Archive issue


Current Health Sciences Journal

vol. 47 no. 1, 2021

1. A Clinical Study Determining Pulp Vitality in Oropharyngeal Cancer Patients Undergoing Radiotherapy Using Diagnostic Tool-Pulse Oximetry

S.R. Daveshwar, S.V. Kapoor, M.R. Daveshwar

Pulse oximetry is an equipment that evaluates pulp vitality for concrete endodontic diagnosis and treatment plan. One of the treatment methods of oropharyngeal cancer is radiotherapy. Radiotherapy has some harmful effects on dental pulp that affects pulp vitality. The objective of study was to assess pulp vitality before, at the end of radiotherapy and six months after radiotherapy (RT) in oropharyngeal cancer patients undergoing radiotherapy. 25 patients who were diagnosed with oropharyngeal cancer having asymptomatic intact crowns were selected for the study. Pulp vitality was checked before the commencement of radiotherapy (PV1), immediately after radiotherapy (PV 2) and six months post radiotherapy (PV 3). Pulp vitality of first posterior tooth was selected of each patient and was checked with pulse oximetry. Paired t-test was used as statistical analysis. Statistically significant difference was observed when PV 1 and PV 2, PV 1 and PV 3 and PV 2 and PV 3 were compared amongst each other. There was reduction noted in mean SpO2 value when groups PV 2 and PV1 were compared. This was statistically significant. Statistically significant increase in mean SpO2 value was observed six months post radiotherapy (PV 3). Thus, it can be concluded that statistically significant reduction in mean SpO2 level post radiotherapy recovers after six months.

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2. Evaluation of Hepatocellular Carcinoma Patients: Interim Analysis of Cases from a Tertiary Referral Center in Craiova, Romania

A.M. Ciurea, C.C. Vere, M. Schenker, I.A. Gheonea, L. Streba, L.D. Sandulescu, A.M. Mehedineanu, D.I. Gheonea

Although medicine is constantly evolving, hepatocellular carcinoma remains a pathology with a poor prognosis due to the frequent delayed diagnosis and the aggressiveness of the disease. Aim: Our objective was to evaluate liver function and stage of disease of newly diagnosed HCC patients. Methods: We conducted a retrospective study between July 2016 and January 2021 and we included hospitalized patients within the Department of Gastroenterology of the Emergency County Hospital of Craiova. We identified 119 newly diagnosed patients and we collected data from patient history, contrast-enhanced imaging and laboratory analysis. Results: 81 patients were diagnosed in BCLC Stage A and B. Liver function was not significantly modified, despite 91.5% of the patients presented with elevated AST levels. Because of the cirrhotic liver already affected, 73 patients had thrombocytopenia. Contrast-enhanced ultrasound was performed in 79 patients, as a complementary imaging exploration. Alfa-fetoprotein values could not be correlated with the severity of disease. Conclusions: Early diagnosis was mostly established. It is mandatory for treatment management and overall survival to follow a rigorous surveillance of patients at risk for HCC.

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3. Investigation of the Epidemiological Situation and the Incidence of Covid 19 Disease in an Area of Markazi Province in Iran Country

M. Akbari, Y. Kazemzadeh, N. Fayazi, K. Sadeghi, M.A. Orouji, H. Momeni, M. Didehdar, B. Abedi

Introduction. Coronavirus is an emerging virus that has caused many casualties. Therefore, the purpose of this descriptive study is to investigate the epidemiological situation of coronavirus in Khomein city in the province of Markazi in Iran. Method. This cross-sectional descriptive study was performed on all people with coronavirus disease from the first date of admission of positive PCR of patients with coronavirus until 21 September 2020. Information on the records of definitively discharged and deceased patients due to coronavirus (having positive PCR) was extracted from 20/2/2020 to 21/9/2020 and demographic characteristics such as age, gender, area of residence, occupation, and past medical history were assessed for each patient with coronavirus disease. Results. The range of age of this study was from 2 months to 95 years old and their mean age was 52.9±19.2 years old. The mean age of men and women in this study was 52.36 and 53.84 years old, respectively, which showed no significant relationship (T=0.966, N=691, P-Value=0.335, df=689). 52.1% of deaths were in rural areas and 47.9% were in urban areas. Conclusion. With observing the protocols by the people as well as traffic restrictions and social distance, we gradually experienced a decreasing trend in positive coronavirus cases and hospitalization cases. Then, due to the decrease in people's sensitivity and false confidence, the second outbreak of the disease began again and reached its peak in May and July.

