Calcific constrictive pericarditis is an uncommon, yet severe manifestation of chronic pericardial inflammation, leading to diastolic heart failure through lower myocardial compliance secondary to pericardial stiffening. Its etiologies are diverse, including infectious, iatrogenic and autoimmune causes, with tuberculosis remaining a primary offender in endemic regions. We present the case of a 67-year-old male with a history of chronic obstructive pulmonary disease (COPD) and permanent atrial fibrillation, admitted with decompensated global heart failure. Chest radiography revealed extensive, circumferential pericardial calcifications, resembling a plate armour, and a large, calcified saccular collection. Echocardiography confirmed features of constriction, including septal bounce and annulus reversus. Computed tomography further delineated the “armored heart” morphology and a large, compressive, calcified collection over the right ventricle. Diagnostic pericardiocentesis yielded a smooth, “café au lait” coloured fluid. While microbiological analysis for Mycobacterium tuberculosis was negative, the pericardial fluid Adenosine Deaminase (ADA) level was exceptionally high at 952 U/L. The diagnosis of tuberculous effusive-constrictive pericarditis in its late, burnt-out fibrocalcific stage was thus established. This case provides a striking visual correlation between classic clinical signs of constriction and their underlying anatomical pathology, underscoring the diagnostic utility of ADA in culturenegative cases.
Artificial Intelligence (AI) has become a transformative tool in the armamentum of respiratory medicine, offering applications in diagnostics, risk stratification, and clinical decision support. Leveraging machine learning (ML) and deep learning (DL), AI systems analyse large datasets— from imaging to electronic health records — to assist clinicians in managing respiratory conditions. In diseases such as COPD, interstitial lung disease (ILD), lung cancer, and obstructive sleep apnea (OSA), AI has achieved diagnostic accuracy comparable to human experts. ML models predict COPD exacerbations and OSA severity, while convolutional neural networks (CNNs) enhance lung nodule detection and ILD classification. Despite promising results, most systems lack prospective validation and regulatory approval. The use of AI also raises critical ethical issues, including bias and fairness, algorithmic transparency, patient autonomy, data privacy, and liability in decision-making. To ensure trustworthy integration of AI into respiratory care, future development must be patient-centered, ethically grounded, and supported by robust regulatory frameworks.
Introduction Angiogenesis and neuroplasticity are biologically based mechanism that mediate stroke recovery and are critical in restoring cerebral perfusion and restructuring neural pathways after injury. Current technology in neuroimaging, such as perfusion-weighted imaging (PWI), diffusion tensor imaging (DTI), functional MRI (fMRI), and transcranial Doppler (TCD), can be used to determine these restorative processes in vivo. However, it is not yet well understood to what degree traumatic brain injury (TBI) alters such regenerative pathways. Material and Methods A comprehensive literature search was conducted in PubMed, Scopus, and ScienceDirect, including both clinical and preclinical studies published between 1999 and 2024. Search terms included “stroke,” “neuroplasticity,” “angiogenesis,” “traumatic brain injury,” “MRI,” “DTI,” “fMRI,” “PWI,” and “cerebral perfusion.” The studies were given priorities based on the inclusion of neuroimaging information pertinent to cerebral repair mechanisms post-stroke. Results The reviewed literature suggests that imaging markers of cerebral perfusion, white matter integrity, and functional connectivity are reliable measures of angiogenic and neuroplastic recovery following stroke. Patients with a history of TBI are often characterized by delayed or modified recovery patterns, which can be probably explained by chronic vascular impairment and impaired plastic capacity. Neuroimaging integration in post-stroke evaluation procedures aims to early detect unfavorable cases and develop more personalized rehabilitation plans. Conclusions Neuroimaging is a powerful stroke recovery assessment modality. The need to identify risks with accuracy and provide a specific line of treatment amplifies its utility among patients with antecedent TBI. The entire dynamics between pre-existing brain injury and post-stroke repair mechanism is invaluable in promoting improved clinical outcomes.
