CHSJ

Current issue

Current Health Sciences Journal

vol. 50 no. 2, 2024

1. Knee Osteoarthritis-Current Diagnosis and Treatment Options-A Narrative Review

G.O.Cioroianu, A.Florescu, L.M.Florescu, O.C.Rogoveanu

Knee osteoarthritis (KOA) represents a progressive and painful disease that in time can lead to loss of function and disability. Early diagnosis and correct treatment are essential in preventing the advancement of the condition to a stage where it can affect the quality of life. The development of new imagistic methods and devices can help detect changes in the structure of the join before the onset of symptoms. At the moment there are no disease-modifying drugs approved, so the current treatment is symptomatic, focusing on pain reduction, improving function and trying to prevent progression towards disability.

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2. Cognitive Decline in Ageing and Disease: Risk factors, Genetics and Treatments

E.Colita, V.O.Mateescu, D.Olaru, A.Popa-Wagner

Aging is the primary risk factor for cognitive decline, impacting multiple cognitive domains and significantly elevating the risk of conditions such as mild cognitive impairment and dementia. In addition to aging, several diseases contribute to cognitive decline. Alzheimer's disease, a progressive neurodegenerative disorder, leads to the loss of neurons and synapses in the brain, resulting in a profound decline in cognitive abilities and functional capacity. Several studies provide compelling evidence that modifiable lifestyle factors play a crucial role in influencing cognitive health. Adopting healthier behaviors has been shown to significantly reduce the risk of cognitive decline. Genetic factors also play a crucial role in cognitive decline, with several genes being identified that influence the risk of developing conditions like Alzheimer’s disease and other dementias. Long-term use of opioids and cocaine is also associated with cognitive decline, affecting functions such as memory and executive processes. Understanding the factors contributing to cognitive decline in aging and disease is essential for developing strategies to mitigate its impact. The drugs available to treat patients with cognitive decline due to advanced aging and drug abuse are also summarized

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3. Liver Damage During Treatment with Reverse-Transcriptase Inhibitors in HIV Patients

G.N.Lungu, G.I.Diaconescu, F.Dumitrescu, A.O.Docea, R.Mitrut, L.Giubelan, O.Zlatian, P.Mitrut

The advent of highly active antiretroviral therapy (HAART) in 1996 has markedly enhanced the life expectancy of people living with HIV (PLWH), largely due to the effectiveness of reverse transcriptase inhibitors (RTIs). These drugs target the reverse transcriptase enzyme, crucial for the HIV virus to convert its RNA into DNA within host cells, effectively disrupting the viral replication process. This action reduces the patient’s viral load, helping preserve immune function and prevent progression to AIDS. Consequently, the predominant causes of mortality among individuals living with HIV have transitioned from opportunistic infections and AIDS-related cancers to liver disease and cardiovascular complications. Liver damage in PLWH could arise from multiple sources including co-infections, chronic substance use, and notably, antiretroviral therapy itself, which can be hepatotoxic. This review highlights the risks of hepatic damage associated with nucleoside and non-nucleoside RTIs and underscores the variability in hepatotoxicity risks among different drugs. It emphasizes the necessity for regular monitoring of liver health in PLWH and adjusting antiretroviral regimens to minimize liver fibrosis risk. This risk is particularly pronounced in patients who associate the infection with hepatitis B or C virus, where the potential for hepatotoxicity significantly increases

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4. Impact of Imaging Techniques in the Assessment of Gallstone Pancreatitis

S.Maces, S.Patrascu, C.I.Dumitrescu, M.R.Balan, L.C.Lascu, A.R.Lazarovici, T.C.Bratiloveanu, S.M.Sandulescu, S.I.Bordu, M.C.Moraru, M.V.Surlin, D.Dumitrescu

From the category of biliary disease, gallstones registered an increase during the last years, approximately 6% of men and 9% of women being affected by the pathology in the United States only. In western countries between 10-20% of the adult population is suffering from cholelithiasis. Although increasing age is a major risk factor for their formation, late studies correlate gallstones appearance with an age decrease for the onset of symptoms. We therefore face a younger population manifesting pain and sometimes functional disability. In accordance with statistical analysis, the economic impact of gallstones in highly industrialized countries such as United States produces costs of up to 6.5 billion dollars annually. In this context, the appropriate timing for intervention becomes a factor of major interest. The present review uses 28 articles and specialized literature. Article selection was based on keywords and followed the effectiveness of imaging investigation such as ultrasound, CT and MRI for patients diagnosed with cholelithiasis. Since a direct comparison between the imaging investigation techniques is not concluding we have tried to establish the sensitivity and specificity offered by each imaging assessment. The comparative analysis revealed a p Kruskal-Wallis <0.001 for sensitivity and p Kruskal-Wallis=0.474 for specificity.

