Summary

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Starting December 2019, in China, the SARS-CoV-2 infection became a local health issue, but its high infectiveness quickly turned it into a pandemic, to be declared an epidemiological emergency of international concern less than two months from identifying the first cases. Despite tremendous efforts aimed at discovering new drug classes that would slow down or stop the evolution of the COVID-19 disease and curb the number of severe cases and related complications, there is no specific antiviral treatment to date. The only efficient measure proved to be the prophylaxis, through vaccination.
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University of Medicine and Pharmacy “Carol Davila”

Options of Treatment in SARS-CoV-2 Infections

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<bold>Background:</bold> The coronavirus disease (COVID-19) pandemic and the lockdown imposed due to it have served as a major setback to tuberculosis (TB) control. We therefore conducted this study to assess the profile of TB patients presenting to our department immediately after COVID-19 lockdown, which was imposed in India from 24 March 2020 and continued for >3 months, and to compare it with the pre-pandemic pattern.
<bold>Methods:</bold> This was an observational study conducted at the pulmonary medicine department of our tertiary care institute. We evaluated the consecutive cases of TB referred to or diagnosed new by our department as soon as the lockdown was lifted and non-COVID services resumed. The data of 2020 and 2019 during September and October month were gathered and analysed retrospectively.
<bold>Results:</bold> A total of 162 patients were hospitalised from September to October 2019, while 40 non-COVID patients were hospitalised during September to October 2020 in our unit. The mean duration of symptoms was 1 month in both the groups. The incidence of TB cases amongst the patients needing hospitalisation after lockdown was more in 2020 [57.5%; 23 diagnosed TB cases (12 males and 11 females) out of 40 non-COVID hospitalised cases] than in 2019 [13.5%; 22 diagnosed TB cases (13 males 9 females) out of 162 hospitalised cases], and this was statistically significant (chi-squared test: p &lt; 0.00001). There was a statistically significant increase in transfers to the TB hospital where patients requiring further long-term medical care were referred to; in 2020 (12.5%; 5 out of 23 diagnosed TB cases) as compared with those in 2019 (0 out of 22 diagnosed TB cases) (p = 0.049, Fischer’s exact test). There was a statistically significant increase in the duration of hospital stay in 2020 than that in 2019 (p = 0.0076, unpaired t-test). There was no statistical difference in occurrence of pulmonary versus extrapulmonary TB (EPTB) or in occurrence of complications of TB in the two years.
<bold>Conclusion:</bold> The COVID-19 pandemic and its lockdown have skewed the profile and pattern of the clinical manifestations and the complications of TB with a more severe trend.
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Tuberculosis at the time of Coronavirus disease (COVID-19) lockdown - Back to the days of yore!!!

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Few patients are fortunate enough to get detected in the early stages of tumors whether benignant or malignant. This chance, with multiple hidden ethical issues, has pitfalls for both doctors and patients. We are presenting two cases, a male and a female with diagnosis problems successfully managed even if they are not convinced about the necessity of the surgery. The male, aged 63 years, non-smoker, with occupational exposure for 41 years, oligosymptomatic, during a preoperative routine X-ray and thorax CT for a left hydrocele operated in June 2020, was identified an acidophilic tumor formation, located in the anterior mediastinum. Additional investigations revealed a left vocal cord paresis and the transthoracic needle biopsy raised suspicion of thymoma with glandular areas and clear cells, also confirmed by surgery, an N0 stage. In the second case, a 42 years female with a recent history of SARS-COV-2 viral infection, mild clinical form, while performing a CT scan to assess COVID status, discovered a tumor mass located in the anterior mediastinum. ENT examination establishes the diagnoses of subacute laryngitis, dysphonic syndrome under etiological observation, and chronic rhinitis. The excision of the mediastinal formation is performed with favorable postoperative evolution. Histopathological examination highlighted changes that argue the diagnosis of mature intrathymic teratoma. Apparently, there were fortunate cases with curative resection, but being oligosymptomatic also involved substantial efforts to convince the patient and the caregivers about the need for urgent surgery.
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Oligosymptomatic tumors – Traps for doctors and patients

