Diagnostic Challenges in Hemophagocytic Lymphohistiocytosis, a Rare, Potentially Fatal Disease: Two Case Studies.

Hemophagocytic lymphohistiocytosis (HLH) is a rare, and potentially fatal, syndrome, characterized by immune system dysregulation, with excessive activation of the macrophages and cytotoxic T cells. It can be classified into primary (genetic) and secondary (acquired) forms. HLH presents with fever, hepatosplenomegaly, cytopenia, and hyperferritinemia, with involvement of various organs. The initial symptoms of HLH are non-specific, but as, if untreated, it can progress rapidly to multiorgan failure, timely diagnosis is essential. We present here two cases of HLH in infants that illustrate the importance of early diagnosis and appropriate treatment, along with a short review of HLH.

The development of a sleep apnea screening program in Romanian type 2 diabetic patients: a pilot study.

To determine the feasibility of a sleep apnea screening program in Romanian patients with type 2 diabetes and obesity attending outpatient clinic of a diabetes center (the standard for routine care in Romania). The Epworth Sleepiness Scale was administered to 80 consecutive patients with type 2 diabetes and a body mass index (BMI) ≥30 kg/m2. Patients with a score >10 at this scale were referred to polysomnography for a sleep study. Overall, 20% of these patients had excessive daytime sleepiness (Epworth Sleepiness Scale >10), and in all of these cases, obstructive sleep apnea was confirmed. Of these patients, 33.3% had moderate OSA (AHI = 15-30 events/h of sleep), and 58.3% had severe OSA (AHI ≥30 events/h of sleep). Individuals with OSA were more frequent males, have higher BMI, higher waist circumference, and lower HDL-cholesterol compared with non-apneic subjects. Hb A1c, diabetes duration, and age were not statistically different between the two groups. OSA odds increased 1.1 times with every 1-cm increase in abdominal circumference (95%CI: 1.01-1.13) and 1.2 times with every kg/m2 increase in BMI (95%CI: 1.05-1.38). These associations remained statistically significant even after adjustment for age and sex. The prevalence of OSA in the sampled population was high. These findings suggest the need for more data regarding prevalence of obstructive sleep apnea in Romanian patients with type 2 diabetes. Furthermore, associations found may form a basis to develop specific recommendations for screening of sleep apnea in patients with type 2 diabetes from Romania.

[The impact of continuous positive pressure on systemic consequences and quality of life for patients with obstructive sleep apnea syndrome]. / Impactul tratamentului cu presiune pozitiv continua asupra consecintelor sistemice si calitatii vietii la pacientii cu sindrom de apnee în somn de tip obstructiv.

Obstructive sleep apnea syndrome (OSAS) is a complex disease, which frequently links and interacts with other conditions, such as cardiovascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, erectile dysfunction. OSAS has a significant response on daily activities, including an increased risk for acute cardiovascular events, metabolic and respiratory events and a higher rate of road accidents. In this article, we intend to present some data about the impact of continuous positive pressure therapy (CPAP) on quality of life of patients with OSAS and it's systemic comorbidities, while trying to draw a warning as to the importance of early initiation of CPAP treatment, which, despite the increased cost, remains the gold standard in treating patients with OSAS.

[Chronic eosinophilic pneumonia--clinical case]. / Pneumonia eozinofilica cronica--prezentare de caz.

Eosinophilic pneumonia (EP) is a rare, heterogeneous group of respiratory diseases, characterized by eosinophilic pulmonary infiltrates, with or without peripheral blood eosinophilia. The hallmark of chronic eosinophilic pneumonia (CEP) is a massive accumulation of eosinophils in the lungs, and an increased number of eosinophils in the bronchoalveolar lavage (BAL) fluid. We present the case of a 58 years-old female patient who came to the Clinical Hospital of Pneumology "Leon Daniello" from Cluj Napoca, Romania, with the suspicion of a recurrent diffuse interstitial pneumonia, despite of a proper antibiotic and symptomatic treatment. After clinical and paraclinical investigations the patient was diagnosed with idiopathic chronic eosinophilic pneumonia. Corticosteroid treatment was started, with rapid improvement in both clinical and radiographic abnormalities.

[Lung metastases in a primitive neuroectodermal tumor]. / Determinari secundare pulmonare în cadrul unei tumori neuroectodermale periferice.

Primitive neuroectodermal tumor (PNET) is a soft tissue sarcoma and is common among children and young adults. We present a case of a 27 years old woman with PNET localized at left arm and with lung metastases. Local ultrasound of the arm presented a tumor mass of 55/20 mm, computed tomography showed multiple pulmonary nodules in bilateral fields. The biopsy made during bronchoscopy and the biopsy made at arms level described PNET. CD99 markers was positive in both examinations.