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Communication is a vital skill in the medical world and it differs from the communication in any other areas due to the particular problems that are exposed and their intimate nature. The talent to speak effectively with the patient constitutes a basic element in achieving a safe and successful medical act. The art of conversation in the relationship between the doctor and his patient must be learned and mastered with craftsmanship especially when the patients are children. Because communication is the most common “medical procedure”, it is important for the physician to have the ability to communicate openly, to show tolerance and compassion for the patient, in order to carry out an effective daily medical activity. Diagnostic errors in pediatrics represent a branch which is less explored and accepted. Mistakes are not easy to accept by anyone, and doctors make no exception. In order to carry out his activity in optimum conditions, a doctor must be versed not only in pediatrics pathology, but also in child psychology.

The physical rehabilitation of patients with cardiovascular pathology is poorly studied and developed in our country, especially in patients with heart failure. There are studies in the literature that confirm that a decrease in the grasping force of the hand is associated with an increase in morbidity and mortality. The physical deconditioning of patients with heart failure can be assessed with the help of the Amadeo robot, which is a device capable of measuring the flexion and extension force of the hand in kilograms. Material and methods. We prospectively analyzed a group of 44 patients diagnosed with heart failure class II-III NYHA who were hospitalized between June 17 and July 15, 2019 in the Cardiology Department of Elias Hospital. We evaluated the grasping force of the hand of patients with heart failure using the Amadeo robot. The Amadeo robot is a device used in the rehabilitation of stroke patients, which can measure the flexion and extension force of the hand using sensors attached to the hand and fingers. Results. By evaluating patients with heart failure using the Amadeo robot, the average value of the hand extension force was 2.364 kg at admission and 2.264 kg at discharge. The flex-ion force of the hand was 6.78 kg at admission and 7.361 kg at discharge. Patients enrolled in the study who had valvulopathies, atrial fibrillation and diabetes had a lower value of the extension force of the hand compared to patients with heart failure who did not have these pathologies. Patients with valvulopathies, high blood pressure, and ischemic heart disease also had a lower flexion strength than those without these diseases. Conclusions. It is known that the grasping force of the hand is an important indicator in assessing the fragility status of patients. Patients with heart failure are frail patients with multiple comorbidities in which physical deconditioning acts as a negative prognostic factor on morbidity, mortality, and increased hospitalization rates. Thus, the physical rehabilitation of patients with heart failure is essential for increasing the quality of life and also for decreasing morbidity and mortality and the rate of hospitalization. [ABSTRACT FROM AUTHOR]

Lately, easier and shorter tests have been used in the functional evaluation of cardiac patients. Among these, walking speed (WS) and Timed Up and Go (TUG) tests are associated with all-cause mortality, mainly cardiovascular and the rate of re-hospitalization, especially in the elderly population. We prospectively analyzed a group of 38 patients admitted to the Cardiology Clinic from Elias Hospital, Romania, with chronic coronary syndrome (CCS) (n=22) and STEMI (n=16). We assessed the patients immediately after admission and before discharge with G-WALK between the 1st and 30th of September 2019. Our study group had a mean age of 62.7±12.1 years. Patients with a low WS were older (69.90±12.84 vs. 59.90±10.32 years, p=0.02) and had a lower serum hemoglobin (12.38±1.20 vs. 13.72±2.07 g/dl, p=0.02). The WS significantly improved during hospitalization (p=0.03) after optimal treatment. The TUG test performed at the time of admission had a longer duration in patients with heart failure (14.05 vs. 10.80 sec, p=0.02) and was influenced by patients' age (r=0.567, p=0.02), serum creatinine (r=0.409, p=0.03) and dilation of right heart chambers (r=0.399, p=0.03). WS and TUG tests can be used in patients with CCS and STEMI, and are mainly influenced by age, thus having a greater value among the elderly. [ABSTRACT FROM AUTHOR]

