Background and aim: Acne fulminans is a rare and severe form of acne which usually appears in young men with a personal history of mild to moderate acne. It is characterized by a sudden onset with nodules and ulcerative lesions mostly located on the thorax and extracutaneous manifestations (fever, weight loss, osteoarticular damage). The pathophysiologic mechanism is represented by a type III or IV hypersensitivity reaction to Propionibacterium acnes. Patient: We present the case of a 16-year old patient with acne fulminans. The lesions were accompanied by an impaired general condition with fever and weight loss. Paraclinically an inflammatory syndrome was revealed without osteoarticular changes. It was treated with prednisone 40 mg/day, erythromycin 2g/day and local antiseptic solutions. A gradual tapering of the prednisone dose (5 mg/week) and a dermatological revaluation after 3 weeks to introduce systemic treatment with retinoids were recommended at discharge. Conclusions: Acne fulminans is a severe form of acne with systemic manifestations and corticotherapy is the first line treatment.
Introduction: Solar exposure is a major causative factor for multiple skin pathologies. Even though UV radiation is the most important factor implicated in skin cancer pathogenesis, still, few European countries recognize UV occupational-induced skin cancer as an occupational disease, Romania not being part of this category. The objectives of this study were to evaluate the UV exposure doses in agriculture and construction workers and to establish efficient protective measures. Materials and methods: In our Department, a prospective, observational, analytical study was conducted, including six outdoor workers (in construction and agriculture), over a period of three summer months (July, August, September). Subjects were asked to wear personal dosimeters and the following parameters were analyzed: profession, duration of exposure, UV exposure doses, skin aspect, preexisting preventive measures. Results: The wearing of dosimeters was well tolerated by all subjects, without any interference with daily professional activities. Daily UV radiation doses ranged from 1.79 SED (tractor driver) to 19 SED (agriculture worker). Maximum UVR doses were recorded between 10:00 am and 4 pm. Clinical examination was made after measurements, with no detectable skin changes. Conclusion: Even though workers in agriculture and construction in Romania are exposed to significant UV doses, with 40% more than the general population, these professions are not recognized as high-risk professions for developing skin tumors. More prospective and retrospective studies are necessary for more significant statistical results and for demonstrating the necessity of introducing primary, secondary and tertiary preventive measures.
Background and Aim: Psoriasis is an inflammatory skin disorder with important influence on the lipid profile, insulin resistance and cardiovascular disease. The aim of this study is to compare the lipid profile of classical therapy versus anti-TNFs patients and asses the associated diseases. Methods: We conducted a prospective study. Patients’ data were collected from two Romanian Dermatology Clinics, during the period January 2015 – June 2016. The patients were divided into two groups: study group (on TNF inhibitors) and control group (on classical treatment). Results: The subjects in the study group had more associated diseases and much more patients suffered from dyslipidemia. There were not statistically significant differences in the lipid profile between the two groups. But eliminating patients treated with Acitretin and Methotrexate, a p- value of 0.0259 (significant statistically) was observed when comparing the values of triglycerides in the two groups. Conclusions: We did not observe a beneficial effect of the TNF inhibitors therapy in psoriatic patients on the lipid profile. Subjects on biological treatment suffer from a more severe form of psoriasis vulgaris and associate much more comorbidities.
Epilepsy is one of the world's oldest diseases. Social stigma, misunderstanding and thus, discrimination have surrounded patients and their families from the beginnings until nowadays. Approximatively up to 80% of epilepsy cases worldwide are found in developing regions. The risk of premature death is two to three times higher than for the general population. There is contradictory evidences concerning the question of whether to inform patients about the possibility of sudden unexpected death in epilepsy (SUDEP). Actual guidelines states that individuals with epilepsy and their families or careers should be given access to information on SUDEP. We have information about how, when and what to say to the patients and families about SUDEP. But it's a delicate subject, and some patients do not want to know that they are at risk for this.
Object: The aim of the study is to select the most active new imidazolium-quinuclidinum- oxime, from some similar chemical compounds synthesized in our chemistry department, with sufficient efficacy to decrease the acute toxicity of neurotoxic organophosphates known as nerve agents. Method: The experimental study consist in vivo testing the antidotal efficacy of obidoxime and of selected imidazolium oximes synthesized in our chemistry department. Each oxime was included, by equimolar replacing the obidoxime, in an antidotal formula, which also contains atropine. The above mentioned formula containing atropine and obidoxime was used as reference. The protective ratio, defined as the ratio between the lethal median dose of the poisoned and treated study group and the median lethal dose (LD50) of the poisoned and untreated study groups was one of the used parameters in order to select a new active chemical structure in counteracting the neurotoxic organophosphorus compounds acute toxicity. Another studied parameter was the erythrocyte acetylcholinesterase value measured in whole blood 24 hours after exposure. Results: The protective ratio against an organophosphorus compound were the follow: obidoxime chloride: 2; 1,3- dimethyl-2-hydroxyethyl-imidazolyliodide: 1,75;3-oxime-[3-(2-hidroxyimino-methyl-1-imidazolyl-)- 2oxapropyl]quinuclidin-dichl-oride: 2,5; 1-methyl-quinuclidin-3-iodide: 1,5. The erythrocyte acetycholinesterase main values were the following: the unpoisoned and untreated study group:3,45 ±0,13mmol/dl; the poisoned and untreated study group: 0,89 ±0,09 mmol/dl; the poisoned and 3- oxime-[3-(2-hidroxyimino-methyl-1-imidazolyl-)-2oxapropyl]quinuclidindichloride study group:2,89 ±0,11 mmol/dl; the poisoned and obidoxime treated study group: 2,53±0,15 mmol/dl. Conclusions: quinuclidindichloride synthesized in our chemistry department, has shown a better protective ratio and a more prolonged surviving time than the reference (obidoxime). It has shown the best AChE reactivation of all the synthetized compounds. This compound can be a cheap and good option for replacing obidoxime in the antidotal formula active in nerve agent exposure. 3-oxime-[3-(2-hidroxyimino-methyl-1-imidazolyl-)-2oxapropyl] treated
