Hepatitis C With Moderate or Severe Liver Disease: A Cohort Study . Clin Infect Dis 2017; 65 :235-43.  FACCIORUSSO A., DEL PRETE V., TURCO A., BUCCINO R.V., NACCHIERO M.C., MUSCATIELLO N. Long-term liver stiffness assessment in HCV patients undergoing antiviral therapy: Results from a 5-year cohort study. J Gastroenterol Hepatol 2018; 33 :942-9.  CHEN YI MEI S.L.G., THOMPSON A.J., CHRISTENSEN B., CUNNINGHAM G., MCDONALD L., et al. Sustained virological response halts fibrosis progression: A long-term follow-up study of people with chronic hepatitis
Paula Ionilă, Ruxandra Jurcuţ, Nicoleta Ferariu, Monica Roşca, Monica Chivulescu, Adriana Mursă, Sebastian Militaru, Alin A. Ionescu, Cristina Căldăraru, Ana G. Fruntelată, Silvia F. Goanţă, Simina Crişan, Adina Ionac, Ana-Maria Avram, Attila Frigy, Radu Sascău, Cătălina Arsenescu-Georgescu, Ioan M. Coman, Bogdan A. Popescu, Carmen Ginghină and Eduard Apetrei
., GIMENO JR., SHARMA S., PENAS-LADO M., MCKENNA WJ. Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy . J Am Coll Cardiol. 2003; 42 (5):873-9. 13. ADABAG AS., CASEY SA., KUSKOWSKI MA., ZENOVICH AG., MARON BJ. Spectrum and prognostic significance of arrhythmias on ambulatory Holter electrocardiogram in hypertrophic cardiomyopathy . J Am Col. Cardiol. 2005; 45 (5):697-704. 14. MARON MS, OLIVOTTO I, ZENOVICH AG, LINK MS, PANDIAN NG, KUVIN JT, et al. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract
Polliana Mihaela Leru, Ana-Maria Eftimie and Michel Thibaudon
Introduction. Respiratory allergies induced by allergenic plants pollen represent an important public health problem with increasing prevalence and severity. Aerobiologic study of allergenic pollens is performed in many countries on regular basis and correlated with health data from allergists in the frame of national aerobiology networks. Romania has no aerobiology network and pollen measurements have been done between 1999-2012 in West region only. In the frame of COST Action called Sustainable management of Ambrosia artemisiifolia in Europe (SMARTER FA 1203), three years collaboration with Reseau National de Surveillance Aerobiologique (RNSA) from France and the first pollen monitoring center in Bucharest were established.The aim of this paper is to present results of first pollen monitoring in Bucharest, activities of Romanian SMARTER group and collaboration with European aerobiology specialists.
Material and method. We used a Hirst-type pollen trap placed on the roof of the Research Center from “Colentina” Clinical Hospital and the pollen monitoring method based on European Aeroallergen Network (EAN) standardized requirements. Monthly results during the pollen seasons 2014-2016 were sent to RNSA and EAN and posted on the European pollen information site.
Results. We found high amounts of allergenic pollen, mainly grasses from May to September and Ambrosia artemisiifolia during September.
Conlcusions. We concluded that SMARTER offered access to aerobiology training, improved multidisciplinary collaboration and perspectives to further develop national and international projects. More coordinated efforts to develop national aerobiology network and to recuperate the gap comparing to other European countries in the field of aerobiology and respiratory allergology are needed.
Tica Ovidiu, Tica Otilia Anca, Rosan Larisa, Vidican Madalina, Rosca Elena, Pantea Vlad, Ignat Romanul Ioana, Sandor-Huniadi Anca, Sandor Mircea, Vesa Cosmin, Babes Katalin and Popescu Mircea-Ioachim
Introduction. Dilated cardiomyopathy (DCM) is characterized by global cardiac dilation associated with left ventricular (LV) systolic dysfunction without valvar substrate or ischemic heart disease. Diagnosis of idiopathic DCM can only be sustained after excluding other nongenetic causes.
