Zilele Medicale Dobrogene 2023
Discipline Clinice Medicale II
Discipline clinice chirurgicale
Presbycusis is
age-related hearing loss. It is a gradual and progressive loss of hearing that
occurs as a person ages, usually starting around the age of 60. Presbycusis can
affect both ears and may initially affect high-pitched sounds as well as the
ability to distinguish between similar sounds. It is the most common cause of
hearing loss in adults and can be caused by a variety of factors, including
genetic predisposition, exposure to loud noises throughout life, and the
natural aging process.
Although
presbycusis cannot be cured, there are compensatory hearing options available
to help manage symptoms, such as hearing aids or cochlear implants.
Audiological tests, such as pure-tone audiometry, voice audiometry, as well as
other methods of theater of auditory function, can help diagnose presbycusis
and assess the extent and nature of hearing loss. These findings can be used to
develop a treatment plan that may include hearing aids, assistive listening
devices, or other interventions to improve communication and quality of life.
Newborn audiological screening should be done soon after the baby is born to check the baby's hearing. The test is usually done in the maternity or hospital before the baby is discharged or at a follow-up appointment shortly after leaving the hospital.
The purpose of newborn audiological screening is to identify any hearing problems early so that appropriate interventions can be provided as soon as possible. Early identification and intervention of hearing loss can prevent delays in speech, language and cognitive development.
There are two main types of newborn audiological screening tests: otoacoustic emission (OAE) and auditory brainstem response (ABR) testing. Both the OAE and ABR tests are safe and non-invasive, and the tests are usually completed within minutes. If a newborn does not pass the initial screening, additional testing and follow-up protocols will be recommended to accurately determine the presence of hearing loss, the possible etiology, or available therapeutic methods.
To know the distribution of a variable with a high degree of certainty, the first step is to know the behavior of the target variable by determining the possible outcomes and observing whether the distribution of values is discrete or continuous. Estimating event probabilities using distribution functions creates the opportunity to better understand the behavior of target variables. The probability distribution depends on the statistical indicators of the sample (arithmetic mean, standard deviation, skewness and kurtosis) and the most used is the normal distribution, known in the specialized literature as the Gaussian distribution (after the mathematician Carl Friedrich Gauss).
In nature the probability distributions of
most variables follow approximately a normal distribution. Many health,
psychological, or educational variables such as weight, height, student grades,
job satisfaction, or memory are among the many approximately normally
distributed psychological variables.
The aim of the study
is to analyze several methods to assess whether data are normally distributed
by classifying these analyzes into two broad categories: graphical (histogram,
QQ-Plot probability diagram) and analytical (Shapiro-Wilk test, Lilliefors and
Kolmogorov-Smirnov test).
The conclusion of the study is that for the quick and visual identification of a normal distribution, one can use the QQ-Plot diagram and the histogram, if there is only one variable, and the Box Plot diagram if there are several variables. As a statistical test to confirm the hypothesis of normality, the most powerful test is the Shapiro-Wilk.
Keywords: Normal distribution, histogram, Shapiro-Wilk test, Kolmogorov-Smirnov test.
A high quality medical
act implies, in addition to the scientific component, adherence to a set of
social, deontological and legal norms from which rights and obligations derive,
both for the doctor and the patient. Modern medicine entails a litigious
vulnerability of the medical profession, materialized by medical malpractice
lawsuits, medical negligence, disciplinary misconduct, etc.
Knowledge of the
fundamental principles of the rules of jurisprudence specific to the medical
profession is a necessary but not sufficient condition for good medical practice.
The aim of this paper
is to clarify the different forms of legal liability as required by the
criminal and civil law of our country in relation to the medical act, given the
upward trend of allegations of deficient medical care.
Keywords: legal liability,
medical malpractice, medical negligence.
The aim of this study is to evaluate the pyramidal fascicles, by diffusion tensor, both in terms of their anatomy and from a clinical point of view in inflammatory and tumor pathology. We assessed the limits of tractography in the evaluation of the nerve fiber. The role of tractography in the diagnosis and prognosis of various neurological lesions.
Material and method: The examinations were performed in Medimar Imaging Services Constanța clinic, on a 1.5 T device. The tracts were divided into unaffected, displaced or distorted, disintegrated, or partially disintegrated. The images were evaluated in correlation with the clinical manifestations of the patients.
Results: We found reconstruction abnormalities in
tractography at the level of fibrillar crossings and at the direction changes.
We observed that a complete reconstruction of the tract,
without the detection of fibrillar destruction, was associated with the absence
of clinical manifestations. Motor deficits were present in patients with the
lack of visualization of some fibrillar contingents in comparison with those
without clinical manifestations, in which we didn’t found changes in
tractography. In the case of fibrillar movements or fibrillar dissociations,
the clinical manifestations were of low intensity.
The value of the anisotropy fraction (F.A.) was also evaluated.
Conclusions: We observed a direct relationship in the
fibrillar integrity of the pyramidal bundles and clinical manifestations.
Tractography can be a useful method in the preoperative
evaluation of the neurosurgical patient, especially in tumor pathology to avoid
and assess the risks of neurological deficits after surgical intervention.
Also, DTI is a useful method in evaluating the prognosis of inflammatory pathology, by measuring the evolution of F. A.
Introduction: Lumbar and/or sacral pain is one of the most common medical problems faced by a large part of the population and which does not occur only in old age, as was usually believed, a fact demonstrated by the study carried out. Osteoporosis is a chronic condition, which causes a decrease in bone mass, most frequently at menopause, with a high risk of vertebral fracture.
Material and Method: The morphology part was performed in the anatomy laboratory of the Faculty of Medicine in Constanţa by direct measurements on the bone pieces with the help of the graduated tape and the caliper. The anatomical landmarks of the lumbosacral spine were also followed by CT examinations performed on a 64-slice Lightspeed VCT installation and osteodensitometry tests. The clinical-imaging study of the lumbosacral spine was performed on a total number of 315 female patients, who presented themselves in the specialized outpatient clinic in Constanţa county, for pain in the lumbosacral spine in order to create a treatment program and medical recovery, for a period of approximately 16 months.
Personal Results: The height of the lumbar spine measured from the upper circumference of the L1 vertebra to the lower circumference of the L5 vertebra on the midline of the anterior face of the spine, has a value between 167.0-173.7mm. The height of the lumbar vertebral bodies L1-L5 has a value between 23.2-28.7mm.
Discussions: We found a gradual increase in the average height only at the level of the first three lumbar vertebrae, after which the average height gradually decreased at the level of the last two lumbar vertebrae. Within the studied pathology, from the analysis of the distribution by age groups, the preponderance of patients between 60 and 69 years of age can be observed.
Conclusions: Lumbar pain is the most common reason for which patients present to the recovery medicine and endocrinology services. Postmenopausal osteoporosis is frequently accompanied by an increased risk of vertebral fractures, being a condition that cannot be cured, but can be managed throughout life.
Purpose
of the paper. Research of number,
shape, grip and ramification of papillary muscles.
Methods
and working material. The study has been performed by disection of 100 fresh or
formolized human hearts, in wich the cavities were opened through aortic
orifice for left ventricle, and through pulmonary orifice for right ventricle.
Results. We have described the shape of papillary muscles in right and left ventricle. For the anterior right papillary muscles, we have found most frequently the cilindric and conic shape (37%) and less often, chandelier shape, iregular shape or even two or three muscles bodies. For the posterior right papillary muscles, we have encounter a conic and cilindric shape, and less often archway shape. For septal papilar muscle we found three or six tendinous cords, and also with the conic shape formed by several small muscles bodys. For the anterior and posterior left papillary muscles, the most often we have found cilindric or conic shape, and less often „H” shape, „N” shape, or iregular shape. The left poerterior papillary muscle can be formed by 3 muscles bodys, in wich the middle one has an arched shape, or it can have tendinous cordages that have a paralel trajectory with the ventricular wall, crossway shape, or even an arch display.
Conclusions. Our study has targeted the morfological variability of papillary
muscles in shape, lenght, insertion and end of tendionous cordages, double or
tripple muscle bodys, with different implantation zone for each one in the
ventricular wall. Allegedly, the archway papillary muscles, in old people, have
less tonicity, in particular on the curved side, as a result of higher laxity
of tendinous cordages, wich can evolve in valvular insuficiency. The splitter
of tendinous cordages in secondary thin branch explain the rupture of those
during effort.
Purpose
of the paper. Anatomical study of scapulo-humeral joint
regarding defining elements of this region, like glenoid cavity shape,
configuration, size and position of glenoidian labrum, as well as shape and disposition
of the ligaments and tendons of the muscles that serve the joint.
Methods
and working material. The study has been performed by disection of 30
scapulo-humeral human joints, fresh or formolized, followed by photography and
analysis of morphological aspects.
Results. Scapula’s glenoid
fossa had most frequently an oval shape (50% of cases), pear-shape (30% pf
cases), kidney-shape (13.33% of cases), circular (6.67% of cases). In 80% of
cases we have found same shape in both cavities. Glenoid labrum we have found
more evolved in the upper side, and frequently perforated by the fibers of the
biceps brachial long head. Coraco-humeral and gleno-humeral ligaments we have
found overlayed on the superior edge, with an often trapezoidal shape, and the
long edge facing towards the glenoid cavity. We found a short and wide
gleno-humeral ligament. The long head of the brachial biceps we found in the
thickness of the capsule, with a flat end, or rarely semi-cylindrical.
Frequently he leaves the capsula through its inferior side into the
intertubercular groove.
Conclusions. The morphological characteristics of the studied articular elements can lead to the important conclusion according to which the anatomical complexity and variability of the region represents, without a doubt, a favorable ground for the appearance of arthrosis-type conditions. The different anatomical features and characteristics existing between the two scapulo-humeral joints of the same individual can explain why different affect can occur in only one joint.
Cessation of smoking can be quite challenging nowadays; relapses are common and only few people reach their goal. Based on the experiences of others, we set out to determine the most effective method to stop smoking. Eighteen individuals of various ages and backgrounds completed a self-administered questionnaire with fourteen questions. Methodological approach used in investigating research problem “Practical ways to quit smoking” is a mixed method, additionally; various kinds of sampling were used as well. This project is secondary research. 36.4% of people started smoking at the age of 17 years old, and 81.3% of them have been smoking for at least three years; 50% of the people stopped for a period between two to six months maximum, and 62,5% of them relapsed while 53,3% found substitutes for cigarettes. The findings show that using nicotine cessation aids, the Voxra method, and increasing self-awareness are the most widely used techniques. These results aim to guide individuals in selecting the most effective smoking cessation strategy.
Keywords: smoking cessation, tobacco, cigarettes
Assisted death is the act of a physician ending a patient’s life with their consent when unfortunately, further treatment will no longer improve the patient’s condition, and it would be unethical to recommend the patient to continue living in a state of pain. This is a very relevant option to consider, as some medical fields simply have not had the opportunity to complete the research needed for the ailment in question. In other situations, the patient has simply exhausted all of their options and physically can no longer handle the toll on their body. For physicians, this is a clear example of when they would need to evaluate their medical ethics, and recommend the best solution whilst considering what the patient themselves would like to happen.
This topic is also extremely important for current medical students to consider as they are more than likely to encounter a situation like this in their future careers. It is also key to identify how much knowledge the students themselves think they have and how prepared they would be to handle an issue such as this.
We looked into the history of assisted death to understand how assisted death has evolved over time. It is also imperative to understand to what level socioeconomic and cultural factors affect a person’s view on assisted death, because as a physician, the background of the patients that will come for treatment is not limited to a single type. We used previously published articles to carry out the research. A small survey was also conducted amongst medical students to attain views of the current student body. This survey allowed us to collect qualitative results on each student who participated in terms of their lifestyle and background and if there is any correlation to their view on this matter.
We felt it would be useful to find out the same information from non-medical students as well to compare the level of understanding of assisted death. This information could also potentially project the views of the general public compared to those with medical training, and how much of a critical difference the academic background of a person makes. From the survey, purely preliminary findings are that most of the students who answered that they would be able to perform assisted death had a moderate to complete understanding of the procedure. The level of study varied amongst these students, but a good proportion of them answered that they do not follow a religion.
Our aim is to make students aware of the possibility that assisted death can and will be used on a patient that they may encounter in the future and that they should be prepared mentally and have the appropriate skills to handle such a situation.
Vaccines
against COVID-19 have been developed in record time by several manufacturers
and distributed globally to help eradicate the pandemic caused by the
SARS-CoV-2 virus.
The
vaccines authorized so far in the European Union have undergone rigorous safety
tests and have been developed using different types of technologies, depending
on the manufacturer. Some use established subunit technologies that use
specific parts of the virus that the immune system must recognize, while others
use new technologies with selected and safe viral vectors that can trigger an
immune response without causing disease. Some use a new genetic approach with
ribonucleic acid in the form of messenger RNA that produces the specific
protein to be recognized and responded to by the immune system.
Approval
of vaccines was conditioned on manufacturers fulfilling specific
post-authorization obligations, including the submission of well-defined
periodic safety and efficacy reports. The final clinical study report, a
randomized, placebo-controlled trial conducted in a blinded observer setting
for each vaccine, is expected to complete the approval process. Undesirable
adverse drug reactions (ADRs) to vaccines against the SARS-CoV-2 virus are
continuously monitored, and the data collected and synthesized allow for the
permanent updating of information on the reactogenicity of each vaccine and the
dose administered. This guarantees that any potential risks are detected and
managed as quickly as possible.
Most
side effects to vaccination are expected and are associated with the body's
response to the vaccine. After widespread use, reports of individual cases and
small series of serious adverse events and rare syndromes have emerged, but
studies to date have not confirmed whether they are a coincidence or a result
of recent COVID-19 vaccination.
Studies
have shown that anti-COVID-19 vaccines have significant benefits that outweigh
the risks, significantly reducing the degree of illness and hospitalization. In
this brief presentation, we will focus specifically on post-vaccination side
effects of COVID-19 vaccines, analyzing the realities, the importance of
COVID-19 vaccination in the context of the global pandemic that has affected
humanity, and debunking myths.
Keywords: COVID-19, vaccination against covid-19, post-vaccination side effects covid vaccine
The normal
vaginal flora is complex and includes various organisms, many of them
conditioned pathogens. The vaginal microbiome is controlled by estrogens that
is why a major difference it encountered between pre-menopausal and menopausal
women.
Bacterial
vaginosis was associated with inflammatory changes on Papanicolaou (PAP) smears
and chronic inflammation may eventually tead to potentially precancerous and cancerous
processes of the cervix.
We asses the importance of PAP test and early discovery of vaginal
infections because bacterial vaginosis has been associated with inflammatory
changes on PAP smears.
Background: the performance of the students in their academic life is reflected by their sleep habits and timing. This research has been done in order to get a deeper understanding of the relationship between sleep quality and quantity among students of Ovidius University.
Methods: The study was conducted on 30 students of Ovidius University, 55% were male and 45% were female, by collecting their sleep information for 2 weeks, followed by a PSQI global scale (Pittsburgh Sleep Quality Index) survey.
Result: difference in students’ academic performance was noticed, 36% got an excellent performance, 45% got a very good performance, 19% got a good performance. Medication usage was not reported by most students (87%), yet a small number (3%) used medication to sleep better. PSQI scale didn't show a noticeable variety among students, the average sleeping time rate was the same for both genders. PSQI scale for female was 6.98 points and for male it was slightly higher with 0.4 points.
Anemia is common in cardiac patients and affects prognosis. Even moderate levels of anaemia are associated with increased cardiovascular mortality compared with normal hemoglobin values in the context of acute coronary syndromes. Anemia is a comorbidity potentially treatable, with significant prognostic implications.
A restrictive transfusion is triggered by hemoglobin is ≤8g/dl (severe anemia) and a liberal transfusion is considered when hemoglobin ≤10 g/dL.
We analysed the results of blood transfusions in patients from the Cardiology department of the County Emergency Clinical Hospital Constanța, in 2021, a total of 270 patients, with 64% male and 36% female. According to the living enviroment 68% patients were from the urban area and 32% patients from the rural area.
The majority of patients received a single blood unit 63 % and 37% were polytransfused.
The mean hemoglobin (Hb) before transfusions was 7.83g / dl (6.10g/dl-10.80g/dl) and reached 9.03g/dl (7.10g/dl-11.80g/dl). In patients who received a single blood unit, was observed an increase of 1-2.2 g/dl and in polytransfused the increse of hemoglobin was 2-3,5 g/dl.
Rapid correction of anaemia by transfusion was a key factor in the increase of hemoglobin, the goal Hgb 10-11 g/dl correcting the Oxygen supply , vital for the proper functioning of organism processes and saving the pacient,s live.
Keywords: transfusions, anemia, cardiac patients
Giant Cells Glioblastoma is a malignant tumor of the nervous tissue, rarely spread among the adult population, being more common among children.
I have decided to present an atypical case of a female adult patient who, following an inconclusive clinical-imaging picture, was diagnosed with giant cell glioblastoma.
From a clinical point of view, the uncertain symptomatology led to a different presumptive diagnosis than the true pathology of the patient. The imaging reports revealed a suspicion of metastasis in the Isle of Reil, having a surgical indication. Both immunohistochemistry techniques - for diagnosis- and fluorescent in situ hybridization methods - to determine aggressiveness – were used on the tumorectomy piece. Due to the intervention and the immunohistochemical and cytogenetic examinations, the final diagnosis was concluded. Following a correctly administered treatment, she suffered two relapses in the same hemisphere, but in different lobes, even though the prognosis seemed favorable. The purpose of this presentation is to compare the characteristics and evolution of this particular case of giant cell glioblastoma with information already known in the specialized literature, which pictures this pathology as having a favorable evolution. We thus discover on this study a deceptive character that hides the particular aggressiveness of the pathology. This is revealed following a series of further histological and genetic investigations. However, the rapid evolution of the symptomatology and the aggressiveness denoted by the short time recurrence - only 5 months after the treatment had ended - could not keep up with the diagnostic protocol.
The information found on this study helps us understand the mechanism of these rare neoplastic pathologies, in order to be able to improve patients management and implicitly the therapeutic activity.
Keywords: Giant Cell Glioblastoma, Imaging, Immunohistochemistry, Recurence
The reaction time, which represents the length of time from the reception of a stimulus to the execution of a voluntary behavior appropriate to the stimulus, which makes possible measuring this time, taking into account the possible factors that can influence the obtained values.
The present work represents a study of the variability of the reaction time according to the different factors.
The importance of knowing the effect of these factors on reaction time is of great value from the point of view of choosing a profession, studying working conditions, controlling the reaction time of aircraft commanders, cosmonauts, in sports medicine (choosing the sport to practice, following training) , in the of work capacity expertise, curative medicine, psychology and, also, in pharmacological research.
This study was carried out between April and December 2022, on a number of 47 subjects, aged between 20-70 years.
The anamnestic assessment of the factors that influence the reaction time, was performed using a questionnaire that was completed by all the participants in our study. The objective assessment of the reaction time was carried out using the Biopac Student Lab program, from the Physiology laboratory
All subjects were tested for reaction time on both the dominant upper limb and the non-dominant limb. The dominant upper limb recorded in all participants was the right arm.
In women, an average of 288 ms was recorded in the right upper limb and an average of 264 ms in the left upper limb, and the difference between the dominant and the non-dominant arm has a value of 24 ms.
In men, an average of 268 ms was recorded in the right upper limb and an average of 252 ms in the left upper limb with a difference between the dominant and non-dominant arm of 16 ms.
The performance of the reaction time depends on the age, the degree of training, the state of fatigue and attention and last, but not least, the personality type of the subjects.
The COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 has led to a global health crisis and has impacted almost every aspect of human life. The virus is highly contagious and primarily spreads through respiratory droplets. Symptoms range from mild to severe and can lead to pneumonia, acute respiratory distress syndrome, and death. Treatment options are limited, and vaccination programs are being implemented worldwide to control the spread of the virus. However, the emergence of new variants with different transmission and virulence patterns continues to pose a challenge. Public health measures such as social distancing, wearing masks, and hand hygiene remain critical to reducing transmission rates. The pandemic has also highlighted the importance of international collaboration and the need for preparedness for future pandemics.
This review describes the treatment route developed countries undertook (i.e vaccines) and the route which developing countries took (i.e traditional medicine, herbal and even dietary).
Introduction: We present the case of a 30-year-old patient, who was
admitted to the Intensive Care Unit of the Obstetrics-Gynecology Clinic for
septic and hemorrhagic shock after an incomplete spontaneous abortion, who
required emergency hysterectomy. A few hours after the surgery, she presented
fever and leukocytosis with lymphopenia, thrombocytopenia, systemic
inflammatory syndrome, increased d-dimers. A SARS-COV2 antigen test was
positive at admission, raising the suspicion of SARS-COV2 infection, but RT-PCR
SARS-COV2 test was negative. The clinical evolution was negative, a new chest
radiography identifies multiple bilateral disseminated alveolar opacities.
Thoracic CT and angioCT of pulmonary arteries confirmed the thromboembolism and
pulmonary infarction in the postero-basal segment of the right lower lobe, also
highlighting some ground glass areas, bilateral pleural effusion. Thoracentesis
revealed the presence of a transudate. The patient underwent complex treatment
with blood transfusions, broad spectrum antibiotics, vitamins, low molecular
weight anticoagulant, positive inotropic support. Imaging monitoring revealed
the appearance of a cavity in the area of the pulmonary
infarction, suggesting a possible superinfected pulmonary infarction.
Bronchoscopy identified bilateral purulent secretions and multiplex
bacteriological examination of the bronchial aspirate detected multiple
gram-negative germs; antibiotic therapy was adjusted. On the 42nd day of
hospitalization, she presented polyuria, the suspicion of polyuric-polydipsic
syndrome was raised, but urinary density, urinary aldosterone, urinary sodium
and urinary potassium showed normal values. Was diagnosed with acute
tubulointerstitial nephropathy. After stopping the antibiotics and hydric
rebalancing, the diuresis normalized. She was discharged with the
recommendation to continue the anticoagulant treatment and multidisciplinary
reassessment in the outpatient clinic.
Discussions: The presence of several atypical germs significantly
influenced the evolution, and antibiotic therapy led to the appearance of
tubulo-interstitial nephropathy.
Conclusion: Toxic-septic and hemorrhagic shock is associated with high
mortality risks, but the efforts of the multidisciplinary team resulted in the
patient's survival and favorable evolution.
Introduction: Pulmonary pathology with radiological expression of cavitary type has a very wide spectrum, cavitary images beeing met in 50% of bronchopulmonary neoplasms, 45-50% of cases of secondary pulmonary tuberculosis and in approximately 5% of cases of pulmonary infarction.
