Immunologic and nonimmunologic sclerodermal skin conditions - review

Scleroderma-like cutaneous lesions have been found in many pathological conditions and they have the clinical appearance of sclerotic or scleroatrophic lesions. Affected skin biopsies described histopathological changes similar to those of scleroderma located strictly on the skin or those of systemic sclerosis. These skin lesions can be found in inflammatory diseases with autoimmune substrate (generalized morphea, chronic graft versus host disease, eosinophilic fasciitis), tissue storage diseases (scleredema, scleromyxedema, nephrogenyc systemic fibrosis, systemic amyloidosis), metabolic diseases (porphyrya cutanea tarda, phenylketonuria, hypothyroidism, scleredema diabeticorum), progeroid syndromes. Given the multiple etiologies of sclerodermal lesions, a correct differential diagnosis is necessary to establish the appropriate treatment

ACTUALITĂŢI PRIVIND EPIDEMIA HIV LA ADULŢII DIN SUD-ESTUL ROMÂNIEI

Obiective. Identificarea priorităţilor actuale de intervenţie pentru combaterea epidemiei HIV/SIDA în regiunea de Sud-Est a României. Metode. Am evaluat retrospectiv profilul pacienţilor adulţi confirmaţi cu infecţie HIV în perioada 2005-2016, rata mortalităţii şi factorii de risc pentru deces. Datele demografice, epidemiologice şi clinice au fost colectate din dosarele medicale din Clinica HIV/SIDA Galaţi. Rezultate. În ultimii 12 ani, au fost confirmate 225 de noi cazuri de infecţie HIV la adulţii din Spitalul de Boli Infecţioase din Galaţi. Caracteristicile cazurilor nou diagnosticate cu HIV au fost: vârsta medie 25,17 ± 11,94 ani la iniţierea studiului, transmiterea predominant heterosexuală (73%) şi diagnosticul în stadii avansate de imunodepresie (67,6%). După diagnostic, 95% dintre pacienţi au primit tratament antiretroviral (TARV) şi 91% au rămas in evidenţă pentru HIV. Rata medie anuală a mortalităţii a fost de 14,6‰. O treime dintre decese au avut loc în primul an după diagnostic. Rata mortalităţii a avut o tendinţă de creştere în ultimii 6 ani, comparativ cu perioada 2005-2011, din cauza fenomenului de îmbătrânire asociat supravieţuirii mai îndelungate a pacienţilor cu HIV şi creşterii morbidităţii prin afecţiuni non definitorii-SIDA. Prima linie de TARV s-a bazat pe combinaţii cu inhibitori de protează, inhibitori non-nucleozidici de reverstranscriptază şi inhibitori de integrază. Ratele de supravieţuire nu au fost influenţate de tipul combinaţiilor TARV, dar supravieţuirea a fost semnificativ mai scăzută la pacienţii fără TARV, faţă de orice combinaţie antiretrovirală. Concluzii. Tratamentul antiretroviral a îmbunătăţit speranţa de viaţă a persoanelor cu infecţie HIV, dar mortalitatea s-a menţinut mai crescută faţă de cea din populaţia generală. Comorbidităţile nondefinitorii de SIDA tind să crească în următorii ani, pe măsura îmbătrânirii pacienţilor diagnosticaţi cu infecţie HIV. Priorităţile locale actuale de combatere a HIV sunt: creşterea eficienţei TARV, diagnosticarea precoce a infecţiei şi menţinerea pacienţilor în sistemul de îngrijire şi tratament

