Prophylactic use of antibiotics in neurosurgery which mean to use an antibiotic before infection ... more Prophylactic use of antibiotics in neurosurgery which mean to use an antibiotic before infection start, to reduce the incidence of postoperative wound infections, still is a controversial issue for strong arguments against the use of antimicrobials: promotion of antibioticresistant strains of bacteria, superinfection and adverse drug reactions Prophylaxis has become the standard of care for contaminated, clean-contaminated surgery, insertion of artificial devices. The antibiotic: first/second generation of cephalosporins or vancomicin in allergic patients should recover only the cutaneous posibily contaminating flora (S. aureus, S. epidermidis) and shoud be administrated 30’ before the surgical incision, intravenously in a single dose. Most studies pointed that identification of the risk factors for infections, correct asepsia and minimal prophylactic antibiotic regimen adopted to each case, help neurosurgeons to improve patient care and decrease mortality without selecting resistan...
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2014
We present a 31-year-old woman with a depressive disorder admitted in the Infectious Diseases Dep... more We present a 31-year-old woman with a depressive disorder admitted in the Infectious Diseases Department with high fever, cervical lymphadenopathy, generalized rash and progressive jaundice. Sepsis with hepatic involvement was initially suspected, but the bacteriological and serological profiles for viral and bacterial pathogens remained negative. The exposure to antidepressant medication including lamotrigine, an aromatic anticonvulsant molecule, raised the suspicion of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome. The antidepressants were withdrawn and methylprednisolone therapy was started with a favorable outcome and lent recovery after two months. This case highlights a rare drug allergic complication to antidepressant medication evolving as a sepsis with hepatic dysfunction.
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
Because of a low risk of infection (around 2-3%), prophylactic use of antibiotics in neurosurgery... more Because of a low risk of infection (around 2-3%), prophylactic use of antibiotics in neurosurgery is a controversial issue. Some neurosurgeons consider that there are strong arguments against the use of antimicrobials (promotion of antibiotic-resistant strains of bacteria, superinfection and adverse drug reactions) and meticulous aseptic techniques could be more usefully than prophylactic antibiotics. On the other hand, despite of being rare, the consequences of a neurosurgical infection can be dramatic and may result in a rapid death, caused by meningitis, cerebritis, abscess formation or sepsis. Clinical studies emphasized that the most important factors influencing the choice of antibiotic prophylaxis in neurosurgery is the patient's immune status, virulence of the pathogens and the type of surgery ("clean contaminated"--procedure that crosses the cranial sinuses, "clean non-implant"--procedure that does not cross the cranial sinuses, CSF shunt surgery, sk...
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2005
Hepatitis virus C (HCV) is worldwide a health problem, which may lead to serious complications. T... more Hepatitis virus C (HCV) is worldwide a health problem, which may lead to serious complications. The aim of this study was to correlate the onset of the cerebral ischemic attack accompanied by mixed cryoglobulinemia, with the chronic hepatitis C virus infection. These studies were carried out in 12 patients with serologic/virusologic confirmed chronic HCV infection associated with ischemic stroke. Ischemic stroke occurred in equal proportion in women and men. The patients did not know of HCV infection diagnosis at that moment. All patients had type II mixed monoclonal cryoglobulinemia, hypergammaglobulinemia with polyclonal IgG and monoclonal IgM, blood hyperviscosity, high level of cryocrit, positive rheumatoid factor, normal levels of serum transaminases, negative serum hepatitis B surface antigen (HBs Ag), negative anti HBc antibodies, positive HCV antibodies, positive serum RNA HCV, decreased serum C3 and C4 levels, antinuclear antibodies-false positive. Immunological tests for a...
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2003
Some mediators of inflammation are associated with sepsis, involving nervous system. Proinflammat... more Some mediators of inflammation are associated with sepsis, involving nervous system. Proinflammatory cytokines, TNF-alpha, IL-6, and IL-8, and procalcitonin (PCT), proinflammatory protein, were investigated in patients with neurologic complications in sepsis. TNF-alpha, IL-6, IL-8, and PCT were prospectively investigated in 62 patients with neurologic complications in sepsis. TNF-alpha and IL-6 were studied both in serum as in the CSF, IL-8 and PCT were studied only in serum. TNF-alpha, IL-6, and IL-8 were studied by ELISA (R & D Systems), and the PCT by immunoluminometric assay (BRAHMS). Mean value of TNF-alpha in serum was 578+/-214 pg/ml, and in CSF was 458+/-167 pg/ml (p<0.01). Mean value of IL-6 in serum was 749+/-213 pg/ml, and in CSF was 617.5+/-182 pg/ml (p<0.01). Mean value of IL-8 in serum was 332+/-196 pg/ml (p<0.01). Mean value of PCT in serum was 80+/-16 ng/ml (p<0.01). The investigated parameters do not permit the identifying of cases with neurologic compli...
