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Bobeica C, Niculet E, Musat CL, Iancu L, Craescu M, Luca AM, Stefanescu BI, Gheorghe E, Debita M, Vasile CI, Balan G, Busila C, Tatu AL. The Association of Telangiectasias with Other Peripheral Vascular Lesions of Systemic Sclerosis. Clin Cosmet Investig Dermatol 2024; 17:211-218. [PMID: 38292323 PMCID: PMC10826706 DOI: 10.2147/ccid.s432422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/25/2023] [Indexed: 02/01/2024]
Abstract
Purpose Systemic sclerosis (SSc) is a relatively rare collagenosis manifested as microvasculopathy, excessive cutaneous and visceral fibrosis in a background of autoimmune alteration. Autoimmune vasculopathy in SSc occurs early and begins with endothelial cell activation followed by blood vessel intimal proliferation in a context of defective angiogenesis. The alteration of peripheral micro and macrocirculation in SSc is evident through vascular lesions, such as Raynaud's phenomenon, telangiectasias, acrocyanosis, digital ulcers, gangrene, peripheral pulse deficiency. Our paper details the results of the study on the association between telangiectasias and other types of immune-mediated peripheral vascular lesions that can be identified in SSc. The presence of these peripheral vascular lesions can provide information about the magnitude of the peripheral vasculopathy. Patients and Methods A total of 37 patients diagnosed with SSc, recruited from a university clinic in Bucharest between February 2019 and March 2020, were enrolled in an observational study. We evaluated the presence of telangiectasias, as a stigma of autoimmune microvasculopathy, and their association with other immune-mediated peripheral vascular lesions that may be present in SSc. Results The presence of telangiectasias was identified in the absence, but especially in the presence of acrocyanosis and digital ulcerations, and patients with peripheral pulse deficiency almost always had telangiectasias. Less than a quarter of the patients with digital ulcers progressed unfavorably to gangrene, and only one required amputation, telangiectasias being present not only in the patient with amputation but in all patients with gangrene. Conclusion We appreciate that telangiectasias may be the clinical expression of peripheral vasculopathy characteristic of SSc, they can often be present in association with other peripheral vascular lesions and may represent a valuable indicator for the gangrene risk of digital ulcerations in SSc.
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Affiliation(s)
- Carmen Bobeica
- Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, Romania
| | - Carmina Liana Musat
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Lina Iancu
- Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, Romania
| | - Andreea Mioara Luca
- Department of Plastic Surgery, “Sf. Ioan” Clinical Emergency Hospital for Children, Galați, 800487, Romania
| | - Bogdan Ioan Stefanescu
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
| | - Emma Gheorghe
- Department No. 1 (Preclinical), Faculty of Medicine and Pharmacy, “Ovidius” University, Constanța, 900527, Romania
| | - Mihaela Debita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Claudiu-Ionut Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Gabriela Balan
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
- Department of Gastroenterology, “Sf. Apostol Andrei” County Emergency Clinical Hospital, Galaţi, 800578, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, “Dunărea de Jos” University, Galaţi, 800008, Romania
| | - Camelia Busila
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania
- Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galați, 800179, Romania
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Martínez JD, Franco R, Sáenz LM, Alvarado AG, García JA, Delgado SM, Ionescu MA, Busilă C, Tatu AL. DRESS and Stevens-Johnson Syndrome Overlap Secondary to Allopurinol in a 50-Year-Old Man-A Diagnostic and Treatment Challenge: Case Report. Life (Basel) 2023; 13:2251. [PMID: 38137852 PMCID: PMC10744808 DOI: 10.3390/life13122251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/13/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug reaction commonly related to eosinophilia, from uncertain epidemiology, and without consensus for diagnosis and treatment globally. It presents a great challenge in its management and is characterized by fever, lymphadenopathy, skin rash, and multisystemic involvement. An aggressive and difficult-to-manage clinical case is presented in a 50-year-old man with chronic kidney disease due to diabetes mellitus type 2 and systemic arterial hypertension, who developed an unusual variant similar to DRESS and Stevens-Johnson syndrome (SJS) overlap secondary to allopurinol, with skin manifestations without eosinophilia, but fulfilling clinical and laboratory criteria for DRESS and SJS syndrome.
