Archive issue


Current Health Sciences Journal

vol. 44 no. 3, 2018

1. Histopathological Prognostic Factors in Clear Cell Renal Cell Carcinoma

B.C. ANDREIANA, A.E. STEPAN, C. MARGARITESCU, A-M. AL KHATIB, M.M. FLORESCU, R.N. CIUREA, C.E. SIMIONESCU

Clear cell renal cell carcinoma (CCRCC) are the most frequent type of renal cell carcinoma. Fuhrman grade and tumor stage are prognostic factors with great importance in survival rate. This study was performed on 75 cases of CCRCC diagnosed by the Anatomical Pathology Laboratory of the County Clinical Emergency Hospital of Craiova between 2014 and 2017. The biological material was represented by pieces of nephrectomy. The cases were analyzed on two criteria: epidemiology (age, sex) and histopathology (Fuhrman grade, tumor stage, architectural pattern, sarcomatoid transformation, and necrosis). Statistical analysis was done using Chi Square tests in IBM SPSS software. Average diagnosis age of CCRCC was 58.8±10.2 years, predominantly in male patients (66.7%). Tumor sizes were between 2 and 14cm, with an average of 6.7±2.9cm. Most cases were determined to be tumor stage III (60%) and Fuhrman grade 2 (56%), followed, in order of frequency, by tumor stages I and II (28% and 10.7%) and Fuhrman grades 3 and 1 (21.3% and 20%). High Fuhrman grade CCRCC were significantly associated with advanced tumor stage (p<0.05, χ2 test). Most cases presented a mixed pattern, significantly associated with advanced tumor stages (p<0.05, χ2 test). Even though the presence of sarcomatoid transformation was more frequent in advanced tumor stages, it wasn’t significantly linked to them (p<0.05, χ2 test). Conclusions: Analyzed histopathological parameters are useful for determining CCRCC aggressiveness. CCRCC in advanced tumor stages is associated with high Fuhrman grade and mixed architectural pattern.

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2. Noninvasive Fibrosis Assessment in Chronic Viral Hepatitis C associated with End Stage Renal Disease

D.C. CARAGEA, B.S. UNGUREANU, D.N. FLORESCU, P. POPA, M.V. SACERDOTIANU, D.I. GHEONEA, C.C. VERE

Introduction. HCV is considered the most encountered viral infection that affect patients after hemodialysis sessions. Even though liver biopsy is considered the golden standard for hepatic diagnosis, additional methods have been used for assessing liver fibrosis. Transient elastography (TE) has evolved as a reference method in some European countries and allows the physician to carry out a fibrosis evaluation in a noninvasive, low-cost and rapid method. Our objective was to assess the efficacy of TE in staging patients with HCV liver disease associated with ESRD, thus choosing the correct moment to perform the procedure. Materials and Methods. We included 34 patients known with ESRD within the regional Nephrology Clinic of Olt County Hospital and also having positive hepatitis C viral liver marker. TE was performed before and hemodialysis and data was analyzed. Results. The patients where we have encountered significant changes were especially within the F0 and F1 stage with a decrease of fibrosis after hemodialysis. Thus, 7 patients which had no fibrosis (F0) went from 4,14±0,98kPa to 3,54±0,84 (p<0,05) and 12 patients from the F1 stage went from 6,22±0,39kPa to 5,47±0,58kPa. The other stages had no significant changes with F2 changing after hemodialysis from 8.03±0,62kPa to 7,76±0,6kPa. Conclusions. TE represents a valuable tool for stiffness assessment and should be taken into considerations as a major option for ESRD patients with liver disease. However, more patients should be enrolled to strengthen this theory and thus providing more reliable results.

