Oana Arghir

Post-traumatic occipital psoriatic plaque complicated by extensive necrotizing fasciitis of the head and neck: a case report and literature review

Necrotizing fasciitis (NF) is a severe infection involving the superficial fascial layers, subcutaneous cellular tissue, and possibly skin. It usually has a fulminant evolution, rapidly leading to death in the absence of early diagnosis and aggressive surgical treatment. We herein report a rare case of NF secondary to a traumatized occipital psoriatic plaque in an alcoholic 47-year-old woman and compare this case with the published literature. The NF extended to the entire scalp, right face, and posterior and lateral cervical region. Despite the initially guarded prognosis, the patient’s survival emphasizes the importance of aggressive surgical treatment with wide excision of all necrotic structures without any aesthetic compromise.

Clinical consideration and lung function in different groups of COPD patients (smokers, ex-smokers, nonsmokers)

Background: Smoking is the well-known main risk factor for COPD but inhaled pollutant may be significant contributors to COPD severity. Aims and methods: We studied two groups of COPD patients: the first (70 patients - 35 active smokers, 35 ex-smokers) and the second: 68 nonsmokers. We analyzed correlation between smoking (alone or combined with occupational exposure) and clinical/functional parameters in COPD patients. Results: COPD patient’s age was lower in active smokers and ex-smokers. The male/female ratio was 4:1. Occupational exposure met high levels in all the 2 groups: 60.2% in non-smokers, 50% in smokers/ex-smokers. Current and former smokers had more cardiovascular disorders (hypertension, ischemia, and arrhythmias - 54.2%), depression (27.1%) and tuberculosis (24.2%) than nonsmokers (32.3%, 14.7% respectively 16.1%). Lung cancer was significant frequent in all patients but extremely high (22.8%) in smokers/ex-smokers with professional exposure versus unexposed nonsmokers (7.4%). FEV1 (48.6%) and Tiffeneau index average values (65%) were higher in nonsmokers comparing with ex-smokers (44.7%; 61.3%) and smokers (45.7%; 50.5%). Despite of the severity of the disease active smokers had a poorer compliance to treatment compared with former smokers and nonsmokers (4 months/year versus 8 and 9 months/year with a correct treatment). Conclusions: In both COPD groups occupational exposure had an important contribution to the disease development. Comorbidities were common in all COPD patients but much frequent in smokers and ex-smokers group. On the other hand smoking quitting improved twofold the treatment adherence in COPD patients.

Different Valuations of COPD Treatment Goals Between General Practitioners and Pulmonology Specialists in a Real-World Evidence Study From Romania (ACORD)

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a progressive disease with poor clinical outcomes if not appropriately treated. General practitioners (GPs) and pulmonology specialists are the pillars of the COPD care team. Little is known about the way the Romanian GPs and pulmonologists value the COPD treatment goals. The study ACORD aimed to evaluate the concordance of treatment goals between patients and physicians in COPD management in Romania and included both GPs and pulmonologists. We will present here the results for the two groups of physicians.

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

Differential diagnosis between occupational chronic intoxication with organic solvents and ethanol abuse by biological markers. Case report and literature review

Abstract Given the occupational exposure to substances contained in petroleum heated to high temperature, cholestatic liver disease, neurological signs and symptoms can occur. We present a case report of a male patient with no tobacco exposure or alcohol use, but with prolonged occupational exposure to petroleum vapours and natural gases like methane, propane butane who developed liver and neurologic disease, in the absence of protective equipment. Delayed diagnosis was established after 9 years of the first symptoms occurrence. Differential diagnosis with alcoholic etiology was considered and biological biomarkers were useful.

Occupational exposure and lung cancer risk - Study in two different Romanian areas

Abstract Lung cancer is the most frequent neoplasm worldwide and the incidence in Constanta County is in continuous increasing. Occupation as a cause of lung cancer is common. The authors examined the relation between occupation and lung cancer in two patient cohorts from different areas of Romania: Constanta and Valcea. In 2005-2010, in Constanta and Valcea counties, 488 and 344 incident lung cancer cases were enrolled. Lifetime occupational histories (industry and job title) were coded by using standard international classifications and were translated into occupations known (list A) or suspected (list B) to be associated with lung cancer. An exposure excess of 14.6% for patients from Constanta ever employed in occupations known to be associated with lung cancer (list A) was found, with the largest contributions from the oil refinery and shipbuilding industries No overall excess was found for list B with the exception of bus and truck drivers (men) and launderers and dry cleaners (women), in both groups of patients. These results indicate that past exposure to occupational carcinogens remains an important determinant of lung cancer occurrence.

The evolution of pain in knee osteoarthiritis treatment with sodium hyaluronate

Abstract Although the knee osteoarthritis is often benign, severe degenerative modifications can determine serious malfunction. In joints affected by arthritic processes, Sodium hyaluronate is found in reduced concentrations, the normal articular cartilage being replaced by fibrocartilage [6]. The present concepts suggest that osteoarthritis is not a predictable stage in ageing and prophylactic and therapeutic approaches could be taken in the future

Pulmonary silicotuberculosis in an electrician male - Case report and literature review

Abstract This is a case report of a pulmonary silicotuberculosis in a former smoker, male, 43 years old, having 21 years of occupational exposure to particulate coniotic-free crystalline-silicon dioxide as an electrician, developing symptoms as fever higher than 38°C, dry cough and diffuse chest pain, being diagnosed with miliary of the lung in 2002. Silicosis was confirmed later by histological exam obtained through an exploratory thoracotomy and it was included in the transient first to second stage of pneumoconiosis. Three years later, in July 2005, Pulmonary Tuberculosis was diagnosed by acid-fast stains positive smears. The evolution of the case was to a progressive deterioration till 2008, leading to silicosis stage III. Silicosis is a pulmonary fibrosis which must be always suspected in persons working in conditions of occupational exposure to dust of silicon dioxide, having suggestive radiological changes including micronodular radiological pattern or pseudotumoral one. Once the diagnosis of silicosis is confirmed, tuberculosis may be frequently associated. The more advanced silicosis is, the more the combination of the two diseases is commonly revealing and, often, the TB morbidity among workers in the silica industry exceeds that of general population. A hint orientation for the silicotuberculosis’ diagnosis, in this reported case, was represented by the radiological dynamic of the lesions. Tuberculosis lesions are less dense and imprecisely defined, located in upper lobes and develop necrotic centers.

Ethical issues of diagnosis and therapy in patients with HIV-AIDS and Tuberculosis

Abstract Like medicine, ethics is a practical discipline, which they acquire the knowledge of the general principles and skills to solve problems. Long term care involves both clinical and ethical issues in medicine. Effective medical education of long-suffering patients has to be focusing on increasing their adherence to treatment. The occurrence of AIDS pandemic has changed the physician’s way of thinking in terms of ethics in general, and in medicine in particular. HIV/AIDS has focused attention on deficiencies in the field of therapy, long care issues, medical training and education of the patients, as well as in deontology. The treatment of HIV infected patients with all new drugs discovered is not yet completely curative and the association of opportunistic infections, as tuberculosis (TB), is representing a permanent challenge for therapist. Both ethical and medical training in general as regards AIDS and TB, should focus mainly on exposed people and learning through experience, to form skills that would make doctors to work with sensitivity in regard to sexuality, substance abuse, lack of treatment, relapses of disease and even death. In the same time, any ethical or cultural environment can enrich and support the real moral education of medical staff. Medical ethics and ethics relating specifically to TB and HIV/AIDS, often meet highly complex problems. Alternative possibilities and decisions to take of what is right or wrong may create a real ethical, clinical and therapeutic dilemma.