CHSJ

Current issue

Current Health Sciences Journal

vol. 50 no. 3, 2024

1. Potential Biomarkers for Disease Activity in Systemic Lupus Erythematosus

O.R.Predescu, A.F.Vreju, S.C.Dinescu, A.Florescu, C.E.Bia, A.E.Muetescu, A.L.Barbulescu, P.L.Ciurea

Objectives: The study has as main objective the evaluation of the potential roles of vitamin D, the neutrophil to lymphocyte ratio (NLR), and the systemic inflammation index (SII) as future biomarkers regarding the classification of flares in systemic lupus erythematosus (SLE). Material and Methods: Individuals diagnosed with SLE were encompassed in this observational study. The current applicable criteria, namely The European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) 2019 criteria had to be fulfilled. The participants underwent specific musculoskeletal examination, paraclinical investigations including complete blood count (CBC), determination of serum creatinine levels, as well as liver enzymes, and also the markers of inflammation. The fractions of the serum complement (C3 and C4) were also evaluated, together with serum vitamin D concentrations. Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) was required in order to analyze the research group’s disease activity. Results: NLR and SII demonstrated validity, having statistically significant correlations with SELENA-SLEDAI (p value less than 0.001). The ROC analysis proved a strong discriminative power for NLR (AUC=0.96) and SII (AUC=0.963) in predicting severe disease flares. Optimal cut-off values were 3.45 for NLR and 877,002.19 for SII. Serum vitamin D concentrations had a weak association with the SLEDAI score (p=0.048, r=0.213). Conclusions: NLR and SII can be considered reliable biomarkers for discriminating between the levels of disease activity in SLE individuals. Low serum levels of vitamin D may also influence disease severity, but require further validation.

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2. Comparison of Blood Pressure Measurement Results from Two Different Regions (Upper Arm and Ankle)

A.Cobanoglu

Background: This study was conducted to determine the clinical concordance of non-invasive blood pressure (NIBP) measurements from the upper arm and ankle and to determine whether there is a difference between them. Methods: A prospective and cross-sectional research design was used in this study. The study population included 106 patients hospitalized in the surgical clinics of a training and research hospital. Non-invasive blood pressure measurements were performed from both upper arms and ankles in the supine position. In the data analysis, ANOVA and the Bland-Altman plot were employed. Results: Based on the results of NIBP measurements from the arm and ankle, the differences between diastolic blood pressure (DBP) and mean blood pressure (MBP) were acceptable and within the limits of concordance. The difference between the mean systolic blood pressure (SBP) was found to be significantly different and outside the limits of concordance. The difference between the mean SBP measured from the ankle and the upper arm was determined to be 18 mmHg. Conclusion: It was determined that the results of SBP measured from the ankle were significantly higher and outside the limits of concordance compared to the upper arm, while the results of DBP and MBP measurements were within acceptable limits.

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3. Limb Salvage Surgery in Pediatric Patients with Osteosarcoma

S.A.Niculescu, A.F.Grecu, C.Gheonea, D.C.Grecu

Osteosarcoma, although rare, is acknowledged as the most common primary bone tumor in children and adolescents. Osteosarcoma is a highly malignant osteogenic tumor that can develop in any bone, but commonly develops at the metaphysis of long bones. The positive diagnosis of osteosarcoma is based on the pathology exam, since there are no other specific diagnostic tools, and the patients with osteosarcoma are typically treated by a multidisciplinary team of specialists. The mainstream for the surgical treatment of limb osteosarcoma is the limb salvage surgery, whenever this approach does not compromise the oncological outcomes. A large spectrum of reconstructive surgical procedures is used in various centers, and to date there is no large consensus on recommending one over another. It is often that the practitioner has to decide whether the final impact on the quality of life of the child undergoing endoprosthetic replacement or osteoarticular allograft is better with the subsequent inequality of the length of the limb or the radical approach by amputation is better. Special consideration has to be given on the aspects of psychosocial wellbeing of the patients following the initial surgical intervention.

