The Benefit of Benralizumab Monoclonal Antibody Treatment for Severe Eosinophilic Asthma in a Case Series (Pulmonology Clinic Târgu Mureș, Romania)

Background: Monoclonal antibody therapy is currently an additional treatment option to reduce exacerbations and improve symptom control in patients with severe eosinophilic asthma (SEA) that is uncontrolled despite treatment with high-dose inhaled corticosteroids and long-acting beta-2 agonists. Benralizumab, a monoclonal antibody that binds to the interleukin-5 receptor (IL-5), significantly reduces symptoms and annual exacerbations, as well as the use of systemic corticosteroids in patients with SEA. However, few studies are available on the effectiveness of this biological treatment in real life. The aim of this case series was to evaluate the efficacy of benralizumab by analyzing changes in clinical parameters and blood eosinophils in patients with SEA. Methods: We analyzed four patients with SEA who started treatment with benralizumab. The history of symptoms and exacerbations, eosinophil counts, data regarding the oral corticosteroid dose, need for rescue treatment, spirometry measurements and asthma control questionnaires (ACT) regarding the level of asthma control were recorded. A positive response to treatment was defined by a significant reduction in eosinophil counts, increased ACT scores, and lower rates of exacerbations. Results and conclusions: Benralizumab monoclonal antibody was effective in all four patients. This was shown by a reduction in exacerbation rates, symptom severity, and lower dose of oral corticosteroids and rescue medication. This novel treatment was well tolerated by the analyzed patients, thus indicating that benralizumab is an attractive choice for patients due to eosinophilic count reduction as well as the less frequent dosing schedule. However, further studies are required, on larger populations.

The Ugly Face of Face Masks

Introduction: Prolonged and tightly use of face masks has been identified as cause for skin damage during the COVID-19 pandemic. Case series presentation: We evaluated patients seen in the outpatient clinic between March and May 2020, during the lockdown period, focusing on skin damage related to the use of face masks. We aimed to highlight the major impact of routine usage of face masks on the skin of individuals of different ages and professions. Contact dermatitis was prevalent, but we also recorded many cases of outbreak of seborrheic dermatitis, acne, rosacea, perioral dermatitis, atopic dermatitis, folliculitis, as well as neurotic excoriations caused by anxiety, tinea, and impetigo. We also observed a delay in the diagnosis of benign and malignant tumors. Conclusions: The most important step should be the assessment of dermatologic pathology related to the use of face masks. They say a picture is worth a thousand words. So take off the face mask, and look at the skin!

Correlation between Magnetic Resonance Imaging and Arthroscopic Findings in Knee Lesions

Background: Magnetic resonance imaging (MRI) is a noninvasive diagnostic method with no known side effects and a high sensitivity for detecting meniscal lesions as well as lesions of the anterior and posterior cruciate ligaments. For a correct and complete diagnosis, MRI results must be interpreted in the context of clinical examination and anamnesis. MRI results can support the surgical indication for arthroscopy, which is a minimally invasive intervention that facilitates the visualization, investigation, diagnosis, and treatment of intra-articular lesions of the knee. The purpose of this study was to assess the correlation between MRI results and the intra-articular lesions detected arthroscopically. Material and methods: This retrospective study evaluated a total of 60 patients admitted and treated between January 1, 2013 and January 1, 2014 in the Clinic of Orthopedics and Traumatology of Mureș County Hospital, Târgu Mureș, Romania. Results: In the 43 patients with lesion of the anterior cruciate ligament, the lesions were seen on MRI in 40 patients (93%) and confirmed arthroscopically in 37 patients (86%). In 34 cases (79.1% of the total of 43), the MRI and arthroscopic results were similar, the Kappa coefficient showing a high degree of correlation (0.90). Conclusion: By assessing the Kappa coefficient to highlight the correlation between MRI results and arthroscopic diagnosis for knee injuries, a statistically relevant correlation between the two methods was found. This suggests that a correct diagnosis can be achieved by both methods.

Etiopathogenic and Clinical Aspects in Inflammatory Bowel Disease – Literature Review

Inflammatory bowel disease (IBD) is a chronic inflammatory condition which encompasses Crohn’s disease and ulcerative colitis. IBD does not only affect the gastrointestinal system, but also associates many extraintestinal complications that can affect almost any organ. A large number of patients may have these complications before or after the diagnosis of IBD. Early diagnosis and management of these complications involves a multidisciplinary team and contributes to decrease patient morbidity and mortality, but also to increase the quality of life. The purpose of this extensive literature review is to present systematically and comprehensively the latest data on the extraintestinal manifestations of IBD, and to draw clinicians’ attention to the fact that this condition can have extradigestive manifestations that can be misleading and delay the diagnosis.

