Violeta Diana Oprea

Background: Beyond the well-known etiologies of ischemic stroke associated with recognized vascular risk factors, the literature describes a spectrum of uncommon causes with low prevalence but significant diagnostic and therapeutic implications. Materials and methods: A case series report of seven rare etiopathogenic mechanisms (in patients aged 25–85) who presented within a 3-year interval (2022–2025) to our stroke unit at the Neurological Department—“St. Ap. Andrew” County Emergency Clinical Hospital in Galati, Romania. Results: The seven uncommon embolic stroke cases included three patients with infectious cerebral ischemia (hydatid cyst with double simultaneous embolism, mycotic aneurysm of the carotid artery, syphilis-associated stroke), three cases of rare cardioembolic strokes (patients with Lambl excrescences, cor triatriatum, left ventricular non-compaction), as well as one patient with multiple etiological associations triggering acute stroke. Conclusions: Rare etiologies of ischemic stroke should be actively considered when classical vascular risk factors are absent, particularly in young patients. Comprehensive diagnostic evaluation is mandatory, especially in cases of embolic stroke of undetermined source (ESUS). Such cases represent significant diagnostic and therapeutic challenges and require a multidisciplinary approach to optimize patient outcomes.

Background: The COVID-19 pandemic has disproportionately affected the elderly population, with inflammation and impaired immune response being key drivers of disease progression. Clinicians require predictive models integrating immunological and inflammatory biomarkers to optimize risk stratification in this vulnerable group. Methods: We retrospectively analyzed 1429 elderly patients (aged >60 years) admitted with COVID-19 between March 2020 and August 2022. Demographic, clinical, and laboratory data were collected at admission. Correlation and regression analyses were performed to assess the prognostic significance of hematological and inflammatory markers. Results: Lymphopenia and neutrophilia were predominant findings, frequently associated with elevated C-reactive protein levels. Correlation analyses revealed significant associations between inflammatory markers and discharge status or death, while lymphocytes exerted a protective effect, reducing mortality risk by 14.4%. Notably, a higher platelet-large cell ratio (PLCR) was linked to increased mortality, suggesting an important contribution of thrombosis to severe COVID-19. Conclusions: Our findings indicate that immunological and inflammatory markers may serve as significant predictors of outcomes in elderly COVID-19 patients. While the predictive power of the model remains limited, these biomarkers can contribute to a better understanding of patient trajectories and may inform therapeutic strategies.

Background: Parkinson’s disease (PD) in advanced stages becomes, over time, a significant challenge, as oral medication becomes ineffective, and it may become necessary to switch to device-assisted therapy (DAT). This should be personalized according to the stage of the disease, the cognitive status of the patients, the association of frailty syndrome or other comorbidities, the support in care from the family, etc. Levodopa–carbidopa–entacapone intestinal gel can significantly improve the status of patients, provided that they are correctly selected for this type of treatment. Materials and Methods: We conducted a single-center prospective study including 20 advanced PD patients, who received a levodopa–carbidopa–entacapone gel through an intestinal pump, within the Parkinson’s Disease Multimodal Treatment Center of the Neurology Clinic of the “St. Ap. Andrew” County Emergency Clinical Hospital in Galați, Romania. The evaluations were performed at baseline (T0), after intestinal pump insertion (T1), and 6 months after the procedure (T2). Results: In the study group, the administration of the levodopa–carbidopa–entacapone intestinal gel, using the device for intestinal administration, had significant benefits, especially for motor symptoms. The periods of off, no-on, freezing, sudden-off, as well as dyskinesia and morning akinesia, were significantly reduced. Among the non-motor symptoms, depression and sleep disorders improved, with no changes in cognitive status and psychotic disorders. Conclusions: Adding new data for the use of device-assisted therapy in advanced PD, our study also highlights the need to further research this challenging patient profile.

