Myelin oligodendrocyte glycoprotein antibodies in neuromyelitis optica spectrum disorder.

Neuromyelitis optica spectrum disorder (NMOSD) is a severe inflammatory disease of the central nervous system characterized, in particular, by disabling episodes of optic neuritis and longitudinal extensive transverse myelitis. Its main pathogenic characteristic is the presence of anti-aquaporin-4 antibodies (AQP4-Abs) in the serum of affected patients. However, a proportion of patients with the typical NMOSD phenotype are, in fact, negative (seronegative) for AQP4-Abs and, within this category of patients, a proportion of them instead express antibodies to myelin oligodendrocyte glycoprotein (MOG-Abs). The presence of MOG-Abs in the sera of seronegative NMOSD patients is more frequently associated with monophasic disease and moderate symptom severity, and also appears to predict a better outcome. The present report is a review of the clinical and immunological features of MOG-Ab-positive NMOSD.

A randomized double-blind placebo-controlled trial of low-dose interleukin-2 in relapsing-remitting multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is associated with regulatory T cells (Tregs) insufficiency while low-dose interleukin-2 (IL2LD) activates Tregs and reduces disease activity in autoimmune diseases. METHODS: We aimed at addressing whether IL2LD improved Tregs from MS patients. MS-IL2 was a single-center double-blind phase-2 study. Thirty patients (mean [SD] age 36.8 years [8.3], 16 female) with relapsing-remitting MS with new MRI lesions within 6 months before inclusion were randomly assigned in a 1:1 ratio to placebo or IL-2 at 1 million IU, daily for 5 days and then fortnightly for 6 months. The primary endpoint was change in Tregs at day-5. RESULTS: Unlike previous trials of IL2LD in more than 20 different autoimmune diseases, Tregs were not expanded at day-5 in IL2LD group, but only at day-15 (median [IQR] fold change from baseline: 1.26 [1.21-1.33] in IL2LD group; 1.01 [0.95-1.05] in placebo group, p < 0.001). At day-5, however, Tregs had acquired an activated phenotype (fold change of CD25 expression in Tregs: 2.17 [1.70-3.55] in IL2LD versus 0.97 [0.86-1.28] in placebo group, p < 0.0001). Regulator/effector T cells ratio remained elevated throughout treatment period in the IL2LD group (p < 0.001). Number of new active brain lesions and of relapses tended to be reduced in IL2LD treated patients, but the difference did not reach significance in this trial not powered to detect clinical efficacy. CONCLUSION: The effect of IL2LD on Tregs in MS patients was modest and delayed, compared to other auto-immune diseases. This, together with findings that Tregs improve remyelination in MS models and recent reports of IL2LD efficacy in amyotrophic lateral sclerosis, warrants larger studies of IL2LD in MS, notably with increased dosages and/or modified modalities of administration. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov: NCT02424396; EU Clinical trials Register: 2014-000088-42.

[Splenic angioembolization--a safe, efficient and rational approach]. / Angioembolizarea terapeutica în trauma splenica--eficienta, sigura si rationala.

The authors present a case of postraumatic splenic rupture grade III (AAST-OIS), with injury severity score 10, revised trauma score 7841 managed nonoperatively, by angioembolization, with successful outcome. The indications and different types of splenic angioembolization in trauma are discussed, together with the role of this procedure in increasing the success rate of nonoperative management. Up to our knowledge, this is the first reported case of therapeutic splenic angioembolization in the Romanian medical literature.

The Study of Uropathogenicity Factors for Escherichia Coli Strains.

Urinary tract infection (UTI) is the most common form of extraintestinal Escherichia Coli infection (E.coli), and E. coli is the most common cause of UTI.The aim of this paper is to study the uropathogenicity factors for some strains of E.coli involved in the etiology of UTI and the affiliationof urinary E.coli strains to the serogroups involved in the UTI.We studied 208 strains of E. coli from urine samples sterilely collected from patients with clinical suspicion of urinary tract infection.The study was conducted in Emergency County Hospital Craiova between 2012-2014.Out of the 208 strains of E. coli submitted to the study, 60 strains (28.84%) - MRHA with human red cells, 28 strains (13.50%) - MRHA human red cells and blood red cells MSHA with guinea pigs, and 44 strains (21.12%) - MSHA with guinea pig red blood cells; 76 strains (36.54%) - no hemagglutination. Regarding our study, 42,34% of E.coli strains presented human MRHA putting forward their potential to cause pyelonephritits. The 68 hemolytic strains (37,20%) of urinary E. coli were tested for the production of the cytotoxin, thus obtaining characteristic cytotoxic effect for 26 strains (38.20%) whereas its absence was registered in 42 strains (61.80%). E. coli O6 strains isolated from hospitalized adults are more frequently hemolytic than those isolated from the other groups and MRHA was more common in hemolytic strains of the same group O6). Mannose-resistant hemagglutination is more frequent in strains that develop HLy but do not produce CNF(Cytotoxic Necrotizing Factor), than in strains producing CNF.

