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Irena Kafedziska, Snezhana Mishevska-Perchinkova, Dubravka Antova, Mimoza Kotevska Nikolova, Anzhelika Stojanovska and Filip Guchev

. Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AMBITION study. Ann Rheum Dis 2010; 69: 88-96. 14. Smolen JS, et al . Effect of interleukin-6 receptor inhibition with tocilizumab in patients rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomized. Lancet 2008; 371: 987-997. 15. Fleischman RM, et al . Tocilizumab Inhibits Structural Joint Damage and Improves Physical Function in Patients with Rheumatoid Arthritis and Inadequate Responses to

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Borjanka Taneva and Dejan Ristevski

infarction in patients with left ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001; 357: 1385-1390. 7. Sparrow J, Parameshar J, Polle-Willson PA. Assessment of functional capacity in chronic heart failure: time-limited exercise on a self-powered trade mill. Br Heart J 1994; 71: 391-394. 8. Swedberg K. Exercise testing in heart failure: a critical review. Drugs 1994; 47 Suppl4: 14-24. 9. Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure

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Zsuzsánna Ágnes Szász, Enikő Székely-Vass, Gyopár Horváth and Mădălina Hozoi

Abstract

Introduction: Our article underlines the importance of a good professional anamnesis, knowing all the chemical components with which the patient had been exposed to during her active life as a teacher.

Case presentation: A 64-year-old female patient, teacher for 27 years, who had been retired for six years, presented cough with white phlegm and shortness of breath occurring during physical exertion, diffuse thoracic pain, and fatigue. Several lung functional tests were performed, which established the diagnosis of irreversible minor mixed ventilatory dysfunction. In order to establish the etiology of the patient’s symptoms, multiple clinical, laboratory, imaging, and functional investigations were performed including a chest radiograph, pulmonary functional testing, bronchial reversibility testing, a thoracic CT scan, fibrobronchoscopy, alveolar-capillary diffusion capacity measurement, otorhinolaryngology examination, thyroid ultrasound, as well as a cardiological consult. Finally, a positive diagnosis was established: bronchial hyperreactivity syndrome, chalk dust-induced diffuse pulmonary fibrosis.

Conclusion: An essential part of clinical practice is a proper anamnesis, including detailed information on the professional history and exposure, as well as the composition of the dust/particles with which the patient had been in contact with.

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Ioan Ţilea, Elena Andreea Bocicor, Codruţa Maria Gal and Andreea Varga

;52:3792-3800. 8. Clements PJ, Tan M, McLaughlin VV, et al. The pulmonary arterial hypertension quality enhancement research initiative: comparison of patients with idiopathic PAH to patients with systemic sclerosis-associated PAH. Ann Rheum Dis . 2012;71:249-252. 9. Van der Hogen, et al. 2013 ACR/EULAR Classification Criteria for Scleroderma, Arthritis and Rheumatism. 2013,65:2737-2747. 10. Kavanaugh A, Tomar R, Reveille J, et al. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. American College

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Mihai Roman, Radu Prejbeanu, Andrei-Marian Feier, Octav Russu, Adrian Todor, Vlad Predescu, Bogdan Codorean, Tiberiu Bățagă and Radu Fleaca

References 1. Logerstedt D, Grindem H, Lynch A, et al. Single-legged Hop Tests as Predictors of Self-Reported Knee Function After Anterior Cruciate Ligament Reconstruction: The Delaware-Oslo ACL Cohort Study. Am J Sports Med. 2012;40:2348-2356. 2. Tan SH, Lau BP, Khin LW, et al. The Importance of Patient Sex in the Outcomes of Anterior Cruciate Ligament Reconstructions: A Systematic Review and Meta-analysis. Am J Sports Med. 2016;44:242-254. 3. Tegner Y, Lysholm J. Rating systems in the evaluation of knee

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Sandor Viski and Laszlo Olah

;8:1-7. 12. Homburg A-M, Jakobsen M, Enevoldsen E. Transcranial Doppler recordings in raised intracranial pressure. Acta Neurologica Scandinavica. 1993;87:488-493. 13. Hansen HC, Helme K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. J Neurosurg. 1997;87;34-40. 14. Helme K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol. 1966

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Neha Gupta and Chrystal Rutledge

. Definitive diagnosis is usually made by genetic testing. Structural abnormalities of the brain are quite common in PDCD. A case of a patient with a late-onset diagnosis of PDCD with proximal muscle weakness, lactic acidosis and a normal brain magnetic resonance imaging (MRI) with an unusual presentation is presented. Case Report A 20-month-old boy with a past medical history of developmental delay, hypotonia and feeding difficulty, presented to the emergency department (ED) with runny nose, cough, and increased work of breathing for five days. Birth history was

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Piero Portincasa, Emilio Molina-Molina, Gabriella Garruti and David Q.-H. Wang

associated with gallstones. During painful episodes, some non-specific gastrointestinal symptoms may occur. In about 60% of cases, pain radiates to the angle of the right scapula or shoulder, and in less than 10% of cases to the retrosternal area [ 27 , 31 ]. In two-thirds of patients, a colicky pain may be associated with the urgency to walk [ 32 ]. Nausea and vomiting [ 27 , 28 , 32 ], as well as diaphoresis may be related symptoms, while pain is usually not relieved by flatus or bowel movements [ 28 ]. Following a painful attack, physical examination may be normal