(1) Background: Monomorphic intestinal epitheliotropic T-cell lymphoma (MEITL) is a very rare subtype of lymphoma, being involved in less than 5% of lymphomas of the digestive tract. Accurate diagnosis is extremely challenging due to the lack of specific clinical symptoms and the low specificity of the diagnostic approaches. (2) Methods: We present the case of a patient admitted to the Neurology Clinic of the Emergency Clinical Hospital of Galati, Romania, with progressive cranial nerve impairment. (3) Results: Analyzing clinical and paraclinical data and corroborating the previous known diagnosis of MEITL, the positive diagnosis was that of meningitis with atypical lymphocytes with MEITL as starting point. The cytology of CSF was the basis for the diagnostic confirmation. (4) Conclusions: The present case is a rare situation of secondary dissemination of MEITL. We were not able to identify a similar report in the available literature that associated urothelial carcinoma with leptomeningeal MEITL-sourced neoplastic lesions.

Background: Elderly patients with COVID-19 often exhibit a complex interplay between hypercoagulability and coagulopathy, key factors in determining the risk of severe complications and mortality. This study aimed to analyze coagulation and inflammatory markers to identify critical predictors of adverse outcomes in this vulnerable population. Material and Methods: The retrospective study was conducted on a sample of 1429 elderly patients (≥60 years) diagnosed with COVID-19, hospitalized in “Sf. Ap. Andrei” St. Apostle Andrew’s County Emergency Hospital in various wards between March 2020 and August 2022. Data were collected from medical records and included inflammatory markers (C-reactive protein, procalcitonin, ESR) and coagulation markers (prothrombin time, INR, fibrinogen, D-dimer). The SPSS 2.0 statistical software was used to conduct the study. Results:Coagulation markers: Prothrombin activity averaged 74.22%, below normal levels, indicating a heightened bleeding risk, while fibrinogen levels were significantly elevated (mean: 531.69 mg/dL), reflecting hypercoagulability. Prolonged prothrombin time (mean: 17.28 s) and elevated INR (International normalized ratio) (mean: 1.51) were associated with increased mortality, emphasizing their role in risk stratification. Elevated D-dimer levels (mean: 2.75 mg/L) further highlighted thromboembolic risks. Inflammatory markers: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) showed marked elevations (mean CRP: 92.09 mg/L, mean ESR: 58.47 mm/h), correlating with heightened systemic inflammation and poor outcomes. Bacterial infections: Elevated procalcitonin (mean: 1.98 ng/mL) suggested secondary bacterial infections, particularly in mechanically ventilated patients, significantly worsening prognosis. Conclusions: The duality of hypercoagulability and coagulopathy in elderly COVID-19 patients underscores the importance of consistently monitoring coagulation markers such as prothrombin time, INR, D-dimer, and fibrinogen. Simultaneously, elevated inflammatory markers and secondary bacterial infections require prompt therapeutic interventions. This study highlights the critical need for personalized management strategies to mitigate complications and reduce mortality in this high-risk population.

Stroke is a leading cause of death and severe disability worldwide. Rapid diagnosis is critical to ensure the timely administration of medical treatment. Given that in some cases CT scans fail to show the classic clinical signs of stroke, we aimed to evaluate the diagnostic capacity of adiponectin levels and their association with the clinical parameters of patients with acute ischemic stroke (AIS). Adiponectin was measured within 24 h (T1) and 48 h (T2) of AIS onset in 70 patients. A total of 68 control cases were included in the study. Adiponectin levels were significantly higher in the AIS patients than in the controls (16.64 (3.79; 16.69) vs. 3.78 (3.79; 16.69); p < 0.001), with an accuracy of 0.98 (AUC = 0.99). Lower levels were seen in males and in AIS patients with obesity. Higher levels of adiponectin at T1 were associated with a moderate/severe NIHSS score at patient discharge. Moreover, higher levels of borderline significance were seen in patients who died within 12 months of their AIS episode (p = 0.054). Adiponectin may be a useful biomarker for the identification of AIS patients who do not present classic CT signs and could be used to stratify severe cases. Further studies are needed to validate these results.

