rss_2.0ARS Medica Tomitana FeedSciendo RSS Feed for ARS Medica Tomitana Medica Tomitana 's Cover Implications of Tumoral Infiltrating Lymphocytes in Melanoma: PD-L1, CD4 and CD8 - Short Review<abstract> <title style='display:none'>Abstract</title> <p>Melanoma is a tumor developed by malignancy of melanocytes, being one of the most lethal cancers. Usually, it is associated with exposure to ultraviolet radiations, being most common in the skin, but can also be located extracutaneously as in the digestive tract, leptomeninges or uvea. Histopathologically it presents a phase of radial growth and a vertical one, often accompanied by an intra and peritumoral inflammatory infiltrate. Immunohistochemically, the confirmation of the diagnosis of melanoma should be accompanied by the assessment of proteomic markers of lymphocytic infiltrate such as PD-L1, CD4 and CD8. Those have a role in evaluating the prognosis and a possible prediction of the immunotherapeutic response.</p> </abstract>ARTICLE2021-09-13T00:00:00.000+00:00PD-L1 and CD8-Tumor-Infiltrating Lymphocytes Expression in Laryngeal Squamous Cell Carcinoma<abstract> <title style='display:none'>Abstract</title> <p>Studies in recent years have shown that the immune system plays an important role in the prognosis of patients with different types of malignancies. The tumor immune microenvironment has been studied in various cancers in an attempt to find new antitumoral therapies. The therapeutic blockade of PD-1/PD-L1 has revolutionized the treatment of oncological pacients, with anti-PD-L1 monoclonal antibodies having remarkable results in malignant melanoma, cervical, renal and lung cancer. In laryngeal cancer, few reports are available on the immune microenvironment and PD-L1 expression. Considering these, we retrospectively review 23 laryngeal cancer patients with laryngectomy performed in the Otorhinolaryngology Department - Emergency County Clinical Hospital St Andrew Constanta. The aim of our research was to evaluate the immunohistochemical expression of PD-L1, using combined positive score which includes both viable tumoral cells and intratumoral lymphocytes, as well as the level of CD8 intratumoral lymphocytes and to analise the corelation between these markers and the clinicopathological characteristics of the pacients, in order to set these two parameters, in the near future, as new biomarkers. PD-L1 expression was shown to be a prognostic factor for disease-free survival in laryngeal cancer patients (p = 0.006) and was higher in tumors with elevated CD8 lymphocyte levels, with a significant correlation correlation between the two parameters (p = 0.019). The level of CD8 lymphocytes was also a predictive factor for free-disease survival, correlated with patient smoker status (p = 0.04), being higher in non-smoking patients.</p> </abstract>ARTICLE2021-09-13T00:00:00.000+00:00The Most Frequent Neurological Complications in HIV Patients in Constanta and the Influence that Coinfections Have in the Onset of Such Conditions<abstract> <title style='display:none'>Abstract</title> <p>Abstract: This paper shows the results of a retrospective observational analytical study that has enrolled 166 HIV positive patients diagnosed with a neurological complication between June 2012 and June 2020, in Clinical Infectious Diseases Hospital of Constanta. 119 patients (71,69%) were diagnosed with one of the three neurological complications: HIV associated dementia (HAD), Progressive Multifocal Leukoencephalopathy (PML) and CNS Toxoplasmosis (CT). We have noted CD4 levels, viral loads, and the presence/absence of other infections like: HBV, HCV, Treponema pallidum, Mycobacterium Tuberculosis.</p> <p>The results show that PML and CT, in this order, are the main opportunistic infections with important neurological impact. Both, PML and CT are in direct correlation with the immune status, but also with other infections like the infection with HCV or with M. Tuberculosis. CD4 nadir &lt;100 cells/mmc and viral load ≥100000copies/ml have a stronger association with PML (p&lt;0,05). Patients known with HIV and T. pallidum infection are more likely, in case of new sudden neurological signs, to be diagnosed with Neurotoxoplasmosis versus PML, or HAD (p&lt;0,05). Given the fact that HIV patients can have multiple alterations of neurological functions, and spectaculous but complicated neuro imagistic results, knowing the history of the patients, the lab results, and the statistical probability can help the physician, infectious disease specialist or neurologist, to make a faster and precise diagnosis.</p> </abstract>ARTICLE2021-09-13T00:00:00.000+00:00Colon Cancer in Patients with Crohn’s Disease and Diabetes Mellitus<abstract> <title style='display:none'>Abstract</title> <p>Introduction: Diabetes mellitus and colorectal cancer are diseases with an increasing impact on the population. Colorectal cancer is a well-recognized complication of inflammatory bowel diseases, such as ulcerative colitis and Crohn’s colitis. Here we describe an unusual case of diabetes mellitus, Crohn`s colitis-associated cancer.