The HIV Positive Adolescent in a Pandemic Year: A Point of View

In the HIV/AIDS Regional Center from Iasi, Romania, over 1440 patients are closely followed-up. A small percent <1% (12 patients) of cases are represented by adolescences between 14 and 18 years old. The majority of those (10 cases) are adherent and compliant with the treatment. None of the patients is a drug abuser and one patient acquired the infection through vertical transmission. The COVID-19 pandemic, paradoxically, increased the adherence and compliance to treatment, mainly because it seems that the HIV infected adolescent acknowledge the fact that good health can shield them from an unknown enemy. In these pandemic times, they experienced anxiety and depression, but they kept a closer contact through telemedicine with their physician, and most importantly, they required a sustained session, also through telemedicine, with the psychologist. The red thread of their discussion was focused on their fear, insecurities, and lack of control and the fact that they experienced the feeling of abandonment caused by the absence of interpersonal interaction with their support group

The Psychological Impact on Families of Departed Patients with Infectious Diseases

Looking back into history, infectious diseases played an important role in human history being responsible, in terms of pathologies, for more deaths than any other disease. Considering that infectious diseases have a high rate of transmissibility, with an acute debut and sometimes with a fast evolution to exitus, the impact of the news on families of the departed patient diagnosed with an infectious disease can come as a shock. Processing the unexpected death of a family member needs not only the implication of the physician but also the counseling of a specialized psychologist which can help the families through all stages of loss and grief

Ghidurile pentru practica epidemiologică în spital - o necesitate în strategia de supraveghere a infecţiilor nosocomiale

Universitatea de Medicina şi Farmacie Gr. T. Popa, Iaşi, România, Disciplina de Asistenţa Primară a Stării de Sănătate şi Epidemiologie, Unitatea de Epidemiologie, Clinică Iaşi, Disciplina de Boli InfecţioaseIntroducere. Evoluţia infecţiilor nosocomiale (IN) are un caracter dinamic, fiind dependentă de numeroși factori. Monitorizarea terapiei cu antibiotice în cadrul acţiunilor de supraveghere a infecţiilor nosocomiale cu includerea rezultatelor în Ghidul pentru practică epidemiologică de spital are ca scop ameliorarea semnificativă a evoluţiei acestei patologii iatrogene. Scopul studiului a urmărit limitarea infecţiilor nosocomiale prin standardizarea recomandărilor de antibioterapie. Obiectivele studiului au constat în supravegherea sistematică a incidenţei IN apărute în perioada 2002-2011, concomitent cu înregistrarea evoluţiei rezistenţei la antibiotice a tulpinilor microbiene izolate de la pacienţii spitalizaţi în sectiile de Chirurgie toracică, Terapie intensivă și Pneumologie ale Spitalului Clinic de Pneumoftiziologie Iași. Material și metode. Studiul longitudinal, care a inclus pacienţii spitalizaţi, a urmărit identificarea incidenţei IN, conform definiţiei de caz, și a cauzelor de producere a acestora prin înregistrarea factorilor de risc cu ocazia anchetei epidemiologice. Din datele laboratorului de microbiologie privind tulpinile cu semnificaţie clinică izolate din produselele patologice (spută, lichid pleural, aspirat bronșic, secreţie din plaga postoperatorie etc.) a fost analizată sensiblitatea acestora la antibiotice. Rezultate. În perioada studiată au fost identificate cazurile de IN în serviciile de Terapie intensivă și Chirurgie toracică. Numărul total al acestora a fost 180, cu variaţii de la 48 în anul 2002 la 6 în 2011 și o incidenţă specifică de 1,52 IN pleurale/ 100 de pacienţi internaţi. După forma clinică au predominat IN de plagă operatorie profundă (pleurale) și, respectiv, superficială. Etiologia IN a fost dominată de tulpinile multiplurezistente de Pseudomonas aeruginosa și Staphylococcus aureus, iar cele respiratorii, fără caracteristici de nosocomialitate, Streptococcus pneumoniae și Haemophilus influenzae. Strategia generală în IN este de antibioterapie de dezescaladare și utilizarea asocierii unui antibiotic de ultimă generaţie (precum linezolid/vancomicină) cu un aminoglicozid de ultimă generaţie sau o fluorochinolonă în infecţiile cu stafilococ, iar în cele cu Pseudomonas – a carbapenemelor, urmate de asocierea de peniciline cu inhibitori de betalactamaze, cu sau fără aminoglicozid. Concluzii. Beneficiile colaborării dintre clinician, infecţionist, epidemiolog și microbiolog sunt cuantificate prin scăderea riscului și incidenţei IN, iar informaţiile privind profilul de sensibilitate a tulpinilor microbiene izolate oferă posibilitatea antibioterapiei adecvate. Elaborarea unui ghid naţional, cu recomandări generale, la care fiecare spital, să asocieze rezultatele analizei anuale a particularităţilor profilului de rezistenţă a tulpinilor circulante în unitatea medicală proprie, reprezintă o necesitate în contextul actual în care patologia infecţioasă indusă de riscul infecţiilor nosocomiale generează suferinţă și invaliditate pentru pacienţi, dar și pierderi economice importante pentru sistemul de sănătate

