Increased integrated testing for HIV, hepatitis C and sexually transmitted infections in health care facilities: results from the INTEGRATE Joint Action pilots in Lithuania, Romania and Spain.

BACKGROUND: Indicator condition guided HIV testing is a proven effective strategy for increasing HIV diagnosis in health care facilities. As part of the INTEGRATE Joint Action, we conducted four pilot studies, aiming to increase integrated testing for HIV/HCV/HBV and sexually transmitted infections, by introducing and expanding existing indicator condition guided HIV testing methods. METHODS: Pilot interventions included combined HIV/HCV testing in a dermatovenerology clinic and a clinic for addictive disorders in Lithuania; Increasing HIV testing rates in a tuberculosis clinic in Romania by introducing a patient information leaflet and offering testing for HIV/HCV/sexually transmitted infections to chemsex-users in Barcelona. Methods for implementing indicator condition guided HIV testing were adapted to include integrated testing. Testing data were collected retrospectively and prospectively. Staff were trained in all settings, Plan-do-study-act cycles frequently performed and barriers to implementation reported. RESULTS: In established indicator conditions, HIV absolute testing rates increased from 10.6 to 71% in the dermatovenerology clinic over an 18 months period. HIV testing rates improved from 67.4% at baseline to 94% in the tuberculosis clinic. HCV testing was added to all individuals in the dermatovenerology clinic, eight patients of 1701 tested positive (0.47%). HBV testing was added to individuals with sexually transmitted infections with a 0.44% positivity rate (2/452 tested positive). The Indicator condition guided HIV testing strategy was expanded to offer HIV/HCV testing to people with alcohol dependency and chemsex-users. 52% of chemsex-users tested positive for ≥ 1 sexually transmitted infection and among people with alcohol dependency 0.3 and 3.7% tested positive for HIV and HCV respectively. CONCLUSIONS: The four pilot studies successfully increased integrated testing in health care settings, by introducing testing for HBV/HCV and sexually transmitted infections along with HIV testing for established indicator conditions and expanding the strategy to include new indicators; alcohol dependency and chemsex. HCV testing of individuals with alcohol abuse showed high positivity rates and calls for further implementation studies. Methods used for implementing indicator condition guided HIV Testing have proven transferable to implementation of integrated testing.

Effect of dietary chromium supplementation on meat nutritional quality and antioxidant status from broilers fed with Camelina-meal-supplemented diets.

Poultry meat is a valuable source of nutrients and the enrichment with health-promoting substances such as polyunsaturated fatty acids (n-3 PUFA) is an important factor for consumers' choice. Camelina meal (Camelina sativa) is an animal feedstuff used to achieve this goal, but the administration of n-3 PUFA-enriched diets in broiler nutrition can accelerate the oxidative processes in meat leading to a decreased quality of final product. The aim of this study was to investigate the effect of the organic Cr as chromium picolinate (CrPic) on meat quality, fatty acid profile of fat and oxidative stability of meat from broilers fed supplemented dietary Camelina meal. An experiment was conducted on 240 Ross 308 broiler chicken aged 14 days which were assigned to 6 dietary treatments in a randomized complete block design with a 2 × 3 factorial arrangement. Within the treatment arrangement two concentrations of Camelina meal (0% and 3%) and three concentrations of Cr3+ (0, 200 and 400 µg/kg) were used. Dietary treatments were: (1) Control diet (C) containing a corn-soybean diet with no added Camelina meal or Cr3+; (2) a C diet containing an additional 200 µg/kg of Cr3+ as CrPic; (3) a C diet containing an additional 400 µg/kg of Cr3+ as CrPic; (4) a C diet containing an additional 3% Camelina meal; (5) diet 2 containing an additional 3% Camelina meal; (6) diet 3 containing an additional 3% Camelina meal. Chromium supplementation significantly (P<0.05) increased the CP concentrations and significantly (P<0.05) decreased the crude fat concentrations in breast samples. The Camelina meal groups presented higher values of unsaturated fatty acids, particularly n-3 fatty acids (P<0.05). In CrPic groups, increased retention of Zn and Fe (P < 0.05) was observed in breast samples, compared to control group, and thiobarbituric acid reactive substances values were significantly (P<0.05) smaller. Myoglobin fraction (metmyoglobin and oximyoglobin) concentrations differ significantly (P<0.05) from the control group, under the influence of Cr3+ supplements. This study found that broilers fed with CrPic supplements showed improved mineral composition and oxidative stability of breast meat, proving an effective protection of lipid molecules from oxidation in PUFA-enriched meat.

