Clinica de Pneumologie Iaşi

Dry eye disease (DED) has increasingly been linked to oxidative stress; however, the specific redox mechanisms underlying different clinical phenotypes remain incompletely understood. This study aimed to evaluate tear film oxidative stress profiles in patients with primary DED and sarcoidosis-associated DED (S-DED) by assessing lipid peroxidation, antioxidant enzyme activity, and total tear protein content, and to explore their relationship with clinical tear film dysfunction. Tear samples were analyzed for superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities, as well as for malondialdehyde (MDA) and total protein levels, alongside standard clinical tests of tear film stability and secretion. Both DED groups exhibited significant oxidative alterations compared to controls, but with distinct redox signatures. Primary DED was characterized by markedly increased tear MDA levels, indicating predominant lipid peroxidation, whereas S-DED showed a more pronounced impairment of antioxidant defense, reflected by preserved or increased SOD activity in the context of significantly reduced GPx activity. Total tear protein levels were reduced in both groups, with evidence suggesting qualitative protein alterations in S-DED. The tear collection method significantly influenced the measured levels of several oxidative stress markers, underscoring the importance of sampling technique when interpreting tear-based redox profiles. Oxidative stress markers correlated with clinical measures of tear film dysfunction, supporting their physiological relevance. These findings demonstrate that DED encompasses heterogeneous oxidative stress mechanisms and that sarcoidosis acts as a modifier of ocular surface redox homeostasis. Distinct tear-based redox profiles differentiate primary from sarcoidosis-associated dry eye, highlighting the potential value of oxidative biomarkers for phenotyping DED beyond tear deficiency alone.

Background and Clinical Significance: Adults suffering from cerebellar metastases are often at high risk for rapid deterioration of their neurological status because the posterior fossa has limited compliance and the location of these metastases are close to the brain stem and important cerebrospinal fluid (CSF) pathways. In this paper, we present a longitudinal, patient-centered report on the history of an elderly individual who suffered from cognitive comorbidities and experienced a sudden loss of function in her cerebellum. Our goal in reporting this case is to provide a comparison between the patient’s pre-operative and post-operative neurological examinations; the imaging studies she had before and after surgery; the surgical techniques utilized during her operation; and the outcome of her post-operative course in a way that will be helpful to other patients who have experienced a similar situation. Case Presentation: We report the case of an 80-year-old woman who initially presented with progressive ipsilateral limb-trunk ataxia, impaired smooth pursuit eye movement, and rebound nystagmus, but preserved pyramidal and sensory functions. Her quantitative bedside assessments included some of the components of the Scale for the Assessment and Rating of Ataxia (SARA), and a National Institute of Health Stroke Scale (NIHSS) score of 3. These findings indicated dysfunction of the left neocerebellar hemisphere and possible dentate nucleus involvement. The patient’s magnetic resonance imaging (MRI) results demonstrated an expansive mass with surrounding vasogenic edema and marked compression and narrowing of the exits of the fourth ventricle which placed the patient’s CSF pathways at significant risk of occlusion, while the aqueduct and inlets were patent. She then underwent a left lateral suboccipital craniectomy with controlled arachnoidal CSF release, preservation of venous drainage routes, subpial corticotomy oriented along the lines of the folia, stepwise internal debulking, and careful protection of the cerebellar peduncles and dentate nucleus. Dural reconstruction utilized a watertight pericranial graft to restore the cisternal compartments. Her post-operative intensive care unit (ICU) management emphasized optimal venous outflow, normoventilation, and early mobilization. Histopathology confirmed the presence of metastatic carcinoma, and staging suggested that the most likely source of the primary tumor was the lungs. Immediately post-operation, computed tomography (CT) imaging revealed a smooth resection cavity with open foramina of Magendie and Luschka, intact contours of the brain stem, and no evidence of bleeding or hydrocephalus. The patient’s neurological deficits, including dysmetria, scanning dysarthria, and ataxic gait, improved gradually during the first 48 h post-operatively. Upon discharge, the patient demonstrated an improvement in her limb-kinetic subscore on the International Cooperative Ataxia Rating Scale (ICARS) and demonstrated independent ambulation. At two weeks post-operation, CT imaging revealed decreasing edema and stable cavity size, and the patient’s modified Rankin scale had improved from 3 upon admission to 1. There were no episodes of CSF leakage, wound complications, or new cranial nerve deficits. A transient post-operative psychotic episode that was likely secondary to her underlying Alzheimer’s disease was managed successfully with short-course pharmacotherapy. Conclusions: The current case study demonstrates the value of anatomy-based microsurgical planning, preservation of venous and CSF pathways, and targeted peri-operative management to facilitate rapid recovery of function in older adults who suffer from cerebellar metastasis and cognitive comorbidities. The case also demonstrates the importance of early multidisciplinary collaboration to allow for timely initiation of both adjuvant stereotactic radiosurgery and molecularly informed systemic therapy.

