Spices and herbs are widely used for their flavor and therapeutic properties. This narrative review explores current evidence on spice and herb allergies in children, using a scoping approach to synthesize data from case reports, clinical, immunologic, molecular studies, regulatory sources, and previous reviews. Selected adult cases were included for context. Spice and herb allergies are increasingly recognized in children, with symptoms ranging from mild oral reactions to anaphylaxis. The most frequently implicated spices include mustard, celery, coriander, fennel, cumin, anise, pepper, and herbs from the Lamiaceae-family such as mint, oregano, and sage. Both IgE- and non-IgE-mediated mechanisms are involved, with cross-reactivity to pollens (birch and mugwort) being common. Diagnosis remains challenging due to limited standardized tests; oral food challenge is the gold standard. Management relies on strict allergen avoidance and emergency preparedness. Improved clinical awareness, diagnostic tools, and clearer labeling—especially regarding hidden allergens—are crucial for effective care.

The evaluation of medical Artificial Intelligence (AI) systems presents significant challenges, with performance often varying drastically across studies. This narrative review identifies prompt quality—the way questions are formulated for the AI—as a critical yet under-recognized variable influencing these outcomes. The analysis explores scientific literature published between January 2018 and August 2025 to investigate the impact of prompt engineering on the perceived accuracy and reliability of conversational AI in medicine. Results reveal a “performance paradox,” where AI sometimes surpasses human experts in controlled settings yet underperforms in broader meta-analyses. This inconsistency is strongly linked to the type of prompt used. Critical concerns are highlighted, such as “prompting bias,” which may invalidate study conclusions, and AI “hallucinations” that generate dangerously incorrect information. Furthermore, a significant gap exists between the optimal prompts formulated by experts and the natural queries of the general public, raising issues of safety and health equity. In the end we were interested in finding out what the optimal balance existed between the complexity of a prompt and the value of the generated response, and, in this context, whether we could attempt to define a path toward identifying the best possible prompt.

Fatigue is a common and disabling symptom in Sjögren’s disease (SjD), yet its links with hematologic parameters and salivary gland histopathology are not well established. This study aimed to investigate associations between complete blood count (CBC) indices, fatigue severity, and minor salivary gland biopsy findings in SjD using a multidimensional, disease-specific fatigue instrument. Ninety-seven patients meeting the 2012 ACR criteria for SjD underwent CBC, immunologic testing, and detailed clinical evaluation. Fatigue was assessed with the Profile of Fatigue and Discomfort–Sicca Symptoms Inventory (PROFAD-SSI-SF). Histopathology data, including focus score, were available for a subset of patients. Correlation analyses, subgroup comparisons, and multivariable regressions explored associations among hematologic, immunologic, and fatigue variables. No strong correlations were found between fatigue and hematologic indices. The strongest were between total PROFAD and leukocyte (r = 0.18) or platelet counts (r = 0.16). ANA and anti-Ro52 positivity were associated with higher total SSI scores, while anti-SSB positivity correlated with lower somatic fatigue. Joint pain showed a borderline association with increased somatic fatigue. Focus score and other histopathologic features did not correlate with fatigue domains. In conclusion, fatigue in SjD is multifactorial and only weakly related to hematologic indices, emphasizing the need for longitudinal biomarker studies integrating clinical and histopathologic data.

With Generative AI (GenAI) entering medicine, understanding its decision-making under uncertainty is important. It is well known that human subjective risk appetite influences medical decisions. This study investigated whether the risk appetite of GenAI can be evaluated and if established human risk assessment tools are applicable for this purpose in a medical context. Five GenAI systems (ChatGPT 4.5, Gemini 2.0, Qwen 2.5 MAX, DeepSeek-V3, and Perplexity) were evaluated using Rheumatoid Arthritis (RA) clinical scenarios. We employed two methods adapted from human risk assessment: the General Risk Propensity Scale (GRiPS) and the Time Trade-Off (TTO) technique. Queries involving RA cases with varying prognoses and hypothetical treatment choices were posed repeatedly to assess risk profiles and response consistency. All GenAIs consistently identified the same RA cases for the best and worst prognoses. However, the two risk assessment methodologies yielded varied results. The adapted GRiPS showed significant differences in general risk propensity among GenAIs (ChatGPT being the least risk-averse and Qwen/DeepSeek the most), though these differences diminished in specific prognostic contexts. Conversely, the TTO method indicated a strong general risk aversion (unwillingness to trade lifespan for pain relief) across systems yet revealed Perplexity as significantly more risk-tolerant than Gemini. The variability in risk profiles obtained using the GRiPS versus the TTO for the same AI systems raises questions about tool applicability. This discrepancy suggests that these human-centric instruments may not adequately or consistently capture the nuances of risk processing in Artificial Intelligence. The findings imply that current tools might be insufficient, highlighting the need for methodologies specifically tailored for evaluating AI decision-making under medical uncertainty.