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4. Assessment and Rehabilitation in Sarcopenic Patients

B.M.Vladutu, M.Serbanescu, M.R.Traistaru

Sarcopenia is a degenerative disorder that particularly affects older people and is defined by a pathological decrease in muscle strength. This disease represents one of the topics of great interest in the medical world of the last two decades. In our study, we tried to underline the importance of an adapted recovery program based on physical exercise for regaining clinical and functional status in patients with age-related sarcopenia. No nutritional intervention was applied. We performed our rehabilitation program in accordance with present international recommendations for sarcopenia. After complete assessment, our patients were randomised into two groups: G1 (Lot 1=25 patients) and G2 (Lot 2=15 patients). G1 patients were compliant with kinetic training, and performed all rehabilitation measures, and G2 patients accepted rehabilitation program without kinetic exercises. Patients assessment (lab tests, gait analysis, VAS and the Clinical Frailty Scale) was made on two levels-first (T1-inpatient assessment), and after 6 months (T2-outpatient assessment). The rehabilitation program based on the kinetic program brought positive improvements in physical performance and locomotion (gait speed and walking cadence) in sarcopenic patients.

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5. Assessment of Surgical and Non-surgical Outcomes in Patients with Dementia and Hip Fractures

A.V.Bradeanu, I.Bounegru, L.S.Pascu, A.Ciubara, T.A.Balseanu

Introduction: The aging population is associated with increased osteoporosis and risk of hip fractures. Cognitive decline has recorded exponential increases in the last decades, with the rise in life expectancy. Material and methods: We conducted a prospective study on 65 patients over 65 years old associated with dementia and hip fractures. We used pre-and post-treatment variables such as age, type of fracture, type of treatment, Charlson Comorbidity Index (CCI), EQ-5D-5L score, and the Harris hip score (HHS) to assess pain, mobility, and mortality. We performed follow-ups at 6 months, 1 year, 2 years, and 3 years. Results: Patients with dementia typically arrive at the hospital without any previous analgesic treatment and receive lower doses due to poor pain recognition. The 6-month mortality rate was 48.22% and increased to 78.46% at 3 years. The best survival rates were in patients with bipolar prosthesis and Gamma nails, with a 3-year survival rate of 40% and 50%, respectively. Conclusions: Patients with dementia have a higher mortality rate compared to cognitively intact patients and the treatment decisions require a multidisciplinary team and individualized recommendations for each patient, due to high surgical risk in the elderly.

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6. Testing a Psychological Intervention in Elite Athletes to Alleviate the Psychomotor Consequences of Doping: The Moderating Role of Personality

E.Colita, L.Zagrean, M.Grigore, A.Popa-Wagner

This study aimed to evaluate a psychological intervention intended to reduce the psychomotor effects of doping. The research also examined how conscientiousness and emotional stability moderated the intervention's effectiveness. The intervention was developed based on the literature and included two components: biofeedback and mental imagery/rehearsal. Athletes reported higher scores post-intervention in coordination, sports skills, overall physical condition, strength, flexibility, endurance, and general self-esteem. Similar results have been observed in previous studies related to biofeedback and mental imagery. According to the results, athletes with higher conscientiousness benefited more from the intervention in terms of coordination, flexibility, and endurance. The data support the idea that emotionally stable athletes benefit more from the intervention in terms of overall physical condition and general self-esteem. Theoretically, the studies highlight the importance of psychological interventions in enhancing athletes' psychomotor performance and the interaction between these interventions and individual differences among participants. The findings are relevant for sports psychology practitioners, as they provide additional evidence for the use of biofeedback and mental imagery with athletes.

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7. Is Serum Matrix Metalloproteinase 9 and/or D-Dimer Levels a Marker for Identifying Abdominal Aortic Aneurysms in Patients with Significant Coronary Atherosclerosis?