Tuberculosis remains a public health problem in Romania.

BACKGROUND: Tuberculosis (TB) remains a major public health problem in Romania, which has the highest TB incidence in the European Union. METHODS: We undertook a retrospective study to describe changing trends in the main epidemiological indicators of TB in Romania from 1995 to 2016. Data were obtained from the Marius Nasta Institute of Pneumology, Bucharest, official data published by the National Center for Public Health Statistics and Informatics in Health Statistics Yearbooks, the European Health For All database and the World Health Organization 2017 global TB report. RESULTS: Overall TB notifications in Romania declined after 2002, from 142.2 to 74/100 000 in 2016. For new TB cases, the incidence declined after 2002, from 118.9 to 54.5/100 000 in 2016. After peaking in 2002, at 23.3/100 000, the notification rate of relapses declined to 11.8/100 000 in 2014, but almost doubled the following year. The number of multidrug-resistant TB cases decreased from 624 in 2009 to 530 in 2012, but then increased to 670 in 2015. The number of extensively drug-resistant TB cases tripled between 2012 and 2015, from 22 to 68 cases. CONCLUSION: Although the decline in TB nationwide after 2002 confirms the effectiveness of control measures, the current TB burden in Romania remains very high by European standards.

Therapy Side Effects in Systemic Lupus Erythematosus.

Glucosteroids (GS) are widely used drugs for various inflammatory pathologies (Nephrotic syndrome, Proliferative glomerulonephritis, Extramembrane glomerulonephritis, Nephropathy of the Nodous Poliarterita (PAN), Nephropathy from purple Henoch-Schonlein, lupus nephropathy (LN), Acute adrenal insufficiency Waterhouse-Friederichsen, Chronic adrenal insufficiency Addison, Systemic Lupus Erythematosus (SLE), Polymyositis and dermatomyositis, Chronic granulomatosis, Crohn's disease, Hemorrhagic rectocolitis, Hemolytic anemias, Acute leukemias and chronic lymphocytic leukemia, Hodgkin's lymphoma). Although they are prescribed for their anti-inflammatory and immunosuppressive properties, they also have many side effects, hyperglycemia being one of the most common and representative, which is why these drugs need careful monitoring when administered over the long term. This paper presents the case of a 39 year old patient diagnosed with systemic lupus erythematosus (SLE) with class IV lupus nephropathy (LN) who developed numerous complications due to the pathogenic side effects: diabetes, amenorrhea, recurrent infections, and depression.

Left Pleuropericardial Cyst.

INTRODUCTION: Cysts of the mediastinum, which are benign masses, are usually detected by chance, and constitute a small but important diagnose group, representing 7 to 18% of all primary mediastinal tumors. Pleuropericardial cysts, located most frequently in the left anterior and inferior mediastinum, are identified in the fourth or fifth decade of life affecting females more than males with a sex ratio of 8:4. MATERIAL AND METHOD: We present the case of a 52 year old woman diagnosed with pericardial cyst located in the left cardiophrenic angle. CPP was rather big and was initially diagnosed as encysted pleurisy. Ultrasound guided exploratory thoracentesis was performed evacuating 300 ml "water spring" like fluid very scarce in cells. We further investigated our patient for differential diagnosis but the patient refused surgery and she is now managed conservatively with a close follow-up. CONCLUSIONS: A pericardial cyst should always be suspected when a cystic lesion is detected in the mediastinum. Pleuropericardial cysts are usually suspected after an abnormal chest X-ray is obtained. If the patient is asymptomatic and the information provided by CT indicates a benign tumoral process suggestive for a pleuropericardial cyst, conservative management with careful follow-up is justified.