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Invasive testicular cancer develops from carcinoma in situ (CIS)/testicular intraepithelial neoplasia (TIN), and these histological types are often identified in residual non-malignant testicular tissues. The objective was to highlight the need for an immediate multidisciplinary approach in a case of seminoma with lung metastases in a young patient, to approach optimal therapeutic behaviour. We present the case of a 33-year-old patient, a smoker, who presents with an influenced general condition, bilateral crackling rales, the right testicle slightly enlarged in volume. Emergency chest radiography raises suspicion of lung metastases. Computed tomography (CT) sustains the suspicion of secondary malignancies, which is why the pulmonary formation is approached endobronchial, having as a histopathological result seminoma metastasis. Blood tests, before urological intervention show an alpha-fetoprotein (AFP) = 11.05 mUI/mL, beta human chorionic gonadotropin (hCG) = 20.47 mUI/L, lactate dehydrogenase (LDH) = 754 U/L, subsequently performing right radical orchiectomy (2016), pT1N3M1a-stage IIIB. Repeating the blood tests after the fourth chemotherapy session [bleomycin, etoposide and cisplatin (BEP)] reveals a normalisation of AFP = 0.4 mUI/mL, beta hCG &lt; 0.1 mUI/L, LDH = 276 U/L results, and at positron emission tomography-computed tomography (PET-CT) examination the pulmonary tumour formations were not metabolically active. Subsequently, lung metastases were removed by laser surgery (2020), with significant resorption and preservation of healthy lung parenchyma, and is classified according to the TNM8 staging in stage IV-pT3N0M1a. The particularity of this case was the multiple pulmonary secondary malignancies, which, although imagistically persisted, were not metabolically active, and is interpreted as remainings after oncological treatment. Considering the modifications, the advanced stage and the estimated prognosis, the case can be summarised as a therapeutic success.
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University of Medicine, Pharmacy, Science and Technology „George Emil Palade”

Surgery for lung metastases in a testicular seminoma

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SARS-CoV-2 is a new virus belonging to the Betacoronaviruses genus, from the Coronavirus family. The main clinical symptoms encountered in COVID 19 are fever, cough and shortness of breath and they have been affecting more than 80% of patients. Compared to the patients that are infected with MERS Co-V or SARS-Co-V, where diarrheal syndrome was present in approximately 25% of cases, in SARS-Co-V 2 infection, diarrhea syndrome is present in less than 10% of cases.
Clinical case: A 59-year-old patient, smoker, known to have a history of cardiovascular disease and type II Diabetes, presented to the emergency unit with fever, productive mucopurulent cough and multiple diarrhea stools. Pulmonary radiography was performed and showed multiple oval opacities with a tendency to confluence disseminated basally bilateral. A RT-PCR SARSCo-V-2 test was performed with a positive result. The patient was admitted to the hospital and received specialized treatment during which the previous symptoms gradually recovered, including diarrhea syndrome. After 4 days of treatment, the diarrhea of the stools reappeared, and it was decided to investigate for Clostridium Difficile. The test proved to be positive. Treatment was established according to the protocol with favorable clinical and biological evolution.
Conclusions: The newly diagnosed diarrhea syndrome in a hospitalized patient should constantly raise the suspicion of a Clostridium Difficile infection, which may worsen the prognosis of patients infected with SARS-CoV-2.
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‘Ovidius’ University of Constanta- Doctoral School of Medicine, University Alley

Diarrheal syndrome in SARS CoV2 infection

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Sarcoidosis is a chronic systemic inflammatory disease with unknown etiology, whose diagnosis is based on suggestive symptoms/imaging, histopathological examination with non-caseous granuloma, and exclusion of other etiologies. Corticosteroid therapy is the treatment of choice for moderate/severe forms, but medication intolerance or unfavorable evolution may require immunomodulatory therapy. A 40-year-old patient known with poly-allergy was hospitalized for resting dyspnoea, dry cough, night sweats, and itching. Objective examination identifies roughened breathing, wheezing and SpO2 = 98%. Spirometry shows a medium mixed ventilatory dysfunction. Computed tomography (CT) describes multiple mediastinal lymphadenopathies and inhomogeneous hepatomegaly. Osteomedullary biopsy refutes the suspicion of lymphoma. Bronchoscopy detects bronchial hypervascularization. Due to the suggestive imaging context, a transbronchial biopsy was performed (EBUS-TBNA) from the mediastinal lymphadenopathy. Histopathological examination suggested sarcoidosis: granulomas with epithelioid histiocytes, without caseous necrosis, associated with Langerhans cells and lymphocytes. We initiated corticosteroid therapy, but the patient had an allergic reaction that required the interruption of treatment and administration of methotrexate. After eight months, the clinical and imaging aspect worsened, and we replaced the treatment with cyclophosphamide. However, side effects occurred after a few months, it was replaced with azathioprine. The patient’s condition deteriorates significantly with desaturation. We requested a consultation with the ‘Sarcoidosis Center’ in Rotterdam, which recommended treatment with anti-TNF-α or human immunoglobulin. The patient shows a slightly favorable evolution under human immunoglobulin. The poly-allergy and drug intolerance, including corticosteroid therapy, led to the initiation of immunomodulatory therapy for a young patient with moderate/severe sarcoidosis. The choice of medication was difficult due to the side effects.
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Department of Pulmonology, George Emil Palade University of Medicine