Background/Objectives: This study aimed to investigate specific biomarkers of oxidative stress within gingival crevicular fluid (GCF) and plasma obtained from children with leukemia compared to healthy subjects, in relation to the oral hygiene status and gingival inflammatory status, in order to identify a possible association linking childhood leukemia with gingival inflammation. Methods: The study comprised biomarker analysis from 97 children divided into two groups: 47 leukemia subjects and 50 systemically healthy children in the control group. The GCF and plasma specimens were analyzed to determine values of 8-OHdG (8-hydroxydeoxyguanosine) and SOD (superoxide dismutase) using ELISA (enzyme-linked immunosorbent assay) techniques, while MDA (malondialdehyde) values were measured through colorimetry. Results: We found elevated plasma expressions of all investigated biological parameters among leukemic children relative to the control group. GCF measurements highlighted raised 8-OHdG and SOD in leukemic individuals, while MDA recorded no significant shift between the groups. The statistical analysis also revealed a possible GCF and plasma SOD levels associated with the oral hygiene and gingival inflammatory status. Conclusions: The increased expression of oxidative stress markers we found in children with leukemia underlines the heightened inflammatory and oxidative burden in this category of population, yet additional studies are needed to clarify the intricate relation between systemic oxidative stress, oral biomarkers and gingival health outcomes in children, especially in children with critical systemic alterations such as leukemia.

Background: Accurate prognostic assessment in lung cancer is challenging, especially in settings with limited access to molecular testing. Routine hematological markers may complement TNM staging in identifying high-risk patients. Methods: We retrospectively analyzed 304 patients with histologically confirmed lung cancer to evaluate the prognostic value of hematological and inflammatory markers in relation to tumor stage and ECOG performance status. Survival was estimated using Kaplan–Meier analysis and independent predictors were identified through Cox regression. Cluster analysis integrated hematological markers with tumor characteristics. Results: Most patients presented with advanced disease (61.2% T4; 57.1% metastatic). Early stages (≤IIC) were associated with nearly double the median overall survival compared with stages ≥IIIA (p = 0.001). Nodal involvement and metastases further stratified outcomes. Among hematological markers, anemia (Hb < 11.85 g/dL) and leukocytosis (WBC > 11.71 × 109/L) predicted shorter survival and remained independent predictors in the multivariable Cox model (HR 1.70, p < 0.001; HR 1.54, p = 0.004), along with T4 stage (HR 1.47, p = 0.015). PLT count and fibrinogen were significant in univariate analysis but not after adjustment, while CRP and D-dimer showed no association. Cluster analysis identified two subgroups, with patients in Cluster 2 (T4 stage, anemia, leukocytosis) experiencing more than double the mortality risk compared with Cluster 1 (HR 2.33, p < 0.001). Conclusions: TNM stage remains the dominant prognostic factor in lung cancer. However, Hb and WBC count provide additional prognostic information, and cluster analysis may refine risk stratification by capturing clinically relevant heterogeneity.

Students, particularly those in the medical field, are exposed to various stressors that can affect their health-related behaviors, including smoking habits, with implications for oral health and quality of life. Background and Objectives: to analyze the relationship between smoking, oral health, perceived stress level, and self-assessed quality of life in a sample of dental students. Materials and Methods: The cross-sectional study included 338 students, who completed validated questionnaires and were clinically examined. Lifestyle was assessed using a smoking behavior questionnaire, stress levels were measured with the Student Stress Inventory (SSI), and quality of life was evaluated using the EQ-5D-5L instrument. The DMFT index was calculated to determine oral health status. Results: Among the 338 participating students, 53.8% were smokers. The lifestyle analysis revealed slightly higher average scores among non-smokers across all domains-social (3.26 vs. 3.09), attitudinal (2.75 vs. 2.97), and behavioral (3.82 vs. 3.49), but without statistically significant differences (p > 0.25). The mean DMFT score was 12.48, with no significant differences between smokers and non-smokers (p = 0.554). The SSI total score averaged 83.15, indicating a moderate level of perceived stress, again with no statistically significant differences between the groups (p > 0.05). However, slightly higher average stress scores among smokers may suggest the use of smoking as a coping mechanism. In contrast, quality of life as measured by EQ-5D-5L showed significantly worse outcomes for smokers across all five dimensions, including mobility (78.6% vs. 95.5%, p = 0.000) and self-care (93.4% vs. 100%, p = 0.001). Multivariable logistic regression identified smoking (OR = 1.935; p = 0.047) and moderate stress levels (OR = 0.258; p < 0.001) as independent predictors of oral health status. Conclusions: The results obtained suggest that smoking may function as a stress management strategy among students, supporting the relevance of integrating specific psychobehavioral interventions that address stress reduction and oral health promotion among student populations.

Colorectal cancer (CRC) diagnosed in an advanced stage has an increased predisposition for invasion and metastasis, requiring upgraded prognostic markers. CDH17, a liver-intestine cadherin, is an adhesion molecule implicated in tumor progression. This retrospective study assessed the immunohistochemical expression of CDH17 in 84 CRC cases with lymphovascular invasion (LVI), analyzing its correlation with clinicopathological features and survival outcomes. CDH17 expression was evaluated in the tumor core, invasive front, tumor emboli, and lymph node metastases. Statistical analyses showed significant associations between high CDH17 expression and favorable histological types, as well as low-grade differentiation. However, high CDH17 levels in tumor emboli correlated with advanced T stage and poorer overall survival. Multivariable Cox regression confirmed CDH17 expression in tumor emboli as an independent prognostic factor, indicating an approximately twofold risk of death. These findings suggest that CDH17 may have a dual role-maintaining adhesion in low-grade tumors while facilitating tumor emboli-related dissemination. CDH17 expression, particularly in the tumor emboli, could serve as a valuable prognostic biomarker in CRC with LVI.