Profile of Respiratory and Extra-Respiratory Tuberculosis in Patients Living with HIV in Dolj County between 2005-2015.

INTRODUCTION: Tuberculosis (TB) is the commonest and the deadliest opportunistic infection in patients living with HIV/ AIDS. PURPOSE: The paper aims to assess patients with and without TB-HIV coinfection in Dolj county registered in Regional and National database in order to identify risk factors for progression to active TB for immunodepresive patients. MATERIAL AND METHOD: We performed a retrospective descriptive study using records of 336 patients infected with HIV (PIH)-data from medical charts between 2005-2015 and we compared with the data for 1120 patients without HIV between 2005-2012. RESULTS: 64,1% were females and 35,89% were males. Most cases were from rural areas (61,54%) most of them graduating primary (17,94%) and secondary school (48,71%). Most of them don't have a job (87%) and are supported by state with a monthly miminum income. Majority is born between 1980-1990 (64,1%), with predominance of Romanians (92.31%) compared to the Roma. Regarding all TB diagnoses (pulmonary and extrapulmonary) 117 had at least one episode of active TB. TB and HIV have been diagnosed almost at the same time in 25,64% cases. At the time of TB diagnosis 87% of patients had CD4+lymphocytes count <200cel/ml. We also noticed the absence of prophylaxis for TB in PIH, high incidence of hepatitis B among those with HIV/TB coinfection (34%). CONCLUSIONS: Active TB in patients with HIV infection is correlated with severe immunosuppression, poor education, and atypical clinical expression and radiological findings and more cases of extrapulmonary TB.

Rare Case of Pulmonary Tuberculosis with Hematogenous Spread to Larynx and Skin.

INTRODUCTION: Tuberculosis is an infectious disease with various clinical and radiological symptoms which are determined primarily by the immune system of the host towards the infection with Mycobacterium tuberculosis. The infection with M. tuberculosis can be limited to an organ or it can spread through hematogenous or lymphatic route to other organs (especially cases of younger or older people). Tuberculosis always needs bacteriological or histopathological confirmation. Matherial and method: We present the case of a 62 year old woman investigated and treated in our Hospital in 2009-2010 for Pulmonary tuberculosis complicated with Laryngeal Tuberculosis and Skin Tuberculosis (confirmed by histopathological exams). We intend to focus our case report on the cutaneous form of tuberculosis because of its rareness and clinical interest. CONCLUSIONS: Cutaneous tuberculosis is a very rare form of extrapulmonary tuberculosis and can be highly variable in its clinical appearance, significance and prognosis. Lesions of the skin are a real challenge for dermatologists. The treatment of cutaneous tuberculosis in most cases is the same as for pulmonary tuberculosis leading to regression and healing of the skin lesions.

Lung Involvement in Multiple Myeloma - Case Study.

INTRODUCTION: Mutiple mieloma (MM) cells are rarely found in extramedullary sites. The sites of extramedullary dissemination reported in the literature are spleen, liver, lymph nodes, kidneys, thyroid gland, adrenal gland, ovary, tests, lung, pleura, pericardium, intestinal tract and skin. We report a case in which the myeloma was diagnosed after we discovered the presence of monoclonal plasma cells in the bronchoalveolar lavage fluid (BAL). Matherial and method: a case in which diagnosis was established from bronchoalveolar lavage (BAL) fluid demonstrating the presence of monoclonal plasma cells in Craiova Pneumology Departament. RESULTS: Analysis of BAL fluid for the presence of plasma cells and for cytoplasmic immunoglobulin DNA provides a noninvasive means of establishing the diagnosis. CONCLUSIONS: Pulmonary parenchyma is an uncommon site of extramedullary involvement in multiple myeloma. Interstitial lung disease as pulmonary manifestation of multiple myeloma is even rarer; only isolated cases with histological proofs have been reported in the literature.

Histological changes of gingival epithelium in diabetic patients with periodontal disease.

