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Diabetes exacerbates the progression of atherosclerosis and is associated with increased risk of developing acute coronary syndrome (ACS). Approximatively 25-30% of patients admitted for ACS have diabetes. ACS occurs earlier in diabetics and is associated with increased mortality and a higher risk of recurrent ischemic events. An increased proinflammatory and prothrombotic state is involved in the poorer outcomes of diabetic patients. In the past decade advancement in both percutaneous coronary intervention (PCI) and coronary artery by-pass graft (CABG) techniques and more potent antiplatelet drugs like prasugrel and ticagrelor improved outcomes of diabetic patients with ACS, but this population still experiences worse outcomes compared to non-diabetic patients. While in ST elevation myocardial infarction urgent PCI is the method of choice for revascularization, in patients with non-ST elevation ACS an early invasive approach is suggested by the guidelines, but in the setting of multivessel (MV) or complex coronary artery disease (CAD) the revascularization strategy is less clear. This review describes the accumulating evidence regarding factors involved in promoting increased incidence and poor prognosis of ACS in patients with diabetes, the evolution over time of prognosis and outcomes, revascularization strategies and antithrombotic therapy studied until now.

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disorder, predominantly symmetric, which causes joint inflammation, cartilage degeneration and bone erosion, resulting in deformity and the loss of physical function. Although the management of RA has steadily improved, the pathophysiological mechanism is incompletely elucidated, and therapeutic options are still limited. Due to shortcomings in the efficacy or safety profiles of conventional RA therapies, therapeutic alternatives have been considered. Therefore, natural extracts containing polyphenolic compounds can become promising adjuvant agents for RA global management, due to their antioxidant, anti-inflammatory and apoptotic properties. Polyphenols can regulate intracellular signaling pathways in RA and can generate different immune responses through some key factors (i.e., MAPK, interleukins (ILs 1 and 6), tumor necrosis factor (TNF), nuclear factor light k chain promoter of activated receptor (NF-κB), and c-Jun N-terminal kinases (JNK)). The critical function of the Toll like-receptor (TLR)-dependent mitogen-activating protein kinase (MAPK) signaling pathway in mediating the pathogenic characteristics of RA has been briefly discussed. Oxidative stress can trigger a change in transcription factors, which leads to the different expression of some genes involved in the inflammatory process. This review aims to provide a comprehensive perspective on the efficacy of polyphenols in mitigating RA by inhibiting signaling pathways, suggesting future research perspectives in order to validate their use.

Silver nanoparticles (AgNPs) ranging in size from 1-100 nm show good application potential in many medical fields (therapies, medical devices, molecular diagnostics) due to their antimicrobial properties. The purpose of this study is to characterize from physicochemical perspective the colloidal dispersion obtained through phyto-synthesis. The existence of colloidal silver particles was visually highlighted through Thyndall effect. The bio-reduction of silver ions was analyzed through modern techniques, UV-VIS spectrophotometry and Hyperspectral Microscopy. After getting the colloidal dispersion, its antibacterial activity was proved by sowing on different plates the following types of pathogenic agents: Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa. The UV-VIS spectrum for the methanolic extract with 10% H. perforatum L. and for the silver colloidal dispersions was achieved, observing a max at 455 nm. The hyperspectral images were achieved observing the shape, conformation, and the size of the obtained particles. During the antibacterial efficacy testing on those three strains of pathological agents, in all situations, the colloidal dispersion had a promising antimicrobial effect.

Microalbuminuria is a cardiovascular risk factor in type 2 diabetes mellitus patients. It is very important to know which the predictor factors for albuminuria are, because these elements may be influenced by pharmacological measures. In our study we propose three models for the prediction of albumin glomerular excretion in a group of 446 type 2 diabetes mellitus patients: the clinical-biochemical model, the pharmacological model, and the integrative model that reunites the two models. In the clinical-biochemical model, albumin excretion was statistically significant influenced by HbA1c (positive correlation) and blood pressure (positive correlation). In the pharmacological model, albumin excretion was influenced by angiotensin converting enzyme inhibitors or angiotensin II receptor blockers treatment (negative correlation). In the integrative model, the factors were HbA1c (positive correlation), diastolic blood pressure (positive correlation), angiotensin converting enzyme inhibitors or angiotensin II receptor blockers treatment (negative correlation) and statins treatment (negative correlation). The prevalence of microalbuminuria was 16.14 %. Patients with microalbuminuria had statistically significant higher values of HbA1c, systolic blood pressure, diastolic blood pressure, triglycerides and lower values of HDL-cholesterol. A low glucose control was the most important risk factor for an increased albumin glomerular elimination. The importance of our study consists in the fact that all the elements that predict albuminuria can be influenced: HbA1c, blood pressure, therapy with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers and statins.

