CHSJ

Archive issue

Current Health Sciences Journal

vol. 45 no. 4, 2019

1. The Importance of HLA-B27 in the Evolution of Reactive Arthritis

S. BANICIOIU-COVEI , A.F. VREJU , A. ROSU , P.L. CIUREA

Reactive arthritis is an inflammatory joint disease which develops after 1-4 weeks following an enteral, genital or ORL infection, with a higher frequency in HLA-B27 positive patients. AIMS: The objective of this paper is to study the importance of HLA-B27 antigen in the development of reactive arthritis. Patients and methods. The transversal, observational study was conducted in the Rheumatology Clinic of the University of Medicine and Pharmacy of Craiova during the period 2012-2015 and included 112 patients. They were divided into three groups, as follows: group I (52 reactive arthritis cases), group II (30 other spondyloarthritis cases), group III (40 osteoarthritis cases). ELISA and PCR techniques were used to determine the antigen. Results. Those whom had this genetic marker present, the number of enthesitis almost doubled highlighting a possible correlation between the antigen and these imaging changes. We can confirm the same thing for the erosions as well. Unlike enthesitis, erosions occurred also in group III (37.5%), but if we refer to the first two groups, we will observe a significant relationship regarding HLA-B27. More specifically, in HLA-B27 positive patients (68.97%), erosions were found to be twice as numerous than in HLA-B27 negative patients (31.03%). In group I we identified stage 2 sacroiliitis in 68% of HLA-B27 positive patients and 32% in HLA-B27 negative, which shows another link to this antigen with both joint destruction and a possible unfavorable evolution of reactive arthritis. Conclusions. This antigen specific to the seronegative group of spondyloarthritis determines the acceleration of articular destruction, translated by erosion, and the evolution of sacroiliitis to a more advanced stage.

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2. Correlations Between Clinicopathological Features and the Vegetative Nervous System in Gastric Cancer

A.M. BALEA , R. CRUCE , R.A. SCHENKER , A.G. IONESCU , L. STREBA , A.M. CIUREA , M.C. GHILUSI , D. PIRICI , C.C. VERE

Gastric cancer currently represents one of the most important public health problems. Recent studies have demonstrated the existence of strong correlations between the vegetative nervous system and the role it plays in the initiation of the oncogenetic process and the progression of cancer. The purpose of this paper is to demonstrate the involvement of the sympathetic and parasympathetic vegetative nervous system in the evolution of gastric cancer, according to the stage of tumor differentiation. In this current paper we have included a number of four patients diagnosed with gastric cancer post UGI (Upper Gastrointestinal Endoscopy) and have analyzed relations that exist between the tumor differentiation degree and the metanephrine and normetanephrine serum level in the blood of the patients. Following the research, we have observed an increased value of the metanephrine and normetanephrine serum level in the patient which displayed the lowest degree of differentiation.

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3. The Treatment of Arterial Hypertension

A.M. BRASOVEANU , R. CRUCE , L. MOGOANTA , V. CARLIG

Arterial hypertension is the leading cause of death worldwide and is one of the most important public health problems. Arterial hypertension is a major cardiovascular risk factor with an increasing incidence. In this paper we set out to analyze a group of 3050 patients hospitalized between January 2013 and December 2017 in terms of drug therapy. We found that the majority of patients received drug treatment with a converting-enzyme inhibitor as a monotherapy, and the most common drug association was the association between conversion enzyme inhibitor and calcium channel blocker.

