Deficiency of Vitamin D, a Major Risk Factor for SARS-CoV-2 Severity.

BACKGROUND: The SARS-CoV-2 outbreak started in March 2020 with more than 120,552,261 cases at present and having caused over 2,667,248 deaths worldwide at the time this paper was written. The clinical signs of SARS-CoV-2 infection are especially evident in the respiratory and cardiovascular systems. Patients can be asymptomatic or present mild respiratory symptoms to severe acute lung injury leading to multiorgan failure and death. The study aims to assess the levels of serum 25-hydroxyvitamin D (25-(OH)-D) in 20 hospitalized patients infected with SARS-CoV-2 and 20 deceased people and to analyze the influence of vitamin D status on the severity of their disease. METHODS: The present study was conducted on 40 patients who tested positive for SARS-CoV-2 infection. They were divided into two groups: 20 patients admitted to the "Victor Babes" Hospital of Infectious Diseases and 20 postmortem cases autopsied at the Institute of Legal Medicine Timisoara, Romania. During the autopsy, blood and bronchial fluid samples were collected for the laboratory. Automate Viral RNA extraction was performed on the Maxwell 48 RSC Extraction System (Promega, USA) using the Maxwell RSC Viral Total Nucleic Acid Purification kit (Promega, USA). After RNA extraction, the samples were amplified on a 7500 real-time PCR (Applied Biosystems, USA) using the genesig® Real-Time PCR Assay 2G (Primer Design, UK). RESULTS: The living and deceased patients selected for the research presented decreased vitamin D levels, which are associated with increased levels of D-dimers, C reactive protein (CRP), and interleukin-6 (IL-6). These patients had a severe form of the SARS-CoV-2 disease, which led to death. CONCLUSIONS: We conclude that deficiency of vitamin D in patients infected with SARS-CoV-2 presents a major risk factor related to the evolution and severity of the disease.

Dermoscopy Patterns and Histopathological Findings in Nodular Basal Cell Carcinoma-Study on 68 Cases.

Basal cell carcinoma (BCC) is the most common skin cancer, with an increasing incidence in Europe particularly in young individuals. Nodular basal cell carcinoma is the most common subtype and accounts for approximately 57.6-78.7% of all BCCs. We performed an observational, morphological study which involved 68 patients with the diagnosis of nodular BCC. The localization and diameter of the lesion, histological subtype of the lesion, dermoscopic patterns, Fitzpatrick skin type and sex of each patient were recorded. The most common dermoscopic pattern seen in nodular BCCs was irregular vascularity and, arborizing vessels (>0.2mm in diameter) being the most frequent irregular vascular pattern. The second most common dermoscopic feature in patients with nodular BCCs was translucency. The most common dermoscopic features of the 12 pigmented BCCs were: pigmented islands (blue-gray globules and blue-gray ovoid nests); the pigmented distribution pattern (with (maple leaf-like structures and spoke wheel-like areas); arborizing vessels and white streaks/white areas. The histopathological analysis of the 68 BCCs revealed that the nodular type was the most frequently identified for 71.7% of cases The differential diagnosis between basal cell carcinoma and other skin lesions and inflammatory skin diseases is very important, since serious morbidity may result from an undiagnosed tumor.

A kinetic approach on hexavalent chromium removal with metallic iron.

This paper examines the mechanism of Cr(VI) removal with Fe(0), and the possible effect of various experimental parameters, from a kinetic perspective. The experimental data was analyzed using five different kinetic models: three for chemical reactions and two for adsorption processes. It was found that the process fitted well to the zero-order kinetic model for all investigated systems, excepting experiments conducted at 6 °C and those with nano-Fe(0), when the process followed the Ho's pseudo second-order model. Therefore, even though, under acidic conditions, chemical reduction can be generally considered as the main mechanism of Cr(VI) removal with Fe(0), under some experimental conditions (e.g. when working with nano-Fe(0) or at low temperatures), adsorption seems to be the dominant removal path. The enhanced Cr(VI) removal noticed in co-presence of SO42- and Cl- anions reiterates the significance of the secondary reductant Fe(II) within the process of Cr(VI) removal with Fe(0).

A CASE OF POLYMYOSITIS WITH INTERSTITIAL LUNG DISEASE ONSET.