D.A.Brie, A.M.Jianu, R.Popescu, D.M.Brie, M.Boruga

Our research aims to find a connection between the levels of MMP-9 and D-dimers in the blood and the prevalence of AAAs in subjects with atherosclerotic coronary disease. We selected fifty patients from each group and measured their MMP-9 and D-dimer levels in the blood. We discovered that in subjects with significant coronary disease and angina pectoris, the level of MMP-9 is higher compared to the subjects with angina pectoris but without significant coronary disease. When comparing this group with those with significant coronary disease and AAA, the level of MMP-9 is lower. Additionally, the D-dimer level was significantly higher in subjects with both AAA and significant coronary atherosclerosis compared to patients with significant coronary disease alone or those without significant coronary disease or AAAs. Subjects with significant coronary disease and AAA have elevated levels of MMP-9 and D-dimer compared to patients with significant coronary disease alone or without coronary artery disease or AAAs. These two factors could be used as indicators for diagnosing AAA in patients with angina pectoris.

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8. Epidemiological and Histopathological Features of Oral Squamous Cell Carcinoma-A Retrospective Study

I. Ilie, O.C. Margaritescu, A.E. Stepan, R.N. Ciurea, M.M. Florescu, C. Munteanu, M.S. Serbanescu, C. Margaritescu

Oral Squamous Cell Carcinoma (OSCC) it was reported to be the 6th on the list of human malignant neoplasms responsible for high morbidity and mortality worldwide. We conducted a retrospective study between 2009-2019, investigating 50 such cancers hospitalized and diagnosed during this period in our institution. The purpose of the study was to establish a clinical-morphological profile of this type of cancer developed in the geographical area served by our institution. The epidemiological study highlighted the predominance of cases in men over 50 years old, mainly affecting the tongue, followed by the lips and oral floor. The histopathological study showed the prevalence of conventional cases of OSCC (70%) and the rest of the cases belonging to rarer forms (acantholytic-18%, verrucous-6%, basaloid-4% and sarcomatoid-2%). In terms of the degree of differentiation, the moderately differentiated cases prevailed (64%) and according to the TNM clinical stage, most cases were diagnosed in stage II (36%) and IV (26%). 70% of investigated cases presented muscle invasion and 38% perineural invasion. Our investigation highlighted the existence of particular morpho-clinical profiles depending on the tumor topography. Thus, tumors developed at the tongue level reached the maximum frequency in the 6th decade of life, being absent in the 8th decade and most often associated muscle invasion and perineural invasion, being diagnosed in advanced pTNM stages.

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9. Assessment of Neutrophil-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Systemic Scleroderma Patients with Focus on Cardiopulmonary Manifestations

C.Palici, S.C.Dinescu, C.E.Bita, A.Florescu, A.E.Musetescu, F.Vreju, P.L.Ciurea

To quantify levels of two inflammation-related indexes, namely neutrophil-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) in systemic scleroderma patients and determine the association with clinical manifestations and features of heart ultrasound. Methods: The study group consisted of 34 patients with diagnosis of systemic scleroderma which were admitted to the hospital during 2015-2019. Patient data included the presence and type of clinical manifestations of systemic scleroderma, chest imaging to screen for lung disease, heart ultrasound reports and the laboratory investigations needed to quantify inflammatory indexes. We analysed the levels of inflammatory indexes and compared results based on the prevalence of systemic manifestations. Results: Higher serum levels of NLR and SII are associated with the presence of joint, lung and pericardial involvement. Statistical significance was observed only for NLR levels with regard to the presence of articular involvement and ILD. Low ejection fraction was also associated with higher levels of both inflammatory indexes, without statistical significance. Conclusion: Inflammatory indexes are cost-effective markers that reflect active disease manifestations of systemic scleroderma and can thus be a useful tool to include in the regular follow-up of patients in order to better inform organ-specific assessments.

