Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis.

AIMS: This meta-analysis aims to compare the diagnostic performance of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in the assessment of liver fibrosis using liver biopsy (LB) as 'gold-standard'. METHODS: PubMed, Medline, Lilacs, Scopus, Ovid, EMBASE, Cochrane and Medscape databases were searched for all studies published until 31 May 2012 that evaluated the liver stiffness by means of ARFI, TE and LB. Information abstracted from each study according to a fixed protocol included study design and methodological characteristics, patient characteristics, interventions, outcomes and missing outcome data. RESULTS: Thirteen studies (11 full-length articles and 2 abstracts) including 1163 patients with chronic hepatopathies were included in the analysis. Inability to obtain reliable measurements was more than thrice as high for TE as that of ARFI (6.6% vs. 2.1%, P < 0.001). For detection of significant fibrosis, (F ≥ 2) the summary sensitivity (Se) was 0.74 (95% CI: 0.66-0.80) and specificity (Sp) was 0.83 (95% CI: 0.75-0.89) for ARFI, while for TE the Se was 0.78 (95% CI: 0.72-0.83) and Sp was 0.84 (95% CI: 0.75-0.90). For the diagnosis of cirrhosis, the summary Se was 0.87 (95% CI: 0.79-0.92) and Sp was 0.87 (95% CI: 0.81-0.91) for ARFI elastography, and, respectively, 0.89 (95% CI: 0.80-0.94) and 0.87 (95% CI: 0.82-0.91) for TE. The diagnostic odds ratio of ARFI and TE did not differ significantly in the detection of significant fibrosis [mean difference in rDOR = 0.27 (95% CI: 0.69-0.14)] and cirrhosis [mean difference in rDOR = 0.12 (95% CI: 0.29-0.52)]. CONCLUSION: Acoustic radiation force impulse elastography seems to be a good method for assessing liver fibrosis, and shows higher rate of reliable measurements and similar predictive value to TE for significant fibrosis and cirrhosis.

Giant primary splenic hydatid cyst in a rural patient from southwestern Romania: a rare presentation of the hydatid disease.

Echinococcosis or hydatid disease is a parasitic zoonosis acquired by humans through ingestion of viable helminthic eggs of Echinococcus sp. with their food. A hydatid cyst of the spleen is a rare condition, commonly reported in 0.5-8% of patients with echinococcosis. We aim to describe herein an interesting and rare case of splenic hydatid disease diagnosed in a 34-year-old female patient residing in a rural area from Romania, a country endemic for this disorder. The therapy consisted of total splenectomy, and the postsurgical evolution was favorable.

Epizootiology of trichinellosis in pigs and wild boars in Western Romania, 1998-2011.

This article reports for the first time data regarding trichinellosis in sacrificed animals (domestic pigs and wild boars) inspected during the period from January 1998 to November 2011 in the largest of the Romanian counties. The data were collected from the Veterinary Public Health Department of Timis County. A total of 5,586,431 domestic pigs on farms, 609,325 pigs in private households, and 823 wild boars were examined during the study period. The results indicated that 681 domestic pigs (0.01%) on farms and 407 pigs in private households (0.07%) were found to be infected with Trichinella. Regarding wild boars, infection was detected in only 4 animals (0.5%). Although no infected animals have recently been identified during routine examinations (2009-2011), human outbreaks continue to occur yearly, and the main factors for these include improper handling by the population.

Cystic echinococcosis in Arad County, Romania.

