The "Viral" Form of Polyarteritis Nodosa (PAN)-A Distinct Entity: A Case Based Review.

Classic polyarteritis nodosa (PAN) is a vasculitis with systemic manifestations that is characterized by inflammatory and necrotizing lesions affecting medium and small muscular arteries, most frequently at the bifurcation of the vessels. These lesions lead to the formation of microaneurysms, hemorrhaging ruptured aneurysms, thrombosis, and, consequently, ischemia or organ infarction. Background and Objectives: We present a complex clinical case of a patient with a late diagnosis of polyarteritis nodosa with multiorgan involvement. Materials and Methods: The 44-year-old patient, in an urban environment, presented on her own in the emergency room for acute ischemia phenomena and forearm and right-hand compartment syndrome, requiring surgical decompression in the Plastic Surgery Clinic. Results: Significant inflammatory syndrome is noted, alongside severe normocytic hypochromic iron deficiency anemia, nitrogen retention syndrome, hyperkalemia, hepatic syndrome, and immunological disturbances: absence of cANCA, pANCA, anti Scl 70 Ac, antinuclear Ac, and anti dDNA Ac, as well as a low C3 fraction of the plasmatic complement system. The morphological aspect described in the right-hand skin biopsy correlated with the clinical data supports the diagnosis of PAN. Conclusions: The viral form of PAN seems to be individualized as a distinct entity, requiring early, aggressive medication.

PEX6 Mutation in a Child with Infantile Refsum Disease-A Case Report and Literature Review.

The aim of this paper is to describe the temporal progression and clinical picture of a 2-year-old child with infantile Refsum disease, as well as the diagnostic procedures performed; this case presented multiple hematologic, metabolic, and developmental complications and progressive disabilities. Genetic testing revealed a mutation of the PEX6 (Peroxisomal Biogenesis Factor 6) gene, and the metabolic profile was consistent with the diagnosis. Particularly, the child also presented altered coagulation factors and developed a spontaneous brain hemorrhage. The clinical picture includes several neurological, ophthalmological, digestive, cutaneous, and endocrine disorders as a result of the very long chain fatty acid accumulation as well as secondary oxidative anomalies. The study of metabolic disorders occurring because of genetic mutations is a subject of core importance in the pathology of children today. The PEX mutations, difficult to identify antepartum, are linked to an array of cell anomalies with severe consequences on the patient's status, afflicting multiple organs and systems. This is the reason for which our case history may be relevant, including a vast number of symptoms, as well as modified biological parameters.

The Significance of Low Magnesium Levels in COVID-19 Patients.

Magnesium is the fourth most common mineral in the human body and the second richest intracellular cation. This element is necessary for many physiological reactions, especially in the cardiovascular and respiratory systems. COVID-19 is an infectious disease caused by SARS-CoV-2. The majority of people who become ill as a result of COVID-19 have mild-to-moderate symptoms and recover without specific treatment. Moreover, there are people who develop severe forms of COVID-19, which require highly specialized medical assistance. Magnesium deficiency may play a role in the pathophysiology of infection with SARS-CoV-2. The primary manifestation of COVID-19 remains respiratory, but the virus can spread to other organs and tissues, complicating the clinical picture and culminating in multiorgan failure. The key mechanisms involved in the disease include direct viral cytotoxicity, endothelial dysfunction, and exaggerated release of inflammatory cytokines. The aim of this review was to summarize the available data regarding the role of magnesium in COVID-19 patients and its particularities in different clinical settings.

The Effects of the COVID-19 Pandemic on Mental Health: A Web-Based Study Among Romanian Adults.

