Diagnosis and Management of Simple and Complicated Meconium Ileus in Cystic Fibrosis, a Systematic Review.

The early management of neonates with meconium ileus (MI) and cystic fibrosis (CF) is highly variable across countries and is not standardized. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The protocol was registered in PROSPERO (CRD42024522838). Studies from three providers of academic search engines were checked for inclusion criteria, using the following search terms: meconium ileus AND cystic fibrosis OR mucoviscidosis. Regarding the patient population studied, the inclusion criteria were defined using our predefined PICOT framework: studies on neonates with simple or complicated meconium which were confirmed to have cystic fibrosis and were conservatively managed or surgically treated. Results: A total of 566 publications from the last 10 years were verified by the authors of this review to find the most recent and relevant data, and only 8 met the inclusion criteria. Prenatally diagnosed meconium pseudocysts, bowel dilation, and ascites on ultrasound are predictors of neonatal surgery and risk factor for negative 12-month clinical outcomes in MI-CF newborns. For simple MI, conservative treatment with hypertonic solutions enemas can be effective in more than 25% of cases. If repeated enemas fail to disimpact the bowels, the Bishop-Koop stoma is a safe option. No comprehensive research has been conducted so far to determine the ideal surgical protocol for complicated MI. We only found three studies that reported the types of stomas performed and another study comparing the outcomes of patients depending on the surgical management; the conclusions are contradictory especially since the number of cases analyzed in each study was small. Between 18% and 38% of patients with complicated MI will require reoperation for various complications and the mortality rate varies between 0% and 8%. Conclusion: This study reveals a lack of strong data to support management decisions, unequivocally shows that the care of infants with MI is not standardized, and suggests a great need for international collaborative studies.

The Role of Natural Extracts in the Management of Infantile Hemangiomas and Vascular Tumors.

Hemangiomas are vascular tumors resulting from the proliferation of endothelial-like cells; they are the most common childhood tumors, affecting approximately 5-10% of newborns and infants. Besides hemangiomas, which are definitely benign tumors despite their overgrowth potential, there are other vascular tumors like hemangioendotheliomas, which may display intermediate characteristics between benign hemangiomas and highly malignant angiosarcomas. Standard therapy may be constricted by serious adverse effects, high cost, or traumatic influence. Diet is a major resource for health preservation, disease prevention, and treatment. The therapeutic property of edible berries, marine products, or medicinal plants have long been known and used in traditional medicine; a plant-based nutrition can prevent the development and progression of diseases associated with extensive neo-vascularization. The purpose of our review is to highlight those natural treatments that hemangioma and vascular tumor patients can receive in the future, both for their benefit and that of their families. We performed the review according to the Preferred Reporting Items for Systematic Reviews and Metanalysis Statement. We used the Web of Science, PubMed, and EMBASE engines for the study, and searched for the association of hemangioma with naturopathic treatment/plant extract/plants in published articles. We found that natural extracts from plants and fruits are cost-effective and safe treatments for hemangiomas and vascular tumors, as well as for other forms of cancer. In any case, more in vitro and in vivo studies are needed to confirm the proposed signaling pathways in tumors and validate the improvement parameters after natural products administration. The era of molecularly targeted therapy and personalized medicine is approaching and naturally occurring substances are very useful tools for tumor treatment and prevention. Plant extract substances have strong specificity and pertinence, are non- toxic and have few side effects, and may become an emerging cancer treatment.

Blood and Salivary Cortisol Variations in Athletes in Relation to Cardiopulmonary Exercise Testing.

Background and Objectives: Cortisol is a valuable marker for assessing the body's response to any form of stress. We conducted this study in order to evaluate the variations of salivary and serum cortisol levels in professional football players in relation to cardiopulmonary exercise testing (CPET) and their significance in potentially evaluating overtraining in athletes. Also, the question of whether salivary cortisol determination could fully substitute serum sampling was addressed. Materials and Methods: A total of 19 male professional football players were evaluated by measuring serum cortisol levels at rest (T0) and immediately after a CPET (T1) and salivary cortisol levels at rest (T0), 10 min after a CPET (T2), and 30 min after a CPET (T3). Results: T0 serum cortisol showed a statistically significant correlation with the oxygen uptake at the anaerobic threshold divided by the body weight (VO2-AT/weight), as did the T2 salivary cortisol with the maximum oxygen uptake at the anaerobic threshold (VO2-AT) and VO2-AT/weight. T0 salivary cortisol was significantly correlated with the subjects' height and the predicted O2 pulse. Conclusions: While some correlations were discovered, they are insufficient to recommend cortisol as a routine biomarker in athletes' evaluation. However, significant correlations were established between salivary and serum determinations, meaning that the non-invasive procedure could substitute venous blood sampling.

