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Volume XVI, Number 2, 2012 - Therapeutics Pharmacology and Clinical Toxicology

Review


Non-hematologic adverse effects related to interferon therapy in patients with chronic HCV hepatitis

Popescu Cristina, Arama Victoria
Abstract: Pegylated interferon and ribavirin are mandatory in the treatment of HCV hepatitis. An early recognition of side effects related to the antiviral therapy can prevent the discontinuation of treatment and can improve the eradication of HCV infection. Hematologic side effects related to pegylated interferon and ribavirin therapy are the most studied; on the other hand it is difficult to make a correlation between a rarely reported side effect and the medication. Thats why it is important to report and to recognize all these side effects in order to avoid life-threatening. This review analyses non-hematologic side effects correlated with antiviral therapy for HCV hepatitis.

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Cardiovascular risk in patients with chronic hepatitis C virus infection

Daha Ioana Cristina, Olaru Ioana, Iernici Alexandra, Ionescu R. A., Dan Gh. A.
Abstract: Cardiovascular disease and chronic hepatitis C virus (HCV) infection are major public health problems causing significant morbidity and mortality in millions of people worldwide. There is growing evidence that there is an association between HCV infection, cardiovascular disease and metabolic dysfunction. HCV induces a chronic pro-inflammatory state and promotes atherosclerosis, hepatic steatosis, insulin resistance, and the development of type II diabetes mellitus, thus increasing the cardiovascular risk. It can also have a direct effect on the myocardium causing myocarditis and cardiomyopathy in susceptible individuals.

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Original Papers


The role of ultrasound evaluation in the diagnosis of fatty liver

Lazar I. M., Stefan M., Arama Victoria, Ion Daniela Adriana
Abstract: This paper presents the results from a research study which examines the correlations between the biological and morphopathological evaluation of the fatty liver and the ultrasound investigation. The purpose is to establish the utility and accuracy of ultrasound evaluation of fatty liver and to suggest an ultrasound staging of hepatic steatosis. Material and method: we evaluated 2 groups of patients - group A: 222 patients examined using ultrasound and liver biopsy and group B: 167 patients examined using ultrasound and steatotest. The obtained results demonstrate that the echographic evaluation is a reliable diagnostic method for liver steatosis, with over 0,82 sensitivity and over 0,90 specificity, depending on the steatosis stage.

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Acinetobacter spp. Skin and Soft Tissue Infections in the Clinical Infectious Diseases Hospital of Iasi City

Vata D., Filip Olga, Dorneanu Olivia, Luca Catalina, Manciuc Carmen, Dorobat Carmen, Solovastru Laura, Vata A.
Abstract: Acinetobacter (ACB) species have often revealed themselves as highly resistant to antibiotics, occurring preponderantly in vulnerable patients and sometimes causing severe infections, which are difficult to treat. Material and method: retrospective study on patients diagnosed in the Clinical Infectious Diseases Hospital of Iasi City, between January 2006 and December 2010; the demographic, clinical and microbiological characteristics of patients suffering from skin and soft tissue (SST) infections caused by ACB were compared to those of other patients with different infection locations. Results: 24.4% of the whole 45 ACB strains isolated throughout the study were involved in SST infections. Most of them (10/11) had a significant number of associated conditions; average age - 59.4 years, preponderantly males (63.6%). The most frequent isolate was Acinetobacter baumanni (8/11 cases, 4 of whom also had bacteremia). The isolated strains were resistant to multiple classes of antibiotics (anti-pseudomonas cephalosporins - 8/11, imipenem 6/11, amikacin 6/9, and ciprofloxacin 8/10); colistin was the only antibiotic that revealed good anti-ACB activity, as only one of its strains was antibiotic resistant. Multidrug-resistance was noticed in 4/11 strains. ACB SST infections were lethal in 9.1% of the cases. There were no statistically significant differences between the demographic, epidemiological or antibiotic-resistance variables of patients with SST infections and those of other patients with different ACB infection locations. Conclusions: the ACB infection located on SST distinguishes itself by its severity and serious therapeutic challenges, whereas its antibiotic-resistance behavior is similar to that of infections with different locations.

