The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Ileana Adela Vacaroiu

Ileana Adela Vacaroiu

Is the Importance of Magnesium in Chronic Kidney Disease Underappreciated?

Magnesium (Mg) is one of the most important cations in the organism, essential for regulating vascular tone, cardiac rhythm, and endothelial functions. In patients with advanced stage chronic kidney disease (CKD) Mg deficit was associated in various studies with vascular calcifications and increased cardiovascular morbidity and mortality. Patients with CKD frequently have hyperparathyroidism, parathormone (PTH) being an important risk factor for vascular calcifications. Increased serum Mg levels inhibit PTH secretion and stimulate left ventricular hypertrophy, while low serum Mg levels stimulate PTH secretion. Correcting Mg de deficiency results in reduced cardiovascular mortality in these patients.

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Acute Kidney Injury in Heroin Users

The article presents a case of severe necrotizing fasciitis and rhabdomyolysis-induced acute tubular necrosis resulting from the injection of heroin laced with a plant-fertilizer known as „Pure by Magic“. We also review the literature data regarding the renal adverse effects of heroin. Due to the diversity of adulterants used by drug dealers for cutting heroin and the variety of substances patients mix the heroin with before injecting themselves, the effects of this practice are often unknown and the treatment lacks of antidote, being strictly symptomatic.

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Renal Risk of Contrast-Enhanced Imaging – Is It a Myth? The Latest Opinions of the Guidelines

Over the last decade, several divergent views have been expressed regarding the effect that iodinated contrast agents may have on renal function. Evidence-based medicine often requires the recommendation of high-performance contrast-enhanced imaging exams for precise positive diagnosis. The fear of intravenous contrast use in patients with elevated serum creatinine seems to become an old dogma, outdated by the benefits of the procedures. Patients with glomerular filtration rate below 30 mL/min/1.73 m2 can be protected by peri-procedural hydration and withdrawal of other nephrotoxics. Whatever the degree of risk, current guidelines recommend contrast-enhanced investigations in any situations where the advantages for the diagnosis are certain.

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The Diagnosis of Urological Neoplasm in Dialysis Patients - a Brief Review

The ideea of this review arised from a small lot of patients recently evaluated by a joint team of urologists and nephrologists in one of the largest dialysis departments in Bucharest, Romania. We decided to review the existing medical literature in order to have a better grasp of the peculiarities regarding the incidence, symptoms, tumor markers and imaging studies for urological cancers in end stage renal disease (ESRD) patients undergoing dialysis. [...]

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Iatrogenic Ureteral Injury Following Radical Hysterectomy - Case Presentation

Iatrogenic ureteral injuries represent an important complication of abdomino-pelvic surgery with serio-us consequences in the absence of a prompt diagnostic and adequate treatment. According to literature it has been estimated that over 75% of all ureteral injuries are iatrogenic and that the incidence of ureteral lesions during an abdomino-pelvic surgery ranges from 0.5% to 10%[1-5]. Studies concerning this pathology have shown that obstetric and gynecological surgery accounts for approximately 50-60% or even more, followed by colorectal surgery 10-25%, vascular surgery (aortoiliac and aorto-femural bypass) and urological surgery 15-30% (classic, laparoscopic and endoscopic approach)[5-11]. [...]

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Peripheral Arterial Disease in Hemodialysed Patients

There is increased evidence that the prevalence of peripheral artery disease (PAD) in hemodialysed patients is higher than in general population [1,2]. According to ACC/AHA (American College of Cardiology / American Heart Association) guidelines, the following risk factors are associated with PAD [3,4]

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Identification of Osteoarthritis with Multiple Joint Involvement in Elderly Institutionalized Patients Concomitant with...

Related to the rehabilitation of patients with osteoarthritis, kinesiotherapy addresses the methods, procedures and methodology that will be used depending on the anatomic, functional and clinical stage of the disease and its location after setting treatment goals. Furthermore, priorities of the rehabilitation program are established considering both medical issues and also paramedical and social aspects [1].
The kinesiotherapeutic opera tional strategy in rehabilitating patients with osteoarthritis is planned according to the characteristic comorbidities of elderly patients [2]. Clinical trials highlight that cardiovascular mortality is reduced when sedentary individuals become moderately active [3,4].

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The Rehabilitation of Elderly Institutionalized Patients with Osteoarthritis (Multiple Joint Involvement) Using...

Osteoarthritis, as a major cause of disability and due to the high prevalence among chronic diseases, represents one of the most important public health problems worldwide [1]. The limitation of physical function and the restriction of independence produce negative effects on the mental status of patients suffering from osteoarthritis, namely the emergence of depression and decreased self-confidence [2,3].
Developing a kinesiotherapeutic strategy based on the clinical, anatomical and functional stage of the disease and other comorbidities, as well as exploiting psychological and psychopedagogical resources will improve the physical performance and increase the independence of these patients [4,5].

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Nutritional Impact on Cardiovascular Risk in Chronic Hemodialysed Patients - A Systematic Review

Protein-energy malnutrition is a frequent clinical condition in chronic hemodialysis patients (1). The causes of protein-energy malnutrition are: interaction between blood and dialyzer with subsequent activation of the complement, amino acids and peptides losses when undergoing hemodialysis, metabolic acidosis, chronic inflammation and anorexia (2). There are two types of protein-energy malnutrition. Type 1 protein-energy malnutrition is characterized by patients’ poor food intake. This occurs along with slow decrease of serum albumin and loss of muscle mass, the presence of normal levels of C-reactive protein and response to nutritional interventions. The second type of protein-energy malnutrition is characterized by an increased serum level of C-reactive protein and lower serum albumin level than in type 1, even with an optimal food intake. This type of protein-caloric malnutrition is strongly associated with chronic inflammation and does not respond to nutritional intervention (3).

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