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Volume XVIII, Number 1, 2014 - Therapeutics Pharmacology and Clinical Toxicology

Review


Chronic lymphocytic leukaemia. Malignant hemopathy with multiple therapeutic options

Ivanescu Ana-Maria, Oprea Madalina, Colita A., Turbatu A., Lupu Anca Roxana
Abstract: Chronic lymphocytic leukemia is a chronic lymphoproliferative disorder, indolent but heterogeneous in evolution and difficult to predict. Beside cases whith long lasting evolution even without specific treatment, the clinical practice often faces cases with advanced stages, poor prognostic factors and high risk of disease progression in which choosing the best treatment tailored to each patients is a difficult task. Classical chemotherapy schemes have been effective but combining them with or shifting to new therapeutic agents, along with improved investigation techniques, led to a significant increase in the complete remission rates as well as improvement of survival, without risks of disease progression. During and after therapy, patients need to be thoroughly monitored, the detection of minimal residual disease increasing the chance to discover, early in the process, unresponsive cases or relapses. Complete clinical investigations and paraclinical tests, performed at the onset of disease have an important contribution for the selection of the best therapeutic option and moment of treatment initiation.

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Original Papers


Resistance to breast cancer treatment induced by transport mechanisms

Zob Daniela, Gruia Iuliana, Anghel Rodica
Abstract: Breast cancer represents the most common form of cancer women develop. Although prognosis has significantly improved over the last years, due to increasing trends in early diagnosis and advanced treatment, the medical community still faces a series of severe problems. One of them is resistance to certain chemotherapy agents that constitutes the main cause of death in more than 90% of patients. Despite intense and thorough studies on resistance mechanisms, their relevance for the clinical practice continues to be unclear. The present paper aims to identify a possible resistance mechanism pattern to chemotherapy applied in breast cancers, which includes the attachment of cytostatics to albumin thiols, as a consequence of oxidized protein degradation. Given their chemical structure, these thiols may be responsible for the impossibility of cytostatics to bind to transport albumins, thus inducing therapeutic failures and implicitly resistance. The content of this article focuses on the measurement of albumin thiol levels in patients diagnosed with breast cancer that developed resistance after the first series of antitumor treatment. We also assessed the level of copper-carrying proteins, namely ceruloplasmin involved in oxidation-reduction reactions as well as the overall level of non-enzymatic endogenous antioxidants. The results reveal the occurrence of a significantly damaging oxidative stress that destroys the structure of transport proteins and, indirectly, can create resistance mechanisms.

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Risk factors for tuberculosis in HIV infected patients

Stoian Andreea Cristina, Niculescu Irina, Cupsa A., Dumitrescu Florentina, Iocu Cristina, Giubelan L., Marinescu Liliana
Abstract: Objectives: To identify risk factors for tuberculosis (TB) in patients with HIV/AIDS (PIH), through a retrospective study. Methods: A retrospective study compared the period 01/01/2006-31/12/2010 on two groups of PIH born between 1987-1990, horizontally infected with HIV in early childhood and ARV treatment: group A-16 PIH diagnosed with TB in 2010 and lot B-46 PIH without opportunistic infections at the time of inclusion in the lot (2010).

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Thrombo-prophylaxis in total hip arthroplasty using oral anti-thrombotics anticoagulat - Rivaroxaban

Popescu Gh. I., Lupescu Olivera, Patru Cristina, Nagea M., Vasilache Cornelia, Dimitriu Al., Macovei R. Al.
Abstract: Rivaroxaban, a novel anti-thrombotic drug, has been described as having a highly potent activity on the coagulation mechanism, due to its reversible inhibiting action on the central point of the coagulation cascade, Factor Xa. Published studies reveal some advantages of Rivaroxaban compared to previously used anti-thrombotics: it is orally administered and rapidly absorbed and it allows a fixed dose regimen as its pharmacokinetic and pharmacodynamic profile is predictable. Having similar cardio-vascular and hepatic side effects to other anti-thrombotic drugs and a low risk of bleeding, as shown by the published studies, Rivaroxaban can be considered well tolerated and effective in prevention of thrombembolic events. The authors present some aspects regarding their experience with this drug used in thrombo-prophylaxis following hip arthroplasty, a high thrombo-embolic risk procedure with increasing frequency in modern orthopedics. The results of this prospective study post-operative blood loss, the incidence of thrombo-embolic events, side effects confirm the data presented in literature regarding the efficacy and safety of Rivaroxaban in major orthopedic surgery.

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Therapeutical Practice


Communication strategies that improve the relationship between pharmacist and patients with disabilities

Pasca Maria Dorina
Abstract: Patients with disabilities represent a particular category with whom the pharmacist has to know how to communicate and interrelate. Knowing the patients physical and psychological identity, the pharmacist will opt for an efficient communication and relationship, based on the idea that the persons condition can comprise various disabilities: hearing, vision, intellect, motor skills. Given this context, the approach must be different and adapted to the specific needs of the patient. A succesfull communication approach leads to mutual respect, trust, acceptance and responsibility which, ultimately, engender new behaviors for any given context.

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Case Report


Severe outcome of influenza a H1N1 rhombencephalitis in a 6-year-old child

Visan Angelica, Draganescu Anca, Negulescu Cristina, Bilasco Anuta, Vasile Magdalena, Mantescu Ruxandra, Merisescu Madalina, Slavu Diana, Dogaru Cornelia, Marinescu Violeta, Luminos Monica
Abstract: Introduction: Influenza infection is extremely common, but despite being usually self-limited, the frequent occurrence of epidemics entails a considerable economic burden. Influenza-associated encephalopathy/ encephalitis is relatively rare, but carries significant morbidity and mortality. Case report: We report the case of a 6-year-old girl admitted to the intensive care unit of the National Institute of Infectious Diseases Prof. Dr. Matei Bals with acute rhombencephalitis following influenza A H1N1 infection. The child survived but with severe neurological sequelae. Conclusions: Improving primary health care assistance from the point of view of prophylaxis through vaccination programs and improving patient management from the first signs of illness can lead to reducing the number of illnesses, but also to reducing the number of severe or complicated cases of influenza virus infection.

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Cystic adrenal tumour - A case of atypical abdominal pain

Savulescu F., Nica R., Surdeanu D., Cirlan C., Darmanescu M., Trifu V.
Abstract: Introduction. Adrenal tumours are often discovered incidentally, while a patient is undergoing an imaging examination (abdominal ultrasound, computed tomography, magnetic resonance imaging), for a problem unrelated to the adrenal gland, usually having no signs or symptoms suggesting adrenal disorders. Case report. A female patient was presented for moderate abdominal pain which started 2 month prior to her admission, without having any other signs or symptoms. The usual blood tests came up normal. The abdominal ultrasound revealed a relatively large abdominal cystic mass, possibly belonging to the liver. The CT scan could not certify the origin of the tumour, but located it between the right hepatic lobe and the right kidney. Because of the patients growing pain, diagnostic laparoscopic surgery was performed. The surgery was completed with the excision of the abdominal mass. Results. The patients postoperative progress was positive, with complete pain remission. The histological findings revealed that the abdominal mass was in fact a benign adrenal endothelial cyst. Conclusions. Unusual growing abdominal pain may benefit from diagnostic laparoscopy, especially when imaging procedures fail to offer accurate data. Minimal invasive surgery is the modern gold-standard for adrenal lesion excisions.

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