Eating Habits in Patients with Familial Hypercholesterolemia from North-Eastern Romania.

(1) Background: Familial hypercholesterolemia (FH) is a genetic autosomal dominant disorder characterized by elevated levels of low-density lipoprotein cholesterol (LDL) that develops deposits of lipids in the arterial wall. Since it is underdiagnosed and undertreated, the disease has a high risk of premature cardiovascular disease and death. Patients are not always aware of the changes they should make in their diet. Thus, our study aimed to evaluate through a food frequency questionnaire their eating habits. (2) Methods: We included 70 patients with FH and 20 subjects in a control group that were evaluated through a physical examination and blood tests. They also completed a food frequency questionnaire. (3) Results: Throughout our study, we observed several aspects: regardless of age, patients with FH had higher carbohydrate intakes compared to the control group; from the same group, a positive correlation was observed between salami intake and the levels of glucose and glycated hemoglobin. Moreover, the sour cream preference was associated with higher liver function tests. In the control group, we observed a higher intake of pasta and fast food and fewer fruit portions. (4) Conclusions: As far as we know, this is the first study from Romania that evaluated the eating habits of patients diagnosed with FH. Our study reveals that, although patients with FH avoid junk food, they still have a high intake of carbohydrates when compared to the control group. Further research is needed in order to get a comprehensive nutritional evaluation of these patients.

Value of the Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting CPET Performance in Patients with Stable CAD and Recent Elective PCI.

Background and Objectives: Functional capacity (FC) assessed via cardiopulmonary exercise testing (CPET) is a novel, independent prognostic marker for patients with coronary artery disease (CAD). Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are two readily available predictors of systemic inflammation and cardiovascular event risk, which could be used as cost-effective predictors of poor FC. The purpose of this study was to evaluate the utility of NLR and PLR in predicting poor FC in patients with CAD and recent elective percutaneous coronary intervention (PCI). Materials and Methods: Our cross-sectional retrospective analysis included 80 patients with stable CAD and recent elective PCI (mean age 55.51 ± 11.83 years, 71.3% male) who were referred to a cardiovascular rehabilitation center from January 2020 to June 2021. All patients underwent clinical examination, cardiopulmonary exercise testing on a cycle ergometer, transthoracic echocardiography and standard blood analysis. Results: Patients were classified according to percent predicted oxygen uptake (% VO2 max) in two groups­poor FC (≤70%, n = 35) and preserved FC (>70%, n = 45). There was no significant difference between groups regarding age, gender ratio, presence of associated comorbidities, left ventricular ejection fraction and NLR. PLR was higher in patients with poor FC (169.8 ± 59.3 vs. 137.4 ± 35.9, p = 0.003). A PLR cut-off point of 139 had 74% sensitivity and 60% specificity in predicting poor FC. After multivariate analysis, PLR remained a significant predictor of poor functional status. Conclusions: Although CPET is the gold standard test for assessing FC prior to cardiovascular rehabilitation, its availability remains limited. PLR, a cheap and simple test, could predict poor FC in patients with stable CAD and recent elective PCI and help prioritize referral for cardiovascular rehabilitation in high-risk patients.

Implications of the COVID-19 Pandemic on Children and Adolescents: Cognitive and Emotional Representations.

The present research investigated children and adolescents' explicit and spontaneous representation of the COVID-19 pandemic and their related emotions, cognitions, and coping strategies. We explored the self-reported protective factors and coping mechanisms, in addition to similar attributional emotional experiences, i.e., the ways participants evaluated others' pandemic experiences. Our sample consisted of 155 children and adolescents aged 10 to 13 (M = 10.70, SD = 0.85, 56.1% females). We designed a 12-item survey and analyzed our data using both qualitative and quantitative methods. Our findings suggested that most children and adolescents associated masks with the thought of the novel coronavirus, and the most frequently associated emotion was sadness (45.2%), followed by fear (17.4%). Generally, participants reported a medium level of perceived adverse effects of the pandemic, mainly because their regular physical school classes moved to the online setting. We also found a significant association between children's self-reported levels of harmful effects of the pandemic and perceived adverse effects on their families. Most participants expressed their dissatisfaction concerning online school classes, primarily due to poor online interaction. In our sample, the children and adolescents reported positive thoughts and family relationships as their primary coping mechanisms during the pandemic, suggesting similar perceived coping mechanisms in the others around them. Finally, more than half of the participants considered that the COVID-19 pandemic had no positive effects, while 40% considered the increased time spent with their families the primary positive consequences following the COVID-19 health crisis. Results are discussed regarding their implications concerning healthcare, social, and educational policies.

