Acute Myocardial Infarction in a Young Male with Ankylosing Spondylitis – Case Presentation

Cardiovascular risk scores are useful in early detecting and, most important, early correcting the cardiovascular risk factors in order to prevent the cardiovascular disease, but the most commonly used charts have essential limitations when applied to young adults. We present the case of a 39-year-old man, known with HLA-B27-positive ankylosing spondylitis for 15 years, treated only with nonsteroidal antiinflamatory drugs, without any traditional cardiovascular risk factors, who was diagnosed with severe coronary artery disease, sub-occlusion in the proximal and mid-segment of the left anterior descending artery, which required emergency percutaneous coronary intervention with drug-eluting stent implantation. In this case report we aim to highlight the necessity of considering other parameters such as C-reactive protein levels or carotid plaques when estimating the risk of developing a cardiovascular disease, especially in young adults diagnosed with chronic inflammatory disease.

The Most Frequent Neurological Complications in HIV Patients in Constanta and the Influence that Coinfections Have in the Onset of Such Conditions

Abstract: This paper shows the results of a retrospective observational analytical study that has enrolled 166 HIV positive patients diagnosed with a neurological complication between June 2012 and June 2020, in Clinical Infectious Diseases Hospital of Constanta. 119 patients (71,69%) were diagnosed with one of the three neurological complications: HIV associated dementia (HAD), Progressive Multifocal Leukoencephalopathy (PML) and CNS Toxoplasmosis (CT). We have noted CD4 levels, viral loads, and the presence/absence of other infections like: HBV, HCV, Treponema pallidum, Mycobacterium Tuberculosis. The results show that PML and CT, in this order, are the main opportunistic infections with important neurological impact. Both, PML and CT are in direct correlation with the immune status, but also with other infections like the infection with HCV or with M. Tuberculosis. CD4 nadir <100 cells/mmc and viral load ≥100000copies/ml have a stronger association with PML (p<0,05). Patients known with HIV and T. pallidum infection are more likely, in case of new sudden neurological signs, to be diagnosed with Neurotoxoplasmosis versus PML, or HAD (p<0,05). Given the fact that HIV patients can have multiple alterations of neurological functions, and spectaculous but complicated neuro imagistic results, knowing the history of the patients, the lab results, and the statistical probability can help the physician, infectious disease specialist or neurologist, to make a faster and precise diagnosis.

About Lung Cancer in Romania and Constanta County

Abstract: In Romania lung cancer represents the second most common cancer after breast cancer, for both sexes, and is the leading cause of death among patients with cancer. Between 2011 and 2019 the incidence of cancer had a growing trend for both Romania and Constanta County. Unfortunately, the forecast regarding the incidence of cancer in Romania shows a trend of continuous rise of new cancer cases until 332.7%000 inhabitants by 2025. In these conditions we wanted to analyze some aspects of lung cancer situation in Constanta County.

Proteomic Implications of Tumoral Infiltrating Lymphocytes in Melanoma: PD-L1, CD4 and CD8 - Short Review

Melanoma is a tumor developed by malignancy of melanocytes, being one of the most lethal cancers. Usually, it is associated with exposure to ultraviolet radiations, being most common in the skin, but can also be located extracutaneously as in the digestive tract, leptomeninges or uvea. Histopathologically it presents a phase of radial growth and a vertical one, often accompanied by an intra and peritumoral inflammatory infiltrate. Immunohistochemically, the confirmation of the diagnosis of melanoma should be accompanied by the assessment of proteomic markers of lymphocytic infiltrate such as PD-L1, CD4 and CD8. Those have a role in evaluating the prognosis and a possible prediction of the immunotherapeutic response.

Colon Cancer in Patients with Crohn’s Disease and Diabetes Mellitus

Introduction: Diabetes mellitus and colorectal cancer are diseases with an increasing impact on the population. Colorectal cancer is a well-recognized complication of inflammatory bowel diseases, such as ulcerative colitis and Crohn’s colitis. Here we describe an unusual case of diabetes mellitus, Crohn`s colitis-associated cancer. Case report: We report the case of a 49-year-old woman, known with Crohn's disease and diabetes, who developed a transverse colon adenocarcinoma associated with multiple outbreaks of high-grade or low-grade intraepithelial dysplasia/neoplasia, for which a subtotal proctocolectomy with ileorecto-anastomosis with “J” pouch it was made. Conclusions: The risk of colonic carcinoma in Crohn's disease is increasing. An association of colorectal cancer with diabet mellitus and inflammatory bowel disease has been established. From diagnosis to treatment the management of these cases can be difficult and challenging.