Incidence and Antifungal Susceptibility of Candida Albicans Infections.

INTRODUCTION: Candida albicans is the most common inhabitant of the skin, mouth, vagina and gastro intestinal tract of human beings. One of the major reasons for the increase in Candida infection is the development of its resistant strains due to drugs used in the treatment of candidiasis. MATERIALS AND METHODS We studied 4027 samples collected from patients in various wards of the Emergency County Hospital Craiova, Romania between 2014-2015. The specimens were: pharyngeal exsudates, sputum, tracheal secretions, skin secretions, stools, ear secretions, urine, vaginal secretions. All the specimens were transported to the microbiology laboratory and cultured within 3 to 4 h of collection. Among the 4027 samples, 652 showed culture characteristics similar to Candida albicans.The samples were inoculated under sterile conditions using Sabouraud culture media, a medium designed to inhibit bacterial growth and allow the development of fungi. Antifungal Susceptibility Testing was performed by disc diffusion according to CLSI 2014 guidelines using: clotrimazole, ketoconazole, miconazole, econazole, amphotericine B, fluorocytozine, nistatin. RESULTS AND DISCUSSION In our study group the urocultures and dermatological products have a high infection rate, between 100% to 70%, in contrast, we find evidence of secretion ear (3.13%) and the throat swab (9.33%). Various resistant levels were detected against antifungal drugs but, complete resistance to 5 - Fluorocitozina (100%), and the organisms showed highly sensitive to Cotrimazol si Ketoconazol (100%). In the case of Miconazol 256 (39, 26%), Econazol, 215 (32,98%), Amphotericinei B, 230(35,28%). Nystatin 329 (50,46%). CONCLUSIONSElucidating these mechanisms may provide new foundations for antifungal chemotherapy and can present an exciting challenge for the future investigations. Candida albicans infections are present and diverse clinical pathology.

West nile virus surveillance in Romania: 1997-2000.

In response to the 1996 West Nile (WN) fever epidemic that occurred in Bucharest and southeastern Romania, a surveillance program was established. The surveillance system detected 39 clinical human WN fever cases during the period 1997-2000: 14 cases in 1997, 5 cases in 1998, 7 cases in 1999, and 13 cases in 2000. Thirty-eight of the 39 case-patients lived in the greater Danube Valley of southern Romania, and 1 case-patient resided in the district of Vaslui, located on the Moldavian plateau. The estimated annual case incidence rate for the surveillance area during the period 1997-2000 was 0.95 cases per million residents. Thirty-four cases were serologically confirmed, and 5 cases were classified as probable. Twenty-four case-patients presented with clinical symptoms of meningitis (62%), 12 with meningoencephalitis (31%), 1 with encephalitis (3%), and 2 with febrile exanthema (5%). Five of the 39 cases were fatal (13%). Fourteen case-patients resided in rural areas, and 25 in urban and suburban areas, including 7 case-patients who resided in Bucharest. The ages of case-patients ranged from 8 to 76 years with a median age of 45 years. Twenty-four case-patients were males and 15 were females. Dates of onset of illness occurred from May 24 through September 25, with 82% of onset dates occurring in August and September. Limited entomological surveillance failed to detect WN virus. Retrospective sampling of domestic fowl in the vicinity of case-patient residences during the years 1997-2000 demonstrated seroprevalence rates of 7.8%-29%. Limited wild bird surveillance demonstrated seroprevalence rates of 5%-8%. The surveillance data suggest that WN virus persists focally for several years in poorly understood transmission cycles after sporadic introductions or that WN virus is introduced into Romania at relatively high rates, and persists seasonally in small foci.

Entomologic and avian investigations of an epidemic of West Nile fever in Romania in 1996, with serologic and molecular characterization of a virus isolate from mosquitoes.