Behçet disease represents an inflammatory condition capable of affecting blood vessels in both venous and arterial circulations, a clinical pattern like the one encountered in antiphospholipid syndrome, although disease mechanisms differ. This case report presents the occurrence of an acute episode of paraparesis due to aortic thrombosis in a patient with a known history of Behçet disease, treated by way of a thromboembolectomy. There were no systemic inflammatory syndrome or other suggestive symptoms for a relapse of the patient’s underlying condition. A hypercoagulable workup revealed the presence of several prothrombotic factors, including antithrombin III and protein S deficiencies, alongside the confirmation of a positive lupus anticoagulant. This case highlights the clinical challenge that the aortic thrombosis posed, which was finally attributed to the particular association of prothrombotic factors, in a patient with an apparently inactive Behçet disease and an antiphospholipid syndrome that had probably played the most significant role in the acute presentation.
All acute coronary syndrome patients should be included in a comprehensive cardiac rehabilitation programme, which should be initiated as soon as possible after the acute event. Exercise-based cardiac rehabilitation is recommended in all subjects with coronary artery disease to reduce cardiac mortality and rehospitalization rate. We report the case of a 50 year old male patient, a professional athlete, martial arts and box fighter, with a history of anterior myocardial infarction in 2023, diagnosed with two-vessel coronary artery disease, treated with primary percutaneous coronary angioplasty with drug-eluting stent at the level of the left anterior descending artery (LAD), complicated with heart failure with reduced ejection fraction, who was included in the cardiac rehabilitation program after the acute event, with a significant improvement noted in terms of left ventricular ejection fraction and controlled physical exercise, as shown through repeated cardiopulmonary exercise testing. Regarding the return to sport after an acute coronary event, careful individual evaluation is required before starting high-intensity competitive sports. Despite proven benefits, the rates of referral to, participation in, and implementation of cardiac rehabilitation programmes are low.
We report the case of a 66-year-old male with a complex medical history, including grade 3 essential hypertension NYHA class II chronic heart failure with preserved LVEF and chronic ischemic heart disease. The patient was also diagnosed with ankylosing spondylitis, receiving biologic therapy with etanercept, type II diabetes mellitus and gout. The patient presented with a progressive aggravation of his chronic pathology three months anterior to hospitalization, characterized by significant physical asthenia, exertional dyspnea, anterior chest pain, tremor of the extremities, fever with chills and a syncopal episode. These symptoms prompted evaluation in the Cardiology Department of “St. Spiridon” Hospital, Iași, where the diagnosis of infective endocarditis (IE) involving the native anterior mitral valve was established. The diagnosis was based on clinical presentation, laboratory investigations, echocardiographic findings, and the isolation of Streptococcus gordonii from blood cultures obtained during a febrile episode. Following diagnosis, the patient was referred to the “St. Parascheva” Infectious Diseases Clinical Hospital, Iași, for specialized antimicrobial therapy and further management. Notably, despite the patient’s immunocompromised state — attributed to diabetes mellitus and ongoing immunosuppressive therapy with a tumor necrosis factor (TNF) inhibitor—clinical progression was favorable. This was evidenced by resolution of fever, a marked reduction in inflammatory markers and nitrogen retention parameters, and a stable echocardiographic profile at discharge. This case underscores the importance of early diagnosis and appropriate antimicrobial therapy in managing infective endocarditis, even in patients with multiple comorbidities and immunosuppressive conditions, thus highlighting the potential for non-surgical resolution in selected cases.
Marfan syndrome is a genetic connective tissue disorder with autosomal dominant inheritance, caused by a mutation in the gene encoding for fibrillin 1 (FBN1), located on chromosome 15. This mutation causes excessive secretion of the transforming growth factor beta (TGF-beta), causing changes in connective tissue throughout the body - multisystemic disease (especially affecting the eye, cardiovascular and musculoskeletal level). We hereby present the case of a 24-year-old male patient, diagnosed with Marfan syndrome, that was admitted in the Cardiovascular Rehabilitation Clinic of the Clinical Rehabilitation Hospital from Iași, Romania, for cardiovascular recovery after a surgical intervention for aortic dissection, performed through the Bentall procedure.