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10. The Relationship between Sleep Bruxism Index and Quality of Life

E.C.Sin, G.Raftu, S.G.Bustiuc, A.Caraiane, R.Briceag

Aim of the study: The aim of this study was represented by the identification of the type of relation between the bruxism sleep index and the global quality of life. Materials and Methods: The study group was composed of a number of 40 patients, both women and men, who did not report health problems and who were identified with a positive self-report regarding the existence of sleep bruxism. For the identification of the bruxism index, the Bruxoff device, Bioelettronica, Turin, Italy, was used. Quality of life inventory (QOLI) was used to determine quality of life scores (T-score). Results: The gender distribution of the batch is as follows: 52.5%-male, 47.5%-female. The maximum value of the bruxism index was 10.5, and the minimum was 2.10, with a mean of 6.30 and a standard deviation of 2.22. Quality of life T-score recorded maximum value equal to 62, minimum value equal to 40, mean equal to 51.87. The Pearson correlation coefficient calculated to test the correlation between the bruxism indicator and the QOLI T Score presented a negative value (-0.643), which signifies a negative but very strong relation between the two variables. 77.5% of the participants were included in a mean level of quality of life. Conclusions: A statistically strong negative relation was found between global quality-of-life (T-scores) and the bruxism indicator in patients with bruxism activity during sleep.

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11. Two-Year Outcomes in Preterm Infants Suffering from Moderate to Severe Bronchopulmonary Dysplasia with or without Associated Pulmonary Hypertension

I.Branescu, D.O.Alexandru, S.Vladareanu, A.Kulkarni

Objectives: to assess the impact of pulmonary hypertension (PH) on short and long-term respiratory and neurodevelopmental outcomes in extremely preterm infants, diagnosed with moderate to severe bronchopulmonary dysplasia (MSBPD). Study design: cohort study, with retrospective analysis of the medical records of infants born at ?32 weeks gestation admitted to a single neonatal tertiary centre from 2010 to 2020. Primary outcome was consistent with hospital re-admissions by 2 years post menstrual age. Neurodevelopment was assessed using Bayley’s Scales of Infant and Toddler Development 3rd edition (Bayley-III) as a secondary outcome. Results: 201 infants with no PH and 23 infants with PH were analysed. The PH group showed higher risk for respiratory and paediatric intensive care unit re-admission (65%) during the first 2 years of life (OR: 3.15; 95% CI: 1.28 to 7.78; p<0.5). In contrast to current published literature, our study showed that pulmonary hypertension complicating moderate to severe bronchopulmonary dysplasia had no negative impact on neurodevelopmental outcomes (OR: 1.87; 95% CI: 0.72 to 4.88; p value=0.19). However, in our population, ethnicity, chorioamnionitis and need for persistent ductus arteriosus treatment were all independently associated with poor neurodevelopmental outcomes (p values <0.5). Conclusion: infants with MSBPD associated pulmonary hypertension (MSBPD-PH) are more likely to need intensive care and respiratory hospital re-admissions. Ethnicity, chorioamnionitis and need for ductus arteriosus treatment are independently associated with poor neurodevelopmental outcomes regardless of the pulmonary hypertension status.

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12. Cutaneous Metastases of Signet-Ring Cell Gastric Carcinoma: A Case Report

G.I.Kurmus, F.Canpolat, M.Gonul, A.Gokce, S.P.Kartal

The cutaneous metastases from carcinoma of the stomach are rare and either an index of a silent visceral neoplasm or a recurrence of an already diagnosed malignancy. They usually present as asymptomatic nodules or plaques; thus, they can be mistaken for other skin conditions, which leads to a potential misdiagnosis. The definition of signet-ring cell (SRC) gastric carcinoma is that it can easily cause a diffusion enbloc through lymphatic and hematogenous pathways, inducing skin manifestations such as indurated plaques, nodules, and erysipelas-like lesions. The infrequency of skin metastasis from gastric carcinoma underlines once more the need for increased awareness on the part of clinicians. Diagnosis, histopathological examination, and immunohistochemistry are essential. The confirmation of SRC tumors is done by staining for mucin, such as periodic acid-Schiff (PAS) and mucicarmine, and by using immunohistochemical markers like CK7. Almost always, cutaneous metastasis from SRC gastric carcinoma has a poor prognosis since these tumors are highly aggressive and chemotherapy-resistant. We present a case of cutaneous metastasis from SRC gastric carcinoma, a subtype of gastric cancer with a well-documented tendency both for distant and cutaneous spread. Generally, skin metastases from SRC gastric carcinoma are associated with poor prognosis, rapid progression of the disease, and a high mortality rate. This case underlines the need for early detection and a multidisciplinary approach by dermatologists, oncologists, and surgeons to improve outcomes in such patients.