IntroductionColorectal cancer stands as a predominant cause of cancer-related mortality worldwide. Despite progressive strides in surgical methodologies, the specter of postoperative complications is very large, significantly impacting both morbidity and mortality rates. This review aims to meticulously examine existing scholarly works to gauge the prevalence, severity, and therapeutic approaches to postoperative complications arising from colorectal cancer surgeries.MethodsEmploying a systematic approach, this study reviewed 135 peer-reviewed publications from the period of 2000–2023. The corpus was organized into categories reflective of the postoperative complications discussed: anastomotic leakage, port-site metastases, small bowel adhesions and obstructions, thrombosis, ileus, postoperative infections, urinary dysfunctions, and cardiovascular dysfunctions. Advanced artificial intelligence tools were leveraged for in-depth literature searches and semantic analyses to pinpoint research lacunae.ResultsThe analysis revealed that anastomotic leakage and postoperative infections garnered the majority of academic focus, representing 35% and 25% of the studies, respectively. Conversely, port-site metastases and cardiovascular dysfunctions were less frequently examined, accounting for merely 5% and 3% of the literature. The reviewed studies indicate a disparity in the reported prevalence rates of each complication, oscillating between 3% and 20%. Furthermore, the review identified a dearth of evidence-based management protocols, underscored by a pronounced heterogeneity in treatment guidelines.ConclusionsThe literature is replete with analyses on anastomotic leakage and postoperative infections; however, there exists a glaring scarcity of exhaustive research on other postoperative complications. This review emphasizes the pressing need for uniform treatment guidelines and spotlights areas in dire need of further research, aiming at the comprehensive enhancement of patient outcomes following colorectal cancer surgery.

Patients with immune-mediated rheumatic disease-related calcinosis comprise a subgroup at risk of encountering a more severe clinical outcome. Early assessment is pivotal for preventing overall disease progression, as calcinosis is commonly overlooked until several years into the disease and is considered as a ‘non-lethal’ manifestation. This single-center retrospective study explored the prevalence, clinical associations, and impact on survival of subcutaneous calcinosis in 86 patients with immune-mediated rheumatic diseases (IMRD). Calcinosis predominantly appeared in individuals with longstanding disease, particularly systemic sclerosis (SSc), constituting 74% of cases. Smaller calcinosis lesions (≤1 cm) were associated with interstitial lung disease, musculoskeletal involvement, and digital ulcerations, while larger lesions (≥4 cm) were associated with malignancy, severe peripheral artery disease, and systemic arterial hypertension. The SSc calcinosis subgroup exhibited a higher mean adjusted European Scleroderma Study Group Activity Index score than those without. However, survival rates did not significantly differ between the two groups. Diltiazem was the most commonly used treatment, and while bisphosphonates reduced complications related to calcinosis, complete resolution was not achieved. The findings underscore current limitations in diagnosing, monitoring, and treating calcinosis, emphasizing the need for further research and improved therapeutic strategies to improve patient care and outcomes.

Background: Our study aimed to explore the way artificial intelligence (AI) utilization is perceived in pediatric medicine, examining its acceptance among patients (in this case represented by their adult parents), and identify the challenges it presents in order to understand the factors influencing its adoption in clinical settings. Methods: A structured questionnaire was applied to caregivers (parents or grandparents) of children who presented in tertiary pediatric clinics. Results: The most significant differentiations were identified in relation to the level of education (e.g., aversion to AI involvement was 22.2% among those with postgraduate degrees, 43.9% among those with university degrees, and 54.5% among those who only completed high school). The greatest fear among respondents regarding the medical use of AI was related to the possibility of errors occurring (70.1%). Conclusions: The general attitude toward the use of AI can be considered positive, provided that it remains human-supervised, and that the technology used is explained in detail by the physician. However, there were large differences among groups (mainly defined by education level) in the way AI is perceived and accepted.

Background/Objectives: Psoriasis is a chronic inflammatory condition mediated by the immune system with various manifestations. The increased prevalence of subclinical joint involvement has led to the development of early diagnostic methods for psoriatic arthritis, including several instruments that have been validated and used in clinical practice. The aim of this study was to perform the Romanian translation, cultural adaptation, and validation of three assessment tools: the Early Arthritis for Psoriatic Patients (EARP) Questionnaire, Psoriasis Epidemiology Screening Tool (PEST), and Toronto Psoriatic Arthritis Screen 2 (TOPAS 2), which are designed to evaluate early-stage arthritis in patients with psoriasis. Methods: All the activities were carried out in accordance with the internationally recognized methodology recommended by the International Society for Pharmacoeconomics and Outcome Research (ISPOR), the recommendations of the World Health Organization (WHO) regarding the translation process and the validation of instruments, and data from the international literature. These three questionnaires were administered to 29 patients with psoriasis diagnosed by biopsy. A descriptive study was conducted and the data were analyzed with appropriate statistical tests using the PSPP program. A reliability test was assessed using Cronbach’s alpha coefficient. Results: The obtained values were significant for the first two questionnaires, with a value of 0.89 for the EARP and 0.63 for the PEST, but the value was not as significant for ToPAS2, at 0.40. Conclusions: This pilot study revealed that the Romanian and original versions of the three questionnaires are similar.