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5. Algorithm for Growth Evaluation in Juvenile Idiopathic Arthritis

R.Eremciuc, N.Revenco, C.Gheonea

Juvenile Idiopathic Arthritis (JIA) includes a range of inflammatory conditions that exhibit chronic arthritis with various clinical presentations. The disease's heterogeneity leads to different impacts on children's health, both short and long-term. Compromised growth, seen as growth retardation and delayed puberty, is a common complication in children with JIA, severely impacting their quality of life. This impairment is linked to disease duration and activity, with severe cases in systemic and polyarticular subtypes. Literature reports growth retardation incidence from 8% to 41%, but data on pubertal impairment is lacking. Growth in children is influenced by systemic and local mechanisms. Chronic inflammation, prolonged glucocorticosteroid (GCS) use, and nutritional issues contribute to growth stunting and pubertal delays. Chronic inflammation in JIA flattens growth curves, while steroid treatment impairs growth and causes weight gain. Disruption of the GH/IGF1 axis is known, but data on systemic hormonal resistance in JIA are insufficient. Optimizing JIA treatment, including biological therapies, is expected to improve growth velocity and reduce long-term impacts by better disease control and reduced GCS doses. Thyroid function also influences growth and puberty, but comprehensive studies on thyroid involvement in JIA are lacking. Given the early onset of chronic inflammatory consequences, preventive auxological screening measures are necessary for children with JIA. Early detection of developmental disorders can enhance therapeutic management. This article summarizes information from a cohort study on growth in children with JIA and proposes a diagnostic algorithm for clinical use.

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6. Metabolic Syndrome in Psoriasis Patients-an Observational Study

R.C.Dascalu, A.L.Barbulescu, S.C.Dinescu, C.E.Bita, L.E.Stoica, R.E.Sandu, F.A.Vreju

Our observational study included on 54 patients with PsO, evaluated into the Dermatology Department of the Emergency County Hospital Craiova, Romania, between August 2023 and January 2024, and 40 controls. Our research proposed determining the prevalence of MetS in a cohort of PsO patients, and its relationship to subclinical atherosclerosis, evaluated by carotid ultrasound. Metabolic syndrome (MetS) was established according to National Cholesterol Education Program (NCP) Adult Treatment Panel (ATP) III criteria for MetS for 35 of the patients (64.81%) vs. 11 of the control group (27.5%), p=0.0003. An overview of each component of MetS depending on the diagnostic criteria for MetS showed that waist and total cholesterol exerted significant differences. Carotid ultrasound evaluation revealed an increased ITM, of over 0.9mm, for 19 (35.18%) or PsO patients, significantly increased compared to controls, as well as the presence of carotid plaques in significantly different percentages (37.03% PsO vs. 17.5% controls, p=0.001). We also noted that for patients with MetS, US examination displayed increased results for IMT compared to those without MetS. The prevalence of carotid atheroma plaque was augmented in patients with MetS and PsO. In our PsO group IMT exerted a positive inter-relation with: age, MetS, blood glucose, disease duration, and PASI. Important to note is that after multiple linear regression analysis, age and MetS were independent indicators of IMT (p=0.02 for age and p=0.001 for MetS). Our findings sustain a firm relationship between MetS and psoriasis and the major consequence of this observation is the inherent risk of cardiovascular events.

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7. The Effect of Change Position on Cardiac Function Patterns on Patients with COVID-19 Diagnosis: A Clinical Trial Study