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4. Assessment of Left Ventricular Diastolic Function in Young Adults with Nonalcoholic Fatty Liver Disease

C.G. Moise, I. Donoiu, G.C. Tartea, O. Mirea, I. Rogoveanu

There is strong evidence that, in addition to increasing the risk of cirrhosis as well as hepatocellular carcinoma, nonalcoholic liver disease represents an independent risk factor for different diseases including cardiovascular and chronic kidney disease and also type 2 diabetes. Objective: to assess whether nonalcoholic fatty liver disease is associated with diastolic dysfunction of the left ventricle, independent of other classic risk factors. Methods: we included 79 patients aged 15-45, diagnosed with non-alcoholic liver disease, and a group of 80 healthy people in the same age group. We assessed left ventricular diastolic function using Doppler pulsed wave transmitral flow and Tissue Doppler Imaging methods. Results: there were lower velocities of E and e’ wave, a decrease in E/A ratio and an increase in E/e’ ratio in the group of patients with hepatic steatosis and in those with associated diabetes compared to the control group, but not the same was observed when comparing patients with steatosis alone vs. hepatic steatosis and associated diabetes mellitus. Conclusion: nonalcoholic steatosis is linked to echocardiographic features of early diastolic dysfunction that are present in patients suffering from diabetes.

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5. Analysis of the First 300 Cases of SARS CoV2 Infection from the Infection Disease Clinic of Craiova, Romania

L.I. Giubelan, F. Dumitrescu, A.C. Stoian, L. Dragonu

COVID-19 is an ongoing pandemic and an intermediate analysis of the first 300 cases treated in the Infectious Diseases Clinic from Craiova has been performed. We have found that most of the cases were asymptomatic or mild, but the severity of the symptomatic cases increases with age. The main comorbidities associated mainly with the severe cases were high blood pressure, obesity, other cardiac conditions, diabetes mellitus and malignancies. Inflammation, coagulation and metabolic disorders are significantly more expressed in critically ill patients. Fatality rate is relatively low, death seems to be associated with old age.

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6. EndoCuff-Assisted Colonoscopy Versus Standard Colonoscopy in Colonic Polyp Detection-Experience from a Single Tertiary Centre

M. Calita, P. Popa, I.F. Cherciu Harbiyeli, S. Iordache, A. Ciocalteu, M.M. Filip, A. Saftoiu

Background. Standard colonoscopy fails to visualize the entire colon mucosa and consequently a significant amount of polyps are still being missed. New device, such as EndoCuff, have been developed to improve mucosal visualisation, hence the quality in colonoscopy. The aim of this study was to assess the diagnostic yield of EndoCuff-assisted colonoscopy in comparison with standard colonoscopy by taking into consideration several quality indicators. Methods. In this study, 965 adults ≥ 18 years referred for colonoscopy were randomly divided into two groups. The main statistical investigation compared the difference between EndoCuff-assisted colonoscopy (EC) vs. standard colonoscopy (SC) in the detection of colonic polyps and adenoma detection rate (ADR). The second inquiry sought to compare experienced vs. recently trained and female vs. male operators. Results. The ADR was higher for EC than for SC (37.50% vs. 26.64%). Regarding the mean number of detected polyps per procedure (MPP), the result was statistically significant when generally comparing the EC vs. SC (p=0.0009). There were no differences in MPP between EC and SC for recently trained endoscopists (p=0.7446), while a significant difference for experienced doctors (p=0,0020) was noted. A significant difference was observed between female doctors and male doctors only when using SC. EC was more helpful for female doctors when assessing MPP (p=0.0118). No serious adverse events related to EndoCuff-assisted colonoscopy was noted. Conclusions. EndoCuff-assisted colonoscopy seems to be safe and may bring benefits for improving the polyp/adenoma detection rates in regard to missed lesions, usually located in blind areas.