Background: Primary Sjögren’s syndrome (pSS) is a complex autoimmune disorder characterized by organ-specific symptoms in the salivary and lacrimal glands, as well as systemic manifestations. Fatigue, a prominent aspect, significantly influences the overall quality of life for individuals with pSS. Methods: This review seeks to evaluate the impact of fatigue by exploring its consequences, potential causes, and effects on physical and psychological well-being, while also investigating its management strategies. Following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines, our systematic literature review involved a five-step algorithm. Initially identifying 78 articles in reputable international medical databases, we applied eligibility criteria and removed duplicates, resulting in 19 articles for qualitative synthesis. Results: This review delves into the predictive factors for heightened fatigue in pSS, encompassing rheumatoid factor levels, erythrocyte sedimentation rate, and immunoglobulin G levels. Sleep disturbances, specifically nighttime pain and nocturia, emerged as determinants of persistent daytime fatigue. Cognitive impairment in pSS involves deteriorations in global memory, executive functioning, and attentional resources. Furthermore, functional limitations in pSS impact patients’ quality of life. Conclusions: The significance of fatigue in pSS, its consequences, and profound influence on the quality of life necessitate further research for a more comprehensive understanding of this complex issue.

Background: Rheumatoid arthritis (RA) patients are at heightened risk of Coronavirus Disease—19 (COVID-19) complications due to immune dysregulation, chronic inflammation, and treatment with immunosuppressive therapies. This study aims to characterize the clinical and laboratory parameters of RA patients diagnosed with COVID-19, identify predictive risk factors for severe forms of this infection for RA patients, and determine if any RA immunosuppressive therapy is associated with worse COVID-19 outcomes. Methods: A retrospective observational case-control study included 86 cases (43 diagnosed with RA and 43 cases without any inflammatory or autoimmune disease) that suffered from SARS-CoV-2 in two Romanian hospitals between March 2020 and February 2024. Data on demographics, RA disease characteristics, COVID-19 severity, treatment regimens, and outcomes were analyzed. Results: RA patients exhibited a distinct symptom profile compared to non-RA controls, with higher incidences of neurological, musculoskeletal, and gastrointestinal symptoms, while the control group showed more respiratory and systemic manifestations. Severe COVID-19 is correlated with age and laboratory markers like erythrocyte sedimentation rate (ESR), leucocytes, neutrophils, neutrophil-to-lymphocyte ratio (NLR), aspartate aminotransferase (AST), serum creatinine, and urea. Additionally, RA treatments, particularly rituximab (RTX), were associated with more severe COVID-19 outcomes (but with no statistical significance), potentially due to the advanced disease stage and comorbidities in these patients. Post-infection, a significant number of RA patients experienced disease flares, necessitating adjustments in their treatment regimens. Conclusions: This study underscores the complex interplay between RA and COVID-19, highlighting significant clinical heterogeneity and the need for tailored management strategies. Limitations include sample size constraints, possible selection, and information bias, as well as the lack of adjustments for potential confounding variables that hinder the ability to formulate definitive conclusions. Future research plans to expand the research group size and further elucidate these relationships.

This study aimed to determine the prevalence of the risk of orthorexia nervosa (ON) in dietetics students in Greece, and its relationship with diet, risk of eating disorder (ED), body mass index (BMI), body image flexibility, and parental attachment. The participants were 132 dietetics students, with a mean age of 22.94 ± 3.5 years, who completed a series of questionnaires that recorded sociodemographic, clinical, and anthropometric characteristics; adherence to the Mediterranean diet (MedDiet); ON indicators as determined by the ORTO-15 questionnaire; body image flexibility, with the Body Image-Acceptance and Action Questionnaire (BI-AAQ-5); the risk for ED as assessed using the EAT-26; anxiety level according to the STAIT 6 instrument; and recollection of their parents' attitudes towards them during the first 16 years of life, with the Parental Bonding Instrument (PBI). ON risk appeared to be significantly associated with BMI (p = 0.002), exercise frequency (p = 0.023), anxiety level (p = 0.002), risk of ED (p < 0.001), body image inflexibility (p < 0.001), and inversely with the affectionate constraint of maternal bonding (p = 0.036). In conclusion, disordered eating behaviors and body shape concerns are prevalent among dietetics students, with parental attachment to the mother influencing their occurrence. Identification of potential ON and development of prevention mechanisms during childhood could help eliminate these concerns and improve the lives of dietetics students.