M.Akbari, H.Jafarimanesh, A.Nasiri, H.Rostami, Z.Mahdavi, N.Fayazi

Background: Various methods are used to treat patients with coronavirus, including drug therapy and alternative and non-invasive therapies Research has been done on the effects of body position on cardiac function in patients with COVID-19 diagnosis. Methods: This study was performed on patients admitted with COVID-19 diagnosis. Patients with inclusion criteria were selected based on purpose and entered into the study. They were divided into three groups: Group A patients were placed in a semi-sitting position, group B patients were placed in a tripod position, and group C patients were placed in a prone position. After being placed in the relevant positions at 15 and 60 minutes were measured in terms of heart rate and blood pressure at the mentioned times in the relevant checklist. Results: The results showed that there was no statistically significant difference in heart rate between the three groups before the intervention (P>0.05). In other words, changes in heart rate over time between the three groups (in several measurements) were statistically significant (P<0.05). Regarding Systolic Blood Pressure (SBP) and Diastolic Blood pressure patterns, the results showed that the three position groups was not statistically different before and 15 and 60 minutes after the intervention (P>0.05). Conclusion: According to the results, it can be concluded that placing the patient in all three positions of the tripod, prone and semi-sitting can be effective in improving the patient's heart rate pattern and lead to improving the patient's clinical condition.

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8. The External Carotid Artery and the Styloid Process

R.N.Calota, M.C.Rusu, A.D.Vrapciu

Background. The external carotid artery (ECA) is typically regarded as coursing between the styloid muscles to continue into the parotid space. The anatomical possibility of an ECA with an ascending parapharyngeal trajectory continuing posteriorly to an elongated styloid process (ESP), thus retrostyloid, to the parotid space is overlooked. It was, therefore, aimed to document the prevalence of this retrostyloid variant of the ECA's course. Methods. We investigated a retrospective random cohort of 160 archived CT angiograms of 97 males and 63 females aged between 47 and 76. The presence of an ESP and the retrostyloid course of the ECA were bilaterally documented. Results. An ESP was identified in 99/320 sides (30.94%), regardless of the ECA course. In the overall group, we obtained 35% null cases for the two variables on the right and 34.06% for the left. ESPs were identified in 8.75% on the right side and 10.31% on the left. The ECAs had retrostyloid courses in 6.25% on the right side and 5.63% on the left. Thus, of the 320 ECAs documented on both sides, 221 (69.06%) had no retrostyloid courses, and we did not identify any ESP in those cases. ESPs were detected in 19.06% of the sides but without retrostyloid ECAs, and retrostyloid courses of the ECAs were detected in 11.88%. Conclusions. The possibility of a retrostyloid course of the ECA should not be ignored. An ESP may misinform the surgeon about the main carotid artery located immediately deep to it.

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9. Cracked Teeth and Vertical Root Fractures in Pandemic Crisis - Retrospective Study

A.M.Popescu, O.A.Diaconu, S.M.Popescu, L.C.Lascu, M.Ionescu, M.Scrieciu, D.E.Vladutu, V.Mercut

Introduction. Dental fatigue fractures are the result of occlusal overloads occurring because of increased intensity of occlusal forces or decreased resistance of dental hard tissues to habitual occlusal forces. In the COVID-19 pandemic, occlusal stress has increased significantly, and so has the number of dental fractures. The study has the aim to determine if the number of cases of dental fatigue fractures during the pandemic crisis was higher than in the immediately preceding period. Methodology. The retrospective study was carried out in a private dental clinic, selecting from the case series presented during March 2019-March 2021 the cases of dental fatigue fractures presented for diagnosis and treatment. The data collected from the patients included the reason for the presentation, the dental and medical history, and results from dental examination and radiological data. The statistical analysis was carried out with Microsoft Excel and SPSS software. Results. The study included 644 patients, 430 women and 214 men, with ages between 25 and 85 years (61±7.4 years). From a total of 2581 visits, 1534 visits were made to 383 patients between March 2019 and March 2020, and 1047 visits were made to 261 patients between March 2020 and March 2021, the number of visits decreasing by 31.75% during the pandemic. During the pandemic, the number of fractured teeth tripled, increasing from 0.53% to 1.53% (p=0.009). The most affected teeth were the maxillary premolars and the permanent first molar, both mandibular and maxillary. In most cases, the indication for treatment was extraction. Conclusions. The Sars-Cov2 virus pandemic crisis has significantly increased the number of teeth with dental fatigue fractures presented to the dental office for diagnosis and treatment.

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10. Hip Osteoarthritis-Clinical-Statistical Study and Surgical Treatment

A.T.Paraliov, S.Craitoiu, M.M.Iacov-Craitoiu, L.Mogoanta

Osteoarthritis (OA) of the hip, also known as coxarthrosis, is a degenerative disease marked by gradual biomechanics alterations cause by articular cartilage damage in the coxofemural joint. The goal of this study was determining the incidence of patients with hip osteoarthritis who undergo surgery (hip arthroplasty) within the Department of Orthopedics and Traumatology of the Emergency County Hospital of Drobeta-Turnu Severin, hospitalized between January 2014 and December 2019. Furthermore, we proposed gathering details about incidence, distribution according to age group, gender, living conditions, and type of arthroplasty used in studied patient group. The study included 485 patients with hip OA mainly diagnosed in elderly patients, 87.83% being over 60 years old. In terms of gender, the disease primarily impacted women, with a female/male ratio of 2/1.