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Study of clinical and dermoscopic features in acquired hemangioma for a correct therapeutic attitude

Chitu Virginia, Furtunescu Florentina, Zurac A. Sabina, Giurcaneanu Dorina, Giurcaneanu C., Staniceanu Florica
Abstract: The acquired hemangiomas can sometimes raise big clinical and dermoscopic diagnosis problems, it is not always possible to exclude a melanoma. Objectives. The identification of the clinical and dermoscopic features that lead to a more difficult diagnosis of acquired hemangioma. Method. A descriptive transversal study was performed on 23 patients, histopathologically diagnosed with hemangioma, who presented to our clinic, from January to December 2011, for a pigmented skin lesion that had a tendency to change. All the lesions were analyzed clinically and by dermoscopy (dimension, symmetry, chromatic, ulceration, crust, trauma). Results. Hemangiomas are lesions with a rich dermoscopic chromatic, of the 23 lesions in our study, 11 having 4 or 5 colors. The red color was present in 22 lesions, and the lacunar pattern in 13. The two lesions dermoscopically suspected for nodular melanoma lacked the lacunar pattern and presented a blue-white veil-like structure. Conclusions. Dermoscopy allows a relatively easy diagnose of hemangiomas when accompanied by the lacunar pattern, whose absence, together with the blue-white veil-like structure, the homogenous black areas generated by thrombosis create confusions with the melanoma.

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Lipid profile and therapeutic implications in obese children

Mindru Dana Elena, Stana A. B., Azoicai Alice, Moraru Evelina
Abstract: Obesity, as a nutritional chronic disease, has an alarmingly rising prevalence in children, with a major risk for complications. Dyslipidemia is responsible for many comorbidities of obesity and its evaluation and management are compulsory. Objective: To evaluate the presence and prevalence of various dyslipidemic changes in obese children and adolescents, as well as evaluating their lipid profiles and the effects of specific therapeutic measures. Material and methods: The study group included 130 obese children aged 5 to 18 years, followed over 188 admissions in the 2nd Pediatric Clinic - Emergency Hospital for Children "St. Maria" Iasi, Romania from January 2008 to January 2012. The inclusion criteria were the diagnosis of overweight and obesity. Patients were divided into three subgroups for therapeutic reasons, according to age: subgroup I - 5-9 years, subgroup II - 10-13 years and subgroup III - 14-18 years. There were performed anthropometric measurements to classify patients according to the degree of obesity and biological determinations. Results: Blood lipids were modified in more than 50% of obese children, in most cases hypertriglyceridemia, increased LDL-C and decreased HDL-C. Therapeutic measures were lifestyle changes and administration of ursodeoxycholic acid, vitamin E and probiotics. In 5 children was administered rosuvastatin. Conclusions: Obesity in children represents not only a nutritional risk, but also possible lifelong diseases. Evaluation of blood lipids and proper therapeutic measures can reduce the risk of metabolic syndrome.

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Fatigability in HIV AIDS patients

