Angiocatheter Decompression on a Covid-19 Patient with severe Pneumonia, Pneumothorax, and Subcutaneous Emphysema.

BACKGROUND: A novel coronavirus, currently known as Severe Acute Respiratory Syndrome Coronavirus 2, causes Coronavirus disease 2019 (Covid-19). Its most significant complication is a kind of pneumonia known as of 2019 New Coronavirus-Infected Pneumonia (NCIP). Covid-19 pneumonia can have unusual complications that affect both lungs in a widespread manner. Acute lung damage and Acute Respiratory Distress Syndrome (ARDS) are typical in severe Covid-19 cases. Several potential risk factors cause the pneumonia associated with this disease, such as age over 65, diabetes, hypertension, chronic obstructive pulmonary disease, immunosuppression, and pregnancy. Furthermore, various laboratory markers like high levels of C-reactive protein (CRP), D-dimers, ferritin, interleukin-6 (IL-6), and LDH, as well as a low lymphocyte and thrombocyte count, have been linked to increased disease severity and a poor prognosis. METHODS: In this study, we present a case of a 45-year-old patient with a rare evolution of the disease, who made a full recovery against all odds. We highlight the atypical presentation of Covid-19 in this patient, who developed some unusual complications, such as pneumonia, pneumothorax, pneumomediastinum, and subcutaneous emphysema. RESULTS: There is a scarcity of information on patient-related variables linked to pneumothorax in severely sick Covid-19 patients. This study adds to the existing research, reinforcing that spontaneous pneumothorax can be caused by the infection itself, in addition to ventilator-induced trauma in mechanically ventilated patients. CONCLUSIONS: We conclude that patients with Covid-19 pneumonia may develop a more robust and systemic illness characterized by acute lung injury, acute respiratory distress syndrome (ARDS), shock, coagulopathy, and nu¬merous organ dysfunctions, all of which are linked with a high risk of death.

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.

Centenary of Insulin Discovery (1921-2021): Nicolae Paulescu's Original Contributions.

Nicolae Paulescu (1869-1930) was born in Bucharest in an aristocratic family. His education from childhood to maturity (Paris University of Medicine) was marked by illustrious professors, even pioneers of their field. After completing his medical and scientific education in Paris under his mentor, Etienne Lancereaux, considered the founder of modern physiology, he returned to Romania where he founded the first Department of Physiology at "Carol Davila" University of Medicine and Pharmacy. His scientific career is marked by the publishing of 88 original research articles in renown international medical journals of the time and two Treatise on Physiology (comprising in total 8 volumes and 5976 pages). His activity as an endocrinologist reaches the peak with the discovery of insulin with the article Recherche sur le rôle du pancréas dans l'assimilation nutritive published in the Archives Internationales de Physiologie (Liege, Belgium) on August 31st, 1921. While he was not internationally or even nationally acclaimed for the discovery of insulin, his contribution to the reformation of the national education and medical system and the recommendation of his students to pioneers of their fields of interest still have reverberations even today.

TCR binding differs for a bacterial superantigen (SEE) and a viral superantigen (Mtv-9).

Both superantigens (SAG) and many anti-TCR monoclonal antibodies (mAb) have specificity for the V beta region of the TCR encoded by TCRBV genes. For instance the bacterial SAG staphylococcal enterotoxin E (SEE), the retroviral SAG MTV-9 and the mAb OT145 each react with human T cells expressing BV6S7. This BV gene encodes two common alleles. We found that SEE and the mAb preferentially activate T cells expressing BV6S7*1 as opposed to BV6S7*2, but Mtv-9 activates T cells expressing either allele. Thus binding to the TCR differs between the two SAGs. A mutation in the TCR HVR-4 region of BV6S7*1 (G72E), where the two BV6S7 alleles differ, indicated that HVR-4 is a component of the binding site for SEE and for the mAb OT145. BV6S7*2 has a charged E72 which may result in electrostatic repulsion of SEE, as SEE contains a similarly acidic aspartic acid residue at a TCR interaction site (204D).

P21 Immunoexpression in Actinic Keratosis and Cutaneous Carcinomas.