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11. Epidemiological, Clinical and Biological Hemogram Features in a Cohort of Neuroendocrine Tumor Patients

R.Cimpeanu, T.Salmen, L.Boldeanu, M.Mustata, D.Fortofoiu, S.Cazacu, D.Pirici, M.V.Boldeanu, C.Vere

We conducted a retrospective study based on 55 patients diagnosed with gastroenteropancreatic neuroendocrine tumors (GEP-NETs)-gastric (G-NET), small bowel (SB-NET) and colonic (C-NET), hospitalized and evaluated within the Surgical, Gastroenterology and Internal Medicine Clinics, in The Clinical Emergency County Hospital Craiova, between May 2016 and April 2024. We aimed in this study to analyze the epidemiological aspects and clinical characteristics of patients with GEP-NETs. In our study group, the patients' ages were between 39-82 years, with a mean of 66.40 (±12.46) years. The incidence of GEP-NETs cases in young patients was insignificant low-1 case. 45.46% of all patients lived in urban areas. 16.36% were G-NET, 14,54 were SB-NET and 69.09% were C-NET. The GEP-NETs diagnosis was established by immunohistochemistry features. Also, we observed that the most frequency localization was on the ascending colon, while the rarest on the colon it is located on the transverse colon and the rarest is on the small bowel, in spite of the generally literature data. From the C-NET group, 49.09% have been presented arterial hypertension probable explained by serotonin and dopamine secretion an inflammatory through phenotype expression and just one patient has been presented an erythematous psoriasis, which could be also explained by the same neurotransmitter’s involvement as a possible purposed mechanism. The results obtained in our study demonstrate that could be a common profile of GEP-NETs patients through epidemiological general information and clinical characteristics. Also, we demonstrate that, in the last years, the incidence increased for the GEP-NETs

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12. Oral Hygiene Study in Late Adolescence

M.Mociu, C.Bartok-Nicolae, G.Raftu, R.Briceag, A.Caraiane

The objective of this study is to determine prevalent behaviors and knowledge of oral hygiene on the late adolescents. Only individuals in the late stage of adolescence, specifically between the ages of 18 and 24, that were students from the “Ovidius” University of Constanta were chosen. The involvement was optional. A printed questionnaire was provided for them to complete. A total of 50 participants took part in this study, consisting of 26% (n=13) males and 74% (n=37) females. When asked about their toothbrush preference, 50% (n=25) individuals indicated using just manual toothbrushes. Out of all individuals who have utilized orthodontic appliances, 70.8% (n=17) reported that the dentist recommended for them to receive professional dental hygiene care while undergoing treatment. 78.0% (n=39) individuals reported participating in oral hygiene meetings and would be interested for additional information regarding the topic. It is essential to provide youngsters with early instruction about the importance of oral hygiene in order to develop long-lasting healthy habits.

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13. Subclinical Atherosclerosis in a Gout Cohort: Prevalence and Associations

C.D.Parvanescu, A.L.Barbulescu, S.C.Dinescu, C.E.Bita, S.C.Firulescu, B.A.Trasca, R.C.Dascalu, R.E.Sandu, F.A.Vreju

The current observational, prospective study enrolled 65 patients with gout, diagnosed according to 2015 ACR/EULAR criteria [17], evaluated in Rheumatology Clinic, Emergency County Hospital Craiova, and 40 healthy subjects. This research aimed to determine the presence of subclinical carotid atherosclerosis, revealed by an increased intima media thickness and carotid plaques in gout patients, by US examination. Secondary, we aimed to search for the possible correlations displayed between the presence of subclinical carotid atherosclerosis and several disease variables. CCAIMT over 0.9mm was identified for 19 patients (29.23%), percentage statistically significant different compared to controls (7; 17.5%), p=0,0428. For 23 patients (35.38%) carotid plaques were present at US examination, more prevalent compared to controls (19; 29.23%), p=0.002. Using multivariate logistic regression, we pointed out that SUA (OR 2,103; p=0.0002), age (OR=1,051; p<0.001), disease duration (OR=1.740; p=0.0039) and LDLc (OR=1,003; p=0.0029) were independently associated to an increased IMT in patients with gout, similar results being obtained for carotid plaques. MSKUS was performed for all patients, with important results. The presence of deposits associated with an increased risk of a thick IMT; similar results were obtained for double contour sign, aggregates and tophi. A statistically significant risk was noticed for the presence of deposits (p=0.002). Regarding the presence of carotid atheroma plaques, a higher risk was associated to deposits identification, double contour sign, aggregates, tophi and PD signal. Our results sustain that carotid ultrasound is an easily accessible imagistic method that offers important predictors of atherosclerotic status

