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Context: COVID-19 is more than a respiratory infection, with deep implications regarding multiple systems and organs. Thyroid damage is frequent in COVID-19 and may overlap previous HCV or HCC associated diseases. Objective: The objective of this study is to determine the effects of COVID-19 in patients with HCV associated HCC and thyroid comorbidities. Design: We performed a retrospective study of the thyroid function tests and autoantibodies in patients with HCV-associated HCC prior and during COVID-19. Subjects and Methods: We included 52 consecutive patients with HCV-associated HCC and documented thyroid disease, diagnosed with COVID -19 between April and October 2020. Serum values of thyroid-stimulating hormone, free T3, free T4, anti-thyroglobulin antibodies and anti-thyroid peroxydase antibodies were determined and compared to baseline levels. Results: At baseline, 44 patients had positive antithyroid antibodies, 6 had hypothyroidism in substitution and 2 had hyperthyroidism under treatment. During COVID-19 we found an increase in serum values of antithyroid antibodies, and decreased levels of TSH, freeT3 and freeT4 levels. Specific therapies were discontinued in one patient with hyperthyroidism and 3 patients with hypothyroidism. Conclusion: There is a significant impact of COVID-19 on the thyroid homeostasis; a long-term prognostic value for patients with HCC infected with COVID-19 required further extensive research.

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Context: As we progress into the COVID-19 pandemic, it has become apparent that this infection is associated with a multitude of systemic effects, some involving the thyroid gland. The thyroid is also frequently affected in the HCV chronic infection. Objective: The objective of this study is to determine the effects of COVID-19 infection on the presence and severity of thyroid disorders associated with chronic HCV infection, at short and mid-term follow-up. Design: We prospectively evaluated patients with documented HCV- associated thyroid disease (with sustained virologic response after antiviral therapy). Subjects and Methods: The study group consisted of 42 patients with HCV- associated thyroid disease, diagnosed with COVID -19 infection between April and October 2020. We determined serum values of thyroid-stimulating hormone, freeT3, free T4, anti-thyroglobulin antibodies and anti-thyroid peroxidase antibodies at one and three months after resolution of infection and compared them to the baseline characteristics of the patient. We also evaluated the changes in thyroid substitution treatments or antithyroid drugs. Results: At baseline, out of the 42 patients, 5 presented hypothyroidism under levothyroxine substitution therapy, while 2 presented hyperthyroidism under methimazole therapy; 37 patients had positive antithyroid antibodies. At one month follow-up, we note an increase in serum values of antibodies, with a decrease in TSH, freeT3 and freeT4 levels, correlated with the severity of COVID-19 infection. Two patients required discontinuation of levothyroxine. At 3 months follow-up, lower levels of antithyroid antibodies were recorded, with an increase in TSH levels. No medication doses were adjusted at this time. Conclusion: Among the systemic effects of COVID-19, the impact of thyroid dysfunction should not be underestimated, especially in the presence of pre-existing conditions, such as HCV infection.

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Buoyancy anomalies within Earth's mantle create large convective currents that are thought to control the evolution of the lithosphere. While tectonic plate motions provide evidence for this relation, the mechanism by which mantle processes influence near-surface tectonics remains elusive. Here, we present an azimuthal anisotropy model for the Pacific Northwest crust that strongly correlates with high-velocity structures in the underlying mantle but shows no association with the regional mantle flow field. We suggest that the crustal anisotropy is decoupled from horizontal basal tractions and, instead, created by upper mantle vertical loading, which generates pressure gradients that drive channelized flow in the mid-lower crust. We then demonstrate the interplay between mantle heterogeneities and lithosphere dynamics by predicting the viscous crustal flow that is driven by local buoyancy sources within the upper mantle. Our findings reveal how mantle vertical load distribution can actively control crustal deformation on a scale of several hundred kilometers.

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CONTEXT: Hepatitis C and diabetes represent important health problems globally. The new-onset diabetes after transplantation is a particular entity that appears due to the use of immunosuppression among transplanted patients. OBJECTIVE: We aim to describe the clinical and biological aspects of severe hyperglycemia in a kidney transplant recipient undergoing Interferon-free therapy for chronic hepatitis C, discussing the interference of different factors with the glucose metabolism. DESIGN: The occurrence of diabetes in a patient with history of renal transplantation and Interferon-free treated hepatitis C was studied from both clinical and paraclinical points of view. SUBJECTS AND METHODS: When presenting to the hospital, extensive blood tests were performed on the patient, revealing significant hyperglycemia and an elevated level of blood tacrolimus. Creatinine clearance was calculated. ECG presented T-wave alterations. Intensive insulin protocol was applied, the case being managed in a multidisciplinary approach. RESULTS: Blood glucose and tacrolimus were slowly normalized, under therapy. The antiviral treatment was continued, with the achievement of sustained virologic response. CONCLUSIONS: Diabetes mellitus can have many causes, hepatitis C and transplantation both having an impact on glucose metabolism. The association of the three entities should be carefully managed, due to its enhancing effect on morbidity and mortality.