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3. Epidemiological and Histopathological Aspects of Tongue Squamous Cell Carcinomas-Retrospective Study

F.I.I. CIUCA , P.C. MARASESCU, M. MATEI, A.M. FLORESCU, C. MARGARITESCU, S.M.S. PETRESCU, C.I. DUMITRESCU

Tongue squamous cell carcinoma is one of the most commonly diagnosed intraoral squamous cell carcinomas (25-40%), being considered an aggressive form of squamous cell carcinoma, as it is most commonly associated with lymph node metastases and the survival rate at five years is below 50%. In according with these data, we have proposed in this study to individualize an epidemiological and histopathological profile of the patients with such oral cancers, diagnosed and treated in the Oral and Maxillofacial Surgery Clinic and in the Otolaryngology Surgery Clinic of the Emergency Clinical County Hospital Craiova, between 2015-2017. The cases were histopathologically reassessed according to the latest WHO classification of head and neck tumors, the variables of interest being the age of the patients, the gender, the lesion topography, the histological subtype, the degree of tumor differentiation, the pTNM stage, the resection margin status and the Brandwein-Gensler prognostic score. Thus, we recorded an average age of 55.81±14.98 tongue cancer development, 65% of the casuistry being diagnosed during the 7th and 6th decades, with a slight prevalence in men, with development in two thirds of cases in the mobile portion of the tongue. Histopathologically, conventional forms of squamous cell carcinoma prevailed (53.7%), followed by varieties: acantholytic (26%), basaloid (13%), sarcomatoid (5.45%) and verrucous (1.85%). Moderate differentiated forms prevailed (44.44%), half of the cases falling within the moderate degree of Brandwein-Gensler's histological risk score and two thirds were diagnosed in pTNM stage II and III of the disease, and a quarter of the cases having the margins invaded.

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4. Study of Histopatological Parameters of Gastric Carcinomas with Micropapillary Component

M. DOBRITOIU, A.E. STEPAN, C.C. VERE, I. CATARAGA, C.E. SIMIONESCU

Micropapillary carcinoma was recently identified as a carcinoma variant characterized by the presence of small clusters of tumor cells located in optically empty spaces. The study included a number of 14 cases represented by surgical excision specimens diagnosed with gastric carcinoma (tubular, papillary and signet-ring) which associated the micropapillary component in variable proportions. Regarding the low-grade tubular carcinomas, the micropapillary component represented less than 25% of the tumor, while in the high-grade tubular carcinomas and papillary carcinomas it represented 25-50%. Among signet-ring carcinomas, the micropapillary component had a percentage of over 50. The depth of invasion was frequently associated with T3 and T4 categories. Lymph nodes metastasis were found in ten cases and distant metastasis were present in three cases. Recognition of the micropapillary component associated with gastric carcinoma represents an aspect of great importance because it is frequently correlated with unfavorable prognosis parameters.

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5. Pancreatic Head Carcinoma-Implications and Correlations in a Romanian Population

L.M. FLORESCU, I.A. GHEONEA, A.M. LAPADAT, M.M. FLORESCU, A. FLORESCU, T. CIUREA

Introduction: Pancreatic cancers are often an aggressive type of malignancy, with a 5-year survival rate estimated at around 5%. The main purpose of our study was to determine whether or not tumor dimensions influence the presence of jaundice and the diameters of the CBD and Wirsung duct. Material and methods: The study group included 32 patients (19 males, 13 females) diagnosed with various histological types of pancreatic head cancers who were hospitalized in the Surgery Department of the County Clinical Emergency Hospital of Craiova during 2016-2018. All 32 patients underwent an initial abdominal ultrasonography (US), followed by an abdominal computed tomography (CT) scan and an abdominal magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) sequences. Results: Based on tumor dimensions, 19 (59.38%) were equal to or larger than 30mm, while 13 (40.62%) were smaller than 30mm. The average age of male patients was 65.15 years, while the average age of female patients was 60.07 years. Tumor dimensions ranged between 22mm and 52mm (33.53mm on average). Furthermore, the diameter of the CBD ranged from 5mm to 20mm (13.40mm on average), while the diameter of the Wirsung duct ranged from 3mm to 12mm (5.75 mm on average). Conclusion: In conclusion, our study reached its’ initial purpose and revealed a significant association between the tumor dimensions and the diameter of the Wirsung duct and also between the diameter of the CBD and the presence of jaundice.

