Thrombotic risk in antiphospholipidic syndrome: From hypothesis to current evidence (Review).

Thirty-five years after it was first described, antiphospholipid syndrome (APS) is unanimously recognized as a systemic autoimmune disease, a major acquired thrombophilia, which can affect any arterial or venous vascular territory, explaining the great diversity of clinical manifestations. The current classification criteria updated in the International Consensus Statement for Definite Antiphospholipid Syndrome from Sydney cannot explain alone the unpredictable evolution with thrombotic events of the patients diagnosed with APS. Although the link to genetics and epigenetics has not been clearly defined as in other autoimmune diseases, it is clear that a proper stratification of thrombotic risk in the era of personalized medicine must include classic biological markers (antiphospholipid antibodies, aPL), along with the already recognized phenotypes, non-conventional serological markers, and additional genetic risk factors for thrombosis. Moreover, with advancing age, a patient with APS develops other thrombotic risk factors which include: hypertension and dyslipidemia among others. According to the classification criteria, a patient is considered to have a low, moderate or high thrombotic risk. In clinical practice, patients with the same risk score may have completely different evolutions in terms of the recurrence of thrombosis. Concerning this approach, it appears that new non-conventional serological markers, phenotype-assessment and genetic determinants have an increasing importance and should be reconsidered in a proper thrombotic risk evaluation in patients with APS, compared to the initial concept of APS as first defined.

Switching bipolar disorder patients treated with clozapine to another antipsychotic medication: a mirror image study.

Bipolar disorder (BD) is associated with periodic symptom exacerbations, leading to functional impairment, and increased risk of suicide. Although clozapine has never been approved for the treatment of BD, it is occasionally used in severe mania. The aim of the study is to evaluate the risks and benefits of switching clozapine in remitted BD patients. This is an observational, mirror image study of 62 consecutive remitted BD outpatients treated with clozapine. Twenty-five patients were switched to another antipsychotic following a change in a drug reimbursement rule, while 37 continued on clozapine. The mean time in remission was shorter for the switched group (9.2±4 months vs 13±6 months, P=0.018), and the number of patients who relapsed was larger (n=21 vs n=8, P<0.0001). The results suggest that switching from clozapine to another antipsychotic may increase the risk of relapses in remitted patients with BD.

Delayed identification and diagnosis of Huntington's disease due to psychiatric symptoms.

Huntington's disease (HD) is a progressive neurodegenerative illness that affects 2-9/100.000 of the general population. The usual onset is at around age 35-40 years, but there were cases with onset above 55 years. The disease manifests clinically with many neurological and psychiatric symptoms, leading in advanced phases to dementia, but cognitive symptoms are frequently present much earlier in the disease course. HD is caused by an expanded polyglutamine stretch in the N-terminal part of a 350 kDa protein called huntingtin (HTT). This stretch is encoded by a trinucleotide CAG repetition in exon 1 of HTT. An expansion of greater than 36 repeats results in HD. The number of repeats is inversely correlated with the age of onset of motor symptoms, and disease onset during childhood or adolescence is associated with more than 60 CAG repeats. Mood disturbances may be one of the earliest symptoms of HD and may precede the onset of the motor pheno-type for almost 10 years. Neuropsychiatric symptoms may delay the appropriate diagnosis of HD and have major implications for disease management, prognosis and quality of life for patients and families. This case study is about a 58 years old female patient with late identification of Huntington's disease after two admissions to psychiatric inpatient units, for the treatment of behavioral disturbances.

Cardiovascular risk factors in patients with chronic plaque psoriasis: a case-control study on the Brasov County population.

Many studies have suggested that cardiovascular risk factors seem to be more common in patients with psoriasis than in the general population. In this study we aimed to determine the prevalence of cardiovascular risk factors in patients with chronic plaque psoriasis depending on the severity of disease. We conducted a prospective study in Brasov County (Romania) including 142 patients with chronic plaque psoriasis and disease duration of at least six months and 167 controls without psoriasis. The severity of psoriasis was assessed using the psoriasis area and severity index (PASI) score. Along with a thorough medical history and physical examination, serum lipid profile and fasting plasma glucose tests were carried out. The 10-year Framingham risk score (FRS) for general cardiovascular disease, which includes age, gender, total cholesterol, HDL-cholesterol, systolic blood pressure, smoking status, and diabetes mellitus, was applied. The severity of chronic plaque psoriasis was mild in 32 patients (22.53%) and moderate to severe in 110 patients (77.47%). We found a significant higher prevalence of metabolic syndrome in the patient group compared to controls. Individual components of metabolic syndrome like waist circumference, elevated triglycerides, reduced HDL-C, impaired fasting plasma glucose, and arterial hypertension were also more prevalent in patients than in controls. Mean triglycerides, total cholesterol, LDL-cholesterol and HDL-cholesterol levels were significantly raised in patients with psoriasis when compared to controls. The 10-year FRS was significantly higher in patients with psoriasis than in controls (8.36±5.75 vs. 6.61±4.13; P<0.001). FRS was higher in men (P=0.012) and in patients older than 50 years (P=0.008). According to the severity of psoriasis, FRS increases significantly from mild to moderate-to-severe psoriasis (6.82±4.48 to 8.8±6.71; P=0.003). Psoriasis, and especially moderate to severe psoriasis, seems to represent a risk factor for cardiovascular disease. Patients with psoriasis should be risk-assessed for cardiovascular diseases, and comorbidities should be actively managed.

Type-specific prevalence of human papillomavirus by cervical cytology among women in Brasov, Romania.

The oncogenic role of human papillomavirus (HPV) in triggering cervical cancer, the second most common cancer in women worldwide, is well established. Romania ranks in first place in Europe in terms of the incidence of cervical cancer. Geographical widespread data on HPV type-distribution are essential for estimating the impact of HPV vaccines and cervical cancer screening programmes. In this study we aimed to identify the prevalence of HPV genotypes and to establish correlations with abnormal cervical cytology among the female population of Brasov County, Romania. A total of 1,000 women aged 17.3-57 years, attending routine cervical examination in the Obstetrics and Gynecology Hospital of Brasov, Romania, and undergoing both cytological examination and HPV genotyping were screened. Infection with 35 different HPV genotypes was detected in 39.6% of cytological specimens. Overall HPV infections were highest in young women under 25 years (p<0.0001), in which cervical cytological abnormalities also reached the highest prevalence. Patients infected by HPV-16 or HPV-18 showed the highest prevalence of cervical cytological abnormalities. Some 48.2% of women with abnormal cytology were infected with high-risk HPV types whereas less than 3% of them were infected only with low-risk HPV types. Our study showed that the prevalence of high-risk HPV infection among Romanian women is higher compared to other studies in other geographic areas. Thus, we consider that in areas where there is an increased prevalence of high-risk HPV infections, HPV genotyping should be performed in all women aged between 18 and 45 years, and Pap test should be performed every 6 months in women with high-risk HPV infection, even those with previous normal cervical cytology.