Actinic keratosis is a precancerous lesion of the skin with variable rates of transformation into non-melanocytic carcinomas. The present study aims to analyze p21 expression in actinic keratosis and cutaneous squamous carcinomas. P21 expression analysis revealed a positive reaction in 63 (71.4%) of the investigated cases. The immunostaining analysis revealed positivity in 82.1% of the studied actinic keratosis cases and in 43.9% of the investigated carcinomas. High scores of immunoreactions were identified only for the well-differentiated and for the carcinomas in initial stages. Association of p21 expression with pre-invasive or well-differentiated invasive lesions in early stages of tumor progression suggests that p21 may be an early event in squamous carcinogenesis.

CD44 Immunoexpression in the Progression of Actinic Keratosis and Cutaneous Squamouscarcinoma.

CD44 seems to confer the needed conditions for malignant neoplasms to grow and progress. The present study aims to investigate the role of CD44 expression in pre-invasive and invasive squamous lesions of the skin. We investigated 89 cases of preinvasive and invasive cutaneous lesions, of which 28 corresponded to actinic keratosis (KIN- keratinocyte intraepithelial neoplasia) with varying degrees of severity and 61 cases of squamous cell carcinoma with variable degrees of differentiation. The statistical analysis of CD44 immunoexpression indicated significantly higher values for KIN I and II compared to KIN III, as well as for KIN lesions in comparison with squamous cell carcinomas. Similar results were observed in well differentiated carcinomas compared to moderate and poorly differentiated lesions. These observations suggest that CD44 expression plays a role in the progression of cutaneous squamous neoplasia.

Cervical cerclage in advanced prolapsed fetal membranes - Case presentation.

The case presentation of a transvaginal cervical cerclage performed at a 7 cm dilation in a patient in the 22nd week of pregnancy, followed by a prolongation of the pregnancy until the gestational age of 38 weeks, was reported in the context of many similar cases managed by the authors of the article during a program of screening and prevention of preterm birth. The particularity of the case was the lack of a preterm birth in the medical history of the patient and the installation of the isthmus-cervix incompetence in the second pregnancy, after an on term pregnancy. What should be evidenced is the importance transvaginal cervical ultrasound evaluation has in the early diagnosis of this pathology during pregnancy, this being the only method of determining the efficacy of the content of the internal cervical os. Transvaginal cervical exploration has to be implemented as a screening method both in the high-risk patients and in the absence of a suggestive medical history.

Acute zonal occult outer retinopathy: towards a set of diagnostic criteria.

BACKGROUND: Individuals with acute zonal occult outer retinopathy (AZOOR) present with initially progressive scotomata and photopsia. Characteristically, the extent of the visual field defect is unexplained by fundal examination, but there is marked retinal dysfunction evident electrophysiologically. It is the authors' experience that a group of patients exhibit characteristic clinical and electrophysiological abnormalities, which serve as criteria for a working diagnosis. METHODS: A retrospective observational case series of 28 patients were identified with the clinical diagnosis of AZOOR who shared similar abnormal electrophysiology. Details of the history and ophthalmic findings were obtained from the case notes. RESULTS: Electrophysiology demonstrated a consistent pattern of dysfunction both at the photoreceptor/retinal pigment epithelial complex but also at inner retinal levels, essentially comprising a delayed 30 Hz flicker ERG and a reduction in the EOG light rise. CONCLUSION: This study determines diagnostic criteria applicable to a group of patients with AZOOR, typically those with classic symptomatology. Electrophysiological testing can help avoid lengthy, costly, and potentially invasive investigations, and the unnecessary use of immunosuppressive therapy.

[Definition of a reproducible method for acetabular anteversion measurement at CT]. / Définition d'un plan de mesure reproductible de l'antéversion acétabulaire en tomodensitométrie.