UNLABELLED: The pathogenesis of the periodontal disease is complex, because it derives from the initiation and maintenance of the chronic inflammatory process by the plenty microbial flora and its numerous bacterial products. The purpose of our study was to make evidence of the histopathological changes occurring in the gingival epithelium in patients with both diabetes mellitus and periodontal disease. MATERIALS AND METHODS: Our study was carried out on gingival tissue from 68 diabetic patients with specific symptoms of periodontitis. The preparations were processed by Hematoxylin-Eosin staining technique and trichromic staining after the Goldner-Szekely method. RESULTS: Although non-specific, since they have been generally found in chronic gingival inflammation, the noticed changes were significant and some of them had specific aspects for the diabetic patients: gingival epithelium changes like acanthosis type; the presence of inflammatory cells such as polymorphonuclear leukocytes and/or lymphocytes among the cells of the stratified squamous epithelium; surface ulceration areas covered by hematic and fibrino-leukocytary detritus; the epitheliocytes keratinization in the superficial layers. CONCLUSIONS: The diabetic patients with periodontitis frequently associate hypertrophy changes of the gingival epithelium with the epithelial permeability alteration and the presence of the intraepithelial inflammatory cells, subsequently leading to degenerative lesions and epithelial ulceration.

Tuberculosis mesenteric adenopathy and polyserositis.

A 41-year-old female patient was admitted into Surgery Clinic accusing abdominal pain, diarrhea, fever and chills. Based on clinical, biological and imaging data, it was established a diagnosis of pelviperitonitis and it was initiated an antibiotic and anti-inflammatory treatment. As fever and abdominal pain continued, it was decided to go on with surgery that revealed suppurated and perforated mesenteric adenopathy. Pus was sampled for bacteriological exam and also biopsy was performed for pathological exam. The result of pathological exam was suggestive for a specific granulomatous lesion (TB lesion). It was established diagnosis of TB mesenteric adenopathy and it was initiated specific anti-TB treatment according to WHO guidelines. After three, respectively five months of treatment, patient developed a right laterocervical adenopathy that fistulized in both cases, despite the correct treatment administered. No resistant TB strain and no atypical mycobacteria was discovered.

Fractal-like kinetics, a possible link between preconditioning and sepsis immunodepression. On the chemical basis of innate immunity.

In a recent paper the authors hypothesized that the so called fractal-like enzyme kinetics of intracellular reactions may explain the preconditioning effect in biology (Vasilescu C, Olteanu M, Flondor P, Revue Roumaine de Chimie. 2011; 56(7): 751-7). Inside cells the reaction kinetics is very well described by fractal-like kinetics. In the present work some clinical implications of this model are analyzed. Endotoxin tolerance is a particular case of preconditioning and shows similarities with the immunodepression seen in some sepsis patients. This idea offers a theoretical support for modulation of the enzymatic activity of the cell by changing the fractal dimension of the cytoskeleton.

How relevant are in vivo and in vitro studies for clinical sepsis? A mathematical model of LPS signaling based on endotoxin tolerance.

The goal of this paper is to explain: (1) the low-level TNF-alpha concentration in some septic patients and (2) the relevance of the in vivo and in vitro models of endotoxin tolerance for the clinical sepsis. We hypothesized that the low level of TNF-alpha concentration in septic patients can be understood, at least in part, by two particularities of these patients: the kinetics of LPS plasma levels and the existence of a "endotoxin tolerance-like phenomenon" (a particular type of down regulation of LPS signaling). The kinetics of TNF-alpha, as expression of the cytokine releasing capacity, was modeled considering LPS as a command (function of time) and the existence of a brake system (a summation of the down regulating factors of LPS signaling). The mathematical model, based on Michaelis-Menten (Hill) equations, is a non-autonomous first-order differential system of two equations with two unknowns describing the dynamics of TNF-alpha concentration and of the brake system, LPS being considered as an input. To test the above model four scenarios concerning the LPS signaling were considered TNF-alpha dynamics 1) following a single LPS stimulus 2) in in vivo experiments 3) in in vitro experiments and 4) in clinical sepsis. Our hypothesis, that in LPS signaling the kinetics of LPS as well as the existence of an endotoxin-like phenomenon are crucial features, may explain the contradictory data obtained in in vitro, in vivo experimental studies and in sepsis patients.

