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Volume XII, Number 1, 2008 - Therapeutics Pharmacology and Clinical Toxicology


Pharmacogenetics variability of therapeutic response and personalized medicine

Victor A. Voicu
Abstract: The recent great acquisitions generated along with the description of human genome provide the scientific base of individualized (personalized) medicine. For a short analysis of inter and intra - individual variability of drug response we will evoke very briefly to some data regarding the success rate in the pharmacological treatment of important diseases (as prevalence and seriousness) and the incidence of adverse events associated to the respective pharmacotherapy

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Stadializarea infectiilor acute severe. Implicatii terapeutice

Adrian Streinu-Cercel
Abstract: In ultima vreme infectiile acute severe (IAS) recunosc o noua stratificare impusa pe de o parte de diversitatea germenilor patogeni implicati iar pe de alta parte de presiunea selectiva a diverselor antibioticoterapii atat din sectorul ambulator cat si din cel spitalicesc.

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Variability of therapeutic response and personalized medicine

V.A. Voicu
Abstract: The authors present in synthesis the antipsychotics mechanisms consecutive to the interaction with neurotransmission systems receptors, respectively the dopaminergic, serotoninergic, cholinergic system etc. Implicitly, a brief review is performed, by means of the pharmacological proofs of schizophrenia pathogenic theories. Another domain approached hints the ethio-pathogenic aspects of schizophrenia as the background of potential pharmacological targets - genetic components and impact of the factors perturbing the neurodevelopment and neurodegeneration processes initiated in a favorable context. The antipsychotics effects correlations are analyzed at the level of various receptors with the therapeutic effects on one side which can be the direct consequence of action on receptor or indirect consecutive to counter-regulations determined in other neuromediation systems, and on the other side these effects can be relatively immediate (of hours - days order) or slowly installed (weeks) or do not appear at all (resistance to treatment, non-responders etc.). In this context two concepts are brought into discussion: the therapeutic effects with immediate onset and defined after 2-3 weeks and slow effects becoming marked after around one month and defined or not after few months. Another type of arguments are also brought into discussion: the slow and late effects of antidepressant, the addiction phenomenon installation as a complex process of neuroadaptation, but also the experimental and clinical proofs that the antipsychotics induce complex phenomenon on the cerebral structures. In fact in the context of chronic treatment with antipsychotics, the brain also behave following the known rules: it launches short latency, rapid processes with homeostatic destiny and initiating a series of other, more slow reactions implying protein and receptor synthesis, synaptic plasticity, neuroplasticity, neurogenesis etc. These processes implying the changes of some genes expression are approached as epigenetic phenomenon conferring to the organism, on one side, flexibility and adaptability and, on the other side, the genetic stability. In this context, the authors are appreciating that there are some convincingly arguments (direct or indirect) in order to admit that the antipsychotic - pathogenic psychotic processes two successive independent and correlated phases are envisaged: the pharmacodynamic phase in which the active compound determines the known effects consecutive to antagonizing or activation of receptors for which it has affinity and the pharmacotherapeutic phase implying more slow complex processes. The rapid counter-regulations of the interconnected neurotransmission systems are part of the phenomenon probably initiating slower and more complex reactions implying compensatory phenomenon in a positive or negative sense (up or down-regulation) at the level of receptors, neuromediators synthesis, synaptic connections or even appearance of new neurons in some cerebral regions. This second phase will outline the final therapeutic response which will install in weeks, months and in connection with the rearrangement and resetting between different neurotransmission systems (affected in the schizophrenia context) on the basis of the presented epigenetic processes, we will report or not an individual therapeutic effect.

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New vaccine valences in National Program of Immunization

Monica Luminos, Anca Draganescu, G. Jugulete, Roxana Matei, Ruxandra Mantescu, Angelica Visan, Cristina Negulescu
Abstract: Vaccinations as an active metod of prophylactic immunization against infectious diseases is a major public health problem, worldwide. Around 13 million people die annually from infectious diseases. Approximately 2,1 million of them are determinate by diseases can be prevented by immunization and 1,4 million represent death at children under 5 years old. Immunization is one of the most successful intervention in public health, vaccine having high efficiencies (95-100%) and safety, minor adverse reactions.

