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Primary myelofibrosis is a myeloproliferative neoplasm associated with a progressive fibrosis of the bone marrow, which results in insufficient hematopoiesis and is characterized by a low survival rate. It may be frequently associated with a thrombembolic event, and the latter may precede the diagnosis of myelofibrosis. The concomitant treatment of these two nosological entities is a challenge as it limits the use of drugs that can control long-term complications. We present the case of a 62-year-old patient with a history of pulmonary thrombembolism, who addressed the Emergency Department with the following accusations: inflammatory edema of the lower right limb, palpitations, dizziness, diaphoresis, dyspnea at regular efforts. Based on the clinical signs and objective examination, vascular ultrasonography, the diagnosis of deep vein thrombosis was established. Complete blood count and marked splenomegaly raised suspicion about the presence of a myeloproliferative disease. The bone marrow biopsy and identification of the JAK2V617F supported the diagnosis of primary myelofibrosis. Anticoagulant treatment was performed, but there were two recurrences of deep vein thrombosis prior to the inclusion in the ruxolitinib treatment program. The aim of this paper is to emphasize the role of the predictive factor of thromboembolic events in myelofibrosis and the role of personalized therapy in the management of these patients. The report concluded that a complex therapy, personalized to each individual case, lead to improved prognosis of these patients. [ABSTRACT FROM AUTHOR]

Purpose: Starting from the observations of the in vitro studies that describe a lower pathogenicity of the Omicron variant, we proposed to comparatively analyze two groups of patients admitted to our clinic, one at the beginning of the COVID-19 pandemic, and the other one at the beginning of the Omicron wave of the pandemic, and to compare the severity of disease episodes. Patients and methods: 2 groups of patients with COVID-19, one group of 480 patients hospitalized in our clinic in March-August 2020 and one group of 320 patients admitted in January-June 2022, were selected. Demographic data, paraclinical profile at admission, comorbidities, the type and duration of treatment and the evolution of the patients in the two groups, were analyzed comparatively. Results: Our study showed statistically significant differences between group A compared to the group B, which support the aggressiveness of the Wuhan strain and the severity of its disease forms, such as: the predominance of pulmonary opacity on radiographies, a higher need for immunosuppressive therapies, a lower oxygen saturation, and a higher average values of inflammatory markers at admission, in the first group. Also, some factors with predictive potential for a severe clinical form, with predominance in group 2 (older age, a higher score of cumulative comorbidities, a higher value of D-dimers and aspartateaminotransferase, a lower value of concentration of prothrombin, and the higher average CURB-65 score, at admission) were observed. Conclusion: Our study identified predictive parameters of severity (D-dimers, aspartate-aminotransferase, prothrombin concentration, CURB-65 Score), statistically significant modified in the Omicron wave group compared to the Wuhan wave group, which draw attention to the possibility of severe and unfavorable evolution of the infection with Omicron in elderly population with multiple comorbidities. [ABSTRACT FROM AUTHOR]

Hyponatremia induced by hypothyroidism is a rare phenomenon and a correlation between them can be argued only with possible mechanisms. Hyponatremia often results from the concomitant development of several overlapping pathological events. The association between hypothyroidism and hyponatremia should be considered only if explanations for any other etiological causes have been exhausted. We present the case of a female patient aged 67 years who has previously undergone surgery for a meningioma and who presented with symptoms such as nausea, biliary vomiting, headache and epigastric pain. Laboratory results indicated multiple electrolyte imbalances, including hyponatremia, but the brain imaging studies did not confirm cerebral edema or the presence of tumor development. Under electrolytic correction treatment which was supplemented with L-thyroxine, the biochemical parameters were corrected and normalized and the patient was relieved of her symptoms. This case thus raises the possibility that hyponatremia could be induced or at least precipitated by hypothyroidism. Thyroid dysfunction tests should be targeted in cases of hyponatremia with non-specific causes, even if hypothyroidism is rarely the cause. [ABSTRACT FROM AUTHOR]