Background In Romania, as in other parts of the world, the family doctor is the first to make contact with a healthy patient and is also the first to notice even the smallest pathological changes. In the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the patient's communication with the family doctor became even closer and some behavioral changes could be easily noticed. Objective To assess the symptoms of anxiety and depression in the Romanian population using social media platforms in the context of the COVID-19 pandemic. Methods We conducted an anonymous, web-based cross-sectional survey consisting of 31 questions related to general characteristics (age, gender, education, inhabitancy, residence, smoking status, and alcohol consumption) and adapted GAD-7 (7-item General Anxiety Disorders questionnaire) and PHQ-9 (9-item Patient Health Questionnaire). This questionnaire was sent to volunteers in an electronic format through a social network (Facebook, Twitter). The data collected were statistically processed using IBM SPSS v25.0 (IBM Corp., Armonk, NY). The inclusion criteria were age over 18 years and no history of chronic disease. The exclusion criteria consisted of the absence of a mental illness diagnosis. Results From the 1254 respondents, 1232 cases were selected for statistical analysis after applying the exclusion criteria. The mean age was 35.94 (SD = 11.4, 95%CI=10.9-11.9) with a minimum of 18 years and a maximum of 97 years. Eighty-four point nine percent (84.9%; N=1046) of all study participants are female and 79.13% (N= 975) live in the urban area. A total of 188 (15.25%) were diagnosed with COVID-19 of which 31 (16.66%) were male and 157 (15%) were female. N=170 (13.8%) reported moderate symptoms of anxiety during the last two weeks before the survey while N=96 (7.8%) had severe anxiety. Twenty-two point two percent (22.2%; N=274) of the participants reported moderate symptoms of depression while 10.1% (N=125) had moderately severe symptoms and 6.6% (N=81) could be diagnosed with severe depression. A greater likelihood of screening for depression diagnosis was associated with ages between 25 and 34 years (OR=0.90, 95%CI=0.86-0.94, P<.001), 35 and 44 years (OR=0.88, 95%CI=0.84-0.93, P<.001), and 45 and 54 years (OR=0.87, 95%CI=0.82-0.92, P<.001). Also, a tendency was observed for women to be more prone to high levels of anxiety (OR=1.21, 95%CI=1.08-1.35, P< .001) and depression (OR=2.16, 95%CI=1.51-308, P< .005). Conclusions Regarding the high prevalence of depression and anxiety, especially in women, appropriate measures for the risk categories should be applied. In the new social context created by the COVID-19 pandemic, screening for psychiatric and psychological disorders should be performed by telemedicine.

Long-term survival in a patient with advanced gastric cancer and metachronous right-sided colon cancer.

Gastrointestinal carcinomas represent the most common cancers worldwide. The coexistence of gastric cancer with metachronous colon cancer represents a rare phenomenon, and the prognosis of the patient is poor. We present here a case of an elderly patient with primary gastric intestinal type well-differentiated adenocarcinoma (pT3N0, stage IIA) who developed a metachronous right-sided colon cancer diagnosed and treated after 11 years from the first surgical intervention. Histopathological and immunohistochemical examination revealed a well-differentiated adenocarcinoma (strongly positive staining for cytokeratin 20 and CDX2), pT3N0 stage IIA. The patient is still alive and active after 16 years from his first surgical intervention, even though no treatment has done after the removal of his second cancer. In conclusion, in any case of gastric cancer, first the surgeon, and then the general practitioner should be alert to recognize a second primary tumor with different origin and to perform complete postoperative control. The correct diagnosis could lead to the patients' best prognosis.

[Contributions to the implementation of screening tests for assessing the neuropsychic development in children]. / Contributii la implementarea unui test screening de apreciere a dezvoltarii neuropsihice la copil.

