Volume 15 (2018): Issue 1 (March 2018)

Patients recently diagnosed with diabetes mellitus need to go to a complex evaluation regarding not only glycaemia and HbA1C, but also blood pressure values, lipid metabolism, kidney function, medical history and lifestyle choices. Cardiovascular risk assessment can reveal which patients fall into moderate and high categories of risk, where regular follow-up and intensive therapy addressing all the risk factors must be strictly performed. We selected a group made of 385 diabetes mellitus type II patients, a representative for the whole population of newly diagnosed diabetic patients from our county in 2017. We determined their anthropometric indicators, their biochemical parameters, their lifestyle choices and we assessed their coronary heart disease risk at 10 years using UKPDS risk engine.

Introduction. Dilated cardiomyopathy (DCM) is characterized by global cardiac dilation associated with left ventricular (LV) systolic dysfunction without valvar substrate or ischemic heart disease. Diagnosis of idiopathic DCM can only be sustained after excluding other nongenetic causes.

Methods. This study was performed on a cohort of 256 patients who died in Emergency County Hospital of Oradea and had diagnosis of DCM; the study was performed on a period of 2 years, from January 2014 until the end of December 2015. These patients were differentiated according to social criteria, background, department of admission, number of autopsies and co-morbidities.

Results and Discussion. Diagnosis of DCM was more common in male patients up to the age of 70; after this age the tendency is towards equalization. In patients aged 61-80 years, DCM played a major role in tanatogenesis. Existing clinical trials have shown that patients with idiopathic DCM have a lower mortality than patients with cardiac ischemic disease.

Conclusions. Despite the possibility of diagnosis with increased sensitivity and the large number of therapeutic options, multicentre studies and registries are needed to improve the life expectancy of these patients.

Bihor is a county in north-western Romania with a population of approximately 600000. One ⁽⁵⁾ study performed at the beginning of this decade addressing diabetes epidemiology in Romania demonstrated a high prevalence of diabetes in Bihor, the cause being the obesity ⁽¹⁾ epidemics as consequence of inadequate diet (high lipid content, refined sugars) and physical inactivity. Our study demonstrates the increasing prevalence (4.71% in 2011 vs. 5.24% in 2016) of diabetes in the county. Also by analyzing different epidemiological parameters we determined the profile of the newly diagnosed diabetes patient in Bihor including only the patients diagnosed in 2016 and 2017. The newly diagnosed diabetic patient is more often female than male (52.78% vs. 47.22%), from urban environment (51.84% vs 48.16%), belongs to the age group 47-65 years (57.35%), is obese (54.47%) is affected by hypertension (70.65%), dyslipidemia (72.3%), is smoker in 23.56% of cases and sedentary in 30.50% of cases.

Obstructive sleep apnea syndrome (OSAS) is one of the most common conditions that occur during sleep. OSAS involves the existence of at least 5 breathing breaks of at least 10 seconds in a sleeping hour.

OSAS etiologic factors are numerous, the most important being the increased body weight of patients (a high percentage of 50% of patients with OSAS with different degrees of obesity), age (OSAS is diagnosed in middle-aged people), craniofacial deformities, multiple pathologies leading to narrowing of the upper airways, gender (is more common in men), genetic causes (more common in black and Hispanic people), alcohol, tobacco, hypnotic and sedative medications.

Symptoms of OSAS are characterized by daytime and night-time symptoms. Of the daytime symptoms, patients frequently report headache and morning fatigue, daytime somnolence, memory impairment and concentration. Of the nocturnal symptoms, the most common symptoms experienced by patients are snoring and repeated episodes of apnea. Patients also report nocturia, polakiuria, decreased libido, symptoms that are often attributed to other pathologies. Due to concentration disturbances and low cognitive performance among patients with OSAS, they will experience a decrease in work capacity, which is reflected by the loss of work, reflected by the decrease in the number of working days.

OSAS treatment is complex, different depending on the severity of the disease and the existing comorbidities of the patient.

Atrial fibrillation (AF) is the most common rhythm disorder worldwide, becoming epidemic. Heart failure (HF) is a life-threatening disease and addressing it should be a priority. In this paper, we analyse recent progress on the relationship between HF and AF. The interdependence between AF and HF has not been elucidated and therefore remains an area of interest for research. It is estimated that both the incidence of AF and HF will increase significantly in the next decades worldwide, there will be a significant problem for health systems in several countries. It remains imperative to urgently promote additional research on epidemiology, mechanisms and treatment of AF and HF.

Introduction. Cryptogenic organizing pneumonia (COP), first described in 1985 as BOOP bronchiolitis obliterans organizing pneumonia, is an acute inflammatory disease characterized histopathologically by intracellular granulomas formed by connective tissue and miofibroblasts (Masson bodies).