Oxidative stress is a complex biological process characterized by the excessive production of reactive oxygen species (ROS) that act as destroyers of the REDOX balance in the body and, implicitly, inducing oxidative damage. All the metabolisms are impaired in oxidative stress and even nucleic acid balance is influenced. ROS will promote structural changes of the tissues and organs due to interaction with proteins and phospholipids. The constellation of the cardiovascular risk factors (CVRFs) will usually develop in subjects with predisposition to cardiac disorders. Oxidative stress is usually related with hypertension (HTN), diabetes mellitus (DM), obesity and cardiovascular diseases (CVDs) like coronary artery disease (CAD), cardiomyopathy or heart failure (HF), that can develop in subjects with the above-mentioned diseases. Elements describing the complex relationship between CVD and oxidative stress should be properly explored and described because prevention may be the optimal approach. Our paper aims to expose in detail the complex physiopathology of oxidative stress in CVD occurrence and novelties regarding the phenomenon. Biomarkers assessing oxidative stress or therapy targeting specific pathways represent a major progress that actually change the outcome of subjects with CVD. New antioxidants therapy specific for each CVD represents a captivating and interesting future perspective with tremendous benefits on subject's outcome.

Non-alcoholic fatty liver disease (NAFLD) has a growing prevalence in recent years. Its association with cardiovascular disease has been intensively studied, and certain correlations have been identified. The connection between these two entities has lately aroused interest regarding therapeutic management. In order to find the best therapeutic options, a detailed understanding of the pathophysiology that links (NAFLD) to cardiovascular comorbidities is needed. This review focuses on the pathogenic mechanisms that are behind these two diseases and on the therapeutic management available at this time.

The no-reflow phenomenon following primary percutaneous coronary intervention (PPCI) in acute ST-elevation myocardial infarction (STEMI) patients is a predictor of unfavorable prognosis. Patients with no-reflow have many complications during admission, and it is considered a marker of short-term mortality. The current research emphasizes the circumstances of the incidence and complications of the no-reflow phenomenon in STEMI patients, including in-hospital mortality. In this case-control study, conducted over two and a half years, there were enrolled 656 patients diagnosed with STEMI and reperfused through PPCI. Several patients (n = 96) developed an interventional type of no-reflow phenomenon. One third of the patients with a no-reflow phenomenon suffered complications during admission, and 14 succumbed. Regarding complications, the majority consisted of arrhythmias (21.68%) and cardiogenic shock (16.67%). The anterior localization of STEMI and the left anterior descending artery (LAD) as a culprit lesion were associated with the highest number of complications during hospitalization. At the same time, the time interval &gt, 12 h from the onset of the typical symptoms of myocardial infarction (MI) until revascularization, as well as multiple stents implantations during PPCI, correlated with an increased incidence of short-term complications. The no-reflow phenomenon in patients with STEMI was associated with an unfavorable short-term prognosis.

Current therapies for Parkinson’s disease (PD) are palliative, of which the levodopa/carbidopa therapy remains the primary choice but is unable to modulate the progression of neurodegeneration. Due to the complication of such a multifactorial disorder and significant limitations of the therapy, numerous genetic approaches have been proved effective in finding out genes and mechanisms implicated in this disease. Following the observation of a higher frequency of PD in Gaucher’s disease (GD), a lysosomal storage condition, mutations of glycosylceramidase beta (GBA) encoding glucocerebrosidase (GCase) have been shown to be involved and have been explored in the context of PD. GBA mutations are the most common genetic risk factor of PD. Various studies have revealed the relationships between PD and GBA gene mutations, facilitating a better understanding of this disorder. Various hypotheses delineate that the pathological mutations of GBA minimize the enzymatic activity of GCase, which affects the proliferation and clearance of α-synuclein; this affects the lysosomal homeostasis, exacerbating the endoplasmic reticulum stress or encouraging the mitochondrial dysfunction. Identification of the pathological mechanisms underlying the GBA-associated parkinsonism (GBA + PD) advances our understanding of PD. This review based on current literature aims to elucidate various genetic and clinical characteristics correlated with GBA mutations and to identify the numerous pathological processes underlying GBA + PD. We also delineate the therapeutic strategies to interfere with the mutant GCase function for further improvement of the related α-synuclein–GCase crosstalks. Moreover, the various therapeutic approaches such as gene therapy, chaperone proteins, and histone deacetylase inhibitors for the treatment of GBA + PD are discussed.