Clinical case: 67-year-old patient, non-smoker, without pathological history, admitted to the Pneumology Clinic for cough with hemoptysis, left chest pain, fever, physical asthenia and weight loss (6 kg/2 months). Chest CT with contrast enhancement is performed, which highlights an area of pulmonary consolidation in the apical segment of the left lower lobe of 94 mm diameter, centered by a cavity of 60 mm diameter with a contrast outlet and liquid areas. Bronchoscopy shows trachea with extrinsic compression in the lower 1/3, without endobronchial or infiltrative tumor processes. Bacteriological examination for Koch bacillus - negative. Broad-spectrum antibiotic treatment is instituted, with favorable clinical and biological evolution, but with the persistence of radiological changes. Considering these aspects, the patient is referred to the Thoracic Surgery ward of the "Marius Nasta" Pneumology Institute, where left lower lobectomy with partial pleurotomy is performed. The diagnostic surprise comes with the histopathological diagnosis, which highlights organized and superinfected lung infarction lesions. The postoperative evolution is favorable, without complications, the patient being surgically cured.
Conclusions: Pulmonary cavity lesions are versatile, due to the similar aspect, related to their etiology, so the etiological diagnosis can be difficult. Thorough anamnesis, clinical examination, interpretation of radiological images and clinical evolution are valuable tools in the management of such a case. Surgical excision with histopathological examination establishes the diagnosis.
Introduction: Parkinson disease (PD) is a neurodegenerative movement disorder. Beginning with Braak’s theory that hypothesized a connection between gut, inflammation, and substantia nigra degeneration, many studies were made to put a link between inflammatory bowel disease and P D.
Method: We studied several patients with advanced PD, submitted in our Neurology Center, between July and September 2022 for initiation of device aided therapy with intestinal gel that fulfilled the admission criteria. We took under consideration the demographic data, UPDRS motor part III, ADL and IADL scales at day 1, after discharge and after 3 months. We provided biological analysis for D-Dimers, Fibrinogen, C Reactive Protein, ESR, and we compared the values from the 1st day of hospitalization and after 3 months; fecal samples were collected to evaluate the presence and the levels of fecal calprotectin (FC).
Results: In more than 60% of the cases, fecal calprotectin was higher than 100 ug/g (5 times normal), 80% more than 400, 20% more than 1000 ug/g, associating with modified inflammatory marks and clinical evaluation scores with no significant improvement in motor abilities in 3 months after discharge. In only 2 cases where calprotectin was below 22, there was a positive evolution in UPDRS motor part III score from 52 to 36 and from 29 to 21(from day 1 and after 3 months), alongside with 2 points in ADL, IADL scales.
Conclusions: Inflammation biomarkers and fecal calprotectin in high ranges seem to associate difficulties in obtaining a good therapeutical response in advanced PD stages.
Keywords: Calprotectin, Parkinson Disease, Inflammatory Bowel Disease, Device Aided Therapy
INTRODUCTION: Kounis Syndrome is characterized by the concurrence of acute coronary syndrome with mast cell activation induced by inflammatory mediators released during an allergic reaction.
MATHERIAL AND METHOD: We report a case about a 74 year old male, presented in the Emergency Unit for acute headache in the Christmas day. He had a clinical history of high blood pressure and diabetes and prostate cancer surgically treated, without any known allergies. When we evaluated the patient, his vital signs were in normal parameters and the first ECG had no pathological findings. A symptomatic treatment with Metamizole was administered intravenous. After 30 minutes, the patient experienced a general rash reaction so anti allergic agents were given. After just another 15 minutes an acute chest pain was resented, irradiating to his shoulders leading to collapse and elevated S-T segment in the inferior leads and negative T waves in the anterior ones. Monitoring the patient, we noticed different patterns on the ECG concordant with his angina. At this moment we took under consideration an acute coronary syndrome due to vasospasm. With a high range of Troponin T (27,48 pg/ml), emergency coronary angiography was performed. The result indicates an amount of 50 percent stenotic plaque on the ACX II and 40 percent on the ACD II.
CONCLUSION: The patient was admitted to the coronary care unit and the case was managed as allergic myocardial infarction (Kounis syndrome).
Keywords: Kounis Syndrome, Anaphylaxis, Coronary vasospasm
INTRODUCTION: Methanol is a toxic alcohol that causes serious poisoning due to it’s metabolites: formic and lactic acid, leading to severe metabolic acidosis with high anion gap and toxic encephalopathy. The severity of the clinical features occurs within 6- 72 hours as seizures and altered mental status.
MATHERIAL AND METHOD: We present a case of a 45-year-old patient admitted in the Emergency Department, with no medical history, chronic alcoholic, comatose (Glasgow Coma Scale 4 points), tachypneic, after seizure episode at home. 24 hours before, he had another presentation for head trauma, with preserved level of consciousness. The investigations performed were in normal range the patient being discharged only with a minor nasal fracture. This time, at the clinical evaluation the patient had an acidotic Kussmaul breathing, GCS 4 points with abolished corneal and photo motor reflexes, lower lip injury. Biologically, the severe metabolic acidosis (pH=6,789, HCO3=5 mmol/L) with high anion gap (45,6 mmol/L), moderate hepatocytolisis (AST=182.78 U/L, ALT=72.93 U/L), high serum values of amylase (140 U/L) and lipase (179.53 U/L), toxicology report, urinary sample, ethanol measurement (0 mmol/L) and imagistic scans, were highly suggesting methanol poisoning diagnosis.
CONCLUSION: The patient was transferred to the Intensive Care Unit, where hemodialysis was performed. Sequently brain scans highlighted methanol toxicity patterns: symmetrical necrosis of the basal ganglia, occipital and optic nerve's gliosis. This insights are important for uderstanding the unique importance in never atributing a low GCS to ethanol alone.
Keywords: coma, methanol, emergency, encephalopathy, putamina necrosis.
Introduction: Hepatocellular carcinoma (HCC) represents a frequent complication (2-8%/year) of liver cirrhosis (LC).
Material and methods : 450 patients diagnosed with HCC in the january 2018 – december 2022 both in the Medical Clinic I of the Emergency Clinical Hospital “Saint Andrew the Apostle”Constanta and from the outpatient service. The inclusion criteria were tho imagistic methods and AFP over 10 times normal (80%).Patients with other digestive or non-digestive neoplasia were excluded. The imagistic diagnostication methods were US, CT, MRI,while the elements of interest were the clinical symptoms,the adjuvant factors, the characteristics of the tumour and the accompaniament hepatic ilness.
Results and discussion: The results indicate a possible toxic-nutritional etiology in 45% and VHB presence 38% single or combined with VHD and /or VHC. The most frequent symptoms were astenia (96%),fatigability (96%), abdominal pain localised in the superior area (80%),weight loss (69%),jaundice (32%).The signs and the symptoms didn’t vary significantly in the two groups depending on the presence or lack of hepatic cirrhosis (324 CH/126 nonCH). From an imagistic point of view, although the multicentric tumour is more frequent on a cirrhotic liver,the difference is not significant.
Conclusions: Hepatocellular carcinoma developed either on an healthy liver,or on a cirrhosis liver,has no specific premonitory symptoms.We consider the anti VHB vaccination,as well as the successful therapy of chronic hepatitis C as being important methods in the prevention of this ilness.
Keywords: hepatocellular carcinoma, liver cirrhosis, chronic hepatitits
Metabolic syndrome
is defined by a constellation of interconnected physiological, biochemical,
clinical, and metabolic factors that directly increases the risk of
cardiovascular disease, type 2 diabetes mellitus and other chronic pathologies.
In both children
and adults, the criteria for diagnosing metabolic syndrome are:
·
High blood glucose (sugar)
·
Low levels of HDL (“good”) cholesterol in the blood
·
High levels of triglycerides in the blood
·
Large waist circumference or “apple-shaped” body
·
High blood pressure
·
If the criteria are clear for adults, there are still many
unknowns for children and adolescents.
Three out of five of the following criteria are necessary for a diagnosis of metabolic syndrome in children:
Abdominal obesity, defined in children as waist circumference that is more than 90th percentile for gender, age and height
·
High-density lipoprotein (HDL) cholesterol less than 40
·
Triglycerides more than 150mg/dL
·
Systolic blood pressure more than 90th percentile for
gender, age and height
·
Fasting glucose greater than or equal to 100 mg/dL
In adults, the criteria are the same, though several of the thresholds differ:
Abdominal obesity is defined as a waist circumference of more than 102cm in men and 88cm in women
·
Systolic blood pressure over 130
·
HDL under 50 for women and under 40 for men
Although each of these is a risk factor for cardiovascular disease, when a person has three or more and is diagnosed with metabolic syndrome, the chance of developing a serious cardiovascular condition increases.
We often think that metabolic syndrome is linked to obesity, but it can also be found in lean individuals, showing that obesity is a marker of the disease and not its cause.
Different studies around the globe have shown that metabolic syndrome can occur in 20-30% of young lean adults. In a Canadian cohort study, nearly 25% of the normal weight adults >20 years old were metabolically abnormal. Unhealthy diet, such as the western diet, rich in processed food, red meat, sugary snacks- is one of the critical independent predictors of metabolic abnormalities.
Beside diet, other environmental factors are linked to the development of an adverse biochemical phenotype, like stress, sleep deprivation etc.
Nowadays one of the most alarming public health issues is the rise in the prevalence of obesity in children. In the same time there is a rise in pediatric metabolic syndrome.
Childhood obesity is associated with an early risk factor for much of the adult morbidity and mortality. Children rarely develop true cardiovascular events, but there is evidence of accelerated atherogenesis.
Beside CVD and Type 2 DM, metabolic syndrome is associated with many clinical conditions, including low-grade inflammation, oxidative stress, hyperuricemia, dyslipidemia, hyperandrogenism and polycystic ovary syndrome, hepatic steatosis and nonalcoholic fatty liver disease, impaired glucose tolerance, obstructive sleep apnea, hypogonadism, vascular dementia and Alzheimer’s disease and certain forms of cancers. So, the presence of metabolic syndrome in children, increases the likelihood of developing one of the aforementioned conditions throughout adulthood. United Nations Secretary General has declared noncommunicable diseases to be a greater threat to the developing world than acute infectious diseases.
The pathophysiology of the syndrome is complex, with obesity and aging contributing to it, but not being its initiating factors. Since it’s observed in children around the world, it is not linked to genetics. Environment plays a major role, and this gives hope: by adopting the correct lifestyle and diet it can be cured or prevented.
In conclusion, prevention is essential. Screening, including in children and adolescents, is absolutely necessary for a correct management of Metabolic Syndrome.
Keywords:
metabolic syndrome, prevention, obesity, glucose, cholesterol, triglycerides,
blood pressure.
Introduction: HVC antiviral therapy has made significant progress in the last year since the introduction of interferon free therapy.
Material and method: We present the case of a 47-year-old patient diagnosed with Hodgkin's lymphoma stage IV B in remission from the point of view of hematological disease but with non-responsive HVC to antiviral therapy (Peginterferon + Ribavirinum). The quality of life at the initiation of therapy and during therapy was assessed using the SF-LDQOL survey in its short version, which allows the assessment of the main components of quality of life related to health, "symptoms of liver disease", "consequences of liver disease" "problems related to liver disease.”
Results and Conclusions: In terms of eligibility, the patient was evaluated clinically, biologically and imaging to meet the criteria for initiating interferon free therapy and was treated for 12 weeks with Viekirax and Exviera.
Following the analysis and interpretation of the survey used, it was found that before initiating therapy the patient had a psychosocial imbalance (social activities), psychoaffective (stigma of liver disease, life expectancy, sadness) and loss of interest in sexual activity. After completing interferon free therapy, there is a significant improvement in quality of life, increased interest in social activities, self-confidence and increased life expectancy.The eradication of HCV infection allows the resumption of chemotherapy in case of a new relapse of the hematological disease. In terms of quality of life, interferon free therapy is proving effective, imposing itself as first-line therapy.
Keywords: interferon free, chronic viral hepatitis C, quality of life
Anticoagulant treatment in cancer patients with pre-existing liver pathology has become an increasingly studied topic, studies focusing on the balance between thrombosis and hemorrhage associated with end-stage liver diseases. New generation oral anticoagulants versus coumarin anticoagulants representing a challenge for the clinician.
We present the case of a 72-year-old patient known to have cirrhosis of the liver with B virus and cellular hepatocarcinoma presenting for a severe anemic syndrome in which the investigations have objectified both hemorrhage and thrombosis as well as embolisms, subsequent management requiring an interdisciplinary approach . The most difficult decision was related to the continuation or discontinuation of anticoagulant therapy for the secondary prevention of thrombosis with the additional risk of potential hemorrhages.
We consider it useful to report such a case considering that it is part of the category of patients who are outside the standard good practice guidelines.
Myopathies, a rather
rare reason for going to the doctor, represent a heterogeneous group of
generally secondary diseases that can have viral, autoimmune and neoplastic
diseases as the main cause. Dermatomyositis, a particular form of myopathy,
most commonly represents a paraneoplastic syndrome.
We present the case of
a 63-year-old patient who presented with muscle pain and massive peripheral
edema that affected mobility, which appeared following an upper respiratory
tract infection. Laboratory analyzes revealed the presence of a rhabdomyolysis
syndrome. Viral myopathy represented the initial diagnostic suspicion,
disproved by the following investigations. Abdominal ultrasonography was
performed, which revealed an inhomogeneous liver through the presence of
multiple nodular lesions without invasion in the branches of the hepatic
artery. The lack of specific symptoms for a neoplasm made the diagnosis process
difficult. Following imaging studies, bronchoscopy and biopsy, the diagnosis of
small cell lung carcinoma was made.
Small cell lung
carcinoma represents respiratory tract neoplasia with the widest range of
specific paraneoplastic syndromes. The presentation of the case is essential
because the differential diagnosis of this patient also includes testicular,
thyroid and bile duct neoplasia.
Contrast induced nephropathy is defined as an increase in serum creatinine of more than 25% or ≥0.5 mg/dl from baseline within 48 hours. More sensitive markers of renal injury are desired, therefore several biomarkers of tubular injury are under evaluation.
We present the case of a 52-year-old patient, with previously normal renal function, currently diagnosed with acute myocardial infarction and complete heart block with secondary renal insufficiency, who underwent coronary angioplasty, which caused deterioration of the renal function. Considering the patient's life-threatening situation, an angiographic intervention with contrast material was decided because the therapeutic benefits outweighed the risks. Under specific treatment, the evolution was favorable with the improvement of renal function.
The extended literature states that contrast induced nephropathies are generally totally reversible if early diagnosed and supportive treatment is instituted promptly. We conclude that monitoring renal function for at least 72 hours after the administration of contrast agents is essential in all patients regardless of their medical history even more so when the patient presents additional risk factors for acute kidney injury.
Introduction: Post COVID-19 pulmonary fibrosis (PCPF) is a severe and frequently reported sequela of the severe form of COVID-19 (coronavirus disease 2019). The risk factors for fibrosis development are advanced age, male gender, smoking history and underlying conditions, such as diabetes and cardiovascular and lung diseases.
Case description: We present the case of a 77-year-old patient, a smoker with a pack-year index of 20, without environmental toxins exposure, who presented to our hospital for dyspnea at minimum effort, rare cough with mucopurulent sputum, headache, and nocturne sweats, with antecedents of COVID-19 severe form in October 2021, arterial hypertension, paroxysmic atrial fibrillation, and gastroesophageal reflux disease. At the clinical examination, the patient had influenced general condition, dehydrated pale skin, diminished tactile fremitus, diminished amplitude of the respiratory movements, diffuse diminished vesicular sound, SpO2= 92%. Laboratory tests showed a persistent inflammatory syndrome, mild anemia, hyperglycemia. The CT scan showed reticular subpleural and peribronchovascular opacities, with traction bronchiectasis located bilateral, with superior and right predominance The pulmonary function tests showed a mild restrictive disfunction, with a mild decrease of the diffusing capacity of the lungs for carbon monoxide (DLCO). The sputum exam identified the presence of Candida albicans, receiving antifungal and corticoid therapy for 7 days.
Conclusions: COVID-19 can determine sequela for a long period after the acute episode, especially in older patients with comorbidities, causing pulmonary function loss and decreased quality of life. It is important to develop therapy for PCPF.
Introduction: Interstitial lung diseases are a group of over 200 rare diseases, that have a series of common characteristics. A progressive fibrosing phenotype is a relatively new notion that is defined by a worsening of respiratory symptoms, lung function decline, limited response to immunomodulatory therapies, a decline in the quality of life and potentially, early death, all within a relatively short time.
Case presentation: We present the case of a 52 year old woman, non-smoker, with no exposure to respiratory toxins, with a diagnosis of dermatomiositis, who presented with an imagistic suspicion of interstitial lung disease. The pacient reports mild cough and dyspnea. The laboratory tests showed inflammatory syndrome and liver citolisis. The functional lung tests show a moderate restrictive ventilatory dysfunction while the 6 minute walking test is within normal limits. The HRCT scan shows an UIP pattern of fibrosis. Comparing the imaging with an earlier HRCT scan that the pacient had performed in the past, the progressive fibrosing phenotype was raised into question.
Conclusions: establishing that an interstitial lung disease has the progressive fibrosing phenotype is a group effort, witch includes a pulmonologist, a reumathologist and a radiologist. There are clear criteria that need to be met in order to determine that an interstitial lung disease has a progressive fibrosing phenotype.
Abstract: We reviewed the latest clinical studies in regards of Chronic Obstructive Pulmonary Disease (COPD) phenotyping, in an attempt to recognize features that might relate to both underlying disease biologically and clinically significant outcomes, to improve the health status and reduce symptom burden.
The mortality and prognosis in COPD phenotypes can vary depending on the subtype of COPD and the severity of the disease. The emphysematous phenotype is associated with a poorer prognosis, as it is often more severe and progresses more rapidly than other phenotypes. Mortality rates are higher in people with emphysema-predominant COPD, particularly in those with severe or very severe disease. The mortality rates in chronic bronchitic phenotype tend to be lower than in emphysema-predominant COPD, but the disease can still be progressive and lead to significant disability. The prognosis for ACOS is generally worse than for either asthma or COPD alone, because people with ACOS may have more frequent exacerbations, leading to a poorer quality of life. The frequent exacerbator is associated with a higher risk of mortality, as frequent exacerbations can lead to more rapid declines in lung function and increased risk of hospitalization.
Identifying specific biomarkers associated with different COPD phenotypes can help to guide treatment decisions and predict disease outcomes. However, further research is needed to better understand the relationship between biomarkers and COPD phenotypes, and to develop standardized methods for their measurement and interpretation.
Conclusions: The field of COPD phenotypes it’s considered “the future of COPD”, having a great impact on everyday practice and has changed nonpharmacological and pharmacological management of COPD in last decade. From the point of view of the phenotypes, we can conclude that the frequent exacerbator phenotype has the worst prognosis, the quality of life is lower in the chronic bronchitic phenotype /ACOS and the highest death rate belongs to the exacerbating- emphysematous phenotype.
Vitamin D deficiency is a very frequent observation among obese individuals. A question is risen if VD deficiency is either a cause or a consequence of obesity. The aim of this study is to reveal the role of Vitamin D in the development of CVD, the impact of obesity in adults. In order to support the affirmations mentioned claims, it was necessary to investigate the available literature that would allow to compare relevant material and provide sufficient evidence. Quite interestingly was revealed the pathophysiology of vitamin deficiency in obesity as well as the efficiency of oral supplementation of vitamin D.
Between vitamin D deficiency and cardiovascular risk there is a causal relationship already proven by studies. The cause is chronic inflammation which is the basis of chronic diseases. It is not yet known exactly if deficiency D vitamin determines chronic inflammation or is the result of chronic inflammation.
Obesity, because of its high prevalence and strong relation to both vitamin D deficiency and CVD might act as a critical cofounder, which is responsible for the different results on this association.
Keywords: Vitamin D, cardiovascular risk, obesity
. Ezeanu Laura-Mihaela, Ghitulescu
Iuliana, Cirjaliu Roxana-Elena, Gherghisan
Ioana Sinziana,
Fildan Ariadna Petronela:
Introduction: Severe asthma impacts daily life in patients experiencing uncontrolled symptoms and exacerbations. Despite the correct administration of maximal therapy with inhaled corticosteroids and long-acting bronchodilators, patients may experience multiple exacerbations leading to deterioration of respiratory function. Lack of response to conventional asthma therapy makes biological therapy an alternative to control symptoms.
Methods: I present the case of a 41-year-old patient with uncontrolled severe asthma who present a difficult productive cough with mucous sputum, exertional dyspnea and wheezing under maximal bronchodilator therapy with a long-acting β2-agonist and corticosteroid. In the last year, the patient had frequent exacerbations that required the administration of oral corticosteroids.
Functional respiratory tests show severe mixed ventilatory dysfunction with FEV1 40% of predicted and biological tests show blood eosinophilia (430 elem/ul, 4.5%). The ACT test (Asthma Control Test) indicates a severe uncontrolled asthma, having a score of 8 points.
It is decided to start the biological therapy with Benralizumab 30 mg, subcutaneous administration, the first 3 doses at an interval of 4 weeks, then a dose at an interval of 8 weeks and the continuation of the inhaled treatment.
Results: After one month, the evaluation show a rapidly favorable evolution with significant improvement in symptoms, normalization of the pulmonary function (FEV1 88%) and a percentage of 0% eosinophils. Subsequently, the percentage of eosinophils is maintained, and the spirometry show an improvement in pulmonary function with FEV1 (98%).
Discussions: Patients with severe asthma have an increased risk of hospitalization and death due to exacerbations that are difficult to control. Biological therapy can reduce symptoms of asthma, improve lung function and reduce the use of oral corticosteroids.
Conclusions: Identification of the eosinophilic phenotype in severe asthma and association of biological therapy with inhaled treatment helps to improve respiratory function, control symptoms and limiting the administration of oral corticosteroids.
Treating dyspnea in the ED involves knowing the ethiology. Thus, we performed a comparison between the time in which the physician has results from heart and lung ultrasound to those begotten by traditional X-ray and chest CT. We considered a lot of 39 patients which were ultrasounded by the Emergency medic in the ED in a timeframe of 5 minutes on average. The mean time for the 33 patient who underwent X-ray was 2 h and 26 min and for the 10 who underwent CT scanning was of 7h and 17 minutes. With an accuracy result of 87% between ultrasound and traditional imaging methods, heart and lung ultrasonography gives the current physician information sooner for adequate treatment and diagnosis.
Introduction. A major health risk is posed by tuberculosis, particularly for those who have HIV. A TB infection is more likely to affect HIV-positive individuals than healthy individuals. HIV infection has been shown to worsen TB cases, because M. tuberculosis and HIV potentiate one another inside the individual host. If left untreated, the effects of HIV and TB act in synergy to accelerate immune function deterioration and cause death.
