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Volume XVII, Number 1, 2013 - Therapeutics Pharmacology and Clinical Toxicology


New aspects of gut microbial translocation in chronic liver diseases

Munteanu I. Daniela, Arama Victoria, Arama S. St.
Abstract: The gut-liver-axis is a much elaborated system, with strong interrelationships between these two organs. The intestinal microflora, known as comensal bacteria, has important function in the digestion of varied nutrients, prevents the colonization and infection with pathogenic microbes and is controlled by the intestinal barrier and by the detoxifying function of the liver. When pathological conditions, like chronic liver diseases, disrupt the normal homeostasis between the gut and the liver, microbial translocation occurs. The principal mechanisms responsible for microbial translocation from the gut to extraintestinal sites are: bacterial overgrowth, increased intestinal permeability and changes in local immunity. Once viable bacteria or bacterial products (such as the lipopolysaccharide from the Gram-negative bacteria) migrated from the intestine, the innate immune system from the liver is activated through toll-like receptors (TLRs) signalling. Studies conducted in animal models showed that TLRs signalling determine the activation of Kupffer and hepatic stellate cells, finally leading to inflammation and progression of liver fibrosis. There is strong evidence that microbial translocation is directly linked to advanced liver disease: in cirrhosis the reduction of bile secretion favours the bacterial overgrowth in the small intestine and bacterial translocation, which in turn is responsible for cirrhosis complications, like spontaneous bacterial peritonitis and hepatic encephalopathy. Recent data show that microbial translocation occur from the early stages of chronic liver disease, suggesting that in the future it will be possible to identify potential therapeutic targets and treatment molecules, which could positively impact the disease progression.

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Original Papers

Knowledge, attitudes and practices of Romanian international travellers concerning travel-related infectious diseases and vaccinations

Niculescu Iulia, Hristea Adriana, Moroti Ruxandra, Arama Victoria, Streinu-Cercel A.
Abstract: Introduction: Despite economic challenges, there is an increased growth in the number of international Romanian travellers to tropical areas. Health safety during trips depends on factors like previous counselling, vaccination and prevention of infectious diseases. Objectives: Assessment of knowledge, attitudes and practices (KAP) of Romanian international travellers about pre-travel counselling, travel-related infectious risks and preventive measures, routine vaccination coverage. Methods: Transversal study based on a questionnaire survey, including Romanian international travellers who sought pretravel advice at the Medical Department for International Travellers of the Medicover clinic in Bucharest between 2009- 2012. Results: For 512 Romanian international travelers, 59% men, median age 32 years, all with medium-high socioeconomic and education levels, from urban areas, the most common destination was South East Asia (65%), followed by Africa (18%), South America (13 %) and others (4%) travelling to USA, Australia, Middle East. Seventy six percent of them visited malaria-endemic and 19% yellow fever-endemic areas. Business purposes prevailed (71%), the median duration was less than 4 weeks, 79% were staying in a hotel, 23% of them were planning to undertake risk activities and 27% were going to visit rural areas. Most of individuals (71%) came for the first time to a travel medicine consultation and perceived the risk of infectious diseases at the destination as low, 61% were sent by the employer. Pretravel health advice was sought with a median duration of 20 days (5- 60) before departure. Only 24% were vaccinated to date against tetanus and diphtheria and 22% were unaware of which disease they were already protected against. Antimalarial chemoprophylaxis prescribed was Mefloquine (62%), followed by Doxycyclin (30%) and Atovaquone/ proguanil (8%). Conclusion: Specialized travel advice is important for international Romanian travellers, it increases awareness about travel health issues and helps developing a preventative behaviour in order to reduce infectious disease related morbidity. It also plays a role in increasing the level of routine vaccination coverage in Romanian adults who have an inefficient vaccination protection. Romanian citizens lack personal immunisation record cards. Every Romanian traveller should be educated to seek medical advice prior to departure and the implementation of a national centralized database with medical information regarding travel-related risks would be beneficial for both travellers and healthcare providers.

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High-throughput pyrosequencing study of microbial 16s diversity in peripheral blood of an antiphospholipidic syndrome patient

Radu E., Moroti-Constantinescu Ruxandra, Muntean Al. A., Chirca Al., Arama Victoria
Abstract: High-throughput pyrosequencing of 16s rRNA amplicons permits the study of microbial communities composition in different environments, independent of traditional culture-based methods. The method relies on complex software tools and large amounts of genetic information available in public databases. We used this approach to analyse microbial 16s rRNA diversity in the peripheral blood of a 22-year-old female patient with antiphospholipid syndrome, who developed multiple thrombotic APS episodes, almost all presumably having an endogenous infectious trigger. Results show that non-chimeric, aligned 16s sequences clustered in 544 microbial operational taxonomic units, most of them belonging to Actinobacteria, Firmicutes and Proteobacteria phyla. Comparison of the observed microbial diversity to profiles of known normal human microbiota suggests a possible colonic and nasopharyngeal origin for microbial translocation into the bloodstream of the studied patient.