PURPOSE: To demonstrate the variability of acetabular anteversion angle measurement at CT and suggest a new and reproducible method of measurement. MATERIAL AND METHODS: Sawbone pelvis based study: We first realized a series of helical CT of the pelvis, with gradual increase in tilt angle, and measured acetabular anteversion angles on axial sections, then on sections parallel to the superior S1 endplate. Then, we made a series of radial sections centered at the acetabulum, and the anteversion angle was measured on each section. Finally, a test series of five in vivo pelvis was performed to evaluate the feasability of our method. RESULTS: The acetabular anteversion angle varies with pelvis tilt, whereas measurements obtained from sections parallel to the S1 endplate are constant. CONCLUSION: Acetabular anteversion angle should be measured from sections parallel to the S1 endplate, in order to minimize errors during total hip arthroplasties.

Structure of a protein G helix variant suggests the importance of helix propensity and helix dipole interactions in protein design.

Six helix surface positions of protein G (Gbeta1) were redesigned using a computational protein design algorithm, resulting in the five fold mutant Gbeta1m2. Gbeta1m2 is well folded with a circular dichroism spectrum nearly identical to that of Gbeta1, and a melting temperature of 91 degrees C, approximately 6 degrees C higher than that of Gbeta1. The crystal structure of Gbeta1m2 was solved to 2.0 A resolution by molecular replacement. The absence of hydrogen bond or salt bridge interactions between the designed residues in Gbeta1m2 suggests that the increased stability of Gbeta1m2 is due to increased helix propensity and more favorable helix dipole interactions.

Composite adenocarcinoma and carcinoid tumor of urinary bladder.

We present a unique case of primary mixed adenocarcinoma of the urinary bladder consisting of signet-ring cells, glands, and mucinous lakes intimately associated with carcinoid elements. Neuroendocrine differentiation was substantiated with immunohistochemical and ultrastructural studies. The literature on primary carcinoid tumor of the bladder is reviewed.

Metastatic nonfunctioning parathyroid carcinoma: ultrastructural evidence of secretory granules and response to chemotherapy.

A 69-year-old woman was admitted to the hospital because of recurrent cervical nodules, a large anterior mediastinal mass, and malignant left pleural effusion. Light and electron microscopy of the resected cervical nodules and cytology of the pleural fluid showed findings consistent with parathyroid carcinoma. There was no evidence of hyperparathyroidism on clinical evaluation, multiple serum calcium and phosphorus determinations, skeletal survey, intravenous pyelogram, or radioimmunoassay of intact and carboxy-terminal parathyroid hormones in the serum. Electron microscopy revealed secretory granules in the cytoplasma of malignant cells. A dramatic and complete resolution of the mediastinal mass and pleural effusion occurred after 18 months of chemotherapy with "MACC" (methotrexate, adriamycin, cyclophosphamide and CCNU).

Vasectomy and atherosclerosis in Macaca fascicularis. New findings in a controversial issue.

The influence of vasectomy on diet-induced atherosclerosis was studied in ten Macaca fascicularis monkeys. After a six-month control period the monkeys were divided into two groups and matched for cholesterol levels. Five monkeys were given vasectomies and five sham vasectomies, and all animals were placed on a high-cholesterol, atherogenic diet. The vasectomized monkeys showed a significant increase in sperm antibody formation as compared with the control group. Both groups developed similar high cholesterol levels. After ten months all monkeys were necropsied, and their vascular systems were carefully evaluated to determine the extent of atherosclerosis. There was no difference in the occurrence of atherosclerotic plaques between the study and control groups despite sperm antibody development in the study group. This finding is in contrast to those of previous animal studies in which it was theorized that vasectomy aggravated the development of atherosclerosis. This study, however, confirms the results of several human studies that have failed to find any increase in cardiovascular disease among men who have undergone vasectomy.

[Total "pharyngoplastia vera" with the colon in caustic pharyngo-laryngeal stenoses]. / "Pharyngoplastia vera" totale avec côlon dans les sténoses pharyngo-laryngiennes caustiques.

An original procedure for pharyngeal reconstruction with colon in pharyngolaryngeal stenosis due to chemical burns has been named "pharyngoplasty vera" by the authors, since the 3 walls of the pharynx are reconstituted by lining it with visceral material. This is in contradiction with previously used techniques in which the graft caps the pharyngostomy produced by resection of scar tissue (pharyngovisceral anastomosis). The procedure generally respects the principles of conventional cutaneous pharyngoplasty--similar approach, extirpation of scar tissue, epiglotto plasty, conservation of constrictor muscles and above all, solid attachment of visceral material to the latter, and finally suture of the colon at the base of tongue and closure of pharynx. The method was used in a patient who regained deglutition rapidly, but the insufficient glottic space did not allow reopening of the canal.

