Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study

Background: Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial. Methods: AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock. Results: Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5-148.1 pg/ml]. Initial SOFA score was 7 [IQR 5-10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9-2.9]; adjusted HR 1.6 [CI 1.1-2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5-9.8). Conclusions: AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial. Trial registration: ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015

Recovery of Sewage Sludge in the Cement Industry

This paper presents an analysis of the literature that studies the possibility of sewage sludge being used in the cement industry to reduce carbon dioxide emissions from cement production and thus solve the problem of disposing of sewage sludge so that it is no longer stored, avoiding soil pollution with heavy metals, and reducing pressure on the environment. The ash of sewage sludge is a good pozzolanic material, because when it is finely ground, it can be used as a partial substitute for Portland cement. This reduces waste storage costs. Sewage sludge ash was mixed with cement, and it was analyzed to determine whether the paste obtained could be used as a raw material in the cement industry. The presented results are on the hydration characteristics of the sewage sludge ash, the compressive strength of the cement determined after different days, the workability of the cement, and the porosity of the cement paste and the ash

Decoding Neurodegeneration: A Comprehensive Review of Molecular Mechanisms, Genetic Influences, and Therapeutic Innovations

Neurodegenerative disorders often acquire due to genetic predispositions and genomic alterations after exposure to multiple risk factors. The most commonly found pathologies are variations of dementia, such as frontotemporal dementia and Lewy body dementia, as well as rare subtypes of cerebral and cerebellar atrophy-based syndromes. In an emerging era of biomedical advances, molecular–cellular studies offer an essential avenue for a thorough recognition of the underlying mechanisms and their possible implications in the patient’s symptomatology. This comprehensive review is focused on deciphering molecular mechanisms and the implications regarding those pathologies’ clinical advancement and provides an analytical overview of genetic mutations in the case of neurodegenerative disorders. With the help of well-developed modern genetic investigations, these clinically complex disturbances are highly understood nowadays, being an important step in establishing molecularly targeted therapies and implementing those approaches in the physician’s practice

Cannabinoids in Medicine: A Multifaceted Exploration of Types, Therapeutic Applications, and Emerging Opportunities in Neurodegenerative Diseases and Cancer Therapy

In this review article, we embark on a thorough exploration of cannabinoids, compounds that have garnered considerable attention for their potential therapeutic applications. Initially, this article delves into the fundamental background of cannabinoids, emphasizing the role of endogenous cannabinoids in the human body and outlining their significance in studying neurodegenerative diseases and cancer. Building on this foundation, this article categorizes cannabinoids into three main types: phytocannabinoids (plant-derived cannabinoids), endocannabinoids (naturally occurring in the body), and synthetic cannabinoids (laboratory-produced cannabinoids). The intricate mechanisms through which these compounds interact with cannabinoid receptors and signaling pathways are elucidated. A comprehensive overview of cannabinoid pharmacology follows, highlighting their absorption, distribution, metabolism, and excretion, as well as their pharmacokinetic and pharmacodynamic properties. Special emphasis is placed on the role of cannabinoids in neurodegenerative diseases, showcasing their potential benefits in conditions such as Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and multiple sclerosis. The potential antitumor properties of cannabinoids are also investigated, exploring their potential therapeutic applications in cancer treatment and the mechanisms underlying their anticancer effects. Clinical aspects are thoroughly discussed, from the viability of cannabinoids as therapeutic agents to current clinical trials, safety considerations, and the adverse effects observed. This review culminates in a discussion of promising future research avenues and the broader implications for cannabinoid-based therapies, concluding with a reflection on the immense potential of cannabinoids in modern medicine

SPECTRUL EPIDEMIOLOGIC, CLINIC ŞI EVOLUTIV AL CAZURILOR DE RUJEOLĂ INTERNATE ÎN SPITALUL CLINIC DE BOLI INFECŢIOASE ŞI TROPICALE „DR. VICTOR BABEŞ“ DIN BUCUREŞTI ÎN CURSUL EPIDEMIEI ACTUALE