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6. Treatment of Lower Limbs Telangiectasias with Nd: Yag Laser-Prospective Study on 446 Patients

N.G. IANOSI, M.X. CALBUREANU-POPESCU, L. DRAGUSIN, S.L. IANOSI, C.V. TUTUNARU, C.D. NEAGOE

In the last two decades Nd: YAG laser has become a standard of treatment of telangiectasias of the lower limbs in C1EAP stage of chronic venous insufficiency. This paper shows the results of a two years study period of telangiectasias of lower limbs with Nd: YAG laser conducted in a specialised centre in this type of procedures. The study group consisted of 446 patients (21 males and 425 females) with telangiectasias (C1EAP) on the lower limbs between January 2016-December 2017. The patients had to complete a form in which they noted the initial state on a scale from 1 to 10 but also the result of the treatment and the intensity of the pain during the laser treatment. Moreover, the doctor also evaluated the results of the treatment for each and every patient taking also into account the initial phase of the disease. We observed a significant improvement of the clinical appearance (the reduction of telangiectasias) almost in the entire study group, regardless of the gender and the age, but the intensity of the pain was higher in men and in persons under the age of 30. Based on these data we can conclude that Nd: YAG laser represents a minimally invasive therapeutic option with minor side effects and major aesthetic results and furthermore it can be combined with several other methods (microsclerotherapy, radiofrequency, complex surgery) in order to improve peripheral chronic venous insufficiency.

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7. Histopathological Aspects of the Myocardium in Dilated Cardiomyopathy

R. MITRUT, A.E. STEPAN, D. PIRICI

Dilated cardiomyopathy is the most common form of cardiac muscle disease, accounting for approximately 60% of all cardiomyopathies. We proposed to identify histopathological changes of the myocardium in dilative cardiomyopathy. This study comprised a total of 19 cases, represented by myocardial fragments from deceased patients with diagnosis of dilated cardiomyopathy. Histopathological analysis allowed changes to be observed for both myocytes and myocardial interstitial components. We have found a combination of hypertrophic, atrophic and normal myocardocytes, or associated with the presence of hydropic changes. We rarely identified the aspect of myocytosis, cytoplasmic accumulation of lipofuscin pigment or mucinous material, and variable nuclear pleomorphism. At the interstitial level we noticed changes in fibrosis, lipomatosis and rarely the presence of inflammatory infiltrate. Histopathological characteristics of the myocardium in dilated cardiomyopathy are numerous but nonspecific, similar to those in the terminal stages of other cardiac diseases.

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8. Clinical-Morphological Aspects in Spinal Tuberculosis

I. PROCOPIE, E.L. POPESCU, R.M. PLESEA, M. DOROBANTU, R.F. MURESAN, C.V. LUPASCU-URSULESCU, I.E. PLESEA, D.N. ANUSCA

Osteoarticular tuberculosis (OATB) Aim: The authors made a clinical morphological assessment of tissue samples from patients admitted in Surgical Departments of the Emergency County Hospital of Craiova, Romania, between 1990 and 2015, proved as presenting tuberculous lesions of the spine in the Department of Pathology of the same Hospital. Materials and Methods: The studied material consisted of bone, joint and sometimes muscle tissue fragments resulted from biopsies or surgical excisions from 7 cases coming out of 54 patients investigated in the above-mentioned period of time, where the established histological diagnosis was tuberculosis (TB). For diagnostic confirmation, Ziehl-Neelsen staining has been used as a rule but, in some cases, immunohistochemistry was also used. Results: TB lesions have prevailed in men and around the age of 50 years. Thoracic segment of the spine was the most involved. Epithelioid and giant Langhans cells dominated the inflammatory cellular population. Necrosis was always present, usually in its classical acidophilic form. Fibrosis was almost always absent. On the whole, the granulomatous reaction was in almost half of the cases hyporeactive and disorganized. Conclusions: The clinical morphological profile of our series is fitting with data described in the literature. Because of its life threatening potential, spinal TB should be investigated thoroughly especially in its morphological features in order to obtain as quickly as possible an etiological diagnosis.

