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Volume XVIII, Number 4, 2014 - Therapeutics Pharmacology and Clinical Toxicology


Antiplatelet therapy in ST elevation myocardial infarction

Dumitrescu S.I., Cristian G., Nicolaescu Tania, Preda Ana Maria, Voicu V.
Abstract: Antiplatelet therapy in ST elevation myocardial infarction represents the cornerstone of adjuvant pharmacological measures in order to increase the patency of infarct related artery and to obtain myocardial reperfusion. Additionally, there is the most important available treatment for maintaining the results of primary percutaneous coronary interventions and preventing the stent thrombosis. The widespread research in the field resulted in the last few years in the development of new molecules that have solid clinical evidence. Aspirin remains the unchallenged partner of the new antiplatelet agents, being recommended in all patients with acute coronary syndrome with ST segment elevation, regardless of the therapeutic approach chosen. Clopidogrel was surpassed in the clinical trials by the new antiplatelet drugs (ticagrelor and prasugrel) but it should be noted that none of this more potent agents should be used in patients with previous stroke or in patients with moderate to severe liver. The optimal duration of dual antiplatelet treatment and reduction of bleeding risk remain challenging issues, where decision should be individualized.

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Original Papers

Second generation H1 antihistamines and quality of life in patients with persistent allergic rhinitis

Bocsan Ioana Corina, Bujor Ioana Adriana, Negulescu V., Deleanu Diana, Buzoianu D. Anca
Abstract: The aim of the study was the assessment of quality of life in patients with persistent allergic rhinitis (PAR) and their response to H1 antihistamine treatment. Material and methods: 85 patients (mean age 29.91±9.93 years) with PAR were included in the study. All the patients had skin prick tests to common inhalant allergens. Patients were clinically evaluated regarding the presence and intensity of rhinitis symptoms. Based on the total symptoms score the severity of the disease was established. The quality of life was measured based on RQLQ questionnaire. Both evaluations were applied before and after a 4-week treatment with Desloratadine 5 mg/day or Levocetirizine 5 mg/day. Results: 71.76% of the patients had moderate severe forms of allergic rhinitis. 27.1% of the patients were sensitized only to indoor allergens, 20% were sensitized to different types of pollen, while 52.9% of them had double sensitization (pollens and indoor allergens). TSS was significantly higher in patients sensitized to pollen and in those with dual sensitization (indoor and outdoor allergens) (p = 0.026). Sneezing and itchy eyes were significantly more severe than in those with allergic rhinitis induced by indoor allergens (p=0.004, p=0.015). Impaired quality of life is perceived more intensely by patients with allergic rhinitis due to pollen or in those who are both allergic to pollen and indoor allergens (p=0.06), especially the impairment of daily activities and emotional state. Levocetirizine and Desloratadine significantly improved all the symptoms and patients¢ quality of life. In patients with PAR, in terms of symptoms and quality of life improvement there is no difference between compounds. Conclusions: Persistent allergic rhinitis affects the quality of life of patients. Second generation H1 antihistamines relieve the symptoms of allergic rhinitis and improve the quality of life. RQLQ could be another tool for disease assessment and treatment response.

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Results obtained from the association of boron neutron capture therapy with Bevacizumab

Gales Laurentia, Anghel Rodica, Gruia Maria Iuliana, Negoita Valentina, Vasilescu Monica, Panait Marieta, Barbos D., Gruia I.
Abstract: The angiogenesis process represents one of the most optimised biological processes in the hu-man body. With our experiment we aimed to explore the oxidative stress route as enabler of angiogenesis inducing signal pathways. We materialized this scenario by using a lot of experimentally induced RS-1 hepatoma cells carrier animals that we treated with an angiogenesis inhibitor and, in a later phase, with BNCT irradiation. The serum was processed by centrifugation in view of determining the oxidative stress parameters, while cells from the tumour tissue were collected with the purpose to establish apoptosis through flow-cytometry. Results obtained from flow cytometry measurements indicate the occurrence of apoptosis after a second course of Bevacizumab. After a first round of Bevacizumab, apoptosis increased from 9.12% to 20.14% but dropped to 12.05% following BNCT administration. These results highlight an expansion in the oxidative metabolism, at the level of the tumour tissue, compared to values registered after serum determination. The administration of an anti-angiogenic compound triggers lower oxygen and nutrients flow thus determining a slower lipid peroxidation reaction. Even in the context of oxygen intake limitation it turned out that the albumin thiols’ value in the tumour tissue augments. Ceruloplasmin is not expressed in the murine tumour tissue. The obtained values lead to several conclusions, namely: oxygen reactive species are secondary signalling messengers for the initiation of vital biochemical reac-tions; when produced in small quantities they will have an active participation in the signalling cascade but when they come in large concentrations they become destructive effectors and thus can be used in the monitoring of radiation therapy.