Introducere. Începând cu anul 2016, România se confruntă cu o epidemie importantă de rujeolă apărută pe fondul unui procent tot mai scăzut de vaccinare. Evoluţia epidemiei a fost marcată şi de o creştere alarmantă a numărului de complicaţii şi decese. Materiale şi metode. Am evaluat retrospectiv 632 pacienţi diagnosticaţi cu rujeolă, internaţi în Spitalul Clinic de Boli Infecţioase şi Tropicale „Dr. Victor Babeş“, în perioada ianuarie 2016 – decembrie 2017. Datele epidemiologice, caracteristicile clinice şi rezultatele probelor biologice au fost obţinute din fişele medicale ale pacienţilor. Rezultate. Din cei 632 de pacienţi, 341 (53,9%) au fost de sex masculin. Grupa de vârstă cea mai afectată a fost 1-4 ani (39,2%), urmată de cea a sugarilor cu un procent de 19,6%. O treime din cazuri (31,3%) au avut contactul infectant în cadrul familiei. În ceea ce priveşte statusul vaccinal, aproape jumătate din pacienţi (47,1%) nu au fost vaccinaţi, iar 44,3% nu cunoşteau istoricul de vaccinare (probabil nevaccinaţi sau incomplet vaccinaţi). Complicaţiile virale au fost prezente la majoritatea pacienţilor (84,1%) sub forma unei pneumonii interstiţiale. Pneumonia bacteriană a fost prezentă la 15% dintre pacienţi, iar dintre aceştia 45,2% au asociat şi insuficienţă respiratorie. Şase pacienţi au necesitat transfer în secţia de terapie intensivă pediatrie pentru suport respirator, înregistrându-se 2 decese. Laringita a fost prezentă în 8,2% cazuri, otita în 12% cazuri, în timp ce 61,7% dintre pacienţi au avut afectare gastrointestinală. Paraclinic, a fost evidenţiată citoliza hepatică la 101 (15,9%) pacienţi şi diselectrolitemia a fost prezentă la 94 (14,8%) din cazuri. Concluzii. Studiul prezent arată creşterea alarmantă a incidenţei bolii şi a complicaţiilor sale în ultimii 3 ani, mai ales la vârstele mici. Considerăm imperios necesară aplicarea programului de vaccinare pentru a asigura o acoperire vaccinală optimă, utilă atât în stoparea epidemiei actuale, cât şi în prevenirea unor viitoare epidemii

EPIDEMIOLOGICAL, CLINICAL AND PROGRESSIVE SPECTRUM OF MEASLES CASES ADMITTED TO „DR. VICTOR BABES“ CLINICAL HOSPITAL FOR INFECTIOUS AND TROPICAL DISEASES, BUCHAREST DURING THE ACTUAL OUTBREAK

Introduction. Starting with 2016 Romania had to face an alarming measles outbreak due to the continuous poor vaccination coverage. The outbreak associated an increased number of complications and deaths. Materials and methods. We performed a retrospective study, on a group of patients with measles, admitted to „Dr. Victor Babes“ Hospital. Epidemiological data, clinical characteristics and the results of the biological samples were obtained from the patient's medical records between January 2016 and December 2017. Results. Out of the 632 patients, 341 (53.9%) were males. Most of them (39.2%) were children, between 1 and 4 year-old, while 19.6% were infants. A quarter of the patients (31.3%) had familial contact with a measles case. The vaccination history was unknown in 44.3% cases; almost half of the patients (47.1%) were unvaccinated. Almost all of them developed viral complications, 84.1% being diagnosed with interstitial pneumonia. Bacterial pneumonia was diagnosed in 15.0% cases, out of which 45.2% were also associated with respiratory failure. Six patients required transfer to the pediatric intensive care unit for respiratory support and 2 died. Other complications were: laryngitis 8.2%, otitis 12.0% of the cases. Also 61.77% of the patients were diagnosed with enterocolitis. There was no case complicated with encephalitis. 101 (15.9%) patients developed liver cytolysis, while dyselectrolytemia was present in 94 (14.8%) cases. Conclusions. The number of patients diagnosed with measles during the last years registered an alarming increase, especially in children under 4 year old, with a high number of complications. We consider it mandatory to apply the vaccination program to ensure an optimal vaccine coverage, useful both in stopping the current outbreak and in preventing future outbreaks