated in the early stages, where it is still reversible if the harming agent factor is eliminated. Due to the ability of the liver to compensate even when damaged, the diagnosis of the disease is often late, leading to difficulty in treating. Therefore, the treatment consists in preventing cirrhosis and death. The only curable treatment option for patients remains with liver transplant. Material and methods: This study tries to focus on different aetiologies of liver cirrhosis and the associated complications they carry with them and whether there is any exclusivity to an aetiology when it comes to complications.This retrospective study includes 60 patients admitted to the Gastroenterology department of Mures county clinical hospital of Targu Mures, Romania, between the 01.01.2023 and 01.01.2024. The inclusion criteria consist in patients being above 18 years and diagnosed with liver cirrhosis, including all aetiologies presented to the clinic. Results: Most of the patient's diagnosis are caused solely by chronic alcoholic intoxication (44/60), whereas some patients suffer from viral Hepatitis B and C, also combinations of the mentioned aetiologies are present, which present with a significant increase in abnormal blood values.From the included patients, 3 patients died during their stay, where toxic liver cirrhosis caused by alcohol seemed to be the causing factor among other comorbidities. Worth mentioning is that 2/3 of the deceased patients were males and 2/3 below 60 years of age.Most of the patients are male (49/60) and above 60 years of age (35/60). Conclusions: Most of the patient diagnosed with liver cirrhosis in our clinic where due to chronic alcohol consumption, with comorbidities such as chronic cardiac and pulmonary diseases as well as diabetes and obesity. Patients' death was associated with chronic alcohol consumption. [ABSTRACT FROM AUTHOR]