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14. Validity and Reliability of the Romanian Version of a Modified Short Form of Fear of Dental Pain Questionnaire

A.E.Done, E.Preoteasa, C.T.Preoteasa

The study aimed to test the validity and reliability of the Romanian version of short form of Fear of Dental Pain questionnaire (s-FDPQ), modified by adding an item about dental implant insertion. Material and methods: The design of the study was cross-sectional. Data were collected through an online questionnaire completed by university students, administered from January to March 2024. The survey included information about past dental treatments, the Dental Anxiety Scale (DAS), and items of s-FDPQ. Results: 186 participants were included in the study. The Romanian version of the modified s-FDPQ had a good reliability Sperman-Brown coefficient is 0.878, and Cronbach alpha is 0.92. The questionnaire had a good convergent validity, with all items being moderately correlated with the DAS score. The one-factor model was tested and has a good fit according to the confirmatory factor analysis. The participants were afraid of pain mostly regarding having a wisdom tooth extracted or a dental implant inserted. A statistically significant higher fear of dental pain was observed in those who did not previously have a root canal treatment (p=0.008) and in those who had dental implants in the past (p=0.046). Those attending regular dental check-ups had lower levels of fear of dental pain. Conclusion: The Romanian version of s-FDPQ, modified by adding a question about dental implant insertion, has good reliability and validity. Fear of dental pain seemed to be influenced by features of dental procedures and previous dental experience.

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15. Obstructive Ventilatory Dysfunctions-Functional Assessment and Rehabilitation Program

G.Andrei, E.Marcu, M.Olteanu, R.Cioboata, M.R.Traistaru

Background. Obstructive ventilatory dysfunctions have an increased incidence, and through functional assessment determined by the International Classification of Functioning, Disability and Health (ICF), appropriate treatment can be established. Aims. The objectives of our research are represented by the application of respiratory rehabilitation sessions according to the ICF in patients with obstructive ventilatory dysfunctions-with COPD or asthma, using a unique, international language and the evaluation of the results obtained before and after completion pulmonary rehabilitation. Methods. We conducted a randomized prospective study between November 2022-April 2023, which included 84 patients diagnosed with obstructive ventilatory dysfunctions and who performed respiratory rehabilitation. They were divided into two categories: category 1-C1 which included 43 patients with Chronic Obstructive Pulmonary Disease-COPD and category 2-C2 which included 41 patients diagnosed with asthma. The rehabilitation program lasted 8 weeks, with exercises performed from Monday to Friday, with a weekend break. Respiratory rehabilitation consisted of physical therapy, inspiratory and expiratory muscle training (IEMT), proper nutrition, and psychotherapy. Results. At the end of the program, most of the patients showed improvements in the ICF qualifiers, a fact that supported us that respiratory recovery is one of the basic therapies of patients with obstructive ventilatory dysfunctions. Conclusions. The ICF allows the application of a personalized respiratory rehabilitation program. The ICF qualifiers are used for the functional assessment of patients and allow they to be included in individualized medical rehabilitation programs.

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16. Phenotypic Classification and Functional Assessment in Knee Osteoarthritis Patients