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4. The Importance of Dermoscopy in Early Recognition of Melanoma in Situ

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

Early recognition of melanoma in situ (MIS) is an ongoing challenge in dermatology. It rarely arises ‘de novo’, most frequently resulting due to the transformation of an atypical nevus. The diagnostic criteria for MIS are diverse dermoscopy being the most used and it has a sensitivity of 83% and a specificity of 69% in detecting melanomas. The main objective of our study was to establish the sensitivity and the specificity of each of the 7-point checklist criteria used to differentiate melanocytic nevi from in situ malignant melanoma. The study group included 200 patients, aged over 18 years, with atypical pigmentary nevi after clinical aspects that presented changes in clinical appearance (shape, color, dimensions) during the last 6 months. On each patient we used the 7-point checklist of Argenziano (C1-C7). The study was performed at the Medical Center Dr. Ianosi, in Craiova between January 2016 and September 2018 and it was used Molemax HD computerized dermatoscope. The C1÷C3 criteria are significantly relevant in establishing the diagnosis of MIS in comparison with the diagnosis of nevus, unlike the C4-C7 criterion that is not definitely relevant for confirmation of the MIS diagnosis. There are no enough specific dermoscopic criteria to differentiate MIS from atypical nevus.

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5. Combination of Olanzapine Pamoate with Melatonin and Metformin: Quantitative Changes in Rat Adipose Tissue

I.C. MIRON , F. POPESCU , V. ENACHESCU , O.M. CRISTEA , E.C. STOICANESCU , E. AMZOIU , M. AMZOIU , F.D. POPESCU

Olanzapine is one of the atypical antipsychotics widely used in the treatment of schizophrenia and has been associated with metabolic changes as adverse effects, including hyperglycemia, dyslipidemia, and weight gain. In a batch of adult female Wistar rats, we studied the prolonged-release intramuscular olanzapine pamoate induced quantitative changes of visceral and subcutaneous adipose tissue. We also assessed the effects of the combinations of olanzapine pamoate with melatonin, metformin, and melatonin plus metformin, administered by gastric gavage. A higher mean weight of the visceral and subcutaneous adipose tissue per animal was noted in the olanzapine pamoate exposed group compared to controls. The association with melatonin, metformin, or the combination of melatonin with metformin attenuated the olanzapine-induced adipose deposit tissue growth. The effect was more pronounced for the combination of olanzapine with melatonin and metformin. Because most of the results were not statistically significant we can deduce that in the chronic experiment, adaptive type modifications of the receptors on which both olanzapine and melatonin act can occur.

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6. Assessment of Histopathological Parameters Useful in the Diagnosis of Low Grade Non-Invasive Urothelial Carcinomas

A.S. SANDULESCU , A.E. STEPAN , C. MARGARITESCU , A.E. CRISAN , C.E. SIMIONESCU

Urothelial papillary lesions of urinary bladder are frequent lesions in medical practice and sometimes difficult to be histopathologically classified. In this study were included 179 urothelial papillary lesions, represented by low grade non-invasive urothelial carcinomas (LGNIUC), papillary urothelial neoplasms of low malignant potential (PUNLMP) and urothelial papillomas (UP), for which the architectural and cytological histopathological parameters were analyzed in order to determine their usefulness for the classification of lesions. For each parameter, an aggressivity score was set, the sum representing the composite histological score (CHS) for each case. The increase of urothelial thickness, the papillae fusion, the loss of cellular polarity, loss of basal cell palisading and absence of umbelliform cells were commonly associated with diffuse pattern in LGNIUC, were focal/absent in PUNLMP and absent in UP. The nuclear hypertrophy and hyperchromasia, the nucleoli presence and mitotic activity were specific for LGNIUC, rarely associated with PUNLMP and absent/low in UP. CHS values for the three categories of analyzed lesions were superior statistically significant in LGNIUC compared to PUNLMP and UP. The mitotic index and the thickness of cytological atypical epithelial layers support the parameters utility as reproducible criteria for the differentiation of papillary urothelial tumors.

