doi:10.37897/RMJ

Ana Valea

Latest posts by Ana Valea (see all)

Recognizing endogenous Cushing’s syndrome after therapy for scleroderma - 01/03/2017
Bariatric surgery and osteoporosis - 01/03/2017
5-Hydroxytryptamine and skeleton status - 01/03/2017

Articole semnate de acelasi autor in Revista Medicala Romana:

Recognizing endogenous Cushing’s syndrome after therapy for scleroderma

REVISTA MEDICALA ROMANA - Romanian Medical Journal, Vol. LXIII, Nr. 4, An 2016

ISSN 1220-5478 | e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

National Awards “Science and Research”

NEW! RMJ has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

Ana Valea, Dan Nicolae Paduraru, Adriana Elena Nica, Maria Iuliana Oprisor, Adina Ghemigian and Mara Carsote

REZUMAT

Introduction. Scleroderma induces heterogeneous skin changes due to collagen anomalies, including facial. The recommended therapy is, among others, topic cortisol derived products, so an issue of diagnosis differential regarding the etiological type of Cushing’s syndrome (CS) is raised if a patient develops a suggestive phenotype.
Case presentation. This is a 64-year female presenting (since the last few months) red face, high blood pressure, central obesity. She has a 6-year history of scleroderma, intermittently treated with local corticotherapy. On admission, she associated metabolic disturbances as lipid profile anomalies, high uric acid, insulin resistance and increased number of white blood cells (which were not connected with a relapse of scleroderma, neither to an inflammatory syndrome). Low baseline plasma ACTH and morning serum cortisol level (not high, yet detectable) with abnormal diurnal rhythm suggested an adrenal source of CS. A 3 cm right adrenal tumor was found on computer tomography and later removed through a classical intervention. Two weeks after, the patient voluntarily reduced her prednisone dose causing an adrenal crisis which required re-admission as an emergency. After discharge, daily oral adrenal replacement therapy is needed for the moment.
Conclusions. Scleroderma, especially with skin involvement, and some of associated therapies may mask an endogenous CS as adrenal tumor derivate, thus delaying the adequate diagnosis and therapy. Patient’s
education regarding a potential life threatening condition as chronic adrenal insufficiency is necessary since post-operatory recovery of adrenal function is expected within 6 to 24 months.

Cuvinte cheie: Cushing’s syndrome, adrenal tumor, scleroderma

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Ana Valea

Bariatric surgery and osteoporosis

ISSN 1220-5478 | e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

National Awards “Science and Research”

NEW! RMJ has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Mara Carsote, Razvan Petrescu, Adriana Elena Nica, Adina Ghemigian, Dan Nicolae Paduraru and Ana Valea

ABSTRACT

Introduction. Bariatric surgery, regardless the type of approach, has aggressively extended nowadays. The procedure saves lives due to substantial improvement of severe cardio-metabolic co-morbidities, but the influence of nutritional status might not be completely harmless including bone and muscle changes. Our purpose is to introduce data regarding skeleton after bariatric surgery. This is a narrative mini-review including papers from PubMed. A selection of 33 papers has been done.
General data. Longitudinal better than cross-sectional studies confirmed an annual rate of losing bone mineral density at lumbar and femoral neck of 3-10% starting with first year after surgery and continuing within the third year; low vitamin D and calcium absorption with associated secondary hyperparathyroidism is described; others anomalies include elevated bone remodelling markers, damage of bone microarchitecture, fracture healing disturbances and sarcopenia.
Conclusion. Overall, despite spectacular results after bariatric surgery, the bone and muscle are expected to suffer a level of deterioration, which should be taken into account for assuring an adequate quality of life and an immediate and distant good post-operatory prognosis.

Keywords: bariatric surgery, osteoporosis, bone

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Mara Carsote

5-Hydroxytryptamine and skeleton status

ISSN 1220-5478 | e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

National Awards “Science and Research”

NEW! RMJ has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Mara Carsote, Dan Nicolae Paduraru, Adriana Elena Nica, Ana Valea and Adina Ghemigian

ABSTRACT

Introduction. 5-hydroxytryptamin (serotonin) represents a monoamine with different functions. Central neurotransmitter is related to mood, food and energy regulation and indirect positive effects on bone mass via leptin and sympathetic system. Gut-derived 5-hydroxytryptamine directly influences the skeleton through Wnt/Lrp5/beta catenin signalling with opposite actions to the central pool.
Method. This is a mini-review regarding serotonin- related bone changes.
Results and discussions. All the bone cells have receptors for 5-hydroxytryptamine while skeleton may have an intrinsic ability to locally generate it. The monoamine displays paracrine and autocrine actions, some incompletely described. One practical point is the potential bone loss in clinical situations with serotonin excess, as seen in carcinoid syndrome. Up to this moment, non-bone metastatic neuroendocrine tumours are not listed as a cause of secondary osteoporosis. Another practical aspect is the use of circulating 5-hydroxytryptamine as bone turnover marker surrogate for assessing the future fragility fracture probability. Despite some correlations with classical bone remodelling markers, no clear cut conclusion has been established yet.
Conclusion. 5-hydroxytryptamine displays complex effects on skeleton status, whether direct, indirect or local, but there are data still unknown, thus future need to connect the dots in this particular inter-disciplinary field.