Analiza modelului de prescripție a antidiabeticelor la pacienții cu diabet zaharat tip 2 este de mare importanță, având în vedere faptul că noile substanțe active analogii de GLP-1 și inhibitorii de SGLT-2, cu multe beneficii cum ar fi protecția cardiovasculară, continuă să fie puțin prescrise din cauza a numeroase motive cum ar fi: costurile, teama de efecte secundare, inerția clinică sau lipsa de înțelegere a efectelor lor. Studiul nostru a analizat tiparele de prescripție medicală ale antidiabeticelor din centrul de diabet al unui spital clinic și al unei clinici private din județul Bihor. Din analiză putem observa că prescripția inhibitorilor de SGLT2 a crescut semnificativ statistic, prescripția analogilor GLP-1 a crescut semnificativ statistic, prescripția de insulină premixată a scăzut semnificativ statistic și combinația de analogi GLP-1 cu insulină a crescut semnificativ statistic. Toate aceste date demonstrează că tiparele de prescripție ale antidiabeticelor orale și injectabile continuă să se îmbunătățească și să adere la recomandările date de ghiduri. În studiul nostru, de exemplu, 2024 a fost primul an în care inhibitorii de SGLT2 și combinațiile inhibitori de SGLT2 cu doză fixă au fost mai frecvent prescriși decât sulfonilureicele.
Tirzepatide is a new GLP-1 and GIP receptor agonist. We have seen good results in managing type 2 diabetes and obesity using Tirzepatide by improving glycemic control and promoting significant weight loss. The effects on the pancreas include enhanced glucose-dependent insulin secretion, reduced glucagon production, and potential protective actions on beta-cell function and survival among other. Rare cases of acute pancreatitis, such as severe necrotizing pancreatitis, have been reported however. Thus, we need close monitoring of patients for abdominal pain, nausea, or vomiting. While tirzepatide has benefits for metabolic health, its use requires careful supervision to lower the potential pancreatic risks. This highlights the importance of balancing its therapeutic advantages with vigilant monitoring for adverse effects.
Hipercalcemia, definită ca un nivel al calciului seric >10,7 mg/dL, este relativ frecventă, afectând 1-2% din populația globală. Principalele cauze includ hiperparatiroidismul primar și malignitățile. Hipercalcemia poate avea o varietate de manifestări clinice, de la forme asimptomatice până la cazuri severe, care pot pune viața în pericol. Hipercalcemia pe termen lung poate duce la afectarea mai multor organe, în special a oaselor, rinichilor și sistemului cardiovascular. Prezentăm trei cazuri de hipercalcemie cu etiologii diferite. Primul caz este al unui bărbat de 60 de ani cu o tumoră paratiroidiană, evidențiată prin ecografie și scintigrafie, iar excizia chirurgicală și examinarea histopatologică ulterioară au confirmat un adenom paratiroidian. Al doilea caz este al unui bărbat de 69 de ani, cunoscut cu hiperparatiroidism primar și diabet zaharat de tip II, care s-a prezentat cu oboseală și edeme periferice. Al treilea caz este al unei femei de 58 de ani cu hipercalcemie secundară unui sindrom paraneoplazic asociat cu un carcinom mamar, confirmat histopatologic. Primul caz a evidențiat rolul PTH în apariția hipercalcemiei, cu imagistica sugerând o tumoră paratiroidiană drept posibilă etiologie. Al doilea caz a subliniat asocierea dintre patologiile endocrine, în special hipertiroidismul și hiperparatiroidismul, cu diabetul zaharat de tip II și bolile cardiovasculare. Al treilea caz a prezentat o hipercalcemie secundară sindromului paraneoplazic, cu malignitate determinând producția ectopică de proteină asociată hormonului paratiroidian (PTHrP). Tehnicile imagistice precum ecografia și scintigrafia sunt necesare pentru presupunerea diagnosticului de hiperparatiroidism primar, în corelație cu testele sanguine specifice, în timp ce hipercalcemia asociată cu malignitate necesită o abordare interdisciplinară. Identificarea precoce și managementul combinat sunt esențiale pentru prevenirea complicațiilor pe termen lung, hidratarea și bifosfonații fiind pilonii principali ai terapiei. Intervenția chirurgicală pentru adenoamele paratiroidiene rămâne curativă, așa cum s-a demonstrat în două dintre cazurile noastre.
