IMPORTANŢA DIAGNOSTICULUI ETIOLOGIC ÎN INFECŢIILE VIRALE SEVERE ALE TRACTULUI RESPIRATOR INFERIOR LA SUGAR ŞI COPIL

Introducere. Pneumonia comunitară reprezintă una din cauzele principale de deces în lume la copii cu vârsta sub 5 ani. Detecţia virală prin PCR multiplex este din ce în ce mai utilizată în practică; ea este utilă pentru a înţe lege epidemiologia şi impactul virusurilor asupra populaţiei pediatrice, însă există în continuare multe discuţii legate de modul în care detecţia virală infl uenţează modul efectiv de îngrijire al pacientului. Obiective. În studiul efectuat ne-am propus analiza impactului pe care l-a avut identifi carea etiologiei virale asupra duratei spitalizării şi asupra tratamentului administrat pe parcursul internării în spital. Material şi metodă. Am efectuat un studiu retrospectiv pe o perioadă de 4 ani, au fost selectaţi copii între 0-5 ani cu infecţie severă de tract respirator inferior. Am comparat 3 grupuri: un grup cu infecţie virală specifi cată, un grup cu infecţie virală nespecifi cată şi un grup cu infecţie bacteriană. Rezultate. În perioada analizată 72 de copii ce au prezentat semne de insufi cienţă respiratorie acută au avut stabilit un diagnostic etiologic concret de infecţie virală, doar 2% din totalul infecţiilor virale diagnosticate în spital. Etiologia principală a fost reprezentată de virusul sinciţial respirator (VSR) în 73,5% dintre cazuri, urmat de Infl uenza cu 11%, Parainfl uenza cu 4,2%, Metapneumovirusul (HMPV), Rinovirus, Bocavirus şi Adenovirus, toate cu 2,8%. În cadrul infecţiei virale nespecifi cate s-au folosit antibiotice în 85,5% (n = 53) dintre cazuri. În cadrul infecţiei virale specifi cate, deşi etiologia virală a fost certă, rata de folosire a antibioticelor a fost mai ridicată de 92% (n = 57) Durata spitalizării a fost în medie de cu 2,5 zile mai lungă în cadrul lotului cu infecţie virală specifi cată, faţă de lotul cu infecţie virală nespecifi cată. Deşi diagnosticul de infecţie virală a fost cert, dat fiind tabloul clinic sever şi vârsta mică a copiilor, cheltuielile realizate pentru cei cu infecţie virală specifi cată au fost cu 30% mai mari faţă de cei cu infecţie virală nespecifi cată. Concluzii. În studiul efectuat VSR este virusul cel mai frecvent implicat în etiologia ITRI virale, fi ind implicat în forme severe de boală mai ales la sugarii mici şi foştii prematuri. Antibioterapia este utilizată în mod frecvent în formele severe de ITRI, chiar dacă etiologia virală este certă şi cunoscută, clasele de antibiotice folosite fi ind asemănătoare. Determinarea etiologiei virale nu a redus spitalizarea şi nici nu a dus la schimbarea atitudinii terapeutice a medicului curant

The Role of Immunohistochemistry in the Differential Diagnosis between Intrahepatic Cholangiocarcinoma, Hepatocellular Carcinoma and Liver Metastasis, as Well as Its Prognostic Value

Intrahepatic cholangiocarcinoma (iCCA) is the second most frequent primary hepatic malignant tumor, after hepatocellular carcinoma (HCC). Its incidence has risen worldwide, yet the only potentially curative treatment, surgical resection, is seldom applicable, and the median overall survival remains extremely low. So far, there are no personalized therapy regimens. This study investigated whether routine immunohistochemical stains have diagnostic and/or prognostic value in iCCA. Clinical, imaging, and pathology data were retrospectively gathered for patients diagnosed with iCCA, HCC, or liver metastases assessed using liver needle biopsies. Three study groups with an equal number of cases (n = 65) were formed. In the iCCA group, CK19, CA19-9, CK7, and CEA demonstrated the highest sensitivities (100%, 100%, 93.7%, and 82.6%, respectively). The most relevant stains used for diagnosing HCCs were Glypican 3, CD34 (sinusoidal pattern), and Hep Par 1, with corresponding sensitivities of 100%, 100%, and 98.2%. The immunohistochemical panels for diagnosing metastatic tumors were chosen after correlating the clinical data and morphologic H&E aspects. Moderate/intensely positive CK7 expression and absent/low amount of intratumoral immune cells were favorable prognostic factors and correlated with increased overall survival in both the univariate analysis and the multivariate regression adjusted for age, existence of cirrhosis, number of tumors, and tumor differentiation

