Histopathological and clinical traps in lichen sclerosus: a case report.

Lichen sclerosus et atrophicus and limited systemic scleroderma (acrosclerosis) are inflammatory skin diseases that ultimately evolve into two distinct modes of atrophic scar formation, but which can easily be confused clinically. They are very rarely associated. The literature has reported cases in which lichen sclerosus was associated with various forms of scleroderma, but often with localized morphea. The characteristic histopathological picture of lichen sclerosus includes a thin epidermis, with orthohyperkeratosis and vascular degeneration in the basal layer, loss of elastic fibers, and band-like inflammatory infiltrate in the papillary dermis, while systemic sclerosis is characterized by excessive deposition of collagen in the dermis, accompanied by reduction in adnexal structures and their entrapment in collagen, and the presence of perivascular lymphocytic inflammatory infiltrate. We present the case of a 40-year-old female patient clinically diagnosed with systemic scleroderma and lichen sclerosus involving the genital mucosa. Physical examination in conjunction with laboratory findings (elevated antinuclear, anti-Scl-70, anti-SSA antibodies and immunogram) induced the supposition of the coexistence of lichen sclerosus and systemic scleroderma, fact confirmed by pathological examination. Systemic therapy with corticosteroids, immunosuppressive and phlebotropic drugs, peripheral vasodilators and other tropic adjuvants and topically potent topical corticosteroids was initiated. The course was favorable under therapy, the hardened skin slightly regaining elasticity, relief of itching and disappearance of lichen sclerosus lesions. Our case reaffirms the uncommon association of these two disorders. The importance of history, physical and laboratory examinations in making a diagnosis of certainty in emphasized.

NADPH OXIDASE: STRUCTURE AND ACTIVATION MECHANISMS (REVIEW). NOTE I.

NADPH oxidase (nicotinamide adenine dinucleotide phosphate-oxidase), with its generically termed NOX isoforms, is the major source of ROS (reactive oxigen species) in biological systems. ROS are small oxygen-derived molecules with an important role in various biological processes (physiological or pathological). If under physiological conditions some processes are beneficial and necessary for life, under pathophysiological conditions they are noxious, harmful. NADPH oxidases are present in phagocytes and in a wide variety of nonphagocytic cells. The enzyme generates superoxide by transferring electrons from NADPH inside the cell across the membrane and coupling them to molecular oxygen to produce superoxide anion, a reactive free-radical. Structurally, NADPH oxidase is a multicomponent enzyme which includes two integral membrane proteins, glycoprotein gp9 1 Phox and adaptor protein p22(phox), which together form the heterodimeric flavocytochrome b558 that constitutes the core of the enzyme. During the resting state, the multidomain regulatory subunits p40P(phox), p47(phox), p67(Phox) are located in the cytosol organized as a complex. The activation of phagocytic NADPH oxidase occurs through a complex series of protein interactions.

THE PATIENT-DOCTOR-PSYCHOLOGIST TRIANGLE IN A CASE Of SEVERE IMUNOSUPRESSION IN THE HIV INFECTION.

In the last two years the Romanian adult population infected with the human immunodeficiency virus (HIV) has increased due to sexual transmission, both heterosexual and homosexual. The case presented is that of a 33 year-old man, admitted to the Infectious Diseases Hospital in Iasi with acute respiratory failure and a confirmation of Kaposi's sarcoma. Tests later proved positive for HIV, the patient being included in the stage AIDS C3 (acute immunodeficiency syndrome). The respiratory failure was suspected to be caused by Pneumocystis carinii and cotrimoxazol therapy, oxygen therapy and anti-retroviral therapy were established. He was also referred to the oncology hospital for treatment of Kaposi's sarcoma. The patient's adherence to therapy was influenced by a strong doctor-patient relationship, as well as by psychological counseling and support. Creating a functional doctor-patient-psychologist team is key throughout the HIV-positive patient's existence, for supporting long term adherence to therapy and acceptance of the diagnosis. This case highlights the need for a strong psychosocial compartment in every medical center that deals with HIV-infected individuals.

[PPARs: physiological functions and pharmacological roles of agonists in human diseases. Note II]. / PPARs: functii fiziologice si roluri farmacologice ale agonistilor în bolile umane (Nota II).

Increasing attention paid to the main family of peroxisome proliferator activated receptors--PPARs is generated, on one hand by the multiple functions of its members in numerous metabolically active tissues, and on the other hand by the therapeutic benefits expresed by some specific ligands that are used in certain metabolic diseases treatment plan. PPARalpha stimulates the beta-oxidative degradation of fatty acids and controls plasma lipid transport through the mediated action upon the triglycerides and fatty acids metabolism and by modulation of biosynthesis and catabolism of bile acids in the liver. PPARgamma promotes adipocytes differentiation and fat storage. PPARbeta/delta is involved in control and management of adipogenesis. While PPARalpha mediates the hypolipemiant actions of fibrates, PPARgamma is the receptor for thiazolidinediones (glitazones) reccomended in type 2 diabetes treatment; by binding to PPARgamma, glitazones modulates transcription of genes involved in lipid and carbohydrate metabolism.