Vicios Appendix Position Clinical Case

The purpose of this article is to present a rare, particular case of intestinal anatomy, intraoperatively evidenced as a vicious position of intestine determined by nonrotation of primary intestinal loop.

PD-L1 and CD8-Tumor-Infiltrating Lymphocytes Expression in Laryngeal Squamous Cell Carcinoma

Studies in recent years have shown that the immune system plays an important role in the prognosis of patients with different types of malignancies. The tumor immune microenvironment has been studied in various cancers in an attempt to find new antitumoral therapies. The therapeutic blockade of PD-1/PD-L1 has revolutionized the treatment of oncological pacients, with anti-PD-L1 monoclonal antibodies having remarkable results in malignant melanoma, cervical, renal and lung cancer. In laryngeal cancer, few reports are available on the immune microenvironment and PD-L1 expression. Considering these, we retrospectively review 23 laryngeal cancer patients with laryngectomy performed in the Otorhinolaryngology Department - Emergency County Clinical Hospital St Andrew Constanta. The aim of our research was to evaluate the immunohistochemical expression of PD-L1, using combined positive score which includes both viable tumoral cells and intratumoral lymphocytes, as well as the level of CD8 intratumoral lymphocytes and to analise the corelation between these markers and the clinicopathological characteristics of the pacients, in order to set these two parameters, in the near future, as new biomarkers. PD-L1 expression was shown to be a prognostic factor for disease-free survival in laryngeal cancer patients (p = 0.006) and was higher in tumors with elevated CD8 lymphocyte levels, with a significant correlation correlation between the two parameters (p = 0.019). The level of CD8 lymphocytes was also a predictive factor for free-disease survival, correlated with patient smoker status (p = 0.04), being higher in non-smoking patients.

Performance and Consequences for Fecal Transplant in the Treatment of Pseudomembranous Colitis

Under conditions of increased consumption of antibiotics, pseudomembranous colitis has become a common condition in Romanian hospitals. Severe forms of the disease are becoming more common, recurrences are numerous, and metronidazole and vancomycin therapy has failed to prevent these recurrences. The study aims to identify the characteristics of patients who require a fecal transplant, the time for its performance and what are the short-term and possibly long-term consequences of this method. We analyzed 26 patients who had a fecal transplant with a favorable evolution in 96%. We consider that FMT is an effective method for preventing recurrent CDI but also for those with resistance to the usual antibiotics.

Nephrotic Syndrome Associated with Hydronephrosis and Unilateral Renal Agenesis

We reported a case of nephrotic syndrome in a child presenting undiagnosed hydronephrosis and unilateral renal agenesis in a 3 years and 9 months old male patient presenting features of nephrotic syndrome, with left hydronephrosis and unilateral renal agenesis. The association of nephrotic syndrome with congenital anomalies is extremely rare. The importance of this unusual combination was discussed respecting the literature.

The Efficiency of the Fight Against HIV, in Constanta, from the Perspective of Neurological Complications

In order to control and end the AIDS epidemic, we all need to hit the 0-0-0 target. That means 0 HIV infections, 0 mortality caused by AIDS and 0 discrimination. We performed a retrospective observational analytical study on 166 HIV positive patients with a neurological complication, diagnosed between June 2012 and June 2020, in Clinical Infectious Diseases Hospital of Constanta. We collected data from the observational charts that revealed if the patient was known with HIV infection at the time of the neurological complication diagnosis, information about the treatment (how many treatment regimens, classes of antiretroviral drugs, CNS Penetration-Effectiveness Rank), treatment compliance. The patients were divided into two groups: first group “opportunistic infections (OI)” and second group “other neurological conditions (ONC)”. 16 patients (9,6%) have the neurological condition as first manifestation of HIV infection. Opportunistic infections, correlated with a poor immunological status continue to have a high percentage (46,98%) of neurological complications, being associated with a poor treatment compliance (p<0,001). Integrase inhibitors were associated, in this study, more with opportunistic infections and less with other neurological conditions (OR=2,885; 95% IC), this finding needs further research. Long term survivors have problems with treatment compliance manifesting treatment fatigue, even if they have treatment regimens with good CNS penetrability. Poor compliance is associated with high risk of opportunistic infections and opportunistic infections have a higher mortality than other neurological complications. Our task for the future is to find ways to improve treatment adherence in order for HIV patients to have a better and longer life.