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Volume XVIII, Number 3, 2014 - Therapeutics Pharmacology and Clinical Toxicology


Current treatment of cardiovascular involvement in Systemic Lupus Erythematosus

Baluta Monica Mariana, Vintila M.M.
Abstract: Systemic lupus erythematosus (SLE) is an acquired connective tissue disease of unknown origin. SLE may determine rheumatic heart disease among many other systemic involvements. Any cardiac structure such as pericardium, myocardium, heart valves, the conduction system and the vasculature may be involved. Cardiovascular involvement may vary from subclinical to clinical with various complications that determine an increased morbidity and mortality in affected patients. The underlying diseases have plurifactorial etiologies among which inflammation plays a key role. Inflammation is a common pathway for rheumatic diseases and atherosclerosis, the main killer of the 21th century. Systemic lupus erythematosus (SLE) is known today as an important nontraditional risk factor for atherosclerosis. The treatment of cardiovascular involvement in SLE patients remains controversial and provocative. Nonsteroidal anti-inflammatory drugs increase the risk for cardiovascular adverse outcome. Even if old-fashioned, corticosteroids represent even today a ″rescue″ therapy for life-threatening SLE related cardiovascular conditions. Despite many controversies in literature about them, no other drug has been proved as safe and as effective as they can be in cardiovascular involvement. Besides the specific SLE treatment, cardiovascular involvements benefit from guideline recommended therapies for specific conditions established by international societies. Proper and early recognition together with aggressive treatment of the underlying rheumatic disease may prevent the development of cardiovascular involvement.

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Original Papers

Identification of some radio-biochemical effects consecutive to boron neutron capture therapy at experimental hepatoma cells

Gale. Laurentia, Gruia Maria Iuliana, Negoita Valentina, Vasilescu Monica, Panait Marieta, Barbos D., Gruia I., Anghel Rodica
Abstract: The purpose of this study is to identify some molecular mechanisms which occur after the boron neutron capture therapy has been applied to experimental hepatoma cells, compared with the normal surrounding tissues. The purpose is to obtain useful data that could improve the biological and biochemical treatment response. Material and methods: We used tumor cells from a chemically induced experimental hepatoma at Wistar rats. The tumor and normal tissue were removed in the dynamic of the growth and development of the tumor, (14, 21, 28, 35 and 42 days after the inoculation).From these tissues we isolated cells and we performed the determination of cell cycle phases, apoptosis and free radicals of oxygen levels. The cells were then irradiated in the prompt gamma device placed at the radial channel of the TRIGA-ACPR reactor from Pitesti-Romania. After the irradiations we reassessed the same parameters. Results and discussions: Our results show an increase of oxidative stress monitored at a higher level from the investigated parameters values. The cells were not identified in the G0 phase of the cellular cycle, instead we identified apoptotic cells (the apoptosis rate increase to 54.75% and 70.42% after 1800 and 2700 seconds irradiation respectively, compared to an initial value of 11.48%), this suggesting the initiation of irreversible bond breakage, irreparable, mediated by oxygen free radicals.

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Antiemetic therapy in hematologic and nonhematologic malignancies

Georgescu G. Daniela, Popescu Mihaela, Tevet Mihaela, Murat Meilin, Nita Gabriela Rahnea, Ciuhu Anda Natalia
Abstract: Nausea is an unpleasant sensation associated with aversion to food and impending feeling of vomiting. Vomiting represent the oral expulsion of gastric contents, and is preceded or not by nausea. In hemato - oncology, there are multiple etiological factors of emesis. The antiemetic measures imply to identify and treat reversible causes. Antiemetic drugs can be classified as: antiemetics acting on the central nervous system and double-acting antiemetics. Chemotherapeutic regimens used in the treatment of hematologic and non-hematologic malignancies are accompanied by a degree of emesis. Corroborating the data in the literature, individualized approach is required in the antiemetic treatment adapted to each patient, current guidelines directing the clinician in deciding on the anti-emetic prophylaxis. We analyzed a group of 17 patients aged between 20 and 83 years, eight men and nine women, undergoing cytostatic chemotherapy for hematological and non-hematologic malignancies, hospitalized in the Hematology Department of Clinical Hospital Colentina and the Department of Oncology and Palliative Care, Chronic Disease Hospital "St. Luke" from Bucharest. Patient selection was based on the type of chemotherapy, being selected mainly patients undergoing moderate or high emetogenic chemotherapy. In Table 1 there are presented patient characteristics: age, sex, diagnoses, type of diet, anti-emetic scheme, the degree of emesis and the occurrence of adverse reactions to antiemetic therapy. There are presented the conclusions on the use of Palonosetron in the analyzed patients (Table 2). The therapy was well tolerated with no significant side effects and the drug efficiency conforms to the data in the literature, both for hematological and non-hematological malignancies. Conclusions: Anti-emetic prophylaxis is a challenge for clinicians. Beyond current developments, nausea and vomiting after chemotherapy are still the major factors affecting quality of life and compliance with treatment. The Scientific Committees of developing international guidelines are being debated on the strict formal recommendations for the use of antiemetics associated to chemotherapy treatments.