Inflammatory Biomarkers and Endothelial Alteration in Patients with Heart Failure and Acute Coronary Syndromes

Introduction: Systemic inflammation plays a key role in the pathophysiology of acute coronary syndrome (ACS), having a direct effect in promoting the progression and rupture of vulnerable coronary plaques. The aim of this study was to investigate the association between inflammatory biomarkers and the type of ACS (ST-elevation myocardial infarction – STEMI, non-ST-elevation myocardial infarction – NSTEMI, or unstable angina – UA) in patients with confirmed heart failure. Material and Methods: This study included a total of 266 patients admitted to the Clinical Department of Cardiology of the County Emergency Clinical Hospital of Târgu Mureș – Cardiac Intensive Care Unit (CICU) for ACS of various types (UA, NSTEMI or STEMI) between January 1, 2017 and December 31, 2020, in whom the diagnosis of heart failure was established based on clinical and paraclinical data. From the total number of patients, 36 were hospitalized for UA and 230 for MI, of which 165 were STEMI and 65 were NSTEMI. Results: Only hs-CRP and IL-6 were significantly higher in MI compared to UA. Mean hs-CRP was 4.9 ± 4.5 mg/mL in patients with UA vs. 20.4 ± 42.2 mg/mL in patients with MI (p = 0.001), and mean IL-6 was 7.2 ± 13.8 pg/mL in UA vs. 31.6 ± 129.2 pg/mL in MI (p <0.0001). ICAM seems to have had a greater discriminating power between STEMI and other types of ACS in those with heart failure, having a value more than double in those with STEMI (216.1 ± 149.6 ng/mL vs. 448.2 ± 754.4 ng/mL, p <0.0001). Conclusions: In patients with heart failure, the increase of inflammatory biomarkers such as hs-CRP is associated with the development of an acute myocardial infarction but not with its type. Adhesion molecules, especially ICAM, are elevated in patients with STEMI compared to other types of ACS, indicating a potential role of endothelial alteration in the development of an ACS when it adds to systemic inflammation linked to heart failure.

Anatomical Variations of the Peroneus Tertius and Extensor Digitorum Longus Muscles – Case Presentation

Introduction: The extensor digitorum longus and peroneus tertius muscles have multiple morphological variations. The tendinous slips of these muscles are used as grafts to replace other damaged tendons. Case presentation: We present a unique anatomical variant observed during dissection of a cadaver at the Department of Anatomy and Embryology of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania. The peroneus tertius muscle was identified on the left lower extremity as originating from the inferior third of the fibula and interosseus membrane. The posterior belly of this muscle joins the muscular belly of the extensor digitorum longus muscle. The tendons of toes II to V detach from the extensor digitorum longus muscle with an additional tendon. This last tendon gives off an accessory tendinous slip; lateral to this, the peroneus tertius muscle tendon is observed. In case of the right lower limb we also noted the peroneus tertius muscle originating from the distal part of the extensor digitorum longus muscle. Regarding the extensor digitorum longus muscle we describe an accessory tendinous slip. Conclusion: The anatomical variation reported in this study is similar to those reported by previous studies, but displays particular characteristics regarding the VI tendon of extensor digitorum longus and the joining of the peroneus tertius and extensor digitorum longus muscles in the left lower extremity.

Factors Associated with Diabetes-Related Distress in Patients with Type 2 Diabetes Mellitus

Introduction: The aim of this study was to identify factors associated with diabetes-related distress (DRD) in adult patients with type 2 diabetes mellitus (T2DM). Material and Methods: This was an analysis of data previously obtained from two cross-sectional studies, in which medical charts review and direct interviews were employed to obtain medical and demographic data. Vital status assessment and anthropometric measurements were performed. The patients filled out specific questionnaires for DRD (DDS-17), symptoms of depression (PHQ-9), and of anxiety (GAD-7). A clinical meaningful threshold for DRD was set at ≥2.0 points. Symptoms of depression and anxiety, number of chronic complications, therapy for T2DM, anthropometric and cardio-metabolic parameters, as well as demographic, socio-economic data, and lifestyle habits were evaluated as factors possibly associated with DRD by univariate and multiple regression analyses. Results: A total of 271 patients with T2DM were included in this analysis, of whom 25.1% presented a DDS-17 score ≥2 points (and 9.96% a DDS-17 score ≥3). Subjects with a DDS-17 score ≥2 had higher HbA1c levels (p = 0.018), PHQ-9 and GAD-7 scores (p <0.0001 for both). The multiple regression model indicated that anxiety (p = 0.026), depression (p = 0.001), and ethnicity (p = 0.002) were significantly correlated with DRD (p <0.0001). With regards to subscales, the HbA1c (p = 0.005) and PHQ-9 score (p <0.0001) were significantly associated with emotional burden, ethnicity (p = 0.001) and depression (p = 0.004) with regimen-related distress, whereas ethnicity (p = 0.010) and GAD-7 score (p = 0.012) with interpersonal distress. Conclusions: Psychosocial factors like depression, anxiety, or ethnicity significantly contribute to DRD in patients with T2DM, and worse glycemic control is associated with emotional burden.