CURRENT ISSUES ON HIV ADULTS IN SOUTH EAST OF ROMANIA

Objective. To identify the current priorities of the fight against HIV/AIDS in the South-East region of Romania. Methods. The profile of HIV adult confirmed with HIV, the mortality rate and the risk factors related to death were analyzed in a retrospective study. Data were collected from the medical files of Galati HIV/AIDS Clinic. New diagnosed HIV infected patients, over age 15 were followed-up from January 2005 to December 2016. Results. During the 12 years study period, 225 new HIV adult cases were confirmed. The characteristics of the new diagnosed cases were: young age (average 25.17±11.94), predominant heterosexual transmission mode (73%) and high percentage of late presentation (67.6%). The retention in care rate was 91% and 95% of patients received ART. The mean annual mortality rate was 14.6‰, one third of deaths occurring during the first year after diagnosis. In the last 6 years, there was an increase trend in mortality rates, compared to the period 2005-2011, as HIV people are aging and more non-AIDS deaths are registered. The survival rates were not influenced by the first line ART, containing protease inhibitors, non-nucleoside reverse transcriptase or integrase inhibitors. However, all ART regimen significantly improved the survival rate. Conclusions. Even if ART improved HIV survival rates, the mortality rate among persons diagnosed with HIV was still higher than in the general population. As HIV patients are aging, continuing increase in non-AIDS comorbidities are expected in the next years. The local present priorities in the fight against HIV are to enhance the efficiency of ART, early HIV diagnosis and retention in care

ACTUALITĂŢI ÎN ETIOPATOGENIA, EPIDEMIOLOGIA ŞI DIAGNOSTICUL INFECŢIEI CU CLOSTRIDIUM DIFFICILE

Infecţia cu Clostridium difficile (ICD) este o cauză a gastroenteritei acute, cu potenţial de evoluţie severă către colită pseudomembranoasă, ileus şi megacolon toxic. Iniţial, ICD a fost considerată o infecţie nozocomială, dar au fost dovedite şi infecţii comunitare. Susceptibilitatea la ICD este crescută în următoarele condiţii: alterarea microbiotei intestinale după antibioterapie şi imunosupresoare, compromiterea barierelor mucoase după intervenţie chirurgicală, traumatism, proliferare tumorală, ischemie sau necroză, precum şi în cazul scăderii rezistenţei generale a organismului, cauzată de vârstă, alcoolism, diabet zaharat, neoplazii, imunosupresie, angiopatii. Îngrijorarea pentru apariţia unor noi epidemii de ICD se menţine ridicată, din cauza variabilităţii genetice bacteriene şi a rezistenţei sporilor în mediul extern. Diagnosticul ICD rămâne o provocare pentru clinicieni, bazându-se pe corelarea datelor clinice, epidemiologice şi a investigaţiilor complexe de laborator

UPDATES ON THE PATHOGENESIS, EPIDEMIOLOGY AND DIAGNOSIS OF CLOSTRIDIUM DIFFICILE INFECTION

The infection with Clostridium difficile (CDI) is a cause of acute gastroenteritis (AGE), which is likely to severely develop into pseudomembranouse colitis (PMC), ileus and toxic megacolon. At the begining, CDI was considered a nosocomial infection, later proven to be communitary-acquired infections. The susceptibility for CDI is related to the alteration in intestinal microbiota after antibiotics or immunosuppressant treatments, postoperative disruption of mucosal barriers, trauma, tumour proliferation, ischemia or necrosis, as well as in other conditions caused by aging, alcoholism, diabetes, neoplasias, immunosuppression, angiopathies. Concern regarding the outbreak of new CDI-epidemics is still high, due to genetic and bacterial variability and spores resistance in outer environment. The diagnosis of CDI is a continuous challenge for clinicians, based on the correlation between clinical, epidemiological data and complex laboratory investigations

Clostridium difficile infection in patients with chronic hepatic disease

Clostridium difficile infection (CDI) associates in the spectrum of comorbidities, more and more often, chronic toxic metabolic or viral hepatic diseases. Patients with chronic hepatic diseases have more severe episodes of CDI with poorer prognosis than episodes of CDI that have occurred in patients with other comorbidities. The measures of prophylaxis and treatment of CDI in these patients require particularizations according to the risk factors and the clinical-evolutionary specificity of these patients. The present study aims to identify the main risk factors of these patients for CDI, as well as to evaluate the severity of the episodes of CDI, the rate of recurrence and death in these patients, compared to those without liver disease