CHARACTERISTICS OF RESPIRATORY MECHANICS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE.

UNLABELLED: In chronic obstructive pulmonary disease (COPD) the changes in respiratory thoracoabdominal mechanics result from both hyperinflation and functional and structural skeletal muscle alterations. AIM: Evaluation of the particularities of respiratory movement in COPD and identification of inter-relations between respiratory thoraco-abdominal mechanics and clinical and functional respiratory status. MATERIALS AND METHODS: This study comparatively analyzed the respiratory thoracoabdominal mechanics recorded by polygraphy, using piezoelectric film belts, in 34 COPD patients and 30 healthy subjects, during rest, and during 6-minute walk test. RESULTS: In COPD patients, phase angle between direction of thoracic and abdominal respiratory movements presented significantly higher values compared to the control group, for supine (p = 0.023) and sitting position (p = 0.001), revealing the presence of paradoxical respiratory movements. Furthermore, phase angle dynamics increased significantly during walking test compared to sitting position (p = 0.001). Quantitative difference of end-expiratory pulmonary volume (qDEEL) correlated with pack-years (r = 0.372, p = 0.03) in supine position, and with body mass (r = 0.338, p = 0.05) and St. George activity score (r = 0.353, p = 0.041) during walking test. Rib cage inspiratory contribution to tidal volume ratio (%RCi) inversely correlated with pack-years (r = -0.417, p = 0.014) and body mass index (r = - 0.344, p = 0.047) in supine position, and with St. George activity score (r = 0.345, p = 0.046) in sitting position. CONCLUSIONS: In COPD patient thoracoabdominal mechanics is characterized by paradoxical respiratory movements, more prominent during exercise. The alteration of thoracoabdominal mechanics correlated with St. George activity score, pack-years and body mass.

Venous pulmonary thromboembolism and atherothrombosis: need for a new approach.

Pulmonary venous thromboembolism and atherothrombosis are traditionally considered as distinct diseases. As the two entities share common risk factors and mechanisms current experimental and clinical studies support their mutual causal relationship. For the clinician, the current concept requires a different clinical, laboratory and therapeutic approach. The patient with a first arterial or venous thrombosis should be fully assessed for the risk of future clinical events, and, simultaneously addressed to aggressive preventive non-pharmacological and pharmacotherapy intervention. In this context, antiplatelet agents and statins have a potentially beneficial role.

Body composition alterations in chronic obstructive pulmonary disease.

UNLABELLED: Metabolic disorders are involved in the pathogenesis of some comorbid conditions such as atherosclerosis and cardiovascular diseases, which frequently occur in COPD patient. These disorders may also associate alterations in body composition. AIM: To determine the particularities of body composition, assessing its relationship with respiratory function and clinical status in COPD patients. MATERIAL AND METHODS: A prospective case-control study including 31 patients with COPD admitted to the Clinic of Pulmonary Diseases lasi from April 2011 to September 2012, and 29 subjects without lung diseases which served as controls. Body composition (body fat, lean body mass, body water) and basal metabolic rate were measured using bioelectrical impedance analysis. Other assessments included anthropometric parameters, spirometry, 6-minute walk test. In COPD patients, dyspnea scale and health impairment assessment by St George's Respiratory Questionnaire (SGRQ) were used. RESULTS: In COPD group, 67% of the patients were normal weight, 10% underweight, 10% overweight and 13% obese. The results showed that lean body mass (p < 0.001), dry lean mass (p < 0.001), total body water (p < 0.001) and basal metabolic rate (p < 0.001) were lower in the COPD patients as compared to the controls. These findings significantly correlate with age, dyspnea, severity of airway obstruction and exercise capacity in patients with COPD. No significant differences between study groups were observed in body fat mass. CONCLUSIONS: Lean body mass, dry lean mass, and total body water are altered in COPD patients and significantly correlate with age, clinical and functional severity of COPD.

Heart rate variations in chronic obstructive pulmonary disease.