Preformulation and preliminary formulation studies of mesalazine gastro-resistant tablets

Mesalamine, 5-aminosalicylic acid or mesalazine is the standard therapy of inflammatory bowel disease. A small number of pharmaceutical dosage forms with mesalazine are on the market. The aim of this study was preformulation and preliminary formulation studies of oral gastro-resistant tablets containing 500 mg mesalazine. The reasons why a gastro-resistant tablet was chosen are: increased compliance of the patient, increased chemical stability and modified release modulation (mesalazine has a local effect on mucosa). The raw materials were of pharmaceutical grade. The following analytical techniques were involved: differential scanning chromatography (DCS), in vitro release, particle size determination, high performance liquid chromatography (HPLC). The compatibility of mesalazine with several excipients was tested using DSC. Wet granulation of mesalazine and starch showed that the fourth (LM04) formulation generates the highest amount (69.1%) of granules in the range of 1000–300 μm. Oblong tablets (pilot batches) were produced. The cores were coated with an enteric coating acrylic agent in order to achieve gastro-resistance. A new gastro-resistant tablets mesalazine formulation was developed by means of wet granulation, tableting (oblong tablets) and coating

Botulism Cases in Romania—An Overview of 14-Year National Surveillance Data

Botulism is a priority disease worldwide because it has a very severe course of evolution that can lead to death. This paper aims to describe the main epidemiological characteristics of botulism cases confirmed in Romania over 14 years (2007–2020). We performed a retrospective study using the publicly available national surveillance data and reported to the National Institute of Public Health. A total of 325 cases of foodborne botulism were reported in Romania, with no infant or wound botulism. Most of the cases (125, 38.5%) were reported among young adults (25–44 years old), over half (205, 63%) of them living in rural areas. The incriminated food item was identified in 161 cases; in most cases (145, 90%) the food item was prepared in the household. The main food category was represented by meat and meat-based products (94, 68.6%). In almost all cases the identified type was BoNT/B (230/231, 99.5%). Fifteen deaths were recorded, and the case fatality rate was 4.6%. Botulism cases were reported annually in Romania. Surveillance data are essential for implementing control measures and adapting educational campaigns according to existing needs

The Dynamic Risk of COVID-19-Related Events in Vaccinated Healthcare Workers (HCWs) from a Tertiary Hospital in Bucharest, Romania: A Study Based on Active Surveillance Data

Our study describes the frequency and severity of COVID-19 in HCWs and estimates the dynamic risk of COVID-19-related events. We actively surveyed all HCWs from a tertiary infectious disease hospital from 26 February 2020 to 31 May 2023. Of 1220 HCWs, 62.9% (767) had at least one COVID-19 episode. The under 29 years (p = 0.0001) and 40–49 years (p = 0.01) age groups, nurses (p = 0.0001), and high-risk departments (p = 0.037) were characteristics significantly more frequent in HCWs with COVID-19 history. A higher percentage of boosters (53.2%; p < 0.0001) were registered in the uninfected group. The second episode of COVID-19 was significantly milder than the first. Data regarding clinical outcomes from 31 January 2021 to 31 May 2023 were analyzed in a follow-up study to determine the risk of COVID-19-related events. The Cox regression analysis revealed that HCWs with booster shots had a lower risk of COVID-19 across all events, symptomatic events, and moderate to severe events as adjusted hazard ratio (aHR) were: 0.71 (95%CI: 0.54–0.96), 0.23 (95%CI: 0.12–0.46), and 0.17 (95%CI: 0.07–0.43), respectively. Within the vaccinated subgroup, the HCWs with hybrid immunity and booster had aHR for all followed-up events of 0.42 (95%CI: 0.30–0.58), for symptomatic events of 0.52 (95%CI: 0.36–0.74), and 0.15 (95%CI: 0.03–0.66) for moderate to severe events. The risk of COVID-19 clinical events was lower for HCWs with at least one booster than those completely vaccinated