Physical rehabilitation programs for patients with heart failure (HF) are underdeveloped in our country. In order to establish the correct rehabilitation plan, the first step is to evaluate the patient’s functional capacity. G-Walk is a simple and effective test in assessing functional capacity. The aim of the study is to analyze the correlation between the results obtained in Timed Up and Go (TUG) and walking speed test and the prognosis of patients with heart failure. Material and methods. We prospectively analyzed a group of 44 patients with heart failure class II-III NYHA hospitalized in the Cardiology Department of Elias Hospital between June 17 and July 15, 2019.We evaluated the functional mobility of the patients with heart failure with the G-Walk device that contains a wireless sensor. The G-Walk device represents a gait analysis system, performing – according to a protocol – 2 tests: Walk (patient’s walking speed) and TUG (measures balance and mobility). Results. After analyzing the walking speed, the patients were divided into 2 groups: those with a speed <0.8 m/s and those with a speed> 0.8 m/s. Out of 44 patients, 21 patients had a walking speed < 0.8 m/s and 23 patients had a walking speed > 0.8 m/s. It was seen that patients with lower walking speed (V < 0.8 m/s) versus patients with better walking speed (V > 0.8 m/s) were older, had a lower body weight, a lower blood pressure value, a lower value of the oxygen saturation, a lower value of sodium and a higher blood glucose value. After analyzing the value of the TUG test, patients were divided into 2 groups: patients with a TUG test duration < 15 seconds and patients with a TUG test duration > 15 seconds. Thus, out of 44 patients studied, 19 patients had a TUG value < 15 seconds and 25 patients had a TUG value over 15 seconds. It was observed that patients with a higher TUG value (> 15 seconds) versus patients with normal TUG value (< 15 seconds) were older, had a higher creatinine value and a higher blood glucose value. Conclusions. It has been shown that a low value of walking speed and mobility is associated with increased morbidity and mortality of all causes in elderly patients with cardiovascular disease. The physical rehabilitation of patients with heart failure is very important for improving the quality of life. [ABSTRACT FROM AUTHOR]

Dysregulation of the biosynthesis of cholesterol and other lipids has been implicated in many neurological diseases, including Parkinson's disease. Misfolding of α‐synuclein (α‐Syn), the main actor in Parkinson's disease, is associated with changes in a lipid environment. However, the exact molecular mechanisms underlying cholesterol effect on α‐Syn binding to lipids as well as α‐Syn oligomerization and fibrillation remain elusive, as does the relative importance of cholesterol compared to other factors. We probed the interactions and fibrillation behaviour of α‐Syn using styrene–maleic acid nanodiscs, containing zwitterionic and anionic lipid model systems with and without cholesterol. Surface plasmon resonance and thioflavin T fluorescence assays were employed to monitor α‐Syn binding, as well as fibrillation in the absence and presence of membrane models. 1H‐15N‐correlated NMR was used to monitor the fold of α‐Syn in response to nanodisc binding, determining individual residue apparent affinities for the nanodisc‐contained bilayers. The addition of cholesterol inhibited α‐Syn interaction with lipid bilayers and, however, significantly promoted α‐Syn fibrillation, with a more than a 20‐fold reduction of lag times before fibrillation onset. When α‐Syn bilayer interactions were analysed at an individual residue level by solution‐state NMR, we observed two different effects of cholesterol. In nanodiscs made of DOPC, the addition of cholesterol modulated the NAC part of α‐Syn, leading to stronger interaction of this region with the lipid bilayer. In contrast, in the nanodiscs comprising DOPC, DOPE and DOPG, the NAC part was mostly unaffected by the presence of cholesterol, while the binding of the N and the C termini was both inhibited. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the effects of neuromuscular electrical stimulation (NMES) therapy on functional capacity and oxidative stress in patients hospitalized for acute heart failure (AHF). Design: We included 30 consecutive patients admitted for AHF with a left ventricular ejection fraction ≤ 50% who were randomized into two groups: NMES therapy added on conventional rehabilitation (CR) (n = 15, 67.2 ±13.35 years) and CR alone (n = 15, 63.26 ± 10.29 years). NMES therapy was performed at the level of the quadriceps muscle bilaterally, daily, for 60 minutes with a frequency of 10 Hz. Results: The mean duration of NMES therapy was 6.93 ± 2.54 days. Functional capacity assessed by the 6 minute walk test was significantly improved in the group with NMES therapy (p=0.036). The oxidized LDL value showed a decreasing trend compared to the admission value in the group with NMES therapy, but without statistical significance. Conclusion: This paper shows that for patients with AHF, NMES therapy used for a short term and initiated early during the hospitalization period improves exercise tolerance, suggesting the importance and possible necessity of including it as standard cardiac recovery therapy. NMES did not influence the plasmatic value of oxidized LDL. [ABSTRACT FROM AUTHOR]