Background The significance of anti-Ro antibodies in systemic sclerosis (SSc) is still unclear as their presence could represent an epiphenomenon of the strong immune response in severe visceral involvement or directly participate in tissue damages in SSc patients. Recent data suggest that the presence of anti-SSA/Ro antibodies is an independent risk factor for worse pulmonary outcome and higher all-cause mortality in patients with SSc [1]. Objectives To determine the frequency of anti-SSa/Ro antibodies in a cohort of SSc patients and its association with clinical, serological features and survival, in order to analyze the diagnostic utility of their separate detection. Methods This was a single-center retrospective study of a SSc cohort followed over a 10-year period in our rheumatology department. Duration of disease progression, symptoms and parameters related to a specific organ involvement according to MEDS evaluation sheets, were evaluated in all patients. Results 270 SSc patients were selected, from which we identified a final population of 28 (10%) anti-Ro-positive patients. The anti-SSA/Ro group included more women (26/28) with a mean age of 47.9 ± 13.7 years, most of them with diffuse subset (16/30). The presence of anti-SSA/Ro antibodies was positively correlated with presence of anti-Scl 70 antibodies (p=0.012), elevated modified Rodnan score (p=0.041), myositis (p=0.013), and lower DLCO (p=0.019). Moreover, associations were strongest for elevated CRP levels (p<0.001) and calcinosis cutis (p<0.001). Compared to non-anti-SSa/Ro patients, both groups were similar regarding demographic data, age at diagnosis, disease duration and type of skin involvement. As expected, the anti-SSa/Ro group had significantly more frequent erosive synovitis (p=0.002), myopathy (p=0.010), gastrointestinal involvement and interstitial lung disease (ILD) (p=0.001). No statistically significant differences were found regarding frequencies of Raynaud’s phenomenon, pulmonary hypertension, renal, vascular and cardiac involvement, nor neoplasia. There was a greater proportion of digital ulcers and calcinosis in the anti-SSa/Ro group (42% vs 17% and 58% vs 14%), but without statistical significance. Again, among those patients, a much higher proportion (64% vs 42%) was treated with immunosuppressive agents. No differences in mortality were found between the groups. Conclusion Anti-SSA/Ro antibodies seem to characterize a distinct group of SSc patients who are almost exclusively female, express elevated CRP levels, have a high prevalence of ILD, myositis, joint involvement and calcinosis, and commonly receive immunosuppressants. Reference [1]Meridor K, et al Anti-Ro/SS-A antibody is associated with worse pulmonary outcome and reduced overall survival in systemic sclerosis. Mod Rheumatol. 2022 Oct 15;32(6):1086-1093 Acknowledgements: NIL. Disclosure of Interests None Declared.

Background In systemic sclerosis (SSc), a specific nailfold videocapillaroscopy (NVC) pattern is observed in 90% of cases and seems to be associated with severity and progression of the disease. Data about SSc patients with normal/nonspecific NVC are scarce [1]. Objectives This study aims to investigate the clinical and immunologic characteristics of SSc patients with normal or nonspecific NVC and to compare them to those with a scleroderma NVC pattern. Methods This was a single-center retrospective study which enrolled 270 SSc patients referred for NVC since January 2000, in our rheumatology department. Demographic and clinical features, symptoms and parameters related to a specific organ involvement according to MEDS evaluation sheets and survival were evaluated. Results 270 SSc patients were selected in the database, from which we identified a final population of 19 (7%) patients with normal/nonspecific NVC pattern. The group comprised 14 females and 5 males, with a mean age of 52.7 (±17.4) years, most of them with diffuse subset (12/19). Among the cases, 8 (42%) had normal NVC and 11 (58%) had nonspecific NVC changes, characterized by isolated ramified capillaries in 42%, curved capillary limbs in 33%, giant capillaries in 16% and focal microhemorrhages in 9 % of patients. The mean Raynaud phenomenon’s (RP) duration was longer (18.4 ± 14.4 years) compared to the other cases (10.2 ± 1.5 years). The difference was not significant (p=0.107). Significantly higher percentages of cases had lower overall frequency of digital ulcers (28% vs 51%, p=0.04). Presence of synovitis (p=0.010) and myositis (p<0.001) was positively correlated with normal/nonspecific NVC changes. Regarding other organ involvement, the cases also had less severe pulmonary involvement, less frequent digestive involvement and/or pulmonary arterial hypertension than controls, but these differences did not reach significance. No differences in mortality were found between the groups. Conclusion SSc patients with normal/nonspecific NVC changes have less organ involvement and less overall disease severity than those with a typical SSc specific NVC pattern, with no between-group differences. Musculoskeletal involvement was the only factor independently associated with normal/nonspecific NVC. It is possible that SSc with normal NVC may be at lower risk of progression to severe visceral and skin involvements, but prospective studies are required. Reference [1]Cutolo M, Smith V. State of the art on nailfold capillaroscopy: a reliable diagnostic tool and putative biomarker in rheumatology? Rheumatology (Oxford). 2013 Nov;52(11):1933-40. Acknowledgements: NIL. Disclosure of Interests None Declared.