Oxidative stress, inflammation and endothelial dysfunction: implications in atherosclerosis. Note II.

NADPH oxidase (nicotinamide adenine dinucleotide phosphate-oxidase), with its generically termed NOX isoforms, is the major source of ROS (reactive oxigen species) in biological systems. The oxidant/ antioxidant imbalance in favor of oxidants in the vascular system generates ROS via activation of NADPH oxidase. ROS are small oxygen-derived molecules with an important role in various biological processes (physiological or pathological). Some processes are beneficial and necessary for life under physiological conditions, but they are noxious, harmful under pathophysiological conditions. NADPH oxidases are present in phagocytes and in a wide variety of nonphagocytic cells. The enzyme generates superoxide by transferring electrons from NADPH inside the cell across the membrane and coupling them to molecular oxygen to produce superoxide anion, a reactive free-radical. Structurally, NADPH oxidase is a multicomponent enzyme which includes two integral membrane proteins, glycoprotein gp91phox and adaptor protein p22phox, which together form the heterodimeric flavocytochrome b558 that constitutes the core of the enzyme. During the resting state, the multidomain regulatory subunits p40phox, p47phox, p67phox are located in the cytosol organized as a complex. The activation of phagocytic NADPH oxidase occurs through a complex series of protein interactions. The increased production of free radicals under pathophysiological conditions is an integral part of the production of cardiovascular diseases and in particular of atherosclerosis. At the onset and progression of atherosclerosis, various non-traditional intercorrelated risk factors contribute such as oxidative stress, inflammation and endothelial dysfunction. Oxidative stress plays a crucial role not only in the formation but also in the evolution and destabilization of lesions. Oxidative stress is closely linked to endothelial damage. Endothelium modulates vascular tone by releasing specific vasoactive substances. At the onset and progression of atherosclerosis contributes to decreasing the bioavailability of NO (nitric oxide) or EDRF (endothelium-derived relaxing factor) with an important role in conserving vasodilation and inhibiting vasoconstriction. Clinical and paraclinical investigations show that inflammatory reactions operate at all stages of atherosclerotic events. According to the theory of oxidative stress, atherosclerosis is also the result of the particularly oxidative changes of LDL (low density lipoproteins) in the arterial wall. Excess ROS can produce peroxinitrite with NO, the cytotoxic oxidant important mediator of LDL oxidation with proaterogenic action

Seroprevalence of Anti-Hepatitis E Virus Antibodies among Patients from a Tertiary Hospital from Northeast Romania