Borduselu Matilda, Streinu-Cercel A., Mardarescu Mariana, Ungurianu Rodica, Petre Cristina, Draghicenoiu Ruxandra, Tudor Ana-Maria, Matei Carina
Abstract: Objectives: Fatigue assessment and its influencing factors in patients infected with HIV/AIDS, who are under antiretroviral treatment and multiexperienced. Method: Prospective study, with descriptive character which included 2 lots of patients, namely 60 persons known to be HIV/AIDS infected for over ten years, with multiple ART schemes in their antecedents as shown by National Institute -Matei Bals- records and 20 other persons, representatives of the general population, uninfected with HIV and without current acute diseases. The study subjects answered standardized self assessment questionnaires on fatigue, pain, adherence to treatment (for HIV infected patients); depression, AIDS Dementia Complex and social status were also evaluated. We considered their haematological (Hb, Hct); and immunological status (CD4, CD8, CD4/CD8 ratio), viral load, hepatic status (TGP, TGO, alkaline phosphatase, GGT, hepatic viruses B and C), thyroid, gonadal and renal functions. Results: Statistical analysis of the data highlighted that the impact of fatigue (at a threshold of 75 points on PEDsQLTM scale) was significantly higher in patients with HIV infection than in persons with no health problems (RR=3.1, p=0.005). Anaemia, thyroid dysfunction, liver or renal impairment were not present in patients accusing fatigue with Karnofsky score>50%. For the patients with Karnofsky score -<50% fatigue was multifactorial. Unlike most studies published in specialty magazines, our study evinces a correlation between the severity of fatigability and viral load (r^2 = 0.17 and p=0.003) or immunological status (r^2 =0.12 and p=0.006). A statistically significant relation between depression and fatigue was noticed. In HIV patients, depression was two times more frequent in those who presented fatigue than in those with no signs of it. In non-HIV patients, depression was discovered in one case and was also associated with fatigue. Likewise, fatigue was linked with patients adherence to treatment, namely patients with a high rate of fatigue (<= 65 points on PEDsQLTM scale) being 42% non-adherent to treatment, while those with no fatigue being 33% non-adherent. Lack of adherence was identified in only 17% of study respondents, with fatigue between the abovementioned values on PEDsQLTM scale. Pain represented a strong interference factor, emphasizing the importance of systematic identification and treatment of all symptoms. Conclusions: In HIV patients, fatigue often stands for a chronic pain, incompletely treated or/and for a hidden depression. Assessment of fatigue and its influencing factors are essential elements of a global therapeutic approach of HIV patients. Proper management of pain and depression, as well as the treatment of fatigue can lead to an improvement in the quality of life and to an increase of adherence to treatment.

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The safety profile of etoricoxib in autoreactive urticaria

Tudose Adriana Mihaela, Popescu F.D., Vieru Mariana, Popescu Florica
Abstract: Background: A subset of chronic idiopathic urticaria (CIU) has recently been classified as autoreactive urticaria on the basis of the presence of anti-IgE and/or anti-IgE receptor antibodies. Such antibodies can be detected by skin testing with autologous serum (ASST). The clinical forms of hypersensitivity to nonsteroidal antiinflammatory drugs (NSAIDs) are rhinitis, frequently associated with nasal polyps, aspirin-intolerant asthma or nonselective NSAIDs, urticaria / angioedema, anaphylaxis and, rarely, hypersensitivity pneumonitis. In subjects with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) and autoreactive urticaria, tolerance to selective COX-2 inhibitors has not been evaluated in large series of well-phenotyped cases. Methods: We evaluated 238 patients referred to our clinic, during a 12-month period, for evaluation of chronic urticaria (more than six-week duration). Autologous serum test was performed in all these patients (ASST). From them, we selected subjects having history of hypersensitivity to NSAIDs, manifested as urticaria and/or angioedema. All patients with a history of hypersensitivity to NSAIDs underwent drug challenge test with etoricoxib. The cumulative dose was 60 milligrams. Results: One hundred thirty-three patients (55.88%) were evaluated having strong positive ASST. In this group we detected ninety-eight patients (73,68%) with a history of hypersensitivity to NSAIDs (urticaria and/or angioedema). In the group of patients with negative ASST, twenty patients had a history of hypersensitivity to NSAIDs. All patients with this history (one hundred eighteen) underwent drug challenge test for etoricoxib 60 mg total dose. Only two patients (1,69%) developed urticaria in approximately two hours after reaching the total dose. Both cases belonged to the group with positive ASST. Conclusion: The hypersensitivity to NSAIDs was more frequent in patients with positive ASST. Etoricoxib is a COX-2 selective inhibitor and appears to be well tolerated by patients with history of hypersensitivity to traditional NSAIDs (98,31%). These findings suggest that a common mechanism may be responsible for the pathogeneses of both autoreactivity and NSAID hypersensitivity in chronic urticaria. It might be further speculated that delayed, prolonged, and pronounced autoreactivity may be a possible predictor for multiple NSAID sensitivity. Patients with autoreactive urticaria should avoid all inhibitors of COX-1. These patients may use COX-2 inhibitors, after single-blinded oral challenge.