Background Pain represents one of the main clinical symptoms of Rheumatoid Arthritis (RA) being used as an indicator of disease activity. However, many RA patients reports clinically significant levels of pain even in the periods of remission. Recent studies [1] revealed that biological treatments are inequal in terms of how they manage inflammation and pain. The concept of Post-Remission Syndrome was defined in the context presence of residual pain in RA patients that are in clinical remission but still present clinical symptoms that impairs their quality of life [2]; the syndrome might be a reason for decreased work productivity [3,4]. Apart of the nociceptive pain previous works identified neuropathic and nociplastic pain in the composition of residual pain. In order to better understand and manage this situation is paramount important to identify and explain the exact nature of pain present during and after the periods of activity in RA. Objectives The present study intended to explore the quality of pain assessment and management in subjects with RA in a major tertiary clinic. Methods In a major tertiary clinic of rheumatology consecutive subjects with RA have been questioned about the history, evolution and management of their disease; separately the level of nociceptive, neuropathic and nociplastic (fibromyalgic) pain was evaluated by using validated instruments. For a better understanding of the differences, we included and compared subjects with osteoarthritis and other inflammatory rheumatic diseases. Results 43 subjects have been evaluated in a 6 months interval with a 2:1 F:M ratio; 22 of them received biological therapy (8 different molecules have been identified). Although 32 subjects did not present any sign of inflammation 21 of them declared significant level of pain (VAS>4), 12 have identified with neuropathic pain and 11 with nociplastic pain. Both in case of neuropathic and nociplastic pain groups less than 50% have been previously actively evaluated for non-nociceptive pain. Non-nociceptive pain was poorly treated and prolonged anti-nociceptive pain treatment was used despite evident lack of effect. The variable ability of pain reduction of biological DMARDs has not been previously discussed with any subject; the subject of residual pain was also poorly covered during biological drug selection. Conclusion Non-nociceptive pain has the potential to be considered a major reason of residual pain in RA and non-RA subjects. Rheumatologists seems to be captured in the paradigm of nociplastic = inflammatory pain with little interest in other types of pain that results in suboptimal diagnostic and management of pain. References [1]Taylor PC, Lee YC, Fleischmann R, Takeuchi T, Perkins EL, Fautrel B, Zhu B, Quebe AK, Gaich CL, Zhang X, Dickson CL, Schlichting DE, Patel H, Durand F, Emery P. Achieving Pain Control in Rheumatoid Arthritis with Baricitinib or Adalimumab Plus Methotrexate: Results from the RA-BEAM Trial. J Clin Med. 2019 Jun 12;8(6):831. doi: 10.3390/jcm8060831. [2]Berghea F, Berghea CE, et. al. - Residual Pain in the Context of Selecting and Switching Biologic Therapy in Inflammatory Rheumatic Diseases. Front Med (Lausanne). 2021 Aug 17;8:712645. doi: 10.3389/fmed.2021.712645. [3]Putrik P, Ramiro S et.al. -Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries. Ann Rheum Dis. 2019 Nov;78(11):1472-1479. doi: 10.1136/annrheumdis-2019-215294. [4]Suzanne M.M. Verstappen, et. al Considerations for Evaluating and Recommending Worker Productivity Outcome Measures: An Update from the OMERACT Worker Productivity Group, The Journal of Rheumatology Oct 2019, 46 (10) 1401-1405; DOI: 10.3899/jrheum.181201 Acknowledgements: NIL. Disclosure of Interests Florian Berghea Speakers bureau: Angelini, Pfizer, Richter Gedeon, Egis, Novartis, Roxana Bratu: None declared, Nita Cristina: None declared, Ana-Maria Spoeala: None declared, Tiberiu Dogaru: None declared, Andreea Dinoiu: None declared, Andrei Mihailescu: None declared, Catalina Boromiz: None declared, Elena Juganaru: None declared, Alexandra Constantinescu: None declared, Violeta Zanfir: None declared, DENISE MARDALE: None declared, Aida Doran: None declared, Madalina Duna: None declared, Violeta Vlad: None declared, Mihai Abobului: None declared, Maria Magdalena Negru: None declared, Ioana Saulescu: None declared, Claudia Cobilinschi: None declared, Cosmin Constantinescu: None declared, Diana Mazilu: None declared, Andreea Borangiu: None declared, Sanziana Daia-Iliescu: None declared, Laura Groseanu: None declared, Daniela Opris-Belinski: None declared, Denisa Predeteanu: None declared, Violeta Bojinca: None declared, Dumitru Zaharia: None declared, Andreea Trandafir: None declared, Andra Balanescu: None declare.d.