Total cardiovascular risk estimation in Romania. Data from the SEPHAR study.

OBJECTIVE: of this sub-study was to assess the impact of major CV risk factors on mortality due to CV diseases among Romanian adult subjects using the SCORE System. STUDY DESIGN AND SETTING: In 2005, a survey for CV risk factors (SEPHAR) was performed in Romania involving 2017 subjects aged over 18 yrs, a representative sample for the Romanian adult population. Romania's area was divided into ten regions recommended by The National Commission of Statistics. We evaluated the relationship between gender, age, smoking status, systolic blood pressure and total cholesterol and cardiovascular risk. Ten year risk of fatal cardiovascular disease was estimated according to the SCORE (Systematic COronary Risk Evaluation) System. RESULTS: Average total risk in Romanian adult population was 3.5%. Male population had a significantly higher risk than females (5.4% vs. 1.7%, p<0.01). About one fifth of subjects (20.7%) had a high risk > or = 5%. Four percent of subjects (all males) had a very high risk > or = 15%. The CV risk was relatively homogeneously distributed between Romania's geographic regions. The prevalence of hypercholesterolemia as CV risk factor was high (40%), and also was the prevalence of high systolic blood pressure (36.6%). The prevalence of smoking was similar to other European countries (27%). CONCLUSION: Our study showed Romania as a country with a high cardiovascular risk, being also one of the regions in Europe with the highest CV risk.

The pattern of protein and energy retention and the chemical composition of the body in White Leghorn pullets.

The change of body composition, energy content and energy and protein balance was studied in White Leghorn pullets from hatching to 140 days of age. The animals received corn, soybean meal and fish meal based diets ensuring maximal growth. Correlations were established between ingested feed and body weight gain both from the point of view of quantity and quality, determining the content of protein, fat, ash, water and energy in the total body and in feathers, separately. On the basis of digestibility and comparative slaughtering the energy and protein requirements for maintenance and for protein and fat retention were calculated. The obtained results can be utilised to develop a mathematical model for energy and protein retention in growing White Leghorn pullets.

The pattern of nutrient and energy utilization, retention and the chemical composition of the body in broilers from hatching to maturity.

The change of the body composition, of the energy content, and of the energy and protein balances was studied in male and female broiler chicks from hatching to maturity (about 140 days). The animals received corn, soybean meal and fish meal based diets which ensured maximal growth. Correlation were established between the ingested feed and the body evolution both from the point of view of quantity and quality, determining the content of protein, fat, ash, water and energy. By experiments of digestibility and by comparative slaughterings the energy and protein requirements both for maintenance and for protein and fat synthesis were determined.

[Variable pressure changes (+/-) in the anterior ischemia syndrome--the elements of a reserved prognosis in the surgery of retinal detachment]. / Modificari tensionale variabile (+/-) din sindromul de ischemie anteriora--elemente de prognostic nederivat în chirurgia dezlipirii de retina.

The authors show that the variations of intraocular hyper- and hypotension stand for a reserved prognosis in the evolution of the operated retina detachment. Likewise, they consider that the repeated operations in the retina detachment may lead to the syndrome of anterior ischemia, unfavourable to the visual function.

[Trends in automation at the ophthalmology clinic]. / Tendinte de automatizare în clinica oftalmologica.

The authors report on the automation of an ophthalmologic clinic that includes the following steps: a) electronic, information, automation networks in certain departments of the clinic; b) integration of all the important tasks in a system that ensures a certain functional framework to the clinic (electronic clinic); c) inclusion of the ophthalmologic clinic in an all-country information specialty system; d) establishment of international information links in the field of ophthalmology.

[The 1987/1988 new developments in drug therapy in ophthalmology]. / Actualitati 1987/1988 în terapia medicamentoasa în oftalmologie.

The authors present some of the most important data in medicamentous therapy in ophthalmology.