[False surgical acute abdomen with intermittent acute porphyria]. / Fals abdomen acut chirurgical în cadrul unei porfirii acute intermitente.

This article presents a case of acute intermittent porphyria admitted to the Surgery Department of C.F. Craiova Hospital between 18.08.2003-26.08.2003 then transferred to the Colentina Hospital in Bucharest for diagnosis confirmation and adequate treatment. The purpose of this paper is to bring attention on a rare metabolic inherited disease that, due to its non-specific and often noisy symptoms and limited possibilities of biochemical, enzymatic and genetic diagnosis, could generate potential serious confusions. The presentes case illustrates the fact that sometimes the acute attack may be mistaken for an acute surgical affection which requires an emergency operation with all the aggravating consequences and delay in the real diagnosis. About 1% of acute attacks of porphyria may be fatal. Only the drugs known as safe should be prescribed. Basic treatment consists in oral and intravenous glucose and hematin administration.

Some considerations concerning cochlear implantation in IFACF-ORL.

The article analyzes the patients who have received a cochlear implant at "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, over a period of 13 years, from the beginning of this program in the year 2000. It presents the types of devices used, the particularities of the patients, the surgical techniques and the outcome, critically analyzing the complications encountered. The authors' comments on the selection of patient protocol, surgical intraoperative challenges and cochlear implant technologies and capabilities are presented.

[Branch retinal vein occlusion in a 20-year-old patient]. / Retinaler Venenastverschluss bei einem 20-jährigen Patienten.

HISTORY: A 20-year-old patient from India was referred because visual acuity of the left eye had deteriorated four weeks ago. A left branch retinal vein occlusion (BRVO) had been diagnosed in an external eye clinic. INVESTIGATIONS: His best corrected visual acuity was 1,0 in the right eye but only 0.3 in the left. Intraocular pressure was normal. Fundoscopy of the left eye confirmed the finding of a left BRVO. Fluorescein angiography showed evidence of a retinal vasculitis resulting in an ischemic BRVO. Full blood count showed leucocytosis. Chest X-ray, thoracic CT and an Interferon-Gamma Release Assay (IGRA) were suggestive of systemic tuberculosis (TB). TREATMENT AND COURSE: Antituberculosis treatment with ethambutol, isoniazid, rifampicin and pyrazinamide was administered for 4 months followed by maintenace therapy of isoniazid and ethambutol for 6 months. 6 months after treatment visual acuity of the left eye had improved; the findings of lung TB had regressed. CONCLUSION: BRVO associated with ocular TB is a rare presentation of retinal vasculitis. This rare manifestation of a BRVO emphasizes the need of thorough systemic evaluation in young patients with BRVO.

Non-alcoholic fatty liver disease and the statins treatment.

Even if the fatty liver is an entity recognized long time ago, only recently the non-alcoholic liver disease (NAFLD) came in attention. The fact that NAFLD might progress from simple steatosis to steatohepatitis and cirrhosis showed that NAFLD is not always a benign disorder. NAFLD has many etiological factors, but the majority of cases are those in the context of metabolic syndrome, known as primary NAFLD. Statins are well known as 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) inhibitors, but this class has also pleiotropic actions non-related with HMG-CoA inhibition. Particularly, the possible anti-inflammatory and anti-fibrinogenesis qualities make statins an option in NAFLD. So, regarding the statins treatment in NAFLD, there are two aspects that are important. First of all, if statins (that are essential in the therapy for the improvement of cardiovascular risk) are safe at patients with NAFLD, given their adverse effect of increasing hepatic transaminases. Secondly, considering the strong associations between NAFLD and metabolic syndrome components, like obesity and insulin resistance, if statins could be a therapeutic option for the patients with NAFLD in the absence of dyslipidemia.