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Systemic fungal infections therapy in new born and infant

S. Rugina, Claudia Simona Cambrea
Abstract: Fungal infections are a serious p problem in outpatients and hospitalized paediatric patients. Candida is a common cause of oral mucous membrane infections (thrush) and perineal skin infections (candidal diaper dermatitis) in newborn infants. Disseminated candidiasis and candidemia have become a frequent problem in neonatal intensive care units. These fungal infections in neonates and infants are associated with the aggressive use of chemotherapy, widespread use of broad spectrum antibiotics, extensive use of indwelling intravascular catheters, the immunodeficiency associated with AIDS and new borns in intensive care units. Amphotericin B, which frequently causes serious nephrotoxicity, and 5-fluorocytosine were once the only drugs available to treat serious fungal infections. Newer agents have had a major impact on our ability to treat, more safely and effectively, local and systemic invasive fungal infections. Fluconazol, a triazole agent, has been used to treat > 20 million patients with primarily Candida and other yeast infections. As might be expected, antifungal resistance has emerged and has led to an increase in the development and marketing of several even newer azole drugs as well as other classes of antifungals. The paediatric dose for new antifungals used in therapy of systemic infections is not established yet.

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Pharmacokinetical and Immunological Interactions of Liposomal Drug Delivery Systems

A. Neamtu, C. Neamtu, O. C. Mungiu
Abstract: Liposomes are largely used in fundamental medical research and especially in physio-pharmacological one. They are often used as transporters for different types of substances including drugs. That is why a comprehensive understanding of their interaction within the body is extremely important. There is a great amount of experimental data in this respect in the field literature, few even contradictory. Because of this great diversity of data there is need for some systematization which will be useful in understanding the liposome biological interactions. This material tries succinctly to present such a synthetic view, which, because of the huge amount of data published in the last 20 years, will surely be subjected to refinements.

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Endogenouse cannabinoid system

Aurelia Nicoleta Cristea, B. S. Velescu
Abstract: Endogenous cannabinoid system (SCBE), classified as a lipidergic system, is relative recently discovered. Only in 1990, the first cannabinoid receptor CB1 has been cloned from cerebral tissue. The first endocannabinoid was identified from the porcine brain in 1992 (Devane et al.) as arachidonoylethanolamide (AEA) and named anandamida (from Sanskrit: ananda=joy, happiness, bliss, sensual pleasure). The effects of anandamide are mimed by delta 9-tetrahydrocannabinol (THC), identified in 1964 as the active phytocannabinoid responsible for the psychoactive effects of cannabis, resulting from the stimulation of the CB1 receptor type. This paper represents a review of the up-to-date knowledge about endogenous cannabinoid system (SCBE): history, receptors, mediators, catalyzing enzymatic systems of biosynthesis and metabolize, regulation and correlations with another signaling systems, physiological functions and pathological implications, as well as pharmacological perspectives. In a future paper the new drugs will be presented.

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The oxidative stress role and blood brain barrier disruption in Alzheimer disease

T. Papacocea, Raluca Papacocea
Abstract: The blood-brain barrier (BBB) consists of the vascular wall, represented by endothelial cells belonging to cerebral microvessels connected by tight junctions on a basal memebrane and astrocytes which surround the cerebral cappilaries. The astrocytes act as a filter between blood microvessels and neurons, providing the permanent regulation of BBB permeability. A number of pathological instances can injury the BBB, some of these related with the oxidative stress. For instance, the cerebral ischemia is associated with an increase in BBB permeability due to tight junction involvment (Mark et al., 2002). More, free oxigen radicals may increase the transcelular permeability (Cipolla et al., 2004). The oxidative stress increases the proinflamatory cells migration, increases the expression of some cell adhesion molecules and induces the lipidic peroxidation in BBB (Haorah J., 2005). Similary foundings were identified in postmortem sample of brain from patients with Alzheimer disease (AD). More than 30% of patients with AD present cerebrovascular pathology involvind celular elements from BBB structure.AD is the most frequent neurodegenerative progressive disease, characterized by cognitive decline to dementia. Histologically is characterized by senile plaques appeareance, and the main constituent of the plaques is a fibrillar protein, B amiloid (BA). The relation between BA and oxidative stress is still controversial: while some researchers are claiming a prooxidative role (Butterfield DA. et al., 1996) others are showing the opposite: a protective and antioxidant role, acting as an iron/cooper chelator (Cuajungco et al., 2000) or as an antioxidant (Nunomura et al., 2001). In the last decade, the concept of neurovascular unit was introduced and can be applied in AD approaching for a global view of injuries. Together with neuronal injuries, the vascular oxidative aggresion is a target for intense research. It was demonstrated that oxigen and nitrogen free radicals not only decrease the vascular response to various vasodilators, but also can induce a vascular remodeling. The NADPH oxidase was identified as the major source of free radicals because, acting by reducing of vascular NO (nitric oxide) biodisponibility (Park et al. 2005). Cerebral microvessels represent early targets for oxidative stress and BA (Park et al. 2004). The role of the vascular component in AD development is growing and the very early cerebral hypoperfusion could be an important contributant to neuronal and cognitive deficits. (Benarroch, 2007). The BBB increased permeability due to BA deposits in vascular wall, followed by seric protein extravasation (Kumar Sinhg et al, 2005) can also contribute to extravascular damage initiation. The identification of new molecules able to modulate the BBB function in response to oxidative stress aggresion, could be a potential hope for AD patients as much as antioxidants alone were no table to improve the AD evolution (Luchsinger A. J, Tang M.Xet al, 2003)

