Doina Tofolean

Lethal disseminated tuberculosis in patients under biological treatment – two clinical cases and a short review:

Tumour necrosis factor (TNF)-α inhibitors are highly used in Romania for the treatment of autoimmune disorders, such as rheumatoid arthritis (RA), psoriasis, inflammatory bowel diseases, and ankylosing spondylitis. Biological therapy using TNF-α inhibitors is very effective but is associated with an increased risk of opportunistic infections, including active tuberculosis. Here, two cases are presented of patients with RA and psoriasis under biological therapy who developed very aggressive forms of disseminated tuberculosis, with a rapid progression to death. The authors conclude that patients undergoing biological therapy require thorough evaluation prior to initiating treatment, followed by continuous and rigorous monitoring by a multidisciplinary team during biological treatment, particularly in countries with a high incidence of tuberculosis.

Multiple faces of non-cystic fibrosis bronchiectasis: defining etiology and disease severity

Non-cystic fibrosis bronchiectasis is a common respiratory disorder of diverse etiology, characterized by permanently dilated airways due to chronic bronchial inflammation, to date, regarded as an orphan disease. The aim of this study was to review the etiology of non-cystic fibrosis bronchiectasis and correlate it with disease severity. To this end, we performed a retrospective study of patients diagnosed with bronchiectasis using high resolution computed tomography scans, between january 2014 and december 2016 at Clinical Hospital of Constanta, Romania. The patient group consisted of 70 adults (19 women and 51 men) and the etiology of bronchiectasis was determined in 51 cases. This included: postinfective (20 patients), chronic obstructive pulmonary disese related (18 patients), asthma related (6 patients), connective tissue disease related (4 patients). Also, we identifyed less common conditions causing bronchietasis like: Primary immunodeficiency, Allergic bronchopulmonary aspergilosis and Swayer James syndrome. Furthermore, the severity of bronchiectasis was determined using Bronchiectasis Severity Index. In terms of finding an etiology, disease severity was not the most reliable marker for identifying different etiological phenotypes. Unederlying cause and prognosis of non-cystic fibrosis are both heterogenous, thus, establishing a specific etiological diagnosis and assesment of disease severity is fundamental to therapeutical management and to prevent disease progresion. Overall, non-cystic fibrosis bronchiectasis is an underestimated disease, not only in prevalence and incidence, but also in its ability to cause great morbidity and mortality.

Aging and extrapulmonary effects of chronic obstructive pulmonary disease

Introduction People with COPD have a decline in functional status, but little is known about the rate of decline and factors that contribute. Of particular concern is the decline in cognitive and functional performance. Decrease in cognitive and functional performance will finally lead to decreased health status, sedentary life style and premature frailty. Aim The aim of this study is to compare functional performance and cognitive status in patients with COPD of different ages and to examine the changes in extrapulmonary effects. Patients and methods This study included 62 patients with COPD risk class D who were divided into two groups (<70 years, N=30 and >70 years, N=32). Patients first completed the Montreal Cognitive Assessment (MoCA), which is a 30-point test that assesses different cognitive domains, while isometric knee extension (IKE) was measured using a digital handheld dynamometer, and functional exercise level was assessed using the 6-minute walking distance (6MWD) test. Results The patients’ older age (age higher than 70 years) was associated with a significantly lower body mass index (BMI, 27.50 vs 24.24 kg/m2; P=0.020), higher vital capacity parameters, forced vital capacity (FVC, 2.74 vs 2.82 L; P=0.799), FVC (%) (73.00 vs 66.50, P=132), forced expiratory volume in the first second (FEV1, 0.93 vs 1.13 L; P=0.001) and FEV1 (%) (28.50 vs 30.50, P=0.605). In addition, patients at older age presented a significantly reduced physical activity capacity, 6MWD (385.93 vs 320.84 m, P<0.001) and IKE (24.75 vs 22.55 kgf, P=0.005), as well as higher values for inflammatory biomarkers, C-reactive protein (8.77 vs 3.34 mg/L, P=0.022). Moreover, patients at older age presented significantly lower score at the cognitive assessment, MoCA (23.50 vs 20.00, P<0.001). Conclusion Elderly COPD patients have reduced exercise capacity and muscle strength, deteriorated cognitive function and increased inflammatory markers. Furthermore, inflammation markers were significantly correlated with muscle strength, walking distance and cognitive impairment.

Unusual Presentation Of Sarcoidosis: Case Report

Abstract Sarcoidosis is a multisystem granulomatous disease with polymorphic manifestations, of unknown etiology, that can affect any organ in the body, but most commonly the lungs [1,2,3]. Extrapulmonary involvement is common, can occur in association with or in the absence of intrathoracic disease, and all organs can be involved, but it is rare to find an isolated extrapulmonary disease (less than 10% of patients) [3,4]. On occasion, the presentation of sarcoidosis may be atypical. We report a case of systemic sarcoidosis, with particular clinical data: extrathoracic onset with subdiaphragmatic lymph nodes, hepatomegaly and splenomegaly.

Prognostic Intake of Molecular Markers in Lung Cancer The Pulmonologist Point Of View

Abstract Lung cancer remains one of the most frequent pathologies in Pulmonology Departments. Tumor extension, histopathological types, and treatment influence the prognosis and survival in lung cancer. Five years survival dramatically decreases for the 4th-stage of the disease. Non-small cell lung cancer (NSCLC) represents the vast majority of lung cancers. In the last decades, important findings have been made on identifying standardized molecular biomarkers that control tumor growth in lung adenocarcinoma. The discovery of new drugs led to the increased survival, even in extensive forms of the disease. The greatest advances could be obtained by targeting EGFR genetic mutations or EML4-ALK translocate in patients diagnosed with adenocarcinoma lung cancer

Asthma and pregnancy

Asthma is the most common chronic medical illness that affects pregnant women; uncontrolled forms and its exacerbation may adversely affect both mother and baby. With a careful monitoring by a multidisciplinary team and timely implementation of therapy, these complications can be significantly prevented. This article reviews the aspects related to asthma diagnosis and treatment during pregnancy, focusing on the recently published studies about asthma control, asthma medications or common pathogenesis factors as contributors to adverse perinatal outcomes.

A case of late diagnosis of Gaucher disease with lung involvement (case study)

Abstract The present authors report the case of an adult male with no medical history, who developed prolonged fever of unknown cause, progression of anemia and lung fibrosis. A hematological disease was suspected and further investigations were done. The bone marrow aspirate raised the suspicion of Gaucher’s disease. The positive diagnosis was Gaucher’s disease with lung involvement (pulmonary fibrosis and pulmonary hypertension), and cardiac involvement (restrictive cardiomyopathy). Clinical evolution was unfavorable, and the patient died of cardiorespiratory failure. In conclusion, the present case report illustrates a late diagnosis of Gaucher’s disease with lung and cardiac involvement resulting in death in a short period

Pulmonary thromboembolic disease – clinical and etiological aspects in internal medicine department

Abstract 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.