Primary aldosteronism is a frequently overlooked cause of secondary hypertension, despite its association with significant cardiovascular morbidity. Spontaneous or diuretic-induced hypokalemia can serve as an important clinical clue, particularly in younger individuals with resistant hypertension. This case report describes a 39-year-old female who was admitted with high blood pressure (160–180/100 mmHg) and severe hypokalemia (serum potassium: 2.4 mmol/L), requiring frequent potassium supplementation. Biochemical evaluation revealed suppressed renin levels and significantly elevated plasma aldosterone concentration, with an aldosterone-to-renin ratio diagnostic for primary aldosteronism. Adrenal computed tomography identified an unilateral adrenal nodule consistent with an aldosterone-producing adenoma. The patient underwent laparoscopic adrenalectomy, with histopathological confirmation of a benign aldosterone-producing adenoma. After surgery, her blood pressure improved significantly, hypokalemia was corrected, and her antihypertensive medication requirements decreased. Early recognition and targeted treatment, including adrenalectomy for unilateral lesions, can lead to improved long-term outcomes by reducing hypertension severity, cardiovascular risk, and medication burden. This case underscores the need for increased awareness and systematic screening in hypertensive patients, particularly those with hypokalemia or resistant hypertension, to ensure timely diagnosis and optimal management.
Prezentăm cazul unui pacient, în vârstă de 54 de ani, obez, de sex masculin, din mediul urban, fără antecedente personale patologice semnificative, fără medicație cronică, care se prezintă în regim de urgență pentru dizartrie și asimetrie facială, simptomatologie ce a debutat cu o zi anterior prezentării. Examenul clinic a evidențiat facies asimetric, eritroză generalizată, splenomegalie grad I, sindrom piramidal drept, pareză facială centrală dreaptă cu ștergerea șanțului nazogenian drept, coborârea comisurii bucale pe partea dreaptă, dizartrie, valori tensionale crescute. Electrocardiografic nu s-au decelat modificări semnificative, aspect observat și la ecocardiografia transtoracică. CT-ul cranio-cerebral nativ nu a obiectivat leziuni acute ale parenchimului cerebral, dar a evidențiat două lacune cronice la nivelul coroanei radiate drepte, respectiv la nivelul capsulei externe stângi, confirmându-se astfel diagnosticul de accident ischemic tranzitor stâng. Examenele de laborator au evidențiat eritrocitoză, leucocitoză cu neutrofilie, glicemie bazală modificată, dislipidemie tip IIa. S-a inițiat tratament de prevenție secundară a accidentului cerebral vascular ischemic și tratament suportiv, cu remiterea simptomatologiei prezente la internare. S-a ridicat suspiciunea de poliglobulie, iar prin rezultatele testelor de biologie moleculară, nivelului scăzut al eritropoetinei, și creșterea hemoglobinei și hematocritului, s-a confirmat diagnosticul de sindrom mieloproliferativ cronic tip policitemie rubra vera. S-a inițiat tratament citoreductor, iar pe parcursul internării s-au efectuat patru flebotomii terapeutice. Pacientul s-a externat cu recomandarea de a reveni pentru control și noi sedințe de flebotomie în regim ambulator. De asemenea, din cauza asocierii factorilor de risc cardiovascular și a atacului ischemic tranzitor din antecedente, pacientul necesită reevaluare cardiologică periodică.