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Affiliation(s)
- José Dario Martínez
- Department of Internal Medicine, Faculty of Medicine, Hospital Universitario José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico;
| | - Rodolfo Franco
- Department of Human Pathology, Faculty of Medicine, Hospital Universitario José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico; (R.F.); (J.A.G.)
| | - Luis Manuel Sáenz
- Faculty of Medicine, University Hospital José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico; (L.M.S.); (S.M.D.)
| | - Americo Guadalupe Alvarado
- Department of Internal Medicine, Faculty of Medicine, Hospital Universitario José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico;
| | - José Antonio García
- Department of Human Pathology, Faculty of Medicine, Hospital Universitario José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico; (R.F.); (J.A.G.)
| | - Sergio Máximo Delgado
- Faculty of Medicine, University Hospital José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico; (L.M.S.); (S.M.D.)
| | - Marius-Anton Ionescu
- Department of Dermatology, University Hospital Saint Louis, 63110 Paris, France;
| | - Camelia Busilă
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania;
| | - Alin Laurentiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania;
- Dermatology Department, “Sfanta Cuvioasa Paraschiva” Hospital of Infectious Diseases, 800179 Galati, Romania
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3
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Bobeica C, Niculet E, Craescu M, Parapiru EL, Corduneanu-Luca AM, Debita M, Pelin AM, Tiutiuca C, Vasile CI, Nicolescu AC, Miulescu M, Balan G, Tatu AL. Immunologic and nonimmunologic sclerodermal skin conditions - review. Front Immunol 2023; 14:1180221. [PMID: 37600771 PMCID: PMC10432860 DOI: 10.3389/fimmu.2023.1180221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/16/2023] [Indexed: 08/22/2023] Open
Abstract
Scleroderma-like cutaneous lesions have been found in many pathological conditions and they have the clinical appearance of sclerotic or scleroatrophic lesions. Affected skin biopsies described histopathological changes similar to those of scleroderma located strictly on the skin or those of systemic sclerosis. These skin lesions can be found in inflammatory diseases with autoimmune substrate (generalized morphea, chronic graft versus host disease, eosinophilic fasciitis), tissue storage diseases (scleredema, scleromyxedema, nephrogenyc systemic fibrosis, systemic amyloidosis), metabolic diseases (porphyrya cutanea tarda, phenylketonuria, hypothyroidism, scleredema diabeticorum), progeroid syndromes. Given the multiple etiologies of sclerodermal lesions, a correct differential diagnosis is necessary to establish the appropriate treatment.
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Affiliation(s)
- Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
| | - Elena-Laura Parapiru
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | | | - Mihaela Debita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Ana Maria Pelin
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Carmen Tiutiuca
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Claudiu Ionut Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Alin Codrut Nicolescu
- Dermatology Department “Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania
| | - Magdalena Miulescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Gabriela Balan
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, “Dunărea de Jos” University, Galaţi, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galaţi, Romania
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Niculet E, Bobeica C, Onisor C, Gurau G, Nechita A, Radaschin DS, Tutunaru D, Bujoreanu-Bezman L, Tatu AL. Basal Cell Carcinoma Perineural Invasion and Suggestive Signs of Perineural Invasion-Findings and Perspectives. Life (Basel) 2023; 13:1406. [PMID: 37374188 DOI: 10.3390/life13061406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Basal cell carcinoma (BCC) is a malignant tumor with a rising incidence and is the beneficiary of several innovative evaluation techniques. Histopathology remains the gold standard for assessment, having the possibility of addressing multiple high-risk factors such as perineural invasion (PNI). The current study included a number of 244 BCC patients and targeted the identification of positive PNI and its suggestive signs, and whether they correlated or not with other high-risk tumor signs. PNI was found in 20.1% of patients, with 30.7% of patients having perineural chronic inflammation (PCI), which is a suggestive sign of PNI. PNI was also found in larger tumors, with deeper Clark levels, in high-risk BCCs and high-grade tumors. PNI and PCI are both important for pathology reporting, aiding in treatment choice and further patient management, with possibly positive outcomes concerning morbidity and mortality.