UNLABELLED: Currently, in Romania the general practitioner does not use screening tests to detect the developmental problems in children. That might be the reason why many cases are diagnosed too late. AIM: To evaluate the impact and the usefulness of a screening tool for neurodevelopmental disorders in primary care. MATERIAL AND METHODS: This trans-sequential study was carried out a on a series of 324 children under the age of 5 in the interval January 2007-December 2010. The neurodevelopmental status of the children was assessed by two methods: routine clinical assessment, and ASQ screening tools. RESULTS: Compared to routine assessment, by which 33 children (10,2%) with development delays have been detected, the use of parent-addressed questionnaires raised the detection percentage to 12% (6 more children). The use of parent-addressed questionnaires also improved the doctor-patient communication, increased the degree of parental involvement in their child's development stimulation, especially with regard to the malfunctions in verbal and cognitive behavior. CONCLUSIONS: The use of validated screening tests is a goal for improving the primary care practice.

[Correlations between the level of bacterial resistance and the rate of clinical efficiency in the therapy of community-acquired respiratory tract infections]. / Corelatii intre nivelul rezistentei bacteriene si rata de succes clinic in terapia infectiilor de tract respirator comunitare.

The aim of the study is to evaluate the efficiency of the first-line antibiotic treatment of the community-acquired respiratory tract infections in a population of young adults from an urban setting and to establish the pattern of antibiotic resistance of the germs involved. The bacteria most frequently identified have been: S. pneumoniae, H. influenzae, M. catarrhalis, atypical agents also being suspected. Antibiotic treatment has been chosen accordingly to the recent guidelines, total clinical remission rate being of 91.08%, despite the increasing resistance for the commonly used antibiotics; a close monitoring of the phenomenon is mandatory.

[Clinical and epidemiologic aspects of attention deficit hyperactivity syndrome (ADHD) in ambulatory practice]. / Aspecte clinice si epidemiologice ale sindromului hiperkinetic cu deficit de atentie (ADHD) în practica de ambulator.

The purpose of the study was to determine the prevalence and to describe the clinical presentations of Attention Deficit Hyperkinetic Syndrome in the pediatric patients of the Outpatient Specialty Clinic of the "Sf. Spiridon" University Hospital of Iasi (a pediatric neuro-psychiatry practice and a general pediatric practice). The studied group consisted of 51 children and adolescents ages 2 years 6 month-18 years of age (urban environment 34 children--66%, rural environment 17 children--34% ; male gender 36 children--70%, female gender 15 children--30%). The pediatric patients represented a prevalence of 1.9% of the Attention Deficit Hyperkinetic Syndrome having the main features: motor and psychological instability, lack of attention, negativism, impulsivity, and social and school integration difficulties. The existence in 40% of cases of family problems (couple pathology, parents with psychiatric disorders, alcoholism, etc) proves the importance of the family patterns description in the apparition and evolution of Attention Deficit Hyperkinetic Syndrome. The study performed underlines the existence of the Attention Deficit Hyperkinetic Syndrome, the necessity of multi-disciplinary intervention with the purpose of precise and on-time diagnosis of this syndrome, to ensure a better integration of these children and teenagers in the social and school environment.

[Headache in children and adolescent in ambulatory practice]. / Cefaleea la copil si adolescent in practica de ambulator.

Headache in children and adolescent represents one of the most frequent and potentially severe pathological conditions, requiring a paediatric consult. The purpose of the study was to establish the headache prevalence from the total paediatric consultations in ambulatory practice as well as to establish the main etiological causes of the headache. The study, including 400 children and adolescents (M/F ratio=150/250, U/R ratio=290/110) with headache selected from 3100 cases between 2003 and 2004, in two practices (one general paediatric office and one paediatric neuropsychiatry office) from the Outpatient Clinic of the "Sf. Spiridon" Hospital of Iasi, has shown a prevalence of headache of 12.9%, the most affected age group being that of 5-12 years (52.5%). The etiologic study proved a high frequency of trauma 46.25%, ophthalmologic diseases 13.28%, psychogenic headache 10.75%, migraine 10%, general causes (infections, anaemia, hypoglycaemia) 9%, ENT causes 6.25%, intracranial causes 0.75%. The study confirms the necessity of a multidisciplinary approach, most causes being benign and the prognosis favourable in most cases.