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Pharmacodinamics implications of fuoroquinolones on the appearance of resistance

Cristina Monica Popescu, Adriana Hristea, Mihaela Radulescu, Victoria Arama, Daniela Nicolae, Daniela Munteanu, Ruxandra Moroti, Raluca Mihailescu
Abstract: Fluoroquinolones are antibacterials with a broad activity, which is not identical for all the molecules in this class. The first fluoroquinolones are active mostly on gram negative aerobian bacilli and less on gram positive germs, while new generations of fluoroquinolones (starting with levofloxacine) are highly active on gram positive and atypical germs. Fourth generation fluoroquinolones are also active on anaerobic bacteria. Fluoroquinolones inhibit DNA synthesis, by interacting with DNA and DNA-gyrase and topoisomerase IV complexes, leading to bacterial death. There are three mechanisms of fluoroquinolone resistance: chromosomal mutations affecting the genes which encode the two target enzymes - DNA-gyrase and topoisomerase IV (this tipe of resistance is step installed); diminution of intracellular penetration; active efflux. Lowering of intracytoplasmatic antibiotic level is due to reduction of porines (the penetration route of antibacterial through bacterial membrane) and also over-expression of efflux pumps. Fluoroquinolones are well absorbed in the upper digestive tract, the new fluoroquinolones having a higher biodisponibility. In addition, new fluoroquinolones have Cmax and AUC significantly higher as compared to ciprofloxacine, and longer half time allows administration once daily. Binding to serum proteines is low, fluoroquinolones usualy reach higher concentrations in tissue and fluids comparing to serum. Fluoroquinolones have concentration dependent bactericid activity, so the AUC/MIC can be improved by increase the dose, with better bactericidal activity. Knowledge of the farmacokinetic and the farmacodynamic properties of fluoroquinolones allows a better clinical use, considering that in high bacterian inoculum infections there are populations of resistant bateria which are not detected by susceptibility standardised tests. The concept of mutant prevention concentration gives an explanation for selecting and amplifying resistance, at the same time offering important data for a preventing strategy against amplifying of resistant subpopulations.

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Melatonin from molecule to clinic

Ioana Cristina Amihesei, Elena Cojocaru, O. C. Mungiu
Abstract: The drop of the melatonin secretion is so obvious with aging, that the plasma level of melatonin is one of the criteria used to establish the biological age of the individual. The maximum secretion of melatonin from the pineal gland, takes place at 2 a.m. in healthy young adults and at approximately 3 a.m. in old subjects. The jet -lag syndrome is caused by too rapid crossing of numerous meridians, by plane, especially when the flight is on the direction east-west. It is characterized by disturbances of the wake-sleep cycles, with intense fatigue, insomnia, irritability and decrease of the immunity. Besides the treatment of the jet-lag, melatonin is used for the improvement of the sleep condition and for the treatment of sleep disturbances of the old individuals. Altered electromagnetic fields, such as high voltage lines and ELF transmission (extremely low frequency fields) are also affecting melatonin secretion and circadian rhythms. The benefits of melatonin in the treatment of malignant tumors is still studied. The melatonin secretion is altered during acute and also chronic stress. The dose is strictly individual, as well as the timing, for the administration of melatonin, otherwise a severe jet-lag syndrome may develop.