— The immune modulating role of vitamin D has been extensively studied but less documented in chr... more — The immune modulating role of vitamin D has been extensively studied but less documented in chronic infection with hepatitis C virus (HCV). The aim of our study was to assess the vitamin D status and adaptative immunity in HCV chronic infected patients. 46 patients were selected, 25 diagnosed with chronic hepatitis C infection and 21 healthy controls. HCV patients were classified according to the degree of hepatic necroinflammatory activity recorded using Actitest. A2-A3 scores were considered relevant for active HCV hepatitis, while A0-A1 indicated inactive HCV hepatitis. We measured: a) vitamin D status using 25-hydroxyvitam D plasma level (Elisa method) and the calcium-phosphorus equilibrium, b) the immune status according to the CD4+ T helper cells and CD8+ T helper cells detected by flow cytometry, and c) the extent of liver cytolysis disclosed by alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. All HCV patients, as well as healthy controls displaye...
In this paper we propose to present the biochemical modifications in children and adolescents wit... more In this paper we propose to present the biochemical modifications in children and adolescents with HIV infection/AIDS undergoing antiretroviral therapy (ART). We have carried out a retrospective study on 200 HIV-seropositive children registered in our department, without any prior workup modifications, in which antiretroviral therapy was initiated. In all patients we have monitored serum glucose, amylasemia, natremia, and liver enzymes. Most of the biochemical modifications were mild and moderate and did not necessitate cessation of therapy. In only 2 cases, modifications were severe enough to impose a temporary interruption of the ART: one case with elevated triglycerides and one case with elevated liver enzymes. After 24 months of ART, approximately 11.5% (23/200) of the monitored patients had biochemical modifications: 3.5 % elevated triglycerides, 5% elevated liver enzymes, 2.5 % hyperamylasemia, and 0.5 % hypernatremia. Biochemical modifications were more significant in patient...
In this paper we propose to evaluate the lipid metabolism abnormalities in children and adolescen... more In this paper we propose to evaluate the lipid metabolism abnormalities in children and adolescents with HIV/AIDS undergoing treatment with protease inhibitors (PIs). There are over 1000 children and adolescents with HIV infection of various stages registered in the Pediatric Department of the National Institute of Infectious Diseases Prof. Dr. Matei Bals. We have carried out a retrospective study on 200 HIV seropositive children without previous lipid metabolism abnormalities in which antiretroviral treatment was initiated. In these patients we have monitored modifications in lipid metabolism secondary to antiretroviral treatment (triglycerides, cholesterol, and lipids). The majorities of abnormalities of the lipid metabolism were not severe and did not require modification or cessation of treatment. 24 months of treatment later, approximately 23.5% of patients treated with 2 NRTI+PI/r had modifications of the lipid metabolism: 34.6% had hypercholesterolemia, 38.4% had hypertriglyc...
Prophylactic use of antibiotics in neurosurgery which mean to use an antibiotic before infection ... more Prophylactic use of antibiotics in neurosurgery which mean to use an antibiotic before infection start, to reduce the incidence of postoperative wound infections, still is a controversial issue for strong arguments against the use of antimicrobials: promotion of antibioticresistant strains of bacteria, superinfection and adverse drug reactions Prophylaxis has become the standard of care for contaminated, clean-contaminated surgery, insertion of artificial devices. The antibiotic: first/second generation of cephalosporins or vancomicin in allergic patients should recover only the cutaneous posibily contaminating flora (S. aureus, S. epidermidis) and shoud be administrated 30’ before the surgical incision, intravenously in a single dose. Most studies pointed that identification of the risk factors for infections, correct asepsia and minimal prophylactic antibiotic regimen adopted to each case, help neurosurgeons to improve patient care and decrease mortality without selecting resistan...
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2014
We present a 31-year-old woman with a depressive disorder admitted in the Infectious Diseases Dep... more We present a 31-year-old woman with a depressive disorder admitted in the Infectious Diseases Department with high fever, cervical lymphadenopathy, generalized rash and progressive jaundice. Sepsis with hepatic involvement was initially suspected, but the bacteriological and serological profiles for viral and bacterial pathogens remained negative. The exposure to antidepressant medication including lamotrigine, an aromatic anticonvulsant molecule, raised the suspicion of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome. The antidepressants were withdrawn and methylprednisolone therapy was started with a favorable outcome and lent recovery after two months. This case highlights a rare drug allergic complication to antidepressant medication evolving as a sepsis with hepatic dysfunction.
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
Because of a low risk of infection (around 2-3%), prophylactic use of antibiotics in neurosurgery... more Because of a low risk of infection (around 2-3%), prophylactic use of antibiotics in neurosurgery is a controversial issue. Some neurosurgeons consider that there are strong arguments against the use of antimicrobials (promotion of antibiotic-resistant strains of bacteria, superinfection and adverse drug reactions) and meticulous aseptic techniques could be more usefully than prophylactic antibiotics. On the other hand, despite of being rare, the consequences of a neurosurgical infection can be dramatic and may result in a rapid death, caused by meningitis, cerebritis, abscess formation or sepsis. Clinical studies emphasized that the most important factors influencing the choice of antibiotic prophylaxis in neurosurgery is the patient's immune status, virulence of the pathogens and the type of surgery ("clean contaminated"--procedure that crosses the cranial sinuses, "clean non-implant"--procedure that does not cross the cranial sinuses, CSF shunt surgery, sk...