[Can the child with congenital heart disease have a normal life-style?]. / Copilul cu malformatie congenitala de cord poate avea un stil de viata normal?

Is it possible for the child with Congenital Heart Disease to have an adequate life-style? The life-style of the child mainly depends on the life-style of his/her family. Consecutively, the parents themselves must adopt a healthy life-style to be a good example for their children; on the other side, certain restrictions (hyponatremic regimen, the limitation of the physical activity) must be shared among entire family, the education of the parents being essential. To accomplish this, there must be an interdisciplinary team, including the GP, the cardiologist, the psychotherapist and the physiotherapist. This article discusses the factors influencing the life-style, their dependence on the family social status, on the diagnosis, on the child's age. The psychotherapeutic approach becomes very important at puberty. There is also essential the transition to the adult life, so these children will benefit of maximum of choices in life.

[The study of two immunological markers in patients with type-1 diabetes and in their first degree relatives]. / Studiul a doi markeri imunologici la pacientii cu diabet de tip 1 si la rudele de gradul I ale acestora.

UNLABELLED: The prediction of diabetes mellitus is mostly based on the existence of plasma markers. The aim of this preliminary study was to determine islet cell antibodies (ICA) and glutamic acid decarboxylase antibodies (GADA) in 28 diabetic children (12 of them having an evolutive disease of 1 year and 16 at the beginning of the diabetes) and to 47 of their first-degree relatives. There have been determined the levels of these two autoantibodies using the ELISA technique. RESULTS: To 17 of the patients with type I diabetes have been found high levels of GADA (60.7%) while 8 cases have positive ICA (28.5%). For the patients whose disease was diagnosed 1 year ago there have been found differences between the patients with and without antibodies regarding the level of the average values of Hb A1c, the daily insulin needs and the remission period. From the tested parents (a total of 25), 7 was GADA positive (28%), 6 had both antibodies present (24%) and one mother was ICA positive (4%). 9 of the brothers and sisters of the diabetic patients had high levels of GADA and 2 had both antibodies present. To the first-degree relatives with autoantibodies must be determined other plasma markers too (IAA, IA-2A) as well as genetic markers (HLA typing). CONCLUSION: The use of plasma markers is recommended as a first step in discovering the relatives with potential risk of developing the disease.

[Aspects of the children's candidiasis in outpatient practice]. / Aspecte ale candidozelor la copil în practica de ambulator.

Candidiasis are conditions caused by fungi from Candida genus. The most frequently involved in humans pathology is Candida albicans, which, even if is in balance with endogenous bacterial flora, became pathogenic in certain conditions. The hereby study aims to evaluate retrospectively on a period of 5 years (1999-2003), an group of 101,000 children aged 14 days-18 years, the prevalence of candidiasis, the clinical aspects determined in pediatric population diagnosed and treated in the paediatric offices of the outpatient clinic of "Sf. Spiridon" Hospital, as well as the risk factors of these diseases. From 3806 positive samples for Candida, 2650 (69%) have presented signs of pathogenicity of a significant intensity of colonization. 65% of samples have been observed in female gender, 35% in male gender, 58% of cases from urban areas, 42% from rural environment. The concordance of the lab results having significant values with the manifest clinical symptoms was 85% for the nasal and pharyngeal exudates; 93% for the examination of the stools and 95% for vaginal secretions. The most frequent clinical aspects were oropharyngeal candidiasis (39%), mycotic esopharyngitis (0.4%), enterocolitis (15%), mycotic colitis (22%), vulvovaginitis (25%). The most frequent risk factors for the appearance of candidiasis have been repeated or prolonged antibiotic treatments (90% of cases), diabetes mellitus (0.3% cases), steroid therapy (0.2% cases), deficient hygiene (5% cases), diet rich in carbohydrates (9%). This study confirm that Candida albicans can become pathogenic producing signs and symptoms of disease in certain conditions, the most important factor being prolonged or repeated antibiotic treatment.