O.Fugaru, D.Radulescu, M.Serbanescu, M.R.Traistaru

The purpose of our study was the phenotypic classification of patients with osteoarthritis of the knee (KOA) and the dynamic assessment of functional status, monitored both numerically and in conformity with the International Classification of Functioning, Disability, and Health (ICF-basic set, shortened form). We conducted a prospective study in the Department of Physical Medicine and Rehabilitation, Filantropia Hospital, Craiova, from June of 2022 to November of 2023. In total, 100 patients with KOA were enlisted. Using data from the literature, physiotherapeutic examination, and results from paraclinical examinations, we classified studied patients into the five phenotypic categories: chronic pain (F1), local pathology with predominance of inflammatory mechanisms (F2), local pathology with predominance of metabolic mechanisms of bone and cartilage structures (F3), metabolic disorders (F4) and comorbidities (F5)-primarily chronic venous insufficiency in the lower limbs. We analyzed the values of generic qualifiers (at two evaluation time points) for the most significant elements of the core ICF set, abbreviated form, used in OAG, across each of the five phenotypes. Phenotypes F4 and F5 showed significant improvements across all evaluated functions, indicating increased efficacy in patients with comorbidities and metabolic diseases. Reduction in pain sensation, improvement in joint and muscle mobility, as well as enhancements in functions related to walking, dressing, and hand use, reflect an overall improvement in the quality of life for these patients.

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17. Population Profile of Children in Romania Affected by Burns

D.M.Canut, M.E.Ciurea

Burns in children represent a significant challenge in the global health domain. The research aims to analyze the profile of children in Romania affected by burns, focusing on demographic characteristics, severity of burns, applied treatment, and impact on parents. Through this analysis, we aim to better understand the factors involved in these cases and provide relevant information for improving the management and care of children with burns. This study aims to explore various aspects related to the healing of burn injuries in pediatric patients in Romania, analyzing data collected through a questionnaire administered to 107 parents. The profile of children in Romania affected by burns is primarily composed of relatively young children, with an average age of 8.7 years and an even distribution between genders. Most come from rural areas, and the degree of burns ranges from first to fourth degree, reflecting a wide range of severity of injuries. Treatment is diverse, with a tendency towards conservative approaches and a significant proportion of cases without complications. Parental satisfaction is not significantly influenced by the type of treatment, indicating a similar perception regardless of the mode of medical intervention. Improving the management and care of children with burns is achieved through adopting a multidisciplinary and integrative perspective. This involves the use of non-pharmacological therapies such as hypnosis and regional anesthesia for pain and anxiety control. Additionally, the inclusion of adjunctive therapies, such as the use of mesenchymal stromal cells and tilapia skin xenograft, contributes to improving the healing process.

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18. Patent Foramen Ovale Secondary to a Paradoxical Embolism Leading to Acute Limb Ischemia: A Case Report and Brief Review of Literature

K.English

Acute limb ischemia, or ALI, is a rapid decrease in limb perfusion due to an occlusion of an artery or a bypass graft. Most cases result from in situ thrombosis or embolism in patients with antecedent peripheral arterial disease. Potential sources of arterial embolism as a cause of this condition include cardiogenic, aortic, peripheral aneurysms with an associated mural thrombus or, less commonly, a paradoxical embolism through a septal defect. We present a rare case of ALI due to an underlying patent foramen ovale that was successfully treated following revascularization. This article emphasizes one of the more unusual mechanisms of ALI. Despite the rarity, physicians should maintain a high index of clinical suspicion for a paradoxical embolism across a patent foramen ovale in unexplained arterial occlusion. Correct mechanism identification ensures adequate referral and prompt treatment that may reduce complications

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19. Case Series Analysis of Late-Onset Atopic Dermatitis: Unraveling Clinical Variants

G.G.Mitroi, M.R.Mitroi, G.F.Mitroi, L.S.Ianosi

Atopic Dermatitis (AD), recognized as one of the most prevalent chronic inflammatory skin disorders among children, is characterized by skin barrier dysfunction and immune system abnormalities. Historically viewed as a childhood condition, recent findings underscore a notable prevalence of AD in adults, prompting a critical examination of this demographic. Diagnosis hinges largely on subjective clinical assessments due to the absence of universally accepted biomarkers. Consequently, efforts are underway to identify dependable biomarkers to enhance diagnostic precision. This paper underscores the scarcity of AD diagnoses in adults despite its pediatric prominence, emphasizing the need for heightened awareness and tailored diagnostic approaches in adult populations. Severity scores such as SCORing Atopic Dermatitis (SCORAD) and dermatological life quality index (DLQI) play pivotal roles in evaluating disease severity and its impact on quality of life, guiding the development of personalized treatment strategies for adult AD patients. In this study, we aim to present four compelling cases of adult-onset atopic dermatitis, each offering unique insights into this increasingly recognized phenomenon. What makes these cases particularly noteworthy is the absence of any prior atopic history in two out of four patients, challenging the conventional understanding of AD as a condition predominantly linked to childhood. Moreover, the clinical presentation in all four cases was markedly atypical, underscoring the elusive nature of adult-onset AD diagnosis. In our investigation, interleukin 4 (IL-4), interleukin 13 (IL-13), and Immunoglobulin E (IgE) were utilized as diagnostic biomarkers for our patient cohort. Given the established pivotal roles of IL-4 and IL-13 in AD pathogenesis, elevated serum levels of these biomarkers, although not universally endorsed, hold potential for diagnostic utility. Furthermore, heightened levels of IgE, indicative of allergic responses and inflammation inherent to the condition, emphasize its significance as a key biomarker and therapeutic target in AD management.