Methods. This study was performed on a cohort of 256 patients who died in Emergency County Hospital of Oradea and had diagnosis of DCM; the study was performed on a period of 2 years, from January 2014 until the end of December 2015. These patients were differentiated according to social criteria, background, department of admission, number of autopsies and co-morbidities.
Results and Discussion. Diagnosis of DCM was more common in male patients up to the age of 70; after this age the tendency is towards equalization. In patients aged 61-80 years, DCM played a major role in tanatogenesis. Existing clinical trials have shown that patients with idiopathic DCM have a lower mortality than patients with cardiac ischemic disease.
Conclusions. Despite the possibility of diagnosis with increased sensitivity and the large number of therapeutic options, multicentre studies and registries are needed to improve the life expectancy of these patients.
Andrada-Loredana Popescu, Florentina Ioniţa-Radu, Mariana Jinga, Andrei-Ionuţ Gavrilă, Florin-Alexandru Săvulescu and Carmen Fierbinţeanu-Braticevici
The prevalence of obesity is rising, becoming a medical problem worldwide. Also GERD incidence is higher in obese patients compared with normal weight, with an increased risk of 2.5 of developing symptoms and erosive esophagitis. Different treatment modalities have been proposed to treat obese patients, but bariatric surgery due to its complex interactions via anatomic, physiologic and neurohormonal changes achieved the best long-term results, with sustained weight loss and decrease of complications and mortality caused by obesity. The bariatric surgical procedures can be restrictive: laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG), or malabsorptive-restrictive such as Roux-en-Y gastric bypass (RYGB). These surgical procedures may influence esophageal motility and lead to esophageal complications like gastroesophageal reflux disease (GERD) and erosive esophagitis. From the literature we know that the RYGB can ameliorate GERD symptoms, and some bariatric procedures were finally converted to RYGB because of refractory reflux symptoms. For LAGB the results are good at the beginning, but some patients experienced new reflux symptoms in the follow-up period. Recently LSG has become more popular than other complex bariatric procedures, but some follow-up studies report a high risk of GERD after it. This article reviews the results published after LSG regarding gastroesophageal reflux and the mechanisms responsible for GERD in morbidly obese subjects.
Vlad Pădureanu, Anca Ştefania Enescu, Isabela Siloşi, Maria Forţofoiu, Aurelia Enescu, Maria Bogdan, Mircea Cătălin Forţofoiu, Amelia Genunche Dumitrescu, Diana Rodica Tudoraşcu, Adrian Mita, Ioana Streata, Mihai Ioana, Florin Petrescu and Adrian Săftoiu
Introduction. Chronic pancreatitis is morphologically characterized by ductal dysplasia, breeding grounds for the proliferation of the ductal cells, the degenerative changes in pancreatic acinar cells and fibrosis, and it is defined on the basis of the clinical, morphological and functional criteria.
Aim. The aim of our study is to examine the existence of a possible correlation between the iNOS-2087A>G polymorphism and chronic pancreatitis by means of the genetic analysis.
Material and method. We have conducted the study at the Gastroenterology Clinic and the Research Center of Gastroenterology and Hepatology of the University of Medicine and Pharmacy, Craiova, between March 2015 – September 2016. The study had a prospective character. Both for the 58 patients diagnosed with chronic pancreatitis and for the 132 patients in the witness group, the biological material was represented by blood, (around 2.5 – 5 milliliters of venous blood) let on EDTA and kept at 4°C up to the separation of the DNA molecule. All the patients were genotyped for the iNOS – 2087A>G polymorphism, by means of the Real Time PCR technique with TaqMan probes.
Results. Analysing the prevalence of the iNOS genotypes within the study group and witness group, we have noticed that, statistically speaking, there are no significant differences between the two groups.
Conclusion. As a conclusion, in the study lot we can sustain that the risk of developing chronic pancreatitis is not increased by the presence of the iNOS-2087A>G polymorphism.