Uveal Tumor with Retinal Detachment – Case Report of a Rare Malignancy

Introduction: Melanoma, a type of tumor originating from melanocytes, can have different anatomic locations. Ocular melanoma represents about 5% of total melanomas and is a rare condition, with an overall incidence rate of 5.1 cases/million/year. The most frequent location of uveal melanoma is the choroid (90%), followed by the ciliary body (6%) and the iris (4%). The most frequent symptoms of choroidal melanoma are blurred vision and photopsia. The therapeutic approach of uveal melanoma can be classified into two main categories: globe preservation treatments and enucleation. Case presentation: We present the case of a male patient diagnosed at the age of 72 years with right choroidal melanoma, who had a preexisting condition of visual impairment due to the presence of right mature cataract. The diagnosis was delayed in the course of the disease, as retinal detachment had already been installed. The patient was treated with local radiotherapy. Conclusion: Uveal melanoma is a malignancy in which a novel therapeutic approach, including magnetic resonance imaging is needed in order to improve the outcome of these patients, preserve vision and prevent systemic extension of the disease.

Cone Beam Computed Tomography Study on the Incidence of Endodontic Filling Biomaterials Resorption in Patients With/Without Orthodontic Treatment

Background: The differential diagnosis of endodontic and periodontal diseases can sometimes be clinically difficult, but it is vital to establish a correct diagnosis so that predictable treatment can be offered. Aim: The aim of this study was to highlight the prevalence of endo-periodontal lesions in the frontal dental group of the lower jaw depending on the degree of bone resorption as well as endodontic filling resorption in different patients, some of them with orthodontic treatment, using conical beam computed tomography (CBCT). Materials and methods: A number of 31 CBCT imaging volumes and the medical records of these patients were selected for analysis by an experienced examiner. The sites selected for analysis were divided into two subgroups, one where the endodontic treatment was performed with Endomethasone™ (Colthene, Creteil, France) (7 patients), and the other where it was performed with Adseal™ (Meta Biomed, Seoul, South Korea) (6 patients). Results: The mean age of the study population was 24.1 years, and 35.8% presented previous orthodontic treatment in their medical history. There were no statistically significant differences (p = 0.54) between groups regarding the length of the endodontic filling, the Endomethasone group showing a total length of 11.24 millimeters while the Adseal group showed a total length of 10.85 millimeters. Conclusions: The image obtained in clinical situations in which patients present combined endodontic-periodontal lesions is of real help because in many cases, with the help of CBCT, the starting point of a combined lesion can be highlighted, whether it is endodontic or periodontal.

Smoking Habit and Correlation with Hand Eczema in Healthcare Workers in the Time of COVID-19

Background: Hand eczema, in time of COVID-19, is one of the most frequently diagnosed skin disorders in nurses. In this study, we sought to investigate whether smoking could be an additional risk factor for hand eczema in nurses during the COVID-19 pandemic. Method: Using a questionnaire about smoking details and hand eczema, we conducted a study among nurses involved in the frontline management of COVID-19 patients. A total of 1,000 questionnaires were sent out. The questionnaires were anonymous and based on self-reported answers, with no clinical examination or medical data evaluation. All nurses enrolled in the study were women, working in shifts for the last three months since the start of the COVID-19 pandemic. Results: Two-hundred forty-seven questionnaires were accepted for the study, after eliminating non-responders and nurses without hand eczema. The majority of nurses denied smoking (87.85%) in the past and at the moment of the study. Statistics related to years of smoking and occurrence of hand eczema showed no increase in the number of cases in correlation with the number of years of smoking. Similarly, a random distribution of cases of hand eczema was observed when compared to the number of cigarettes per day. Conclusion: Our data does not support the hypothesis that smoking is an independent risk factor for the development of occupational hand eczema during the COVID-19 pandemic.