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7. PRP Enriched with Hyaluronic Acid-PRP from Rat Protocol and Method of Preparation

E.A. Marinescu, O. Nica, E. Ilinoiu, A. Cojocaru, A.A. Negrila, M.E. Ciurea

Observing the positive effects of PRP (platelet-rich plasma) used in various pathologies, both in traumatology, orthopedics, sports medicine, and in plastic and reconstructive surgery, we decided to develop an improved product, using granular hyaluronic acid. The paper aims at establishing a protocol for obtaining PRP enriched with hyaluronic acid, which can be used in the current practice of treatment of skin defects, safely, with minimal side effects and limited possible, but to provide a shorter healing period as compared to native, "free" healing. The experiment aims to find an effective and rapid method of healing wounds with skin defects, by using a local adjuvant (PRP enriched with hyaluronic acid), which is available to any plastic surgeon. Following the combination of PRP with granular hyaluronic acid, we obtained a product that macroscopically has a gelatinous, viscous consistency, with a good adhesion to the tissues. The potential benefits of this experiment could be the basis for the development of treatment protocols for various pathologies, which result in wounds with skin defects, the most important aspect being the shortening of the classic healing period.

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8. The Role of the Body Mass Index in the Acute Pancreatitis Evolution

V. Padureanu, D.N. Florescu, R. Padureanu, D. Radulescu, M.M. Pomacu, D.M. Firu, V.M. Surlin

The etiological factors involved in acute pancreatitis are multiple, both pancreatic and extra-pancreatic, having a predisposing or triggering role. The purpose of our study was to evaluate the role of BMI (body mass index) in the evolution of acute pancreatitis. The study was performed between January 2018-October 2020 on a lot of 110 patients diagnosed with acute pancreatitis and admitted to the 1stSurgery Clinic and the 2ndMedical Clinic of the Craiova Emergency County Clinical Hospital, the study was prospective. The control lot consisted of patients who were not diagnosed with acute pancreatitis (n=232).Comparing the distributions according to the body mass index of the two groups by the Chi square test, a statistically significant difference is observed (p<0.05) regarding the obese patients who are diagnosed with acute pancreatitis. Obesity patients have an increased risk of developing acute pancreatitis compared to non-obese patients.

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9. Retrospective Study of Lung Tumor Cases Presenting at a Large Tertiary Hospital in Romania between 2017 and 2020

A.G. Gheorghe, C. Calarau, F.M. Niu, A.D. Demetrian, C.T. Streba

Lung cancer is a major health concern worldwide. A rise in smoking incidence amongst both genders, increased exposure to air pollutants and unhealthy lifestyle choices steadily contribute to this global situation. Our aim was to assess the main characteristics of this type of cancer through a retrospective analysis at a major referral center. We selected valid and complete electronic medical records of patients admitted between 2017 and 2020 at the Emergency County Hospital of Craiova, one of the largest hospitals in Romania and a major referral center for the region of Oltenia. We obtained ethical approval from both the hospital and the University and analyzed anonymized records by ICD-10 diagnostic code, extracting gender and age data, as well as associated conditions, length of stay, as well as the medical departments where the patient was hospitalized. Our results showed an increased incidence amongst men, with the majority of cases between 50 and 70 years of age. Median hospitalization period was of 6 days, with higher values for oncology and the lowest in thoracic surgery. Distant metastases, pleurisy and hemoptysis were the most prevalent comorbidities encountered. In conclusion, our study presents important data on the main characteristics of lung cancer patients in Romania.