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9. A Simple Method of Calculation in Excel the Protein Requirements in Preterm New Borns

E.C. STOICANESCU, F. POPESCU, A. ZAVATE

Introduction: The nutritional balance between the nutritional requirements of the organism and the intake is a very delicate thing to adjust especially when it comes to the premature new-born in whom often the oral feeding is very challenging and the need for parenteral feeding is very pressing. Purpose: The goal of this article is to present a simple method of calculation for the amino acid parenteral intake in preterm infants using the Excel spreadsheet platform as a platform. Material and Method: Using Excel commands, we translate the algorithms for the protein requirements calculation into an electronic format. This will allow the creation of a template that quickly identifies the need for proteins according to the clinical and evolutional features of the premature new-born, significantly reducing the duration of the calculation. Results: This method is easy to perform, simple and efficient. The calculation template has significantly reduced the errors and the actual working time with the algorithms. These effects are very obvious in intensive care units that take care of a large number of premature babies. Conclusions: Computerized calculation allows a decrease in calculation errors and also reduces the time actually allocated for the calculation, especially for the very complicated algorithms. Following this template in Excel, we can create separate modules for the algorithms necessary to calculate the needs for the intake of liquids, calories, lipids, and minerals.

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10. Prediction of Post Operative Complication in Patients with Valvular Heart Surgery Based on O2 Challenge Test and A-A Gradient

H.A. SADEGHI, S. SADEGHI, B. GHADRDOOST

Patients with valvular heart diseases may have more physiological lung derangements and therefore at current study we studied correlation of O2 challenge, A-AG tests and spirometry values of patients who underwent valve surgery on post op respiratory complications. Method: 180 adult patients undergoing non-emergency cardiac valvular surgery were studied. On operating room all patients had arterial blood gas profile (ABG) at room air, 20 minutes after putting on ventilator with 100% O2, and pump oxygenator. Pulmonary function tests, alveolar Oxygen Pressure, mean Arterial pressure of carbon dioxide and alveolar-arterial gradients measured. Results: FEV1, FVC and FEV1/FVC%, pressure of arterial Blood Gasses (O2 and CO2) with fraction of inspired oxygen of 100% and air (PO2-100 and PO2-air), were significantly different between patients with POPC and patients without POPC (p-value <0.05). Indeed PO2-100 and PO2-air were significantly lower in patients with POPC. A-AG100 (p-value: 0.02) and A-AG21 (p-value: 0.02) were significantly higher in patients with POPC in comparison with patients without POPC. The AUC of A-AG100 for predicting POPC was 0.59 (95% confidence interval (CI) 0.51-0.67). The optimal cut point of A-AG100 was 311 and showed evidence of high relatively sensitivity of 80% and a negative predictive value of 61%. Conclusion: Valvular heart surgery still has significant post op complication and mortality. There is significant correlation between A-AG100, A-AG21 percent, PaO2100, and FEV1/FVC with post op complications in these patients. We recommend measurement of these values in pre op evaluation of patient who need cardiac surgery.

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11. Q-T Interval Prolongation in Patients with Liver Cirrhosis

E. TIERANU, I. DONOIU, O. ISTRATOAIE, A.E. GAMAN, L.M. TIERANU, D.I. GHEONEA, T. CIUREA

Liver cirrhosis (LC) is the end stage of chronic liver disease characterized by the appearance of extensive fibrosis and regeneration nodes associated with hepatocyte necrosis in liver but also by the reshuffling of hepatic architecture. The triad consisting of hepatic parenchymal necrosis, regeneration and scarring is always present regardless of the type of clinical manifestation. The Child-Pugh-Turcotte classification dates back more than 30 years and has been widely used in diagnosing and assessing the severity of liver cirrhosis. This is preferred due to a low degree of complexity and a good predictive value. Prolongation of the QT interval on the electrocardiogram is common, with a prevalence exceeding 60% in patients with advanced stage of cirrhosis. In these cases, beta blockers and antiarrhythmics should be avoided or used with caution and with close QT interval monitoring. Changes in heart rate and Q-T interval are new entities in cirrhosis complications. A prolonged Q-T interval in chronic liver disease could lead to ventricular arrhythmias and sudden death. There is no report on heart rate and Q-T interval disorders in our area.