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20. Congenital Bilateral Anophthalmia: A Case Report

F.Alhubaishi, A.Almedfaa, M.Andacheh

Introduction. Anophthalmia and microphthalmia are orbito-facial developmental disorders characterized by deficient growth and impaired visual capability [1]. These rare disorders may be unilateral or bilateral. Congenital anophthalmia is the complete absence of the eye [2,3]. The prevalence of both conditions is estimated at 0.2-3 per 10,000 births [4]. We report a case of congenital bilateral anophthalmia that was undetected during follow-up but diagnosed after birth. Case Description. 24-year-old Bahraini female, who is not a known case of any medical illnesses, primigravida at 39+6 weeks of gestation gave birth to a live male baby via vacuum extraction delivery due to recurrent variable decelerations and poor maternal effort. On physical examination, bilateral anophthalmia was immediately observed. No other anomalies were detected. The investigations ordered were MRI brain and orbit, which showed: Absence of bilateral eye globes-features of bilateral anophthalmia. We advised the parents the baby will need socket expansion/ conformer placement to maintain facial symmetry and cosmetic outcome with neurocognitive and development assessment every 2 months as well as speech and language evaluation. Conclusion. Although many probable factors leading to anophthalmia are suggested, many cases arise idiopathically. Due to the nature of the defect, oftentimes prenatal diagnosis with routine scans is challenging. Therefore, more research into probable causes will prompt the healthcare professional to use more sensitive studies to detect the anomaly prenatally to potentially reduce the psychological and financial impact on the parents

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21. A Rare Variant of Hashimoto’s Thyroiditis

A.L.Manda, A.L.Dima, V.D.Baleanu, D.Vasile, D.I.Voiculescu

Hashimoto's thyroiditis (HT) is the most frequently diagnosed thyroid disorder worldwide, characterized by hypothyroidy and thyroid autoimmunity. The fibrous variant accounts for a small number of cases. A 48 years old woman, with 20-years history of Hashimoto thyroiditis presented for a large recent goiter with compressive symptoms, in hypothyroidic state and with very high thyroid antibodies antithyroglobulin and antithyroperoxidase. Ultrasound and fine needle aspiration biopsy showed an enlargement of the thyroid gland with nonhomogeneous structure and trachea shifting posteriorly, Bethesda III. CT scan showed similar aspect of the thyroid gland with compression on the trachea and the left common jugular vein. Surgery was performed due to suspicion of malignancy and compression symptoms. Thyroidectomy was uneventful, but the patient developed hypoparathyroid symptoms postoperatively that resolved with high dose calcium, magnesium and vitamin D supplementation. The pathology report was consistent of Hashimoto’s thyroiditis fibrous variant. This case report presents a rare case of the fibrous variant of Hashimoto’s thyroiditis that is rarely taken under consideration in the preoperative setting as diagnosis is hard to establish with the usual algorithm of imaging and FNA biopsy. The multidisciplinary management in pre-and postoperative approach and evaluation are of utmost importance for successful management of such case.

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22. Case Presentation of a Minor Patient, Survivor of a Burn with ABSI Score - 12 Points (Probability of Survival Below 20%)

D.M.Canut, R.Tatar, D.M.Enescu, A.E.Marinescu, A.I.Talaban, V.Parvanescu, M.E.Ciurea, I.Nacea

According to the World Health Organization, burns represent a major global public health issue, causing approximately 180,000 deaths annually. The article presents the case of a 17-year-old patient with burns after electric shock (27,000 volts), with a burned area of approximately 72%, 3rd degree, segment IIB, with ABSI score=12, who was treated in a centre dedicated to paediatric burn patients. The use of treatment of paediatric burns not only enhances the quality of healthcare but also has the potential to reduce suffering and improve the chances of recovery for children who go through such traumatic experiences.

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