Background: Community-acquired pneumonia (CAP) is one of the most significant childhood diseases worldwide and a leading infectious cause of death in children. This study aimed to evaluate the prognostic value of the inflammatory markers—C-reactive protein (CRP) and procalcitonin (PCT)—and the polymorphic glycoprotein mannose-binding lectin (MBL), deficiency of which is associated with severe infections, in the determination of the optimal type and timing of therapeutic intervention for CAP in childhood. Methods: Retrospective evaluation was conducted on a cohort of 204 children aged 4 months–17 years hospitalized with CAP. Their levels of CRP, PCT, and MBL were assessed for their association with a variety of outcomes, including the incidence of local and systemic complications, admission to the ICU, duration of antibiotic treatment and hospital stay, and death. Results: CRP and PCT proved to be better predictors of complications of CAP than MBL. The area under the curve (AUC) value was highest for PCT as a predictor of systemic complications (AUC = 0.931, 95%CI 0.895–0.967), while CRP (AUC = 0.674, 95%CI 0.586–0.761) performed best as a predictor of local complications (AUC = 0.674, 95%CI 0.586–0.761). Regarding admission to the ICU, CRP was the weakest predictor (AUC = 0.741), while PCT performed the best (AUC = 0.833), followed by MBL (AUC = 0.797). Sensitivity and specificity were calculated for the optimal threshold generated by receiver operating characteristic (ROC) curves, rendering sensitivity of 90% and specificity of 87% for PCT in assessing the risk of systemic complications, compared to sensitivity of 83% and specificity of 90% for CRP. MBL showed relatively high sensitivity (96%) but low specificity (25%) for predicting the need for ICU admission. Conclusions: Early measurement of CRP, PCT, and MBL provides clinicians with important information regarding the course and prognosis of children diagnosed with CAP, thus ensuring prompt, optimal therapeutic management.

Background Anticentromere antibodies (ACA) have been reported in primary Sjogren syndrome (pSS) at lower frequencies but have recently been suggested as another clinically important marker in this disease1. Although several papers have been published on ACA-positive pSS, the results have been conflicting2,3. Objectives To evaluate the correlation between presence of ACA and associated symptomatology, especially related to microvascular dysfunction in a Romanian cohort of patients with ACA-positive pSS. Methods We assessed 132 patients who met the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for pSS. For all ACA+ patients, we collected data on the presence of sclerodactyly, puffy hands, Raynaud’s phenomenon, calcinosis, telangiectasia, esophageal involvement, interstitial lung disease, digital ulcerations/pitting scars, pulmonary hypertension and nailfold capillaroscopy findings. Results The prevalence of ACA in our pSS cohort was 13%. ACA - positive pSS patients were older than the ACA-negative patients (median, 59 years [IQR, 48 to 62] vs median, 50 years [IQR, 45 to 60]; p = 0.042), with a shorter disease duration (53 months vs 260 months, p=0.073). Most patients were female (98.7%) and had ocular and oral symptoms of dryness (98.1% and 97.8%, respectively). Among the patients with pSS, 5 patients had ACA and limited cutaneous systemic sclerosis (lcSSc). Although there was no statistical differences between the two groups, ACA-positive patients were characterized by higher prevalence of associated symptomatology related to microvascular dysfunction: RP (Raynaud’s phenomenon) and telangiectasias were present in 50% of the patients (5/10), sclerodactyly and digital ulcerations (DUs) in 33% (3/10); digital gangrene was not found. 60% (6/10) of ACA+ pSS patients had abnormal findings on nailfold capillaroscopy, which were nonspecific in 2 patients (crossed capillaries), while in the remaining 1 patient had an early-pattern, 1 had an active-pattern and 2 patients had late scleroderma-pattern. The presence of ACA was positively correlated with the presence of RP (p = 0.024), DUs (p = 0.034). In our study, patients showed similar severities in extraglandular manifestations compared to the ACA-negative group. Nonetheless, we noticed that even if not statistically significant, the use of vasodilators was more common in the ACA - positive pSS patients (66.7% vs 12.2%, p = 0.911) thus supporting the hypothesis of a symptomatic microvascular dysfunction. A higher proportion of ACA+ pSS (64% vs 42%) was treated with immunosuppressive agents. No differences in mortality were found between the groups. Conclusion Patients in the ACA-positive group were older, had more frequent RP and digital ulcers. In our cohort, ACA - positivity had little impact on the severity of extraglandular manifestations in pSS patients. Although there were no significant differences, use of vasodilators and immunosuppressants agents was more common. This study is the first to investigate the impact of ACA positivity on the vascular manifestations of Romanian pSS patients. References [1]Youngjae Park Clinical influences of anticentromere antibody on primary Sjögren’s syndrome in a prospective Korean cohort Korean J Intern Med 2021;36(6):1492-1503. [2]Nakamura H, Kawakami A, Hayashi T, et al. Anti-centromere antibody-seropositive Sjogren’s syndrome differs from conventional subgroup in clinical and pathological study. BMC Musculoskelet Disord 2010;11:140. [3]Baer AN, Medrano L, McAdams-DeMarco M, Gniadek TJ. Association of anticentromere antibodies with more severe exocrine glandular dysfunction in Sjogren’s syndrome: analysis of the Sjogren’s International Collaborative Clinical Alliance Cohort. Arthritis Care Res (Hoboken) 2016;68:1554-1559. Disclosure of Interests None declared