The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay

Background and objectives: The prognoses of patients experiencing a prolonged stay in the intensive care unit (ICU) are often significantly altered by hospital-acquired infections (HAIs), the early detection of which might be cumbersome. The aim of this study was to investigate the roles of the neutrophil-to-lymphocyte (NLR), derived-NRL (d-NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-C-reactive protein (LCR) ratios in predicting the progression to septic shock and death. Materials and Methods: A retrospective analysis of a consecutive series of ninety COVID-19 patients with prolonged hospitalization (exceeding 15 days) admitted to the ICU was conducted. The prevalence of culture-proven HAIs throughout their hospital stays was documented. NLR, dNLR, PLR, and LCR were recorded on admission, day 7, and day 14 to assess their discriminative prowess for detecting further progression to septic shock or death. Results: The prevalence of HAIs was 76.6%, 50% of patients met the criteria for septic shock, and 50% died. The median time to the first positive culture was 13.5 days and 20.5 days for developing septic shock. Mechanical ventilation was a key contributing factor to HAI, septic shock, and mortality. On admission and day 7 NLR, dNLR, PLR, and LCR values had no prognostic relevance for events occurring late during hospitalization. However, day-14 NLR, dNLR, and PLR were independent predictors for progression to septic shock and mortality and have shown good discriminative capabilities. The AUCs for septic shock were 0.762, 0.764, and 0.716, while the values for predicting in-hospital death were 0.782, 0.778, and 0.758, respectively. Conclusions: NLR, dNLR, and PLR are quick, easy-to-use, cheap, effective biomarkers for the detection of a more severe disease course, of the late development of HAIs, and of the risk of death in critically ill patients requiring a prolonged ICU stay

Targeted EGFR Nanotherapy in Non-Small Cell Lung Cancer

Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality worldwide. Despite advances in treatment, the prognosis remains poor, highlighting the need for novel therapeutic strategies. The present review explores the potential of targeted epidermal growth factor receptor (EGFR) nanotherapy as an alternative treatment for NSCLC, showing that EGFR-targeted nanoparticles are efficiently taken up by NSCLC cells, leading to a significant reduction in tumor growth in mouse models. Consequently, we suggest that targeted EGFR nanotherapy could be an innovative treatment strategy for NSCLC; however, further studies are needed to optimize the nanoparticles and evaluate their safety and efficacy in clinical settings and human trials

Hybrid Immunity and the Incidence of SARS-CoV-2 Reinfections during the Omicron Era in Frontline Healthcare Workers

During the coronavirus disease (COVID-19) pandemic healthcare workers (HCWs) acquired immunity by vaccination or exposure to multiple variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our study is a comparative analysis between subgroups of HCWs constructed based on the number of SARS-CoV-2 infections, vaccination, and the dominant variant of SARS-CoV-2 in the population. We collected and analyzed data using the χ2 test and density incidence of reinfections in Microsoft Excel for Mac, Version 16.84, and MedCalc®, 22.026. Of the 829 HCWs, 70.1% (581) had only one SARS-CoV-2 infection and 29.9% (248) had two infections. Of the subjects with two infections, 77.4% (192) worked in high-risk departments and 93.2% (231) of the second infections were registered during Omicron dominance. The density incidence of reinfections was higher in HCWs vaccinated with the primary schedule than those vaccinated with the first booster, and the incidence ratio was 2.8 (95% CI: 1.2; 6.7). The probability of reinfection was five times lower (95% CI: 2.9; 9.2) in HCWs vaccinated with the primary schedule if the first infection was acquired during Omicron dominance. The subjects vaccinated with the first booster had a density incidence of reinfection three times lower (95% CI: 1.9; 5.8) if the first infection was during Omicron. The incidence ratio in subgroups constructed based on characteristics such as gender, age group, job category, and department also registered significant differences in density incidence. The history of SARS-CoV-2 infection by variant is important when interpreting and understanding public health data and the results of studies related to vaccine efficacy for hybrid immunity subgroup populations