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7. Clinical Study on Abfraction Lesions in Occlusal Dysfunction

A.R. OLARU , M.R. POPESCU , L.P. DRAGOMIR , A.M. RAUTEN

The abfraction theory states that under the action of the occlusal forces non-axially transmitted, the flexion of the tooth occurs in the cervical area, which initially leads to the appearance of cracks in the enamel and dentin, followed by the destruction of the dental structure. These lesions allow bacterial plaque retention, lead to dental hypersensitivity and can affect the vitality of the dental pulp. Thus, the study included 102 participants, of both sexes, 54% representing the male gender (55 subjects) and 46% the female gender (47 subjects), aged between 20 and 80, from the urban area 76% (77 subjects) and rural 24% (25 subjects), who came to the Dental Medicine office, between August 2018 and August 2019, representing 57.3%, of the total number of patients treated during the aforementioned period. They have been described the acid and abrasive processes involved in the generation of these lesions,and special attention was paid to the role of mechanical stress occurring at the occlusal level, due to the transmission of forces outside the dental axis.

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8. Association of QRS Complex Fragmentation with QT Interval Prolongation in Patients with Ischemic Heart Disease

N.J. AQUINO , O.A. CENTURION , J. M. TORALES , L.M. MINO , K.E. SCAVENIUS , J. F. ALDERETE , J.C. CANDIA , L.B. GARCIA , C. CACERES , J.E. MARTINEZ , O.A. LOVERA

Background: The fragmented QRS complex (FQRS) was found to be associated to malignant ventricular arrhythmias and sudden death in patients with hypertrophic cardiomyopathy and other entities. There is scant data available correlating the presence of FQRS with QT interval prolongation in patients with ischemic heart disease (IHD). Methods: A descriptive, retrospective, cross-sectional study was performed in 123 patients with IHD to analyze and correlate the presence of FQRS with QT interval prolongation in the conventional 12-leads electrocardiogram in patients with documented chronic IHD. Results: There were 62% male patients. The mean age was 63.8±12.6 years. Thirty six (44%) patients had fragmented QRS (64% men and 36% women). The duration of QT and QTc, the mean values were 413±59ms, and 463±67ms, respectively. Of the 36 patients with FQRS, 23 patients have prolongation of the QTc interval, and 13 patients did not present it. Of the 45 patients without FQRS, 21 of them have prolongation of the QTc interval, and 24 patients did not have it. These data resulted in a sensitivity of 52% with a moderate SnNout, a specificity of 65% with moderate SpPin, a positive predictive accuracy of 64%, a negative predictive accuracy of 53%. These data resulted in a prevalence of 54%. Conclusion: the presence of FQRS in the ECG has a moderate sensitivity and specificity, as well as, moderate negative and positive predictive value of the existence of QT interval prolongation in patients with ischemic heart disease.

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9. Cerebral Palsy. Considerations Upon 249 Consecutive Patients and Review of Literature

S. BOURGLEH , R.N. NEMES , B. HETAIMISH , A.H. BURILEANU , S. FALLATAH , L.C. CHIUTU

Aim: to determine the prevalence of cerebral palsy (C.P.) among children and to describe its main characteristics (clinical forms, treatment plan, and results). Material and Methods: 249 C.P were studied (120 boys and 129 girls, aged between 0 and 12 years) during 2,321 consecutive clinic visits (incidence 10.7%) to a private pediatric orthopedic clinic in Jeddah, Saudi Arabia, between 2011 and 2016. Spastic type was the main clinical form (231=92.8%), spastic diplegia being the most frequent (166=71.9%). The treatment was complex: conservative only in 42.2%; surgery indicated in 149 (59.8%) cases was performed only in 81 cases, by means of muscle and/or bone procedures, depending on the lesion balance. Results. The postoperative results were excellent in 2.4% of cases, acceptable to some extent in 93.8% and poor in 3.8%. We registered a recurrence rate of 14.8%, a postoperative morbidity rate of 6.17% with a postoperative mortality rate of 0. Treatment results could not be assessed in 129 (51.9%) cases due to lack of follow up. Conclusion: 1. C.P. represents the third most common diagnosis in pediatric orthopedic private practice. 2. The treatment results were acceptable in most cases, but not optimal. 3. Gait analysis using in the preoperative planning could improve significantly the outcome, especially in complicated cases.

