Liliana Tuta

Renal disease in patients with rheumatoid arthritis treated with biological therapy

Abstract The use of biological therapies may have positive impact on chronic renal disease associated with rheumatoid arthritis. The study evaluates retrospectively renal function in 57 patients with rheumatoid arthritis treated with different types of biological therapy, comparative with 62 RA patients treated conservatively with DMARDs. Patients treated with biological therapies presented a lower mean value for serum creatinine measured both at baseline and after 6 months of treatment, statistically significant compared with the subgroup treated with DMARDs (0.69 ± 0.17 mg/dL vs. 1.18 ± 1.01 mg/dL, p = 0.003). Results for estimated filtration rate were significantly increased in biologically treated cohort (100.36 ± 16.76 mL/min/1.73 m2 vs. 63.49 ± 21.60 mL/min/1.73 m2, p < 0.00001). Rituximab presented a better estimated filtration rate compared with other biological tharapies (eGFR 97.037 mL/min/1.73 m2 vs. 90.933 mL/min/1.73 m2). The positive effect of potent biological anti-inflammatory therapies sustains the need of further exploring the risk of reduced kidney function in immune-mediated diseases, including rheumatoid arthritis.

17 Years Old Patient with Nephritic Syndrome Induced by Systemic Lupus Erythematosus

The case study describes the admission of a 17 years old patient in the emergency department of Constanta with main complaints: diffuse abdominal pain, poly arthralgia and intense headache. The first screening tests revealed anaemia, renal impairment associated with nephritic syndrome. In the immunological investigations, the level of antibodies anti-ds DNA was increased and the following renal biopsy presented segmental changes of the glomerular membranes. The clinical features associated with the laboratory results were specific for the diagnosis of systemic lupus erythematosus. The patient was continuously under follow-up and was given mainly antihypertensive drugs and corticosteroids. She also received treatment for correction of anaemia and analgesia. In conclusion, this patient with a newly diagnosed autoimmune disorder was presented with deteriorating renal function associated with hypertension, conditions which appear very rarely in patients of such a young age.

Efficacy Of Pegylated Interferon And Ribavirin Treatment In Coinfected HIV HCV Patients

Abstract The objectives of the study were to determine the efficacy of pegylated interferon alfa 2 b (PegINF) and ribavirin (RBV) treatment in co-infected HIV / HCV patients, to identify predictive factors associated with sustained viral response (SVR) in these patients. Out of the 956 HIV infected patients, 38 were HCVAb (4%) positive, 14 of which had undetectable HCV RNA, only 6 patients met the inclusion criteria. Screening failure was due to: liver cirrhosis Child Pugh B / C, hepatocellular carcinoma, pulmonary TB, thyroid dysfunction, CD4 <200 cells3, detectable HIV RNA and depressive syndrome. We initiated PegINF and RBV therapy for 48 weeks. SVR was achieved in 16.6% of cases (only one patient) and correlated with HCV RNA level, CD4 count, duration of HIV infection, CDC classification and liver fibrosis. In conclusion, our study group has a low prevalence of HIV / HCV co-infection (2.6%) with a large number of patients HCVAb positive but undetectable HCV RNA. Positive predictive factors for SVR were: low levels of HCV RNA, small duration of HIV infection, high levels of CD4, B1/B2 (CDC classification) and low degree of fibrosis.

Acute myocardial infarction with multiple mechanical complications

Abstract The rupture of the inter-ventricular septum is a rare, but extremely severe mechanical complication of the acute myocardial infarction, which in most cases of no immediate surgery is fatal (30 days death rate – 80%). The incidence of the septum ventricular defect post-acute myocardial infarction was 1-3% in the period before crash injury therapy, dropping to 0.2% after introducing the thrombolytic treatment. The acute mitral failure and the septum ventricular defect are two mechanical complications of the acute myocardial infarction associated with high death rate, regardless of the progress made in medical and surgery therapeutic approach. This paper highlights the peculiarities of a clinical case like the acute myocardial infarction as the first manifestation of heart disease in a patient with no history of cardiovascular disease but with risk factors (obesity, dyslipidemia, hypertension), the ECG evident changes in the anterior territory and more discrete in the inferior territory, which established the initial diagnosis to be myocardial infarction and the presence of two mechanical threatening complications: ventricular septal flaw and acute mitral failure through posterior papillary muscle incomplete rupture.