Background Autoantibody formation is one of the hallmarks of systemic sclerosis (SSc). Previous studies suggested that SSc patients who are antinuclear antibody (ANA) negative constitute a distinct subset of SSc patients associated with a better prognosis, defined by male dominance, less vasculopathy and more frequent lower gastrointestinal involvement [1,2]. Objectives To examine clinical and serologic correlations of Romanian SSc patients without ANA/SSc-related autoantibodies (Abs). Methods This was a single-center retrospective study which enrolled 270 SSc. The presence for both circulating SSc-related autoAbs and ANA was screened. Demographic and clinical features, symptoms and parameters related to a specific organ involvement according to MEDS evaluation sheets, were evaluated. Results We identified a population of 32 (12%) patients who had neither SSc-related autoAbs nor ANA. The group comprised 27 females and 5 males, with a mean age of 59.7 (±14.3) years, most of them with diffuse subset (25/32). ANA/SSc-related autoAbs negative patients had a significantly younger disease onset (48 [8-76] vs 60.5 [20-81] years, P <.005), longer disease duration (6 [0.1-50] vs 2 [0.1-25] years, P <.001), lower mRSS (7 [2-21] vs 9 [1-23], P <.001) but higher European Scleroderma Study Group (ESSG) activity index (5.3 [0.1-50] vs 2.9 [0.1-25] P <.001), higher proportion of synovitis (42% vs 16%, P <.001) and calcinosis (42% vs 17%, P <.001). For organ involvement, although the absence of SSc-related autoAbs was positively correlated with presence of digital ulcers (P < 0.001), heart and severe pulmonary involvement (P < 0.001), we didn’t find a statistically significant difference between the two groups. Patients negative for ANA/SSc-related autoAbs more frequently received corticosteroids (58% vs 14%, P <.0001) and immunosuppressants (16% vs 0.5%, P <.0001) than those positive SSc-related Abs. No differences in mortality were found between the groups. Conclusion Our data revealed that ANA/SSc-related autoAbs negative patients are younger and have more frequently diffuse skin involvement, inflammatory arthritis, and calcinosis. Although digital ulcers, severe pulmonary and heart involvement were more common, there was no statistically difference between the two groups. Even though overall disease activity index was significantly higher in seronegative SSc patients, no difference in mortality were found between the groups. Whether the absence of detectable autoAbs persists and is to be viewed as a favorable prognostic factor are questions to be addressed by future studies. References [1]Hudson M, et al. Prevalence and clinical profiles of autoantibody-negative systemic sclerosis subjects. Clin Exp Rheumatol. 2014;32:S127-S132. [2]Salazar GA, et al. Antinuclear antibody-negative systemic sclerosis. Semin Arthritis Rheum. 2015;44(6):680-6 Acknowledgements: NIL. Disclosure of Interests None Declared.

About 70% of patients with Sjogren’s syndrome suffer from fatigue, and for a large proportion of patients, it is one of the most noticeable manifestations leading to disability. To date, no study has been conducted in Romania to determine the quality of life of patients and the impact of fatigue in patients with Sjogren’s syndrome. The present work proposes the translation, cultural adaptation, and validation of two questionnaires for the Romanian context, namely the ‘Profile of Fatigue and Discomfort–Sicca Symptoms Inventory’ (PROFAD-SSI-SF) and ‘Primary Sjogren’s Syndrome—Quality of Life’ (PSS-QoL), whose purpose is to assess quality of life and fatigue in patients with Sjogren’s syndrome. These two questionnaires were administered to 52 patients with Sjogren’s syndrome diagnosed according to the 2016 ACR-EULAR criteria. Subsequently, the conceptual, semantic, and operational analyses of the data were performed with the aim of cultural adaptation. The data obtained were statistically analyzed using indices of measurement accuracy such as internal consistency. Based on statistical analyses, this pilot study shows that the Romanian versions of the PROFAD-SSI and PSS-QoL questionnaires are as reliable as their English counterparts.