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Affiliation(s)
- Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica-CIM-CID), "Dunărea de Jos" University, 800201 Galati, Romania
| | - Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Cristian Onisor
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Gabriela Gurau
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Aurel Nechita
- Department of Pediatrics, 'Sf. Ioan' Clinical Hospital for Children, 800487 Galati, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Diana Sabina Radaschin
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica-CIM-CID), "Dunărea de Jos" University, 800201 Galati, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
- Dermatology Department, "Sfanta Cuvioasa Parascheva" Hospital of Infectious Diseases, 800179 Galati, Romania
| | - Dana Tutunaru
- Department of Pharmaceutical Sciences, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Laura Bujoreanu-Bezman
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica-CIM-CID), "Dunărea de Jos" University, 800201 Galati, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Medicine and Pharmacy, 800008 Galati, Romania
- Dermatology Department, "Sfanta Cuvioasa Parascheva" Hospital of Infectious Diseases, 800179 Galati, Romania
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5
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Stefanopol IA, Petecariu A, Baroiu L, Neagu AI, Bogdan-Goroftei RE, Nechifor A, Ciortea DA, Sarbu N. Giant Benign Struma Ovarii with High-Grade Fever, Elevated CA 125, and Hormonal Function in an Adolescent Patient. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050856. [PMID: 37238404 DOI: 10.3390/children10050856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Struma ovarii (SO) is a monodermal teratoma containing at least 50% thyroid tissue. Classically, SO is a hormonally inactive benign neoplasm that occurs in premenopausal women, and has unspecific clinical and imaging features. Its treatment is surgical and its diagnosis is established histopathologically. We report the case of a euthyroid 16-year-old girl presenting with abdominal girth increase. An abdomino-pelvic ultrasound showed a giant multicystic mass with transonic content and multiple septa, and magnetic resonance imaging suggested the diagnosis of right ovarian mucinous cystadenoma. Blood tests showed inflammatory syndrome, iron deficiency anemia, mild hepatocytolysis, and elevated serum CA 125 levels. High-grade fever occurred on the third day of hospitalization, but none of the preoperative tests could identify its origin. Cystectomy was performed, and the histopathological examination revealed benign SO with a few small cysts with purulent content. The patient developed hypothyroidism postoperatively. In conclusion, this case report reunites most of the uncommon features of SO and confirms the superiorityof histopathology in its definitive diagnosis, as well as the suitability of ovarian sparing techniques, as the best treatment option for cystic ovarian pathology in pediatric patients, even in cases of large tumoral size and elevated serum CA 125 levels.
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Affiliation(s)
- Ioana Anca Stefanopol
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, 800216 Galați, Romania
- Department of Pediatric Surgery, "Sf Ioan" Clinical Emergency Hospital for Children, 800487 Galați, Romania
| | - Alexandru Petecariu
- Department of Pediatric Surgery, "Sf Ioan" Clinical Emergency Hospital for Children, 800487 Galați, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, 800216 Galați, Romania
- Infectious Diseases Department, "Sf Cuv Parascheva" Clinical Hospital of Infectious Diseases, 800179 Galați, Romania
| | - Anca-Iulia Neagu
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, 800216 Galați, Romania
- Department of Anatomopathology, "Sf Ioan" Clinical Emergency Hospital for Children, 800487 Galați, Romania
| | - Roxana-Elena Bogdan-Goroftei
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, 800216 Galați, Romania
- Emergency Department, "Sf Ioan" Clinical Emergency Hospital for Children, 800487 Galați, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, 800216 Galați, Romania
| | - Diana-Andreea Ciortea
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, 800216 Galați, Romania
- Pediatric Department, "Sf Ioan" Clinical Emergency Hospital for Children, 800487 Galați, Romania
| | - Nicolae Sarbu
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, 800216 Galați, Romania
- Department of Radiology and Medical Imaging, "Sf Ioan" Clinical Emergency Hospital for Children, 800487 Galați, Romania
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Dumitriu Buzia O, Păduraru AM, Stefan CS, Dinu M, Cocoș DI, Nwabudike LC, Tatu AL. Strategies for Improving Transdermal Administration: New Approaches to Controlled Drug Release. Pharmaceutics 2023; 15:pharmaceutics15041183. [PMID: 37111667 PMCID: PMC10143057 DOI: 10.3390/pharmaceutics15041183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
In this work, we aim to address several strategies to improve transdermal drug delivery, such as iontophoresis, sonophoresis, electroporation and micron. We also propose a review of some transdermal patches and their applications in medicine. TDDs (transdermal patches with delayed active substances) are multilayered pharmaceutical preparations that may contain one or more active substances, of which, systemic absorption is achieved through intact skin. The paper also presents new approaches to the controlled release of drugs: niosomes, microemulsions, transfersomes, ethosomes, but also hybrid approaches nanoemulsions and microns. The novelty of this review lies in the presentation of strategies to improve the transdermal administration of drugs, combined with their applications in medicine, in light of pharmaceutical technological developments.