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10. Clinicopathological Correlations in Cutaneous Squamous Cell Carcinomas

A.R. Ciuciulete, A.E. Stepan, B.C. Andreiana, C.E. Simionescu

Squamous cell carcinomas (SCC) represent 20% of all nonmelanoma skin cancers, most tumors responding favorably to the conventional therapy. Incisional or excisional biopsy is essential for diagnosis and prognosis evaluation. The study included 103 cases of SCC, following the assessment of some clinical and histopathological aggressivity factors, which were digitally stored and statistically analyzed using comparison tests. The tumor grade was significantly associated with the histological variant, the maximum tumor size, the perineural and lymphovascular invasion, the depth of the invasion and the status of resection limits. The pT category was significantly associated with the location and maximum tumor size, perineural invasion, depth of invasion and status of resection limits. It was observed a significant association of tumor grade and pT category. The evaluation of the clinical and histological characteristics of SCC is an important step in obtaining relevant prognostic information and applying appropriate therapy.

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11. Can We Use the Bishop Score as a Prediction Tool for the Mode of Delivery in Primiparous Women at Term Before the Onset of Labor?

L. Dira, R.C. Draguin, M. Sorop-Florea, S. Tudorache, M.L. Cara, D.G. Iliescu

The Bishop score serves as an evaluation system performed by digital vaginal examination (DVE) to determine cervical ripening. The scoring system includes cervical dilatation, position, effacement and consistency of the cervix and fetal head station1. Nowadays, the Bishop score is frequently used as an important parameter for the prediction of successful induction of labor. Objective: Our objective was to demonstrate the role of the Bishop scoring system in prediction of the mode of delivery in primiparous women at term before the onset of labor. Method: We included in this study unselected primiparous women at term, after 37 weeks of gestation, who presented to the Prenatal Diagnostic Unit (PDU) of the University Emergency County Hospital of Craiova. We excluded from the study multiparous patients, pregnancies with a planned Caesarean section delivery (CD), non-cephalic presentations and multiple pregnancies, twin pregnancies and those with detected fetal anomalies. The protocol included weekly DVEs until delivery for all patients, to determine the evolution of the Bishop score at term and in the week before delivery, and potential correlations with delivery outcome. To reduce clinical bias, the DVEs were performed by three experienced obstetricians involved in the research. Results: Statistical analysis yielded a 4 to 6 Bishop score in all weekly examinations. At 37 weeks of gestation, the majority of primiparous women had a Bishop score of 4, with no significant differences between the primiparous who delivered vaginally and the ones where Caesarean section was necessary. During the following weekly evaluations, we noted a slight turn to a Bishop score of 6 for most of them, without any significant differences between the two groups. However, at 41 weeks of gestation, there was a significant higher Bishop score in the group of primiparous women who delivered vaginally. Conclusion: In our study, the use of the Bishop score failed as a prediction tool for the mode

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12. Basal Cell Carcinoma and its Impact on Different Anatomical Regions

A. Cojocaru, E.A. Marinescu, O. Nica, E. Ilinoiu, A. Negrila, M.E. Ciurea

Basal cell carcinoma (BCC) is the most common skin cancer. We conducted a retrospective study over a period of two years (2018-2019), on 214 patients from the Plastic Surgery clinic in order to identify the clinical and histopathological aspects of the disease: the case distribution according to sex, living environment, age, histopathological subtype, location. Results. The F/M ratio was of 1.03 in favour of women. The incidence was higher for patients from rural areas (55.14%). The most affected group age was between 70-80 years old, with 76 patients (35.51%). The most frequent histological type was nodular basal cell carcinoma (65.42%), followed by micronodular subtype (17.29%). We observed the association of basal cell carcinoma with a number of other conditions such as: high blood pressure (92 cases), diabetes (19 cases), chronic kidney disease (2 cases), liver disease (5 cases), epilepsy (2 cases). Correlating the histopathological subtype and the invasion of the edges of the surgical excision specimen, we noticed that edge invasion was present: in the case of nodular basal cell carcinoma (15.71%), micronodular subtype (43.24%), superficial subtype (50%), morpheaform subtype (40%). Dividing the cases by location, we highlighted the risk areas: nasal region (29.44%), cheek (10.75%), orbital region (13.55%), scalp (10.75%), auricular region (7.48%), forehead (8.41%), etc. Thus, 89.72% of cases were located on photo-exposed areas (head and neck). Patients from rural areas registered a higher number of cases both in photo-exposed and non-exposed areas.