Aims: This study's objective was to analyze lung ultrasonography (LUS) characteristics in hospitalized pediatric patients with complicated community-acquired pneumonia (CAP). We hypothesized that LUS could be correlated with the clinical outcome in these cases. Materials and methods: In this retrospective study, we evaluated the LUS appearances (at admission and five days after the beginning of the treatment) and the progression of complicated CAP. Results: We identified 45 patients who fulfilled the inclusion criteria. Several complications occurred in these subjects during follow-up including: serofibrinous pleurisy (62.2%), empyema (15.6%), encapsulated pleurisy (11.1%), lung abscess (6.7%) and necrotizing pneumonia (2.2%). In addition, 22.2% of the patients required surgical treatment: draining tube (11.1%), decortication (6.7%) and resection (4.4%). Intensive care unit admission was needed in 8.9% of patients. The median duration of hospitalization was 14 [9.7; 19.7] days. The thickness of pleural effusion with a cut-off value of 10 mm seen by LUS was a predictor for the need for continuous thoracic drainage (p<0.01), segmentectomy or thoracoscopic surgery (p=0.03) and prolonged hospitalization over 10 days (p<0.01). Hyperechogenic pleural effusion, presence of septa and fluid bronchogram on 1st LUS evaluation were independent predictors of segmentectomy or thoracoscopic decortication (p<0.01) and of longer hospitalization (p=0.02, p<0.01, p<0.01 respectively). Conclusions: The ultrasound characteristics of complicated CAP can offer valuable information to predict the clinical evolution of CAP and so can help the development of personalized medical management plans in these patients.

Background Calcinosis is a common and disabling complication of systemic sclerosis (SSc) with poorly understood pathogenesis and no effective treatment. Little is known about the etiology of this condition and management is essentially based on case studies and series. Objectives The objectives of this study were to describe the prevalence and characteristics of calcifications, and to investigate the relationships between calcinosis and clinical features in a population of patients with SSc. Methods This was a single center descriptive and retrospective study of patients treated at “Saint Mary” Clinical Hospital in Bucharest since January 2000 for SSc. Demographic and clinical features, including duration of disease progression, symptoms and parameters related to a specific organ involvement according to MEDS evaluation sheets, were evaluated in all patients. For testing the association between nominal variables chi-square test was performed while independent t test was used to compare the differences between subgropus.Logistic regression analysis was used to predict the risk of all-cause mortality. Results 154 SSc patients were selected in the database, from which we identified a final group of 31 (20%) patients with calcinosis related to systemic sclerosis. The calcinosis cohort comprised 25 females and 6 males, with a mean age of 52.6 (±14.3) years, most of them with diffuse subset (16/31). Mean disease duration was 5.6 years (±3.1). Mean modified Rodnan skin score (mRSS) was 9.46 (±3.4) and mean adjusted EScSG activity index in the subgroup with calcinosis was 3.6 (±1.9). 45.16% (14/31) patients from the calcinosis subgroup developed interstitial lung disease (ILD) vs 43.9%; pulmonary hypertension was seen in 51.6% (16/31) cases vs 10.5% (13/123). As expected, calcifications were closely associated with vascular (p=0.004) and gastrointestinal (p=0.001) involvement and pulmonary hypertension (p=0.049). Moreover, associations were stronger for severe gastrointestinal involvement defined as chronic intestinal pseudo-obstruction (p=0.001). Females (p=0.024), patients with digital ulcers (p=0.004), those with disease duration longer than 10 years (p=0.001), those with pulmonary hypertension (p=0.049) and patients with gastrointestinal involvement (p=0.044) presented significantly more calcinosis. There were no significant associations between calcinosis and disease activity, myositis, interstitial lung disease, type of scleroderma or autoantibodies. Furthermore, in the logistic regression equation we identified calcinosis as a risk factor for all-cause mortality in SSc patients [OR:2.607 (CI:1.062,6,397), p=0.037]. Conclusion Calcinosis cutis is a common manifestation is patients with SSc regardless of skin subset and type of autoantibodies. It seems to occur more often in patients with long-standing disease and is more commonly associated with vascular involvement such as digital ulcers and pulmonary hypertension. Furthermore, the present study has demonstrated that calcinosis could be an important prognostic factor when it comes to predict mortality. Given the fact that the management of calcinosis in scleroderma is an unmet need in almost half of patients with long-standing disease duration, systematic clinical trials are required to find effective measures to prevent this complication. References [1]Richardson C, Plaas A, Varga J. Calcinosis in Systemic Sclerosis: Updates in Pathophysiology, Evaluation, and Treatment. Curr Rheumatol Rep. 2020 Aug 27;22(10):73. doi: 10.1007/s11926-020-00951-2. PMID: 32856128. [2]Jinnin M. ‘Narrow-sense’ and ‘broad-sense’ vascular abnormalities of systemic sclerosis. Immunol Med. 2020 Sep;43(3):107-114. doi: 10.1080/25785826.2020.1754692. Epub 2020 Apr 23. PMID: 32324110. [3]Chander S, Gordon P. Soft tissue and subcutaneous calcification in connective tissue diseases. Curr Opin Rheumatol. 2012 Mar;24(2):158-64. doi: 10.1097/BOR.0b013e32834ff5cd. PMID: 22227955 Disclosure of Interests None declared