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Affiliation(s)
- Olimpia Dumitriu Buzia
- Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galați, 800008 Galați, Romania
| | - Ana Maria Păduraru
- Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galați, 800008 Galați, Romania
| | - Claudia Simona Stefan
- Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galați, 800008 Galați, Romania
| | - Monica Dinu
- Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galați, 800008 Galați, Romania
| | - Dorin Ioan Cocoș
- Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galați, 800008 Galați, Romania
| | | | - Alin Laurențiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University, 800008 Galati, Romania
- Dermatology Department, "Sf. Cuvioasa Parascheva" Clinical Hospital of Infectious Diseases, 800179 Galati, Romania
- Multidisciplinary Integrative Center for Dermatologic Interface Research MIC-DIR, 800010 Galati, Romania
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Sweet Syndrome Associated with Myelodysplastic Syndrome—A Review of a Multidisciplinary Approach. Life (Basel) 2023; 13:life13030809. [PMID: 36983964 PMCID: PMC10053503 DOI: 10.3390/life13030809] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Sweet syndrome (SS) is a rare disease described as a febrile neutrophilic dermatosis with acute onset, the pathogenesis of which has not yet been elucidated. The syndrome is characterized by the sudden onset of erythematous infiltrated papules or plaques located on the upper body and is associated with fever, leukocytosis and neutrophilia. The lesions show a dense dermal infiltration with mature neutrophils. The condition is responsive to systemic steroids. The central nervous system, bones, muscles, eyes, ears, mouth, heart, lung, liver, kidneys, intestines, and spleen may be affected by SS as extracutaneous manifestations. More and more cases have been found to be associated with malignancies, particularly myelodysplastic syndrome, and, less frequently, other hematologic malignancies or solid tumors. Approximately 21% of patients with SS have an associated malignancy and up to 80% of MASS cases are associated with hematological diseases, predominantly myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Myelodysplastic syndrome is a clonal disease of the bone marrow characterized by inefficient hematopoiesis, dysplasia of the bone marrow and peripheral cytopenias. Affected patients have a high risk of leukemic transformation. After analyzing later studies and current practical aspects regarding MDS-related SS, we suggest an algorithm for evaluating these patients.
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Pharyngeal-Esophageal Malignancies with Dermatologic Paraneoplastic Syndrome. Life (Basel) 2022; 12:life12111705. [PMID: 36362860 PMCID: PMC9693568 DOI: 10.3390/life12111705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
Systemic changes often send signals to the skin, and certain neoplastic diseases of the internal organs can also trigger skin manifestations. In this article, the authors make clinical photography presentations of the patients seen at our clinic with dermatologic paraneoplastic syndromes within pharyngeal–esophageal malignancies, describe several paraneoplastic dermatoses, and also review high-quality scientific literature in order to be able to highlight the dermatological signs of pharyngoesophageal malignant tumors. The majority of our patients with paraneoplastic dermatoses, filtering for pharyngoesophageal malignancies, had esophageal neoplasms, out of whom seven were female and two were male, making esophageal cancer more common within the paraneoplastic dermatoses within pharyngoesophageal malignancies. An early recognition of paraneoplastic dermatoses can diagnose neoplasms and sequentially contribute to a better prognosis for the patient. This matter is also useful for front-line medical personnel in order to improve early diagnosis of the underlying malignancy, curative interventions with prompt therapy administration and good prognosis.
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Ciobotaru OR, Stoleriu G, Ciobotaru OC, Grigorovici A, Voinescu DC, Matei MN, Cobzaru RG, Manolache N, Lupu MN. Postanesthetic skin erythema due to succinylcholine versus atracurium. Exp Ther Med 2020; 20:2368-2372. [PMID: 32765716 PMCID: PMC7401908 DOI: 10.3892/etm.2020.8792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/14/2020] [Indexed: 12/28/2022] Open
Abstract
Intraoperative anaphylactic reactions may range from mild, erythema-like to anaphylactic shock, with tension crash and bronchospasm. The substances considered to be most responsible for the occurrence of intraoperative allergic reactions are neuromuscular blocking agents, antibiotics and latex. Recent studies have identified a new receptor, Mas-Related G-Protein-coupled Receptor X2 (MRGPRX2), considered as a target for some neuromuscular blockers such as atracurium, rocuronium or fluoroquinolone, resulting in pseudoallergic or anaphylactoid reactions. Induction of anesthesia can use both depolarizing myorelaxants, useful especially in emergency situations, in the patient with gastric plenitude or at high risk of intubation, and non-depolarizing myorelaxants such as atracurium, cisatracurium and rocuronium. Succinylcholine has a short time of action and it is rapidly metabolized. Atracurium, although having a slightly longer time to action, has the benefit of a low risk of increased levels of potassium in blood, which is extremely important in patients with cardiac pathology or associated kidney diseases. The present study compared the side effects of systemic anesthesia with succinylcholine vs. atracurium.