Case report. We are presenting the case of a 59 year- old male patient, hospitalized in August 2022, in Constanta Clinical Pneumology Hospital, who reported a tobacco use of 28 packs-years, occasionally alcohol intake, occupational exposure to gas and dust, and 3 administered doses of Phizer vaccine against COVID19. The patient was admitted in hospital for persistent dry cough and weight loss (10kg in 4 months), symptoms that firstly appeared 4 months ago, and a chest Xray with micronodular lesions distributed in both lungs area. AntiTB therapy was decided suspecting miliary TB. Generally, the patient had asthenia, loss of appetite and sweats. Biologically, our patient presented with a non-specific inflammatory syndrome, associating monocytosis, anemia, negative SARS CoV2 antigen rapid test, negative microscopically Ziehl Neelsen sputum for acid fast bacilli. For a left inguinal adenopathy, HIV screening was requested and positive ELISA HIV test as well as positive Western Blot test sustained HIV infection. CT scan of the chest showed bilateral apical and basal pachypleuritis, and multiple bilateral subpleural nodules and micronodules, but no miliary syndrome. Fibrobronchoscopy revealed bronchial mucosa with a chronic inflammatory aspect, without any proliferative processes in the explored area. Löwenstein-Jensen solid cultures of bronchial aspirate collected sample was positive for Mycobacterium Tuberculosis. Based on the bacteriological findings, a diagnosis of TB disease HIV related was assessed.
Discussion. Particular for this case, is the onset with both respiratory and peripheral adenopathy as manifestations of TB and HIV association. Additional investigations were made for HIV diagnosis and for the institution of antiretroviral treatment, in Medeea Center of Constanta. Clinical care of HIV-associated TB entails combining effective anti-TB medication with concurrent antiretroviral therapy, preventing HIV-related comorbidities, managing drug cytotoxicity, and managing immunological reconstitution inflammatory syndrome. Concentrated efforts to provide antiretroviral therapy to all HIV-infected people with Mycobacterium tuberculosis infection would decrease the number of people who develop active TB and are essential to stop the two epidemics from feeding one another. People living with HIV should be given priority for TB clinical examination, if they share a home with active TB cases or are in close proximity to them. The control of TB would be further enhanced by more thorough TB screening, both for active and latent TB, with larger definitions of target populations and expanded indications for screening in high HIV prevalence settings.
Conclusions. This case of concomitant TB and HIV association had atypical imagistic expression of nodular pulmonary pattern and peripheral unilateral inguinal adenopathy and was not highly suggestive for TB HIV related. HIV Screening is recommended in all TB patients.
Paraneoplastic neurological syndromes are immune-mediated diseases of the nervous system indirectly determined by an underlying neoplasia, usually without clinical manifestation, or by its metastases or therapy, associated with autoantibodies against neuronal antigens expressed by the tumor. The diagnosis and treatment of paraneoplastic neurologiocal syndromes are important because the disability caused by these syndromes is severe in most cases and the correct diagnosis allows the discovery of an incipient tumor with a chance of cure. The work presents an up-to-date synthesis of the main paraneoplastic neurological syndromes.
Keywords: paraneoplastic neurologiocal syndromes
The prevalence of disc degenerative pathology increases significantly with age and with the presence of mechanical or traumatic overload. The symptomatology, often non-existent or little noticed in the early stages (slight pain when overexerting, giving way at rest), acquires an important clinical resonance later, with muscle contracture and even violent stabbing pain that radiates depending on the area of compression, on the nerve path, being accompanied by a sensitive and/or motor neurological deficit. The importance of a correct and early diagnosis and an appropriate therapeutic attitude results from this. The paper presents the clinical course of the disease, together with the most important diagnostic tools and therapeutic methods.
KEYWORDS: disc disease, radiculopathy
Obiectivul studiului:
Pacientii cu tentative suicidare prezinta un diagnostic nosologic variabil,
heterogen. Evaluarea riscului suicidar a inclus si masuratori din domeniul
cognitive, al tulburarilor de memorie pentru a se urmari legatura dintre
acestea si tentative de suicide.
Material si metoda: A
fost efectuat un studio retrospective asupra cazurilor de tentative suicidare
ce s-au prezentat in clinica de psihiatrie din cadrul Spitalului Clinic
Judetean de Urgenta Constanta in perioada 01.01.2020-31.12.2022.
Rezultate: factori de risc
pentru tentative suicidara au fost identificati sexul feminin , prezenta unui
diagnostic psihiatric, perturbari in sfera
memorie autobiografice comparative cu lotul pacientilor fara tentative
suicidare.
Cuvinte cheie: tentative
suicide, intricare toxietilica, memorie de lucru, lunga durata, autobiografica,
abuz, trauma in copilarie.
Posture is a function of the neuromyoarthrokinetic system necessary for stability, balance and constant relations between the body and the environment and between body segments in the most varied positions and motor acts. Sport dance is a partnership formed by a couple of dancers who interpret different musical rhythms using specific techniques. Practicing a type of sport is essential for children and adults, but sports dance occupies a special place due to the intense motor development which it supposes. Being a physical activity in the first place, it involves a combined type of aerobic and anaerobic effort, impacting the locomotor system, the dance developing the correct posture and joint mobility. However, this sports activity also has a strong psychological impact on those who practice it as a form of personal development. This sport is also a method of cardiovascular prevention or body weight control, two of the pathologies that have recently increased in frequency among the young population. In addition to harmonious physical development, another effect with clinical medical impact is the increase of the body's non-specific immunity, so important, especially in the current global epidemiological context. Classical physical therapy programs with postural impact may not create good compliance for the child and adolescent at the therapeutic level, so sports dance, practiced in a professionally controlled environment, is an essential alternative for achieving postural goals.
Keywords: posture, sports dance, physical therapy
Introduction. Ankylosing spondylitis is a chronic rheumatic disease that progresses over time, generally affecting the sacroiliac joints and those of the spine. From a functional point of view this disease impresses with the phenomenon of ankylosis. Complex deformation in the spine and chest causes cardio-vascular and respiratory changes.
Objectives: It is important for patients with SA to start respiratory physical therapy as early as possible through a program of training the locomotor muscles. . The objective of respiratory reeducation in ankylosing spondylitis is to ensure good pulmonary ventilation by maintaining the amplitude of respiratory movements and improving general trophicity and neuropsychic tone.
Material and method. Patients have personalized programs of respiratory physical therapy, which take into account the age, the degree of its impairment, but also the possible associated diseases. Damage to the dorsal vertebral segment and the cost-vertebral joints by the inflammatory process limits the expansion of the chest and causes the onset of chronic respiratory failure syndrome of a restrictive type. It is insisted on increasing the inspir by appropriate placements, by coupling the movements of the upper limbs with those of the trunk. Thus, regional thoracic openings are achieved that facilitate the inspir. The diaphragm, necessary in breathing of the abdominal type, will tone by contraction and relaxation of the abdominal wall with backpressure. In the ante- and retropulsion movements of the abdominal wall, an important role is played by the toning of the transverse abdominal muscle. Respiratory reeducation – analytical but also global type, will aim at relaxation, oppression, ensuring a respiratory drainage, ensuring ventilatory synergism but also improving ventilatory mechanics.
Result. Respiratory reeducation is of major importance for patients with SA, because a satisfactory ventilatory mechanics with a certain rhythmicity of respiratory frequency, a reeducation of inspiratory and expiratory muscles, a satisfactory adaptation of breathing to effort and prevention of respiratory complications are obtained.
Conclusions. Biosocial considerations for people with ankylosing Spondylitis include continuous education of the patient and family. Respiratory reeducation is a multidisciplinary program that gives patients the opportunity to adapt to the disease. It aims to increase the strength, endurance and quality of life of the patient.
Keywords: Ankylosing spondylitis, respiratory reeducation, chest box.
Frailty is a progressive, age-related decline in physiological systems, a decline that leads to diminishing reserves of intrinsic capacity, which confers extreme vulnerability to stressors and increases the risk of adverse health effects. Frailty syndrome is characterised by decreased upper and lower limb muscle strength, gait speed, nutritional status and cognitive decline, as well as increased risk of falling. The prevalence of frailty among community-dwelling older people is increasing, with estimates ranging from 1% to 22%. Targeting pre-fragile adults is possible with simple screening tools and effective and sustained interventions.
Multidisciplinary rehabilitation is increasingly targeted and accepted as essential in the management of frailty syndrome. While traditional rehabilitation models were strictly focused on recovery, preserving independence and delaying functional decline are now considered as core goals, even when full recovery is not feasible.
The main objectives of lifelong rehabilitation strategies are therefore to maintain functionality, improve quality of life, delay dependency and the need for care and, not least, prevent decompensation.
Kinesiotherapy, as a form of rehabilitative treatment, involves the execution of an exercise programme with the objectives of improving the patient's balance, coordination and muscle strength. In addition, kinesiotherapy can help patients increase their range of motion and flexibility, which can help them carry out daily activities with greater ease and confidence.
In addition to the physical benefits, kinesiotherapy can also provide psychological benefits by increasing the patient's confidence and self-esteem. This, in turn, can help them feel more in control of their physical abilities and reduce the fear of falling, which is often a significant concern for frail patients. Overall, kinesiotherapy can be an effective approach to help reduce a patient's risk of falling and improve their overall quality of life.
As life expectancy increases rapidly worldwide, various approaches and studies are underway to prevent age-related diseases. Among the common ailments of the elderly is the decline in cognitive function - dementia. As there is currently no cure for dementia, early diagnosis and prophylactic approaches can be helpful. Mild cognitive impairment can be reversed using multidisciplinary intervention. Mild cognitive impairment is recognised as a transitional condition between normal ageing and dementia, and early identification of mild cognitive impairment can occur in older people in the form of memory dysfunction. The rate of return of mild cognitive disorders to cognitive normality varied by age group. Because risk factors are multiple, including physical, dietary, cognitive and psychological elements, there is currently no credible evidence that a single intervention can alleviate this condition. When a multidisciplinary intervention is administered, an increase in muscle strength and energy are the main markers of cognitive reversal. Better cognitive reserve has been associated with a lower risk of mortality. Moreover, cognitive reserve and frailty interact in association with mortality, so that higher cognitive reserve is particularly associated with lower mortality in frail people. Training techniques, such as mnemonic aids, motivational techniques to increase attention and integration of physiotherapy into continuing care have been shown to help patients with cognitive impairment. Digital technology can help us make the transition from a 'diagnosis and treatment' to a 'prediction and prevention' strategy. Augmented reality-based therapeutic interventions to train neuro-motor functions have proven effective in minimising cognitive function decline among the elderly. Using the features of augmented reality technologies, physical activities such as a physiotherapy exercise programme can be supported, or 'serious games', which stimulate the maintenance and improvement of cognitive function through sensory stimulation, can be included in the patient's treatment protocol. These augmented reality systems aim to induce active patient participation with goal setting and motivation through a gamified training system. In addition, they can eventually be used as assessment tools by recording performance capability.
These types of augmented reality-based rehabilitation and prevention systems have so far proven effective in improving cognitive functions such as working memory, attentional focus and visual memory.
Ageing as a phenomenon, the way we age, the integration of the elderly into society, and maintaining well-being in old age are becoming key issues for medical research, a sector which must provide and promote in the public arena appropriate solutions to prevent the risks associated with ageing. Maintaining this important segment of the population - the elderly - at an optimal level of health, both physically and cognitively, is fundamental to the future development of society. From this point of view, anticipating possible physiological and cognitive decline is part of the solution. The sooner the potential physical/cognitive deficit is diagnosed, the better the chances of solving the problem. Analysis of the connections between physical strength and cognitive decline is a relatively new but growing area of research. The number of studies on this topic has increased exponentially from the 1970s to the present. The effect of grip strength on mental health has been examined in numerous studies that have shown a significant association between grip strength and risk of mental illness in the elderly population, as well as a specific link between grip strength and general cognitive decline, and correlations between physical strength and Alzheimer's disease. As older people's physical function deteriorates, they find it increasingly difficult to carry out daily activities, which can lead to avoidance or limitation of these activities. By the time the older adult becomes unable to perform the activity, subtle and gradual changes can often go unnoticed by healthcare providers and family members. This is legitimate, given that at least two important aspects are sought: the possibility of predicting possible physical or cognitive deficits as early as possible and slowing the decline when it occurs. These are the two goals that are necessary to be at the basis of a functional hand recovery program. Improving the grip strength of a patient's hand is necessary to be achieved through interventions that are tailored to the patient's individual needs and abilities. To achieve both goals, a comprehensive approach is needed that includes physical exercise, manual therapy, and other therapies such as orthotics, soft tissue mobilization techniques to improve local circulation and muscle flexibility, or the recommendation of medication to combat local pain or inflammation.
Abstract. Osteoporosis is a frequent disease in postmenopausal women. Despite the fact that fragility fractures cause many problems, osteoporosis is still underdiagnosed and undertreated. This work outlines the topics diagnosis of osteoporosis, fracture risk prevention, and therapy after fracture. Regular physical activities, a sufficient intake of calcium, and a normal vitamin D level are important for bone health. Through dual X-ray absorbtion (DXA) the diagnosis of osteoporosis or osteopenia is made and the risk fracture status is evaluated. The newest tool to identify osteoporosis is the TBS score (trabecular bone score) which measures the skeletal status in terms of the risk of suffering a minimal trauma fracture. The rehabilitation of patients with bone fragility varies depending on the location of osteoporosis and should be performed by a multidisciplinary team.
Keywords: Osteoporosis, diagnosis, rehabilitation, fracture.
Introduction. Osteoporosis is a systemic skeletal pathology, characterized by the decrease in bone mineral density and deterioration of bone tissue architecture. Vitamin D plays a central role in bone remodeling by ensuring sufficient amounts of calcium and phosphorus and by its direct action on osteoblasts and osteoclasts. Studies show that people with low levels of vitamin D have lower bone density and are more likely to develop osteoporosis.
Objectives. Currently, there is no consensus on the definition of vitamin D insufficiency or the minimum targets for an optimal vitamin D concentration. The purpose of this presentation is to summarize aspects of vitamin D metabolism, the consequences of vitamin D deficiency and the impact of vitamin D supplementation on the musculoskeletal system, for the optimal management of people suffering from osteopenia or osteoporosis.
Methods. The diagnosis of osteoporosis is established by measuring bone mineral density, by dual- energy X-ray absorptiometry, and the status of vitamin D in the body can be revealed by measuring the serum level of 25-hydroxyvitamin D3. Following the results and the establishment of a threshold value for an adequate nutritional status, we can intervene with vitamin D substitution to establish an optimal level of vitamin D.
Results. Vitamin D values below 20 ng/mL are a red flag for ensuring the integrity of the bone system and avoiding fractures due to decreased bone mineral density. Obtaining an adequate vitamin D status is necessary for a maximal response to the administration of antiosteoporotic treatments, to increase the bone mineral density, to increase the muscle strength, and for the anti-fracture effect in patients with osteoporosis.
Conclusion. Low vitamin D levels are common in people with osteoporosis, so vitamin D supplementation is justify in these cases.
Keywords. Vitamin D, osteoporosis, bone mineral density
Introduction: Mycobacterium tuberculosis meningoencephalitis is a life-threatening disease with severe prognosis in immunocompromised patients as HIV late presenters. Late presenting HIV positive patients with low CD4+ count are likely to develop extrapulmonary TB, without having an associated pulmonary diseases concomitantly. Many of them do no present typical symptoms of TB.
Case report: We present the case of a 45-year-old male, patient, with no personal pathological history although with multiple presentations in the emergency units from two hospitals for abdominal pain, vomiting, lack of bowel movement in the last 3 weeks, productive cough, dysphonia, headache, weight loss. Last examination in the Emergency Department for confusion add to the previous symptoms revealed nuchal rigidity thus, cerebral CT scan was performed followed by lumbar puncture. Xantocromia of the CSF with 272 cell/mmc , increased level of protein 6889mg/L and low level of glucose - 21mg/dl imposed urgent initiation of antibiotic treatment. He was transferred in the Clinical Hospital of Infectious Diseases with Glasgow Coma Scale score of 7, cachectic, with thrush (Candida glabrata isolated), generalized lymphadenopathy, pulmonary rales, hepatosplenomegaly, ileus, urinary retention that impose insertion of a Foley urinary catheter, intense neck stiffness. During the screening process CT scans was performed with normal findings, and patient was diagnosed with HIV infection (CD4+ T lymphocytes 38 cell/mm3 and HIV viral load 1.080.000 copii/ml - log 6.03). Mycobacterium tuberculosis was suspected even Xpert MTB/RIF Ultra assay was negative after other etiologies have been ruled out (CSF Gram stain negative, culture negative, Bio-fire negative) and tuberculostatic treatment was associated to depletive agents and cortisone, antimycotic and prophylactic PCP treatment with positive improvement of the Glasgow score and of the clinical status. Due to the high risk of immune reconstitution syndrome (IRIS), the cART initiation was postponed for 2 weeks as his CD4 count was less than 50 cells/mm3.
Conclusions: M. tuberculosis in HIV-late presenters remain a challenge for the medical system as symptoms are less specific than in classical form and diagnosis methods are sometimes not reliable for rapid confirmation. Tuberculostatic medication was initiated with good clinical results. Tuberculostatic medication could be a game changer for this very immunosuppressed patient.
Keywords: HIV, extrapulmonary tuberculosis, meningoencephalitis, late presenter
Toxic megacolon is
an acute form of colonic distension. It is characterized by a very dilated colon,
accompanied by abdominal distension, and sometimes fever, abdominal pain, or
shock. Toxic megacolon is usually a complication of inflammatory bowel disease,
such as ulcerative colitis and, more rarely, Crohn's disease, and of some
infections of the colon, including Clostridioides difficile infections, which
have led to pseudomembranous colitis. In Clostridioides difficile
infection, the treatment consists in the administration of antibiotics,
corticosteroids, and if the evolution is unfavorable, colectomy is recommended.
We present the case of an 84-year-old patient, recently discharged from the
orthopedic clinic, hospitalized in the Infectious Diseases Clinic with serious
general condition, fever, multiple diarrheal stools, hypotension, dehydration,
significant abdominal distension, PCR toxin A+B Clostridioides difficile
positive. Computed tomography shows toxic megacolon, accompanied by ascites due
to hypoalbuminemia. Laboratory analyzes show important leukocytosis, increased
inflammatory samples, positive procalcitonin, hydroelectrolytic and acid-base
imbalances. Under treatment with oral and enema Vancomycin, Tigecycline,
corticosteroids, hydroelectrolytic and acid-base rebalancing, administration of
albumin and plasma (due to the dramatic decrease in fibrinogen), the evolution
was favorable. The patient was discharged after approximately 3 weeks of
hospitalization, with the recommendation to continue the treatment with
vancomycin at home. Judicious management of antibiotic administration and rapid
initiation of antibiotic treatment in patients at risk could prevent these
complications.
Key words:
Clostridioides difficile infections, Toxic megacolon, antibiotic
Introduction:
Varicella-Zoster virus (VZV) is the etiological agent of varicella (primary
infection) and herpes zoster (reactivation of latent infection). Although
varicella is most often a relatively common and self-limiting disease of
childhood, the disease can be associated with a variety of serious and
potentially fatal complications as well as immunocompetent and immunocompromised hosts.
Case
presentation: We present the case of a 20-year-old patient, without significant
APP, who presented to the emergency room for myalgias, arthralgias, low fever,
vomiting, ataxic gait and paresthesias ascending from the plantar level to the
cephalic extremity associated with speech disorders, accusations with 7 days debut and with progressive agravation. It should be
mentioned that 2 weeks ago, the patient presented a papulo-vesicular rash with
a polymorphic character, generalized, intensely pruritic, diagnosed as an
allergy, following symptomatic treatment (antihistamine and antipyretic) at
home.
At
the time of hospitalization, objectively was observed a general condition with low fever, skin with
depigmented elements post-varicella, cardio-respiratory balance, BP: 110/70
mmHg, AV: 138bpm, rhythmic, regular, SpO2: 99%aa, soft, mobile abdomen with
respiratory movements, painless spontaneously and on palpation, TSO, conscious,
cooperative, no back pain, no signs of meningeal irritation.
Management
and results: As a result of the present symptomatology, a neurological consultation
and lumbar puncture are performed with the highlighting of clear fluid,
normotensive, cytological 25 elements/mm3, normal biochemistry, and the
cultures at 24h and 48h are negative, with the absence of yeasts, denying both
diseases the meningeal damage, as well as Guillain-Barre Syndrome. Thus, based
on the clinical-biological data (mild inflammatory biological syndrome) and
imaging (CT brain and spine cervical, thoracic and lumbar segment without
suggestive pathological changes), the diagnosis of post-varicella syndrome with
neurological damage was established, so antiviral therapy was instituted with
Acyclovir 500 mg/8 hours i.v., for 10 days, Dexamethasone 4mg/ml/12 hours i.v.,
for 9 days, PPI gastric protection, antipyretics, analgesics and PEV of
hydroelectrolytic, metabolic rebalancing and vitamin therapy with favorable
evolution
Conclusion:
The presented case highlights the importance of correct diagnosis and early
treatment. Therapy initiated early in the course of the illness maximizez benefits.
The decision to use antiviral therapy and the route and duration of therapy
should be determined by the patient's
immunity, extent of infection and initial response to therapy.
Keywords:
varicella, VZV virus, neurological complication.
Psoriasis vulgaris is a chronic, immune-mediated inflammatory condition with evolving cutaneous and systemic manifestations, having a negative impact on patients quality of life. Psoriasis has multiple forms of clinical presentation, of which psoriasis vulgaris is the most common. It is characterised by the appearance of erythemato-squamous plaques predominantly on the extensor areas (elbows and knees), scalp and lumbosacral region. Although plaque psoriasis predominantly affects the extensor areas, it sometimes involves flexural regions such as the inframammary area, axillary region or perianal region.
Hailey-Hailey disease, also called familial acantholytic dermatosis or familial chronic pemphigus, is a rare autosomal dominantly transmitted bullous genodermatosis characterized by vesicular-bullous lesions on healthy skin or on an erythematous background and erosions, predominantly on intertriginous areas.
We present the case of a 67-year-old patient who was admitted to our department both for the presence of psoriatic skin lesions and erythematous and erosive, macerated plaques with flaccid vesicles on the surface, located in the right axilla and in the groin area, accompanied by pruritus and local burning sensation, with a hereditary history of similar lesions on the paternal line.
Although this type of genodermatosis has its onset of symptoms in decades 1-4 of life, it can manifest at any age. The disease is inherited in an autosomal dominant pattern, which means that there is a 50% chance that every child who has an affected parent will inherit the condition.