Tumoral retroperitoneal masses and their impact to renal function

Abstract Retroperitoneal tumors, either benign or malignant, usually cause problems both for an accurate diagnosis and for therapeutic approach, due to their reduce incidence, late presentation and anatomical location, in the neighborhood of vital structures from the retroperitoneal space. Materials and methods: Aim of study was to search correlations between, gender, age, and histo-pathological type of retroperitoneal tumors, as well as their impact upon renal function. Results: Sarcomas represented about 30% of retroperitoneal tumors. The most frequent benign retroperitoneal tumors included: neurogenic tumors, paragangliomas, renal angiomyolipomas and benign retroperitoneal lipomas. Renal function was altered in about 55% of the patients, and postsurgical mortality was 8.73%.

Spatial statistics detect clustering patterns of kidney diseases in south-eastern Romania

Abstract Medical geography was conceptualized almost ten years ago due to its obvious usefulness in epidemiological research. Still, numerous diseases in many regions were neglected in these aspects of research, and the prevalence of kidney diseases in Eastern Europe is such an example. We evaluated the spatial patterns of main kidney diseases in south-eastern Romania, and highlighted the importance of spatial modeling in medical management in Romania. We found two statistically significant hotspots of kidney diseases prevalence. We also found differences in the spatial patterns between categories of diseases. We propose to speed up the process of creating a national database of records on kidney diseases. Offering the researchers access to a national database will allow further epidemiology studies in Romania and finally lead to a better management of medical services.

Nuclear morphometric study of prostatic atrophy

Abstract The prostatic atrophy is a lesion with small glands that can mimic adenocarcinoma, commonly diagnosed in the elderly and whose preneoplastic role is controversial. Over time several classifications have been developed for this lesions according to its architectural and cellular aspects. Materials and Methods: Aim of the study is morphometrically assessment of epithelial component nuclei in prostatic atrophy. We evaluated parameters represented by nuclear area (NA), nuclear perimeter P (μm) Elongation factor (E), average diameter (DEQ), maximum diameter (Dmax), Minim diameter (Dmin). The control group was represented by adenomatous hyperplasia component of benign hyperplasia of the prostate. Results: Morphometric analysis revealed significantly higher values of nuclear parameters in atrophy compared with adenomatous component in controls (p <0.05) which can signify nucleomegaly and a potential preneoplastic role.

Medical causes of acute kidney injury- clinical and therapeutic aspects in constanta county

Abstract Introduction. Acute kidney injury represents an important clinical syndrome within nephrology, approximately 5% of hospitalised patients being affected. Establishing a diagnosis for acute kidney injury can be challenging and requires many steps. A complete and correct diagnosis is essential for appropriate therapy and, ultimately, the patient’s prognosis. Methods. An objective of this study is to determine the presentation of certain characteristics for the diagnosis of acute kidney injury. It is also intended to show the therapeutic methods undertaken for patients presenting with acute kidney injury, as well as evolution under therapy. Results. The most common causes of acute kidney injury were medical causes and within that category, cardiovascular diseases were the most common etiological factor (18%). Nephropathies represented a minority, with acute pyelonephritis, responsible for 5% of medical causes, and acute glomerulonephritis accounting for 6%. Hemodialysis was initiated only in 15% of patients. The rest of the patients were treated conservatively and responded favourably to this therapeutic approach. The etiological factors that had the greatest number of patients requiring hemodialysis were Rifampicin administration and leptospirosis (~20% each). Conclusions. The clinical characteristics of acute kidney injury are variable and are usually specific to the etiology of the disease. The most common causes were cardiovascular diseases (18%). The therapeutic approach was rather conservative. Hemodialysis was instituted only in 15% of the patients. Almost 5% of all patients evolved to chronic kidney disease in a variable period of time, and the overall mortality was 18%, mainly due to infections and cardiovascular complications.