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Psoriasis represents a chronic autoimmune disease of great interest as its incidence has increased over the last decades. It encompasses a multitude of subtypes with various manifestations and complications. Erythrodermic psoriasis represents one of the most severe forms of the disease and is characterized by the appearance of a generalized erythematous rash on top of pre-existing lesions. We present the case of a 71-year-old patient with history of arthropathic psoriasis who is admitted to the dermatovenerology clinic for deterioration of his general condition, exacerbated pre-existing cardiovascular conditions, a diffuse generalized erythematous skin rash, pronounced leg edema and nail changes. After following topical and systemic treatment, the patient was discharged in an improved condition. Two weeks later the woman is found dead in their home. An autopsy was performed and the necropsy examination describes the skin lesions presented before but in an aggravated form and the histopathological examination establishes the cause of death which is represented by acute heart failure, the consequence of lymphocytic interstitial myocarditis. The particularity of the case is represented by the simultaneous exacerbation of cardiac and skin pathology, both having autoimmune components and an inflammatory substrate.

Since their first mention, almost 60 years ago, there were a plethora of articles about oxidative stress and antioxidants, published in a wide range of journals (biochemistry, cell physiology, molecular biology or environmental biology). Also, in the last decade the definition of oxidative stress (OS) undergone different changes, and currently OS is seen as a disruption of redox signalling and control. This review aims to offer the perspective of Complexity Theory on antioxidants framework, and diabetes disease is taken as an example.

We present a case of severe thromboembolic pulmonary hypertension in a patient with history of recurrent deep vein thrombosis and pulmonary restrictive disease due to pulmonary and vertebral tuberculosis in young adulthood. He was considered not eligible in the National Program for Primary Pulmonary Hypertension, being referred for thoracic surgery, but he was considered unfit for thrombendarterectomy. Despite guidelines, we administered him specific medical therapy (phosphodiesterase-5 inhibitors and endothelin receptor antagonists). His clinical evolution was satisfactory, with increasing effort tolerance and decreasing need for ambulatory oxigenotherapy.

The pharyngeal tonsil is a lymphatic tissue mass located in the roof of the nasopharynx. The function of the pharyngeal tonsil is to prevent infections with the help of antibodies. Chronic inflammation and allergies lead to hyperplasia of the adenoids that is found almost exclusively in children. The treatment of choice is surgical treatment; conservative treatment is only indicated preoperatively or if surgery is contraindicated. In this paper, we will present a new surgical method for adenoidectomy performed trans-orally with coblation, under endoscopic control.

The rapid implementation of stents in standard practice and expansion of the indication for their utilization also introduced a new problem: in-stent restenosis. Management of patients with restenosis after stent implantation is still considered an important clinical problem. Although balloon angioplasty is still one of the prefered strategies that provide satisfactory results and a low incidence of complication, repeat stenting with “drug eluting” stents or “drug balloon” angioplasty become a very atractive methods of treatment for selected lesions and patients.

Celiac disease is a clinically heterogeneous disease characterized by an inadequate immunological response when patients with specific genetic phenotypes are exposed to gluten. This article presents a case of a young woman diagnosed in Gastroenterology Department of “ St. Andrew Apostle” Emergency Hospital of Constanta with celiac disease after multiple admissions into the hospital for unspecific symptoms such as pallor, fatigue, pirosis, weight loss and 1-2 soft stools/day. The history with period irregularities and infertility without a known cause, a recent unexplained bone fracture, the muscle weakness, neuropsychiatric symptoms characterized by sleep disturbances and irritability correlated with the biological features characterized by moderate feriprive anemia, Ca and Mg decreased level, thyroid autoimmune impairment and gastrointestinal symptoms raised the suspicion of an autoimmune disorder with multiple targets. The videcapsule endoscopy (VCE) revealed the specific pattern of the celiac disease: villous atrophy of jejunum, scalloping, absent folds and cobblestone mucosal pattern. Results were correlated with immunology tests results. The patient was transferred on a gluten free diet and the clinical and VCE controlsrevealed the healing of the jejunum mucosa. The VCE can be the tool for positive diagnosis of an unusual and heterogeneous celiac disease in patients with various symptoms without an apparent cause.