</p> <p>Case report: We report the case of a 49-year-old woman, known with Crohn's disease and diabetes, who developed a transverse colon adenocarcinoma associated with multiple outbreaks of high-grade or low-grade intraepithelial dysplasia/neoplasia, for which a subtotal proctocolectomy with ileorecto-anastomosis with “J” pouch it was made.</p> <p>Conclusions: The risk of colonic carcinoma in Crohn's disease is increasing. An association of colorectal cancer with diabet mellitus and inflammatory bowel disease has been established. From diagnosis to treatment the management of these cases can be difficult and challenging.</p> </abstract>ARTICLE2021-09-13T00:00:00.000+00:00Performance and Consequences for Fecal Transplant in the Treatment of Pseudomembranous Colitis<abstract> <title style='display:none'>Abstract</title> <p>Under conditions of increased consumption of antibiotics, pseudomembranous colitis has become a common condition in Romanian hospitals. Severe forms of the disease are becoming more common, recurrences are numerous, and metronidazole and vancomycin therapy has failed to prevent these recurrences. The study aims to identify the characteristics of patients who require a fecal transplant, the time for its performance and what are the short-term and possibly long-term consequences of this method.</p> <p>We analyzed 26 patients who had a fecal transplant with a favorable evolution in 96%. We consider that FMT is an effective method for preventing recurrent CDI but also for those with resistance to the usual antibiotics.</p> </abstract>ARTICLE2021-09-13T00:00:00.000+00:00Nephrotic Syndrome Associated with Hydronephrosis and Unilateral Renal Agenesis<abstract> <title style='display:none'>Abstract</title> <p>We reported a case of nephrotic syndrome in a child presenting undiagnosed hydronephrosis and unilateral renal agenesis in a 3 years and 9 months old male patient presenting features of nephrotic syndrome, with left hydronephrosis and unilateral renal agenesis. The association of nephrotic syndrome with congenital anomalies is extremely rare. The importance of this unusual combination was discussed respecting the literature.</p> </abstract>ARTICLE2021-09-13T00:00:00.000+00:00The Efficiency of the Fight Against HIV, in Constanta, from the Perspective of Neurological Complications<abstract> <title style='display:none'>Abstract</title> <p>In order to control and end the AIDS epidemic, we all need to hit the 0-0-0 target. That means 0 HIV infections, 0 mortality caused by AIDS and 0 discrimination. We performed a retrospective observational analytical study on 166 HIV positive patients with a neurological complication, diagnosed between June 2012 and June 2020, in Clinical Infectious Diseases Hospital of Constanta. We collected data from the observational charts that revealed if the patient was known with HIV infection at the time of the neurological complication diagnosis, information about the treatment (how many treatment regimens, classes of antiretroviral drugs, CNS Penetration-Effectiveness Rank), treatment compliance. The patients were divided into two groups: first group “opportunistic infections (OI)” and second group “other neurological conditions (ONC)”. 16 patients (9,6%) have the neurological condition as first manifestation of HIV infection. Opportunistic infections, correlated with a poor immunological status continue to have a high percentage (46,98%) of neurological complications, being associated with a poor treatment compliance (p&lt;0,001). Integrase inhibitors were associated, in this study, more with opportunistic infections and less with other neurological conditions (OR=2,885; 95% IC), this finding needs further research. Long term survivors have problems with treatment compliance manifesting treatment fatigue, even if they have treatment regimens with good CNS penetrability. Poor compliance is associated with high risk of opportunistic infections and opportunistic infections have a higher mortality than other neurological complications. Our task for the future is to find ways to improve treatment adherence in order for HIV patients to have a better and longer life.</p> </abstract>ARTICLE2021-09-13T00:00:00.000+00:00Vicios Appendix Position Clinical Case<abstract> <title style='display:none'>Abstract</title> <p>The purpose of this article is to present a rare, particular case of intestinal anatomy, intraoperatively evidenced as a vicious position of intestine determined by nonrotation of primary intestinal loop.