Cystic echinococcosis (CE) is a major parasitosis in Romania, a country where in the past at least one person from 45.5% of its localities underwent surgery for this disease. This survey aimed to provide new epidemiological and clinical data regarding human cases of CE in a western Romanian county. We have retrospectively investigated the medical records of the patients with CE hospitalized during the period of 2004-2010 in the surgical sections of Arad County. A total of 79 patients aged 5-88 years (mean age: 35.9±20.1 years) were diagnosed with CE during the study period. The average yearly incidence was 2.4 cases per 100,000 inhabitants, and the majority of the patients (29.1%) were aged 0-19 years. Most of the adult cases (≥18 years) were people with limited formal education (laborers) (45.6%). The analysis for trend showed an overall decrease in the affected persons over the study period (R(2)=0.66, p=0.026). Hepatic localizations of the hydatid cysts predominated within the study group (73.4%). Only 21.5% of the diseased presented complications and the mean length of hospital stay was 16.2±10.9 days. Eosinophilia of at least 10% of the leukocyte value occurred in 14% of cases and leukocytosis was noticed in 24.1% of patients. Although the rates of CE cases have decreased in Arad County (Romania), this parasitic disease continues to be a concern for public health services and requires the implementation of more stringent prophylactic measures.

The roots of evil: the amazing history of trichinellosis and Trichinella parasites.

This review aims to investigate, from a historical point of view, the roots of the Trichinella pathogens and the disease they produce, beginning from the times first recorded in the Bible and continuing until the scientific mysteries of the pathogen were finally unveiled. Our journey sheds light on "strange" epidemics developing before the discovery of the parasite and bearing a clinical similitude to trichinellosis; it follows the controversies that erupted after the nineteenth century discovery of the parasite and the subsequent official outbreaks, and then examines the pioneering methods used for its visualization. Finally, it tries to reveal the possible relationship of trichinellosis with the arts. Furthermore, it seems that the saga of the helminth, "destined to remain with us, both in nature and in the laboratory," will continue to haunt and fascinate scientists from both developing and developed countries, as they try to answer new questions about the parasite's "evil" nature.

How to build a scientific publishing career based on hundreds of letters-to-the-editor: "The Art of Loss".

Letters-to-the-editor represent an important characteristic of scientific interchange especially because the initial peer-review may not fulfill the qualitative control of a manuscript. On the other hand, it is well known that such publications are accepted easier than regular ones and may be a gateway for authors without outstanding scientific merits to input their names in high impact factor journals. A letter-to-the-editor (intended as a commentary to one of our works) allowed us to discover a very peculiar and unexpected fact for the medical literature, worthy to be shared with the worldwide scientific community.

Epidemiology of syphilis, gonorrhea and chlamydia in Romania, 1980-2009.

OBJECTIVES: This study aims to analyze the epidemiology of syphilis, gonorrhea and genital chlamydial infections in Romania during 1980-2009 when radical changes occurred during transition from a communist regime to a democratic society. METHODS: Surveillance data was retrieved from the National Center for Surveillance and Control of the Communicable Disease in Romania and the World Health Organization. RESULTS: The mean annual incidences of syphilis, gonorrhea and genital chlamydia infections in Romania were 25.2 ± 15 cases per 100,000 inhabitants (1980-2009), 33.2 ± 26.6/100,000 (1980-2009) and 0.3 ± 0.4/100,000 (1994-2009), respectively. Although the infection rates for syphilis followed a significant ascending trend over the study period (p < 0.001), they declined dramatically since 2002 (p < 0.001). There was a significant decrease in gonorrhea-affected persons over the study period (p < 0.0001), while genital chlamydia infections registered a general ascending trend (p = 0.02) with insignificant decrease since 2006. CONCLUSIONS: The declining trend of syphilis and gonorrhea infections in the general population especially during the last years is very encouraging but should not challenge the amount of resources dedicated to sexually transmitted infections. Consequently, compelling strategies and policies based mainly on education of the population should be put forth in order to advance efficient prevention.

International travel increase and malaria importation in Romania, 2008-2009.

OBJECTIVES: This report aims to assess the epidemiological characteristics of imported malaria in Romania in the context of international travel increase, and to compare them with the data reported by other European countries. METHODS: Data on malaria cases were provided by the National Centre for Surveillance and Control of the Communicable Disease, whereas the data regarding international travels to and from Romania were retrieved from the Romanian Statistical Yearbook. RESULTS: The number of Romanian citizens who traveled to Africa in 2007 increased by over 600% as compared to the previous year. During the years 2008-2009, 25 cases of imported malaria were registered in Romania, with no fatalities. All patients were male and most of them (84%) acquired the infection in Africa. Plasmodium falciparum was involved in 68% of cases. The majority of the affected patients (41%) were aged 31 to 40 years. Labor was the main reason for traveling (72%), and 92% of cases took either partial or no chemoprophylaxis. CONCLUSION: The continuous growth of professional and leisure voyages to malaria-endemic regions may lead to a dramatic increase of imported cases, especially if prophylactic measures are not strictly followed.