Background & Aims. Triple therapy with Peg-IFNs, Ribavirin and protease inhibitors raise the treatment success for hepatitis C up to 83%, but also bring together with the significantly higher rates of sustained virologic response (SVR) more side effects, interfering with patient’s quality of life (QoL) and work productivity. We aimed to analyze the factors influencing the adherence and the QoL during triple therapy using Peg-IFNs, Ribavirin and protease inhibitors in 50 patients diagnosed with chronic hepatitis C with first line therapy failure. Multivariate Cox proportional hazards regression was used to analyze determinants of retreatment initiation and treatment compliance, according to patient features. Results: We identified as major drivers of retreatment initiation the younger age, the female gender, the urban provenience, the high income, and the psychiatric and alcohol or drugs abuse history. The adherence and the QoL during retreatment therapy were similar, despite the regimen used, and obvious lower in patients with history of previous abandon, drugs and alcohol abuse or hematologic/ psychiatric decompensation. A lower capacity to work and a temporary withdrawal from job necessary to continue the therapy were seen similar in patients taking Boceprevir/Telaprevir. Abandon of therapy without a known reason was more frequent in males, with alcohol and drugs intake history, from rural region, with low income, and with psychiatric disturbances in personal history. Conclusion. Physicians should focus to develop medical strategies or drugs to increase the adherence and to provide a better QoL for patients with chronic hepatitis C making antiviral therapy.

Background: Pulmonary embolism (PE) represents the third most frequent vascular disease following acute myocardial ischemic disease and stroke. It is a common and potentially lethal disease. Aim: We observed etiological spectrum, clinical aspects and diagnostic tests for patients with PE. Material and methods: Retrospective observational study that included 53 patients diagnosed with PE between 01.01.2009- 31.12.2013. We followed epidemiological aspects, risk factors, clinical manifestations and methods for positive diagnosis. Results: 53 patients which represents 0.66% from the patients admitted in our department (n=8,011), were diagnosed with PE. The main risk factor for PE was malignancy (n=16). Twenty patients with PE presented deep venous thrombosis (DVT) and 12 patients arterial thrombosis (AT). Main clinical syndromes of patients with PE were pulmonary infarction (n=32), isolated dyspnea (n=11) and circulatory collapse (n=10). A lot of paraclinical investigation sustained positive diagnosis,mainly by high performance techniques. Four cases were diagnosed postmortem. Conclusions: Clinical diagnosis of PE has a low accuracy. Clinical evaluation, even unspecific has a considerable value in the selection of patients who needed further paraclinical diagnostic procedures.

Scientific research proves that the cardiac and the metabolic functions are improved by the consumption of flavonoids, natural elements found in cocoa. The dark chocolate is the main alimentary compound rich in flavonoids, and for this reason it can be used to prevent some cardiometabolic disorders. This study aims to demonstrate the relationship between chocolate consumption and the cardiometabolic disorders risk in 85 patients hospitalized in Internal Medicine Unit of Emergency Hospital “St. Apostle Andrew” of Constanta. Patients were split according to the quantity of the dark chocolate consumption into 2 groups. The study groups were matched by the demographic parameters, the BMI, the physical activity and other risk factors (fats, saturated lipids, etc). We found that the daily consumption of dark chocolate, with content of cocoa > 35% according to European recommendations, had cardiometabolic benefits. The risk of coronary heart disease was reduced with 23% by the daily dark chocolate intake. The cardiovascular disease mortality and the risk of any cardiovascular disease were decreased with 19%, respectively with 38%. The risk of incident diabetes decreased with 28% after daily dark chocolate consumption, regardless the gender of patients. The number of ischemic cerebral events was reduced with 32%. In summary, the daily consumption of dark chocolate rich in flavonoids decreases the cardiometabolic disorders in patients at risk [1].