Keywords: 5-hydroxytryptamine, bone, osteoporosis

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Mara Carsote

Bone and menopause: threshold of intervention

REVISTA MEDICALA ROMANA - Romanian Medical Journal, Vol. LXIII, Nr. 3, An 2016

ISSN 1220-5478 | e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

National Awards “Science and Research”

NEW! RMJ has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Adina Ghemigian, Ana Valea, Anda Dumitrascu, Dana Terzea, Mara Carsote and Otilia Radu

ABSTRACT

Menopause comes with different changes including estrogen deficiency – related qualitative and quantitative progressive skeleton deterioration. The physiological process turns to pathology, respective osteopenia and osteoporosis at central DXA (Dual-Energy X-Ray Absorptiometry) or low lumbar – DXA derived TBS (Trabecular Bone Score) or increased 10-year probability of major osteoporotic/hip fractures provided by FRAX. We aim to briefly introduce the methods of menopausal fracture risk assessment if back pain is presented from an endocrine point of view.
This is a vignette type of manuscript focusing on imagery tools. A 60-year old smoker woman with 10 years since menopause and prior corticotherapy accuses persistent back pain for a few weeks, with mild to medium intensity and responsive to small doses of pain medication. Profile plain X-Ray showed no vertebral fractures. FRAX estimated risk was low. Lumbar DXA (GE Lunar Prodigy) showed osteopenia (a T-score of -1.9 SD) while TBS showed a deterioration of lumbar micro-architecture based on a value of 1,199. Further recommendations of stop smoking, healthy diet, physical exercise, vitamin D and calcium supplementation are necessary. Retesting using DXA is not necessary sooner than 2 years or even longer. Related to back pain, rheumatologic and balneology support and intervention are required for spondylarthrosis.
For daily practice, the approach of bone health and estimation of future fragility fractures in menopause combines gold standard DXA to most modern instrument TBS together with easy accessible online algorithms as FRAX. These do not display individual medical decision and adequate use of guidelines.

Keywords: menopause, bone, fracture, DXA, TBS, FRAX

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Adina Ghemigian

Emerging approach of bone remodelling indices

ISSN 1220-5478 | e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

National Awards “Science and Research”

NEW! RMJ has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Adina Ghemigian, Ana Valea, Mara Carsote, Otilia Radu, Razvan Petrescu and Rene Baloescu

ABSTRACT

The field of osteoporosis, especially of primary type, tidily connected with estrogen deprivation and aging, is complex and dynamic. Bone turnover markers (BTM) have been and still are a hot spot on this panorama, because no straight cut lines are found yet. We aim to briefly introduce the current status of BTM, as a short commentary. BTM have a high inter- and intra- individual variation, they are rather expensive for daily practice, they are not necessary to diagnose osteoporosis. Low or normal levels do not necessary mean that a person will not suffer fragility fracture while a higher level is associated with an increased fracture risk. Moreover, BTM seem better players for clinical studies to point out the efficacy of anti-osteoporotic drugs rather than helping each patient’s decision. BTM prematurely detect remodelling variations before DXA. No algorithm or calculation model of fracture prediction has incorporated yet BTM, most probably due to heterogeneity of reports. Traditional BTM are alkaline phosphates, osteocalcin, and collagen- derived fragments. New BTM, that proved useful, are represented by P1NP. Atypical BTM like osteoprotegerin, sclerostin, and serotonin are still far from daily practitioners’ assessment. Regardless classical or modern, the way that BTM represent a reflection of skeleton health is still an emerging subject.

Keywords: bone turnover marker, serotonin, osteoporosis

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Adina Ghemigian

Hypovitaminosis D and menopause: still an issue in 2016?

ISSN 1220-5478 | e-ISSN 2069-606X
ISSN-L 1220-5478
DOI: 10.37897/RMJ

National Awards “Science and Research”

NEW! RMJ has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Adina Ghemigian, Ana Valea, Andra Buruiana, Mara Carsote, Nicoleta Dumitru and Otilia Radu

ABSTRACT

Vitamin D in menopause is essential for skeleton and metabolic involvement. Our purpose is to introduce the level of evidence regarding menopause – related hypovitaminosis D through a brief review of papers published on PubMed in 2016. The correlation between low vitamin D and risk of falls is a traditional observation. Lack of vitamin D remains one of the major contributors to osteoporotic fractures which have an annual incidence of 8.9 million worldwide. Yale FIT trial referring to menopausal cancer survivors after 12 months of aerobic physical exercise confirmed the bone loss under aromatase inhibitors opposite to tamoxifen is significant, a bone loss that is lower if vitamin D ranges are low. Arzoxifene Generations Trial followed for 5 years menopausal women treated only with vitamin D and calcium and found a fracture risk increase by 46% for each unit of lumbar T-score that decreases. A meta-analysis of 34 studies on 11,090 patients treated with ibandronate showed that hypovitaminosis D at baseline is a predictor of bone mineral density improvement only at lumbar spine. Another study revealed that 77% of menopausal females have 25-hydoxyvitamin D (25-OH D) less than 30 ng/mL while a negative correlation between 25-OH D and waist circumference was found knowing that android fat disposition in women with hipovitaminosis D is a hallmark of metabolic syndrome. Overall, in 2016, PubMed published papers regarding vitamin D in menopause still reflect its deficiency and associated metabolic risk.

Keywords: menopause, hypovitaminosis D, vitamin D

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Adina Ghemigian

Arhiva autor

Ana Valea

Latest posts by Ana Valea (see all)

Articole semnate de acelasi autor in Revista Medicala Romana:

Recognizing endogenous Cushing’s syndrome after therapy for scleroderma

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