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Cricoid malformations vary according to their severity and anatomic features. Some of them get a delayed diagnosis in spite of the complex medical care. Objective: To present a case with a laryngeal malformation and our surgery technique. Material, method: A case presentation of a cannulated child, who previously had a heart surgery, with difficult decannulation. RESULTS: The patient was considered to have an acquired subglottic stenosis due to his medical record. A cricoid cartilage malformation was elicited intraoperatively. A submucosal drilling of the redundant cartilage, with a preservation of the covering laryngeal mucosa was performed. Decannulation was possible at 13 days after surgery. Conclusion: Instead of having extensive resection surgery we decided to perform an endolaryngeal submucosal drilling, after laryngofissure, with quick and long lasting success. Laryngeal surgery should always be tailored to the patient needs and the surgeon's preferences.

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Osteomas of the external ear are uncommon benign tumors that need to be differentiated from the external ear canal exostoses, bony proliferations that are linked mainly to cold-water exposure. Clinical manifestations vary from no symptoms to recurrent local infections and external ear cholesteatoma. Objective: presenting a rare case that we did not find described in the published literature. A patient with multiple long-term asymptomatic osteomas of both external ear canals presented to our department. Material: Data recorded from the patient's medical record was reviewed and analyzed. Surgery was performed and histology confirmed the presumptive diagnosis. Results: There was a discrepancy between the local severity of the disease, with a complete obstruction of his ear canals, and the long-term disease-free status of the patient. Conclusion: We hypothesized about the etiology of these multiple bilateral osteomas of the EAC, in light of the clinical and surgical findings.

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We studied the relationship between Chlamydia pneumoniae antibodies, C-reactive protein (CRP) and interleukine 8 (IL-8) in 87 patients with ischemic heart disease: 29 patients with acute myocardial infarction, 18 patients with unstable angina pectoris and 40 patients with stable effort angina. We determined in all patients IgG and IgA antibodies to Chlamydia pneumoniae, CRP and IL-8. Species specific antibodies to Chlamydia pneumoniae (IgG and IgA) were detected by indirect ELISA technique (Savyon Diagnostics Ltd, Israel). Interleukine-8 measured by a commercially available ELISA kit (CLB, Amsterdam, The Netherlands). CRP was determined by radial immunodiffusion (Mancini). The IgG antibodies were present in 25 patients (29%), the greatest percentage being noted in patients with unstable angina pectoris (50%). The IgA antibodies were present, as a sign of chronic Chlamydia pneumoniae infection, in 56% of the patients with IgG antibodies. CRP was positive in 52% of the 25 patients with positive IgG antibodies, but in only 34% of the 62 patients without IgG antibodies (p < 0.01). IL-8 was positive in 12% of the patients with IgG antibodies, and in 21% of the patients without IgG antibodies but the difference is not significant (p > 0.05). It is concluded that there is a relationship between the presence of the Chlamydia pneumoniae infection and inflammatory reaction in patients with ischemic heart disease, but the neutrophils are not implied in this process.

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A study was conducted on the specific and non specific immunomodulator effects of the inactivated vaccine NIVGRIP. The results revealed the seroconversion of HAI antibodies against influenza and mumps viruses and the reduction of viral and microbial flora of the pharynx. The kinetics of some proteins specific to the acute stage (siderophiline antitrypsin, microglobulin, complement C1q and C2 factors, C reactive protein and fibronectin) was also investigated and significant quantitative modifications were noticed in vaccinated subjects. The mean illness duration (acute respiratory disease) was three times as short in vaccinated subjects as in controls.

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As part of the localized encephalic contusions, the cerebellar contusion, by its etiopathogenic, clinic, paraclinic, therapeutic and prognostic aspects represents a distinct individuality. Studying a series of 30 cases of cerebellar contusions the authors notice the increased incidence in children (28 cases), the cerebellar vulnerability in children being explained by the high site and increased elasticity of the occipital bone as well as by the nape muscles thinness. The clinical syndrome, more common of archicerebellar type, can occur alone or associated with a minor or mild diffuse mental shock. The paraclinic investigation is reduced to lombar puncture, cranial radiography and EEG. The evolution, especially in children, is towards healing in 2-3 weeks of conservative treatment.

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Out of a series of 364 patients, 56 cases of essential trigeminal neuralgias operated upon by retrogasserian radicotomy by intradural temporal route are presented. Pointing out that we are in a period of confrontation between the great surgery, classical or micro-neurosurgery of the trigeminal nerve and the drug therapy or percutaneous surgery, the authors conclude that the indication of great surgery is restricted but has not disappeared--taking into account the good permanent results obtained (89%) and the reduced rate of failures and recurrences (11%). In the conditions of a general anesthesia with intracranial hypotension and correct surveillance the surgeon has gaine an extra security when performing these operations.

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