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Original Papers

Complications of upper-airways after respiratory prosthesis

A. E. Muresan, Loredana Duta, D. Alexianu, L. Tiganiuc, R. Macovei
Abstract: Management of the airways is the most important task of the anaesthesiologist; it can be performed by the classic approach of the intubation manoeuvre or by tracheostomy. There are several devices for this procedure: endotracheal tubes and tracheostomy cannulas. In this paper are reviewed the methods necessary for endotracheal intubation. The complications of classical intubation are described and classified by the moment of appearance: early and late. The pathophysiology is related to the structure of the tracheal wall and the most important layer, the mucosae and its capillaries. The inner cuff pressure can exceed the perfusion pressure and ischemia occurs; this a frequent condition (over 60%) leading to stenosis and tracheo-esophageal fistulae. In the mean time underinflation of the cuff lead to aspiration syndrome and leakage. We performed in our Neurosurgical ICU a program by routine cuff pressure measurement and recording in the chart of these values; the purpose was to obtain the minimal pressure, necessary to prevent all kind of complications due to overinflation and underinflation.

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Prognostic score of hyperlactatemia under ARV

Corina Itu, C. Jianu, Doina Tatulescu, Mirela Flonta, Ligia Ursu, Virginia Zanc, D. Carstina
Abstract: Background: mitochondrial toxicity is an adverse event of nucleoside reverstranscriptase inhibitors. The biochemical marker is the increased level of serum lactate. Objectives: to identify the risk factors for hyperlactatemia and to establish a prognostic score. Methods: we prospectively studied 49 adults under ART. Lactate level and other parameters were studied. Univariate and multivariate statistics were used. Results: risk factors for hyperlactatemia are: age over 40 and hemoglobin under 11g%. The result of prognostic score was 0.5. Conclusions: a good prognosis means a score under 0.5. The score might be a replacement method for the lactate concentration.

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Clinical and prognostical considerations on severe enterococcal infections

Carmen Dorobat, Laura Ghibu, Carmen Manciuc, M. Hurmuzache, Andra Teodor, Codrina Bejan
Abstract: The treatment of severe enterococcal infection is an important challenge for clinicians, several factors appear to be involved, including the multiple resistances characteristics of many enterococci, heavy use of antimicrobial agents to wich this organisms are resistant and incrising numbers of seriously ill and debilitated patients in hospitals. This study included 12 patients with systemic enterococcal infections admitted in our clinic between2002-2006. The purpose of our study was the evaluation of predisposing factors to severe enterococcal infection and evolution under therapy with antibiotics.

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Particularities of acute meningitis epidemic in 2007

Cristina Popescu, Victoria Arama, Adriana Hristea, Adriana Paise, Daniela Munteanu, C. Tiliscan, Ruxandra Moroti, M. Chiotan, Raluca Nastase, Violeta Molagic, Mihaela Radulescu, Daniela Nicolae, Raluca Mihailescu, Rodica Bacruban
Abstract: We made a prospective descriptive study about viral meningitis like a reaction to epidemiological alert from June 2007 in Romania. Objective: to analyze the cases of meningitis in order to identify a possible etiological agent. Methods: we excluded the cases of pyogenes and tuberculosis meningitis. We analyzed 28 cases of meningitis with a case definition: meningian syndrome with more than 7 nucleate cells/mmc. Results: mean age 23,8 years (between 14 and 38 years), the predominance of male, equivalent distribution regarding rural vs urban provenience and water distribution. Clinic: were moderate cases, without encephalitis syndrome, with moderate meningeal syndrome in 46% of cases. In 4 cases we observed lymphatic nods inflammation, 12 patients associated sinusitis, 16 patients had moderate increased level of fibrinemia and 4 patients had more than 12000 leucocytes/mmc. CSF examination showed: in 23 cases below 250 cells/mmc and 8 patients below 100cells/mmc. The CSF glucose was normal in 25 patients, 3 patients had moderate increase of CSF glucose. CSF protein was increased but the value was below 200 mg% for all patients (below 100 mg% for 22 patients). For five patients we identified echo4 virus in CSF and for 2 cases we identified serum antibody for adenovirus. All the patients received pathogenic and symptomatic medication. 22 patients received for more than 24 hours antimicrobial therapy, the most frequent, Ceftriaxone. Conclusions: 2007 viral meningitis epidemia affected young people, male, and outcome was favorable in all the cases.