Infective endocarditis, a potentially fatal condition and a serious public health problem can be difficult to diagnose due to non-specific symptoms. Thus, the multidisciplinary approach to this pathology by the Endocarditis Team is essential for optimizing management and reducing mortality. Echocardiography is the main way to diagnose an infective endocarditis. Coronary CT angiogram is an alternative to invasive coronary angiography for the preoperative evaluation of the coronary status in patients with aortic valve affected by the infectious process. We hereby present the case of a 45-year-old patient known with a bicuspid aortic valve, diagnosed with mitral valve and aortic valve infective endocarditis, complicated with valvular ruptures and severe bivalvular regurgitation 5 months after the onset of an intermittent febrile syndrome, identified and treated as bronchopneumonia in another hospital. Multimodal imaging helps to confirm the diagnosis. Echocardiography, both transthoracic and transesophageal, is the main diagnostic method. Coronary CT angiogram reveals severe bicoronary lesions with "high risk" atheroma plaques. After a complex double valve replacement with mechanical prostheses, two aortocoronary bypass and prosthetic aortic replacement of the ascending thoracic aorta, the result was excellent and the patient was discharged without clinical symptoms of heart failure at rest and during exertion. At the 1-month postoperative follow-up the patient had no symptoms and the transthoracic echocardiography showed the improvement of the systolic dysfunction of the left ventricle. Multimodal imaging plays an extremely important role in the diagnosis of infective endocarditis and associated pathologies. Although the surgical risk is very high in this type of interventions, the patients can well overcome the operative moment and can be quickly socio-professionally reintegrated. The multidisciplinary evaluation of these complex patients is mandatory to find the best management strategy for such cases.
Insuficienţa cardiacă este un sindrom clinic complex cu evoluţie severă care în ciuda tratamentului complex şi complet conduce la distrucţie miocardică cu progresia bolii. Insuficienţa cardiacă a fost clasificata in funcţie de fracţia de ejecţie (FE) în: insuficienţa cardiacă cu FE păstrată şi insuficienţa cardiacă cu FE redusă. Insuficienţa cardiacă cronică progresează prin scăderea continuă a eficienţei functiei de pompă, remodelare miocardică şi dilataţie cardiacă, retenţie de hidrosalina (sindrom cardiorenal) modulată de axa cardio-renală pe calea mecanismelor neurohormonale: sistemul nervos simpatic, sistemul renină-angiotensină-aldosteron, sistemul arginin-vasopresina, endotelina, peptidele natriuretice.
Cardiac amyloidosis is an infiltrative condition characterized by the extracellular deposition of insoluble amyloid proteins in myocardial tissue. This accumulation leads to structural and functional remodeling of the heart, resulting in progressive ventricular dysfunction and heart failure with a predominantly restrictive phenotype. Etiologically, cardiac amyloidosis can be primarily classified into forms associated with immunoglobulin light chains (AL) and transthyretin (TTR), either in hereditary or wild-type variants. AL-type amyloidosis represents a secondary manifestation of a systemic plasma cell disorder, with cardiac involvement being associated with a poor prognosis. In contrast, TTR-type amyloidosis has a relatively slower and more favorable clinical course. The use of Tc-99m-labeled bone tracers in scintigraphy enables the confirmation of TTR-type amyloidosis due to specific cardiac uptake. In AL-type amyloidosis, the absence of uptake makes diagnosis confirmation through this method impossible. Conversely, compounds such as Pittsburgh Compound B (C-11 PiB), F-18 florbetaben, and F-18 florbetapir, used in PET-CT, have demonstrated specific uptake in cardiac AL-type amyloidosis. These methods not only allow for the early identification of amyloid deposits but also reduce the need for cardiac biopsy, which was previously considered necessary in many cases. This review aims to present current data on the integration of nuclear medicine technologies into modern cardiology practice, redefining the paradigm for diagnosing and monitoring cardiac amyloidosis. Nuclear cardiology offers a precise, non-invasive, and personalized approach with significant clinical implications, providing valuable support for practicing cardiologists.
With the introduction of new drugs like tirzepatide, the relationship between metabolic treatments and oncology has attracted a lot of interest lately. Tirzepatide, a dual agonist of glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) receptors, has shown promising results in the treatment of type 2 diabetes and obesity, two disorders associated with an increased risk of gastric cancer. The purpose of this study is to examine tirzepatide's possible effects on the development and prevention of stomach cancer. We investigate the therapeutic potential of tirzepatide and pinpoint areas in need of more investigation by looking at the body of existing literature and mechanistic insights . The results emphasize the need [1] , [3] for more research into tirzepatide's direct impact on gastric carcinogenesis as well as its complex modes of action and function in modifying risk factors.