Keywords: Hailey-Hailey disease, Familial chronic pemphigus, Psoriasis vulgaris, Psoriatic arthritis
Introduction: Coronaviruses are a family of viruses that can cause respiratory disease in humans and animals. In recent decades there have been several outbreaks of coronaviruses in humans, in February
2020 the World Health Organization named it SARS-CoV-2 and the respiratory disease caused by it was named COVID-19.
Aim: The main objective of the study was the efficacy of treatment with Tocilizumab, an important therapeutic pillar in this pathology, in patients who raised a high suspicion of developing Cytokine Release Syndrome.
Material and method: We conducted a retrospective study on a series of patients, diagnosed with SARS-CoV-2 infection who were admitted to the Infectious Diseases Hospital of Constanta between January 2021 and October 2021 but also the period of January 2022 and March 2023; the activity of the hospital being suspended starting November 2021 due to the fire in the intensive care unit.
Results: In the period mentioned above, there were a total of 156 patients who benefited from immunomodulator treatment.
The monitored parametres were represented by the changes of the inflammatory markers considered indicators of Cytokine Release Syndrome (VSH, C-reactive protein, fibrinogen, ferritin, interleukin IL-6) 5-10 days post-administration, also changes in lung injury severity score, decrease in the number of days of hospitalisation, evolution according to age, as well as the influence of other comorbidities on the final prognosis. Less than half of patients died (17,94%), the therapeutic response was favorable, with important improvement of the inflammatory markers.
Conclusion: In our study treatment with Tocilizumab improved the evolution of majority of patients.
CHIRURGIE GENERALĂ
Giant hiatal hernia is defined by more than 30% of stomach content herniated through the diaphragmatic hiatus into the thorax. In general, patients with giant hiatal hernia present gastrointestinal symptoms such as dysphagia and pyrosis, while severe epigastric pain and vomiting are rare, also giant hiatal hernias may result in other secondary conditions such as gastroesophageal reflux disease, gastric volvulus, etc.
Our 65-year-old rural patient presented to the outpatient department complaining of dysphagia and pyrosis as well as epigastric pain after heavy meals, a symptomatology that started one year ago and exacerbated in the last months. The history also shows intense daily physical activity involving weight lifting. Following investigations confirming the suspected diagnosis, the patient was admitted for specialist surgical treatment. The surgery was performed laparoscopically and consisted of reducing the herniated elements back into the abdominal cavity, dissecting the formed adhesions and the hernia sac, highlighting and calibrating the diaphragmatic hiatus and performing a "floppy" Nissen fundoplication to prevent migration of the stomach through the hiatus. The postoperative evolution of the patient was favorable, with improvement of symptoms, resumption of digestive tolerance and discharge 3 days after surgery.
The presentation details the operative technique used along with anatomical details and also demonstrates the status of the laparoscopic approach as the gold standard in the treatment of hiatal hernias
Postoperative wound infection refers to an infectious process, which occurs after surgery in the area of the body where the incision was made and develops in the first 30 days of the postoperative period. They may be superficial involving only the integument or complex involving the subcutaneous tissues, underlying layers, viscera or implanted materials.
A body with normal immunity defends itself very well against such infections, as evidenced by the many traumatic peripheral wounds that heal per primam. At the same time, surgical wounds from peripheral operations such as thyroidectomy, mastectomy, haemorrhaphy have a lower risk of staphylococcal infection.
In digestive surgery, most wounds are contaminated uninfected because there is a so-called "septic time" of contamination, but with the measures taken by the surgeon and the pre-existing pathology, the wound will ooze to a reduced extent. Contamination and infection of the wound can also start as early as during surgery in the case of abscesses, purulent peritonitis or perforated abscessed tumours.
Prophylactic measures are the first acts to avoid suppuration. To counteract this extremely unpleasant and disabling postoperative complication for the patient and burdensome and costly for a surgical service, aseptic and antiseptic measures are required, as well as rigorous organisational programmes, which give the mark to a hospital and guarantee the functionality of all surgical activity.
The treatment of suppuration itself is difficult and time-consuming. It will be done in an isolated subsection for septic patients, with separate staff and instruments. Local treatment will be done with open wound, daily removal of purulent material, removal of sutures and excision of tissue debris from the wound, oxygenation, antisepsis and granulation of tissues.
Pressure ulcers, also called pressure ulcers or bedsores, are a health
problem with a high social and economic impact. Age is an important factor in
the development of pressure ulcers. About two thirds of cases occur in elderly
patients. The occurrence of such lesions involves repeated hospitalisations,
numerous surgical operations and complications with increased mortality.
Pressure ulcers are areas of ulceration and necrosis located in compressed
tissues between hard surfaces and bony prominences. They usually occur in
bedridden people. The number of patients with pressure ulcers is estimated to
be increasing. All patients are potentially at risk of developing pressure ulcers.
In order to be able to properly care for a pressure ulcer, it is necessary to
correctly classify it into one of the four known grades in order to establish
the appropriate specialist treatment as early as possible. For scars classified
in stages I and II, conservative treatment should be instituted, and for those
classified in stages III and IV, surgical treatment involving debridement,
excision and lavage is indicated. An important role in this pathology is played
by prevention, which is primarily represented by careful care manoeuvres, such
as lifting the patient at the bedside or off the bed, removing hard objects
that may cause injuries, and in the case of those immobilised in bed,
alternating air mattresses (anti-scalding mattresses) can be installed.
Keywords: bedsores, ulcers, decubitus, immobilization, dressing
Acute appendicitis is
a surgical condition characterized by inflammation of the vermiform appendix
and is one of the most common causes of acute abdominal pathology. Therefore,
it is a surgical emergency that occurs when the appendix undergoes inflammation
due to lumen obstruction, when the confluence site joining the cecum and
appendix is blocked with a coprolite or lymphoid hyperplasia.
The exact cause of
acute appendicitis remains unknown. If an inflamed appendix is not properly
treated, it can perforate leading to initially localised, then generalised
acute peritonitis.
Depending on the
degree of development of the inflammatory process in the appendix wall we
distinguish: Acute catarrhal appendicitis, in which inflammation encompasses
the mucosa and submucosa of the appendix; Acute phlegmonous appendicitis, which
encompasses all layers of the appendix; Acute gangrenous appendicitis is the
result of insufficient blood supply;
Perforated acute
appendicitis is the result of a necrotic lesion arising in the appendix with
exteriorization of its contents into the peritoneal cavity.
The treatment of
choice is strictly surgical and can be performed laparoscopically or
classically.
In recent years, there
has been a clear increase in laparoscopic appendectomy, explained by
considerably shorter hospital days compared to classical appendectomy, the
patient's socio-economic reintegration and a much lower complication rate.
Inguinal hernia represents the externalization of abdominal contents
through a defect in the inguinal canal. Laparoscopic treatment is a surgical
method to treat inguinal hernias, which is chosen according to the needs and
associated defects of the patient, this is a minimally invasive technique that
can have results far superior to conventional surgery.
Laparoscopy consists of small incisions through which the optical
system is inserted together with working ports and with the help of which an
alloplastic material, polypropylene mesa, will be fixed to repair the abdominal
wall defect and the contents of the hernia sac.
Laparoscopic treatment is suitable for all types of inguinal hernia in
adults, especially bilateral or recurrent hernias. Surgical treatment is
recommended to prevent future complications that may occur in this pathology
and also to completely remit the algic syndrome and limit certain activities
that require intense physical effort and automatically precipitate and
accentuate this algic syndrome.
The advantages of laparoscopic treatment compared to classical
treatment are the following: reduced postoperative pain; faster socio-economic
reintegration, shorter hospitalisation days. In addition to these advantages,
we should not forget to mention the disadvantages of laparoscopy compared to
classical surgery, namely: prolonged intervention; prolonged general
anaesthesia; inability to use laparoscopic surgical instruments in certain areas.
Chronic kidney disease is a condition that
occupies an increasingly high place in the category of chronic diseases
worldwide (3rd to 4th place). This condition is defined by structural and/or
functional abnormalities of the kidneys that may progress to end-stage renal
replacement therapy. The main monitoring is serum creatinine determination and
calculation of the glomerular filtration rate, which in end-stage V falls below
15 ml/min/1.73m2 . Diabetic nephropathy and cardiovascular disease are the most
common causes that can lead to end-stage CKD.
Initiation of renal replacement therapy is
based on well-defined clinical and biological criteria, and the choice of
therapy type is based on a doctor-patient discussion covering all options.
Peritoneal dialysis is the first treatment option at patient initiation and
several conditions have to be met for a good preparation of the therapy. It is
an option for both acute and chronic therapy initiation. At the same time,
peritoneal dialysis is a viable option for haemodialysis patients in whom the
depleted venous capital no longer allows the performance of an arteriovenous
fistula or the insertion of a dialysis catheter and thus transfer to peritoneal
dialysis allowing survival and continuation of renal replacement therapy.
Peritoneal catheterisation is the first step in this type of therapy and
involves a specific surgical technique. It can be performed percutaneously in
major emergencies, surgically or laparoscopically. Currently, the laparoscopic
approach has become the procedure of choice for peritoneal dialysis catheter
placement. Its advantages are that the catheter can be placed in plain view
with the possibility of fixation in the pelvis and the costs of the procedure
are considerably lower.
"There are a thousand forms of evil, there will be a thousand
remedies" said Publius Ovidius Naso before our era. The source of the
quotation is not chosen by chance, the Latin poet having close ties with the
ancient city of Tomis, now known as Constanta. In the autumn of AD 8,
unexpectedly, without a prior vote of the Senate, Augustus decides to exile
Ovidiu to Tomis, on the shores of the Euxine Bridge. It was also here that the
poet met his end, but not before leaving us a variety of writings on the life
of the people of the city.
Although in the early years of his exile Ovidiu was governed by
feelings of sadness and longing, although he considered the Tomitani to be
"barbarians", he eventually came to value and even love them.
Ovidiu's poetry provides vital, if distorted by exaggeration, information about
the local Geats, Sarmatians and Greeks, about the sea, sailing and seafarers,
about mores and customs - in other words, about everything that the city by the
sea stood for.
Ovidiu saved this people from the war against time by the history he
bequeathed to the next generations - generations of which we are part. So there
could be no more fitting name for the Faculty of Medicine and Pharmacy on the
seashore than that of the illustrious poet.
But the history of medicine in Dobrogea began long before the Faculty
was founded. It begins with the Legend of the Argonauts, in which Asclepius
Coronides is mentioned as doctor. Leaving the legends, the presence of Dr
Diocles is known at Histria. At Tomis lived Cladaios, a physician of the school
of Hippocrates. The Romans had military hospitals in the territory of today's
Dobrogea, at Troesmis, Capidava, Carsium and Tropaeum. A picture on Trajan's
Column, immortalising the 'dressing of a wound', bears witness to this.
Other names of note include Papasaul, Carol Davila, Louis Ernest,
Kefalas, Lorentoni, Stavru Atanasiu, Bogliaco, Ioan Drăgescu, Corvin,
Victor Climescu, Dem Teodorescu, Ibrahim Themo and many others who will be
mentioned during the presentation. In all specialties, but especially in
surgery, Constanta had doctors of great prestige, known nationally. Some of
them we have the honour to have known, the pleasure to have listened to them
and the luck to have learned something from them, and here we are talking
especially about Professor Vasile Sârbu, the founder of the faculty.
The aim of this project is to shed a little more light on the history
of Dobrogean medicine - medicine that has survived and evolved in spite of the
capricious, perhaps often even harsh, times that this people has gone through.
Keywords: history of medicine, Faculty of Medicine and Pharmacy
Constanta
Every year more and more patients all over the world undergo surgery.
Surgical preparation usually includes psycho-emotional preparation of patients,
preparation by performing routine local and general hygiene, preparation of the
organ to be operated on and last but not least preparation of the medical team.
It should be noted, however, that this preoperative preparation is greatly
influenced by the way the patient is admitted, depending on the pathology, in
emergency or scheduled mode. Given that the patient's accessibility to the
doctor has increased considerably post-pandemic (SARS virus COV-2), in order to
cope with the large number of requests, but also to make the flow of admissions/discharges
as efficient as possible, both in emergency surgery and in scheduled surgery,
we want to focus as much attention as possible on the preparation of the
patient admitted under scheduled treatment. This topic is topical and we would
like to present the advantages of some modernizations of the outpatient
structure that can bring real improvements in terms of the time of a scheduled
admission, which can be considerably optimized by up to 72 hours.
Approximately 10-18% of colon cancer patients present with intestinal
obstruction at initial emergency diagnosis. From anatomical considerations,
newly diagnosed obstructive colon cancer occurs more frequently in the left
colon, right colon obstructive tumors being rare, and when they appear at the
time of emergency diagnosis, they are in a more advanced oncological stage. In
recent years, the surgical treatment of urgently diagnosed obstructive right
colon cancer has evolved from the traditional treatment that included initial
intestinal decompression by stoma formation followed by secondary colonic
resection at another time, to initial emergency right hemicolectomy with
primary anastomosis with similar postoperative results in selected cases. We
present the case of a 86-year-old patient, urgently diagnosed with an acute
bowel obstruction due to ascending colon complete stenotic tumor with massive
caecal dilatation and subcapsular hepatic infracentimeter secondary lesions,
who underwent emergency laparotomy and one-stage right hemicolectomy with
side-to-side ileo-colic double layer hand-sewn anastomosis. Based on this
case-report, we reviewed the specialized literature on this important topic.
Drainage, as a surgical procedure, is very old, its principles being
used since ancient times, by Hippocrates. The first to apply an original
procedure for pleural drainage of purulent effusions was Lae'nec, who used a
drainage system using a suction cup.
Today drainage in surgical pathology of the chest is a widely
recognised method. Drainage in surgical pathology of the chest is an important
surgical act, the sole responsibility for which must rest with the operating
surgeon. However, it should be emphasised that even this is not sufficient, as
drainage must be continuously monitored until it is removed, also by the
operating surgeon. Monitoring the correct functioning of the drain, correcting
any defects found, together with correct execution, are indispensable elements
of effective pleural drainage.
Pleural drainage is a relatively simple procedure, which can be a
definitive solution in 90-95% of all cases of thoracic trauma (haemothorax and
pneumothorax) and an obligatory procedure in general thoracic surgery which
consists of inserting a tube into the pleural cavity to evacuate fluid or air
in a closed suction system to restore negative intrathoracic pressure and
prevent potentially lethal complications. Insertion of a drain into the pleural
cavity may be associated with multiple and severe complications, therefore the
indications for pleural drain placement must be strict and the person
responsible for their insertion must be able to manage its complications.
In this scientific report we review the objectives of pleural drainage,
indications for drain insertion, complications that may occur immediately and
late in pleural drainage and management of the drainage tube.
Pleural drainage is a seemingly minor therapeutic gesture, but one that
has major significance and engages both physician and patient, if indicated at
the optimal time and executed correctly, can achieve expected therapeutic
results.
Keywords: pleural drainage, chest trauma, pleural drainage
complications, drainage tube management
Breast neoplasm is the most common type of cancer in women, about 1 in
8 women being diagnosed with this condition during their lifetime. Breast
cancer survival rates have been on an upward trend over the last 20 years due
to screening programs and effective treatment. From 2008 to date there has been
an increase of more than 20% in the incidence of breast cancer.
The aim of the presentation is to exemplify current treatment methods
for breast cancer. It also aims to discuss the dependency between breast cancer
staging and the treatment methods applied, based on the idea that the choice of
surgical treatment is closely related to the stage at which the breast neoplasm
is discovered.
Another important aspect to consider in the treatment of breast cancer
is the aesthetics of this surgery, which is much more important in this type of
cancer than in other sites, and this is still an issue. Treatment methods have
evolved greatly over time, from Halsted's radical mastectomy (1894), which is
considered mutilating today, to breast reconstruction or breast conservation
techniques.
Finally, I would like to motivate the need for a multidisciplinary
approach for which a very good collaboration between general surgery, plastic
surgery, radiology, oncology and even psychiatry is necessary in the case of
people with dysmorphia resulting from surgery.
Keyworsds: breast neoplasm, breast neoplasm treatment
Vesicular lithiasis is one of the most common surgical conditions,
especially in the adult population. Regarding the incidence of the pathology,
it is known that it is more frequent among women, especially obese women and
also after menopause. However, in practice we encounter a large number of
patients presenting with symptoms specific to the disease, regardless of
gender, age or BMI.
The aim of this presentation is both to better understand the pathology
in question and to exemplify the best method of surgical treatment that can be
chosen according to the characteristics of each patient.
Various studies of the history of vesicular lithiasis reveal that in
many cases the pathology remains asymptomatic until complications develop, in
which case the treatment of choice will be surgical.
Also, in what follows during the course of the project, we have tried
to address both classic situations in which such a patient may present, and
particularities in the management of special situations, such as those caused
by the COVID-19 pandemic.
Treatment is the totality of methods used to fight the disease and try
to cure it. It calls on the principles of therapeutics, which the doctor adapts
in the most appropriate way to current knowledge. In other words, as far as
possible, the treatment should be as minimally invasive as possible and as
effective as possible.
Keywords: vesicular lithiasis, COVID-19, modern treatment
Introduction: Acute appendicitis is one of the most common emergencies
in surgical pathology, with different forms of evolution that can represent a
diagnostic challenge and a complex therapeutic approach.
Materials and methods: This is a 21 years old patient, who presents in
the on-call room with right iliac fossa pain, accompanied by fever with onset
of 10 days, for which she is investigated biologically and imagistically
detecting increased evidence of inflammation, and ultrasound and CT scan showed
a 12 mm diameter, retrocecally located, thickened appendix with a 62/56 mm
diameter, pericecally located, hyperechogenic, fluid and airy formation with
adjacent parietal peritoneal thickening.
Local examination reveals an abdomen with muscular guarding in the
right iliac fossa with irradiation in the right lumbar region.
Results: Emergency laparoscopic surgery was decided. Intraoperatively,
an inflammatory block located pericecally, extended to the lateral abdominal
wall was observed. The suction dissection allows the evacuation of a purulent
secretion of about 400 ml from a parietal abscess. Subsequently, pericecal
dissection revealed a gangrenous appendix, perforated at the apex, with an
uninjured but dilated base that closed using a stapler. Lavage and perilesional
drainage completed the operation.
Discussion: Postoperative evolution under antibiotic treatment was
favorable.
Conclusions: Laparoscopy may be the method of choice in complicated
cases of acute appendicitis when the surgeon has the necessary equipment and
experience in advanced minimally invasive surgery.
Complete mesocolon excision (CME) with
central vascular ligation (CVL) has been proposed for the treatment of colon
cancer based on the same principles as total mesorectal excision.
Complete mesocolon excision is resection of
the mesocolon with intact peritoneal sheets associated with extensive
lymphadenectomy through a high vascular ligation.
Complete mesocolon excision in step-by-step
rectal colon cancer and the associated oncological significance will be
presented.
A retrospective study conducted over a period of 2 years and 4 months (April 2020 - August 2022) on 430 patients diagnosed with pertrochanteric fractures in the Orthopedics Department. The surgical indication depended on the patients' age, degree of osteoporosis, activity level, associated pathologies and clinical-anatomical features of the fractures. All patients in the study underwent Gamma rod osteosynthesis. Surgery was performed within the first 24-72 hours, patients were then followed up clinically and radiologically at 2, 4, 6 months postoperatively. The age of the patients was between 28-95 years, female gender was predominant in 65% of cases. One case of intraoperative fracture during stem progression, 11 bronchopulmonary complications, 5 phlebitis, 7 cases of postoperative haematoma, one case of pseudoarthrosis with weakening of implant stability and four deaths were reported. No septic complications were recorded. Fractures healed in 12-14 weeks. Outcomes were interpreted in terms of fracture reduction, implant stability, consolidation time and ability to walk and put weight on the operated limb.
This paper represents the analysis of literature
data in the treatment of distal femur fractures. Fractures of the distal end of
the femur occur in approximately one tenth of the fractures of the proximal end
of the femur and represent 6% of all cases of femoral fractures. This is a
bimodal distribution of fractures based on age and gender. The majority of
fractures of the distal femoral extremity caused by high-energy trauma occur in
men aged 15-50 years, whereas the majority of fractures caused by low-energy
trauma occur in osteoporotic women >50 years. The most common high-energy
trauma mechanism is motor vehicle accident (53%) and the most common low-energy
trauma mechanism is home injury (33%).
The goals of treatment of these fractures include
anatomical reduction of the articular surface, restoration of limb alignment,
early postoperative knee resurfacing (important for articular cartilage
nutrition) and early patient mobilisation. To achieve these goals, several
metal constructs and operative techniques are currently being proposed.
Introduction/Objectives: Tumor and pseudotumor lesions of soft tissues are a diverse but rare pathology, most of which are suspected in other imaging investigations (radiography, ultrasonography or CT). Magnetic resonance imaging is superior to characterize tissue components, vascular load and relationship with adjacent tissues.
Materials/Methodology: We performed dedicated protocol musculoskeletal MRI examinations from 2015-2023 in 15 patients, who presented with volume enlargement of the affected segment and relative functional impotence, without a post-traumatic context in the personal pathological history.
RESULTS: The MRI investigation presented a key role in the diagnostic slicing, using native, fat-suppressive, water-diffusing and post-contrast sequences. Of the total examinations performed, 7 patients had benign expansive formations (lipoma, hydatid cyst, intramuscular hematoma, "cold" abscess, intramuscular venous malformation), and 8 patients had malignant expansive formations (osteosarcoma, liposarcoma, secondary determinations of femoral osteosarcoma or within the underlying disease - LMNH).
Conclusions/Discussion: Magnetic resonance imaging is the gold standard for the exploration of soft tissue tumour and pseudotumour formations, as it can decide the differential diagnosis between benign and malignant aetiology using fat saturation, water diffusion and dynamic contrast sequences, and is important in therapeutic planning and assessment of response to treatment.
Introduction/Objectives: Tumor and pseudotumor lesions of the adult heart are detected in the first instance by echocardiography. Both for upper tissue characterization and for assessing the relationship between the tumor mass and adjacent structures, sectional imaging (CT and MRI) provides accurate information.
Materials/Methodology: From 2016-2023 we performed CT and cardiac MRI examinations with a dedicated protocol for patients experiencing precordial pain, exertional dyspnea, fatigability and rhythm disturbances. Out of the total investigations, 8 patients had suspected intracardiac expansive lesion of unspecified origin on echocardiography, with the recommendation to perform additional sectional imaging investigations in addition.
