Volume 15 (2018): Issue 5 (December 2018)

Objectives. The aim of this paper is to compare the degree of accuracy between the BASDAI and mini-BASDAI indices in assessing the activity of ankylosing spondylitis (AS), especially in patients without peripheral manifestations.

Materials and method. Our cross-sectional study consisted of a group of 124 patients with AS, according to the modified New York criteria. All patients offered their informed consent. All the individual characteristics of the patients were documented, both demographic and disease-related. The activity of the disease was measured using the BASDAI questionnaire, from which we calculated the mini-BASDAI by eliminating the questions about peripheral arthritis and entesitis. The functional impairment of mobility in the spine and sacro-iliac joints was measured by the Schober index, lateral spinal flexion, occiput-wall, menton-sternum and finger-ground index.

Results. The mean age of the patients was 43.43 +/− 13.27 years, mean height 174.3 +/− 8.46 cm, weight 78.23 +/− 14.19 kg, duration of disease in years 15.06 +/− 9.19 and number of years from initiation of biological therapy 6.42 +/− 3.08. The BASDAI score was 1.26 +/− 1.93, while the mini-BASDAI score was 1.51 +/− 2.08. In the group of patients without peripheral manifestations, both BASDAI and mini-BASDAI correlated significantly with the occiput-wall index, besides ESR, CRP, ASDAS-CRP and the Schober index.

Conclusion. Mini-BASDAI is not superior to BASDAI in evaluating patients with ankylosing spondylitis without peripheral manifestations, but it has shown a better correlation in addition to BASDAI with the indices of flexion of the cervico-dorsal spine.

The intestinal transit disorders are polymorphic clinical manifestations requiring complex differential diagnosis and a multidisciplinary medical team.

A major challenge for the clinician is the differentiation of patients with organic suffering versus functional disorder.

Anemia is the most common extra-digestive manifestation of intestinal inflammatory diseases.

We have evaluated biologically and by imaging patients with diarrhea and alternating diarrhea/constipation without including infectious causes. We plan to determine in these patients the status and type of anemia, as well as its correlation with local and systemic inflammation.

Based on the latest medical research, it is supposed that lichen planus is an inflammatory disorder, associated with autoimmune diseases, hepatitis C infection, oxidative stress or antioxidant deficiency. The purpose of the present work is to determine a panel of serum antioxidants, possibly involved in the development/persistence of the disease. The determination of extracellular antioxidants (bilirubin, uric acid, albumin, iron, transferrin, ferritin, copper, ceruloplasmin, total antioxidant capacity) in patients with lichen planus during exacerbations have revealed a significant reduction in non-enzymatic antioxidant systems. Hepatitis C virus enhances the deficit of antioxidants in patients with lichen planus. Based on these findings, the authors consider that lichen planus is a complex disease of unidentified cause and its pathogenic mechanisms are still incompletely elucidated. It may be speculated that several interconnected mechanisms are involved in the onset and evolution of lichen planus.

Obesity, a component of the metabolic syndrome, is a rising public health problem, continuously increasing in the European countries. The therapeutic success of the patient with metabolic syndrome requires a multidisciplinary approach to lifestyle changes, weight loss, continuous and dynamic dietary improvement, sedentary reduction, normalization of blood pressure, glycemia and lipid parameters. We performed a retrospective study that was conducted in the Clinical Rehabilitation Hospital in Iasi, with 4627 patients that were admitted in the Cardiovascular Rehabilitation Clinic from January 2011 to December 2015 with the diagnosis of metabolic syndrome according to WHO definition (Group 1) or with other comorbidities (Group 2). In the first group were included 1064 patients diagnosed with metabolic syndrome. This group has predominantly smoking female patients. Also, in group 1 were diagnosed more patients with left ventricular hypertrophy and coronary heart disease compared to group 2. Most of the patients with inflammatory syndrome were included in the group without metabolic syndrome (group 2). The results of our study confirm that metabolic syndrome is a cluster of abnormalities whose evolution determines the development of coronary heart disease. All this would advocate for treating metabolic syndrome as the primary method of preventing cardiovascular disease.

