Volume 17 (2020): Issue 6 (December 2020)

In patients with liver cirrhosis treated for portal vein thrombosis, there was no increase in the risk of bleeding, but there was a decrease in the incidence of liver decompensation and an increase in the survival of treated patients when compared to the untreated ones⁽¹⁾.

Current guidelines⁽²⁾ do not provide specific recommendations for the prophylaxis or treatment of thromboembolic diseases in patients with liver cirrhosis⁽³⁾.

In order to determine the influence of anti-thrombotic treatment on the prognosis of liver cirrhosis, 85 patients with liver cirrhosis were followed clinically, by laboratory and ultrasound parameters, for 6 months. Microsoft Excel and IBM SPSS Statistics 20 were used to analyse the data of patients, divided into two groups according to the presence or absence of anti-thrombotic treatment initiated for cardiovascular pathology.

The obtained results showed that the mortality rate between the two groups was similar: 11.54% untreated, 12.12% treated, the decompensation rate of untreated patients was higher than that of the treated ones (36.54% vs. 24.24%) with antithrombotic drugs and that no patient among those treated with antithrombotic drugs showed upper digestive haemorrhage (p =0.038).

The conclusions drawn from this study were that patients with liver cirrhosis in antithrombotic treatment have a better prognosis than untreated ones, in the absence of major bleeding complications, but for a change in guidelines and current practice, studies are needed on a larger number of patients in order to validate these observations.

Microbial resistance to antibiotics represents a complex global, cross-border and intergenerational problem that requires interventions in due time, taking into consideration the enormous potential impact on human health.

The purpose of this study is to evaluate the prevalence of extended-spectrum beta-lactamase producing bacteria (ESBL), carbapenemase-producing enterobacteriaceae (CPE) multidrug-resistant bacteria in urinary tract infections in the County Emergency Clinical Hospital of Târgu-Mureş during 2017-2018.

Acute drug-allergic tubulointerstitial nephrites are increasingly common conditions in current practice due to increased patient access to a variety of drugs. The clinical-biological panel associates acute renal injury with hypersensitivity phenomena. Considered classically reversible after the cessation of the incriminated drug, drug-allergic tubulointerstitial nephrites have changed their evolutionary characteristics in recent decades, even under treatment. This article presents the clinical-biological, therapeutic and evolutionary characteristics of drug-allergic tubulointerstitial nephrites.

Fragility is an important concept in geriatric medicine, and the study of its etiology has become a fundamental aspiration of many researchers in the field of aging⁽¹⁾ Fried’s model of defining fragile individuals has been praised for reproducibility and clinical consistency and has been validated despite negative results from large population studies. This index based on physical parameters evaluates only one aspect of frailty, while frailty is probably a complex, multidimensional concept⁽²⁾. Therefore, new strategies for identifying and assessing frailty in the elderly are needed. The use of biomarkers as new methods for diagnosing frailty could ensure greater accuracy in the detection of fragile subjects in the early stages⁽³⁾.

The aim of the paper was to evaluate the role of biomarkers in identifying people at high risk of frailty. The results of studies on biomarkers used to assess fragility were evaluated from the PubMed and Cochrane databases.

Conclusion. It is considered that biomarkers may be useful for the management of fragile patients only in combination with several biomarkers or with a clinical marker.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology, presenting with variable clinical picture. Having a high heterogeneity and lacking pathognomonic features, very often the diagnosis poses a great challenge for the clinician. Several unusual clinical manifestations such as nasal septal perforation and digital gangrene can occur in LES patients.

Case report. We report the case of a 42-year-old woman, known with SLE, hospitalized in our department for a clinical presentation consisting of a recent major epistaxis, physical asthenia and acral necrosis of the upper limbs. Physical examination revealed an afebrile patient, with a cushingoid facies, facial telangiectasias, and necrotic scars localized on the distal phalanges, bilaterally.

A diagnostic nasal endoscopy showed a large septal perforation with the absence of the cartilaginous nasal septum. CT highlighted an extended defect at the level of the cartilaginous part of the nasal septum.

Conclusion. Nasal septal perforation remains an underdiagnosed invalidating complication of lupus and treated and discovered early could have an important impact on the general health of an already burdened by disease patient.

Simultaneous or sequential combination of prosthetic valve (PV) thrombosis and infectious endocarditis is a rare clinical finding. The management of these patients involves a complex multidisciplinary strategy using clinical judgment and imaging techniques. Transesophageal echocardiography (TEE) and especially 3D transesophageal echocardiography is essential. Moreover, positron emission tomography with fluorodeoxyglucose (F18-FDG PET/CT) can be a valuable tool to diagnose and manage these complicated clinical scenarios.

We present the case of a 65-year-old patient who was admitted in our clinic for paroxysmal nocturnal dyspnea and chills for one week. He had multiple surgical interventions for rheumatic mitral valve disease (percutaneous mitral valvuloplasty in 2008, and mitral valve replacement and tricuspid annuloplasty in October 2019).

At admission, the diagnosis of prosthetic valve thrombosis was established taking into account the clinical context (low INR values for the last two months), the patient symptoms and the echocardiographic findings. IV unfractionated heparin was administered. One week after admission the patient’s clinical status further deteriorated. TEE reevaluation showed partial thrombus regression with elements suggestive for concomitant infectious endocarditis. The diagnosis key is the clinical evolution and repeated TEE evaluations. In our case, they enabled the probable diagnosis of a sequential association of thrombosis and infectious endocarditis on mechanical PV. The therapeutic approach requires a high clinical suspicion and a prompt management, emergent surgery being the only lifesaving strategy in unstable patients with obstructive mechanical pathology.

Solitary fibrous tumours of the pleura (SFTPs) are rare neoplasms, usually described as relatively benign neoplasms and only 10-20% presenting malignant features. Imagistic investigations are useful in the incipient evaluation of SFTPs, and the histopathological and immunohistochemical examinations after surgical resection are mandatory for establishing the diagnosis and for differentiating SFTPs from other aetiologies of pleural masses. The unpredictable evolution (10%-20% of the cases reported in literature display malignant features) and limited data regarding the treatment needs an early detection, a complete surgical resection and long-term imagistic follow-up. We present a case of SFTPs alongside a review of the typical clinical, imagistic and pathologic features consistent with this diagnosis.