Background: Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of intensive care unit (ICU) admissions and in-hospital mortality. Several hematological inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), derived NLR (dNLR), and systemic immune-inflammation index (SII), have been proposed as markers of disease severity and mortality. Methods: A retrospective study was conducted on 104 ICU patients with AECOPD over a two-year period. We collected and analyzed clinical, demographic, and laboratory data. The hematological indices of the two groups-survivors (n = 39) and non-survivors (n = 65)-were compared to assess differences. We used t-tests, ANOVA, chi-square tests, and Mann-Whitney U tests to compare the groups. The factors that independently predicted mortality were identified using multivariate logistic regression. We examined survival differences using Kaplan-Meier analysis, and ROC curves were utilized to evaluate the predictive power of each biomarker. Results: Mortality was substantially predicted by higher SII (OR: 1.92, 95% CI: 1.24-3.08, p = 0.002) and NLR (OR: 2.89, 95% CI: 1.72-4.82, p < 0.001). Patients with NLR > 8.0 and SII > 1800 had significantly lower survival rates (log-rank p < 0.001), according to Kaplan-Meier analysis. SII (AUC = 0.79) and NLR (AUC = 0.82) were the best predictors of death, according to ROC analysis. Conclusions: In ICU-admitted AECOPD patients, NLR, MLR, PLR, dNLR, and SII are independent predictors of mortality. Due to their ease of evaluation and predictive capabilities, they should be included in ICU risk models for early interventions.

Introduction: Urinary tract infection is the most common infectious pathology, both community-acquired and healthcare-associated. Diagnosing a urinary tract infection (UTI) also requires a complete investigation of the patient, polymicrobial infections usually occurring in patients with urological pathology that often requires the use of urinary catheters. The evolution to urosepsis can be encountered in patients with predisposing factors. Objective: This case report discusses a 78-year-old patient, who presented by transfer from a urology department where he was hospitalized for suspected prostatic abscesses and urinary tract infection with Klebsiella XDR, during which the patient developed fever, productive cough, and hypotension. Material and method: Therefore, tracheal secretion, urine culture, lingual mycotic examination, and infectious screening were collected in order to establish the etiology of the symptoms. These revealed the presence of multiple hospital microbes, confirming the suspicion of healthcare-associated infections. Results and discussions: After multiple investigations, it was established that the state of immunodepression, undiagnosed urological pathology, and prolonged hospitalizations in various hospital departments were the triggering factors of the slow evolution towards urosepsis, as well as remote complications through multiple colonizations with hospital germs. Conclusions: The evolution towards urosepsis and colonization with hospital microbes can be encountered in patients with predisposing factors such as advanced age, immunodepression, and prolonged hospitalization. Bacteriological investigations are essential for a correct therapeutic decision Rezumat Introducere: Infecția de tract urinar reprezintă cea mai frecventă patologie infecțioasă, atât comunitară cât și asociată asistenței medicale. Diagnosticarea unei infecții de tract urinar (ITU) impune și o investigare completă a pacientului, infecțiile polimicrobiene întâlnindu-se de obicei la pacienții cu patologie urologică care necesită adesea folosirea de catetere urinare. Evoluția către urosepsis poate fi întâlnită la pacientul cu factori predispozanți precum vârsta înaintată, stare de imunodepresie și durată prelungită de spitalizare. Scop/Obiectiv: Această prezentare de caz aduce în discuție un pacient vârstnic de 78 de ani, care s-a prezentat prin transfer dintr-o secție de urologie unde a fost spitalizat pentru suspiciune de abcese prostatice și infecție de tract urinar cu Klebsiella XDR, pe parcursul căreia pacientul a dezvoltat febră, tuse productivă și hipotensiune arterială. Material și metodă: În cadrul evaluării pacientului, au fost recoltate secreție traheală, urocultură, examen micotic lingual și screening infecțios în vederea stabilirii etiologiei simptomatologiei. Acestea au relevat prezența multiplilor microbi de spital, confirmându-se suspiciunea de infecții asociate asistenței medicale. Rezultate și discuții: După multiple investigații efectuate s-a stabilit faptul că starea de imunodepresie, patologia urologică nediagnosticată și spitalizările prelungite în diverse secții de spital au reprezentat factorii declanșatori a evoluției trenante către urosepsis, precum și complicațiile la distanță prin multiplele colonizări cu germeni de spital. Concluzii: Evoluția către urosepsis și colonizarea cu microbi de spital poate fi întâlnită la pacientul cu factori predispozanți precum vârsta înaintată, stare de imunodepresie și durată prelungită de spitalizare. Investigațiile bacteriologice sunt esențiale pentru o decizie terapeutică corectă.