</p> </abstract>ARTICLE2021-09-13T00:00:00.000+00:00Acute Myocardial Infarction in a Young Male with Ankylosing Spondylitis – Case Presentation<abstract> <title style='display:none'>Abstract</title> <p>Cardiovascular risk scores are useful in early detecting and, most important, early correcting the cardiovascular risk factors in order to prevent the cardiovascular disease, but the most commonly used charts have essential limitations when applied to young adults.</p> <p>We present the case of a 39-year-old man, known with HLA-B27-positive ankylosing spondylitis for 15 years, treated only with nonsteroidal antiinflamatory drugs, without any traditional cardiovascular risk factors, who was diagnosed with severe coronary artery disease, sub-occlusion in the proximal and mid-segment of the left anterior descending artery, which required emergency percutaneous coronary intervention with drug-eluting stent implantation. In this case report we aim to highlight the necessity of considering other parameters such as C-reactive protein levels or carotid plaques when estimating the risk of developing a cardiovascular disease, especially in young adults diagnosed with chronic inflammatory disease.</p> </abstract>ARTICLE2021-09-13T00:00:00.000+00:00About Lung Cancer in Romania and Constanta County<abstract> <title style='display:none'>Abstract</title> <p>Abstract: In Romania lung cancer represents the second most common cancer after breast cancer, for both sexes, and is the leading cause of death among patients with cancer.</p> <p>Between 2011 and 2019 the incidence of cancer had a growing trend for both Romania and Constanta County. Unfortunately, the forecast regarding the incidence of cancer in Romania shows a trend of continuous rise of new cancer cases until 332.7%000 inhabitants by 2025.</p> <p>In these conditions we wanted to analyze some aspects of lung cancer situation in Constanta County.</p> </abstract>ARTICLE2021-09-13T00:00:00.000+00:00Complex Polypathology Infectious, Rheumatological, Neurological and Orthopedic – Real Challenge for Functional Rehabilitation - Case Report<abstract> <title style='display:none'>Abstract</title> <p>Introduction. Infectious and autoimmune rheumatic diseases (ARDs) are closely linked. Apart from the challenging, sometimes differential, diagnosis between these conditions, it is recognized that microbes play an important role in the pathogenesis of the latter. Material and method. We present the case of a 45-year-old female patient from our rehabilitation department, with complex pathology (infectious, neurological, rheumatological and orthopedic pathology) that began more than 15 years ago. The patient’s pathological history began insidiously at theage of 30 when she was diagnosed with neurotoxoplasmosis. She received anticoagulant, antiepileptic, steroidal, antibiotic and antihelmintic treatment. After four years, the patient shows insidious onset of inflammatory pain in the large joints and in 2010 is diagnosed with seropositive rheumatoid arthritis, according to American College of Rheumatism/European League against rheumatism (ACR/EULAR) criteria with symmetric impairment of the large joints (shoulder, elbow, hip, knee, ankle). Despite the treatment with disease-modifying anti-rheumatic drugs (DMARDs) received, in the following years she needed 4 arthroplasties in the large joints due to osteonecrosis. Conclusions. On clinical grounds, infections, especially chronic infections, can cause a plethora of autoimmune phenomena, thus mimicking ARDs. Therefore, the differential diagnosis between ARDs and infectious diseases is sometimes challenging as they often display similar clinical manifestations. It is highlighted that the immune system can be our friend or our foe considering that its function and dysregulation are the common denominators in autoimmune and infectious diseases. In the era of new drugs and new therapeutic strategies, safety of the patients should always be our first concern.</p> </abstract>ARTICLE2021-07-01T00:00:00.000+00:00Multivisceral Resection of Advanced Sigmoid Colon Cancer<abstract> <title style='display:none'>Abstract</title> <p>Introduction: Colorectal cancer is one of the most common digestive malignancies, with a high mortality and morbidity rate, with nonspecific symptoms in the early stages and with a diagnosis in the advanced stage most often. In a significant percentage there are cases in which tumors with invasion in the border organs and multiorgan resections are required. In women, the invasion frequently occurs in the vagina, uterus and bladder.