Introduction: Venous thromboembolism (VTE), in its clinical spectrum, includes both deep venous thrombosis (DVT) and pulmonary embolism (PE). It is a disease with high incidence and morbidity in hospital and community settings. Venous thromboembolism has various risk factors and there are studies proving that the risk of increasing the incidence of the disease is proportional to the risk factors. Diagnosis, treatment and complications of lower limb deep vein thrombosis (DVT) depend on the anatomical location and extent of the process. The post-thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) and clinically it is characterized by chronic pain, edema, enlarged veins, skin induration and other signs of the affected limb, while, in severe cases, it can develop venous ulcers. The incidence of peripheral trophic disorders by age and the prevalence of risk factors for deep vein thrombosis of the lower limbs were examined in this regard. Materials and method: A retrospective study (January 2013 - December 2015) was conducted by collecting data from medical documents available in "Floreasca" Emergency Hospital Bucharest, Romania. The patients diagnosed with deep vein thrombosis, on the basis of Doppler ultrasound, were divided into two groups, according to age: group A (59 patients aged ≤50 years) and group B (130 patients aged> 50 years). A number of data from the medical anamnesis, along with clinical and paraclinical data were collected by us and we were interested in the incidence of peripheral trophic disorders caused by deep vein thrombosis of the lower limbs correlated with the risk factors. The study showed the incidence of deep venous thrombosis in a certain age and a certain environment of origin. The incidence of patients who have had a VTE history is half the patients with deep vein thrombosis who have had prophylactic anticoagulant therapy before hospitalization. The incidence of patients who have had prophylactic anticoagulant therapy before hospitalization is 61.1% of the patients with deep vein thrombosis and a VTE history. The incidence of trophic disorders caused by deep vein thrombosis of the lower limbs in patients who have had prophylactic anticoagulant therapy before hospitalization and in patients who also had a history of VTE is higher in those over 50 years old. The study showed the association of some risk factors for venous thrombosis with an age-related factor. Conclusions: Improving preventive strategies and an optimally efficient utilization of these strategies for patients at risk of venous thrombosis can lead to improved clinical outcomes in practice and also to the post-thrombotic syndrome prevention. Taking into consideration the risk factors by age group and a better understanding of epidemiology and the risk factors for the first or recurrent venous thrombosis can lead to optimal use of prophylactic strategies and improved quality of life. DVT affects all age groups and the incidence associated with PTS is high, therefore the prevalence of PTS in general population is considerable. 1 Sanitary Post High School “Fundeni”-Bucharest 2 Carol Davila University of Medicine and Pharmacy, Bucharest 3 Toxicology Clinic, “Floreasca” Emergency Hospital, Bucharest 4 Surgery Clinic, “Sf. Pantelimon” Emergency Hospital, Bucharest 5 Carol Davila University Emergency Military Hospital, Bucharest 37
The ancient Greek medicine was based on the principle that philosophy influences all natural sciences as a whole. The doctor had, first of all, a humanistic formation followed by study of applied sciences specific to medicine. If humanism is purely theoretical, medicine is an applied science and the two-philosophy and medical knowledge, despite the apparent antinomy are able to create a union to the benefit of humanity. Medicine is the art of treating patients, identifying diseases and malady prevention. In its endeavor, medicine is based on the findings of numerous other fields such as physics, chemistry, anatomy, physiology, etc. Philosophy, on the other hand, can be defined as an attempt to understand human life as a whole. It is inevitable that the two ways of dealing with human beings to have influenced each other and the history of mankind. Both forms of knowledge have a major impact and influence on the world. Philosophy, understood in its older meaning, urged towards the prophylaxis and treatment of diseases of the soul whereas medicine, relying on philosophical teachings is aimed at healing the body and study its psychosomatic features.
Matching drugs with anxiolytic properties- but without the potential of inducing dependence or abuse- with clinical manifestations of various affective disorders is a very important challenge for psychiatrists. Although the first line of pharmacologic treatment for anxiety disorders remains antidepressants with serotoninergic properties, calcium channel alpha-2-delta ligands are adjuvant agents which could be useful for augmenting antidepressant agents’ clinical effects. Unfortunately, calcium channel alpha-2-delta ligands efficacy and tolerability are not very well known, due to a lack of large scale, randomized, placebo-controlled trials focused on psychiatric disorders. Data regarding pregabalin and gabapentin pharmacology and clinical effects are reviewed and conclusions with pragmatically impact based on the discovered evidence are formulated accordingly.
Osteoporosis is a major health problem, and the economic costs are expected to rise due to an increase in life expectancy throughout the world. Its major consequence is fractures, and especially hip fractures are associated with institutionalization and increased mortality. Homocysteine is an amino acid intermediate formed during the metabolism of methionine. Homocysteinuria is a rare autosomal recessive biochemical abnormality which causes elevated plasma concentrations of homocysteine and severe occlusive vascular disease. In patients with homocysteinuria, there is an increased prevalence of skeletal deformities, including osteoporosis, which is a primary risk factor for hip fracture. The high prevalence of osteoporosis among patients with homocysteinuria suggests that high levels of plasmatic homocysteine may also increase the risk of fractures. Nutritional factors such as vitamins B12, B6, and folate are cofactors in homocysteine metabolism, and vitamin intakes may inversely affect plasma homocysteine levels.