Delia Tulbă, Marius Balea and Cristian Băicuş
Introduction. Macrophage activation syndrome (MAS) is a life-threatening hyperinflammatory state mediated by uncontrolled cytokine storm and haemophagocytosis. Although rarely reported, MAS might occur in systemic lupus erythematosus (SLE), notably as an inaugural manifestation. Glucocorticoids (GCs) are the cornerstone of SLE therapy. However, in some cases high doses of GCs are required to achieve remission (i.e. glucocorticoid-resistance), leading to significant side effects.
Case report. A 28-year-old Romani male was admitted to our hospital for polyarthralgia, polyserositis and fatigability. The patient had high-grade fever, jaundice and generalized lymphadenopathy. Laboratory tests revealed severe mixed hemolytic autoimmune anemia, leukopenia, hepatocytolysis, coagulation abnormalities, hypertriglyceridemia, biological inflammatory syndrome, hyperferritinemia and persistent proteinuria of nephritic pattern. Imaging studies showed pleuropericardial effusion, hepatosplenomegaly and polysynovitis. Additional blood tests revealed hypocomplementemia and positive ANA, anti-dsDNA and anti-Sm antibodies. Haemophagocytosis was not identified either on bone marrow or axillary lymph node biopsy specimens. However, SLE-associated MAS seemed to fit this set-up. High-dose corticotherapy (6.5 g methylprednisolone followed by prednisone, 1.5 mg/kg/day after discharge) and intravenous cyclophosphamide were necessary to induce and sustain remission.
Conclusion. MAS is a potentially severe manifestation that should be considered at SLE onset whenever high fever and elevated serum levels of aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin and procalcitonin are noted. Early diagnosis and prompt treatment lead to remission in two thirds of cases.
Glucocorticoid-resistance leads to the use of high-dose corticotherapy or immunosuppressive agents that could elicit serious side effects. New insights into the molecular mechanisms of glucocorticoid-resistance are needed in order to conceive more adequate GC-therapies.
Simella Provatopoulou, Dimitra Kalavrizioti, Maria Stangou, Maria-Nikoleta Kouri, Pantellitsa Kalliakmani, Marios Papasotiriou, Evangelos Papachristou, Dimitrios S. Goumenos and Aikaterini Papagianni
Introduction: Circulating autoantibodies against phospholipase A2 receptor (anti-PLA2R) are recognized as key elements in the pathogenesis of idiopathic membranous nephropathy. In current clinical practice, they are increasingly gaining attention as novel tools for diagnosis and disease monitoring. We investigated the diagnostic and prognostic utility of anti-PLA2R antibody measurements in Greek patients with biopsy-proven membranous nephropathy. Methods:Anti-PLA2R levels were measured in serum samples from 33 patients at diagnosis using ELISA and were associated with treatment outcome. Moreover, serial anti-PLA2R measurements were performed in 15 patients under different clinical conditions and level alterations were correlated with disease activity. Results:Positive anti-PLA2R antibodies at diagnosis were found in 16 of 33 patients (48.5%). Anti-PLA2R levels were independently associated with the achievement of complete remission of nephrotic syndrome after immunosuppressive treatment compared to partial remission (p=0.02, R2= 0.265, 95%CI -0.019 to -0.0003). Higher detectable antibody levels at diagnosis were correlated with higher proteinuria levels (r=0.813, p=0.0001, 95%CI 0.532 to 0.933) and lower eGFR at the end of follow-up (r=-0.634, p=0.0083, 95%CI -0.86 to -0.202). Serial antibody measurements during follow-up showed that anti-PLA2R titers were significantly reduced at the end of treatment after complete remission was achieved, remained low under sustained clinical remission, and increased during relapse. Conclusions: Our findings confirm the usefulness of anti-PLA2R measurements in the diagnosis of idiopathic membranous nephropathy. Low levels of anti-PLA2R antibodies at diagnosis are predictive of complete remission of nephrotic syndrome following immunosuppressive treatment. Serial anti-PLA2R measurements correlate well with clinical status throughout the follow-up period and could be used routinely for monitoring of disease activity and treatment planning.