[PPARs: structure, mechanisms of action and control. Note I]. / PPARS: structura, mecanisme de actiune si de reglare.

PPARs (peroxisome proliferator activated receptors) are proteine receptors that act as transcription factors activated by ligands. There are three known isoforms of PPARs (alpha, beta/delta, gamma) with similar modulated structure, consisting of distinct regions with specific functions. PPARs activate transcription of their target genes by forming cytoplasmatic heterodimers (PPARs:RXR) with his partner RXR (retinoid X receptor), and once translocated into the nucleus bind to specific DNA sequence called PPRE (peroxisome proliferator response elements) and modulate the expression of genes. Each PPAR is differently expressed in various tissues. Modulatory function of PPARs is induced by natural or synthetic ligand binding. Additional activator proteins are recruited to form a complex that coordinates and regulates the expression of many genes. Moreover, nuclear receptors' activity is also regulated by posttranslational changes.

[Viral hepatitis--trends]. / Hepatitele virale--încotro?

Viral hepatitis is a serious health problem all over the world. The aim of the study is to present the actual achievements in the therapeutically field and the general knowledge concerning the subject. Are presented the etiological agents of the acute and chronic hepatitis with the focus on hepatitis B and C, which has become a priority of WHO, with an incidence of the diseases of 360 billion/year for hepatitis B and an sub estimated level for C hepatitis. The most used drugs are presented and the therapeutical combination meant to decrease biological and virusological markers (ALAT, viral load) and to ameliorate the histological aspects of the liver. In conclusion, acute and chronic viral hepatitis represents a challenge for epidemiologists who try to stop the spread of the disease, but also for the infectious diseases specialists and gastroenterologists.

[Statins and endothelial dysfunction]. / Statinele si disfunctia endoteliala.

UNLABELLED: Studies carried out to determine the abilities of statins showed that they have multiple cholesterol-independent benefits, named pleiotropic. These effects are highly diverse and assume such properties as the improvement of endothelial dysfunction, damaged by multiple pathologic conditions, with secondary increase in NO bioavailability. Also at endothelial level, statins have the ability of diminishing the adhesion molecules expression, thus having an indirect vasodilatator role. Their antioxidant ability is manifest in various ways: decreases the superoxide radical anion production, fact that theoretically makes them useful in the treatment of other conditions like dyslipidemia or cardiovascular diseases. Their antiinflammatory role is complex and consists, among others, in the increase of antiinflammatory cytokines production, diminution of the action of the proinflammatory ones, and decrease of monocyte recruitment. CONCLUSION: From this perspective, we believe the understanding of the innermost mechanisms through which statins act, their effects, and their use in other therapeutic schemes than the already accepted ones is useful.

[Statins and oxidative stress]. / Statinele si stresul oxidativ.

Statins, as inhibitors of the first regulatory enzyme in cholesterol biosynthesis --HMG-CoA reductase--have a special impact in medical practice. Given their therapeutic efficacy, statins are believed to be the strongest class of agents in the treatment of cardiovascular disorders. Moreover, besides decreasing total cholesterol and C-LDL levels, numerous fundamental and clinical researches suggest that statins also have an antiinflammatory effect. Inflammation is closely related to the production of oxygen-derived reactive species (ROS). The antioxidant effects of statins associated with their ability to block the formation and/or action of ROS may add up their therapeutic efficacy. Within this context, the present paper presents data in literature related to the effect of statins on the expression and activity of NAD(P)H oxidase, activity of the enzymes involved in the antioxidative defence (SOD, GPx, catalase, paraoxonase), and their ability to act as free radical scavengers and oxidized-LDL inhibitors. By their antioxidant properties statins may decrease the atherogenic potential of lipoproteins.

[Complementary therapies in the treatment of bronchial asthma]. / Tratamente complementare în astmul bronsic.

The clinical and paraclinical benefits of drugs that are not included in the standard therapy strategies, to patients suffering from bronchial asthma, are illustrated in a particularly rich specialty literature. Magnesium, furosemide, heparins, antioxidative drugs, nitric oxide donor substances have real qualities, that make them useful in the management of patients suffering from asthma. The tremendous amount of studies that inspired this work suggests that, for the asthmatic patients, there are other alternative therapies, which can be administrated as adjuvant medication to the classical medication. At the same time, unconventional treatments are a solution worth considering for treatment-resisting cases, for cases in which side reactions develop to the standard therapy, and a source of inspiration for future research.