Hepatocellular carcinoma (HCC) is one of the most common malignancies with increasing incidence in developed countries. Epidemiological studies show that the cause of new discovered HCC cases remains unclear in 15%-50% of cases. Obesity and the subsequent/ underlying nonalcoholic fatty liver disease (NAFLD) can be responsible for most of these cases. The aim of our study was to estimate the risk of HCC in obese patients diagnosed with NAFLD, without clinical or imagistic features of liver cirrhosis, in order to see if HCC can develop in fatty liver in the absence of cirrhosis. Patients with regular/daily alcohol consumption or diagnosed with liver viral infections were excluded. We studied 214 obese patients with NAFLD over a period of 5 years. We evaluated all patients using abdominal ultrasound and serum alpha-fetoprotein every 6 month, in order to detect the HCC occurrence. Kaplan-Meier analysis estimated the cumulative incidence of HCC. Univariate and multivariate Cox regression analysis were used to assess associations between HCC and obesity. The median follow-up was 4.3 years. During the study period, 16 from 118 cirrhotic NFLAD patients (13.5%) and 12 from 96 non-cirrhotic NAFLD patients (12.5 %) developed HCC (p = 0.07, ns). The cumulative incidence of HCC was found to be 2.9% in obese patients with NAFLD-cirrhosis, compared with 2.2% in obese patients without cirrhosis (p = 0.09, ns). Multivariate regression analysis revealed that older age (p = 0.04) was independent variable associated with development of HCC in patients with/without NAFLDcirrhosis. Obesity seems to be an independent risk factor for HCC occurrence, regardless the presence of mild or advanced liver fibrosis in NAFLD patients.

Background. Capsule endoscopy is a revolutionary new diagnostic method for the detection of digestive diseases, especially localized at the level of small bowel and colorectal tract. This method is the only technique that allows endoscopic examination of the digestive tract without sedation. Obscure gastrointestinal bleeding is the most common indication for capsule endoscopy, which commonly diagnoses arteriovenous malformations, small bowel tumors, ulcers or tumors missed at standard endoscopy or other imaging examinations [1]. Aim. Our study aimed to detect the accuracy of endoscopic videocapsule in detecting the cause of microscopic anemia in patients with supposed digestive pathologies. Material and method. We used PillCam 2 Platform provided by Given Imaging, a system consisting of PillCam 2 videocapsules, a data recorder, a set of sensors and the Rapid 7 Access computer soft capable to receive and transform pictures into films, in order to visualize the entire digestive gastrointestinal tract. We examined 25 patients with chronic anemia, all of them without any known hematologic, renal or digestive disease, investigated by standard imagistic and lab techniques. Results. From the total of 25 investigated patients, 18 (72%) of them presented sources of bleeding discovered with videocapsule endoscopy. The source of bleeding was the small bowel in 10 cases (55%) and the colorectal tract in 8 cases (45%). The accuracy of videocapsule was very good for detecting the digestive tract obscure sources of bleeding (Sn=74%, Sp=87%). Conclusions. The videocapsule endoscopy is an accurate imagistic option to detect digestive sources of bleeding and to identify the cause of many chronic anemia

Upper endoscopy is the “golden standard” for the diagnosis of upper gastrointestinal bleeding (UGB); it appreciates the persistence of bleeding in more than 90% of cases, it reveals the UGB lesion, gives prognostic information about re-bleeding risk and offers the possibility of endoscopic haemostasis. Uncomplicated STEMI by itself is not a contraindication for upper endoscopy [1,2]. The aim of our study was to observe the haemorrhagic lesions in STEMI patients with postthrombolysis UGB and to evaluate the safety and therapeutic utility of upper endoscopy in this category of patients. We performed upper endoscopy in STEMI patients with postthrombolytic UGB during a period of 4 years (1st of Jan 2008 - 31st of Dec 2011). Patients with systolic blood pressure (SBP) 1, with unstable ECG and/or with severe associated conditions (respiratory distress, cerebrovascular stroke, consciousness disorders) were withdrawn from undergoing upper endoscopy, as well as patients who refused the investigation. During studied period, 618 STEMI patients underwent pharmacological coronary reperfusion. Postthrombolysis UGB occurred in 42 of them (6.79%). We could perform upper endoscopy in 30 patients (71.43%), the rest of 12 (28.57%) being withdrawn from endoscopy (6 patients with Killip class>1, 4 patients with systolic blood pressure

