POLYGLANDULAR AUTOIMMUNE SYNDROME ASSOCIATED WITH MULTIPLE AUTOIMMUNE CONDITIONS AND ATOPIC DERMATITIS - AN UNUSUAL MANIFESTATION OF A POLYAUTOIMMUNITY PHENOTYPE.

INTRODUCTION: The polyglandular autoimmune syndrome (PAS) type III is a rare condition defined as the coexistence of autoimmune thyroid disorder with other endocrine autoimmune diseases, including type 1 diabetes, without adrenal dysfunction. PAS may associate with other non-endocrine autoimmune diseases, overlapping with the multiple autoimmune syndromes (MAS). We present a case of PAS III/ MAS type 3, including autoimmune thyroiditis, autoimmune diabetes, vitiligo, lupus erythematosus, associated with adult-onset atopic dermatitis, a combination not reported previously. CASE REPORT: A 40 years old woman, registered as nurse working in dialysis unit, previously diagnosed with vitiligo, euthyroid autoimmune thyroiditis and disseminated granuloma annulare, with personal and familial history of atopic disorders, presented in our clinic for disseminated eczematous and lichenoid cutaneous rashes. She was tested positive for antinuclear, anti-double stranded DNA and anti-histone antibodies, with inflammatory syndrome and marginal lymphopenia and she was diagnosed with systemic lupus erythematosus (SLE). Subsequently, moderate hyperglycemia, positive anti-glutamic acid decarboxylase antibodies and low C-peptide level prompted the diagnosis of autoimmune diabetes. Recurrent flexural eczematous rashes, with negative epicutaneous tests but positive specific IgE tests for common allergens fulfilled the clinical criteria for the diagnosis of atopic dermatitis. The clinical, immunological and glycemic status were controlled with low doses of oral prednisone (<0.5 mg/kg), methotrexate (10mg/week), antimalarials, metformin, emollients and photoprotection. After changing her workplace, the immunosuppressive treatment could be discontinued, and the patient maintained normal immunological and biochemical profile at 6 months follow-up.This case brings a unique perspective on the evolution, associations spectrum and the management challenges of endocrine polyautoimmunity associated with atopic diathesis.

Prognosis of acute myocardial infarction using systolic time intervals recorded on the carotidogram.

The prognostic value of systolic time intervals and of other clinical and laboratory parameters was investigated in 68 patients with acute myocardial infarction (AMI) (55 males and 13 females; mean age 61 years) over a period of one month after onset of the disease. The statistical analysis of data was made by the STR stepwise regression method, using an IBM-360 computer. Finally the study resulted in a stepwise multiple regression equation with 4 factors of maximum statistical significance in the prognosis of AMI: peak SGOT level, age of patients, uncorrected left ventricular ejection time and index of preejection period. This new prognostic index allows a classification of patients with acute myocardial infarction (starting with the second day after onset) into groups of various severity, thus helping the practitioners in the choice of therapy.

Prognosis of acute myocardial infarction using systolic time intervals recorded on the carotidogram.

The prognostic value of systolic time intervals and of other clinical and laboratory parameters was investigated in 68 patients with acute myocardial infarction (AMI) (55 males and 13 females; mean age 61 years) over a period of one month after onset of the disease. The statistical analysis of data was made by the STR stepwise regression method, using an IBM--360 computer. Finally the study resulted in a stepwise multiple regression equation with 4 factors of maximum statistical significance in the prognosis of AMI: peak SGOT level, age of patients, uncorrected left ventricular ejection time and index of preejection period. This new prognostic index allows a classification of patients with acute myocardial infarction (starting with the second day after onset) into groups of various severity, thus helping the practitioners in the choice of therapy.