UNLABELLED: Autonomic nervous system dysfunction proved in chronic obstructive pulmonary disease (COPD) patients might determine an elevated cardiovascular risk by heart rate alteration. AIM: To assess the particularities of heart rate as a possible cardiovascular risk factor in COPD patients. MATERIALS AND METHODS: This prospective, case-control study comparatively analyzed the pulse rate continuously recorded with a polygraph in 32 COPD patients and 29 healthy subjects during rest (supine and sitting position) and during submaximal exercise (6-minute walk test). The relation between pulse rate and respiratory, functional or clinical alterations was analyzed in COPD patients. RESULTS: The mean pulse rate was significantly higher during rest and exercise in COPD patients compared with the controls. However, the chronotropic response determined by exercise was similar in COPD and control groups: 55.19 beats/minute and 57.21 beats/minute, respectively (p=0.686). The mean pulse rate during exercise correlated with hypoxemia (r=-0.354, p=0.47) and with resting pulse rate (r=0.871, p<0.001 for supine position). CONCLUSIONS: COPD associates elevated pulse rates during both rest and exercise. Hypoxemia and resting pulse rate are determinatives of chronotropic response during submaximal exercise in COPD patients.

Body composition alterations in chronic obstructive pulmonary disease.

UNLABELLED: Metabolic disorders are involved in the pathogenesis of some co morbid conditions such as atherosclerosis and cardiovascular diseases, which frequently occur in COPD patient. These disorders may also associate alterations in body composition. AIM: To determine the particularities of body composition, assessing its relationship with respiratory function and clinical status in COPD patients. MATERIAL AND METHODS: A prospective case-control study including 31 patients with COPD admitted to the Clinic of Pulmonary Diseases lasi from April 2011 to September 2012, and 29 subjects without lung diseases which served as controls. Body composition (body fat, lean body mass, body water) and basal metabolic rate were measured using bioelectrical impedance analysis. Other assessments included anthropometric parameters, spirometry, 6-minute walk test. In COPD patients, dyspnea scale and health impairment assessment by St George's Respiratory Questionnaire (SGRQ) were used. RESULTS: In COPD group, 67% of the patients were normal weight, 10% underweight, 10% overweight and 13% obese. The results showed that lean body mass (p < 0.001), dry lean mass (p < 0.001), total body water (p < 0.001) and basal metabolic rate (p < 0.001) were lower in the COPD patients as compared to the controls. These findings significantly correlate with age, dyspnea, severity of airway obstruction and exercise capacity in patients with COPD. No significant differences between study groups were observed in body fat mass. CONCLUSIONS: Lean body mass, dry lean mass, and total body water are altered in COPD patients and significantly correlate with age, clinical and functional severity of COPD.

[Comparative evaluation of prognostic scores in pulmonary embolism ]. / Evaluarea comparativa a scorurilor prognostice in embolia pulmonara.

AIM: Pulmonary embolism is a life threatening disease and one of the main causes of in-hospital mortality. There are multiple risk stratification scoring systems for the forecast of the outcomes in patients with pulmonary embolism. MATERIAL AND METHODS: We conducted a prospective observational cohort study to evaluate the comparative validity of four prognostic models: pulmonary embolism severity index (PESI), simplified PESI score, PESI risk classes and shock index, for predicting short-term mortality in acute pulmonary embolism. The PESI and PESI--simplified scores and shock-index were calculated. PESI scores were segregated into risk class (I-V) obtaining PESI classes. Shock index was dichotomized into 0 (for value < 1) versus 1 (for value > 1) risk groups. We determined the area under Receiver Operating Characteristic curve, the sensitivity, specificity, likelihood ratio (LR+, LR-) for PESI score, simplified PESI score, PESI risk classes and shock index, to compare the ability of these scoring tools. RESULTS: The cohort consisted of 362 subjects. The mortality was 21.54%. The sensitivity, specificity and likelihood ratios were different between scores but the area under Receiver Operating Characteristic curve showed values in range 0.6-0.7. CONCLUSIONS: The assessed prognostic scores performed comparably for identifying pulmonary embolism patients at short-term risk of mortality, even for PESI score segregated in risk classes and dichotomized version of shock index.

Lung cancer - a comorbidity in chronic obstructive pulmonary disease.

Chronic Obstructive Pulmonary Disease (COPD) is an important public health challenge, representing the fourth leading cause of death in the world. A very important characteristic of COPD is represented by the coexistence of comorbidities. Lung cancer, a major cause of morbidity and mortality throughout the world, is also a frequent comorbidity in COPD. Cigarette smoking represents the best-known risk factor in both COPD and lung cancer, causing common pathogenic mechanisms like oxidative stress and inflammation. However, the etiopathogenic link between COPD and lung cancer implies a common underlying genetic susceptibility, acting in addition to environmental risk factors. These trigger more complex cellular and molecular mechanisms, represented by immune dysfunction, abnormal activation of transcription factors, altered signaling pathways, epithelial to mesenchymal transition. A better understanding of the etiopathogenic link between COPD and lung cancer at the molecular level will allow the discovery of more sensitive diagnostic methods and also new molecular targets for an efficient treatment.