Reemergence of human infections with West Nile virus in Romania, 2010: an epidemiological study and brief review of the past situation.

OBJECTIVES: The aim of this report was to provide concise epidemiological data regarding a recent reemergence of West Nile virus (WNV) in the human population of Romania simultaneously with the threatening occurrence of this condition in other European countries. Also, we attempted to present a brief synopsis of the past situation regarding WNV infections in this country. MATERIALS AND METHODS: Data were collected from the National Centre for Surveillance and Control of the Communicable Disease, Bucharest. Additionally, supplementary information was extracted from the reports provided by the Romanian Ministry of Health. RESULTS: As of September 30, 2010, 50 confirmed cases of human infections with WNV have been registered in Romania. The median age of patients was 59.5 years (range: 12-81 years). Male patients predominated (68%, p < 0.001) and 52% of cases were rural inhabitants. The fatality rate was 10% (p < 0.0001). Deceased patients were aged over 65 years and had a positive history for chronic disorders. A detailed anamnesis revealed that none of the infected individuals used substances intended to remove mosquitoes around or inside their homes or skin repellents. CONCLUSIONS: Our article adds important data to the European map of WNV infections. Also, it highlights the particular conditions (ecological and climatic) as well as improper habits regarding the maintenance and transmission of WNV in the environment and provides appropriate indicators for individual risk assessment.

Cystic echinococcosis in Romania: the pediatric approach.

Cystic echinococcosis (CE) has represented a leading parasitic disease in Romania since 1862 when the first case was detected. Following the extremely high number of human and animal cases registered in 1995, Romania was framed in the forefront of Europe and among the first countries worldwide. This review aims to overview and analyze important data concerning CE in Romania from a pediatric point of view. To fulfill these goals, we focused on information provided by major epidemiological studies and rare/unusual case presentations. CE represents a serious concern for both public health services and the society, mainly because of prolonged hospitalization and convalescence periods. Moreover, the situation is much more problematic in children because physical, psychical, or intellectual impairments may impact negatively on their developmental and educational progress. The management of the disease consumes considerable healthcare resources estimated at about 1500-2000 United States Dollar (USD) for each uncomplicated case and approximately double for the complicated ones. A systematic analysis of data framed important epidemiological characteristics that may be useful when assessing individuals at risk: children (0-19 years old) represented 22.1% of the total number of cases, patients aged 13 years were most frequently affected (p < 0.0001), male patients and rural inhabitants predominated (p = 0.01 and p < 0.0001, respectively), and pulmonary involvement was detected most frequently (p < 0.0001). Considering the immense burden of this disease in Romania, emphasis should be given to the wide-scale implementation of effective prophylactic measures toward its eradication. Among them, education of the population plays an important role and should begin in early childhood.

Epidemiology and history of human parasitic diseases in Romania.

Intestinal parasitic diseases such as enterobiasis, giardiasis, and ascariasis are detected most frequently in Romania, but their importance is definitely surpassed by trichinellosis, cystic echinococcosis, and toxoplasmosis. Malaria was common until its eradication in 1963, and only imported cases are reported nowadays. The aim of this review was to bring together essential data on the epidemiology and history of human parasitoses in Romania. Information on 43 parasitic diseases was collected from numerous sources, most of them unavailable abroad or inaccessible to the international scientific community. Over time, Romanian people of all ages have paid a significant tribute to the pathogenic influences exerted by the parasites. Sanitary and socio-economical consequences of the parasites diseases have great negative impact on the quality of life of affected individuals and the overall well-being of the population. Implementation of efficient public health measures and informative campaigns for the masses as well as changing the inadequate habits that are deeply rooted in the population are mandatory for cutting successfully this Gordian knot.