C. Socoliuc, Sabina Zurac, R. Andrei and Florica Stăniceanu
Dermatofibrosarcoma protuberans (DFSP) represents a low-grade cutaneous sarcoma which may have different histological aspects, presenting as a fibrosarcomatous, pigmented, juvenile, myxoid, atrophic, sclerosing or myoid lesion. Some of these subtypes may occur isolated or in association with one of the others creating hybrid lesions. We present the case of a 66 years old woman having a 4 cm diameter tumor located on the abdominal wall. Histopathological examination of the resection specimen revealed areas of typical DFSP associated with fibrosarcomatous transformation, myoid and myxoid areas. Also, focally, pleomorphic tumor cells and foreign-body type multinucleated giant cells were observed. Immunostains revealed CD34 positivity in typical DFSP and myxoid areas with negative staining of some of the tumor cells in fibrosarcomatous areas and negative staining of myoid areas. Smooth muscle actin was positive in myoid areas. The nature of myoid fascicles in DFSP is a matter of debate, being uncertain whether these represent a type of tumor differentiation or a reactive myoid proliferation. In this particular case, finding the association of myoid cells with blood vessel walls sustains their reactive nature. We present the morphological aspects of the different areas of the tumor with emphasis on differential diagnostic problems and clinical implications.
Alina Dima, Simona Caraiola, C. Jurcut, Eugenia Balanescu, P. Balanescu, Doina Ramba, Camelia Badea, V. Pompilian, R. Ionescu, Anda Baicus, C. Baicus and G. A. Dan
Background. The antiphospholipid syndrome (APS) is one of the most encountered autoimmunity in systemic lupus erythematosus (SLE) patients and pathogenesis of these two seems to be intricate.
Aim. To investigate the association of antiphospholipid antibodies (APLAs) titer with the presence of secondary APS diagnosis in SLE patients.
Methods. 65 patients fulfilling the 2012 Systemic Lupus Collaborating International Clinics (SLICC) SLE’s criteria were included. The APS diagnosis was sustained according to the 2006 Sydney APS’s criteria. Three groups of patients were defined: SLE patients with secondary APS, SLE with history of positive “criteria” APLAs but without APS clinical features, respectively SLE patients without positive APLAs or clinical APS criteria. An extended APLAs panel was searched in all cases: both IgM and IgG of anticardiolipin antibodies (aCL), anti-β2 glycoprotein I antibodies (aβ2GPI), antiphosphatidylethanolamine antibodies (aPE), antiphosphatidylserine antibodies (aPS), respectively antiprothrombin antibodies (aPT).
Results. Only the aβ2GPI, both IgM and IgG serotypes, had significantly higher titers in patients with SLE and secondary APS compared to no APS (with/without positive APLAs): median (min; max) 7.0 (0.0-300.0) vs. 1.0 (0.0-28.0) vs. 1.0 (0.0-12.0), respectively 3.0 (0.0-79.0) vs. 1.0 (0.0-3.0) vs. 1.0 (0.0-12.0) (p<0.001, Kruskal-Wallis test)]. Also, in regression logistic models, only the aβ2 GPI (IgG and IgM) were identified as risk factors for secondary APS diagnosis in the SLE patients: OR(95%CI) 5.9 (2.2-15.7), respectively 1.3 (1.1-1.5). In regard with the SLE markers, the IgG serotypes of the “non-criteria” APLAs analyzed (aPS, aPT, aPE) were correlated with the antiDNA titers while the IgM serotypes inversely associated with the complement C3 levels.
Conclusions. IgG aβ2 GPI are accompanied by almost 6-fold increase risk of secondary APS when screening SLE patients. On the contrary, the “non-criteria” APLAs do not seem associated with the APS diagnosis in SLE patients. Some correlates of the “non-criteria” APLAs with the antiDNA and complement C3 levels were also observed.