Between July and October 1996, a West Nile (WN) fever epidemic occurred in the southern plain and Danube Valley of Romania and in the capital city of Bucharest, resulting in hundreds of neurologic cases and 17 fatalities. In early October 1996, entomologic and avian investigations of the epidemic were conducted in the city of Bucharest and nearby rural areas. Thirty (41%) of 73 domestic fowl sampled had neutralizing antibody to WN virus, including 5 of 13 ducks (38%), 1 of 1 goose, 19 of 52 chickens (37%), 1 of 1 peahen, and 4 of 6 turkeys (67%). Seroprevalence in domestic fowl (27%, or 7 of 26) from the urban Bucharest site was not significantly different (P = 0.08, by Fisher's exact test) than rates at three rural sites (50%, or 23 of 46). Serum collected from one of 12 Passeriformes, an Erithacus rubecula, was positive for neutralizing antibody to WN virus. A total of 5,577 mosquitoes representing seven taxa were collected. Culex pipiens pipiens accounted for 96% of the mosquitoes collected. A single virus isolate, RO97-50, was obtained from a pool of 30 Cx. p. pipiens females aspirated from the walls and ceiling of a blockhouse located near the center of Bucharest, resulting in a minimum infection rate of 0.19 per 1,000. Antisera prepared against RO97-50 failed to distinguish among RO97-50, WN virus strain Eg101, and Kunjin (KUN) virus strain MRM16. A 2,323-basepair DNA fragment of the envelope (E) glycoprotein gene from RO97-50 and a Romanian WN virus strain obtained from a human cerebrospinal fluid sample, RO96-1030, were sequenced. Phylogenetic analyses of 23 WN virus strains and one KUN virus strain using the amino acid and nucleotide sequences for a small portion of the E gene suggest the existence of two large lineages of viruses. Bootstrap analysis of the nucleotide alignment indicated strong support (95%) for a lineage composed of WN virus strains from northern Africa, including isolates from Egypt and Algeria, and west, central, and east Africa, all of the European isolates, those from France and Romania, an Israeli isolate, and an isolate of KUN virus from Australia. The nucleotide sequence of RO97-50 was identical to the sequence of a WN virus isolate obtained from Cx. neavei mosquitoes from Senegal and Cx. univittatus mosquitoes from Kenya. The phylogenetic analyses were compatible with the introduction of virus into Romania by birds migrating from sub-Saharan Africa, to northern Africa, and into southern Europe.

Histopathology of the experimental tick-borne encephalitis in mice.

This paper is concerned with the histopathology of the tick-borne encephalitis virus experimental infection in mice. The lesions observed in the kidneys, spleen, myocardium and especially in the encephalon are characteristic of severe vasculitis which could be the first and probably the most important event in the virus-induced encephalitis.

Laparoscopic surgery complications: postoperative peritonitis.

INTRODUCTION: Complications within laparoscopic surgery, similar to classic surgery are inevitable and require immediate actions both to diminish intraoperative risks and to choose the appropriate therapeutic attitude. Peritonitis and hemorrhagic incidents are both part of the complications aspect of laparoscopic surgery. Fortunately, the incidence is limited, thus excluding the rejection of celioscopic methods. Patient's risks and benefits are to be analyzed carefully prior recommending laparoscopic surgery. MATERIALS AND METHODS: This study presents a statistical analysis of peritonitis consecutive to laparoscopic surgery, experience of "Sf. Ioan" Emergency Hospital, Bucharest, and Department of Surgery (2000-2010). RESULTS: There were 180 (0,96%) complicated situations requiring reinterventions, from a total of 18676 laparoscopic procedures. 106 cases (0,56%) represented different grades of postoperative peritonitis. Most frequently, there were consecutive laparoscopic appendicectomia and colecistectomia. During the last decade, few severe cases of peritonitis followed laparoscopic bariatric surgical procedures. CONCLUSIONS: This study reflects the possibility of unfavorable evolution of postoperative peritonitis comparing with hemorrhagic incidents within laparoscopic surgery.

[Preliminary data on possibilities for the early detection of risk for primary liver carcinoma in chronic HBsAg carriers]. / Date preliminare asupra posibilitatilor depistarii precoce a riscului de carcinom hepatic primar la purtatorii cronici de AgHBs.

The investigations on the risk of hepatocarcinogenesis in the HBsAg chronic carriers have suggested that the early detection of primary liver carcinoma requires epidemiological and laboratory follow up of their state of health. The preliminary results of the comparative investigations of 103 HBsAg carriers detected among blood donors and 93 controls without HBsAg are presented. Epidemiological inquiries, clinical examinations and laboratory tests (HBsAg, serum alpha-fetoprotein, alkaline phosphatase, gamma-glutamyltranspeptidase, glutamic-pyruvic transaminase, proteinogram, siderophilin, immunoglobulins M, A, G) were carried out. Elevated levels of alpha-fetoprotein, alkaline phosphatase and gamma- glutamyltranspeptidase were recorded in carriers as compared to controls (38.8% and 86%, respectively). The elevation of the levels of liver damage markers was significantly correlated, in the HBsAg carriers, with the carrier state over 3 years and less with the age-group. In the case of two carriers with elevated levels of alpha-fetoprotein (> 600-> 1,000 ng/ml) ultrasonography confirmed the suspicion of primary liver carcinoma.

Isolation of Bhanja virus in Romania.