Addison's disease, also named primary adrenal insufficiency, rare on children, can occur in both acute and chronic form. Acute adrenocortical insufficiency, also called adrenal or addisonian crisis, is severe and life-threatening. Except for this situation, the diagnosis may be delayed. Omission or delay of diagnosis occurs most frequently because of the misleading clinical picture, as the main symptoms (fatigue, anorexia and weight loss) are nonspecific, and can be found also in other disorders. Once suspected, it must be confirmed or disproven by dosing cortisol and ACTH hormones. We present the case of a girl who was diagnosed only when the adrenal crisis occurred. [ABSTRACT FROM AUTHOR]

Introduction: Patient safety is fundamental for a qualitative medical system. Although the topic of medical errors has been in the spotlight for many years, they continue to be responsible for many deaths worldwide. Out of these, the highest morbidity is claimed by diagnostic errors. Cognition is the key factor responsible for this type of errors. The aim of this study was to evaluate how medical residents are taught to employ cognition in the process of clinical reasoning. Materials and methods: The study made use of a 14-items online questionnaire filled in by 51 male and female medical residents in Iasi, Romania, between July 4th and September 4th 2017. Results and discussion: Most of the respondents (84.2%) have recognized the existence of cognitive biases during the diagnostic process. Almost half of the contributing residents (41.2%) think that the experience of older physicians is helping them commit less cognitive errors. The same percentage of respondents admits that they do not know how to reduce the incidence of diagnostic errors. Conclusions: The survey reveals the lack of information in preventing diagnostic errors and the need for education regarding clinical reasoning during residency training. [ABSTRACT FROM AUTHOR]

Communication is a vital skill in the medical world and it differs from the communication in any other areas due to the particular problems that are exposed and their intimate nature. The talent to speak effectively with the patient constitutes a basic element in achieving a safe and successful medical act. The art of conversation in the relationship between the doctor and his patient must be learned and mastered with craftsmanship especially when the patients are children. Because communication is the most common “medical procedure”, it is important for the physician to have the ability to communicate openly, to show tolerance and compassion for the patient, in order to carry out an effective daily medical activity. Diagnostic errors in pediatrics represent a branch which is less explored and accepted. Mistakes are not easy to accept by anyone, and doctors make no exception. In order to carry out his activity in optimum conditions, a doctor must be versed not only in pediatrics pathology, but also in child psychology. [ABSTRACT FROM AUTHOR]

Communication is a vital skill in the medical world and it differs from the communication in any other areas due to the particular problems that are exposed and their intimate nature. The talent to speak effectively with the patient constitutes a basic element in achieving a safe and successful medical act. The art of conversation in the relationship between the doctor and his patient must be learned and mastered with craftsmanship especially when the patients are children. Because communication is the most common “medical procedure", it is important for the physician to have the ability to communicate openly, to show tolerance and compassion for the patient, in order to carry out an effective daily medical activity. Diagnostic errors in Pediatrics represent a branch which is less explored and accepted. Mistakes are not easy to accept by anyone, and doctors make no exception. In order to carry out his activity in optimum conditions, a doctor must be versed not only in Pediatrics pathology, but also in child psychology. [ABSTRACT FROM AUTHOR]

The CW domain binds to histone tail modifications found in different protein families involved in epigenetic regulation and chromatin remodeling. CW domains recognize the methylation state of the fourth lysine on histone 3 and could, therefore, be viewed as a reader of epigenetic information. The specificity toward different methylation states such as me1, me2, or me3 depends on the particular CW subtype. For example, the CW domain of ASHH2 methyltransferase binds preferentially to H3K4me1, and MORC3 binds to both H3K4me2 and me3 modifications, while ZCWPW1 is more specific to H3K4me3. The structural basis for these preferential bindings is not well understood, and recent research suggests that a more complete picture will emerge if dynamical and energetic assessments are included in the analysis of interactions. This study uses fold assessment by NMR in combination with mutagenesis, ITC affinity measurements, and thermal denaturation studies to investigate possible couplings between ASHH2 CW selectivity toward H3K4me1 and the stabilization of the domain and loops implicated in binding. The key elements of the binding site-the two tryptophans and the α1-helix form and maintain the binding pocket- were perturbed by mutagenesis and investigated. Results show that the α1-helix maintains the overall stability of the fold via the I915 and L919 residues and that the correct binding consolidates the loops designated as η1 and η3, as well as the C-terminal. This consolidation is incomplete for H3K4me3 binding to CW, which experiences a decrease in overall thermal stability on binding. Loop mutations not directly involved in the binding site, nonetheless, affect the equilibrium positions of the key residues., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Bril’kov, Dobrovolska, Ødegård-Fougner, Turcu, Strømland, Underhaug, Aasland and Halskau.)