Background and Objectives. Being an enterically transmitted pathogen with a growing prevalence in developed countries, hepatitis E virus (HEV) infection remains an underdiagnosed disease in Eastern Europe. As far as Romania is concerned, only a few studies address this issue. Our goal was to estimate the prevalence of serum anti-HEV IgA/IgM/IgG antibodies in a group of patients admitted to the Clinical Hospital for Infectious Diseases “St. Parascheva” Iasi. Materials and Methods. The cross-sectional study consisted of enrollment of 98 patients admitted to the clinic for COVID-19 over a period of three months in 2020. Results. The median age in our study was 73 years, with an equal gender ratio and with a predominance of people from the urban environment (75%). The overall HEV antibody seroprevalence was 12.2%. The main risk factors associated with HEV infection were consumption of water from unsafe sources (58.3% HEV-positive patients vs. 26.7% HEV-negative patients, p = 0.026) and improperly cooked meat (58.3% HEV-positive patients vs. 23.2% HEV-negative patients, p = 0.01). Zoonotic transmission was an important criterion in our study, with patients reporting contact with pigs, poultry, rats, or other farms animals, but no significant differences were found between HEV antibody positive and negative groups. Conclusions. The seroprevalence rate of HEV antibodies was similar to other previous reports from our area but higher than in most European countries. The fact that HEV antibodies were detected in patients without identifiable risk factors for hepatitis E is evidence of subclinical infection as a silent threat

An Update At The Interface Between Infectious Pathology And The Stomatognathic System

The stomatognathic system normally hosts of an extremely diverse microbial flora responsible for the anti-infectious defence, but which, preponderantly in some special categories of patients, through dissemination or toxin release, may have an unfavourable influence on patients’ health state. Both dental patients and medical staff are exposed, due to direct contact with mucus and secretions of the stomatognathic system, to a great number of non-bacterial pathogens, such as hepatitis virus B or C, Epstein-Barr virus, herpes simplex virus 1 or 2, HIV, fungi, which colonize, infect or are just expressed at this level. A large series of infectious diseases have primary or secondary manifestations located in the area of the stomatognathic system, and a well-trained medical personnel can decisively contribute to avoid the spreading or aggravation of infection, by setting an early diagnose or an adequate treatment

Palliative Care in AIDS Cases

Terminal stages of AIDS must enjoy special attention and care for both patients and their relatives. Material and method: There were studied retrospectively case report forms of patients who died of AIDS in the Infectious Diseases Clinic of Iasi. In the department of HIV-infected patients of the Infectious Diseases Hospital of Iasi, within the last 3 years (2007-2009) there were 28 deaths, with an average of 9 patients per year. Most of them died of multiple organ failure, in the final stage of AIDS (10 cases), meningeal coma (5 cases) or respiratory failure during the terminal pulmonary pneomocystosis TB (13 cases). The palliative therapy was conducted throughout the hospitalisation of the terminal stage. The patients who survived longer required psychological support from admission until they lost their state of consciousness – they were 23 in number, with a duration of psychological palliation from 2 to 32 days. Objectives: Establishing a team and protocols of palliative care for these patients. Conclusions: Palliative care, in cases of terminal AIDS disease, must be conducted by a team including specialists in infectious diseases, in intensive care, psychologists and it also addresses the patients’ families

PALLIATIVE CARE IN AIDS CASES

Introduction Terminal stages of AIDS must enjoy special attention and care for both patients and their relatives. Material and methods There were studied retrospectively case report forms of patients who died of AIDS in the Infectious Diseases Clinic of Iasi. In the department of HIV-infected patients of the Infectious Diseases Hospital of Iasi, within the last 3 years (2007-2009) there were 28 deaths, with an average of 9 patients per year. Most of them died of multiple organ failure, in the final stage of AIDS (10 cases), meningeal coma (5 cases) or respiratory failure during the terminal pulmonary pneomocystosis TB (13 cases). The palliative therapy was conducted throughout the hospitalisation of the terminal stage. The patients who survived longer required psychological support from admission until they lost their state of consciousness - they were 23 in number, with a duration of psychological palliation from 2 to 32 days. Objectives Establishing a team and protocols of palliative care for these patients. Conclusions Palliative care, in cases of terminal AIDS disease, must be conducted by a team including specialists in infectious diseases, in intensive care, psychologists and it also addresses the patients’ families