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13. Anterior Pituitary Hormones are Important in Growth, but does their Deficiency Cause Skeletal Deformity? A Case Report

Y.Yumusakhuylu, A.Icagasioglu, A.Guven

Hypopituitarism is a clinical syndrome that occurs when the anterior pituitary gland fails to secrete one or more hormones. Developmental delay is frequently seen in these patients. However, skeletal deformities and postural instability are unexceptional. We present a 17-year-old male patient with panhypopituitarism (PHP) with back and leg pain, postural malalignment, and skeletal deformities referred by the pediatric endocrinology clinic. According to the physical examination, laboratory tests, and radiographic assessments, the patient was considered as sequela spondyloarthropathy (SpA). Autoimmune and rheumatic diseases are frequently encountered in patients with hypogonadism. However, the association of PHP and ankylosing spondylitis (AS) has not yet been demonstrated. This case was presented to draw attention to the alignment of PHP and SpA and also to emphasize that skeletal deformities were not encountered in the absence of anterior hypophysis hormones.

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14. Acute Epstein-Barr Virus and SARS-CoV-2 Coinfection: A Case Report

M.E.Tesch Ferreira Alves, L.De Figueiredo Mello, F.R.Ferreira Alves

Introduction. The present case describes one of the few reported occurrences of coinfection by EBV and SARS-CoV-2, initially treated as streptococcal pharyngitis. Case Description. An 18-year-old female was admitted with whitish plaques in the throat associated with pain, cough, hoarseness, asthenia, tonsillar exudate, hypertrophy, hyperemia, and adenomegaly on the cervical region. Based on suspicion of bacterial tonsillitis, the patient was already taking amoxicillin with clavulanate. A rapid test was negative for group A streptococci. Laboratory exams revealed elevated counts of Anti-VCA IgM and Anti-VCA IgG for EBV. The cytomegalovirus (IgM and IgG) result was negative, and the blood count was within normal limits. However, a COVID-19 infection was confirmed by qPCR. The management was supportive treatment for symptom relief and isolation for 14 days. The patient remained afebrile and clinically stable during this period, with saturation ranging from 98% to 100%. However, the patient evolved with anosmia and ageusia. Then, olfaction training therapy was initiated, as well as continuing asthenia. Five days later, she presented petechiae on the chest and upper limbs, associated with mild pruritus. Conclusion. Epstein-Barr mononucleosis and COVID-19 are similar in some aspects, and their viruses may be associated with a coinfection, which could make the diagnoses difficult and aggravate the clinical condition. In addition, it is essential to emphasize the importance of laboratory tests to avoid erroneous treatments that may worsen the patient's condition and change his prognosis.

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15. Non-Alpine Thyroid Angiosarcoma Presenting with Unique Spinal Metastasis: A Rare Case Report from Pakistan

S.Faisal, H.Wali, T.Muhammad, T.E.Kamran, R.Saleem

Thyroid angiosarcoma is an extraordinarily sparse malignancy, often populating alpine regions. Clinically, thyroid angiosarcomas tend to be nonspecific in presentation, starkly dependent on site, size, extension, and metastases. Tumors are locally aggressive and can present with sudden onset pain due to intra-nodular hemorrhage and compressive symptoms from sudden expansion. Due to the disease being a scarcely reported entity, there is little scholarship regarding its management. We report an interesting case of a 63-year-old man presenting with a swelling in the neck, incidentally found to be a thyroid angiosarcoma with a first-time reported associated spinal metastasis. The patient has a uniquely presenting thyroid angiosarcoma and is the first patient to present as such within a non-alpine South Asian region.

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