The main objective of this analysis is to evaluate the impact of lung cancer and diabetes association on cancer treatment and outcome of lung cancer patients. Lung cancer, as well as diabetes mellitus, are two diseases with very high prevalence. Lung cancer, despite the improvement in diagnosis and therapeutic methods, is still the 1st cause of cancer-related deaths. The influence of diabetes on cancer patients survival is well established among patients with hepatic, pancreatic or breast cancer. Diabetes implication on lung cancer outcome is not well known. Several studies reported a negative impact, whereas other studies reported a better prognosis for these patients. Our study took place in the Oncology Department of the Clinical Emergency Hospital of Constanta, Romania. 80 patients with diagnosis of non-small cell lung cancer were elected to participate in this study; 29 patients had also diabetes. Selected patients were divided in 2 groups, one group of lung cancer and diabetes, and one group without diabetes. Features of the patients among both groups were analyzed. Our study showed that preexisting diabetes is an unfavorable factor, and has influence on lung cancer prognosis, treatment adhesion and quality of life. To amend the outcome of patients with lung cancer, a better evaluation of patients� co-morbidities, including diabetes mellitus, is required.

Adiponectin is secreted by fatty tissue; it has a peptide biochemical structure and among other roles, it seems to inhibit endothelial inflammation. C-reactive protein has an essential role in host defense. Troponin is a protein that is part of cardiac and skeletal muscle contraction. Myocardial infarction is an acute event defined as myocardial cell necrosis, caused by sudden and sustained ischemia. The purpose of our search work was to analyze the connection between various biomarkers over the early phase of acute STEMI: adiponectin, high sensitive-C reactive protein (hs-CRP), high sensitive-Troponin T (hs-Troponin T), triglycerides, total -, LDL- and HDL-cholesterol. Our study included two groups of patients - one group of 30 patients diagnosed with STEMI in the first 12 h after onset, and the second group of 30 patients with unstable angina pectoris, normal hs-Troponin T, and normal findings at coronary angiography computed tomography (CT). Subjects in the STEMI-arm had a higher serum level of hs-CRP, hs-Troponin T, total cholesterol, LDL cholesterol, triglycerides, and decreased levels of HDL-cholesterol and adiponectin than those in the angina-arm. We identified diminished adiponectin plasma concentrations during the first hours of STEMI evolution. We also found out a directly proportional ratio among adiponectin and HDL-cholesterol and an inverse report between this hormone and all other studied biomarkers. Our results may support the anti-inflammatory and anti-atherogenic features of adiponectin.

This study aimed to investigate gender differences in the relationship between ferritin levels and 25(OH)vitamin D deficiency in overweight persons and whether this relationship is mediated by total and visceral adiposity and fatty liver index (FLI), a marker of non-alcoholic fatty liver disease.Our study was a retrospective one in which were collecting data from 92 patients seen in an outpatient clinical centre between January 2011 and October 2017. Patients were classified with vitamin D deficiency if 25(OH)vitamin D levels were [ 20.0 ng/mL. Univariate linear regression analysis assessed the association between ferritin levels and 25(OH)vitamin D deficiency, with and without correction for age, body composition (total fat mass and visceral fat mass) and FLI. In men, a statistically significant positive association between 25(OH)vitamin D deficiency and ferritin levels were found (b=0.424, p=0.008) in univariate and model adjusted for age. After adjustment for age and total fat mass and for age and visceral fat mass the association became non-significant in men (b=0.327, p=0.067 and b=0.295, p=0.106, respectively) and maintained non-significant after further adjustment for FLI (p [0.05). In women, ferritin level was negatively associated with 25(OH)vitamin deficiency in the model adjusted for age, visceral fat mass and FLI (b=-0.335, p=0.026). In this study, we showed that serum ferritin levels were negatively associated with the presence of 25(OH)vitamin D deficiency in women and this association was independent of age, body composition and FLI. No association was observed in men.