Polymyositis is an idiopathic inflammatory myopathy of unknown aetiology that affect skeletal muscles causing symmetrical, proximal muscle weakness, and also other internal organs. The investigations reveal elevated skeletal muscle enzyme levels and characteristic electromyography (EMG) and muscle biopsy findings. Pulmonary involvement in polymyositis includes respiratory muscle weakness, aspiration pneumonia, interstitial lung disease, infection and drug-induced pneumonia. We expose the case of a young woman (47 years old) who presented to the Pulmonology Clinic with fever, cough, purulent sputum, discrete myalgia, being diagnosed at that moment with interstitial lung disease and treated with antibiotics, low dose of corticosteroids and symptomatic drugs. The evolution was slowly favorable for the respiratory impairment, but the patient developed exacerbated myalgia, muscle weakness, reaching even the impossibility of maintaining orthostatism, and also joint pain. Biological investigations revealed an important hepatocytolysis syndrome and also increased levels of muscle enzyme. The hypothetical diagnosis was polymyositis and to sustain this theory it was performed a muscle biopsy. The patient was transferred afterwards to the Rheumatology Clinic, in order to perform other specific investigations. In our clinic the patient maintained elevated levels of skeletal muscle enzymes and the muscle biopsy revealed polymyositis findings. Also immunological investigations objectified the presence of Jo1 antibodies. Therefore we pleaded for the diagnosis of idiopathic polymyositis, acute form. A multidisciplinary approach is needed in order to establish an accurate diagnosis and to institute a proper treatment.

Hospital stay following complex major head and neck resection: what factors play a role?

OBJECTIVES: Identify factors which have an impact on the length of postoperative hospital stay in patients undergoing major surgical resection for head and neck cancer. DESIGN: Retrospective study using hospital case notes. SETTING: Tertiary centre. PARTICIPANTS: One hundred and eighty-four patients who underwent 191 major head and neck resections between 2006 and 2010 were identified from the head and neck oncology database. An additional cohort of 52 patients from a second centre was used to externally validate the model. METHODS: Data collected on 13 variables including age, preoperative haemoglobin level, body mass index, timing of surgery (primary or recurrent tumour), category of surgical procedure (clean, clean-contaminated, contaminated, dirty), tracheostomy (yes or no) and duration of the operation were analysed using a multiple linear regression. RESULTS: In the 13 parameter model, the four variables that were found to significantly (P < 0.05) prolong length of stay (LOS) were surgical wound type (clean-contaminated, P = 2.19 × 10(-6) versus clean), tracheostomy (P = 0.0034), operation time (P = 0.011) and American Society of Anaesthesiologists (ASA) grades 3 and 4 (P = 0.0067) versus 1 and 2. The statistically significant variables were used to generate a preoperative submodel without the operative time and a postoperative submodel with all four variables. Overall, the best model based on adjusted R(2) was the postoperative model. When fitted on the external data set, there was no significant difference in the residuals, indicating that the models generalise across centres. CONCLUSION: Clean-contaminated wound was the most significant factor affecting the LOS, with others being ASA grades 3 and 4, longer duration of surgery and presence of a tracheostomy. Using these parameters, it is possible to predict the LOS in patients undergoing major surgical resection for head and neck cancer.

Forensic necroptic epidemiology -- a useful method for the evaluation of renal, cardiac and cerebral lesions. Can it represent an addition to the information provided by clinical studies?

Our paper reviews the value of necroptic epidemiology in the evaluation of renal, cardiac and cerebral lesions. The necroptic epidemiology studies performed on American war casualties from Korea and Vietnam had practical implications in the prophylaxis of atherosclerosis in young age groups. The special interest they initially raised has been diminished by the advance of clinical studies that are nowadays dominant in the field of epidemiology. Given the fact that for the evaluation of certain diseases, such as chronic kidney disease, the morphological criterion is useful for the diagnostic, necroptic epidemiology can complete the epidemiological data provided by clinical studies. The use of data offered by forensic necroptic epidemiology can represent a reliable method for evaluating the epidemiology of certain diseases and of their complications.

Ocular trauma and its consequences in the forensic practice.