Clostridioides difficile (CD) is responsible for nosocomial diarrhea syndrome with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to additional health risks. Patients with recurrence of this disease are difficult to identify, so the purpose of this study is to quantify various demographic, clinical, and treatment factors that could prevent further progression to recurrence of the disease. In the period 2018&ndash, 2019, about 195 patients were diagnosed with more than one episode of CDI in the three months following the first episode. The recurrence rate for CDI was 53.84% (60.95% for one episode and 39.05% for multiple episodes). Most commonly afflicted were 60&ndash, 69-year-old patients, or those with higher Charlson Comorbidity Index (CCI). Multiple analyses associated cardiovascular (odds ratios (OR) = 3.02, 95% confidence intervals (CI) = 1.23&ndash, 7.39, p = 0.015), digestive (OR = 3.58, 95% CI = 1.01&ndash, 12.63, p = 0.047), dementia (OR = 3.26, 95% CI = 1.26&ndash, 8.41, p = 0.014), immunosuppressive (OR = 3.88, 95% CI = 1.34&ndash, 11.21, p = 0.012) comorbidities with recurrences. Risk factor identification in the first episode of CDI could lead to the implementation of treatment strategies to improve the patients&rsquo, quality of life affected by this disease.

This study explored the link between insulin sensitivity, insulin resistance and leptinaemia in people with prediabetes with and without non-alcoholic fatty liver disease (NAFLD). A total of 143 prediabetes patients were evaluated in the study. Ultrasonography was used for diagnosis of NAFLD, and fasting insulin, postprandial insulin, leptin levels, common clinical/biochemical determinations were determined. In total, 69 (48.25%) of the patients were diagnosed with NAFLD and 74 (51.75%) without NAFLD. Leptin values correlated statistically with fasting insulin in prediabetes patients, while in the patients that were also diagnosed with NAFLD the correlation was stronger. Values of log-leptin

Non-alcoholic fatty liver disease (NAFLD) is a component of metabolic syndrome that significantly increases the cardiovascular risk of patients with glucose metabolism alterations. This study identified the prevalence of NAFLD, predictors of NAFLD and explored the link between insulin sensitivity, insulin resistance and leptinemia in 143 patients registered with prediabetes. Abdominal ultrasound was performed, and fasting insulin, postprandial insulin, leptin levels, common clinical/biochemical determinations were assessed. Certain variables that can predict NAFLD existence were determined and it was found that there is a high prevalence of NAFLD in patients with prediabetes. In univariate analysis, statistically significant associations (P

Anticoagulant therapy represents a pivotal element that strongly influences the thromboembolic risk of non-valvular atrial fibrillation (NVAF) subjects. The main purpose of this review was to identify issues and suggest strategies to improve the oral anticoagulants (OACs) treatment adherence, which is the most important predictor of NVAF outcome. Advantages, efficacy, and impact of these drugs on patients' prognosis were revealed in important clinical trials on large cohorts of patients and are often prescribed nowadays. A real-life data registry, the Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD-AF) analyzed the profile and outcome of patients diagnosed with NVAF receiving oral antithrombotic treatment. The observations gathered in the registry were crucial for identifying relevant elements that clinicians must improve, such as adherence strategies and predisposing factors that correlated with stroke. Adherence to OACs in AF patients is essential from the viewpoint of clinical efficacy and safety. Major adverse events and negative outcome are correlated with a weak anticoagulation control caused by an ineffective treatment adherence strategy. Solving the issue of oral anticoagulation adherence is possible using new technologies, but future directions should be explored. Mobile phone applications centered on patients' needs, telemedicine programs that evaluate patients' evolution and detect adverse reactions or events, encouraging an adequate management of the event without interruption of OACs, represent perspectives with a major impact on treatment adherence.

