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Volume XVII, Number 2, 2013 - Therapeutics Pharmacology and Clinical Toxicology

Review


Early and late outcome determinants in prosthetic valve endocarditis

Baluta Monica Mariana, Benea Elisabeta Otilia
Abstract: Prosthetic valve endocarditis represents the infections of a prosthetic heart valve. Despite advances in diagnosis techniques and therapy, this syndrome still has a poor outcome due to high mortality. The patient characteristics, cardiac and noncardiac complications, the causal microorganism and contraindication to surgery due to co-morbid condition may influence patient prognosis. The identification of factors influencing prognosis should be a useful tool to select the appropriate therapeutic strategy: medical versus surgical and medical. The current trend favors early surgery; however, antimicrobial treatment offers favorable results in cases without poor prognostic factors. This paper will focus on early and late outcome determinants of prosthetic valve endocarditis.

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Original Papers


The management of hematological side effects in chronic hepatitis C treatment

Ionescu R.A., Daha Ioana Cristina, Onogea C., Nitescu Doina, Tanasescu C.
Abstract: The side effects of chronic hepatitis C treatment can have a significant impact on the desired treatment outcome defined as SVR (sustained virological response - absence of detectable RNA of the hepatitis C virus in blood serum for at least six months after treatment completion). The aim of this study was to retrospectively assess the effect of different management approaches for hematological side effects in a group of patients treated for chronic hepatitis C with peg-interferon and ribavirin, at the National Institute for Infectious Diseases `Prof. Dr. Matei Bals`, from November 2009 to December 2010. The SVR for the studied group was 65%, with a lack of statistical correlation between age group, gender, baseline viremia and SVR rate. The study results showed that anemia management by ribavirin dose reduction and erythropoietin administration had no effect on the sustained virological response rate, whereas for patients with neutropenia, maintaining constant peg-interferon doses displayed a significant effect on the sustained virological response rate. There was no correlation between developing hematological side effects and the SVR rate.

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Treatment of hepatitis C viral infection in patients with thalassemia major - the experience of an internal medicine department

Ionescui R.A., Daha Ioana Cristina, Onogea C., Nitescu Doina, Tanasescu C.
Abstract: Thalassemia major (also known as beta thalassemia major) is a disease that produces anemia that needs to be treated by regular blood transfusion. In turn, these has the risk of iron overload as well as that of infection with hepatitis C virus (HCV). Aim. This paper presents the experience of a tertiary internal medicine department in observing and treating major thalassemia patients having chronic hepatitis C viral infection. Matherial and methods. We have been following 21 patients with major thalassemia positive for anti HCV antibodies, of which 13 have detectable levels of viral RNA. Twelve of them are treated with standard of care treatment for thalassemic patients chronically infected with HCV, that is they receive PegInterferon-alfa-2b in standard doses for 48weeks. The iron load of the patients was assessed using ferritin plasma levels. The efficacy of treatment was appreciated by assessing RNA-HCV plasma levels at weeks 12, 24, 48 and 24 weeks after the completion of treatment. We also assessed alanin-amino-transferse levels, the need for transfusion and the occurrence of adverse events. Results. Ferritin levels were less than 1g/dl at 12 weeks into treatment in 10 of the 12 treated patients, while the plasma alanin-amino-transferase level normalized in 6 patients at week 12. We also had 8 complete early viral response after 12 weeks of treatment and 2 cases of hematologic side effects, one respiratory infection and 2 mild depression. Conclusion. Using Pegylates alfa-2b Interferon in our major thalassemia patients with chronic haptitis C infection can be efficacious in obtaining viral response, with a similar safety profile as that of non-thalassemic patients. In our small study, response to treatment seems to be parallel to the normalization of serum alanin-amino-transferase levels but not to the reduction of the iron overload.

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Determining the oxidative metabolism involved in the dynamics of radiotherapy

Aldea Alina, Gruia Maria Iuliana, Romosan Marilena, Anghel Rodica
Abstract: Medical literature disposes of a multitude of theories that account for the essential role of free radicals and other reactives in human pathology. The great number of illnesses containing free radicals speaks for the reality of oxygen reactive species and the association between their excessive formation and tissue lesions, namely lesions that cause oxidative stress. A malignant cell undergoes a dual cause-effect relationship sending into a grey area the exact function of oxidative stress - a cause or a consequence of malignant transformations? Although intense oxidative stress generated during radiotherapy might be held responsible for inducing tumoral cytotoxicity, chemotherapy related moderate oxidative stress could have contradictory side effects that enable the development of therapy resistance mechanisms in tumoral cells, with the disadvantage of decreased efficacy in treatment. This material aims to evaluate certain biochemical parameters connected to oxidative stress involved in the dynamics of radiotherapy, in view of monitoring its efficacy in female patients, diagnosed with cervical cancer. Our study was deployed on 93 female patients undergoing radiotherapy at the Oncological Institute in Bucharest, aged between 39-80 years, monitored in active treatment and by determinations of biochemical oxidative stress. The results we obtained on a relatively small lot of patients suggest significant individual differences at the level of oxidative metabolism associated to radiotherapy. Investigated parameters have marker values within a process of structuring a general risks scale. Establishing them in dynamics can be used as a tool in monitoring the risk of complications occurrence, as a consequence of further treatments.