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Therapeutical Practice

Pneumococcal vaccination in patients with high risk for invasive pneumococcal disease

Draganescu Anca, Luminos Monica, Visan Angelica, Bilasco Anuta, Negulescu Cristina, Dogaru Cornelia, Slavu Diana, Streinu-Cercel A.
Abstract: Streptococcus pneumoniae is a major pathogen involved in nasopharyngeal colonization and severe invasive disease like meningitis, bacteremia and pneumonia, especially in children < 5 years of age and adults ≥ 65 years of age, for whom routine pneumococcal vaccination is recommended. Other patients with high risk for invasive pneumococcal disease are those with congenital or acquired immunodeficiency, CSF fistula, cochlear implant, chronic diseases or malignancy, for whom specific and well defined pneumococcal vaccination is recommended. In 2013 the Advisory Committee on Immunization Practices (ACIP) recommended the expanded use of PCV 13 for children aged 6-18 years with immunocompromising conditions, functional or anatomical asplenia, CSF fistulas or cochlear implants. For children aged 2-5 years with these conditions the recommendation for the use of PCV 13 was published in 2010.

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Therapeutical approach and prognostic factors in chronic myeloid leukemia

Patrinoiu Oana
Abstract: Chronic myeloid leukemia is one of the most studied malignancy and also a very successful model of targeted oral therapy in cancer. Over the last decade, the majority of chronic phase CML patients treated with tyrosine kinase inhibitors (TKIs) enjoy excellent overall survival and disease-free survival. In the TKI era, complete cytogenetic response (CCyR) stands firmly as a response milestone affording critical protection against transforming disease. The odds of CCyR (0 Ph+ metaphases) at 12 or 18 month of treatment are lower for patients with higher Sokal risk score but once achieved it improves outcome. Also, a small increase of BCR-ABL transcript level at patients that achieved and maintain CCyR does not necessarily mean a change of therapy but a more careful follow-up. Allo-HSCT remains a vital therapeutic approach for patients with CP-CML that fail TKIs treatment and also for those diagnosed in a more advanced phase of disease.

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Case Report

Small cell neuroendocrine thyroid carcinoma

Mitulescu Ruxandra Ortansa, Anghel Rodica, Dumitrache M., Cirjan Adriana, Oprea V., Mitulescu D.
Abstract: Extrapulmonary small cell neuroendocrine carcinomas are defined by the presence of the small cell cancer in the absence of any evidence of primary lung cancer. We present the case of a 51 years old female that was diagnosed with primary thyroid small cell neuroendocrine carcinoma. After thyroid biopsy was performed, the histological and IHC profiles revealed a small cell neuroendocrine tumor with, with positive reaction to synaptophysin, chromogranin, cytokeratin 7. The negative reaction to TTF-1, thyroglobulin, calcitonin and further investigations (PET-CT, brain MRI, bronchoscopy) exclude primary lung carcinoma, thyroid carcinoma (differentiated or medullary types) and distant metastasis. After 6 Cisplatin-Etoposide cycles, poor disease response was found. Radiotherapy was performed with favourable results. The team managing the case chose to follow the guidelines for primary thyroid carcinoma in delineating the treatment volumes and the small cell lung cancer guidelines for dose and fractionation schedule. Due to its rarity, primary thyroid small cell neuroendocrine carcinoma poses a challenge for physicians because there are no set guidelines for the management of this disease.

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