Interval colorectal cancer (ICRC) means CRC discovered at or before the second colonoscopy during a screening interval. Literature provides data concerning the present issue, 7.2-9% of CRCs meeting the definition of interval CRC, without knowing the risk factors for this. We aimed to study if diabetes mellitus (DM) patients have a greater risk to develop ICRC/advanced adenomas (ACRA). We randomly included in the study 50 patients aged over 50 years old diagnosed with DM in whom colonoscopy was done for different reasons. Were excluded patients with CRC/ACRA diagnosed at first colonoscopy and results were compared to those of an age/gender-matched group of patients without DM as background. The interval of colonoscopies was fixed at 36 months (the shortest interval used for surveillance after a polypectomy). The total number of interval lesions significantly differs in our two groups (p=0.022, q=0.17). Interval CRC, serrated adenomas and villous adenomas were more frequent in the T2D group. (p = 0.013, p= 0.032, respectively p=0.011, q=0.14). DALM lesions were more frequently present in controls than in T2D (p=0.049) Results showed that patients with interval ICRC were two times more in DM group in male gender (p=0.003, ss) (4 pts, respectively 2 pts) and 1.5 times greater in female group (3 pts, respectively 2 pts). The rate of CRC occurrence during the interval period of 36 months was 0.16% for male and 0.12% for females. Regarding the occurrence of ACRA (villous/tubulovillous adenomas), male patients with DM had 3 times more ACRA lesions than the control group (p=0.029, ss) (9 pts vs 3 pts) while females patients with DM had 2 times more ACRA than controls (p=0.031, ss) (6 pts vs 3 pts). The rate of interval advanced CR lesions occurrence during the interval period of 36 months was 0.36% for male and 0.24% for females. DM looks be a risk factor ICRC/ACRA by accelerating the colorectal epithelial proliferation rate. Male gender looks to be more exposed to ICRC/ACRC, especially when they are diagnosed with metabolic co-morbidities like T2D.

Lung cancer is the most common cause of cancer-related mortality, and non-small cell lung cancer (NSCLC) represents about 85% of all lung cancers. In the last years, novel targeted therapies have been developed and approved in the treatment of NSCLC. Angiogenesis is a very complex process, and cancer angiogenesis is the most important event concerning cancer growth, invasion and metastasis. VEGF signalling pathway plays a significant role in cancer angiogenesis, and it is demonstrated that VEGF levels are correlated with increased angiogenesis and with poor prognosis and metastasis in NSCLC patients. Bevacizumab is a recombinant humanised monoclonal IgG1 antibody, it is one of the first agent used for anti-angiogenic treatment, and it was approved for the treatment of non-squamous NSCLC in combination with chemotherapy.

NSCLC accounts around 80% of all lung cancers. NSCLC patients have usually a lousy quality of life (QoL), influenced by the malignant disease itself and by cancer treatment modalities. We conducted an observational study in Oncology Department, Clinical Emergency Hospital, Constanta, on a sample of 50 patients diagnosed with NSCLC one year. Our study data showed that younger patients have a better QoL regarding social/family well-being, but without other significant differences. Also, patients living in the urban area have a better QoL regarding social/family well-being. Patients having better performance status obtain higher scores from all subscales of the FACT- G questionnaire and, also a higher FACT-G total scale, these results are showing that better the performance status and general status of the patient, better the QoL. We detected a significant relationship between QoL and disease stage or presence of metastasis. We found no clinical significance between QoL scores with respect with chemotherapy protocol or the number of cycles of chemotherapy. We aimed to show that factors influencing the QoL of NSCLC patients are stage of the disease and performance status of the patients. To diminish the negative impact, one important step in ameliorating the QoL of NSCLC patients is to detect all factors influencing it and offer psychological spiritual and social support.

