In patients with obstructive sleep apnoea (OSA), a consequence of the intermittent hypoxia is nocturia. The frequency of nocturia related OSA is increased because many pathological pathways are present simultaneously. The aim was to assess the prevalence of nocturia among OSA patients and to identify the relationship with OSA and its comorbidities. A transversal study determining the prevalence of OSA�s comorbidities and nocturia related OSA and smoking was assessed, from 2011 to 2015, in 2 Romanian centres of Somnology, in Constanta county. All patients suspected of sleep breathing disorders were investigated by polygraphy and all patients diagnosed with OSA were recruited. Demographic and clinical characteristics were assessed, including the onset of nocturia. The comparison between groups with and without nocturia was performed using SPSS software, using Anova for numerical outcomes and c2 test for the categorical ones. Nocturia was highly prevalent (62.75 %) among 204 OSA patients, especially in elderly (p [ 0.00001). High blood pressure (hypertension), obstructive pulmonary disease (COPD), smoking exposure were more frequently reported in the OSA patients presenting nocturia (p[0.05). Type 2 diabetes and cardiac failure were also frequent, but did not reach a significant threshold of 95%. In conclusion, the nocturia is a frequent symptom and it is influenced by the OSA severity and comorbidities as hypertension and COPD. A further multidisciplinary approach in these patients is justified, especially in smokers.

Rheumatoid arthritis is an inflammatory disease characterized by chronic joint erosive processes, affecting approximately 1% of the population. [1] The pathogenic mechanisms processes involve the activation of pro-inflammatory cytokines, including TNF alpha. [2] The purpose of this case presentation is to elucidate a possible correlation between the high level of blood TNF alpha and the apparent lack of response to biologic therapy directed against this molecule. A female patient, aged 55 years, diagnosed with rheumatoid arthritis in 2006, presents an increased inflammatory biological syndrome. The patient was being treated biologically (adalimumab, and two years of etanercept previously. One year ago, the patient presents the elevation values of the blood tests commonly used to monitor the status of patients with inflammatory rheumatoid arthritis up to 2.5-3 x than normal values. Initially, this increase is considered to be due to a respiratory seasonal condition. We continued monitoring the status, after subsequent remission of these respiratory disorders, and we observed the persistence of those elevated test, this time without an obvious possible causing comorbidity. We decided to evaluate the current patient status and we obtained the following information: Biological syndrome currently moderately exceeds the maximum normal values. ESR was 47 mm/h and CRP 1.5 than the normal value. TNF alpha value determined by immunochemical methods with detection by chemiluminescence (CLIA) is 67.2 pg / mL Biological confirmation by determining serum TNF alpha and increased observation that the current level may be one explanation for the possible reactivation of the disease prompted us to continue the study in patients receiving anti-TNF alpha biologic. This study is ongoing. We can imagine this correlation between the level of TNF alpha and the degree of disease activity at least in the case of a group of patients treated with biological drugs. If this could be demonstrated, then perhaps we can expect a change in the curative approach of these patients, meaning that dose adjustment can be considered depending on the level of TNF alpha, and why not, depending on other cytokines that may be included in future studies.

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The routine conventional phenotypic bacteriological tests available for pulmonary tuberculosis (PTB) diagnosis, such as microscopy by Ziehl Neelsen staining, and Lowenstein Jensen method of solid culture, requires a long time for revealing positivity, resulting in a delayed diagnosis. After Mycobacterium tuberculosis (MTB) genome was discovered, nucleic acid amplification techniques were developed with more rapid detection and identification of rifampicin resistance in respiratory and extra-pulmonary specimens. GeneXpert is a DNA-polymerase chain reaction technique based on NAA, which allows an accurate genotypic method for a quick diagnosis of PTB diagnosis. The aim of the study was to assess retrospectively the yield of genotypic assay GeneXpert in revealing multidrug resistant TB compare to phenotypic confirmation by solid culture. 512 patients with positive and negative smears of suspected PTB were investigated by conventional phenotypic assays. PTB diagnosis assessed by positive genotypic assay and confirmed by phenotypic conventional solid culture method was 78.12%. The yield of GeneXpert in revealing rifampicin resistance was high (n=79/512; 15.43%) with 12.5% additional resistance against isoniazid revealed by positive solid cultures and drug susceptibility test. GeneXpert assay is a very useful method for rapid detection of MTB and drug resistance, which facilitates timely diagnosis and appropriate management of pulmonary tuberculosis.