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Therapeutical Practice

Over the counter drugs during pregnancy - tips for a correct approach

Abstract: From the viewpoint of pharmaco-therapeutic approach, pregnancy is a period that deserves special consideration. Health care providers face concerns regarding the safety and efficiency of drugs for both mother and fetus. Ethical considerations limit clinical testing during pregnancy, so there is an important lack in safety data. There is a general misconception that all drugs are harmful to the fetus, therefore mothers expose themselves to high risks refusing medication in life threatening medical conditions. On the other hand, although they are readily available, over-the-counter (OTC) drugs should not be used by pregnant women without the physicians advice. While there is a fairly good safety record for some commonly used OTC medication like short-acting NSAIDs, calcium based antacids, Chlorpheniramine, or PPIs, the misuse of others can be harmful to the fetus. Therefore it is very important to always assess that benefits overweight the risks while using OTC drugs during pregnancy.

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Case Report

Diagnosis in acute intoxication with methanol - clinical presentation

Tanasescu Andreea, Macovei R., Ionica M., Tudosie M.
Abstract: Methyl alcohol poisoning usually occurs through accidental ingestion or confusion of the containers. Accidental industrial exposure to methanol vapors could be the cause of poisoning. Methanol is obtained by destructive distillation of wood and used as solvent, antifreeze solvents for paints and additives [1]. We present a patient who was admitted to hospital with a symptomatology limited to eyes and CNS and with mild metabolic acidosis which led to the assumption that the patient ingested methanol. The diagnostic was confirmed by toxicological analysis. The patient ingested concomitant ethanol, overlapping with methanol for alcohol dehydrogenase, the first enzyme in the degradation pathway, with reduction of methanol toxic metabolites of. The presence of methanol metabolites completed the patients clinical picture at the time of presentation at hospital. . The patient showed ocular disorders which persisted after discharge. . It is known that these ocular disorders may still persist 6 month after intoxication and in some instances could be irreversible. The prognosis in methanol poisoning is theoretically good if the treatment is started early, is directly dependending on the severity of intoxication, the time since ingestion of methanol and admission to hospital. A successful medical management is based on early recognition of the extent of methanol metabolites toxicity of in each patient. This assessment is critical in determining the necessity of ADH inhibition and hemodialysis. The antidotal therapy with ethanol is readily available in most hospitals; it is inexpensive, and can be administered orally as well as intravenously.

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Synthetic psychotomimetics substances, falsely associated with phitoterapy, a new presence among the substances of abuse

Avram Oana, Avram Ruxandra, Caragea Gina, Forje Margarita, Truta Elena, Ionica M., Macovei R.A., Voicu V.A
Abstract: In recent years, synthetic psychotomimetic drug abuse has experienced an increasing popularity, especially among young people. The most important enablers to this phenomenon are: easy product purchase, lack of information about the potential threat posed by their consumption and the difficulties of identifying analytes in biological products through simple techniques Thus developing the proper methods to identify these substances has become a priority. m. The expansion in consumption has outlined a complex pathology, given both their psychogenic and addiction effect. Symptoms can often be mistaken for pathology affective disorders. The clinical picture of acute intoxication with synthetic psychotomimeticsfrequently includes major imbalances of vital functions that require urgent remedial measures.

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Radiotherapy in extramedullary solitary plasmacytoma of the nasopharinx

Mitulescu Ruxandra Ortansa, Anghel Rodica, Dumitrache M., Cirjan Adriana, Oprea V., Mitulescu D.
Abstract: Plasmacytomas are monoclonal proliferation of plasma cells. Extramedullary plasmacytoma (EMP) is a rare tumor (3-4% of all plasma cell tumors) that forms in soft tissues. The most common site for EMP is the head and neck (HN) region representing 0,4% of all HN malignant tumors. There are no set guidelines for the management of this disease due to its rarity. For most of the cases radiotherapy is the standard treatment. We present a case of a 41 years old female diagnosed with extramedullary solitary plasmacytoma of the nasopharinx.

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Severe sepsis and meningoencephalitis with Streptococcus Pneumoniae serotype 23F in a 5 year-old child with transethmoidal meningocele and CSF fistula

Draganescu Anca, Bilasco Anusa, Visan Angelica, Negulescu Cristina, Vasile Magdalena, Condria E., Dogaru Cornelia, Slavu Diana, Merisescu Madalina, Luminos Monica
Abstract: Invasive pneumococcal disease (IPD), defined as isolation of Streptococcus pneumoniae from any normally sterile body site, continues to remain a major health problem, especially in the countries where pneumococcal vaccine was not introduced in the national immunization programs. Factors that increase the risk for IPD are young age, chronic conditions like humoral immunodeficiency, functional or anatomic asplenia, the presence of cochlear implants, CSF fistula and in child day care attendance. The most common serotypes involved in IPD were 14, 6B, 19F, and 23F in the pre vaccine era and 1, 19A, 3, 6A, and 7F since the introduction of PCV7. Methods & Results: We report the case of a 5-year-old girl admitted to our clinic with the diagnosis of Severe sepsis with Streptococcus pneumoniae serotype 23F, Severe Meningoencephalitis, with medical record of left trans-ethmoidal meningocele with CSF fistula. Conclusion: We present this case in order to highlight the importance of pneumococcal immunization in preventing serious infections with Streptococcus pneumoniae, especially in patients with increased risk factors for IPD and recurrent bacterial meningitis.

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