The presence of Bhanja virus was notified for the first time in our country in 1986, by the serological study performed on human and domestic animals sera. In 1988 four Bhanja virus strains from Dermacentor ticks were isolated in Alba and Caras-Severin counties. A high percent of domestic animals, originating in this region, presents antibodies to the isolated strains and also to Bhanja virus reference strain.

[Clinico-epidemiologic and laboratory studies of patients with primary hepatocellular carcinoma]. / Investigatii clinico-epidemiologice si de laborator la bolnavi cu carcinom hepatocellular primar.

The investigations carried out in 92 patients with confirmed diagnosis of primitive hepatocellular carcinoma (HCC) have demonstrated that in almost half of them hepatitis was present in their antecedents, indicating the intervention of hepatitis virus in the etiology of this disease. In this context, the primary prophylaxis of primitive HCC is mainly based on the prophylaxis and control of viral hepatitis. As the interval detection-death was in most cases very short (1-2 month), the secondary prophylaxis consisting in performing more of the investigations recommended for the early diagnosis of primitive HCC is essential.

[Epidemiological and laboratory observations on viral hepatitis morbidity in child social welfare institutions]. / Observatii epidemiologice si de laborator asupra morbiditatii prin hepatita virala in institutii de asistenta sociala a copiilor.

The investigations revealed that in the interval 1978-1987 the mean incidence of viral hepatitis type B in children was 40 at 100,000 inhabitants as compared to 767 in the children from orphanages. In 27.5% of the cases, the children from orphanages, with or without HBs antigen, had viral hepatitis in their case history. The prevalence of AgHBs carriers was of 21.6%, the highest value (46.1%) being recorded in the children from orphanages in the age group 0-3 years. It was also found that 14.9% of the children had AgHBs when admitted to orphanage and 28.7% became carriers later on. It is suggested that in children homes there are conditions for an increased risk requiring special measures for viral hepatitis prophylaxis and control.

Our experience in viral hepatitis (VH) immunoglobulin prophylaxis.

Two experiments on 72 888 children, out of which 36 270 received standard immunoglobulins (IG) and another 36 618 represented the control group, were carried out. IG was administered preventatively, during autumn before the occurrence of the annual peak, and in focus after contact with VH patients. Prophylactic IG administration led to a 4-14 fold decrease in the incidence of icteric VH as compared with controls, and to the disappearance of the peak characteristic of autumn-winter. The efficacy lasted for 5-6 months. The incidence of subclinical VH forms--as evaluated by clinical examinations and SGPT was about 3 times lower in IG pre-exposure recipients. In the group of children where IG was administered only to the contacts in epidemiological foci, the incidence of icteric VH remained as high in the controls and the incidence of subclinical VH forms was twice as high in the controls.

[Epidemiological investigations among the viral hepatitis contact in a close children collectivity]. / Investigatii epidemiologice printre contactii de hepatita virala dintr-o colectivitate închisa de copii.

The results of the clinico-epidemiological and laboratory (TGP, tymol and HBsAg) investigations carried out in 164 contacts of an icteric case of viral hepatitis from a creche type children collectivity are presented. A wide spread of the infection, expressed by subclinical forms of disease identified on the basis of the alterations of TGP and their dynamics (27.4%) was pointed out. The increased incidence of HBsAg carriers and the correlation with the TGP increased values allowed the conclusion that the infection was caused by the hepatitis virus type B. The epidemiological investigation established that the infection was transmitted by direct contact favoured by children's close physical contact.

Investigations on the efficacy of two schemes of standard gammaglobulin administration in the prevention of viral hepatitis.

Prophylactic administration of standard gammaglobulin (G) to over 5,000 children led to a more than 6-fold decrease in the incidence of icteric viral hepatitis (V.H.) as compared with the control group and to the disappearance of the autumn--winter epidemic peak. A 3-fold decrease in the incidence of subclinical forms was also achieved. In another group of 5,000 children G was only given to contacts in epidemic foci; the incidence of icteric V. H. was similar to that recorded in controls, while subclinical forms were 2 times more frequent in children having received G after the infectant contact.

[Studies regarding the chronicization potential of viral hepatitis in children]. / Cercetari privind potentialul de cronicizare a hepatitei virale la copii.

Out of 205 children, former patients with viral hepatitis, investigated after the end of the follow-up period by clinical and laboratory examinations, 9 (4.4%) presented mild or moderate pathological alterations. At the second control, carried out after an another interval de 1-1½ years, the pathological alterations were refound only in 2 of the former patients, suggesting that all the others presented lasting forms of acute viral hepatitis evolving towards healing. The presence of AgHBs and the alteration of proteinogramme in the acute phase of VH can serve as criteria of unfavourable prognosis of the disease evolution and impose a preferential follow-up of this category of patients.