Volume 17 (2020): Issue 3 (June 2020)

„Unsmoke world” is another offer in the last years of the tobacco industry. Manipulating the youngs is not something new but the strategies of this industry changed and we need to analyse what means this new attitude and how it works. In the same time the new „healthy products” of the same industry are promoted agressively and with scientific arguments, splitting the medical world and with the help of researchers sponsored by this transnational tobacco companies. Harm reduction means not harmless and e cigarette and heat not burning tobacco are not healthy if we are looking to the independent researchers.

Acute pancreatitis (AP) represents an inflammatory condition,-with a wide spectrum of local and systemic complications. Early stratification of severity of pancreatitis is an important step in guiding the management of the disease and improving outcomes. Throughout the years many researchers have looked at various risk stratification parameters which could be used from the admission of patients, however current available scores are cumbersome.

Our aim was to evaluate the role of biochemical and hematological parameters in the early stratification of severity of AP, regarding the length of hospitalization.

We conducted an observational study which included 100 patients with AP admitted to the Gastroenterology Department over a period 18 months. AP diagnosis was set according to 2013 ACG criteria. Demographic, clinical and imaging data related to the pancreatitis flare were collected from their charts. Length of hospital stay was used as surrogate marker for severity of AP. We evaluated different biochemical and hematological parameters which influenced the length of hospitalization.

Several hematological parameters and ratio did not correlate with length of hospital stay in our study cohort, however there was a significant relation of hyperglycemia and alkaline phosphatase levels with hospitalization duration.

Early risk stratification in AP remains difficult with routine blood work done at admission. Glycemic control and serum level of alkaline phosphatase seems to be correlated with length of hospital stay.

Cardiovascular disease is a complex process that includes genetic, inflammatory and endocrine components. During the last decades, much emphasis has been given to cholesterol and lipids as the primary determinants in cardiovascular disease. However, many endocrine and biochemical factors are involved in the atherosclerosis process as well, both systemically and vascular. Multiple obvious data suggest that hormones are responsible for subtle cardiovascular changes long before the development of overt atherosclerotic. Much research remains to be done regarding the interaction between endocrine systems and their role in atherogenesis.

Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection and it is an important global health problem. After the Sepsis 3 definition, sepsis is only the tip of the iceberg. Only when is life-threatening, an infection is declared sepsis, so the rapid medical intervention is paramount. As the sepsis is a so important medical condition in daily clinical practice, many scores and biomarkers were studied in order to have a better risk stratification in early phases of an infection. By design, some scores were intended to be used in Emergency Departments (ED), Intensive Care Units (ICU), or in specific wards.

Ideally, the intervention should take place as rapid and earlier as possible. A possible research direction should be based on a rapidly, low-resources, none or minimum equipment requested for measuring parameters for determining a EWS (increased sensitivity) used with a biomarker (rapidly determined) for gaining specificity in order to buy time, further used to reduce the length of stay in ICU and mortality. Verified and revised scores as NEWS2 and biomarkers such as procalcitonin and presepsin offer a research direction to be explored.

Sleep is and remains an important feature in difficult times as: wars, bankrupt, stress periods but also in pandemic times. COVID 19 is changing our life. Sleep is analysed by the authors looking at all the potential effects on human organism, population, authorities, health workers and patients with sleep disturbances. Finally there are also described some treatment options for people suffering from coronavirus infections.

Introduction. Hypereosinophilia (HE) is defined as an absolute eosinophil count >1.5 x 10⁹/L in the peripheral blood on two examinations separated in time by at least one month and/or pathologic confirmation of tissue HE. A hypereosinophilic syndrome (HES) is defined by the association of HE with eosinophil-mediated organ damage and/or dysfunction if other potential causes of them have been excluded.

Case report. We report a case of a 52-year-old woman admitted to Rheumatology Department for diffuse, highly intense (10/10) myalgia, associated with paravertebral, upper and lower limbs muscular edema and stiffness, having the onset of symptoms for about 4 months. During rheumatological evaluation, the patient developed posterior cervical diffuse pain with brachial irradiation associated with severe functional impotence reason for which it was indicated MRI of cervical spine. The blood count showed leucocytosis with hypereosinophilia. No evidence of Raynaud’s phenomenon, cutaneous and muscular sclerosis or visceral involvement. All muscular groups and deep fascia appeared affected on the whole-body MRI and the findings were suggestive for Shulman’s eosinophilic fasciitis or eosinophilic myopahty. All autoimmune, parasitic and allergic causes for myopathy were ruled out. Muscle tissue biopsy revealed high eosinophilic infiltrate predominantly in the deep muscular fascia, in the striated muscles and in the superficial dermis.

The patient received methyl-prednisolone pulse-therapy with a low-maintenance dose of prednisone which showed clinical improvement and normalized peripheral blood eosinophilia. A hematologic evaluation revealed high percentage of bone marrow eosinophil count which harbored FIP1L1-PDGFR alpha mutation and data was suggestive for the diagnosis of myeloproliferative variant of HES syndrome along with Shulman’s eosinophilic fasciitis for which Imatinib treatment was indicated.

Conclusion. The particularity of this case consists in the diagnosis of a myeloproliferative variant of HES with atypical presentation as a Shulman’s eosinophilic fasciitis, a rheumatological condition. Even though initial symptoms were suggestive for a myopathy, it was difficult to establish the positive diagnosis without any obvious paraclinical data. Further investigations such as MRI and muscle biopsy were conclusive for the diagnosis of Shulman’s eosinophilic fasciitis and clinical improvement was observed after corticosteroid treatment. Considering that after 4 months of evolution of the disease the patient did not present any atrophic lesions of the affected muscles and skin characteristic for Shulman’s eosinophilic fasciitis the patient was referred to Hematology Department with the diagnosis of HES. Advanced exams established the hematological condition as primary FIP1L1-PDGFR positive HES which could benefit from tyrosine-kinase inhibitors treatment (Imatinib) known to induce in this situation improved clinical and paraclinical status.

We present the case of a female patient diagnosed in 2004 with systemic lupus erythematosus, initially with joint and hematological damage complaint, for which she was treated with Methylprednisolone for 6 months. Subsequently, symptomatology and paraclinical screening raised the suspicion of renal impairment, a pulse therapy with Solumedrol and Cyclophosphamide was initiated, a total of 6 pulses. She is in the database of our Clinic since March 2008, when a renal biopsy was performed, revealing a class IV lupus nephritis, initiating treatment with Mycophenolate mofetil and Prednisone until 2010, when the dose of Prednisone is progressively reduced until cessation at the time of remission. Subsequently she presented two relapse episodes, recovered by pulse therapy with Methylprednisolone and Cyclophosphamide, followed by maintenance therapy with Mycophenolate mofetil and Prednisone with a good clinical evolution. In 2017 the patient has a pregnancy with favorable evolution (under treatment with Azathioprine), presenting normal values of cDNA, C3, C4 during the 9 months, but with a persistent nephrotic-range proteinuria; in these conditions gives birth physiologically at 37 weeks. During 2019 apparent remission is maintained (stationary nitrogen retention, anti-dsDNA antibodies within normal range), but with moderate anaemia and persistent, but diminished proteinuria (being under treatment with reduced dose Prednisolone and Mycophenolate mofetil); along the way proteinuria is accentuated again and it is decided to return to reduced dose Azathioprine treatment, with good clinical evolution.

Conclusion. The presented case reinforces the idea of systematic monitoring of patients with SLE and the need for permanent adaptation of treatment especially when there is an increased risk of relapse. Pregnancy, paradoxically well tolerated, increases subsequently the risk of reactivation of lupus nephritis.