RESULTS: Of the group examined, two patients underwent CT examination, which revealed the presence of two left intra-atrial formations, both benign, with different behaviour after administration of iodinated contrast medium (the first of them without contrast uptake - thrombus, the second discretely iodophilic - myxoma). By performing MRI investigations of the 6 patients, we were able to decide the diagnosis between benign etiology, developed mitral valve (fibroelastoma and degenerative caseous calcifications) and ventricular (fibroelastoma and intraventricular thrombus), and malignant etiology (secondary determinations, with extension to the pulmonary artery and right atrium).
Conclusions/Discussion: The method of choice in the examination of adult cardiac tumour and pseudotumour lesions remains MRI, which allows a specific diagnosis, assessing myocardial, pericardial infiltration and intracardiac extension. In contrast, CT examination has the advantages of a shorter acquisition time and the possibility of reconstructing images at key points in the cardiac cycle using EKG gating.
Introduction: Diastematomyelia is a neural tube defect, characterized by a division of the spinal cord, frequently at the level of the upper lumbar vertebra, in sagittal direction. This congenital anomaly may be associated with meningomyoceles, the most common primary neural tube defect, which involves saccular dilatation of the neural elements, usually through bony and tissue defects. In association with tethered cord neurological syndrome, mobility of the spinal cord is limited through the spinal canal following restrictive anatomical changes.
Material and method: We present the case of a full-term, harmonically developed AGA female neonate, delivered vaginally from a cranial presentation, at 38-39 weeks of pregnancy, with a birth weight of 3120 grams and Apgar score 9, from an unmonitored pregnancy. First child of a minor mother, 16 years old, gesta I, para I.
Results: On clinical examination, a well-demarcated pseudotumoural formation, mobile on the underlying planes, approximately 1/1 cm with intact integument, approximately 1 cm high right lumbar paravertebral, accompanied by a lumbar blind fossa at the same level, was observed at birth. Following the investigations - echography of the spine, CT and MRI of the thoracolumbar spine, the diagnosis of diastematomyelia with lumbosacral meningomyeloceles associated with tethered cord syndrome was confirmed.
Conclusions: According to the literature, these neural tube defects may have different degrees of bony involvement, with neurological manifestations present by abnormal deformities or developments of neural structures, sensory deficits, seizures, muscle hypotonia, impaired bladder tone, bowel transit disorders, gait disorders.
Keywords: neural tube defect, diastematomyelia, newborn
Introduction. Cardiac tamponade is the accumulation of fluid under pressure in the pericardial cavity, resulting in compression of the heart and impaired diastolic filling.
Pericardial effusion is quite rare in neonatal pathology, the most common cause being the iatrogenic one through the insertion of central venous catheters.
Percutaneously inserted central catheters are commonly used in neonatal intensive care units to provide parenteral nutrition and administration of drug therapy. Their insertion is associated with a number of specific complications: occlusions, infections, thrombosis, rupture, migration, including rare life-threatening complications such as pericardial effusion and cardiac tamponade.
Material And Methods: We present the case of a male neonate, at the SCJU Constanta Maternity Hospital, G:2380g, APGAR score: 5/7,vaginally extracted in cranial presentation, gestational age: 33 weeks, from a 21 years old pregnant woman S.A, gesta I para I, unmonitored, presenting to the emergency department for acute renal symptoms, reason for which she will be admitted to the nephrology department.
Results: The newborn was diagnosed with spontaneous intestinal perforation 48 hours after birth and required surgery ( excision of a portion of small bowel with end-to-end anastomosis) which resulted in the need for long-term parenteral nutrition (14 days). He had a successful post-operative course but showed a slow evolution of digestive tolerance.
At 18 days of age, due to difficult peripheral venous approach, a central venous catheter was inserted for intake and administration of drug therapy. Approximately 72 hours after its placement, he presented with sudden cardiorespiratory instability, echocardiography demonstrating severe pericardial effusion with signs of cardiac tamponade.
Emergency ultrasound-guided subfixoid pericardiocentesis was successfully performed, collecting approximately 15 ml of sero-hemorrhagic fluid, which was consistent with the composition of the infused hyperosmolar solution.
Conclusions: Although a rare complication, cardiac tamponade should be considered in any neonate with a central venous catheter and suddenly occurring suggestive symptoms,who is unresponsive to resuscitative maneuvers, even when catheter placement is considered to have been performed correctly.
Timely diagnosis accompanied by correctly performed pericardiocentesis can save lives.
The study was carried out in the "Santerra" Medical Center, Constanta on a group of 120 patients wearing the "T" IUD - copper. The ultrasound aspects, the state of the intrauterine devices after the extraction (presence or not of the extraction wires, the degree of corrosion, the integrity of the devices) were analyzed. The study establishes an optimal duration of use of these devices of ~ 4 years, under conditions of maximum safety.
Platelet-rich plasma therapy has been used for decades with effectiveness to speed up wound healing process. Being an autologous blood-derived product, it gained popularity in various aspects of medicine. It is known that the concentration of growth factors and stem cells trigger rapid cell growth, tissue repair and collagen production. The aim of using it as a new treatment for pelvic floor disorders can be related to the fact that one third of the adult woman experience at least one form of this pathology. Patients with pelvic floor disorders will be evaluated initially prior to administration of PRP therapy and a certain interval after performing the procedure.
Platelet-rich plasma therapy can become a relevant option of treatment in pelvic floor disorders. Although limited to case reports and small studies, the use of PRP in urogynecology appears promising and further studies should be evaluated. Improving the quality of life of patients is a desiderate to be accomplished.
Keywords:
platelet-rich plasma, pelvic floor disorders.
Recent studies have shown that SGLT2
inhibitors, classically used as oral antidiabetic agents, reduce proximal tubular sodium reabsorption, thereby
increasing distal sodium delivery to the macula densa, causing
tubule-glomerular feedback, which results in reducing hypertension and
intraglomerular pressure. By these mechanisms SGLT2 inhibitors provide
nephroprotection not only in patients with diabetic kidney disease, but also in
patients with glomerular disease.
We will present a
clinical case of a 49 year old male patient, registered in the Nephrology
Clinic, with stage IIIb chronic kidney disease, Alport Syndrome (shown by renal
biopsy in 2011) with nephrotic range proteinuria, arterial hypertension
complicated with hypertensive heart disease and dislipidemia. Clinical and
biological exams showed renal edema, nephrotic range proteinuria
(6.1g/24hours), increasing from the previous examination (2 months earlier)
when proteinuria was 3.4g/24 hours, altered renal function with serum
creatinine 2mg/dl and e GFR of 40ml/min/1,73m2. Considering the
rapidly increasing proteinuria in a patient treated with a maximal dose of
angiotensin II receptor blocker (Candesartan- 32mg/day) we decided to
supplement the antiproteinuric therapy with an SGLT2 inhibitor-Dapaglifozin
10mg/day and monitoring renal function, proteinuria and screening the patient
for urinary tract infections. After a month, we observed that serum creatinine
increased to 2.5mg/dl, but proteinuria was reduced to 4.3g/24hours. After one
year of treatment, proteinuria was reduced to 0.9g/24hours.
Case particularity: New therapeutic options to manage chronic kidney disease, with an important reduction of proteinuria in a non-diabetic patient, with a genetic disease affecting the glomerular basement membrane- Alport Syndrome- which before introducing SGLT2 inhibitors had no therapeutical options for slowing the progression of chronic kidney disease and reducing nephrotic range proteinuria and its complications.
Introduction. Adolescent idiopathic cervical scoliosis does not account for a large percentage of total adolescent idiopathic scoliosis, often the pathological curves at this level being secondary or compensatory curves. It is, however, the most precarious area criminalized as a source of pain at the time of the presentation to the doctor and the area least involved in the rehabilitation of scoliosis. In this paper we propose to bring to the forefront recent studies that advocate the introduction of this segment in the rehabilitation plan.
Methodology. It was based on the premise of recent studies involving defects in the integration of primitive reflexes in patients with vertebral static disorders, and from their results the literature was analyzed seeking evidence to justify, possibly why pain occurs at this level and why it would be necessary to introduce the cervical area into the physical-kinetic treatment plan.
Results. In children and adolescents, morphological changes related to skeletal growth and maturation of the postural control center change the alignment of the spine to improve spinal balance. During neurological maturation, the child needs to develop adapted, almost reflexive motor responses in the trunk and lower limbs so that he is capable of effective vertical position and locomotion.
In patients with non-integrated Galant reflex on one side, an asymmetry of the ipsilateral trunk was observed, as mentioned below: “In almost half of the children, the rotation of the body was observed, in most cases to the right (p = 0.012). This asymmetry was positively correlated with the Galant reflex not integrated on the same side (r = 0.335, p = 0.050). The presence of torso rotation is associated with sex: There was a higher frequency of asymmetry among girls than among boys.”
Conclusion. Primitive and postural reflexes seem to play an important role in trunk rotation, which is one of the main characteristics of scoliosis. Working to integrate these reflexes means working with the cervical spine and the head. It is a good assumption for putting the cervical spine in the rehabilitation plan for scoliosis, along with pelvic and trunk stabilization.
Keywords: scoliosis, rehabilitation,
spine
The seronegative spondyloarthropathies are a
family of joint disorders that include ankylosing spondylitis, psoriatic
arthritis, arthritis associated with inflammatory bowel disease (or
enteropathic arthritis), reactive arthritis, and undifferentiated
spondyloarthritis. Recently, these conditions have been differentiated into
three additional categories, namely non-radiographic axial spondyloarthropathy,
peripheral spondyloarthropathy, and finally juvenile-onset spondyloarthropathy.
These clinical entities are characterized by a wide spectrum of clinical
manifestations, laboratory abnormalities, and imaging features.
Spondylararthropathies are inflammatory conditions, where both peripheral and
axial joints can be affected. The consequence of disease progression and disability
significantly compromise work capacity, quality of work, quality of life, with
significant impairment of functional independence. In the Techirghiol Balneal
and Rehabilitation Sanatorium, the most common pathology in this spectrum of
ailments is represented by ankylosing spondylitis. There are many methods for
evaluating it, among which we can list: the specific scales (BASDAI, BASFI,
BASMI), the MIF scale, VAS or the scale for ADL. Also, another important method
is represented by the Walker View evaluation system. The scale evaluation is
performed at the patient's consultation and then at the end of the treatment,
in order to monitor the therapeutic effects on the activity of the disease. The
evaluation was performed over 245 number of patients hospitalized with the
diagnosis of ankylosing spondylitis in our unit during 2022. The evaluation
scales applied at the beginning and end of the treatment with a particular
importance in the patient's balance sheet, objectively revealing the
improvement of functional independence, the increase of the quality of life,
the decrease of the disease activity and the decrease of the pain perception.
Keywords: scale, spondilytis, disease activity
Introduction. According to current medical studies, intermittent hypoxia-hyperoxia therapy can increase exercise tolerance in patients with cardiovascular, bronchopulmonary, metabolic and neuropsychiatric pathologies. This therapy consists of the use of controlled and repeated intervals of hypoxia, interspersed with episodes of hyperoxia. It can be applied passively or during physical exercises.
Material and methods. Case report of a 53-year-old female patient admitted to the Techirghiol Balneal and Rehabilitation Sanatorium for mechanical polyarthralgia. The patient had a personal pathological history of COPD - therapeutically uncontrolled, hepatic steatosis and mitral insufficiency - therapeutically controlled. During hospitalization, the patient received complex balneo-physical-kinetic treatment, which also included intermittent hypoxia-hyperoxia therapy. Both at admission and at discharge, the 6-minute walk test was performed, the HTi index was evaluated and blood samples were collected to evaluate liver function, kidney function, lipid profile and glycemic status.
Result. The dynamic evaluation suggested an improvement in the clinical and paraclinical parameters. The 6-minute test was performed on admission over a distance of 464 meters, while on discharge it was performed over a distance of 487 meters. The initial HTi at admission registered a value of 23, while at discharge it was 81. Improvements were identified in total serum cholesterol, alanine aminotransferase, serum creatinine, urea and blood glucose values.
Discussion. Obtaining some promising results indicates that intermittent hypoxia-hyperoxia therapy can be an alternative treatment for multiple pathological conditions, among which we mention COPD.
Keywords: intermittent
hypoxia-hyperoxia, COPD
Background.
Cartilage’s changes represent a main part of knee osteoarthritis (OA) pathogeny
and ultrasonography is a sensitive technique to identify its damages and other
joint’ development.
Objectives. The aim was to evaluate the echographic changes
of patients with knee OA and to observe their correlation with clinical
symptoms.
Methods. We used a descriptive study, including 50
consecutive patients, with bilateral knee OA (according to Kellgren-Lawrence
scale) admitted in our unit, during two months, complaining of pain at that
moment. They were clinically evaluated, the body mass index (BMI) was
calculated, the pain was quantified using visual analogue scale (VAS) and the
functionality was appreciated trough The Western Ontario and McMaster Universities Osteoarthritis Index
(WOMAC). The knee joint was evaluated using ultrasound, cartilage'
thickness (mm) on the femoral condyles and its echogenity, the presence of
osteophytes, meniscal’ protrusion, tendons’ changes and fluid collections being
described according to OMERACT˛ definitions.
For statistics, we used the Student t test and for analysis between the
linear parameters we calculated the Pearson coefficient (r).
Results. Our group included 50 subjects with
knee OA, aged 39 to 81 years, 35 women and 15 men, 42 coming from urban areas
and 8 from the rural ones. 43 of them had thickened cartilage, 9 presented
intraarticular effusion, 18 had tendinopathy, 20 osteophytes and 33 meniscal
injuries. We found a weak inverse correlation between VAS and the cartilage
size only on the lateral femoral condyle (r = - 0.33). WOMAC score was directly
correlated with BMI (r= 0.45) and the presence of osteophytes (r= 0.42).
Conclusion. In our group, the pain intensity was
correlated with decrease in cartilage thickness on the lateral femoral condyle
and the joint functionality with the presence of the osteophytes and the BMI
value.
Keywords: Osteoarthritis, knee, ultrasonography,
cartilage, pain.
Background: This study was performed because it is important to know the risk factors for acquiring infection, colonization with Stenotrophomonas maltophilia and the risk of death associated with this bacterium in patients admitted to the intensive care unit.
Material and methods: A retrospective, case-control study was performed from a single center, which included all patients admitted to an Infectious Disease Hospital between January 2017 and July 2022, who had Stenotrophomonas maltophilia infection or colonization. A total of 36 patients were included in the study. There were 13 cases (patients with Stenotrophomonas maltophilia hospitalized in the intensive care unit) and 23 control patients (patients with Stenotrophomonas maltophilia who were not hospitalized in the intensive care unit). Demographic data, pathological history of patients and biological data were statistically analyzed using the Statistical Package for Social Sciences (SPSS version 20, IBM Corp., Armonk, NY, USA) and Microsoft Excel 2019 (Microsoft Corporation, USA).
Results: In our study, 13 patients with Stenotrophomonas maltophilia hospitalized in the intensive care unit were detected, of which 12 (92.30%) had infection with Stenotrophomonas maltophilia and 1 (7.6%) patient had colonization with Stenotrophomonas maltophilia. The univariate analysis identified that patients aged > 65 years, leukopenia on admission, infection with the SARS CoV2 virus were risk factors for acquiring infection or colonization with Stenotrophomonas maltophilia in the intensive care unit. Regarding the mortality rate, death is statistically significantly higher in patients who had infection or bacterial colonization with Stenotrophomonas maltophilia and were admitted to the intensive care unit, P ≤0.05.
Conclusions: Our study detected the risk factors for the acquisition of Stenotrophomonas maltophilia in patients hospitalized in the intensive care unit and it was observed that infection with the SARS CoV2 virus is one of the risk factors, increasing the risk 9.23 times (OR 9.23, 95% CI,1.02-83.33, P ≤0.05) to acquired Stenotrophomonas maltophilia.
Keywords: risk factors, Stenotrophomonas maltophilia, ICU
Lower urinary tract symptoms (LUTS) can be
observed in both males and females throughout lifetime, having a higher
prevalence in patients with autoimmune diseases. We present a case of a women
which was admitted at Obstetrics & Gynecological Department from “Sf. Apostol Andrei” Emergency Clinic County Hospital
Constanta, Romania for urinating problems,
including sudden urge to urinate, nocturia, the feeling that the patient hasn’t
completely emptied the bladder or the bladder fills up too quickly. On
examination, an irreductible stage III of uterine prolapse, stage III of
cystocele and I stage of rectocele was noted and from pathological obstetric antecedents we retained one
ectopic pregnancy, dyslipidemia with body mass index of 30, hepatitis C virus
infection and rheumatoid arthritis (RA) from 5 years ago. The choice of treatment was surgical, total
vaginal hysterectomy, uterosacral ligaments colposuspension, anterior colporrhaphy
and colpoperineoraphy. The operative course was
without complication, the patient being discharge 3 days postoperatively. Therefore,
female patients with both LUTS and RA should be seriously evaluated to
determine the most accurate treatment modality to decrease the possible effects
of urinary complaints on their daily quality of life.
Keywords: lower urinary tract symptoms, prolapse, cystocele, rectocele, rheumatoid arthritis, hysterectomy.
Introduction. Respiratory rehabilitation (RR) is a non-pharmacological component defined as a personalized intervention for the patient with pulmonary pathology and not only, based on evidence, which includes increasing knowledge through education, modification of vicious behaviors, elements of physiotherapy and kinesitherapy, improving on a long-term physical and mental health of the patient`s status.
Case report. We present the clinical case of a 67-year-old patient, known to have Overlap between chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), hypertension and grade II obesity (BMI=36.9), admitted to Constanța Pneumophthiology Clinical Hospital in a severe exacerbation. Therapeutic management of COPD consisted of both pharmacologic treatment and early respiratory rehabilitation over a period of 14 days. Within the program, it was clinically-functionally evaluated through the 6-minute walk test, dynamometry, bioimpedance, but also through symptom monitoring scales such as the BORG, CAT, MMRC, LinQ scale.
Disscussions. The social and economic burden in the evolution of COPD are severe exacerbations due to different trigger factors (bacterial or viral infections, polarization, etc.) that generate local and systemic inflammation and accelerate the decline of lung function. RR during exacerbation periods is important in decreasing the length of hospitalization and mortality, increasing the quality of life and the clinical-functional status objectived by the 6-minute walk test.
Conclusions. The respiratory rehabilitation program included corrective gymnastics, proper respiratory gymnastics, bronchial drainage and dosed exercise training with significantly improved results by increasing muscle strength, exercise tolerance, weight loss (BMI=35.5) and the impact of symptoms by decreasing dyspnea , expectoration and sleep interruptions.
This is a case of a 45
year old woman, with a persistent unilateral serous otitis media for more than
six months. When eventually she addressed the ENT department of SCJU Constanta,
a nasopharynx endoscopy was performed and a nasopharynx tumor was identified. Persistent
unilateral hearing loss in adults is often ignored resulting in a delayed
diagnosis of nasopharyngeal cancer. Endoscopic images and CT scans will be
attached below in order to support the final diagnosis. The purpose of this
case report is to emphasize the importance of a complete ENT examination in
patients with persistent unilateral serous otitis media.
Keywords: otitis media,
nasopharynx, nasopharyngeal cancer
Tranexamic
acid is a medication with antifibrinolytic properties that has been used for
the treatment of a variety of conditions, including heavy menstrual bleeding,
traumatic injury, and surgical bleeding. In recent years, tranexamic acid has
been the subject of research for its potential use in a number of new and
innovative applications.
A
short review of the literature to provide practical suggestions for clinical
use of TXA across a broad spectrum of bleeding disorders.
Keywords: Tranexamic acid, hemorrhages, anti-fibrinolytic agent
Introduction: An
accurate prenatal diagnosis of Placenta accreta spectrum (PAS) disorders is
fundamental, due to the fact that it significantly reduces maternal mortality
and morbidities using an individualized case management.
In the present
study, we evaluated the diagnostic and prognostic accuracy of the most
important ultrasonographic (US) and magnetic resonance imagining (MRI) markers
for PAS disorders.
Material and Methods: Our
study included 39 pregnant patients that previously had at least one cesarean
delivery and were diagnosed using both US and MRI investigations with placenta
previa at our tertiary maternity hospital ‘Cuza Voda’, Iasi, between 2019 and
2021.
By ultrasonography
we evaluated the following signs: intra-placental lacunae, loss of the
retroplacental hypoechoic zone, myometrial thinning < 1 mm, bladder wall
interruption, placental bulging, bridging vessels, and the hypervascularity of
the uterovesical or retroplacental space.
Using MRI, we
evaluated the following signs: intra-placental dark T2 bands, placental
bulging, loss of the retroplacental hypointense line on T2 images, myometrial
thinning, bladder wall interruption, focal exophytic placental mass, and
abnormal vascularization of the placental bed.
Results: Both US and MRI
signs presented adequate sensitivities and specificities for PAS, but there
wasn’t identified a unique sign that could be used as a predictor by itself.
By assessing the
presence of three or more US markers for accretion a sensitivity of 84.6.6% and
a specificity of 92.3% (p < 0.001) was identified. Three or more MRI
signs observed improved the diagnosis and were associated with a sensitivity of
92.3% and a specificity of 61.5% for predicting PAS (p < 0.001). Furthermore, our
findings were associated with FIGO grading and correlated with the severity of
PAS.
Conclusions: Even
though no US or MRI sign can predict by itself a case of PAS disorder with high
sensitivity and specificity, our study shows that three or more imagistic signs
present could increase the diagnostic accuracy of this patology. Furthermore,
US and MRI could be useful tools for evaluating prognostic and perinatal planning.
Introduction. According to current medical studies, endometrial cancer is the most common gynecologic cancer in the U.S., with increasing incidence and mortality. One of the risk factors for this condition is family history: Lynch Syndrome-microsatellite instability (MSI). MSI is characterized by abnormalities in the number of microsatellites and occurs as a consequence of inactivation of the DNA replication repair system.
Lynch syndrome is an
autosomal-dominant pathology resulting from mutations in MLH1, MSH2, MSH6, PMS2
genes, which predisposes to hereditary cancer (colorectal, endometrial,
ovarian, stomach, urinary, rarely brain and others).
Material and methods. This is a prospective
study with 35 patients operated
for endometrial cancer who underwent testing for MSI. Method - we used:
histopathological results, clinical data, immunohistochemical results: MLH1,
MSH2, MSH6, PMS2 and we tried to establish correlations
between the surveyed parameters.
Results. Average age
at diagnosis is much lower (55 years vs. 60-64 years) for patients with MSI-H.
Nuclear positivity loss in genes encoding proteins involved in DNA replication
error repair in MSI-H patients: MLH1:
66.66%, PMS2: 66.66%, MSH2: 16.66%, MSH6: 16.66%. MSI is
associated with the endometrioid type of endometrial cancer. Patients have a
normal body mass index.