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Estrogen-Progestin/Tibolone hormone therapy

Popescu Alina, Marinescu B.
Abstract: The purpose of this study is to demonstrate what benefits and risks are when using menopause hormone treatment (MHT). Methods: We evaluate disappearance of climacteric syndrome, the improvement of quality of life and appearence of adverse events after one year following hormonal replacement treatment with estrogen-progestin and Tibolone. Results: In 26 cases there were significant improvements of climacteric syndrome associated with a visible improvement of quality of life. In 3 cases we have major adverse events and all three pacients droped out therapy. Conclusion: Comparing the results obtained in both groups, there were no major differences in therapy efficacy. Both groups showed improvements at one year of treatment particulary life quality and a significant reduction of climacteric phenomenas. This paper besides studying the impact of menopause on womens health, evaluate one year hormone replacement therapy benefits and risks.

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Therapeutical Practice

The amniotic membrane - why and how to use it in ophthalmology

Stanca T.H., Balta F., Branisteanu D., Munteanu M.
Abstract: The amniotic membrane is the internal layer of the fetal membrane in direct contact with the amniotic fluid. The amniotic membrane is an immunological and inert tissue, similar to conjunctiva for its physical properties, which can be replanted without the risk of rejection and without immunosuppressant treatment. This property, along with another ones, recommends it as a therapeutical solution very encouraging for the treatment of various ocular surface diseases. There are some international medical regulations, in order to properly sampling, preparing, preserving and using the amniotic membrane in ocular surgery, which had to be respected.

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The stages of psycho-therapeutic intervention in dementia

Pasca Maria Dorina
Abstract: Aims: The work aims to present a series of strategies concerning the psycho-therapeutic intervention in a certain evolutionary sequence of the condition (dementia). Methods used: Being aware that the psycho-therapeutic intervention in this case is made according to the identity and the life history of the patient logistically can be used: cognitive-behavioral therapy, occupational therapies, graphic-therapy, and narrative therapy and also environmental therapy, each finding itself in the therapeutic trajectory of the condition. Summary of results: Applying the adequate psycho-therapies in the evolution of the condition, represents a strategy based on maintaining that extremely necessary inner equilibrium and also a valuable construction of the individual, influencing positively a state of the behavioral-attitudinal conduct, concerning the place and the role still inside the community to which the patient reports to. Such an intervention needs team work, bringing to evidence the connections of maintaining the patient as long as possible in the sphere of diurnal and consciousness. Conclusions: Implementing the strategies concerning the psycho-therapeutic intervention at the dementia, determines new conceptual attitudes that materialize into an individualized program, fact that determines a new configuration of the term team work and also of communication and relation doctor-patient versus patient-doctor in this case.

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Case Report

Serositis associated to HCV infection Cryoglobulinemia - vasculitis or coincidence

Ionescu R. A., Daho Ioana Cristina, Onogea C., Tanasescu C
Abstract: Cryoglobulinemia is almost always secondary to chronic hepatitis C infection, as it is an extra hepatic manifestation of it. The most common clinical manifestations are palpable purpura, arthralgia and asthenia (Meltzer syndrome). However, in some instances the presence of cryoglobulins triggers the development of vasculitis which, in turn, can produce variable manifestations. We describe the case of a young woman infected shortly after birth with hepatitis C virus who develops at age 37 polyserositis in the context of increasing cryocrit. This suggests a causality relation between the two. All symptoms associated to the presence of serositis subsided to cryopheresis and corticotherapy.

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Metachronous breast and rectal cancer

Kocsis Alexandra, Rusu Octavia Cristina, Marinescu B.
Abstract: We present the case of a 51 year old diagnosed with mammary tumor and rectal tumor within 9 months. After investigations, pelvic posterior exenteration is performed. She receives adjuvant therapy the following post operative days with favorable postoperative evolution. She returns to regular checks after polychemotherapy presenting normal tumoral marker values, no visible metastases on ultrasound, imaging or scintigraphy. Breast cancers are not highly aggressive, unlike the rectal cancer. Metachronuos cancers tend to be more aggressive. This patient benefited from vitamin and protein adjuvant therapy and the evolution was favorable with no metastases at 2 years.

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