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2005
Hepatitis virus C (HCV) is worldwide a health problem, which may lead to serious complications. T... more Hepatitis virus C (HCV) is worldwide a health problem, which may lead to serious complications. The aim of this study was to correlate the onset of the cerebral ischemic attack accompanied by mixed cryoglobulinemia, with the chronic hepatitis C virus infection. These studies were carried out in 12 patients with serologic/virusologic confirmed chronic HCV infection associated with ischemic stroke. Ischemic stroke occurred in equal proportion in women and men. The patients did not know of HCV infection diagnosis at that moment. All patients had type II mixed monoclonal cryoglobulinemia, hypergammaglobulinemia with polyclonal IgG and monoclonal IgM, blood hyperviscosity, high level of cryocrit, positive rheumatoid factor, normal levels of serum transaminases, negative serum hepatitis B surface antigen (HBs Ag), negative anti HBc antibodies, positive HCV antibodies, positive serum RNA HCV, decreased serum C3 and C4 levels, antinuclear antibodies-false positive. Immunological tests for a...
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2003
Some mediators of inflammation are associated with sepsis, involving nervous system. Proinflammat... more Some mediators of inflammation are associated with sepsis, involving nervous system. Proinflammatory cytokines, TNF-alpha, IL-6, and IL-8, and procalcitonin (PCT), proinflammatory protein, were investigated in patients with neurologic complications in sepsis. TNF-alpha, IL-6, IL-8, and PCT were prospectively investigated in 62 patients with neurologic complications in sepsis. TNF-alpha and IL-6 were studied both in serum as in the CSF, IL-8 and PCT were studied only in serum. TNF-alpha, IL-6, and IL-8 were studied by ELISA (R & D Systems), and the PCT by immunoluminometric assay (BRAHMS). Mean value of TNF-alpha in serum was 578+/-214 pg/ml, and in CSF was 458+/-167 pg/ml (p<0.01). Mean value of IL-6 in serum was 749+/-213 pg/ml, and in CSF was 617.5+/-182 pg/ml (p<0.01). Mean value of IL-8 in serum was 332+/-196 pg/ml (p<0.01). Mean value of PCT in serum was 80+/-16 ng/ml (p<0.01). The investigated parameters do not permit the identifying of cases with neurologic compli...
— The immune modulating role of vitamin D has been extensively studied but less documented in chr... more — The immune modulating role of vitamin D has been extensively studied but less documented in chronic infection with hepatitis C virus (HCV). The aim of our study was to assess the vitamin D status and adaptative immunity in HCV chronic infected patients. 46 patients were selected, 25 diagnosed with chronic hepatitis C infection and 21 healthy controls. HCV patients were classified according to the degree of hepatic necroinflammatory activity recorded using Actitest. A2-A3 scores were considered relevant for active HCV hepatitis, while A0-A1 indicated inactive HCV hepatitis. We measured: a) vitamin D status using 25-hydroxyvitam D plasma level (Elisa method) and the calcium-phosphorus equilibrium, b) the immune status according to the CD4+ T helper cells and CD8+ T helper cells detected by flow cytometry, and c) the extent of liver cytolysis disclosed by alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. All HCV patients, as well as healthy controls displaye...
In this paper we propose to present the biochemical modifications in children and adolescents wit... more In this paper we propose to present the biochemical modifications in children and adolescents with HIV infection/AIDS undergoing antiretroviral therapy (ART). We have carried out a retrospective study on 200 HIV-seropositive children registered in our department, without any prior workup modifications, in which antiretroviral therapy was initiated. In all patients we have monitored serum glucose, amylasemia, natremia, and liver enzymes. Most of the biochemical modifications were mild and moderate and did not necessitate cessation of therapy. In only 2 cases, modifications were severe enough to impose a temporary interruption of the ART: one case with elevated triglycerides and one case with elevated liver enzymes. After 24 months of ART, approximately 11.5% (23/200) of the monitored patients had biochemical modifications: 3.5 % elevated triglycerides, 5% elevated liver enzymes, 2.5 % hyperamylasemia, and 0.5 % hypernatremia. Biochemical modifications were more significant in patient...
In this paper we propose to evaluate the lipid metabolism abnormalities in children and adolescen... more In this paper we propose to evaluate the lipid metabolism abnormalities in children and adolescents with HIV/AIDS undergoing treatment with protease inhibitors (PIs). There are over 1000 children and adolescents with HIV infection of various stages registered in the Pediatric Department of the National Institute of Infectious Diseases Prof. Dr. Matei Bals. We have carried out a retrospective study on 200 HIV seropositive children without previous lipid metabolism abnormalities in which antiretroviral treatment was initiated. In these patients we have monitored modifications in lipid metabolism secondary to antiretroviral treatment (triglycerides, cholesterol, and lipids). The majorities of abnormalities of the lipid metabolism were not severe and did not require modification or cessation of treatment. 24 months of treatment later, approximately 23.5% of patients treated with 2 NRTI+PI/r had modifications of the lipid metabolism: 34.6% had hypercholesterolemia, 38.4% had hypertriglyc...
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