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures

Therapeutic challenges in a case of sarcoidosis

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<bold>Background:</bold> Central nervous system (CNS) tuberculosis (TB) accounts for 1% of all cases of TB and is a major cause of mortality and morbidity. Cerebral tuberculomas represent 30% of CNS TB and is a diagnostic challenge.
<bold>Case presentation:</bold> A 42-year-old male patient, known with alcoholic cirrhosis, performs a cerebral computer tomography (CT) after a lipothymic episode accompanied by right hemiparesis, which showed multiple parenchymal ring-lesions (inflammatory-infectious substrate/secondary tumours). Subsequently, the thoracic-abdominal-pelvic-CT-scan reveals micronodular diffuse pulmonary infiltrate and right pleural effusion. Cerebral Magnetic resonance imaging (MRI) describes bilateral infra/supratentorial lesions, raising the suspicion of tuberculomas. HIV serology was negative, cerebrospinal fluid showed no pleocytosis, but high protein level, pleural lymphocytosis in the pleural effusion and positive GeneXpert test in bronchial aspirate. The diagnosis of military TB with cerebral tuberculomas was established. The outcome was favourable under antituberculous treatment initially associated with corticosteroids. At two months the patient had a significant improvement in pulmonary lesions, but while some cerebral lesions decreased in size other lesions increased (paradoxical reaction). At the 14-month end-of-treatment re-evaluation there was an important regression in number and size of the brain lesions.
<bold>Conclusions:</bold> The diagnosis of cerebral tuberculoma remains a challenge for the clinician due to non-specific clinical and radiological findings. The survival rate is over 80% with early diagnosis and correct treatment.
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Cerebral tuberculosis - a diagnostic challenge

Testing strategy for COVID-19 in India – A need to move further ahead from purposive testing to a clinical testing strategy

AHEAD OF PRINT

Volume 71 (2022): Issue 4 (December 2022)

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Pneumologia

 Pneumologia is the journal of the Romanian Society of Pneumology, being continuously edited since 1951. Pneumologia is an open-access journal, edited in English, 4 issues per year and is included in international databases. It publishes clinical and experimental research articles in the field of respiratory medicine, paediatrics, thoracic surgery, allergology, respiratory intensive care and oncology.  Pneumologia aims to publish scientifically valid papers, related to the respiratory field, offering a good visibility of the published papers. It is also an educational platform for physicians, educators interested in this domain, and aims to promote research and good clinical practice.  Pneumologia publishes original articles in the field of respiratory medicine, paediatrics, thoracic surgery, allergology, respiratory intensive care, and oncology. The following types of submissions are accepted:   Original research papers  Case reports  Reviews  Letters to the editor  Educational materials: practice guidelines, new techniques description and use  News, chronicles   All submitted papers are confidentially peer-reviewed in a timely manner, by at least two independent reviewers selected according to the topic of the article. The peer-review process aims to check the originality, scientific validity, and coherence of the submission.  Pneumologia offers fast publication; the eligible submissions are typically published within 3 months. There is no publication fee, and the online version is available open access on the Journal’s web site. The printed journal is distributed to the members of the Romanian Society of Pneumology and several public libraries.  Romanian and international authors are welcome to submit papers to Pneumologia, which is one of the few journals specifically dedicated to respiratory medicine in the region.  Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process.  Back issues www.pneumologia.eu/en/all-articles arhiva.pneumologia.eu/ 