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Affiliation(s)
- Oana Roxana Ciobotaru
- Clinical Department, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University, 800008 Galati, Romania
| | - Gabriela Stoleriu
- Clinical Department, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University, 800008 Galati, Romania
| | - Octavian Catalin Ciobotaru
- Department of Surgery, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University, 800008 Galati, Romania
| | - Alexandru Grigorovici
- Department of Surgery, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Doina Carina Voinescu
- Clinical Department, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University, 800008 Galati, Romania
| | - Madalina Nicoleta Matei
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University, 800008 Galati, Romania
| | - Roxana Gabriela Cobzaru
- Department of Preventive Medicine and Interdisciplinarity, Discipline Microbiology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Nicuta Manolache
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University, 800008 Galati, Romania
| | - Mary-Nicoleta Lupu
- Department of Surgery, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University, 800008 Galati, Romania
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Awad VM, Sakhamuru S, Kambampati S, Wasim S, Malik BH. Mechanisms of Beta-Blocker Induced Psoriasis, and Psoriasis De Novo at the Cellular Level. Cureus 2020; 12:e8964. [PMID: 32766006 PMCID: PMC7398737 DOI: 10.7759/cureus.8964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Beta-blockers are a commonly prescribed medication, but the increase in use goes hand in hand with increasing side effects; one of particular interest lately has been its dermatological reactions. Although rare, beta-blockers can exacerbate pre-existing psoriasis and also cause de novo psoriasis in patients naïve to the disease. The mechanism by which this occurs is still unclear, although numerous articles have been published throughout the years as to how this unusual effect takes place. The most common mechanism suggests that beta-blockers cause intracellular changes in calcium, affecting both keratinocyte proliferation and granulocyte function via decreased cyclic adenosine monophosphate (cAMP) levels. Several inflammatory mediators are known to play a role, as well as reduced expression and desensitization of the beta-adrenergic receptor itself. We discuss these posed pathways in-depth and how each contributes to the worsening or formation of new psoriasis. With this knowledge, future physicians may be more mindful of this side effect should it occur, and why they occur, to better manage our patients on this widely used medication.
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Affiliation(s)
- Vanessa M Awad
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sirisha Sakhamuru
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield , USA
| | - Srikala Kambampati
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Shehnaz Wasim
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Nwabudike LC, Miulescu M, Tatu AL. Case series of an alternative therapy for generalised lichen planus: Four case studies. Exp Ther Med 2019; 18:943-948. [PMID: 31384327 PMCID: PMC6639946 DOI: 10.3892/etm.2019.7677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/01/2019] [Indexed: 12/11/2022] Open
Abstract
Lichen planus (LP) is an idiopathic, cell-mediated immune disorder, accompanied by itching. Spontaneous remission occurs. Topical and systemic therapies are utilised. Four cases of generalized LP with and without mucosal involvement treated homeopathically are presented. Case 1: A 48-year-old female presented with a 7-month history of generalized itchy rash, which had been diagnosed as LP, treated unsuccessfully with topical steroids and removal of dental fillings. Examination revealed violaceous papules on upper and lower limbs, oral mucosal lesions and an irregular, erythematous, blanching, macular rash on the chest. She received homeopathic Ignatia amara at medication dilution factor (MK) potency, weekly dose and went into remission at 3 months. Patient remains in remission. Case 2: A 65-year-old female presented with a 27-year history of generalized, LP, which had been unresponsive to topical steroids. Examination showed generalized, violaceous papules, with no mucosal involvement. She received homeopathic Aurum metallicum, MK potency, weekly, and went into remission. She relapsed at 8 months after onset of therapy, following a very stressful incident, but gained remission again with Aurum metallicum after 1 month of therapy. She remains in remission. Case 3: A 38-year-old male presented with a 21-year history of generalized LP. Medical history was significant for hepatitis B and asthma. Topical steroid therapy was only partially successful. Examination revealed generalized, violaceous papules, with oral and genital involvement. He received homeopathic Lycopodium at MK potency, weekly, and remitted by 2 months. He remains in remission. Case 4: A 41-year-old male presented with a 12-year history of generalized hypertrophic LP, which had responded partially to topical steroids and ultraviolet A therapy. Medical history was significant for reduced sense of smell. Examination revealed generalized, violaceous, hypertrophic papules and nodules. He received homeopathic Carcinosinum at MK potency and remitted at 6-months. In its long-standing, generalized form, with mucosal involvement, LP may respond to individualized homeopathy. More research may clarify homeopathy's place in LP therapy.