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10. The Approach to Tetanic Hypocalcemia Caused by Vitamin D Deficiency

I. BAKALLI , E.KOLA , E. CELAJ , D. SALA , I. GJETA , D. KLIRONOMI , A. GJIKOPULLI

Recently studies have shown that over half of infants, children and teenagers may be inadequately supplemented. A high prevalence of vitamin D deficiency in children has been observed worldwide, even in sunny countries. Regardless of the recommendations, vitamin D supplementation is sometimes underestimated, supporting the idea that for children in sunny country it is unnecessary. In the modern area of supplementation, tetany seems to be a problem of the past. Usually it occurs at 3 to 6 months of age, that’s why diagnostic suspicion may be low after this age. We report a case of severe hypocalcemia presented with tetany, in an18-months-old child with severe vitamin D deficiency, because of not receiving vitamin D as supplementation. With underestimation of vitamin D supplementation, tetany may emerge again. Through our report we aim to highlight the aggressive approach to tetanic hypocalcemia in children with vitamin D deficiency and to sensitize a rigorous surveillance in order to ensure adequate vitamin D supplementation by pregnant, breastfeeding mothers, children and adolescents.

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11. Palatal Reconstruction after Major Surgical Excision

A. CIUCA , A. GRECU , M. CIUREA , E.M. CIUCA , A.I. SALAN

Oncological excision surgery in the oral and maxillofacial area amputates important structures or open cavities (sinus, nose, mouth) which are usually "closed". The disappearance of an eye, tongue, soft palate or cheek, raises serious issues regarding the resumption of partial or total functions of that region, in terms of social reintegration of the patient. In the cephalic extremity, the reconstruction material is limited, so specialists resort to resources located away from the defect to achieve closure. The temporal flap isn’t used very often, although this procedure has the advantages of a shorter time for surgery and for healing.

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12. Sialocyst of the Parotid Gland in a Child

M.C. MUNTEANU , G.S. PETRESCU , A.M. SANDU , A.R. PITRU , C.B. OPRIS , M.O. PETRESCU

Non-neoplastic cysts localized in salivary glands are quite rare and represent approximately 2-5% of all salivary gland lesions. Salivary duct cyst, also known as sialocyst is a true cyst with the epithelium lining the inner side of its walls. It is generally observed in minor salivary glands and it rarely involves the parotid. Patients are mostly affected between the ages of 30 and 40 and the lesion is rarely seen in children. The current case is a rare report, as the patient was a child. The diagnosis has been difficult to ascertain due to the presence of pain, symptom characteristic for inflammatory lesions.

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13. Primary Pulmonary Diffuse Large B-Cell Lymphoma Presenting as an Endobronchial Lesion: The Youngest Adult Patient in the Literature

O. TURAN , P.A. TURAN , M.A. UYAROGLU , F. POLAT , A.O. CALLI

A 20-year-old female patient was admitted to hospital with complaints of chest and back pain in September 2018. There was a cavitary lesion in the upper zone of the left lung in the chest X-ray. Thorax CT revealed an irregular contoured and shaped mass with 87x67x79 mm sizes, in the upper lobe of the left lung lying to paramediastinal area. Since there was a doubt about malignancy, positron emission tomography (PET) was performed; there was a cavitary lesion in the left upper lobe with high FDG uptake (SUVmax: 23.2). Bronchoscopic examination revealed an endobronchial lesion with nearly complete occlusion in the apicoposterior segment of the left upper lobe. Bronchoalveolar lavage (BAL) performed in this session for acid-fast bacilli (AFB) was negative. The patient was diagnosed as primary pulmonary diffuse large B-cell lymphoma (DLBCL) by histopathological and immunohistochemical evaluation of endobronchial biopsy specimens. Following the final diagnosis of Bronchus-Associated Lymphoid Tissue Lymphoma (BALTOMA), the patient was referred to the department of haematology, and chemotherapy was planned for therapy. Since DLBCL is extremely rare, and uncommonly presenting with an endobronchial lesion, we want to present this patient as the youngest adult case of primary endobronchial BALT lymphoma in the literature.

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