</p> <p>Case report: We report the case of a 52-year-old woman, who presented in the Department of Surgery with the following complaints: fecaluria, pneumaturia, constipation and moderate abdominal pain, with onset of 4 months, in wich the patient neglected her symptoms. Following the investigations, a large tumor formation of sigmoid colon was diagnosed, with invasion in the uterus and bladder, with which it communicates through a 16mm fistula. The result of the biopsy was of low / moderate grade adenocarcinoma differentiated G2. Cystoscopy revealed bladder trigone invasion without being able to identify ureteral orifices, biopsy and urine cytology was also positive for cancer. The surgery was performed by a multidisciplinary team and a multivisceral resection was performed.</p> <p>Conclusions: Multiorgan resections require trained, experienced teams, and oncological pathology raises special issues when it comes to radical visa. The management of invasive colonic tumors in the border organs must be established preoperatively, in agreement with the patient, because it involves problems related to the quality of life and the potential for survival.</p> </abstract>ARTICLE2021-07-01T00:00:00.000+00:00Indicators of Iodine Status in Pregnancy and Postpartum in a Group of Pregnant Women from Perimarine Area of Romania<abstract> <title style='display:none'>Abstract</title> <p>Objective: Assessment of iodine nutritional status in pregnant women in the perimarine area of Romania, a region without iodine deficiency. Adequate iodine intake is the main source for normal thyroid function, ensuring the need for maternal thyroid hormones during pregnancy, but also for the development and growth of children in the fetal and postpartum period.</p> <p>Material and method: Prospective study performed on 74 pregnant women in the first 2 trimesters of pregnancy, originating from the perimarin area. The following indicators of iodine status were analyzed: urinary iodine concentration (UIC), the ratio between urinary iodine concentration and urinary creatinine (UIC/UCr), the prevalence of maternal goiter and the value of neonatal TSH (thyroid stimulating hormone). Results: The mean gestational age was 11 weeks. The ways of iodine intake are: iodized salt - 59.4%, iodized salt and iodine supplements- 23%, only iodine supplements -10.8% and 6.8% consume only non-iodized salt. The median of UIC was 133.03 mcg/l considered insufficient iodine intake (normal in pregnancy UIC &gt;150 mcg/l), but the adjustment of UIC to urinary creatinine reveals a median of 152.83 mcg/g, a value that reflects an adequate iodine intake. The prevalence of goiter was 25.6% characteristic for a moderate iodine deficiency. The prevalence of neonatal TSH &gt;5 mIU/L was registered in 18.8% characteristic of mild iodine deficiency. Conclusions: Monitoring of the iodine nutritional status is recommended for the prevention of disorders due to iodine deficiency under the conditions of universal salt iodization. Perimarine areas considered sufficient in iodine may show variations in iodine status in subpopulations under certain physiological conditions, such as pregnancy. An indicator of iodine status of the population is UIC, but the UIC/UCr ratio may be a more optimal indicator for pregnant women, to avoid possible overestimated results of iodine deficiency in pregnancy.</p> </abstract>ARTICLE2021-07-01T00:00:00.000+00:00Diagnostic and Therapeutic Challenges in Hepatocellular Carcinoma<abstract> <title style='display:none'>Abstract</title> <p>Introduction: Early detection of hepatocellular carcinoma is essential to provide effective therapy to high-risk patients, including patients with viral cirrhosis (eg HBV, HCV), haemochromatosis, alpha 1 antitrypsin deficiency or alcohol users.</p> <p>Material and method: The group of patients studied was represented by patients from the records of the Medical Clinic I of the Clinical Hospital “Saint Andrew the Apostle” Constanța for a period of 3 years (2017-2019). We included 82 patients aged between 32 and 82 years (60.22 ± 10.66 years) of which 55 were male and 27 were female.</p> <p>Results: Out of a total of 82 patients, 74 (90.25%) had cirrhosis (CH) and a number of 8 patients (9.75%) had chronic hepatitis without cirrhosis. Child-Pugh stage B had the highest prevalence among patients with hepatic cirrhosis. The etiological factor was hepatitis C virus infection 46 patients (56.1%), followed by hepatitis B virus infection 23 patients (28.05%), 4 patients (4.87%) had double hepatitis virus infection ( HBV + HCV), and 9 patients (10.98%) had a mixed viral and ethanolic etiology. Most of the lesions were located in the right hepatic lobe 58 patients (70.74%), respectively right + left hepatic lobe 22 patients (26.83%) and in 2 patients (2.44%) there were no visualized liver nodules. All patients had parenchymal fibrosis.</p> <p>Conclusions: It is recommended to screen patients with chronic liver disease to assess the risk of developing hepatocellular carcinoma, initially by liver ultrasound that can accurately detect and locate suspected nodules later the definite diagnosis of hepatocellular carcinoma is confirmed by magnetic resonance imaging (MRI).