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13. Risk Factors and Genetic Predisposition in Colorectal Cancer: A Study on Young and Old Adults

C.B. Petre-Mandache, D.N. Margaritescu, R. Mitrut, A.M. Kamal, V. Padureanu, M.G. Cucu, P. Mitrut

According to GLOBOCAN 2018 data Colorectal cancer (CRC) represents the third most commonly diagnosed cancer in the world and has the second-highest mortality rate. The incidence of CRC has been rising worldwide, the majority of cases being in developing countries mostly due to the adoption of an unhealthy lifestyle. The main driving factors behind CRC are a sedentary lifestyle, obesity, red meat consumption, alcohol, and tobacco; however, early detection screenings and standardized treatment options have reduced CRC mortality. Better family history and genetic testing can help those with a hereditary predisposition in taking preventative measures.

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14. VEGF Immunoexpression in Prostate Adenocarcinoma

A. Panu, C.E. Simionescu, P.O. Dragoescu, A.E. Stepan

Angiogenesis is a basic biomolecular mechanism for tumor progression, the vascular endothelial growth factor (VEGF) being one of the main enhancers of this complex process. In this study, we analyzed VEGF-A immunoexpression in 61 prostate adenocarcinomas (PAs), related to the prognostic parameters of the lesions. VEGF scores were higher in PAs that associated serum PSA values above 20ng/ml, in tumors with pure complex or mixed growth patterns, as well as in high-grade and advanced lesions. The results obtained indicate the involvement of VEGF in prostate angiogenesis and the usefulness of the maker for the identification of aggressive lesions.

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15. Outcomes in Renal Cell Carcinoma with Inferior Vena Cava Thrombus Treated with Surgery

S.I. Gamboa-Hoil, A. Martinez-Cornelio, N. Hernandez-Toriz, C. Riera-Kinkel

Introduction. Renal cell carcinoma can invade through the renal vein into the inferior vena cava, and can extend intraluminally, with tumor-thrombus formation. Methods: Retrospective study from January 2003 to August 2016. Surgical outcomes were analyzed. Neves classification was used for patient categorization. Kaplan Meier and Log-Rank test were used for survival analysis. Results: A total of 134 patients were included, 69 males (51.4%) and 65 females (49%), M:F ratio 1.06:1. Tumor size, bleeding and surgical time were higher in level IV thrombi (mean 16.1cm, 3 064ml and 6.5hrs, respectively), compared to level I (8.5cm, 1033ml and 3.1hrs, respectively). A higher frequency of positive lymph nodes was observed in levels III and IV compared with levels I and II (49% vs. 17.7%, p=0.0001). Distant metastases were observed in 36 pts. (27%). Overall surgical mortality was 4.5%. 5-year overall survival was 63%. We observed a 5-year survival in patients with level I-II 82% and level III and IV 46%. Conclusions: Our results suggest the benefit for the patient of an aggressive surgical approach with an acceptable mortality and 5-year survival rate. The results obtained justify an aggressive surgical approach to these tumors.

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16. Doppler Uterine Artery Ultrasound in the Second Trimester of Pregnancy to Predict Adverse Pregnancy Outcomes

M. Stoenescu, M.S. Serbanescu, A.L. Dijmarescu, M.M. Manolea, L. Novac, A. Tudor, C. Tabacu

Purpose. To determine in uterine artery (UtA) the mean pulsatility index (PI), systolic/diastolic (S/D) ratio and the presence/absence of notch in the second trimester of pregnancy, with normal or abnormal pregnancy outcome. Material and Methods. We performed an analysis of 135 cases with high risk pregnancy in Obstetrics and Gynecology Department of The Municipal Hospital Filantropia, Craiova, between October 2016 and May 2020. The ultrasound evaluation in the second trimester was performed during the second trimester morphology scan, or after this, but up to 24 weeks of pregnancy. Results. The study showed only in the case of early preeclampsia (PE) a statistical significance for mean PI-UtA percentiles in the second trimester. In the other studied categories of pregnancy outcome, even we did not have a statistical significance, we found a specificity of 75% and positive predictive value of 88.89% in late PE. The presence of notch in the second trimester was statistically significant (p value <0.05) in the case of premature birth (PB) and early PE. A positive predictive value of 77.50% we found only in case of late PE. Conclusions. Our results show that routine Doppler screening of the uterine arteries during the second trimester did not make an accurate prediction of fetal growth restriction, preeclampsia or preterm birth. However, we believe that the present study results prove that this screening may select a population with increased risk of adverse outcome, which would give them the opportunity to benefit from an early intervention.