Chronic liver diseases are a public health issue, because of their high incidence and prevalence, the important impact on the quality of life and high mortality rates. From a pathogenic point of view, in almost all liver diseases there is an increase in oxidative stress. Oxidative stress represents as an imbalance between the production of oxidizing agents and antioxidants. This imbalance contributes to the initiation and progression of hepatic injury. Among the most important risk factors for increased oxidative stress in chronic liver diseases are alcohol, drugs, environmental pollutants and irradiation. For the restoration of the oxidant-antioxidant balance and reduction of the oxidative stress in chronic liver diseases, a promising role may have the antioxidants. This hypothesis is now based on experimental evidence of their efficacy in animal models. In low concentrations, antioxidants improve liver function by preventing the oxidation of an oxidizable substrate, but in high doses, they may cause adverse reactions, such as the pro-oxidant effect, glutathione S transferase inhibition and thus the inhibition of detoxification and interference with coagulation. The objective of the article is to review the benefits of antioxidant treatment in chronic diseases of the liver, in order to put them in balance with their adverse reactions.

Gut microbiota plays a major role in the process of food absorption and low grade inflammation, two key steps in obesity and diabetes mellitus occurrence. Gut microbiota metabolites, such as short chain fatty acids (SCFA), have an important impact over the metabolic pathways like insulin signalling, incretin production and inflammation. [1-3] We aimed to study the microbiota patterns in obese and T2D patients from Black Sea Coast region, considering the ethnic mixture, environmental and geographical particularities, involving diet or various habits in this area. 100 patients and 100 controls matched by age, gender and ethnicity were studied regarding feaces predominance of Lactobacillus and Bifidobacterium species. We compared the results of microbiota patterns from patients to those obtained in a similar control group of healthy subjects. The standard pour plate 0.05% L-cystine enriched method was used to obtain the bacterial cultures and anaerobic conditions. Morphological and biochemical tests were used to identify the Lactobacillus and Bifidobacterium spp. Fecal organic acid concentrations were explored in frozen samples. The association between bacterial counts/organic acid concentrations and independent variables, including age, diet, ethnicity and other risk factors were calculated using multivariable linear regression analysis. Pearson�s correlation coefficients were calculated to detect associations between fecal bacteria counts/organic acid concentrations and laboratory variables (serum biomarkers, body mass index, age, and severity of obesity/T2D according to international scales). Junk and sweet diets, lack of physical activity and familial aggregation of hypercholesterolemia and diabetes were significantly more often present in our T2D/obese patients than in controls. The bacterial counts of the L. acidophilus, L plantarum and L. reuteri subgroups of Lactobacillus sp were significantly lower among patients with T2D and obesity than in controls. The counting of Bifidobacterium spp revealed a higher presence of B. bifidum in controls than in obese or T2D patients. Diet type (junk food and sweets), BMI (]25) and personal history of metabolic disorders were associated with decreased counts of L acidophilus and increased counts of L. fermentum and B. adolescentis in T2D patients. Ethnicity, metabolic disorders history and junk and sweet diet were associated with low counts of L. acidophilus and L. reuteri and low counts of B. longum. Junk and sweet diet was associated with low counts of B. bifidum. Romanian ethnicity and metabolic disorders were associated with low counts of B. choerinum at obese patients, independent of age or previous antidiabetic treatments. The concentrations of acetic and butyric acids were significantly lower in all patients groups, while the concentrations of valeric acid were significantly higher in patients with untreated T2D and obese patients compared to the controls. Low counts of L. acidophilus and L. reuteri were positively correlated with the increased levels of HbA1c, LDL cholesterol, TG and inflammatory markers such as CRP, ESR and IL-6, no matter of diet, age, ethnicity or metabolic disorders history. Also, low counts of B. bifidum and B. infantis were positively correlated with high levels of CRP, IL-6 and TG. In obese patients, statistic analysis results showed that low counts of L. acidophilus, L. plantarum, L. johnsonii and L. reuteri were positively associated with increased levels of CPR, IL-6 and TG, while low counts of B. bifidum, B infantis and B. breve were positively correlated with higher counts of CPR, LDL cholesterol and TG. Low counts of B. bifidum and B choerinum were positively correlated with low counts of HDL cholesterol in Romanian ethnicity patients and in those with previous metabolic disorders. Low bacterial counts of some particular strains of Lactobacillus spp and Bifidobacterium spp were positively correlated with diet type, BMI, Romanian ethnicity and personal history of metabolic disorders obese and T2D patients from Romanian Black Sea Coast Region.