</p> </abstract>ARTICLE2021-07-01T00:00:00.000+00:00Monitoring Dysfunction after Stroke Sequelae in Patients undergoing Hydro-/ Thermo-/ Kinesio-Therapy<abstract> <title style='display:none'>Abstract</title> <p>Stroke is an important health problem generating a set of musculoskeletal and cognitive consequences that significantly affect the patient’s clinical-functional status and quality of life, as well as the effectiveness of the recovery treatment. Hydro-/ thermo-/ kinesio-therapy with water from Lake Techirghiol, known for its special properties, is also used for patients with neurological disorders and consists in immersing the patient in the therapeutic pool with specific exercises under the strict supervision of specialized medical staff. The aim of this study is to analyze the effects of Lake Techirghiol water on the functional deficit in patients with post-stroke sequelae. In this sense, 200 patients who were hospitalized in the Balneal Rehabilitation Sanatorium of Techirghiol, Constanta County, Romania during 2018-2020 were included in the study and they were divided into two groups: patients from group 1 performed on a daily basis, for 12 days, hydro-/ thermo-/ kinesiotherapy and other physical-kinetic procedures, and the patients from group 2 performed on a daily basis, for 12 days, only physical-kinetic procedures, without hydro-/ thermo-/ kinesio-therapy. Patients’ assessment was made based on the Functional Independence Measure scale and a better evolution was observed in the patients who performed hydro-/ thermo-/ kinesio-therapy as compared to those who did not perform this procedure, in the sense of a diminution of the functional deficit by making self-service activities easier and by improving gait disorders and transfers. We consider appropriate that we extend the period of patients’ treatment and follow-up in our next research so as to highlight, if relevant, any notable changes in terms of increasing functional independence also in the case of patients undergoing land-based kinesiotherapy.</p> </abstract>ARTICLE2021-07-01T00:00:00.000+00:00Correlations Between Respiratory Manifestations And Nutritional Status In Children With Cystic Fibrosis<abstract> <title style='display:none'>Abstract</title> <p>Background: Cystic fibrosis is a multisystemic genetic disease with autosomal recessive transmission, with progressive clinical evolution and potentially fatal, predominantly found in the Caucasian population. It is characterized by chronic lung disease and malabsorption caused by exocrine pancreatic insufficiency.</p> <p>Objective: Screening of patients with persistent respiratory disease and malabsorption syndrome to diagnose cystic fibrosis and monitoring the correlation between respiratory manifestations and nutritional status.</p> <p>Methods: A retrospective study on 8 patients diagnosed with cystic fibrosis, from Department of Pediatrics - Constanta County Emergency Hospital, during the period from 2015 to 2018.</p> <p>Results: 8 patients were diagnosed by genetic test for 34 mutations and polymorphism of CFTR gene; 2 homozygous patients with ∆F508 mutation (second class of mutations) with severe disease, 2 heterozygous patients with ∆F508 mutation del 2,3; 2 heterozygous patients with ∆F508 and R553X mutations, 1 heterozygous patient with N1303K and 394delTT mutations, 1 heterozygous patient with 2183 AA96 and ∆F508 mutation; 7 out of 8 patients were diagnosed in the first year of life by performing the sweat test, with values higher than 120 mmol/L.</p> <p>Clinical manifestations at onset were represented by diarrhea and failure to thrive in 4 cases and in 4 cases respiratory manifestations were associated. More than half of cases had less than 6 months of age at first respiratory exacerbation, which was associated with failure to thrive. Analyzing the correlation between genotype and anthropometric indicators, it was observed that the weight was more affected than the height. The analysis between nutritional status and lung function revealed that obstructive respiratory dysfunction with low FEV1 was correlated with nutritional status.</p> <p>Conclusion: Cystic fibrosis is a severe genetic disease and it is important to diagnose early, because it has been observed that if the diagnosis is established late, the consequences will be severe and lung function will deteriorate earlier.