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Sepsis in elderly patients

Irina Niculescu, A. Cupsa, I. Diaconescu, Florentina Dumitrescu, L. Giubelan, S. Dinescu, Manuela Musa, Stefania Ionescu
Abstract: Background: Sepsis in elderly patients is an important cause of morbidity and mortality. Objectives: to establish the influence of age upon the incidence, etiology and evolution of sepsis. Methods: retrospective study (January 2006 - December 2006) on 278 patients with sepsis of 5219 patients hospitalized in Adult Clinics of Infectious Diseases Hospital Victor Babes Craiova. Incidence of sepsis, severe sepsis and septic shock, infection, etiology and evolution of sepsis were assessed on two groups of age. The two groups were: one with patients more than 65 years of age and other with patients less than 65 years of age. Results:16,1% of hospitalized patients were elderly individuals. Incidence of sepsis among hospitalized patients was 5,33%. Incidence of sepsis was significantly greater among older patients than among younger patients (7,62% versus 4,89%; RR=1,56; IC 95% - 1,19
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Nosocomial sepsis

Victoria Birlutiu, Mirela Mitrea
Abstract: Starting from the serious issue represented by nosocomial sepsis, associated with an important increase in morbidity and mortality, long-term hospitalization and high costs, the aim of the study is to analyze the frequency of this illness in County Clinical Hospital Sibiu. We selected for this study patients hospitalized in the clinical departments of our hospital, between January 2006 and August 2007, with positive hemocultures. For each such patient we had regard to the inclusion criteria of nosocomial sepsis, having in view the general data, previous health status, aggravating factors, the etiology, the response to etiologic therapy. Results: from all 385 nosocomial infections during 2006, nosocomial sepsis was identified in 24 cases, representing 6,23%; in 2007, from the 123 patients with nosocomial infections, 6 cases were defined as nosocomial sepsis, meaning 4,88%. The majority was associated with the male sepsis patients - 24 cases, with main incidence at age range 50 to 60 (8 cases), followed by the age range 40 to 50 (7 cases) and over 60 (also 7 cases). The risk factors related to the development of sepsis were: multiple traumatic injuries, comatous patients (5 cases), abdominal surgical interventions (10 cases), neoplasia (6), diabetes mellitus (5 cases, out of which 3 new identified ones), chronic renal failure (1 case). 24 cases were indentified in The Intensive Therapy Service, at patients with central venous catheterism (10 patients), hemodialysis catheter placement (1 case), mechanical ventilation for more than 5 days (16 cases), urinary catheterism (12) or patients who stayed in hospital for more than 3 weeks (15 patients). The etiology of nosocomial sepsis was represented by gram-positive bacteria: Staphylococcus (9 cases), Enterococcus (5 cases); 18 infected patients with gram-negative bacteria: Acinetobacter (7 cases), Klebsiella and Enterobacter in 3 cases, Escherichia Coli (2 cases), Pyocianic bacillus, Chryseomonas luteola and Serratia each one case; Candida (6 cases). Six patients had combined etiology, one of them presenting 3 different isolated strains. All Staphylococcus aureus strains were Methicillin-resistant. Enterobacter and Extended-Spectrum Beta-Lactamase (ESBL) Producing Klebsiella strains appears to be sensible to Carbapenems, while Acinetobacter keeps 100% susceptibility only to Colistin.

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Clinico therapeutically features of staphylococcal infections with methicilin-resistant strains

L. Cochior, E. Miftode, D. Dorneanu, E. Nastase, D. Teodor, V. Luca
Abstract: The rate of Methicillin-resistance among staphylococcal strains is rising continually, affecting both the hospital-acquired strains and those responsible for community infections, with a large range of severity, from limited infections, bacteriemia with SIRS and systemic infections. Objectives: The aim of our study was to evaluate the clinical features of staphylococcal infections with methicillin-resistant (metiR) strains and the therapeutical choices of first line antibiotherapy, based on the presence of RFMR (risk factors for the acquisition of methicillin resistance): complication of a prior hospitalization, recent surgery, repeated hospitalizations, pacient living in institution, presence of catheters or prosthetic devices, prior antibiotherapy, auto medication. Matherial and method: We included in this study 125 cases of staphylococcal infections with metiR (methicillin-resistant) strains, diagnosed in the University Clinic of Infectious Diseases from October 2006 to October 2007. The identification was made by conventional methods and by using ID32Staph strips, the susceptibility to antibiotics being tested by difusimetric methods and by using the ATBStaph strips (bioMerieux, France). Results: We analyzed 125 cases of staphylococcal infections, 70c.(56%) with SA (Staphylococcus aureus) and 55 c.(44%) with SCN (coagulaze-negativ staphylococci), with a global rate of methicilline-resistance of 53,33% (67c.) : 50% in SA (35c.), 58% in SCN (32c.). In 65% cases we identified RFMR. Discordances between the first-line antibiotherapy, guided by the presence of RFMR and the results of antibiogramme were encountered in 38% cases, prominently sepsis with SCN. Conclusions: the rate of methicillin resistance reported by our study places us among the European countries with a high level of methicillin resistance. In 35% cases we found no history of FRMR, which correlates with the 38% cases of inadequate first line antibiotherapy. The efficient treatment was based on major antistaphylococcal agents (glycopeptides, linezolid) and fluoroquinolones. The clinical outcome was positive in 72% cases and worsened in 28% cases.