Abstract Background Cardiac resynchronization therapy represents a well established treatment for heart failure patients, recommended for those with severely depressed left ventricular systolic function and left bundle branch block. The aim of this study was to determine the correlation between electrocardiographic changes, clinical, functional, and demographic parameters with the improvement in left ventricular ejection fraction after resynchronization therapy. Another focus of this study was to identify which parameters have predictive value for better patient selection and proper resynchronization strategy. Methods The study included 69 patients who underwent cardiac resynchronization therapy in our center. The parameters were monitored at 4 different key moments: before the procedure and at 6, 9 and 12 months after procedure. Results There was a significant improvement in the ejection fraction, which reached a peak at the 12-month follow-up. The value of atrial natriuretic factor precursor was negatively associated with the evolution of ejection fraction. QRS duration and left ventricular enddiastolic volume correlate with improvement in ejection fraction. Newer variables, such as the QRS area, the R wave amplitude in the right precordial leads, the QS duration, the percentage of biventricular pacing, and the intraprocedural blood pressure, were examined for their potential association with cardiac resynchronization therapy outcomes. However, the presence or absence of significant correlations with ejection fraction improvement requires further analysis. Conclusion Cardiac resynchronization induces cardiac remodeling, leading to echocardiographic and quality of life improvements. It also provides electrical improvements and correct ventricular dyssynchrony. Patients with narrower QRS durations after CRT experienced a rise in the ejection fraction based on higher rates of reverse remodeling.
Abstract Chronic smoking remains one of the most significant public health concerns worldwide, serving as a major risk factor for respiratory and cardiovascular diseases, as well as various types of cancer. This study explores the impact of smoking on chronic obstructive pulmonary disease (COPD) and lung cancer, focusing on aspects such as prevalence, symptom severity, and epidemiological correlations between these conditions. This study was conducted on a cohort of 164 patients monitored at the National Institute of Pneumophthisiology “Marius Nasta” in Bucharest, identifying a significant association between smoking and pulmonary disease severity. The findings suggest that COPD may contribute to an increased risk of lung cancer, possibly due to shared pathogenic mechanisms such as chronic inflammation, oxidative stress, and tissue hypoxia. Considering the profound impact of these diseases on patients’ quality of life and mortality, the study highlights the urgent need for effective preventive strategies, including smoking cessation programs, lung cancer screening, and a multidisciplinary approach to COPD management.
Abstract This article presents a case of infective endocarditis caused by Coxiella burnetii in a 58-year-old male shepherd from a rural background. The patient was admitted with symptoms of dyspnea, fatigue, lower limb edema, and oliguria. Clinical examination revealed significant cardiac and systemic findings, while paraclinical investigations indicated inflammatory status and renal impairment. Blood cultures were negative, while serological testing revealed and confirmed the presence of Coxiella burnetii. The diagnosis of infective endocarditis affecting the aortic valve was established. The patient received treatment for cardiac failure and targeted antibiotic therapy with Doxycycline, resulting in a favorable clinical response and resolution of symptoms. This case emphasizes the importance of recognizing zoonotic infections in individuals with occupational exposure and highlights the need for comprehensive diagnostic approaches in atypical presentations of endocarditis.
Abstract Modern healthcare emphasizes the importance of assessing the quality of life in patients with metabolic syndrome and risk of sleep apnea using validated tools such as the SF-36 Short Form. Studies reveal a high prevalence of metabolic syndrome in Romania, with rates of 45% in women and 44% in men, and its frequent association with sleep apnea due to shared risk factors. Research findings indicate a strong connection between hypertension, dyslipidemia, and insulin resistance, all of which are central components of metabolic syndrome. Furthermore, sleep apnea exacerbates cardiometabolic complications through recurrent episodes of hypopnea and apnea, leading to sleep fragmentation and intermittent hypoxemia. These dysfunctions trigger cascades of hemodynamic, autonomic, and inflammatory responses, increasing cardiometabolic risks and impairing quality of life. The objective of this study is to investigate the correlations between metabolic parameters and quality of life, offering valuable insights into the mechanisms linking metabolic syndrome and sleep apnea.