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12. Clinical and Histopathological Assessment on an Animal Model with Experimental Autoimmune Encephalomyelitis

L.E. TOADER, G.C. ROSU, B. CATALIN, V. TUDORICA, I. PIRICI, O. TAISESCU, D.F. MURESANU

Multiple sclerosis (MS) is a disease of the Central Nervous System (CNS) which alters over 2 million people, and involves an abnormal autoimmune response directed against the brain, nerves and spinal cord. The antigen or the autoimmune target still remains unknown, a fact for which MS is considered to be an immune mediated disease. The pathology involves mainly the white matter, but the gray matter demyelination plays an important role in its pathogenesis. In 80% of the cases with MS, the disease develops relapses. Experimental autoimmune encephalomyelitis (EAE) is the most used model to study MS and for assessing potential treatments. In the present study we report on the histopathological characterization of an EAE model in C57BL/6 mice immunized by injection with myelin oligodendrocyte glycoprotein, MOG35-55 in complete Freud's adjuvant supplemented with pertussis toxin. On a group of 10 immunized animals and on 5 control animals, we followed the development and grading signs of motor deficiency, and after a survival of 34 days, the study aimed to evaluate the histopathological changes in the telencephalon, brainstem, cervical spinal cord, the optic nerve and retina. We utilized histochemistry, immunohistochemistry, and densitometric image analysis methods to assess myelin loss [Luxol fast blue, immunohistochemistry for the presence of microglia (Iba1) and reactive astrocytes (GFAP)]. Moreover, the study includes a first analysis of the detailed histopathological changes of the optic nerve and retina on an EAE model, all of these as the background for testing drugs with potential therapeutic role in MS.

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13. Therapeutic Options in Pregnant Women with Thrombophilia Depending on the Genetic Mutations-a Prospective Study

J.G. NACEA, I. ROTARU, A.M. PATRASCU, N. CERNEA

The aim is to evaluate the effects of anticoagulant therapy (Enoxaparine) compared to antiaggregant therapy (Aspirin) on pregnancy outcome depending on the mutational status of clotting factors. The study was conducted prospectively over a 2 years period and included 110 pregnant women, of whom 80 patients diagnosed with hereditary thrombophilia and 30 healthy pregnant women, representing the control group. After careful observation, we concluded a positive influence of Enoxaparine on pregnancy outcome in pregnant women homozygous carriers for factor V Leiden gene mutation and compound heterozygous for Factor V Leiden and Prothrombin G20210A gene mutation. The study did not find significant positive results in women with heterozygous Factor V Leiden and G20210A prothrombin gene mutation who received anticoagulant therapy as well as pregnant women who received low-dose Aspirin compared with controls.

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14. Anaplastic Thyroid Carcinoma with Gastric Metastasis

A.A.L. CHAVEZ, P. IYER, I. M. CAZACU, M.E. CABANILLAS, A. RASHID, M.S. BHUTANI

Introduction. Carcinomas of the thyroid gland represent 3% of all malignancies, with 1.3 to 9.8% corresponding to anaplastic thyroid carcinomas (ATC). Metastases are present in 50% of patients when ATC is diagnosed. Gastrointestinal metastases are a rare finding in patients with thyroid carcinoma. Case report. A 68-year old gentleman with a history of papillary thyroid carcinoma (PTC) underwent surgery and radiopharmaceutical therapy. Restaging studies nine months later suggested wall thickening localizing to the distal stomach. Endoscopy results showed a large, infiltrative, subepithelial, and ulcerated gastric mass and biopsies revealed anaplastic thyroid carcinoma Conclusion. Incidental thickening or other findings in the stomach in a patient with ATC without gastrointestinal symptoms should be further investigated with endoscopy and biopsies to rule out gastric metastases from anaplastic thyroid carcinoma.

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15. 3 Tesla Magnetic Resonance Imaging Role in Articular Degenerative Pathology

A.I. COTOI, M.S. DINU, R.E. MEETESCU, A. BONDARI, I.A. GHEONEA

Osteoarthrosis is one of the most common degenerative diseases, affecting most of the middle and advanced age population. It is responsible for joint pain, and reduces mobility to functional impotence, thus becoming a public health problem. It is characterized by the destruction of articular cartilage and bone structures forming joints. Although osteoarthritis is considered a disease that occurs predominantly in the elderly, we present herein the case a young female patient, known for pelvic limb inequality and flat leg with advanced arthrosis in the left ankle, secondary to multiple surgical interventions performed at the lower limb. Because of the degenerative phenomena, the patient had reduced mobility, functional impairment and local pain. For the quantification and therapeutic management of degenerative changes produced by this pathology, magnetic resonance imaging (MRI) exploration technique is recommended, allowing visualization of alterations in bone structures and cartilage. This is the standard diagnosis method due to important details on bone structures and cartilages, even in the early stages of the disease. The importance of this case is suggested by the young age of the patient (28 years old) and the advanced stage of the degenerative phenomenon, being rare at this age.