Conclusion. Testing
for MMR/MSI status is recommended in all endometrial cancers because it could
improve treatment, new therapeutic options (immunotherapy with immune
checkpoint inhibitors, such as pembrolizumab), increased quality of life, improved
prognosis, genetic counseling for patients with Lynch Syndrome.
Keywords: microsatellite instability, Lynch syndrome,
checkpoint inhibitors
People
living with human immunodeficiency virus have an increased cardiovascular risk.
They have higher prevalence of traditional risk factors, such as smoking,
dyslipidemia, hypertension or diabetes and particular risk factors, such as
endothelial dysfunction, inflammation and antiretroviral therapy. The
pathophysiology of atherosclerosis in people living with human immunodeficiency
virus is complex.
The
incidence of coronary artery disease in these patients may be twice as high
compared with general population with similar characteristics. Clinical presentation of acute coronary syndromes in HIV
patients may be atypical and requires special attention. Short-term prognosis
of HIV patients and acute coronary syndromes is similar with that of negative
HIV patients, but long-term evolution is characterized by the recurrence of
major cardiovascular adverse events. Medical treatment for coronary disease in
these patients has no special particularities comparing to general population,
but possible drug interactions must be considered. Indication for coronary
revascularization, either angioplasty, or aorto-coronary by-pass follows
general indications for general population.
Although the birth of a child is usually a happy event, many women`s with postpartum state develop symptoms like depressive disorders. In a comprehensive way, the concept of postpartum depression is defined as a mild or moderate non-psychotic depressive episode, with onset in the first year after the child`s birth. In the narrow sense, postpartum depression refers to a major depressive episode that begins within 4 weeks after the child`s birth. Untreated postpartum depression can have negative consequences for the mother and the newborn.
Material and method: We are presenting the case of a 28-year-old patient, with no known psychiatric pathology or antepartum depression, who developed immediately postpartum a major depressive episode.
Conclusion: Undiagnosed and untreated accordingly, postpartum depression can lead to serious consequences.
Postpartum depression is not a myth, it's a real problem!
Keywords: depression, postpartum, newborn
Introduction: Mangalia balneary resort is situated in the south of the Black Sea seaside and is different from the others resorts in the region of Dobrogea because of the sulphurous water springs around the city area. The benefits of the sulpurous water spring therapy în internal and external aplication are well known from ancient times.
Objectives: The primary objective of this study was to describe the effect of sulphurous water of digestive tube pathologies, including infection with H. Pylori.
Methods And Results: Considering that sulphurous water has a bacteriostatic effect and that most gastritis are caused by H. Pylori infection, we propose that a group of 15 H. Pylori positive patients with dyspepsia which ingest sulphurous water in an amount of about 200-300 ml/ day, for 10 days and afterwards. The patients were in therapy with concomitent proton pump inhibitors type with antibiotic therapy.
Conclusion: The curative effects are due to the bacteriostatic effect of sulphurous water and to stimulation action on the digestive tube.
Chronic kidney disease (CKD) is a global health problem that affects about 10% of the adult population in developed countries. In the context of the uremic environment, as well as associated cardiovascular comorbidities, the risk of venous thrombosis is at least twice as high in patients with advanced CKD than in the general population. The risk for atrial fibrillation and acute coronary syndrome is also 10-20 times higher in patients with CKD. In this context, these patients will frequently require anticoagulant therapy, both short-term and long-term. Paradoxically, patients with CKD not only have a higher risk of thrombosis, but also an increased risk of bleeding. Furthermore, the pharmacokinetics and pharmacodynamics of many anticoagulant therapies are significantly affected by renal dysfunction, and patients with advanced CKD have often been systematically excluded from major clinical trials. So, the decision whether or not to be anticoagulated, and if so with which agent, poses significant challenges for patients with severe CKD.
We present a clinical case of a 59-year-old patient, with polymedication, in the records of the Nephrology Clinic with chronic kidney disease stage G3B (e GFR = 32 ml/min/1.73 sq m), type II diabetes mellitus insulin-requiring with multiple micro- and macroangiopathic complications, essential HTN grade III, very high risk, Hypertensive heart disease with NYHA class II heart failure with preserved LVEF, Ischemic coronary heart disease - Exertion angina, Mild-moderate mitral and aortic regurgitation, Permanent atrial fibrillation with medium AV , COPD, who is currently hospitalized for dyspnea on small efforts, chest pain and cough with muco-purulent expectoration for about 7 days. The clinical examination, corroborated with the paraclinical explorations reveals marked nitrogen retention syndrome (serum creatinine 6.19 mg/dl, GFR = 9.9 ml/min/1.73 sq m and urea 159mg/dl). During hospitalization, it is decided to discontinue the administration of the personal chronic oral anticoagulant – Dabigatran in maximum doses, due to the current eGFR below 30 ml/min, and to replace it with a low molecular weight heparin, Fraxiparine 0.4 ml/day, until the renal function improves.
Particularities of the case: Aggravation of nitrogen retention syndrome can be determined by the occurrence of respiratory infection, an aggravating and precipitating condition for cardiac decompensation with low cardiac output syndrome and mixed, prerenal and renal AKI. The administration of apixaban 2.5mg x2/day, which is a new generation oral anticoagulant with the lowest renal elimination rate (27%), which can be administered at eGFR below 30 ml/min, seems to be the most therapeutic option good for this patient, although randomized clinical trials in large groups of patients with predialysis and/or dialysis ckd are not yet completed.
Conclusion. Anticoagulation in patients with advanced CKD and multiple comorbidities is a real challenge and requires a holistic approach to the patient, the establishment of a personalized therapy, in a multidisciplinary team, with the appropriate assessment of risks and benefits.
The
decrease in number of vaginal births may also be due to the discomfort caused
by the episiotomy wounds.
Episiotomy
wounds are characterized by discomfort, stinging, vulvodynia.
The
decrease in immunity, the increase in vaginal pH during pregnancy and
pregnancy, can cause the appearance of bacterial vulvovaginitis and can lead to
poor healing of the episiotomy wound.
The
patients will be initially evaluated by means of a questionnaire at 24 hours
postpartum and then reevaluated at 7 days, when the suture material is removed,
by completing the same questionnaire. Bacteriological vaginal secretion
examination will also be collected both at 24 hours postpartum and at 40 days.
Visual
scales will also be used (REEDA scale, VANCOUVER), at 7 days and at 40 days.
Thus,
starting from the question, is postpartum sexual life influenced by episiotomy
wounds, we will try to find an answer to this question by applying a
questionnaire prepared by us.
Introduction: Pediatric pneumonia is responsible for the deaths of more than 800,000 young children worldwide each year, according to the United Nations Children's Fund (UNICEF). These deaths occur almost exclusively in children with underlying conditions, such as chronic lung disease of prematurity, congenital heart disease, and immunosuppression.
Pneumonia can occur at any age; nevertheless, it is more common in younger children. Pneumonia accounts for 13% of all infectious illnesses in infants younger than 2 years of age.
Case report: We present the case of a 9-year-old child admitted in our clinic with high fever, chills, cough, vomiting, the onset was about 5 days before presentation.
He was first evaluated by chest X-ray with changes of viro-bacterial pneumonia. Blood tests showed a high level of leukocyts and neutrophilia, with elevated inflammatory tests. Antibiotic treatment was instituted with third generation cephalosporin. During the first 48 hours of evolution, the fever decreased and the blood analysis improved. But on the 3rd day of admission, he presented high fever with prolonged chills, with significant chest pain. Tomography was requested, the result revealed abscessed pneumonia of middle lobe with parapneumonic pleurisy. The antibiotic regimen had been modified, according to the antibiogram of the sputum exam, enterobacter cloacae beeing isolated. On the new regimen, meropenem in association with vancomycin the evolution was favorable, with the remission of the septic state.
Background: In the epoch of antiretroviral therapy (ART), diffuse large B-cell lymphoma (DLBCL) is the most prevalent and aggressive type of non-Hogkin lymphoma, which is typically aggressive. Lymphoma is the primary cause of cancer-related morbidity among HIV-infected individuals. Between 5 and 10 percent of cases of large B cell lymphoma (DLBCL) is CD5-positive; nevertheless, this relatively novel type of DLBCL has not undergone enough research. The current study provides an overview of this HIV-related lymphoma's clinical aspects, diagnostic approaches, and clinical outcomes and highlights the significance of CD5-positive DLBCL early diagnosis.
Material & Methods: We present a case of a 30-year-old male patient, with a medical history of HIV-positive serology and antiviral therapy, who presented with diffuse abdominal pain and symptoms of obstruction or perforation. He underwent exploratory laparotomy and surgical resection of the small intestine with other areas of involvement. The surgical specimen was morphologically evaluated and immunohistochemically stained.
Results: A morphological evaluation of the small intestine revealed extensive neoplastic proliferation of large B lymphocytes, which lacked characteristics of other recognized subtypes of large B-cell lymphoma. After immunostaining with twelve monoclonal antibodies, the CD5-positive DLBCL subtype was identified as the source of the disease (CD3, CD5, CD10, CD20, CD23, CD30, CD68, Cyclin D1, MUM1, Bcl2, Bcl6, and Ki-67). By using the Hans algorithm towards the expression profile of immunohistochemical markers (CD10, Bcl6, and MUM1), the cell of origin of this case of DLBCL was determined.
Conclusion: While CD5-positive DLBCL has a bad prognosis, the current report emphasizes the significance of early detection and underlines how essential it is to identify immunodeficiencies because doing so influences the types of treatments that are provided. The GCB and ABC subtypes remain heterogenous, with better and worse prognostic subsets within each type, despite the fact that cell-of-origin is effective for predicting outcomes.
Keywords: Lymphoma, Large B-Cell, Diffuse, Germinal Center, Immunohistochemistry, CD5 Antigens, Immunological Deficiency Syndromes.
Introduction: Grade 4 gliomas are represented by Glioblastoma IDH wild type and Astrocytoma IDH mutant. These entities are highly aggressive, with a high mortality rate. The hypoxic consequences of the pathogenetic process are represented by tumor necrosis, cellular immaturity and tumor angiogenesis. The study aims to investigate these three parameters in the evaluation of the prognosis of patients with grade 4 gliomas.
Material and method: A retrospective study was carried out over a period of 10 years in which 85 cases were identified. Immunohistochemical (IDH1, Ki-67, Nestin and MGMT) and genetic markers (CDKN2A gene study) were used. The obtained results were analyzed through the SPSS Statistics program.
Results: The presence of a predominantly immature population, in the case of glioblastomas, was associated with a low survival (p=0.007). Cellular immaturity, together with an increased percentage of necrosis, was correlated with mutations (deletions or amplifications) at the level of the CDKN2A gene, denoting an aggressive nature of the tumor. In the case of astrocytomas, the presence of a high percentage of tumor necrosis (over 20%) represented an independent risk factor for mortality (HR=3.181, P=0.006), correlating with low survival. An increased microvascular density (over 50/mm2) was associated with a low patient survival, thus representing a risk factor regarding survival (HR=5.023, p<0.001). The processes of angiogenesis and tumor necrosis also had an impact on the DNA methylation status. An increased immunoexpression was observed, which indicates a low compliance with the chemotherapeutic treatment. Also, cellular immaturity is maintained through multiplication processes, an aspect highlighted by its association with an increased proliferative index.
Conclusion: The main risk factors, predictors of mortality, identified were cellular immaturity in the case of glioblastomas, and in the case of astrocytomas an increased necrotic index and an accentuated microvascular density.
Keywords: glioma, microvascular density, necrosis, Nestin.
Introduction: There are many diverse histopathology variants and locations for salivary gland neoplasms. Although the majority of these neoplasms (80%) are benign, they vary in their propensity to recur and/or develop into malignant tumors. The study focuses on benign mesenchymal-epithelial tumor pathology of the salivary glands in order to highlight some socio-demographic and morphological characteristics, as well as a report on them in the specialized literature.
Material and methods: We performed a retrospective study of the cases of pleomorphic adenoma for a period of 5 years diagnosed in the Clinical Service of Pathological Anatomy of the Constanta County Emergency Clinical Hospital. The study batch was analyzed according to clinical, imaging and histological criteria. Data statistical analysis was carried out using the Microsoft Office Excel, version 2016.
Results: Between 2018-2022, 102 cases of pathology of the salivary glands were diagnosed. Of these, 65 were benign. 31 were pleomorphic adenomas, 28 were Warthin tumors and 3 were myoepitheliomas. The average diagnostic age is 44.41 years old and the female gender has an increased predilection of 74.19%. Topographic, these tumors had a predominant unilateral distribution in the parotid gland, producing chronic inflammatory reactions in 24% of cases. In 87.10% of cases, the histopathological diagnosis confirmed the complete excision of these tumors.
Conclusion: Salivary gland tumors can be treated in specialized facilities, and even the most common benign tumors need careful surgical management and follow-up. Because tumor forms vary morphologically from one another, rigorous histological evaluation of an excised specimen is necessary for diagnosis. There is a small chance of malignant transformation. The likelihood that the lesion will become malignant increases with the length of time it has been present. Therefore, excision is necessary in all situations. Age, radiation therapy, tumor size, and recurrence are other risk factors for cancer.
Keywords: Histopathology, Pleomorphic adenoma, Salivary glands
Background: The development of primary lipoid tumors at the uterine level is a rare phenomenon that includes lipoleiomyoma, lipoma and liposarcoma. Lipoleiomyoma is a benign tumor, made up of an association of smooth muscle fibers and mature fat cells. The incidence of this tumor is between 0.03%-0.2%. Most of the patients are asymptomatic, and the clinical manifestations are not specific, usually identifying a single lesion located most frequently at the level of the posterior uterine face. From a pathogenic point of view, there are several theories that vary from the erroneous placement of embryonic adipocytes to the degeneration of the connective tissue. The main treatment is surgical.
Case presentation: We present the case of a 66-year-old patient who presented with abdominal pain, pollakiuria and abnormal vaginal bleeding. Echographically, an increase in size of the uterus secondary to a hyperechoic nodular lesion with a maximum diameter of 20 cm was observed. Microscopic evaluation of the nodular lesion highlighted the presence of smooth muscle fibers associated with mature adiocytes. To perform the differential diagnosis, the immunohistochemical examination was performed using the following markers: Desmin, S100, MDM2, CD34, Calretinin, confirming the diagnosis of uterine lipoleiomyoma.
Conclusion: Uterine lipoleiomyoma is a rare tumor, patients with this diagnosis having comorbidities such as obesity. Although the pathogenic theories are multiple, the way of formation of this tumor entity is still unexplained. From an imaging point of view, magnetic resonance imaging is the most useful investigation. Taking into account the fact that it is a benign tumor, the prognosis is excellent, treatment being necessary only in symptomatic cases.
Keywords: Adipocyte, Pathogenesis, Smooth muscle, Uterus
Congenital anomalies of the kidney and urinary tract represent the most common cause of all birth defects and the most important cause of chronic kidney disease in children. Many causes of CAKUT are not known yet but there is a strong genetic component, with familial aggregation reported in aprox. 10% of cases. . Most cases are sporadic and non-syndromic. 20-30% of all anomalies can be detected by routine fetal ultrasound in 18-22 weeks of pregnancy. Congenital anomalies of the kidney and the urinary tract continue to be a group of diseases with different degrees of severity and many of them require a multidisciplinary approach for accurate diagnosis and better treatment. Since many of these congenital anomalies are hereditary, advances in prenatal diagnosis, fetal surgery, combined liver and kidney transplants, as well as targeted therapies have improved the prognosis and quality of life in affected families. The family physician/ general practitioner has a key role in early detection and referral to specialized care of patients with CAKUT.It is essential to establish the correct diagnosis in order to facilitate adequate genetic counseling and to alert the families of other possible affected members that could benefit from earlier intervention.
Introduction: Diverticular disease located in the gastrointestinal tract is a frequently diagnosed lesion at colonoscopy, the frequency of which is constantly increasing, with complex, multifactorial etio-pathogenesis, in the context of environmental factors, nutrition and genetic factors. The current study aims to present some morphological aspects encountered in diverticular disease, with different locations (small intestine, colon, appendix), as well as the associated lesions.
Material and methods: The histopathological examination was performed within the Pathological Anatomy Clinical Service of the Emergency County Clinical Hospital, St. Apostol Andrei'' Constanța, on the surgical specimens belonging to the patients admitted to the General Surgery departments of the Hospital.
Results: Following the anatomopathological examination of 20 surgical specimens, digitiform lesions were described at the level of different intestinal segments, and associated lesions such as malignant colon tumors, acute cornic inflammations, with acute peritonitis as well as complications such as fistulization.
Conclusions: The study highlights the importance of the anatomopathological diagnosis of diverticular disease and associated diseases, as well as the correlation with clinical and imaging data; the treatment is still controversial, especially regarding selective versus routine antibiotic therapy, and the correction of risk factors.
Introduction: Neoadjuvant therapy in rectal cancers includes many options, such as radiotherapy and/or chemotherapy, with effective results in reducing tumor volume in advanced curative cancer, followed by radical intervention with excision of the mesorectum, with the aim of reducing local recurrence.
The distribution of cases of rectal malignant tumors treated with neoadjuvant radiotherapy is based on yTNM staging (WHO 2019), the degree of tumor regression (TRG) and changes after neoadjuvant radiotherapy.
Material and methods: The aim of the work is the statistical evaluation of cases of malignant rectal tumors with neoadjuvant oncological therapy between January 1, 2017 and December 31, 2021, in order to establish the morphological characteristics of the studied group.
Results: There were 492 cases of malignant rectal tumors, of which 81 cases underwent oncological treatment. The majority of cases presented invasion in the muscularis propria (ypT2) (43%). In 9.9% of patients, 2-3 regional lymph nodes were positive (ypN1b), while in 4.9% of patients it was positive a single regional lymph node (ypN1a). A percentage of 64.2% of the studied sample did not present metastases in the regional lymph nodes (ypN0). Distant metastases (ypM1) were detected in 4% of patients. A percentage of 47% of the sample of patients showed residual cancer with desmoplastic response (TRG2), according to WHO 2019, with the absence of cancer cells (TRG0) in 21%. Radiotherapy-related histopathological changes were observed, such as fibrosis (41.9%), dystrophic calcifications, mucin lakes, vascular degenerative changes and macrophage collections (0.6%).
Conclusion: The detailed evaluation and reporting of postradiotherapy rectal cancer cases is very important in the multidisciplinary approach and clinical management of patients diagnosed with this disease.
Rapid evolution of antibiotic resistance in Clostridioides difficile (C.diff.) plays an important role in its epidemiology. The consequent effects on the prevention and treatment of Clostridioides difficile infection (CDI) are a matter of concern for public health. The protective intestinal flora is disrupted after antibiotic therapy and ingested or resident C.diff may colonize digestive tract and infect the host and is the most common causative agent of antibiotic-associated diarrhea. Antibiotic resistance enables C. diff to grow in the presence of drugs, so newly multi-drug resistant (MDR) emergent strains have a selective advantage from the use of theses antibiotics.
The most prominent hypervirulent type is ribotype RT027 (by polymerase chain reaction (PCR) responsible for severe infections, high rates of recurrences and morality and reduced susceptibility to the first-line antibiotics for CDI treatment
Rates of antibiotic resistance are variable in different studies depending on local or national antimicrobial stewardship and regions. In CDI several mechanisms of resistance were identified: the acquisition of genetic elements, alterations of the antibiotic target sites, mobile genetic elements, the transfer of genetic elements among C diff. strains or between C diff. and other bacterial species. The resistances may persist in C diff. population also in absence of antibiotic selective pressure.
Resistance to clindamicyn (ribosomal methylation is the most widespread mechanism of resistance to the antibiotics from the macrolide – lincosamide - streptograminB -MLSB family) and cephalosporins (strain-dependent, caused by antibiotic-degrading enzymes β-lactamases and modification of target sites, penicillin-binding proteins- PBPs) are common and to fluoroquinolones (due to alterations in the quinolone-resistance determining region QRDR) in C diff.
Metronidazole (MTZ) is considered the first choice for mild to moderate CDI but C.diff strains resistant to MTZ can explain treatment failure after this treatment. Heteroresistance seems to be a preresistance stage in C diff., as part of the population acquires the capacity of growth in the presence of antibiotics (subinhibitory concentrations of MTZ could select and maintaining colonies with increased MICs, the concentrations achieved in the colon could be insufficient for treating these strains). MTZ resistance is a multifactorial process involving alterations in different metabolic pathways: activity of nitroreductases, iron uptake and DNA repair and a possible role of biofilm.
The mechanism of resistance for vancomicyn (VAN), the first-line antibiotic for moderate and severe CDI is still unclear. Biofilm formation could also be involved in VAN- resistance.
Rifamycins especially rifaximin (RFX) have been proposed for treating relapsing CDI. Fidaxomicin (FDX) is used for treating CDI with high risk of recurrences. Susceptibility to rifampicin (RIF) correlated with the susceptibility to RFX. Strains belonging to RT046 isolated from patients with tuberculosis with prolonged RIF therapy have been found to be highly resistant to these antibiotics. FDX provides cure rates similar to VAN and lower rates of recurrence of CDI with strains non-RT027. It has minimal impact on fecal microbiota, especially on Bacteroides species and high local concentration in the gut and feces.
Resistance to ERY, CIP, moxifloxacin and RIF has been observed in strains RT176 a type closely related to RT027. Strains RT018 are highly transmissible (tenfold higher than RT078) and this infection associated with old age, severe pulmonary comorbidity, previous use of fluoroquinolones has been important risk factors for complicated infections.
Effective antimicrobial stewardship and infection control programs, the development of alternative therapies are needed to prevent spread of resistance and to ensure effective therapy for CDI.
Keywords: Clostridioides difficile infections, antibiotic resistance
Introduction: Pleural effusions are very varied in etiology and clinical presentation, being important to determine the cause, the first step in this sense is the differentiation between transudate and exudate.
Clinical case: We present the case of a
56-year-old patient, smoker, without exposure to respiratory toxins, without
personal antecedents, who presented with an imagistic suspicion of right upper
lobe lung tumor, with secondary bilateral lung metastasis and right pleural
effusion, accusing fever, chills, sweats, physical asthenia, with onset of 10
days. The laboratory tests showed thrombocytosis, inflammatory syndrome, liver
cytolysis, elevated D-dimers. The spirometry objectified the presence of a
moderate obstructive ventilatory dysfunction. At the pleural ultrasound we
found medium amount of liquid with fibrin filaments in the right pleural
cavity, so thoracocentesis was performed. The pleural fluid exam showed the
presence of an exudate, with increased ADA (adenosine deaminase), which was
also increased in the serum and an inflammatory mixt cytological aspect, with
lymphocytic predominance. The bacteriological microscopic exam for BK (Koch’s
bacillus) was negative, however the Bactec and Lowenstein-Jensen cultures were
positive from the sputum, bronchial aspirate and pleural fluid, determining the
presence of Mycobacterium tuberculosis. The patient was put under
antituberculosis treatment and was recommended to repeat the thoracic CT (computer
tomography) after 2 months of treatment.