Case presentation. 62-year-old female patient, known with type 2 DZ, ICC, CIND (paroxysmal FiA) and HTAE, under treatment with Amiodarone, is hospitalized with acute respiratory symptomatology. Laboratory tests show bilateral basaltic crepitation risers, biological inflammatory syndrome, and radiologically multiple opacities with ½ inferior condensation appearance for which empiric antibiotic treatment was initiated. Evolution of the patient was unfavourable, despite antibiotic treatment. Therefore, it is decided to do a fibrobronchoscopic examination (bronchial aspiration for cytology and BK), thoracic CT followed by thoracoscopy and pulmonary biopsy.

The diagnosis of COP was based on the typical radiological appearance of bronchopneumonia but that is not responding to antibiotic treatment. The bronchoalveolar lavage revealed nonspecific inflammatory infiltration with lymphocytes and polymorphonuclear cells, the histopathological examination revealed the presence of Masson bodies, alveolar fibroblast polyps and bronchiolar polyps. As amiodarone is known to have pulmonary adverse effects, among which COP was very rarely quoted, treatment with amiodarone was discontinued and cortisone treatment with prednisone 70 mg/day was initiated, with rapid progressive improvement of symptomatology and slow improvement of imaging. In treatment month 3, after the decrease in prednisone to 30 mg/day, the general condition of the patient worsens in parallel with the biological and imaging parameters secondary to the reintroduction of the amiodarone treatment, an event treated as a recurrence of drug-induced obliterans pneumonia. The evolution of the patient was favourable, with the remission of clinical symptoms and radiological appearance, in the absence of relapses one and a half years after the end of the treatment.

Conclusions. This paper presents a complete case of cryptogenic organizing pneumonia in a patient undergoing amiodarone treatment, which has a complete response to cortisone treatment only after the trigger factor has been removed.

Introduction. Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a systemic vasculitis of the small vessels that often associates asthma and blood/tissue eosinophilia.

Case presentation. A 58-year-old woman was admitted to our hospital for progressive exertional dyspnea. She had been diagnosed with asthma three years earlier. Recent multiple thoracic computed tomography scans displayed non-fixed interstitial lung abnormalities, whereas the infectious workup (HIV, parasites) was negative.

On admission, the clinical examination noted prolonged expiratory phase. Paraclinical tests revealed biological inflammatory syndrome, eosinophilia, polyclonal hypergammaglobulinemia, elevated total IgE level, negative anti-neutrophil cytoplasmic antibodies and proteinuria of nephritic pattern.

The pulmonary evaluation reconfirmed the obstructive ventilatory dysfunction and interstitial lung abnormalities - interlobular septal thickening and diffuse ground-glass opacification. The histopathological examination of a transbronchial biopsy specimen identified leukocytoclastic necrotizing vasculitis and tissue eosinophilia.

Provided the clinical and paraclinical setting, specifically the asthma, blood and extravascular eosinophilia, paranasal sinus abnormalities, non-fixed pulmonary infiltrates and the histopathologically confirmed necrotizing vasculitis, the diagnosis of EGPA seemed appropriate.

Conclusion. In the absence of diagnostic criteria, EGPA diagnosis is often challenging. Although certain clinical and imaging features could assist the diagnosis, biopsy remains the diagnostic gold standard.

In the setting of lung involvement, open lung biopsy is usually required for EGPA histopathological proof, but few cases diagnosed by transbronchial biopsy have been reported. This method often identifies discrete, nonspecific lesions or an incomplete spectrum of pathognomonic abnormalities but has the advantage of minimal invasivity that justifies its use as an alternative diagnostic technique.

Gaucher disease is the most frequent lysosomal storage disease, caused by the deficiency of an enzyme called β-glucocerebrosidase. Three types of Gaucher disease are described. Type I Gaucher disease benefits from lifelong enzyme replacement therapy with imiglucerase.

Herein, we present the case of a 34-year-old female patient, a commercial worker, who was admitted to our Department of Haematology in the Emergency Clinical Hospital of Constanta in order to investigate the aetiology of a persistent splenomegaly. Clinical examination and laboratory testing evidenced the following: splenomegaly, hepatomegaly, anaemia, leukopenia and neutropenia, thrombocytopenia, and a myelogram showing Gaucher cells. In this context, the suspicion of Gaucher disease was raised and the investigations were further completed through specific enzyme testing and genetic testing. The low values of lysosomal enzymes, coupled with the detection of two specific genetic mutations confirmed the diagnosis of Gaucher disease.

In January 2017, treatment with 2400U of imiglucerase in intravenous perfusion every two weeks was begun.