Background. Patients with nonvalvular atrial fibrillation (NVAF) have five times higher risk of stroke than the general population. Anticoagulation (ACO) in NVAF is a class I indication after assessing the CHA2DS2-VASc and HAS-BLED scores. However, in the real world, NVAF patients receive less ACO than needed due to patients’ comorbidities that can be assessed by the Charlson comorbidity index (CCI). The use of non-antivitamin K anticoagulants (NOAC) has improved the decision to anticoagulate. Objective. We analyzed the factors influencing the ACO prescribing decision in NVAF patients in the real world and the changes induced by the introduction of NOAC. Method. We carried out an observational retrospective cross-sectional study that included consecutive patients with permanent NVAF and CHA2DS2-VASc ≥ 2, admitted to a community hospital between 2010–2011 (group 1, 286 patients), when only vitamin K antagonists (VKA) were used, and 2018–2019 (group 2, 433 patients), respectively. We calculated CHA2DS2-VASc, HAS-BLED, and CCI and recorded the ACO decision and the use of VKA or NOAC in group 2. We compared the calculated scores between ACO and non-anticoagulated (nonACO) patients in both groups and between groups. Results. A 31.5% share of patients in group 1 and 12.9% in group 2 did not receive ACO despite a CHA2DS2-VASc score ≥ 2. In group 1, nonACO patients had higher HAS-BLED and CCI scores than the ACO patients, but their CHA2DS2-VASc scores were not significantly different. Old age, dementia, severe chronic kidney disease, neoplasia, and anemia were the most frequent reasons not to prescribe anticoagulants. In group 2, more nonACO patients had dementia, diabetes mellitus, and higher HAS-BLED than ACO patients. Moderate-severe CKD, neoplasia with metastasis, liver disease, anemia, and diabetes mellitus were statistically significantly more frequent in nonACO patients from group 1 than those from group 2. In group 2, 55.7% of ACO patients received NOAC. Conclusions. In real-world clinical practice, the decision for anticoagulation in NVAF is influenced by patient age, comorbidities, and risk of bleeding, and many patients do not receive anticoagulants despite a high CHA2DS2-VASc score. The use of NOAC in the past few years has improved treatment decisions. At the same time, the correct diagnosis, treatment, and surveillance of comorbidities have cut down the risk of bleeding and allowed anticoagulant use according to guidelines.

Systemic lupus erythematosus (SLE) is a chronic multi-systemic immune-mediated disease with confusing symptoms and delayed diagnosis. We report the case of a 32-year-old man with a persistent Venereal Disease Research Laboratory (VDRL)-positive reaction treated for syphilis 5 years previously, who was admitted for rash, weight loss, pancytopenia, inflammatory syndrome, and an important spontaneous prolongation of activated partial thromboplastin time (aPTT). Antiphospholipid antibodies were identified in the patient and he was diagnosed with SLE. The unrecognized false positive VDRL reaction and the delayed diagnosis of SLE were harmful as the patient had developed renal and cardiac complications by the time of diagnosis.LEARNING POINTSVDRL positive reaction as a diagnostic tool for syphilis must be confirmed by other tests like TPHA and Western Blot reaction, especially in the absence of a clinical context, taking into account the possibility of false positive results.Spontaneous prolongation of aPTT can be related to the presence of antiphospholipid antibodies.In medical practice, the clinician must always consider the uniqueness of a diagnosis that integrates all the clinical and laboratory data, even if the associations might seem confusing.

At the end of the 19th century and the beginning of the 20th, the archeological sites unraveled a new category of monuments previously ignored – the ornamented hearths. Discovered for the fi rst time in England and Ukraine, then on the current territories of Bulgaria, Romania, France, Germany, Poland, the Czech Republic and Denmark, they belong, along with some other materials, to the European material and spiritual heritage. They were made from a material that was very much at hand clay. Their polished surface was sometimes decorated with lines made through incisions or by pressing a rope into it and it consisted in squares or concentric circles, meanders; they were separated into panes and had elliptical ornaments in the corners. The context of their discovery indicates that they were used either as mere household fi replaces or in rituals. Archeological literature provides us with an impressive amount of data regarding this subject. Things are completely different when it comes to seeing these architectural monuments in protected archeological sites or in museums. Two decorated hearths of this kind were found in the excavations from Cârlomănești - Cetăţuia in 2004; they are monuments of the Geto-Dacian classical civilization. They were situated in two houses that are believed to have been of public use. The plan of the buildings as well as their orientation, with the front facing North, points to a typical Geto-Dacian sanctuary. A secondary restoration and conservation project that was attached to the initial project of archeological research allowed for one of them (Cpl. 27) to be taken, conserved and eventually exhibited. The methods used in the operation of conservation and restoration are presented in detail hoping that the archaeologists will pay more attention to these kind of monuments in the future. Due to the joint research and conservation project, the Cpl. 27 has presently joined the other monuments of its kind and may be admired or studied in Buzău County Museum (Muzeul Judeţean Buzău).

This article studies in a systematic way, based on specialized research literature, the benefits of the XBRL standardized reporting of the financial-accounting statements and the impact of its use on the company’s relationship with the capital markets. XBRL digital reporting standards emerged as a necessity for the development of economic processes in global markets, realizing the informational link between companies and stakeholders, including investors, through information technology. The paper uses, as a foundation, the research based on the analysis of the specialized literature, highlighting the benefits of XBRL reporting within the information process of the capital markets: reducing the costs of acquiring, accessing, processing and analysing information. The responses of these markets were immediate, the analysed studies demonstrated as immediate effects of the standards implementation, the improvement of the company image among investors, the increase of the entities market value and the increase of the capital markets ensemble efficiency. Our study is primarily addressed to companies, in substantiating the decision regarding of these reporting standards implementation.

Porto-pulmonary hypertension (PPH) is the association between portal hypertension (PoH) due to liver disease or extra hepatic etiology and pulmonary hypertension (PH). It’s prevalence ranges between 2 and 16 % (1,2)and it’s diagnosis requires the exclusion of alternative causes of PH which can be sometimes challenging, especially in the context of a wide range of comorbidities that a patient with chronic liver disease can present with. We describe a 72 years-old man with a clinical presentation of right heart failure and signs of severe PH shown by the echocardiography. The blood tests were positive for anti-HCV antibodies and CT-imaging showed signs of cirrhosis and PoH. Complementary exams and review of the literature allowed use to rule out other potential causes constituting the differential diagnosis of the PH in this patient.