Intestinal nematode infections in Romania: an epidemiological study and brief review of literature.

OBJECTIVES: The main aim of this report was to present the epidemiological, clinical, laboratory, and therapeutic aspects of a series of patients admitted to a reference hospital from Romania and found to be infected with intestinal nematodes. Additionally, we attempted to overview, for the first time in the international literature, the most relevant data regarding diseases caused by these helminthes in Romania. PATIENTS AND METHODS: We have retrospectively investigated the medical records of patients admitted at Victor Babes Hospital of Infectious Diseases in Timisoara (Timis County) who presented infections with intestinal nematode helminthes between 1971 and 2007. RESULTS: Forty-two patients were found to be infected with intestinal nematode worms, with the predominance of Enterobius vermicularis (42.8%). The mean age of patients in this series was 23.5 ± 16.4 years. Women were affected in 66.7% of cases and inhabitants of urban regions in 71.4% of cases. Of this series, 57.2% of patients were adults and most of them were people with limited formal education belonging to the low social class. Overall, abdominal pain was most frequently detected (59.5%) and the mean eosinophil count was 8.2% ± 10.9% (range 1%-56%). Piperazine was administered in most of the cases (33.3%). CONCLUSIONS: Infections with intestinal nematodes are less frequently diagnosed in hospitalized patients despite that they are quite common in the Romanian population. To further limit their occurrence, public health measures and informative campaigns for the whole population should be implemented.

Malaria and the campaigns toward its eradication in Romania, 1923-1963.

Malaria was common in Romania until largely successful campaigns of the 20th century. Researchers Ioan Cantacuzino, George Zotta, and Mihai Ciuca carried out important early contributions to the understanding of malarial endemo-epidemic situation in Romania. The malarial endemy registered a peak in 1942 with an incidence of 1218 cases per 100,000 inhabitants as a result of the disastrous effects of the Second World War. In the following years the incidence increased from 421.5 cases per 100,000 inhabitants in 1944 to 735.1 cases per 100,000 inhabitants in 1946. A Malaria Commission was formed in February 1947 with the mission to reorganize the fight against malaria in Romania based on international guidelines. Following the adoption of proper malarial eradication methods, namely coverage of endemic areas by spraying of residual insecticides, associated with chemotherapy and, eventually, chemoprophylaxis with synthetic products, and by surveillance, indigenous cases disappeared rapidly, relapsing cases were much reduced, and imported and induced cases remained constant or even increased slightly, probably due to the increase in traffic and in the use of blood transfusions. No indigenous cases have been registered in Romania since 1962. In 1963 the Romanian authorities declared malarial eradication in the territory to the World Health Organization.

Leishmaniasis, a global concern for travel medicine.

Leishmaniasis, a parasitic infection listed by the World Health Organization among the 6 most important tropical diseases, is endemic in approximately 88 countries worldwide, with a global estimate of 350 million individuals at risk. The present report aims to review the imported cases of leishmaniasis reported in retrospective studies or described as clusters or single interesting cases. It is apparent that some European countries considered as premier tourist attractions export leishmaniasis: Greece, France, Italy, Spain, Portugal, Croatia and Turkey. Travelling and exploring the New World countries, especially the Amazonian jungle and the archaeological ancient sites, is a continuous challenge, with a risk of acquiring various tropical infections. Imported leishmaniasis has occurred in individuals who have gone to work abroad in improper conditions, without being aware of the risk of severe vector-borne infections. Exported cases are carried by refugees and immigrants from endemic developing countries. Extended military operations are a further source of imported cases. In the new millennium, the import and export of leishmaniasis continue to be of major concern for public health services worldwide as a result of increased mobility.

Occurrence of influenza A(H1N1)v virus in Western Romania in relationship to international travel.