Conclusions: Determining the cause of a
pleural effusion can sometimes rise differential diagnosis problems,
tuberculosis being the most common cause of exudative pleural effusion,
followed by malignant diseases. The clinical and paraclinical examinations are
the key points for an accurate diagnosis.
Chronic obstructive pulmonary disease and heart failure are
the most important causes producing dyspnea especially at old people.
Heart failure is the inability of the heart to pump
sufficient amounts of blood through the cardiovascular system and is caused by compromised contractility and/or
filling of the ventricles leading to forward and backward failure . This is determines subsequently dyspnea.
In COPD, the destruction and remodeling processes of the
bronchiolar architecture inhibit proper exhalation of air, thereby leading to
exhaustion of the thoracic muscles, insufficient oxygen diffusion, producing
also dyspneea.
So, we have fundamental differences in the pathophysiology
of these disorders, but their clinical
presentation may be very similar.
Often patients with severe heart failure end up being treated
as copd in internal clinical medicine. We studied a group of 47 patients
admitted to the Medical Clinic II with
COPD and / or heart failure and we sought to find the benefit of
hospitalization and of the treatment administered.
Do cardiologists pass on cases of heart failure or internists
prove excess zeal?
A peculiarity of the patients in the final stage of liver disease is represented by the presence of low T3 syndrome, highlighted by the low value of T3 level, in euthyroid patients, without thyroid pathology, without clinical signs of hypothyroidism.
In general, this syndrome occurs in diseases with a reserved prognosis, patients with protein-caloric malnutrition, chronic renal failure – final stage, sepsis and severe liver failure.
It should be noted that we exclude thyroid pathology, so that the TSH level of patients with low T3 syndrome is in all cases normal.
This situation is called non-thyroid disease, euthyroid syndrome or low T3 syndrome. In these cases, the administration of the replacement treatment has no benefit, even on the contrary, it can cause harmful effects.
In
this study, we aimed to determine the level of the thyroid hormons level at the
patients in the final stage of the chronic liver disease and whether
administration of propranolol to such patients leads to further changes in
plasma thyroid hormones, since it can affect their peripheral metabolism.
Our conclusion shows that , free T3 levels are inversely correlated with the severity of liver disease and are significantly lower in patients with decompensated cirrhosis who developed severe complications.
Key words- low T3, euthyroid, liver disease
Beyond dyspnea and hemoptysis, alteration of the general condition due to a diselectrolythemia has become more and more often the reason for the presence at the hospital of patients with lung cancer.
Hyponatremia, hypokalemia and hypercalcemia are the changes that occur most often in newly diagnosed patients with respiratory neoplasia. We study the patients admitted in the Constanta County Emergency Hospital – Medical Clinic II, from January 2021 until now in order to make a connection between severity of the electrolytic changes , associated pathology, medication previous to diagnostic, the stage of the disease and evolution of the patients. Patients present also edematous syndrome and symptoms like nausea, restlessness, confusion, seizure and coma. We formulated some conclusions, that hyponatremia is the most common form of dyselectrolytemia in these patients, and the evolution of the patients was more unfavorable proportional to the degree of electrolyte disorders. A particular case is Schwartz- Bartter Syndr., the Syndrome of inappropriate anti-diuretic hormone ( SIADH) , as a paraneoplastic manifestation with hypernatriuria, hyponatremia and normal hidration that usually precedes the diagnostic of the neoplasm.
Although hypercalcemia are reported to be associated with poorer
prognosis in lung cancer, we could not establish a significant connection
regarding the patient's condition and the degree of hypercalcemia. The
unfavorable evolution of patients with marked hypercalcemia we considered that
it could be more hasty due to bone metastases.
Keywords-
lung cancer, diselectrolitemia, onset symptoms
Because ammonia plays
a decisive role in the complex pathophysiology of hepatic encephalopathy, it
was believed that the determination of serum ammonia would bring benefits in
the diagnosis, monitoring and treatment of this condition. It turns out that
the level of serum ammoniac is not reliable for both diagnosis and correlation
with neurological symptoms in patients with cirrhosis. Correlated, however,
with the elements of hepatic, clinical and biological insufficiency, the
suspicion of hepatic encephalopathy is not difficult to confirm.
Blood tests can
identify abnormalities associated with liver and kidney dysfunction,
infections, cytolysis , coagulation disorders . However, these tests are not
specific for hepatic encephalopathy, but help to establish the diagnosis, which
is based primarily on history and symptomatology.
But, not all patients
with cirrhosis of the liver develop phenomena of encephalopathy due to the
increase in ammonia levels. We studied a group of 32 cirrhotic patients with
neurological manifestations and we found that also the thyroid hormones level,
as well as disorders of protein metabolism and coagulation can cause
encephalopathy to varying degrees. It has been proven that in cells exposed to
ammonia, inflammatory cytokines, to benzodiapzepines, the level of reactive
nitrogen increases. A similar effect is
also triggered by a decrease in serum sodium.
These aspects were followed up in the patients studied.
Keywords-
encephalopathy, liver cirrhosis, ammonia
The present
study analyses the data regarding the demography, in general, and the birth
rate, in particular, at the county, national, European and global level in the
period after the onset of the pandemic caused by the SARS-CoV-2 virus, while
comparing them with the data existing before the pandemic. Finally, we will
conclude whether and to what extent this pandemic had effects on the birth
rate.
Of course,
as it results from the name of the SARS-CoV-2 virus, the disease it causes is
most often associated with symptoms in the respiratory system, and not on the
reproductive system. In this context, an important effect on the birth rate was
not had by the disease viewed individually, but even by the necessary restrictive measures adopted by the authorities in
order to slow down the spread of the pandemic, measures that, at the same time,
also led to a decrease in social interactions between individuals.
Keywords: birth rate, COVID-19 pandemic, restrictive measures
Foster care is a
preferred alternative to residential care due to the importance of the family
environment for the physical, emotional and intellectual development of the
child. This enables the development of a sense of security and belonging.
The professional
maternal assistant is a person certified under the terms of the Government
Decision no.679/2003, regarding the conditions, procedures and status of the
professional maternal assistant and according to the Government Decision no.
502/2017, on the organization and functioning of the Commission for Child
Protection. The professional maternal assistant ensures the education and
well-being, necessary for the harmonious development of the foster child.
The paper presents an
analysis of the development process of the maternal assistance network at the
level of Constanta County, with emphasis on reducing the number of
institutionalized children and ensuring the human resource necessary for the
placement of children separated from their birth family, having consequence in
optimizing and increasing the quality of services addressed to children.
Keywords: to institutionalize,
foster care, children
Measles is
a highly contagious viral infection, caused by a Morbillivirus from the Paramyxovirus
family. This paper evaluates the fluctuations of measles cases at the local,
national, continental and global levels.
The
conclusions, that resulted from data analysis, highlight the decisive role of
measles vaccination and everything that this process involves.
Keywords: epidemic, measles, vaccination
Introduction. A pulmonary mass is any area of an opacity measuring in diameter more than 30 mm, having primary lung cancer (LC) as the most common cause of etiology. The long journey of lung mass lesions started with "Bergkrankheit„ the first cases of lethal pulmonary mass, described in the beginning of the XV-th century; went through XX-th century, when association of LC and tuberculosis (TB) was named as cancerous pthsis by Bayle, in 1810; made a stop over in 1961, when the first lung adenocarcinoma was reported, and ″the rest is history″
Case report. A case of a 56 year- old male,
active great smoker of 90 pack year, 12-year-old diabetic, insulin-dependent in
the last 3 years, with persistent respiratory symptoms for 8 months, was
hospitalized and investigated for hemoptysis. Chest X-ray and CT scan were
highly suggestive for LC, revealing right hilar adenopathy, excavated mass
opacity of 12 cm, with thick pericavitary wall, cavitary buds and satellite
nodular lesions, located in the Fowler segment of the right lower lobe.
Initially, the patient was diagnosed with TB because microscopical exam of
sputum and genetic test of Line Probe Assay were positive, as well as
QuantiFERON TB test. Liquid and solid cultures of sputum (Bactec MGIT 960 and
Lowenstein Jensen) had negative results, so bronchoscopy was performed and
squamous cell LC was revealed after biopsy and histopathologic exam.
Discussions. LC) is related with
preexisting Tuberculosis (TB) scars. Radiologic pattern of a mixed
hydro-aerial lesion, with a horizontal level of liquid, thick wall points to an
etiology other than TB, more frequent to lung cancer. The hemoptoic onset of TB is common in LC, too. In many
cases, TB and LC can occur in the same time. The diagnosis of pulmonary TB synchronous with
NBP was suspected based on the genotypic method, but it was not supported and
confirmed by the phenotypic methods, so that, after 2 months, the
antituberculosis treatment was stopped.
Conclusions. The genotypic testing
is inferior to the phenotypic methods in confirming Pulmonary TB. The
appearance of a cavitated squamous carcinoma on nodular lesions of sequelae TB
can lead (through erosion) to the elimination of TB bacillary bodies, through
expectoration, leading to a false-positive BK microscopy.
Post partum haemorrhage after C-section usually is two times important than after vaginal delivery and includes almost 1000ml blood.
Our study included all the patients that were admitted and delivered in Department of Obstetrics and Gynecology I of Emergecy Clinical Hospital " St Andrew" , during January to December 2021. The patients were analised by age, gestational age, parity, maternal anaemia, weight of the newborn and APGAR score and associated pathology. The conclusion of the study was that post partum haemorrhage after C-section delivery can cause maternal anaemia and can influence also the status of the newborn.
Keywords: post partum haemorrhage, C-section delivery, maternal anaemia.
Introduction. Acupuncture is over 10,000 years old, becoming known in Europe in 1939. It is an ancient healing method with origins in Ancient China. It treats by restoring the energetic harmony in the body with the help of special needles that are applied to the acupuncture points on the surface of the body.
Methods. Chinese Scalp Acupuncture (YNSA) is not strictly classical technique because the needles are not inserted into the acupuncture points along the meridian path. In this procedure, the needle is inserted into the scalp at the motor and sensory regions of the brain problem directly below the brain area to stimulate the particular pathological structure of the body. Compared to ancient Chinese acupuncture, this was only developed in the late 1960s.
Results. The indications of the Yamamoto technique are very broad and include a lot of conditions, such as musculoskeletal pathology (spondylosis, disc herniation, osteoarthritis, tendinitis), neurological pathology (hemiplegia, facial paralysis, migraine, cerebral palsy, multiple sclerosis), as well as dysfunctions internal organs (kidney, liver, cardiac, abdominal, pulmonary disorders).
Conclusions. Acupuncture complements modern medicine, but does not replace it, making use of the body's own healing resources, without bringing in any foreign element for this purpose. Therefore, its preferred field of action is the functional conditions, without an organic lesional substrate. Acupuncture can be applied in order to restore some deregulated functions, influencing the body's reactions to the disease, or it can be applied symptomatically, addressing a symptom such as pain.
Keywords: acupuncture, YNSA, scalp,
musculoskeletal, meridians.
The impact of sport on the general health of children and adolescents is an essential topic of medical rehabilitation. It is worth highlighting the type of physical activity we recommend from a medical point of view. A basic medical premise is that sport is carried out in suitable conditions, associated according to the child's age, assimilating a series of benefits: harmonious muscle and bone development, prevention of certain diseases, development of new skills, such as teamwork, punctuality, intuitive thinking, and self-control. Martial arts is a complex sport of contact techniques, considered art because the practitioners of this sport consider this form of movement as a lifestyle, a calling and a philosophy, a form of individual physical and mental development. Because of the discipline they have to apply in martial arts, young athletes perform better academically. They develop their moral principles and learn specific techniques to reduce stress, a significant problem in today's global society. Weighing the benefits and risks (which can occur in any form of sports activity) the martial arts practice for young people who want to be physically active presents multiple positive medical effects. However, it must be emphasized that, without an impeccable technique, a whole series of sports accidents and traumas can occur, primarily with axial and peripheral osteo-articular impact, leading to functional deficits.
Keywords: martial arts, medical,
muscular.
Psoriasis is a chronic immune-mediated skin disease characterized by inflammation. Most types of psoriasis are triggered by common factors such are: medications, stress, genetical background, skin trauma or infections . There is a major importance in knowing all the forms of presentation of the disease, as both the appearance and the treatment vary depending on the present subtype. Pulstular, inverse, guttate and erythrodermic psoriasis represent only some of the existing forms and the erythrodermic form is the subject of the current discussion. Erythroderma is a generalised redness of the skin, it is a very severe skin condition that can be fatal.
We present the case of a 74-year-old patient who was admitted to the Dermatovenereology clinic for generalized erythrodermic rash, accompanied by important desquamation. It should be mentioned that until the time of presentation, the patient was not diagnosed with any skin disorders.
The main clinical challenge in erythrodermic rashes, is to establish the etiology. Histopathological examination is the main investigation used to determine the diagnosis of certainty. Depending on the diagnosis, the therapeutic scheme, evolution and prognosis are different.
The skin biopsy confirmed the diagnosis of Erythrodermic Psoriasis. Recommended treatment was with Methotrexate 10 mg/week in ascending doses until 15 mg/week and the patient is discharged with an improved health status and the slow disappearance of the erythema.
Though erythrodermic psoriasis is a serious life long condition, that can’t be cured, it can be well-managed. For many patients, that includes systemic therapy with Methotrexate.
The conclusions of this clinical case is to highlight the importance of knowing the detailed history of the patient and the possible differential diagnoses.
Keywords: erythrodermic rash, psoriasis, inflammatory syndrome, Methotrexate, skin biopsy
Introduction: In histopathological practice, endometrial hyperplasias cover a wide spectrum of morphological changes, ranging from benign forms induced by the abnormal hormonal environment to premalignant ones.
The current hyperplasia classification systems (WHO 2020) divide endometrial hyperplasia into typical and atypical, thus trying to remove diagnostic problems and implicitly to clearly differentiate lesions with the potential for malignant transformation.
Material and methods: The study was carried out over a period of 5 years, between January 1, 2017 and December 31, 2021, within the Pathological Anatomy Clinical Service of the St. Apostle Andrei'' Constanța. A number of 1576 cases were registered, the biological material being represented by biopsy pieces obtained after uterine curettages and partial or total hysterectomy pieces from patients admitted to the Department of Obstetrics-Gynecology I, Obstetrics-Gynecology II and General Surgery I .
Results: Following the anatomopathological examination of hysterectomy pieces and fractional biopsy curettages, endometrial hyperplasias represented 15.57% of . The other uterine lesions diagnosed were leiomyoma (22.14%), endometrial polyp (20.99%) and proliferative phase disorder -147 cases (12.25%). The most common malignant pathology was endometrioid endometrial adenocarcinoma (9.38%). Most cases of endometrial hyperplasia were identified in 2019, representing 3.83% of the total studied materials. The most common were benign endometrial hyperplasias, representing 229 cases out of the total identified.
Conclusion: The study highlights the importance of the anatomical-clinical diagnosis of endometrial hyperplasia, especially the atypical forms, which can progress to endometrial cancer.
Introduction. A healthy lifestyle is a goal that everyone should follow. Regular physical exercise is considered one of the essential factors for maintaining a healthy lifestyle in every stages of life.
Methods. Regular physical activity promotes mental health and well-being, relieves symptoms of anxiety, stress, depression, decreases the risk of type 2 diabetes, hypercholesterolemia, cardiovascular disease, cancers, obesity, prevents osteoporosis.
Results. Recent studies prove that physical activity could interact with the intestinal microbiota, modulating its composition. Physical exercise can increase the diversity of the microbiota and can stimulate bacterial species that are capable of producing substances with protective action against many types of aliments.
Conclusion. Physical exercise, along with a healthy diet, contributes to maintain an optimal state of health by modulating the intestinal microbiota. This causes positive changes in the composition of the intestinal microbiota, both quantitatively and qualitatively, with benefits for the patient's health.
Keywords. physical activity, microbiota,
health, prevention
Introduction: Neoadjuvant therapy in rectal cancers includes many options, such as radiotherapy and/or chemotherapy, with effective results in reducing tumor volume in advanced curative cancer, followed by radical intervention with excision of the mesorectum, with the aim of reducing local recurrence.
The distribution of cases of rectal malignant tumors treated with neoadjuvant radiotherapy is based on yTNM staging (WHO 2019), the degree of tumor regression (TRG) and changes after neoadjuvant radiotherapy.
Material and methods: The aim of the work is the statistical evaluation of cases of malignant rectal tumors with neoadjuvant oncological therapy between January 1, 2017 and December 31, 2021, in order to establish the morphological characteristics of the studied group.
Results: There were 492 cases of malignant rectal tumors, of which 81 cases underwent oncological treatment. The majority of cases presented invasion in the muscularis propria (ypT2) (43%). In 9.9% of patients, 2-3 regional lymph nodes were positive (ypN1b), while in 4.9% of patients it was positive a single regional lymph node (ypN1a). A percentage of 64.2% of the studied sample did not present metastases in the regional lymph nodes (ypN0). Distant metastases (ypM1) were detected in 4% of patients. A percentage of 47% of the sample of patients showed residual cancer with desmoplastic response (TRG2), according to WHO 2019, with the absence of cancer cells (TRG0) in 21%. Radiotherapy-related histopathological changes were observed, such as fibrosis (41.9%), dystrophic calcifications, mucin lakes, vascular degenerative changes and macrophage collections (0.6%).
Conclusion: The detailed evaluation and reporting of postradiotherapy rectal cancer cases is very important in the multidisciplinary approach and clinical management of patients diagnosed with this disease.
Introduction. Thrombophilia is an increasingly met pathology in obstetric practice that can cause major maternal-fetal complications. Thrombophilia can be defined as a favorable factor for thromboembolic disease, especially associated with the hypercoagulable state of pregnancy. The present work aims to evaluate the impact of thrombophilia in the pathology of pregnancy in a population of patients from Dobrogea district.
Materials, patients and method. The study is a retrospective cohort of 284 cases of pregnant women diagnosed with thrombophilia who were admitted to SCJU Constanța - Department of Obstetrics and Gynecology 1, between 1st January 2017 and 1st January 2023. A chart with patients' biological parameters and with the results of different investigations was performed. Results were statistically analyzed.
Results. Premature birth (21% of pregnant women), risk of premature birth (18.47%), preeclampsia (6.52%) and spontaneous abortion (0,7%) were described in pregnant women with hereditary thrombophilia. Apart from spontaneous abortions, all the studied patients and their pregnancies had a positive evolution.
Discussions. An important direct correlation was observed between thrombophilia and pregnancy complications. Early diagnosis and treatment of thrombophilia before or during pregnancy play an important role in preventing these complications. Even if thrombophilia cannot be prevented it can be controlled, especially in a pregnant patient.
The collaboration and formation of multidisciplinary teams at the present time, represents a gold standard in the fastest and most efficient diagnosis of the patient who is to receive specific surgical treatment.
Nowadays, the increasing number of patients with advanced surgical pathology, learn of their suffering in advanced stages of the disease and sometimes even without surgical solution. We explain this by the omission of minor symptoms, which can lead to early diagnosis, and lack of health education.
Referral to general practitioners or specialists, as we are about to discuss in the present paper, has had catastrophic results, with patients being unable to benefit from elective surgical treatment, resulting even in death.
The online environment undermines the image of the doctor, precisely through those cases that are surgically outdated, leading to a low addressability towards health units and medical professionals.
The patient's pathway must be initiated in family medicine practices and then presented to specialist doctors who, together with imaging and laboratory doctors, will have an important input in shaping the working diagnosis. In neoplastic pathology, this multidisciplinary team is made up of pathologists and oncologists who make a real contribution. For patients who may benefit from surgical treatment, this multidisciplinary team is joined by the surgeon who, at the indication of the oncology committee, will carry out specific treatment with radical or palliative targeting. This cycle, subsequently reaching anatomopathology and oncology.
We wish to present both the advantages and disadvantages of the pathway, which the patient undergoes in order to receive appropriate treatment.
The paper synthetically presents a series of problems of periodontal health known as "accompaniments" of various thyroid function disorders, as well as the diagnostic and treatment challenges that their association brings to the clinician from specialties other than endocrinology, including the dentist. The impact of thyroid pathology is evident in a number of periodontal pathological entities, identified as having a multifactorial etiopathogenesis and not yet fully understood.
The authors approach the subject of interdisciplinary collaboration through biostatistical methods, investigating through questionnaires addressed to clinician respondents from 3 specialties with oro-maxillo-facial and orbital pathology as a sphere of interest.
The conclusions of the study once again underline the fact that the theme of interdisciplinary and inter-human collaboration remains highly topical even in the context of increasing technological advances in diagnosis and treatment in all medical specialties.
The paper refers to the anti-VEGF therapeutic agents currently used successfully in the treatment of exudative form of AMD, a pathology causing blindness and increasingly prevalent in conditions of increasing life expectancy and aging population.
The authors review all the agents of this type administered over time and present the evolution of this type of therapy, in the context of the worldwide efforts of pharmaceutical industry researchers to obtain therapeutic agents that are more effective, more financially sustainable and allow longer injection intervals.
Static disorders in children are frequently encountered in chronic neurological disorders such as cerebral palsy with all its forms, extrapyramidal syndromes, hypoxic-ischemic encephalopathies, neuromuscular disorders, coxarthrosis, arthrogryposis, etc.
In this study we will evaluate visual field changes, refractive and visual acuity disorders, such as visual impairment due to cerebral cause, dyskinetic movements of the eyeballs, recorded in 10 children aged between 4 months and 10 years, admitted to the Pediatric Surgery Clinic of SCJU Constanta, known with static disorders of different etiologies.
The most common changes recorded are represented by decreased visual acuity, dyskinetic movements of the eyeballs, changes in the visual field. Refractive disorders and fundus examination abnormalities have also been found. Visual impairment due to cerebral cause is frequently associated with ophthalmological abnormalities, thus making early evaluation extremely important to establish a correct diagnosis and a personalized habilitation plan.
Diabetes mellitus continues to be a socio-economic challenge worldwide both from a therapeutic point of view and in terms of the costs involved in the treatment of the disease and associated complications, with the International Diabetes Federation estimating that in 2022 the number of people diagnosed with diabetes will exceed 500 million globally.