</p> </abstract>ARTICLE2021-07-01T00:00:00.000+00:00Primary Pulmonary Small B-Cell Non-Hodgkin Lymphoma -Case Presentation-<abstract> <title style='display:none'>Abstract</title> <p>Primary pulmonary non-Hodgkin lymphoma is a rare entity, accounting for 3-4% of extranodal non-Hodgkin lymphomas. Indolent primary pulmonary non-Hodgkin lymphomas are the most frequent types, with the MALT subtype representing majority of cases. Other indolent subtypes of B-cell primary pulmonary lymphomas are rare. We present the case of a 56-year-old patient, non-smoker, who presents for pain in the right hemithorax, worsened by deep inhales. Pulmonary X-ray showed a right paramediastinal superior and medial lobe homogenous opacity with faded contour. Thoracic computed tomography scan described a dense right superior mediastino-pulmonary tumoral mass, the absence of hilar or mediastinal adenopathies. In this context, an ultrasound-guided transbronchial needle aspiration was performed. Histopathology and immunohistochemistry confirmed the diagnosis of primary pulmonary small B-cell non-Hodgkin lymphoma. After 6 chemotherapy cycles, from a clinical and imagistic (thoracic CT scan) point of view, the response was favourable. Positron emission tomography (PET/CT) aspect indicated a complete metabolic response to treatment.</p> </abstract>ARTICLE2021-07-01T00:00:00.000+00:00Anhydrotic Ectodermal Dysplasia – A Cause of Prolonged Fever in Infant<abstract> <title style='display:none'>Abstract</title> <p>Ectodermal dysplasia is a group of conditions characterized by abnormal development of ectodermal tissues including the skin, hair, teeth and sweat glands. Anhidrotic ectodermal dysplasia (Christ-Siemens-Touraine Syndrome) is only one of this large and heterogenous group, but is the most frequent. An inability to sweat (anhidrosis) can lead to high body temperature (hyperthermia), because the body cannot cool itself by evaporating sweat. The authors present the diagnostic difficulties in an infant with this condition, in which prolonged fever was the dominant symptom.</p> </abstract>ARTICLE2021-07-01T00:00:00.000+00:00Correlations between Biochemical Markers in Thyroid Pathology with those in Carbohydrates Metabolism<abstract> <title style='display:none'>Abstract</title> <p>Thyroid dysfunction is increasingly found in patients with diabetes. Diabetes can affect thyroid function to a variable extent and unrecognized thyroid dysfunction, not only worsens metabolic control, but also prevents the management of diabetes. The aim of this study was to screen the incidence of thyroid disease in Constanta County, Romania in patients diagnosed with type II diabetes, in order to assess the tendency to associate thyroid hormone dysfunction with the diabetic process by correlating glycemic parameters and thyroid profile in serum. The study included a number of 153 patients who presented within 3 months for blood tests, in compliance with GDPR rules. The following parameters were processed from these patients: FT3 - free triiodothyronine, FT4 - free thyroxine, TSH - thyroid stimulating hormone, Anti-TPO - thyroid peroxidase antibodies (anti-thyroid peroxidase), Serum glucose, Glycosylated haemoglobin - HbA1C. In patients of both sexes studied, the mean TSH was 3.15 IU / ml, males’ TSH mean being 2.82 IU / ml and higher, but not above the maximum limit. Blood glucose ranged from an average of 92.11 mg / dl in the 153 patients, 92.41 mg / dl in male patients and 93.82 mg / dl in female patients. Glycated haemoglobin (%) ranged from 6.79% in female patients to 6.21% in male patients, with a mean of 6.5%.</p> <p>Pathology derived from disorders of carbohydrate metabolism may be present in patients with thyroid changes.</p> </abstract>ARTICLE2021-07-01T00:00:00.000+00:00Subcoracoid Impingement – A Global View<abstract> <title style='display:none'>Abstract</title> <p>Modifications in joint anatomy on both soft and bony tissue level play a key role in subcoracoid impingement syndrome. The diagnostic is primarily clinical and is based on patient history and functional tests. Imaging tests support, but do not establish the diagnostic. Approach can take the form of targeted exercises with progressive load, or that of invasive surgery.</p> <p>Shoulder pain has a diverse etiology which derives from the complex local anatomy which includes the clavicle, acromion, coracoid process and humeral head, the soft tissues surrounding this area, in particular the rotator cuff, but can also be unrelated to all of the above and be a reflection of a pathology located in the neck, arm or trunk, or adjacent visceral organs. More often, it is the manifestation of a traumatic episode or an anatomical anomaly, or it can be secondary to inflammation, tumors, or surgery.</p> <p>It is the third most common musculoskeletal complaint presenting to physiotherapy, and largely impacts both an individual’s quality of life and the public health system.</p> <p>Coracoid impingement syndrome can present itself as a cause of rotator cuff disease, but its role is not fully established yet. It is less prevalent than subacromial impingement, can coexist with it, and therefore should be considered into the differential diagnosis of anterior shoulder pain when a patient presents themselves with activity related anterior shoulder pain.</p> </abstract>ARTICLE2021-07-01T00:00:00.000+00:00en-us-1