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Pathophysiological mechanisms for infectious complications in multiple myeloma

Amelia Gaman, G. Gaman
Abstract: Infectious complications are frequency in patients with multiple myeloma because hypogammaglobulinemia, granulocytopenia, altered leukocytes and complement fonctions, immunosupresion induced by corticotherapy and chemotherapy .Associated diseases (diabetus mellitus , renal or pulmonary diseases) increase the risk for severe infectious complications.

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Growth defciences in HIV infected adolescents

Manuele Arbune, E. Zbranca, Voichita Mogos
Abstract: HIV related growth deficiencies have complex pathways. Growth pattern for 11-18 years old Romanian HIV infected adolescents was assessed. Significant growth deficiencies (height and weight) were found on HIV 11- age group vs. control group, both for boys and for girls. On 18 age, height and weight tend to be closer to control group, due to `catch up growth`.Catch up growth` is influenced by pubertal status (p<0.001) and immunity (p<0.001). Height deficiency is more significant than weight deficiency, for both sexes. Male sex is more severe affected by growth deficiencies.

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Therapeutical Practice

Cardiovascular risk associate with HAART therapy

O.Rosca, L. Negrutiu
Abstract: The discovery of new antiretroviral therapy raised the life expectancy of HIV infected patients. The use of this in different combinations (HAART) determined some side effects, one of more important being the high cardiovascular risk. We present the cases of 2 HIV infected patients under HAART therapy. In both cases, there was an increase of total seric cholesterol, of triglycerides, of LDL-cholesterol and a decrease of HDL cholesterol. This biologic disturbances were accompanied by lower (the best expressed) and upper limbs lipoatrophy, facial lipoatrophy, and abdominal, pectoral and posterior cervical lipohipertrophy. One of these cases presented ecg disturbances (sinusal tahicardy, abnormalities of Q wave, ST subdenivelation). In the other case, there have been observed hypertensive attacks. The Doppler Ecography of the later patient showed a reduced diameter of the right carotid artery with an atheromatous deposit at this level. Concluding, the patients under HAART therapy have a higher risk for cardiovascular disturbances comparatively to the normal population. A rigorous monitoring of cardiovascular risk factors is necessary, accompanied by an adequate HAART therapy.

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The syndrome of lipodistrophy associated with osteonecrosis in an adolescent infected with HIV

C. Chiriac, R. Pascu, I. Kezdi, A. Balint, M. Dobreanu, A. Incze, D. Parvu, V Careianu
Abstract: HAART significantly increased the lifespan of a patients infected with HIV and at the same time it generated new pathologies of increased complexity and not completely elucidated: mitochondrial pathology, disorders of the glucido-lipid metabolism, lipodystrophy syndrome, osteopenia/osteonecrosis. Objective: it is presented the case of an HIV seropositive patient with lipodystrophy syndrome and osteonecrosis of the femur. Material and method: a complex analysis of demographic and clinical characteristics of risk factors associated with the HAART therapy, which generated the lipodystrophy syndrome and osteopenia, correspondingly the osteonecrosis of the femur in a female adolescent infected with HIV Results: M.A., a 17 year old patient diagnosed with AIDS presents a complex associated pathology: frontal right operated tumor, meningoencephalitis with Cryptococcus neoformans, syndrome of intermittent intracranial hypertension, symptomatic epilepsy, pulmonary tuberculosis. The mean value of TCD4 lymphocytes is 332/mm3. The exposition time to nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI) is of 60 months. Starting from December 2006 the patient complained of aches and pains and functional impotence at the articulation level of the humerus and right hip. As a result of seriate bone radiography, osteodensitometry (DEXA) and orthopedic examination the diagnosis of osteopenia, 1st stage aseptic necrosis of the right femur (ANF) was set up. The associated risk factors were: hyperlipidemia (the mean value of triglycerides was 196mg/dl and the total value of cholesterolemy: 229mg/dl) and exposition to corticotherapy for an average of 2 months. Conclusions: Osteonecrosis correlated with HIV infection appears as an emergent complication with an increasing incidence associated with specific risk factors like hyperlipidemy associated with antiretroviral therapy and exposition to corticosteroids.