Vitamin D deficiency has been shown to be a good predictor of severity in diabetic retinopathy, therefore a cost-effective strategy worthy of consideration in national diabetes prevention programmes and micro- and macrovascular complications may be early oral supplementation in patients with impaired glucose tolerance.
Demodicosis is a parasitic disease of the
pilo-sebaceous follicles, produced by the ectoparasites Demodes folliculorum
and Demodex brevis. Even if these ectoparasites are considered to be part of
the natural skin microbiota, the increase in their number above a certain
threshold can cause multiple facial or ocular inflammatory conditions. The
researches of the last years have demonstrated a close connection between the eye
diseases caused by Demodex ( ) and their increase in density on the face. The
co-existence of ocular and facial demodicosis requires a simultaneous
therapeutic approach, an ophthalmologist and dermatologist collaboration, in
order to reduce the infestation below a certain pathological threshold and
reduce recurrences.
The study was carried out in the Obstetrics-Gynecology II clinic on a group of 120 pregnant patients with dental problems (dental cavities, post-extraction edentulousness). The socio-economic and educational factors, age and parity of these female patients and the fetal birth weight were analysed.
The material was extracted from the observation sheets of the patients and from the birth registers.
It was observed that patients with a low socio-economic and educational level were generally associated with serious dental problems and the birth weights of the babies of these patients were significantly lower than the normal median.
Keywords: pregnancy, dental problems, intrauterine growth restriction, labor, premature birth;
Infection with SARS-CoV-2 virus in children has raised diagnostic problems due to the variability of the clinical picture – from asymptomatic forms to clinical picture of relapse infection, or forms with gastrointestinal manifestations from the onset or during the evolution of the disease. Co-infection with enteric viruses was a challenge in the diagnosis approach, fever, vomiting, and diarrheal stools being a frequent pathology in children and infants.
Objectives: The
authors present the results of a retrospective clinical study aimed to analyze
patients diagnosed with acute viral enterocolitis during the COVID-19 pandemic,
identifying clinical peculiarities, etiological diagnosis, association with
SARS-CoV-2 infection, over a period of 3 months, from January to March 2022, within the Department of
Pediatrics from Constanta Clinical Emergency Hospital.
Material and
method: The study includes 23
patients diagnosed with acute viral enterocolitis confirmed
etiologically (Rotavirus, Adenovirus, Norovirus) and SARS-CoV-2 infection,
selected on the basis of the diagnosis upon discharge, studying the observation
sheets within the hospital archive. The method consisted of the analysis of
demographic, clinical and paraclinical parameters, viral antigens from stools,
serology, or rapid antigenic test for SARS-CoV-2.
Results and
discussions: Patients diagnosed with enteric co-infection viruses and
SARS-CoV-2 represented 0.015% of all patients admitted to the clinic. The sex
ratio was M:F was 14:9 and the
average age was 2.2 years.
The main clinical manifestations associated with diarrheal stools were prolonged fever in 11 patients,
vomiting in 20 patients, coughing in 10 patients, signs of acute dehydration of
varying degrees in all patients.
The determination
of viral antigens in stools identified Rotavirus in 19 cases, Adenovirus in 2
cases and Norovirus in 2 patients,
and SARS-CoV-2 infection was confirmed by rapid antigen test in 2 cases and
by Real-time polymerase chain
reaction (RT-PCR) in 21 patients.
Conclusions: The performed study analyzed the incidence and epidemiological characteristics of acute viral enterocolitis during the pandemic, in cold season, co-infection with the new coronavirus, causing problems with differential diagnosis.
Keywords:
enterocolitis, SARS-CoV-2 infection, Rotavirus, Adenovirus, Norovirus, infant,
children
Introduction: Chickenpox is an infectious and contagious disease caused by the Varicella-Zoster virus and can occur at any age in people not previously immunized by the disease or by vaccination. Most cases of chickenpox occur in childhood, in children aged between 5 and 10 years. Chickenpox usually has a mild clinical expression, but in some cases multiple and severe complications can occur.
Case presentation: 2-year-old child, without known personal pathological antecedents, presents to the Infectious Diseases Clinical Hospital in Constanta for: fever (maximum 40°C), generalized rash, productive cough, dysphagia, inappetence. Clinical examination revealed general condition, feverishness, waxed facies, Filatov's mask, congestive pharynx, and tonsils, generalized rash, crusted rash with several elements showing purulent discharge. Laboratory changes: significant leukocytosis with neutrophilia and lymphocytosis, anemia, secondary biological inflammatory syndrome, increased lactatdehydrogenasis, increased procalcitonin. Pharyngeal exudate: presence of group A beta hemolytic Streptococcus. Chest CT: bilateral pulmonary interstitial changes. Abdominal ultrasound: significant hepatomegaly.
Management and results: treatment was instituted according to protocol with antiviral (Acyclovir), antibiotic (Cefort in combination with Gentamicin), antipyretics, antihistamines, probiotics and intravenous hydro-electrolytic rebalancing. At 48 hours, the child's general condition changes, becoming drowsy, apathetic, with unsteady gait and photophobia. Lumbar puncture is performed: CSF clear, hypertensive with 34 elements/mm3. Associated with steroidal anti-inflammatory and brain depleting treatment. In dynamics he presents pain at the level of the left supraclavicular fossa, with suspicion of subcutaneous abscess, reason why it is decided to substitute antibiotic therapy with Vancomycin and Meronem. The evolution of the child was favorable, with remission of neurological symptoms, with generalized flaking of the rash, good general condition, without fever.
Conclusions: Although most of the time the manifestations of this virus are limited, there are situations in which important complications may occur, therefore prompt management is decisive. One of the methods to prevent these consequences may be vaccination against Varicella-Zoster Virus.
Key words: Varicella, Scarlet fever, encephalitis, child
Introduction:
TB/HIV co-infection is an important public health problem with specific
diagnostic and treatment features. HIV infection causes changes in the clinical
but also in the epidemiological data of tuberculosis. TB and HIV act
simultaneously, accelerating the decline of immune function and increasing the
risk of death. HIV infection increases the risk of progression from latent to
active TB.
Case
report: Patient aged 44, smoker, from personal pathological antecedents we note
that the patient worked in West Africa, and was diagnosed and treated for
malaria 6 years ago. The onset of symptoms occurred 6 months before with fever,
chills, weight loss, productive cough, with a period of lull and recurrence of
symptoms in the last 2 months with fever, inconstant cough, significant right
hemithorax pain, which is why he presented in a secondary hospital, where a
chest CT scan was performed, which showed an imprecisely delimited
inhomogeneous pneumonic opacity located at the base of the right lung field and
involving the cardiophrenic and costodiaphragmatic sinus on the same side.
The
patient was diagnosed with SARS CoV2 infection a month ago. HE was transferred
from the secondary to a tertiary hospital.
Based on anamnestic and imaging data, the diagnosis of left inferior
lobe abcessed pneumonia, oropharyngeal candidiasis, prolonged febrile syndrome,
and newly HIV diagnose was made.
In our
clinic, general examination reveals altered general condition, weight loss,
oral and esophageal candidiasis, pulmonary tightened vesicular murmur, right
basal subcrespitant rales, rhythmic tachycardic heart sounds, elevated blood
pressure values, mobile, supple abdomen with hepatosplenomegaly, loose renal
lochia, no signs of meningeal irritation.
From
laboratory investigations we retain severe immunosuppression (CD4 5 cells/mm3),
detectable HIV-RNA (50,900 copies/ml), elevated level of fibrinogen (725
mg/dl), CRP (24mg/dl), ESR (74mm/1hour), Ag. SARS COV 2 positive, RT PCR
influenza virus negative, antibody for HIV positive.
Antibiotic
treatment was initiated according to Carmeli score with carbapenem and
linezolid. We associated antifungal therapy, low dose pain therapy
anti-inflammatory, symptomatic, and metabolic support. We established the
diagnosis of pulmonary TB, and secondary Fowler's cavity lesion with thick
cavity wall. Tuberculostatic treatment was initiated.
Also
multiplex panel for pneumoniae evidenced H. influenzae, and we continue
antibiotic therapy associated with tuberculostatic treatment, and PCP
prophylaxis. After 3 weeks of tuberculostatic treatment was initiated also
antiretroviral therapy.
Evolution
during hospitalization was favorable, the patient was discharged with good
general condition, cardio-respiratory balance, with maintenance of
tuberculostatic therapy, and continuation of antiretroviral therapy.
Conclusion:
HIV and Mycobacterium tuberculosis coinfection is characterized by significant
immunosuppression and high levels of viral replication. Ongoing screening for
symptoms suggestive of TB is necessary in severely immunosuppressed patients
for early identification of TB and initiation of prophylaxis.
Keywords:
Mycobacterium tuberculosis, HIV, latent TB, Fowler cavitary lesion.
Background: The diarrheal disease produced by Clostridium Difficile (C. diff) in the case of elderly, immunodepressed patients, with severe comorbidities or in the case of patients admitted to the intensive care wards, have a clinical symptoms that can vary from mild forms to life-threatening forms and who have an increased risk of recurrence. It is estimated that up to 70% of children under the age of 2 years are colonized asymptomatically with C. diff. Infants and children under 2 years of age remain asymptomatic due to the lack of cellular receptors for toxins and the inhibition of the binding of toxins at the level of cellular receptors, due to the Imunoglobuline in breast milk. So, testing in infants and children under 2 years of age is not recommended.
Case presentations: We present two cases of acute enterocolitis with C. diff in children, both presenting favorable factors for the disease.
The first case is a 7-year-old female patient, known in recent history with SARS CoV-2 infection, who was hospitalized and for which he underwent antibiotic treatment and who is hospitalized in our clinic with the diagnosis of acute enterocolitis with C. diff associated with acute syndrom of dehydration, presenting for about 5 days fever and diarrheal stools with mucus and blood streaks. The patient has a changed general condition, pale skin, dry lips, saburral tongue, sensitive abdomen diffuse spontaneously and on deep palpation, balanced respiratory and cardio-circulatory, hepato-renal and temporospatial oriented. The clinical-biological investigations carried out at the time of hospitalization: rapid test C. diff positive for GDH and toxin A, cultures from stools without increased microbial cultures, inflammatory syndrome. Treatment was performed with Vancomycin per os, intravenous hydro-electrolytic rebalancing and symptomatic support, with favorable evolution during the hospitalization and at the time of discharge.
The second patient, 9 years old, female, is admitted to our clinic, presenting fever and dysphagia, symptoms that started 7 days before admission and for which she received oral antibiotic treatment for 8 days, subsequently appearing diarrheal stools. The patient had an affected general condition, hyperemic pharynx, pulmonary steatacoustic without changes, depressible abdomen, sensitive to palpation, balanced cardio-pulmonary. The biological investigations carried out at admission showed: leukocytosis with neutrophilia, inflammatory syndrom, rapid C. diff test positive for GDH, toxin A and toxin B, stool cultures without increased any microbial germs. Under the treatment administered with Vancomycin per os, intravenous infusion for hydro-electrolytic and metabolic rebalancing and symptomatic support, the evolution was favorable, with remission of the digestive symptoms.
Conclusion: It can be considered that the infection with C. diff in children has a fast and favorable prognosis, without the appearance of life-threatening complications.
Keywords: children, acute enterocolitis, Clostridium difficile
Introduction: Influenza (flu) is a highly contagious viral respiratory illness occurring in annual outbreaks, usually during the winter season. The most common complications in children are primary viral or secondary bacterial pneumonia, rare but potentially devastating complications include myalgia with elevated creatinine kinase, Guillain–Barré syndrome and Reye's syndrome. Encephalitis/encephalopathy can also occur, with >80% of cases of influenza-associated encephalitis/encephalopathy occurring in children less than 5 years of age, often with severe resulting morbidity or even mortality.
Material and method: We conducted a prospective study during the cold season, from December 2022 to February 2023, in which children diagnosed with influenza were included. The diagnosis of influenza was based on epidemiological, clinical and paraclinical criteria.
Results: During the mentioned period the total number of cases was 169 patients. The distribution by age category was as follows: 1-3 years 85 cases, 4-7 years 60 cases, 8-10 years 18 cases and over the age of 10 there were 6 cases. Distribution according to the environment of origin were 50 patients from the rural environment and 119 from the urban environment. The symptoms varied, patients presenting fever, respiratory symptoms, such as cough, dysphagia, dysphonia, in 47 (27.81%) of patients, digestive manifestations in 62 (36.68%) of patients and myalgia in 5 (2.95%) of patients. The most common complications were pneumonia in 54 (31.95%) of cases, myositis in 5 (2.95%), and 2 (1.18%) patients presented with coinfection with both influenza and COVID-19. All patients benefited from antiviral treatment with oseltamivir, in some cases corticosteroids, also antipyretics, and other symptomatic treatment.
Conclusions: Although the evolution under treatment was favorable, the patients being discharged after approximately 3-5 days of hospitalization, in order to prevent illness and the occurrence of complications, with extention of hospitalization, it would be recommended to vaccinate children against influenza. No patient included in our study was vaccinated.
Introduction. Pulmonary
tuberculosis (PTB) with sensitive or resistant TB bacilli is frequently delayed
diagnosed because of insidious respiratory symptoms. Joint pain is ussually
reported in tuberculosis (TB) ill treated patients, after antituberculous
therapy is administered, if pyrazinamide or fluoroquinolone, or both of them
are included, but data are lacking in the onset of TB, especially in patients
with extensively drugresistant (XDR) forms of TB.
Case report. A case of a 56 year-old nonsmoker women,
with a lack of respiratory symptoms but a very intense joint pain in her right
shoulder, was found with 2 cavitary lesions in the right upper lobe after Chest
X-ray was performed. CT scan revealed 2 escavated lessions of 2 cm in diameter,
one with spiculations, associated bronchiectasis, pericarditis and apical
bilateral pachypleuritis. The patient had no acromioclavicular joint
disability, normal rheumatoid factor, no increased values of inflammatory
tests. Although bacteriological exam for Mycobacterium tuberculosis was
initially negative by Ziehl Neelsen microscopical exam, GeneXpert, Bactec MGIT
960 of sputum, in 28th of November, 2022, associating indeterminate
QuantiFERON-TB test, antituberculous treatment was started. After 2 months of
first standard regimen of therapy, in 17th of January, 2023, sputum
collection was repeated and Xpert MTB/XDR genetic test revealed XDR-TB.
Disscusions. Osteoarticular
localization of TB disease is a more rare involvement than pulmonary TB and is
a cause of joint pain. Peripheral localization of an upper lung cancer can
induce a painful shoulder. PTB can rarely have extrapulmonary manifestations,
but acromioclavicular joint pain is not a common manifestation for suspecting
PTB.
Conclusions. Imagistic
investigations were mandatory for PTB versus LC. Xpert MTB/XDR genetic test was
useful for a new case of XDR-TB detection. Delayed diagnosis of a limited form
of XDR-TB was facilitated by a new molecular test in a patient with
extrapulmonary manifestations of acute painful onset, consisting in right
painful shoulder, without joint disability, without loss in weight, sweats or
any respiratory symptoms.
*Acknowlegdments This work is supported
by the project PROINVENT in the framework of Human Resources Development
Operational Program 2014-2020, financed from the European Social Fund under the
contract number 62487/03.06.2022 POCU 993/6/13/ – Cod SMIS: 153299
Introduction. Acute leukemia is a malignant condition, found in the spectrum of hematologic pathology in children, with complex clinical manifestations, which are of interest for the onset of the disease and evolution.
Objectives. The objective of the study was to describe the clinical manifestations of leukemias, by age groups and subgroups, type of onset, evolution, and the peculiarities of cases. The main objectives were represented by the detection of patients with the diagnosis of acute leukemia, onset of the disease, personal history of patients with acute lymphoblastic and myeloblastic leukemia.
Materials And Methods. The retrospective study was performed on a group of 15 patients, with the diagnosis of acute leukemia, for a period of 5 years, from January 2017 until December 2021, at Pediatrics Department of Constanta County Emergency Clinical Hospital. The medical history of the patients was studied, according to a protocol that included demographic data, personal history, living conditions, clinical manifestations, laboratory results, type of leukemia, type of onset, association with other pathologies and the evolution of patients.
Results. An increased incidence was observed in males (80% of cases), in preschoolers at range of 3-6 years (67% of cases). In the studied group a patient showed malignant proliferation in family medical history. Personal pathological history has revealed an association with respiratory infections and other pathologies such as HIV and epilepsy. It has been observed that 60% of cases are from urban areas, the influence of environmental factors and pollution being suggested. Clinical manifestations at the onset of the disease were represented by pallor and fatiguability in 80% of cases, followed by adenopathy and hepatosplenomegaly (58%), fever and bone pain (33%), on the other hand being found a low incidence of hemorrhagic manifestations and weight loss (27% of cases). Laboratory results revealed the presence of blast cells in the marrow and peripheral blood, the blood count showing anemia (80% of cases), thrombocytopenia (73% of cases) and leukocytosis (53% of cases). Increased value of lactate dehydrogenase (LDH) is an unfavorable prognosis marker. Acute lymphoblastic leukemia with B-lymphocytes was encountered in 93% of cases. In terms of type of onset, the insidious onset was present in 73% of cases, followed by the acute type and the atypical onset. The association with other conditions such as HIV and tuberculosis was found in 4 cases of the studied group. The study revealed a mortality rate of 13%.
Conclusions. Acute leukemias are an entity relatively rare in pediatric pathology, frequently having insidious onset, with atypical clinical manifestations, being a challenge for clinicians. The new therapies significantly reduced the mortality rate and the interdisciplinary approach improved disease management and increased the long-term quality of life of the pediatric patient.
Introduction. The dermatological pathology of the child continues to represent a current topic, being of interest both in the domain of pediatrics and dermatology.
Objectives. The objective of the study was represented by highlighting the characteristics of the most common dermatological diseases encountered in pediatric practice, in infants and toddlers.
Materials And Methods. The paper represents a retrospective study conducted in the Pediatrics Department of Constanta County Clinical Emergency Hospital, between January 1, 2020 and January 1, 2021, on a number of 185 patients, in infants and toddlers, aged between 0-3 years. During the study, out of the total of 3500 patients admitted, 185 were diagnosed with a dermatological disease. Information from the patients observation sheets was used to conduct this study.
Results. Dermatological diseases were more common in the age group 0-1 year (59% of cases), twice as high as the rest of the age groups. It was observed that most patients were from rural areas. No significant difference was found in the sex of the patients. In the analyzed group, 37.8% of the cases come from poor socio-economic backgrounds. In most cases, children are brought to the medical unit for a digestive or respiratory condition, the skin pathology being most often neglected by the parents. Age group 0-1 years represented 58.9% of cases, group 1-2 years was 24.6% and group 2-3 years represented 16.5%. In the age group 0-1 years the most common dermatological diseases are represented by skin diseases produced by alteration of reactivity (urticaria) and eczematous dermatitis (atopic dermatitis, contact dermatitis, diaper dermatitis, seborrheic dermatitis), followed by bacterial infections (staphylococcal impetigo, intertrigo, cellulitis, pyodermatitis), viral infections (nasolabial herpes, aphthous stomatitis, herpangina), fungal infections (candidiasis) and parasitic infections (pediculosis, scabies).
Conclusions. The dermatological pathology of the child is frequent and includes multiple entities determined by various etiologies, produced both by altered reactivity and by bacterial, viral, parasitic, and fungal infections.
Introduction: Variations of an organ represent the structural, anatomical, or developmental differences that it presents, but which do not have a clinical impact or take on mild clinical forms. In the case of the ureters, these variations are found in length, caliber, trajectory, insertion, and number.
These variations can have genetic causes or can be determined by environmental factors that disrupt the evolution of the metanephric mesenchyme. The most common variations are found as differences in sex, age, or height.
Other causes include vesicoureteral reflux, obstruction of the ureteropelvic junction, pelvic tumor masses, some surgical procedures (urinary tract reconstruction, kidney transplantation), prolonged exposure to toxic substances, radiation, or certain medications
The variations of the ureters include differences in number, trajectory, and insertion. Ureters may be singular or duplicated, and they may have different trajectories, such as a sinuous or angular course. Variations in insertion include a distal insertion close to the urethral sphincter or a posterior insertion, which can lead to urine reflux. Treatment options depend on the severity and type of variation and may include medication, drainage, or surgery. Diagnosis can be made through methods such as X-ray, ultrasound, or retrograde ureterography.
Ureter variations are rare anatomical variants, with some being congenital and others having a postnatal cause. This variants have been documented by some big names in anatomy, like: K.L. Moore, L. Testute, F. Netter, H. Gray, Emil Palade and Victor Papilian.
Introduction: Concha bullosa, known
as middle nasal concha pneumatization is a common finding and even it is
asociated with nasal septum deviation, has a small clinical importance. In the
literature, a pneumatization of the middle nasal turbinate- so called- concha
bullosa- has been observed most often.
Clinical presentation: In the vast
majority of cases, these variants are asymptomatic. Although some studies have
suggested a relationship between a concha bullosa and sinusitis, this is
probably not the case, the incidence of sinusitis being similar in patients
with or without concha (1). Concha bullosa is associated with deviation of the
nasal septum, which was itself in some studies associated with an increase in
the incidence of sinus disease (1, 5).
Material and method: A number of 152
cases have been studied using cranio-cerebral computer tomography, on a
Revolution Evo 128 .sl Gen 3 CT device.
Clinical findings: The study was
conducted on the number of 152 cases. Of these, 51 subjects had pneumatized the
middle nasal cornea (27 of the patients were male and 24 female).
Out of the total
number of cases studied:
-
lamellar type - was found in 20 of subjects (39,22%) from
the cases of concha bullosa studied. Out of the total cases of unilateral
concha bullosa, 4 subjects (80%) associated the deviation of the nasal septum.
-
bulbous type - was found in 19 subjects (37,25%) of the studied
cases. Of these, about 14 subjects (73.68%) associated nasal septum deviation.
-
the extended type - was found in 12 subjects (23,53%).
Out of the total
studied cases, at the time of presentation - only 16 subjects (31,3%) had
associated sinusitis and in 3 cases (18,75%) the complete obstruction of the
ostio-meatal ipsilateral complex is associated.
In this study, the
maxillary sinus was the most common sinusitis location, followed by the ethmoid
sinuses and the frontal one.
Conclusions and discussions: In our study we
didn’t find a direct causal link between the pneumatization of the middle nasal
concha and the appearance of sinusitis, thus considering that the discovery of
pneumatization of the middle nasal cornet is accidental.
However, there is opposite
deviation of the nasal septum in cases of unilateral pneumatization of the
middle nasal turbinate, an aspect especially found in patients who had the
bulbous type. Since most cases are asymptomatic and the relationship between a
concha bullosa and sinusitis is controversial, in general, no treatment is
required.