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Evaluation of hepatic circulation in patients with cirrhosis

Lazar I. M., Stefan M., Arama Victoria, Ion I.F. Daniela Adriana
Abstract: We present a retrospective study effectuated on 207 patients aged between 22 and 84 years, diagnosed with cirrhosis by liver biopsy. All the patients were evaluated by ultrasound, measuring the hemodynamic parameters (portal flow velocity, endsystolic velocity and end-diastolic velocity in the hepatic artery), flow pattern in portal vein and hepatic veins, dimensions of portal vein, splenic vein and superior mesenteric vein and hepatic artery. The obtained data were associated with the stage of the disease in order to establish correlations with the ultrasound evaluation. The results showed an increased velocity in the hepatic artery following the severity of the cirrhosis, while the variation of portal flow velocity presented no statistical relevance for different stages of disease. The hepatofugal portal flow pattern and monophasic flow pattern in the hepatic veins were correlated with severe forms of cirrhosis.

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Therapeutical Practice


Estimated sodium content in prescription medication

Polizzi D., Vesbiau D., Sawhney J.
Abstract: Reducing the sodium intake in an individuals daily diet is a priority for many healthcare providers. Consequently, there is an enormous volume of literature on reducing the sodium content in an individuals food intake; however, there are very few medical journal articles that specifically discuss the sodium content in prescription drugs.

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Case Report


Onset, evolution and treatment response in patients with indolent lymphomas. Case reports

Ciobanu Anca, Triantafyllidis Irina, Stanca Oana
Abstract: Indolent lymphomas are malignant tumors of the cells of the immune system, located in different tissues. The clinical evolution is unpredictable, some cases going well beyond the average rate of survival of 8-10 years, and others with an increased probability of transforming into lymphomas with high malignancy. Based on the data provided in literature, we shall describe three cases diagnosed with indolent lymphomas focusing on the type of onset, evolution and treatment response.

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High flow priapism in a pediatric patient. A case report

Balanescu R., Topor Laura, Nechifor R., Malureanu Daniela
Abstract: Priapism is a rare entity in the pediatric population and represents a persistent, usually painful erection that lasts for more than 4 hours and occurs without sexual stimulation in all age groups including newborns. However, it usually affects men between the ages of 5 to 10 years and 20 to 50 years. Priapism is caused by an imbalance between penile blood inflow and outflow. There are two types of priapism, low-flow due to venous occlusion and high-flow priapism due to uncontrolled arterial flow to the veins. High-flow priapism most frequently occurs as a result of penile or perineal trauma in which the intercavernosal artery disruption causes an arteriocavernosal fistula. Treatment ranges from expectant management to open surgical exploration with vessel ligation. The major chronic morbidity associated with all types of priapism is persistent erectile dysfunction, impotence and psychogenic sexual aversion. We report a successful treatment of high-flow priapism in a 5-year-old boy with superselective transcatheter embolization of the fistula with platinum microcoil using a coaxial microcatheter.

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Selective percutaneous cordotomy in the treatment of malign pain. Case report

Bancila Ana Teodora, Ianovici N., Bancila S.C.
Abstract: At least 10% of patients with cancer experience pain that is refractory to systemic analgesics. For most of these paints, interventional techniques may be of benefit but they are often not considered or are difficult to access. Of these techniques, spinal analgesia is most commonly used while neurosurgical procedures, such as percutaneous cordotomy with sectioning of the spinothalamic tract are rarely used. We describe a case illustrating the successful use of percutaneous cordotomy in a patient with refractory mixed nociceptive and neuropathic pain secondary to a lung cancer.

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