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Severe rhabdomyolysis in acute poisoning with CO and ethanol

D. Ardeleanu, R. Avram, O. Constantinescu
Abstract: Rhabdomyolysis is an acute destruction of skeletal muscle characterized by necrosis, breaking of the muscular fibres, release of myoglobin and other cell components. The clinic picture sometimes presents a dramatic aspect. The severe rhabdomyiolysis determins muscular pain and tumefaction, and the released myoglobin will determine acute renal failure. Rhabdomyolisis may be due to the direct toxic effect of ethanol as well as to the CO determined hypoxia. Clinical case : Young man, 34 year old, transferred in our department 48 hours after an acute poisoning with ethanol and accidental exposure to CO. On admitance: conscious, difusse myalgias, tumefaction at the level of lower limbs, acute renal failure with anuria, (BUN 128mg/ml, creatinine 4,88mg/ml), rhabdomyolisis ( CK 150.000 ui) and hepatic disfunction. The MRI highlights diffuse edematous and hemoragic modification at the level of the gluteal and adductor muscles supporting the diagnosis of rhabdomyolisis. An infectious pathology was excluded by specific laboratory tests. The treatment was a supportive one, concomitent with hemodyalisis sessions. During hospitalization: a CT scan rendered voluminous hemorragic modifications in the spinal, gluteal, adductor, and pectineal muscles (with severe anemia HB 4g/l ). The clinic evolution was favorable. Conclusions: Acute ethanol and Co poisoning has sometimes a severe clinic evolution with rhabdomyolisis and acute renal failure, without convulsions, by the direct toxic effect and hypoxia.

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Sepsis with candida albicans to infant - Case presentation

Claudia Simona Cambrea, S. Rugina, Marga-reta Ilie, Claudia Nina Rugina, Valeria Stroia, Sora O. Carp, R. Baz
Abstract: Fungal infections in neonates and infants are associated with the aggressive use of chemotherapy, widespread use of broad spectrum antibiotics, extensive use of indwelling intravascular catheters, the immunodeficiency associated with AIDS and neonates intensive care units. Disseminated candidiasis and candidemia have become a frequent problem in neonatal intensive care units. Objective: To present a case of sepsis with Candida albicans in an infant of 6 months old with multiple hospitalizations, with prolonged antibiotic therapy and indwelling intravascular catheter. Results: We present a case of a female infant who was hospitalized for a Bacterial meningo-encephalitis during January 2007 in pediatric intensive care unit of County Clinical Hospital of Constanta. In this unit patient received complex etiologic treatment and specific treatment. After this episode the child was transferred in Children Infectious Diseases Department with Diagnosis of TB meningo-encephalitis. During both hospitalizations infant received broad spectrum antibiotics, tuberculostatic drugs, indwelling intravascular catheter, naso-gastric probe and a neurosurgical intervention in order to drain internal hydrocephaly secondary to bacterial meningo-encephalitis. After 3 months of hospitalization the child presents an episode of sepsis with Candida albicans that required treatment with Fluconazole for 2 weeks. Conclusions: In this case sepsis with Candida albicans in an infant is a disease associated with medical invasive procedures and broad spectrum antibiotics for a long period of time.

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Aplastic anemia induced by parvovirus b 19 on HIV-positive patient

A.O. Abagiu, Fl.M. Duna, CA. Radulescu, G. Preda, D.E. Seceleanu, I. Niculescu, M. Olariu, E. Resiga, Dr. C. Dobrea
Abstract: Parvovirus B 19 was identified first in 1975, and in 1983 it was found responsible for the erythema infectiosum (fifth disease). The virus can also produce arthropaties in adults, anemia and aplastic crisis, myocarditis and in immunodepressed patients a severe chronic anemia. After treatment with ARV daily and intravenous immuno-globulines 0,4g/kg/day for 5 days and than once monthly the evolution was good.

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Case Report

Arhive Category