Volume 18 (2021): Issue 4 (August 2021)

Shoulder involvement is one of the most frequent findings in rheumatology and many of the rheumatic diseases can determine inflammatory lesions, as well as degenerative ones. Due to the non-specificity of clinical symptoms, imaging methods are emerging into the daily practice in order to establish an accurate diagnosis.

Objectives. The aim of the study was to determine the presence of different pathologic changes in patients with shoulder pain, depending on the concurrent disease and associated risk factors.

Material and methods. We included in our retrospective study 40 consecutive patients that presented with shoulder pain, during the past 6 months, in the Department of Rheumatology. All those patients underwent ultrasound evaluation according to EULAR Guidelines for musculoskeletal Ultrasound in Rheumatology.

Results. Rotator cuff lesions, which most commonly underlie non traumatic pain in adults, were detected with frequencies similar to the ones described by the literature. It seems that comorbidities, as the presence of diabetes, may influence tendon degeneration or rupture.

Conclusions. Although it included a relatively low number of subjects, our paper reveals data similar to the ones previously published and underlines the necessity of applying an algorithm for managing shoulder pathology, that should mandatory include ultrasonography examination, in order to obtain an accurate diagnosis and individualize each patient's therapeutic approach and improve their life quality.

Atopic dermatitis (AD)-the commonest inflammatory skin disease affects up to 25% of children and 2% to 5% of adults. Methods of the diagnostic provide expanded recommendations founded on available evidence. Morphological evaluation remains a principal feature of clinical investigation and the main criteria of diagnosis.

Methods. We collected normal and affected skin from a 6-month child patient who was diagnosed through dermatologic examination. Clinical characteristics and the diagnosis of atopic dermatitis were in accordance with Hanifin and Rajka criteria. Morphology and structural integrity were investigated by Atomic Force Microscopy.

Results. Optical and topography images indicate that in the case of AD skin lesions the cuticle structure was severely damaged and distorted with the flattening and grading of the plates, which have an irregular appearance. From the surface morphologies of the samples, we demonstrate that the shape of the corneocytes, with granular and elongated appearance, specific to normal skin is transformed by AD into broken and collapsed plates with discontinuous appearance.

Conclusions. In the initial diagnosis of AD changes of the skin properties can be an indicator. Hanifin and Rajka criteria together with Atomic Force Microscopy can be a useful and necessary technique diagnosing cases of atopic dermatitis.

COPD is a chronic disease of the respiratory airways due to the partially reversible obstruction of the airflow caused by an abnormal inflammatory response to toxic substances, most often to cigarette smoke⁽¹⁾. COVID-19 is a mild to severe respiratory disease caused by a coronavirus from the Betacoronavirusgenus⁽²⁾. Patients with COPD have a major risk of COVID-19 infection. Treating patients with COPD, chronic cor pulmonale and COVID-19 is a current challenge.

The medical therapy of heart failure (HF) has been traditionally based on inhibiting the main pathophysiologic mechanisms: the adrenergic and renin-angiotensin-aldosterone systems. Introducing the therapeutical triad of beta-blockers, angiotensin converting enzyme inhibitors and mineralocorticoid receptor antagonists in the treatment of HF patients almost 40 years ago marked an important step since they were not only addressing the symptoms of HF, but also the prognosis and life- expectancy of these patients. Although many discoveries have been made in the past years, no other therapeutic class was able to increase survival among HF patients, until recently, when th SA e benefits of modulating the natriuretic peptide system were brought to the attention of the scientific community. Increasing the levels of natriuretic peptides with Sacubitril/ Valsartan (SV) led to several benefits for the reduced ejection fraction HF population, including less long and short term complications, increased survival and a reduced symptom burden. As this article is being written, it is estimated that more than 2.8 million patients are being treated with SV⁽¹⁾. Therefore, SV is an important and validated therapy for HF patients and internists should be aware of its indications, benefits and management in clinical practice.

Acute polyarthritis requires a comprehensive differential diagnosis in order to establish its etiology. Moreover, sometimes it may unfold unexpected comorbidities, thus necessitating an individualized management approach.

This article describes the case of an elderly patient whose initial presentation of acute polyarthritis was interpreted as crystal induced-arthritis demonstrated by the presence of calcium pyrophosphate and lipid crystals in the synovial fluid. The clinical deterioration of the patient along with the suspicion of a systemic infection required interdisciplinary collaboration and led to his transfer to the infectious diseases department where the diagnosis of sepsis from unknown origin was added. Further investigations unmasked a large complicated pancreatic pseudocyst that eventually ruptured into the peritoneal cavity and led to the patient's death.

Granulomatosis with polyangiitis is a multisystem disease characterized by a necrotizing granulomatous vasculitis, typically associated with the presence of anti-neutrophil cytoplasmic antibodies. The lung is the most common organ involved in comparison to other vasculitis, but in the case presented by us the onset is otorhinolaryngology field, with a multitude of symptoms and immunological tests are initially negative. Over time, immunological tests become positive, but all this leading to a delay in diagnosis by 4 years and of course to a delay in treatment. In this paper we emphasize the usefulness of biopsy for diagnosis and use of anti-neutrophil cytoplasmic antibodies to classify the disease.

The anthracyclines, represented by Doxorubicin, Epirubicin or Idarubicin, are paramount in Oncology due to their antitumoral efficacy in a multitude of solid cancers, making them essential in breast cancer treatment. The biggest disadvantage of anthracyclines, cardiotoxicity, happens as a direct effect of the oncologic treatment on the anatomy and the physiology of the heart and acts also as an element which advances pre-existent cardiovascular disease⁽²⁾.

We are presenting the case of a 51-year-old lady, clinically, with imagistic and biopsy diagnosis of breast cancer cT3N3M0, negative HR, HER 2neu-3+, that was treated with neoadjuvant chemotherapy consisting of anthracyclines and biological therapy with Herceptin (Trastuzumab – monoclonal humanized IgG1 antibodies, administered in HER2 + breast cancer).

By cumulating the current clinical data with the therapeutic challenges of the anthracyclines (antitumoral effect vs cardiotoxicity), we are trying to encourage the multidisciplinary approach (oncology and cardiology), in order to reach the best therapeutic decision for each patient.

We are presenting a case of a 38-year -old man was admitted to the hospital with biliary obstruction and Clostridium Difficile infection. The hepatic biochemical profile improved during corticosteroid therapy, which is a change more characteristic of autoimmune hepatitis than of primary sclerosing cholangitis, needs for a positive diagnostic an endoscopic retrograde cholangiopancreatography and a biopsy of gastric and duodenum mucosae. The abnormalities in the results of liver-function tests due to primary sclerosing cholangitis may have been resulted in part to the intestinal inflammation due to Crohn disease; the abnormalities improved with therapy directed at suppressing that inflammation.