A well-functioning immune system of the host body plays pivotal role in the maintenance of ordinary physiological and immunological functions as well as internal environment. Balanced immunity enhances defense mechanism against infection, diseases and unwanted pathogens to avoid hypersensitivity reactions and immune related diseases. The ideal immune responses are the results of corrective interaction between the innate immune cells and acquired components of the immune system. Recently, the interest towards the immune system increased as significant target of toxicity due to exposure of chemicals, drugs and environmental pollutants. Numerous factors are involved in altering the immune responses of the host such as sex, age, stress, malnutrition, alcohol, genetic variability, life styles, environmental-pollutants and chemotherapy exposure. Immunomodulation is any modification of immune responses, often involved induction, amplification, attenuation or inhibition of immune responses. Several synthetic or traditional medicines are available in the market which promptly have many serious adverse effects and create pathogenic resistance. Phytochemicals are naturally occurring molecules, which significantly play an imperative role in modulating favorable immune responses. The present review emphasizes on the risk factors associated with alterations in immune responses, and immunomodulatory activity of phytochemicals specifically, glycosides, alkaloids, phenolic acids, flavonoids, saponins, tannins and sterols and sterolins.

The issue of drug disposal, as well as the development and implementation of efficient collection strategies, represents an important concern at the highest European level. This research looks into the factors that could have an impact on the efficiency of pharmacies in collecting and disposing the medicinal waste of the population. There were 521 pharmacists from all over the country who filled in a questionnaire on their opinion/attitude related to the system of collecting and disposing the pharmaceutical waste of the population. Of the surveyed pharmacists, 16% work in pharmacies that do not collect unused/expired drugs from the population, and nearly 33% of those investigated have refused, at least once, to take the unused medicines from the people. Pharmacists&rsquo, most important reasons for refusing to collect the pharmaceutical waste were the lack of procedure, incomplete legislation, exceeding the amount contracted with the operators, and high costs. Results show that pharmacies in Romania face several deficiencies in the pharmaceutical waste collection services. The lack of implemented programs has contributed considerably to lower standards of pharmaceutical waste management in Romania. This study is the first research on this topic in Romania, a country where the management of drug-based waste generated by the population is at the beginning. The results shown in this survey can provide a reference point for competent authorities in developing and implementing a take-back program for waste medicine whose efficiency is superior to the existing ones.

Stroke is a leading cause of mortality worldwide, as well as a source of long-term disabilities and huge socioeconomic costs. This study investigates the effects of resveratrol, an antioxidant supplement, on blood pressure, weight status, glucose, and lipid profile in patients who had a stroke in the last 12 months. Two hundred and twenty-eight patients were divided into three groups: group I received only allopathic treatment (control group), while groups II and III received allopathic treatment with a daily supplementation of oral resveratrol (100 and 200 mg, resp.) for 12 months. In all groups, the changes of the studied parameters were monitored at 6 and 12 months from the initial evaluation. In groups II and III, resveratrol induced significant changes (p<0.05) in the blood pressure, body mass index, as well as all parameters of the lipid profile, and glucose (in nondiabetic patients), compared to the control group. The supplementation of the allopathic treatment with resveratrol had a beneficial effect on all monitored parameters, which serve as major risk factors for stroke.

The spreading of Mycobacterium tuberculosis (MT) through lymphohematogenous pathways with multi-organ damage is disseminated tuberculosis (DT). The case of a child presenting disseminated tuberculosis and who had an acute cytomegalovirus (CMV) infection at the onset of the disease is described in this study. Patient aged 2 presented to Municipal Clinical Hospital of Oradea, Oradea, Romania area with high fever, generalized lymphadenopathy, multiple abscesses of the skin, poor growth, having a background with numerous hospitalizations for respiratory infections in the paediatric department. Chest and head radiography and computed tomography of the same areas show bilateral pleural effusion and osteolytic lesions. The presence of MT was determined from cultures of gastric aspirate and skin lesions. Serology for CMV-specific IgG and IgM antibodies was positive. The treatment of the patient was recommended following the National Tuberculosis Protocol precisely. The patient`s response to treatment was slow. In order to diagnose DT in children (where this disease is severe and rare), a multidisciplinary approach combined with complex and sometimes invasive paraclinical investigations is required.