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16. Squamous Pulmonary Neoplasia Grafted on Lesions of Pulmonary Tuberculosis Sequelae

A. DANCIU, S. BONDARI, M. MUNTEAN, C. TRIFAN, L. RADU, D. BONDARI

Clinical symptoms of hemoptysis, chest pain, dyspnea, night sweats and weight loss seen in a patient known for 14 years with pulmonary tuberculosis with sequelae lesions, will always guide the diagnose to a reactivated pulmonary tuberculosis. Yet, in this case, the latest pulmonary radiography revealed newly emerging bilateral lesions with the appearance of a macronodular opacity of medium intensity, discreetly non-homogeneous, located apical-sub-clavicular on the right side, but also with an apical-sub-clavicular cavity lesion on the left side, well defined, with uniform opaque content, and clear-cut outline. Complementary examinations, computed tomography and biopsy bronchoscopy, confirmed the diagnosis of upper right lobe pulmonary tumor with suspicion of aspergilloma in the upper left lobe.

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17. A Rare Case of Upper Calf Swelling and Necrosis: The Morel-Lavallée Lesion

O. NICA, A. GRECU, E.A. DINCA, D. MARINESCU, M.E. CIUREA

A 31-year-old patient presented in the Emergency Department with a tibial fracture following a car accident that crushed the lower third of his thigh and the proximal and median part of his calf. Tibial fracture fixation with an intramedullary rod, was complicated by a Morel-Lavallée lesion. Sequential debridement procedures were performed with partially successful granulation tissue proliferation under NPWT (Negative-Pressure Wound Therapy). To further promote the already delaying granulation, plastic surgeons opted for PRP/PRF (Platelet Rich Plasma/Platelet Rich Fibrin) which allowed appropriate skin grafting. In our opinion, PRP/PRF should be considered as a viable adjuvant therapy to promote granulation.

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18. Therapy Side Effects in Systemic Lupus Erythematosus

R. POPA, L.A. LAUTARU, R. LUCRETIU, D.C. RUIU, D. CARAGEA, M. OLTEANU, A.R. MIHAILOVICI, C. ENE, V. PADUREANU, R. PADUREANU, V. CIRLIG

Glucosteroids (GS) are widely used drugs for various inflammatory pathologies (Nephrotic syndrome, Proliferative glomerulonephritis, Extramembrane glomerulonephritis, Nephropathy of the Nodous Poliarterita (PAN), Nephropathy from purple Henoch-Schonlein, lupus nephropathy (LN), Acute adrenal insufficiency Waterhouse-Friederichsen, Chronic adrenal insufficiency Addison, Systemic Lupus Erythematosus (SLE), Polymyositis and dermatomyositis, Chronic granulomatosis, Crohn's disease, Hemorrhagic rectocolitis, Hemolytic anemias, Acute leukemias and chronic lymphocytic leukemia, Hodgkin's lymphoma). Although they are prescribed for their anti-inflammatory and immunosuppressive properties, they also have many side effects, hyperglycemia being one of the most common and representative, which is why these drugs need careful monitoring when administered over the long term. This paper presents the case of a 39 year old patient diagnosed with systemic lupus erythematosus (SLE) with class IV lupus nephropathy (LN) who developed numerous complications due to the pathogenic side effects: diabetes, amenorrhea, recurrent infections, and depression.

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19. Therapeutic Particularities with Depot Medications in Schizophrenia

C. SARBU, G.S. BADESCU, A.E. HROMEI, I.D. STANIA

Schizophrenia is a neurodegenerative disease with personality degradation, changes in behavior, cognition, affective disorder and reduced socio-professional insertion. Early diagnosis is necessary and maintenance is ensured by antipsychotic treatment and for non-compliant patients there is an alternative to depot medication that greatly improves therapeutic adherence. The study presents the case of a 43-year-old patient diagnosed with paranoid schizophrenia using the Diagnostic and Statistical Manual of Mental Disorders V-TR criteria that showed a favorable evolution under depot treatment.

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