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An observational study of abortion in Romania after contraceptive introduction

Simionescu Anca Angela, Horobet Alexandra
Abstract: Objective: To analyze whether the introduction of contraceptive services and the legalisation of abortion contributed to the decrease of the number of on request abortions in Romania between 1989 and 2009. Methods: An observational study of abortions in Romania was performed using data from the National Centre for the Organization and Management of the Health Information System. We included abortion on request, incomplete abortions and septic abortions for all patients that required hospitalisation and suction curettage. We analysed the use of contraception in Romania despite not wishing to get pregnant. The data has been processed using Microsoft Excel. Results: We analysed 3,838,210 patients that underwent suction curettage and we found a significant decrease in the total number of abortions on request, by an average of 25,831 per year. In relative terms abortions decreased, on average, by 49 % per year between 1999 and 2009 and by 93 % overall, if we compare the value from 2009 to that of 1990. We analysed the use of contraceptive services in our country and how they might have influenced abortions. Conclusion: The possibility of using contraception and the related information made available after 1990 has reduced the number of abortions on request. Still, new policies are needed to improve the use of contraception and universal access to family planning centres.

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Primari cleft lip repair using millard technique experience and result

Stoicescu Simona, Enescu D.M.
Abstract: Introduction. Numerous surgical techniques have been described for cleft lip repair, among them the rotation-advancement technique described by Millard remains the most popular worldwide. The aim of this study is to present our cleft team experience in primary cleft lip treatment using Millard technique. Material and methods. A retrospective analysis was performed on medical records of 66 patients who underwent lip repair in the last five years (from 2008 to 2012). All consecutive cleft lip (and palate) patients were incorporated. Information on patients gender, cleft type, age at repair, type of cleft repair and postoperative local evolution were collected and analyzed. Results. A totally of sixty-six patients, forty-seven boys and nineteen girls underwent cleft lip repair under general anesthesia; 80% of them were unilateral, while 20% were bilateral cases. Age at surgery was between 3 and 10 months old in the majority of the cases (85%). Millard technique was used in 96% of the unilateral cleft lip and in all bilateral cleft lip. In 60% of the unilateral cases a modification of the original technique was performed in order to gain length and symmetry of the upper lip. Conclusions. Our study has shown the use of Millard technique for primary cleft lip repair in the first year of life. The postoperative results were favorable; with practically no postoperative complications except for 2 wide bilateral cases where small dehiscence on the red lip occurred.

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The surgical tehniques of using amniotic membrane in opthalmology

Stanca T.H.
Abstract: The ocular surface diseases with structural degradation of cornea and/or conjunctiva need a special care and treatment. The amniotic membrane (AM) is a tissue very similar to conjunctiva, with no immunological reactivity, which can be grafted without the risk of rejection and the need of any immunosupresive therapy. This propriety, along with many others, recommend AM as a promising therapeutic alternative for the treatment of chemical burns, corneal or scleral sterile ulcers or perforations, recurrent pterygium. Nowadays, amniotic membrane grafting has expanded indications to limbal stem cells transplantation, offering the trophic environment for the grafted limbal cells and also to the lid surgery, helping the tarsal conjunctiva to cure and the tarsus to survive.

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Therapeutical Practice


Therapeutic use of botulinum toxin type A in treatment of crows feet

Fragkos A., Stroe S. Roxana, Ionica M., Voicu A.V.
Abstract: Botulinum toxin is a neurotoxin produced by Clostridium botulinum, a gram-positive, rodshaped, anaerobic bacteria. Human botulism is caused mainly by types A, B, E, F and possibly by G. Types C and D cause toxicity only in animals. Although these toxins have different intracellular targets, their biological activity at the neuromuscular junction is similar. Of these serotypes, only A and B are currently available as commercial preparations. In aesthetic medicine, botulinum toxin is used for treatment of expression lines such as glabelar lines, frown lines and lateral canthal lines or `crows feet`. The authors present five cases of treatment with botulinum toxin in crows feet. Botulinum toxin injections have become usual to combat the effects of aging. As the motto `youth without age` is the motto of each of us, people will always continue to fight with all possible weapons against physiological aging. By knowing the best methods of treatment and side effects, doctors can safely apply this treatment.

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Breast cancer incidence and treatment

Kocsis Alexandra, Neagu St., Popa C.C-tin., Rusu Octavia, Marinescu B.
Abstract: Breast cancer is a topical issue in oncology due to the fact that illness frequency is maintained at a high level and evolution is especially severe in advanced stages. Reducing mortality is obtained by breast screening, that allows discovery of the disease before they have clinical manifestations in less advanced stages, situations where a very high percentage of relapses are rare. In the U.S.A. breast cancer mortality was reduced by 11% through screening, which led to reduced treatment costs. In Romania the situation of breast cancer has not improved significantly if we consider that more than half of patients are diagnosed at later stages and therefore treatment costs are high and the results are less good. Treatment involves surgery, chemotherapy, radiotherapy, hormone therapy, and the results depend on many factors such as stage, compliance, comorbidities.

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