Epidemiological and clinical characteristics of the first cases of infection with the novel influenza A (H1N1) variant virus [A(H1N1)v] admitted to a reference hospital in Western Romanian from mid-June to mid-July 2009 are overviewed. Of 74 suspected cases, 7 were laboratory confirmed. All patients were either Romanian citizens, or people originating from Romania and established overseas. The median age was 13 years and the mean length of hospital stay was 7.7 days. Cough (n = 6) and fever (n = 4) were the most commonly reported symptoms, and all cases made complete recovery. Early diagnosis and management of H1N1 flu was not problematic for the infectious disease specialists. Because many Romanians established overseas come yearly to visit their relatives, special attention must be addressed to the international flight passengers.

Evidence of Trichinella spiralis in Timis County, Romania: a report of a winter trichinellosis outbreak in 2008 due to consumption of contaminated pork.

A trichinellosis outbreak occurred in early 2008 in two villages in Timis County, Romania, due to consumption of pork from an infected animal. The infective species, detected by multiplex polymerase chain reaction, was Trichinella spiralis (Isolate Code ISS 1951). This report presents an extensive characterization of the outbreak using the documents of the epidemiological investigation and the medical charts of the hospitalized patients. Fifteen people consumed pork from the same backyard pig, which was slaughtered in the household without veterinary inspection of the meat. Among them, five patients presented clinical forms of the disease and were hospitalized. The analysis within this report includes only the hospitalized cases that were serologically confirmed. The mean age of the patients was 33.4 years. The common symptoms presented by these patients included headache, eyelid and lower limb edema, myalgia, fever, diarrhea, and nausea. Eosinophil counts ranged between 5.5% and 52%. Favorable outcomes were achieved for the patients using antihelminthic therapy. As an important public health concern, trichinellosis outbreaks reinforce the need to urgently implement veterinary and educational programs. Identification of T. spiralis in this case strengthens the supposition that it is one of the most frequently spread species in Romania.

Epidemiology and epizootology of trichinellosis in Romania 1868-2007.

According to the International Commission on Trichinellosis, Romania accounted for the most cases of trichinellosis reported worldwide in 2004. The following report summarizes the evolution of trichinellosis in Romania over a 140-year period (1868-2007). The sylvatic cycle, such as the consumption of meat from wild boar and bear, has been implicated in human cases. However, 95% of human trichinellosis cases originate from specific cultural food practices involving pork consumption. The first report of human and pig trichinellosis in Romania dates back to 1868. After the political changes of 1989, the annual incidence increased from between 0.1 and 4.1 cases per 100,000 inhabitants during the communist period (1963-1989) to 6.2 cases per 100,000 inhabitants, with a range of 2-15.9 per 100,000 between 1990 and 2007. Trichinellosis is a major public health issue in Romania that requires that policies be put forth to advance efficient prevention and control strategies.

Trichinellosis, a threatening and re-emerging disease in a Romanian western county.

INTRODUCTION: Trichinellosis is frequently reported in east European countries like Romania, where the yearly incidence during 1990-1999 was 5.5 cases/100,000 inhabitants. Arad, a western Romanian county, is known as one of the most endemic regions of trichinellosis. A major and unforgettable epidemic of trichinellosis has developed at the beginning of 1973 in this county. The present study focuses on human trichinellosis patients from Arad County, emphasizing on epidemiological, clinical, laboratory, and therapeutic aspects. PATIENTS AND METHODS: Retrospective analysis of the medical records of 335 patients found to have trichinellosis during 1996-2006 and hospitalized in Arad County. The mean age of the trichinellosis patients was 33.6 years, and majority (64.8%) were inhabitants of the rural areas. RESULTS: Winter was the season with the highest number of cases (71.6%). Fever was the most frequent manifestation of the disease (85.4%), followed by myalgia (83%). Eosinophilia ranged predominantly between 20% and 20.99% (19.4%). Albendazole was the specific drug administered in 49.4% of the patients. CONCLUSIONS: Trichinellosis still remains a concern and a major issue of public health in Arad County. Implementation of strict hygienic measures, especially in the rural areas, must be a priority.