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Affiliation(s)
- Lawrence Chukwudi Nwabudike
- Department of Outpatient Dermatology, ‘N. Paulescu’ National Institute of Diabetes, 023553 Bucharest, Romania
| | - Magdalena Miulescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University of Galați, 800010 Galati, Romania
| | - Alin Laurentiu Tatu
- Medical and Pharmaceutical Research Unit/Competitive, Interdisciplinary Research Integrated Platform, ‘Dunărea de Jos’, ReForm-UDJG, Research Centre in the Field of Medical and Pharmaceutical Sciences, Faculty of Medicine, Department of Pharmacy/Pharmacology Sciences, ‘Dunărea de Jos’ University of Galați, 800010 Galati, Romania
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12
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Metamizole for Postoperative Pain in Pediatric Patients Undergoing Subarachnoid Anesthesia. Am J Ther 2019; 27:e338-e345. [PMID: 31356348 DOI: 10.1097/mjt.0000000000000951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Efficient postoperative pain management, which is aimed at decreasing the risk of complications and drug-induced side effects, without affecting the quality of analgesia, is part of today's concept of enhanced recovery after surgery, that is, fast-track surgery. STUDY QUESTION The objective of this study was to determine whether effective management of acute postoperative pain was possible without opioids, while avoiding complications, drug-induced side effects, and suboptimal treatment. Introduction of metamizole, which has regained popularity, into a multimodal analgesia regimen was used, as opioids are not routinely administered. STUDY DESIGN The study was prospective, observational, unrandomized, and without the control group. MEASURES AND OUTCOMES This study was performed in a pediatric hospital with 300 beds and an average of 1700 annual surgical interventions. The study group comprised 378 patients aged 1-17 years, undergoing lower abdominal or limb surgery between June 2016 and June 2017. Children underwent subarachnoid anesthesia combined with intravenous sedation and received not routinely but on demand postoperative opioid analgesia. The pain was self-assessed by the pediatric patient or was assessed by the nurse using pain scores. RESULTS Metamizole proved to be safe, efficient, and very well tolerated by children. Multimodal analgesia using acetaminophen, nonsteroidal anti-inflammatory drug with metamizole for the treatment of moderate to severe pain in children undergoing surgery, required a single opioid dose in 292 patients (77.24%) of the 378 in this study. CONCLUSIONS In pediatric patients undergoing surgery, subarachnoid anesthesia combined with intravenous sedation, multimodal analgesia that includes metamizole, and nonpharmacological complementary therapies in pain management enable avoidance or reduction of opioids to a single dose, without undertreatment. There is also a minimum of anesthesia, accelerated children's recovery and a rapid return to presurgical levels of function.
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Tatu AL, Elisei AM, Chioncel V, Miulescu M, Nwabudike LC. Immunologic adverse reactions of β-blockers and the skin. Exp Ther Med 2019; 18:955-959. [PMID: 31384329 PMCID: PMC6639944 DOI: 10.3892/etm.2019.7504] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/16/2018] [Indexed: 12/11/2022] Open
Abstract
β-Blockers are a widely utilised class of medication. They have been in use for a variety of systemic disorders including hypertension, heart failure and intention tremors. Their use in dermatology has garnered growing interest with the discovery of their therapeutic effects in the treatment of haemangiomas, their potential positive effects in wound healing, Kaposi sarcoma, melanoma and pyogenic granuloma, and, more recently, pemphigus. Since β-blockers are deployed in a variety of disorders, which have cutaneous co-morbidities such as psoriasis, their pertinence to dermatologists cannot be overstated. Likewise, β-blockers, like any other drug category, carry risks of side effects, some of which are dermatologic. These include triggering and exacerbation of psoriasis, psoriatic and rheumatoid arthritis, anaphylaxis, contact dermatitis, occupational contact dermatitis, Raynaud's disease, alopecia, lichen planus-like drug eruption, hyperhydrosis and vitiligo. While recent articles have focussed on the positive uses of β-blockers, it may also be wise to call our attention to the potential dermatologic adverse effects that may follow β-blocker use, as well as possible therapeutic approaches to these. This short review will focus on those dermatoses resulting from β-blocker use, which have an immunologic basis.