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17. The Profile of the Patients with Double Infection HIV and TB in South West of Romania

C. Stoica [Calarasu], A.M. Popa [Miulescu], A.A. Turcu, F.M. Nitu

Background: Co-infection with human immunodeficiency virus (HIV) / tuberculosis (TB) raises important diagnostic and treatment problems as the lung is one of the target organs for HIV. Studies have shown that an HIV patient is 5-15 times more likely to switch from Koch's bacillus-infected status to active tuberculosis. Material and method: Retrospective study on 207 patients with HIV/TB coinfection in the Oltenia area registered in the Regional Center for Monitoring and Evaluation of HIV/AIDS infection in Craiova to define the profile of patients with double TB-HIV infection in southern Romania for cases registered between 2005-2015. Results: 53.14% of patients were females. Most cases were from rural areas (56.10%) Half of them are born between 1988 and 1990 but only 5% graduated university. 66.18% don’t have a job and are supported by state with a monthly minimum income. 29.4% are smokers. More than 60% of cases had pulmonary TB and other 25% had concomitant pulmonary and extrapulmonary TB. TB and HIV have been diagnosed almost at the same time in 25% of cases. At the time of TB diagnosis 75% of patients had CD4+lymphocytes count <200cel/ml. We also noticed the absence of prophylaxis for TB in patients infected with HIV (PIH) and high incidence of hepatitis B (30.43%). Conclusions: Clinical expression, radiological and bacteriological aspects are often atypical in HIV/TB coinfected patients. The lack of TB prophylaxis and TB endemicity in the studied area may justify the large number of TB cases in HIV-infected patients.

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18. Primary Neurosarcoidosis Mimicking Gallbladder Pathology

A. Ullah, R. Munagala, A. Bhatt, S. Mattox, L. Vemavarapu, J. Keshavamurthy

A 40-year-old African American male with long standing headaches and unintentional weight loss presented with nausea, vomiting, and blurry vision. Laboratory findings include hyponatremia and mildly raised liver enzymes. He underwent cholecystectomy six months prior for unexplained nausea and vomiting, which in hindsight was likely neurologic-induced vomiting from neurosarcoidosis. Brain imaging revealed diffuse, leptomeningeal, nodular enhancement involving the brain, brainstem, and upper cervical spinal cord. Further work up showed extensive lymphadenopathy above and below the diaphragm, solitary liver lesion, and multiple lytic lesions involving bones. Iliac spine biopsy revealed ill-defined, non-caseating granulomas with giant cell reaction infiltrating bone fragments. Acid-fast bacilli and fungal stains were negative. Patient was treated with steroids. Diagnosis of neurosarcoidosis is challenging in the absence of physical signs and symptoms. However, radiological and pathological correlation in clinical suspicion of sarcoidosis is helpful in more accurate diagnosis and timely management of the patient.

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19. Mandibulectomy Reconstruction with Pectoralis Major Island Flap Associated with Primary Reconstruction Plate for Mandibular Medication-Related Osteonecrosis

G.A. Ciobanu, M.I. Gheorghia, O.M. Petrescu, S.M. Popescu, I.E. Staicu

A bimaxillary edentulous male patient, aged 67 years, diagnosed with prostate cancer who underwent intravenous bisphosphonates treatment (zoledronic acid) for about one year presented with pain in the anterior mandibular arch, with exposed necrotic bone, and was diagnosed with stage 2 medication-related osteonecrosis of the jaw (MRONJ). MRONJ is the development of bone necrosis in the oral cavity as an adverse reaction in patients treated with antiresorptive and antiangiogenic medication, without radiation therapy to the head and neck. This persistent bone necrosis does not always respond to standard treatments. The reconstruction technique with pectoralis major flap, at a distance, associated with the primary reconstruction plate, was an effective treatment modality for the treatment of large osteonecrosis noncompliant with conservatory treatments. Through this technique, the morpho-functionality of the jaw can be restored almost completely.