AIM: The study concentrated on the analysis of patients with ocular lesions which were determined by different situations and were examined by the forensic expert. MATERIALS AND METHODS: The cases were examined during 2003-2007, including the appreciation of the gravity of violent lesions. RESULTS: The results revealed that the most exposed are men with a ratio of 6:1, with an annual average of 10 cases. The main causes were aggression (84% of the cases), traffic accidents (12%), and other (4%). Most cases presented light lesions, 76%, severe lesions in 20% and very severe lesions, including total loss of sight in 4% of the cases. In the cases with severe lesions, the investigations were more thorough, the treatment highly specialized and the legal consequences were harsher. These cases required a follow-up of 6-9-12 months so that the forensic expert could evaluate the damage correctly. CONCLUSIONS: Despite the fact that the majority of ocular traumas are less severe, in the ocular contusive lesions the evolution can be towards aggravation. Some cases which require a closer observation of the cases and the appreciation of the judicial consequences of the visual organ presenting severe ocular trauma.

[Antimicrobial resistance in Neisseria gonorrheae in North-East Romania]. / Rezistenta la antibiotice a Neisseria gonorrhoeae in zona Moldovei.

OBJECTIVES: The emergence of gonococcal isolates with reduced susceptibility or resistance to antimicrobial agents is a significant concern in the whole world. This study is performed to evaluate evolution of antimicrobial resistance patterns of N. gonorrhoeae isolates from north-east Romania. METHODS: We studied antimicrobial resistance in 81 strains of N. gonorrhoeae isolated from Sexually Transmitted Diseases Clinic in Iasi. The antimicrobial agents tested were Penicillin, Tetracycline, Ciprofloxacin, Cefixime, Ceftriaxone and Spectinomycin. RESULTS AND CONCLUSIONS: As we expected, resistance to Penicillin, Tetracycline and Ciprofloxacin is high and can't no longer be recommended for the treatment of gonorrhea in our area; Ceftriaxone, Cefixime and Spectinomycin should be considered the antimicrobial of choice. We isolated a strain with modified sensitivity to Cefixime, a fact that we should be worry about.

GADA and islet cell antibodies in Romanian children and adolescents with diabetes mellitus.

UNLABELLED: Childhood type 1 diabetes is defined by autoimmunity and insulinopenia. Etiopathogenic definition based on biochemical characteristics has recently replaced the clinical definition based on insulin requirement for treatment. The aim of this study was to describe biochemical and clinical characteristics of children with clinically diagnosed type 1 diabetes, hospitalized at the "Cristian Serban" Center in Buzias. PATIENTS AND METHODS: Fasting C peptide, HbA1c, islet cell autoantibodies (ICA) and antibodies against glutamic acid decarboxylase (GADA) were measured in 278 subjects aged (mean +/- SD; range) 15.1 +/- 4.8 (4-28) years, with a disease duration of 2.1 +/- 0.7 (1.1-3.1) years. GADA and ICA positivity was defined by values higher than the 95th percentile in 99 age-matched non-diabetic controls (0.4 units for ICA and 1.4 for GADA). RESULTS: As many as 66.2% of all patients had positive GADA and 10.1% had positive ICA. While 68.7% had at least one positive antibody, only 7.6% had both antibodies positive. As expected, most of the children (79.9%) had fasting C peptide values in the low range (<0.5 ng/ml), but 3 patients (1.1%) had biochemical signs of insulin resistance (C peptide concentrations >3 ng/ml). Two of the three insulin resistant children had positive GADA and one of them had positive ICA, therefore showing "mixed" features of both type 1 (autoimmunity) and type 2 diabetes (insulin resistance). CONCLUSIONS: Childhood diabetes is now acknowledged to be a complex disorder with heterogeneity in its pathogenesis, clinical course and outcomes. While type 1 diabetes is the most frequent form of diabetes among Caucasian children, measurement of diabetes autoantibodies and C peptide is necessary to better define the types of diabetes in youth.

Autopsy of an intradural haematoma case / Autosia de un caso de hematoma introdural

El autor describe la microscopia de la dura madre en un caso de hematoma intradural, y explica los criterios básicos de diagnóstico e un caso real de hematoma, con alcoholismo y trauma que produjo la muerte.