Caspases are key players in the apoptotic process and have been found to contribute to the pathogenesis of a variety of diseases, including neurological disorders such as ischemic stroke. This study aimed to investigate the serum levels of Caspase-3 in patients with acute ischemic stroke (AIS) and in control patients without ischemic events. Moreover, we explored any potential associations with the clinical outcomes of AIS. We enrolled 69 consecutive patients with clinical signs and symptoms of AIS in the presence of a negative CT scan who presented themselves at the Clinical Neurological Department from the Emergency Clinical Hospital of Galati within the first 24 h of symptom onset. The control group comprised 68 patients without cerebral ischemic pathologies. A comparison of the two groups showed significantly higher levels of caspase-3 at 24 and 48 h after hospital admission. No significant associations between caspase-3 levels and clinical features of AIS were seen. However, in a subgroup analysis conducted on patients with moderate/severe and severe stroke, lower levels of caspase-3 were associated with early mortality. Caspase-3 levels did not directly correlate with AIS severity or prognosis when considering all AIS patients. In patients with moderate to severe National Institute of Health Stroke Scale (NIHSS) scores, caspase-3 might be a prognostic indicator of early death. Further studies are required to confirm these results and further explore the mechanisms behind these findings.

(1) Background: Madelung’s disease—known also as Benign Symmetric Adenolipomatosis (BSA) or Multiple Symmetric Lipomatosis (MSL), is a rare subcutaneous tissue disease characterized by the proliferation of non-encapsulated fat tissue with mature adipocytes. Patients develop symmetrical fatty deposits of varying sizes, (located particularly around the neck, shoulders, upper and middle back, arms, abdomen, and thighs), having clinical, esthetic, and psychiatric repercussions. (2) Methods: We report a case diagnosed with BSA upon admission to the Neurological and Internal Medicine Departments of the Emergency Clinical Hospital of Galati. (3) Results: This patient developed compressive phenomena and liposarcoma with liver metastasis, followed by death shortly after hospital presentation. The histopathology examination confirmed right latero-cervical liposarcoma and round cell hepatic metastasis. The specific metabolic ethiopathogenic mechanism has not been elucidated, but the adipocytes of BSA are different from normal cells in proliferation, hormonal regulation, and mitochondrial activity; a rare mitochondrial gene mutation, together with other interacting genetic or non-genetic factors, have been considered in recent studies. A thorough literature search identified only three cases reporting malignant tumors in BSA patients. (4) Conclusions: The goal of our paper is to present this rare case in the oncogenic synergism of two tumors. In the management of this BSA disorder, possible malignant transformation should be considered, although only scarce evidence was found supporting this.

Background: Heart failure is a global major healthcare problem with millions of hospitalizations annually and with a very high mortality. There is an increased interest in finding new and reliable biomarkers for the diagnostic, prognostic and therapeutic guidance of patients hospitalized for acute heart failure; Our review aims to summarize in an easy-to-follow flow recent relevant research evaluating the possible use and the clinical value of measuring CA 125 serum levels in acute HF. Methods: A thorough search in the main international databases identified a relevant pool of 170 articles, providing recently published data for this narrative review that used PRISMA guidelines. Results: There are data to sustain the role of carbohydrate antigen 125 (CA 125), a worldwide used marker of ovarian cancer, in patients with heart failure. Several studies have shown links between CA 125 levels and congestion seen in acute heart failure, high mortality and readmission rates at 6 months follow-up after discharge from acute heart failure and also a role of CA 125 in the guidance of heart failure therapy. There are also clinical trials that showed that several particularities of CA 125 make it even better than N-terminal pro b-type natriuretic peptide (NT-pro BNP)—a classical and more utilized marker of heart failure) in several scenarios of acute heart failure. Conclusions: Although the mechanism behind the upregulation of serum CA 125 in patients with congestive HF has not been confirmed nor fully understood.

Heart failure is a global major healthcare problem with millions of hospitalizations annually and with a very high mortality. There is an increased interest in finding new and reliable biomarkers for the diagnostication, prognostication and therapeutical guidance of patients hospitalized for acute heart failure. There is data to sustain the role of CA 125, a worldwide used marker of ovarian cancer, in patients with heart failure. Several studies have shown links between CA 125 levels and congestion seen in acute heart failure, high mortality and readmission rates at 6 months follow up after discharge from acute heart failure and also a role of CA 125 in the guidance of heart failure therapy. There are also clinical trials that showed that several particularities of CA 125 make it even better than NTpro BNP ( a classical and more utilised marker of heart failure) in several scenarios of acute heart failure.