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20. The Unusual Impalement Injuries of the Hand

S.B. Singh, H. Vardhan, K. Silwal, D.N. Upadhayaya

Impalement injuries are relatively rare. The most common anatomical site of involvement is the extremities. Impalement injuries are defined as penetrating injuries where traumatic agent remains impaled in the human body. 1 Foreign body penetration of hand and wrist usually present as emergency cases. Due to their rarity, the management of this clinical condition remains controversial. Here we report A case of impalement injury of the hand and their successful management. The patient even though injured by such an object had minimum injuries. Case: 42 years old male presented with history of slipping while trying to cross a fence. He sustained penetrating injury over left hand by iron fence finial 7 hours prior to presentation.

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21. Necrobiotic Xanthogranuloma - Case Report and Literature Review -

L.G. Geoloaica, V. Patrascu, R.N. Ciurea

Necrobiotic xanthogranuloma is a rare type of non-Langerhans histiocytosis, whose main clinical features are the development of red-brown, purplish or yellowish skin papules and nodules, which evolve by forming infiltrated plaques. The periorbital region is the most commonly affected site. Some cases have lesions on the torso or extremities, with no facial involvement. Extracutaneous involvement of the ocular, respiratory, and cardiac tissues have also been described. Most patients have an associated monoclonal gammopathy (IgG k and λ). The treatment is difficult, with progression and recurrence. We present the clinical case of a 65-year-old woman, who was hospitalized for multiple erythematous plaques and placards, with fine squames and telangiectasis on the surface, disseminated within the scalp, ears, trunk, lower limbs; some plaques have a circinate border with reddish-purple, slightly protruding edges and a whitish and erosive atrophic center. The lesions within the scalp are alopecic. The disease began 15 years ago, the patient being diagnosed with Psoriasis vulgaris and treated with dermatocorticoids and Cignolin, with no remarkable results. Paraclinical investigations did not reveal any associated pathologies. Histopathological and immunohistochemical examination confirmed the diagnosis of necrobiotic Xanthogranuloma. The patient was treated with antihistamines, Neuromultivit, Vit E 100mg/day, Oximed spray, Atoderm emollient cream, Neopreol ointment, with slow favorable evolution. The physical examination and laboratory investigations for the diagnosis and surveillance of malignant diseases should be performed on a regular basis in patients with NXG. Our patient had lesions with a course of 15 years, with no development of multiple myeloma or other systemic involvement.

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22. Rare Complication During Anti-TNF-α Treatment in a Patient with Crohn’s Disease: A Case Report and Review of the Literature

R.C. Statie, D.N. Florescu, D.I. Gheonea, T. Ciurea

Crohn's disease represents an inflammatory bowel disease of unknown etiology, with chronic evolution, which may affect any segment of the digestive tract. The main classes of drugs used in patients with inflammatory bowel disease include: aminosalicylates, corticosteroids, immunosuppressants, biological agents and antibiotics. Biological therapy with anti-TNF-α agents offers significant therapeutic benefits, but their use requires caution, as they can also be associated with numerous side effects. We present the case of a female patient known with Crohn's disease, under going biological therapy with adalimumab, who developed a complication, quite rarely described in the literature, possibly as a result of treatment with anti-TNF-α agents.

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23. “The Janus Face” of Thrombocytes in COVID-19

S. Singh, A.R. Singh, B.K. Pathak, S.S. Mohakuda, T. Tilak

A 55 year old patient of COVID-19, with no known comorbidities presented with fever, myalgia and headache and at presentation had leukopenia and thrombocytopenia, however did not have any bleeding manifestations. The patient’s inflammatory markers including ferritin and C-reactive protein were elevated at admission. Later in the course of illness went on to develop severe thrombocytosis and leukocytosis. We discuss the course and outcome of illness in an unusual case of COVID-19 with severe and diametrically opposite haematological abnormalities.

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