Background. Colonoscopy is a common performed procedure in Gastroenterology, and it’s widely used for diagnosis, treatment and surveillance of a wide range of conditions and symptoms. Properly performed, it’s generally safe, more accurate than a virtual colonoscopy and well-tolerated by patients. The completion of a colonoscopy is defined by cecal intubation with the visualization of colonic mucosa and distal terminal ileum when it’s possible.

Patients and methods. We reviewed retrospectively all consecutive endoscopies database of the lower digestive tract, done over a period from 2014-2017 in our clinic. The recommended completion based on the latest guidelines ranges from 90-95% completion rate according to the indication.

Results. 11214 consecutive colonoscopies were done. Overall cecal intubation was successful in 9456 procedures (87.3%). If we exclude the interventional procedures (414 procedures), where cecal intubation was not necessary, the main reasons of non-intubation were due to intolerance of the patients (388 patients), followed on the second place by patients with obstructive cancer (299 patients). The presence of diverticulosis, poor preparation for colonoscopy and post-surgical adhesions were significant findings in non-successful procedures.

Conclusions. In normal daily practice, colonoscopy is completed in 88.01% of the procedures but we think that this result will stimulate the efforts to incorporate more quality measures and time in our endoscopy laboratory.

Cardiovascular disease is the leading cause of death in the world, causing over 17 million deaths annually, of which 7.2 million by coronary heart disease. They are a major public health problem worldwide, of which acute coronary syndromes show special attention due to increased prevalence and incidence and poor prognosis. Although advanced therapies can improve the morbidity and mortality associated with acute coronary syndromes in well-developed countries, developing countries remain exposed to the ravages of these diseases. Of the patients admitted for acute coronary syndrome, about 30% suffer from diabetes mellitus, considered a major risk factor and a predictor for unfavorable evolution regardless of the type of acute coronary syndrome.

The authors discuss an important chapter of iatrogenic pathology – unneccessary medicine, by reviewing epidemiological aspects and financial impact and identifying such elements in no less than 10 areas: surgery, interventional medicine, diagnostic investigation, substitute procedures, preventive medicine, drug therapy, aesthetic shared medical appointments, surgery, unconventional medicine, medicine on political demand. We shall review the causes, motives and mechanisms of unnecessary medicine such as one’s hyperprudence to cover oneself with diagnosis arguments or to prevent potential complications through preventive therapies (defensive medicine), weak functionality of the institutionalized inspection bodies, onerous motivation. The respect for the fundamental principles of medical ethics (the primum non-nocere principle doubled by the principle of doing good), the use of practice guidelines, the proper functioning self-control mechanisms in exercising the medical profession, a different management of error and the existence of a consistent protective legislation for both the patient and doctor would be key-elements to avoiding unnecessary medicine.

Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown origin, characterized by multisystemic involvement and a potentially severe evolution. Pulmonary arterial hypertension (PAH) is a rare complication of SLE, with low 5-year survival.

Case presentation. We are presenting the case of a female patient, aged 56 years old, diagnosed in 1992 with SLE with cutaneous manifestations (butterfly-shaped erythematous rash), joint manifestations (polyarthritis), serositis manifestations (massive pleuropericarditis), and immunological manifestations (positive anti-dsDNA antibodies, decreased C3), ignored therapeutically for a long time. In 2010 she complained of dyspnea on medium exertion and leg edemas, with marked increase of PAPs by echocardiography. She was diagnosed with severe PAH (confirmed by right heart catheterization) and in the “Marius Nasta” National Institute of Pneumology she started a treatment with an endothelin receptor antagonist (Bosentan) in combination with a prostacyclin receptor agonist (Selexipag). Since 2013 the patient is on oral anticoagulant treatment for permanent atrial fibrillation.

In 2015 she was referred back to out clinic as she complained of recurrent episodes of massive ascites with evacuatory paracenteses in amounts of about 6-9L per paracentesis. After excluding other causes, ascites was considered to be secondary to the SLE, and a treatment was initiated with Hydroxychloroquine (HCQ) and pulse therapy with Methylprednisolone, on which the remission of the ascites was achieved during the following months. Currently, the SLE is well controlled without recurrence of ascites on treatment with HCQ and gradual decrease until stopping of cortisone doses, and the PAH is stable.

Conclusion. PAH is a rare complication of the SLE, with a complex pathophysiological immune mechanism, for which - together with the specific vasodilator treatment - the increase of immune suppression is recommended.