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Affiliation(s)
- Alin Laurentiu Tatu
- Medical and Pharmaceutical Research Unit/Competitive, Interdisciplinary Research Integrated Platform 'Dunărea de Jos', ReForm-UDJG; Research Centre in the Field of Medical and Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, Department of Pharmaceutical Sciences, 'Dunărea de Jos' University of Galați, 800010 Galati, Romania
| | - Alina Mihaela Elisei
- Medical and Pharmaceutical Research Unit/Competitive, Interdisciplinary Research Integrated Platform 'Dunărea de Jos', ReForm-UDJG; Research Centre in the Field of Medical and Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, Department of Pharmaceutical Sciences, 'Dunărea de Jos' University of Galați, 800010 Galati, Romania
| | - Valentin Chioncel
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, 'Carol Davila' University of Medicine and Phamacy, 050474 Bucharest, Romania
| | - Magdalena Miulescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos University' of Galati, 800010 Galati, Romania
| | - Lawrence Chukwudi Nwabudike
- Department of Diabetic Foot Care, 'Prof. N. Paulescu' National Institute of Diabetes, 011233 Bucharest, Romania
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Mihăilă B, Dinică RM, Tatu AL, Buzia OD. New insights in vitiligo treatments using bioactive compounds from Piper nigrum. Exp Ther Med 2019; 17:1039-1044. [PMID: 30679971 PMCID: PMC6327422 DOI: 10.3892/etm.2018.6977] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/24/2018] [Indexed: 12/01/2022] Open
Abstract
Although vitiligo is one of the most frequently occurring depigmentary disorder, its pathophysiology is still not fully clarified, resulting in the incapacity to find a targeted cure. Most of the treatment options available at the time have an anti-inflammatory or immunosuppressive effect, influencing the immune factor in vitiligo but without having a direct effect on melanocyte differentiation, migration or proliferation. This study shows that Piper nigrum (PN) extract and its main alkaloid, piperine, promote melanocyte proliferation in vivo, being consistent with previous study. A PN fruit extract and pure piperine were integrated in two different ointments and tested on human subjects affected by vitiligo. A number of 9 areas were treated: 3 using the extract, 3 using pure piperine, 1 using travoprost solution, and 2 using an association of travoprost (prostaglandin F2α analogue) solution and our products. Pigmentation was achieved in all the treated areas. The extract caused faster and more remarkable results than the pure piperine. The association of the travoprost solution speed up the process and changed the pigmentation pattern, especially when associated with the PN extract. Our early studies suggest that PN extract may represent, in the future, a new treatment option for vitiligo, especially considering the mild side effects of the tested products and the reduced amount of time needed for repigmentation. However, more studies are needed to validate this experimental data.
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Affiliation(s)
| | - Rodica Mihaela Dinică
- Department of Chemistry, Faculty of Sciences and Environment, ‘Dunărea de Jos’ University of Galați, 800201 Galați, Romania
| | - Alin Laurențiu Tatu
- Medical and Pharmaceutical Research Unit/Competitive, Interdisciplinary Research Integrated Platform ‘Dunărea de Jos’, ReForm-UDJG; ‘Research Centre in the Field of Medical and Pharmaceutical Sciences’, Faculty of Medicine, Department of Pharmacy/Pharmacology Sciences, ‘Dunărea de Jos’ University of Galați, Galați 800101, Romania
| | - Olimpia Dumitriu Buzia
- Medical and Pharmaceutical Research Unit, ‘Research Centre in the Field of Medical and Pharmaceutical Sciences’, Faculty of Medicine, Department of Pharmacy/Pharmacology Sciences, ‘Dunărea de Jos’ University of Galați, Galați 800101, Romania
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