Seroprevalence of Herpes Simplex Virus Types 1 and 2 among Pregnant Women in South-Western Romania.

BACKGROUND: Pregnancy-related infections with the human herpes simplex virus (HSV) strains HSV-1 and HSV-2 are particularly noteworthy. There are numerous reported examples of intrapartum transmission of herpes infection, notwithstanding the extreme rarity of intrauterine transfer from mother to fetus. The purpose of this study was to evaluate the seroprevalence of HSV-1 and HSV-2 antibodies in pregnant women in the western region of Romania. METHODS: Pregnant women who presented for routine pregnancy monitoring at Romania's County Clinical Emergency Hospital in Craiova between 2013 and 2016 and 2019 and 2022 were included in the study. In order to find anti-HSV-1/2 IgG antibodies, we conducted serological testing on the patients and gathered demographic information from them. RESULTS: HSV-1 seroprevalence was shown to have declined in rural areas and increased in urban areas, with values between 2013 and 2016 being 89.30% and those between 2019 and 2022 being 84.96%, respectively. Women over 35 who were pregnant had the highest seroprevalence. The seroprevalence of HSV-2 decreased from 16.16% in 2013-2016 to 12.43% in 2019-2022, and both rural and urban areas continued to experience this declining trend. Similarly, pregnant women over 35 years old had the highest frequency of HSV-1 infections. CONCLUSIONS: Establishing educational programs and other actions to reduce the transmission rate and ultimately the prevalence of the disease can be made easier with knowledge about the seroprevalence of HSV-1 and HSV-2 infections.

Interrelation of Hypoxia-Inducible Factor-1 Alpha (HIF-1 α) and the Ratio between the Mean Corpuscular Volume/Lymphocytes (MCVL) and the Cumulative Inflammatory Index (IIC) in Ulcerative Colitis.

We intended to investigate the presence and medical application of serum hypoxia-inducible factor-1 alpha (HIF-1α) along with the already known systemic inflammatory markers and the new one's inflammatory indices, the proportion of mean corpuscular volume and lymphocytes (MCVL) and the cumulative inflammatory index (IIC), for patients with ulcerative colitis (UC). We sought to establish correlations that may be present between the serum levels of HIF-1α and these inflammatory indices, as well as their relationship with disease activity and the extent of UC, which can provide us with a more precise understanding of the evolution, prognosis, and future well-being of patients. Serum samples were collected from 46 patients diagnosed with UC and 23 controls. For our assessment of the serum levels of HIF-1α, we used the Enzyme-Linked Immunosorbent Assay (ELISA) technique. Thus, for HIF-1α we detected significantly higher values in more severe and more extensive UC. When it came to MCVL and IIC, we observed statistically significant differences between the three groups being compared (Severe, Moderate, and Mild). Our study highlighted that HIF-1α correlated much better with a disease activity score, MCVL, and IIC. With MCVL and IIC, a strong and very strong correlation had formed between them and well-known inflammation indices. By examining the ROC curves of the analyzed parameters, we recognized that TWI (accuracy of 83.70%) provides the best discrimination of patients with early forms of UC, followed by HIF-1α (73.90% accuracy), MCVL (70.90% accuracy), and PLR (70.40%). In our study, we observed that HIF-1α, MCVL, and PLR had the same sensitivity (73.33%) but HIF-1α had a much better specificity (60.87% vs. 58.70%, and 54.35%). Also, in addition to the PLR, HIF-1α and MCVL can be used as independent predictor factors in the discrimination of patients with early forms of UC.

MMP-13, VEGF, and Disease Activity in a Cohort of Rheumatoid Arthritis Patients.

Identifying certain serum biomarkers associated with the degree of rheumatoid arthritis (RA) activity can provide us with a more accurate view of the evolution, prognosis, and future quality of life for these patients. Our aim was to analyze the presence and clinical use of matrix metalloproteinase-13 (MMP-13), along with vascular endothelial growth factor (VEGF) and well-known cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) for patients with RA. We also wanted to identify the possible correlations between MMP-13 and these serological markers, as well as their relationship with disease activity indices, quality of life, and ultrasonographic evaluation. For this purpose, we analyzed serum samples of 34 RA patients and 12 controls. In order to assess serum concentrations for MMP-13, VEGF, TNF-α, and IL-6, we used the enzyme-linked immunosorbent assay (ELISA) technique. Our results concluded that higher levels of MMP-13, VEGF, TNF-α, and IL-6 were present in the serum of RA patients compared to controls, with statistical significance. We furthermore identified moderately positive correlations between VEGF, MMP-13, and disease activity indices, as well as with the ultrasound findings. We also observed that VEGF had the best accuracy (97.80%), for differentiating patients with moderate disease activity. According to the data obtained in our study, that although MMP-13, TNF-α and C-reactive protein (CRP) have the same sensitivity (55.56%), MMP-13 has a better specificity (86.67%) in the diagnosis of patients with DAS28(4v) CRP values corresponding to moderate disease activity. Thus, MMP-13 can be used as a biomarker that can differentiate patients with moderate or low disease activity. VEGF and MMP-13 can be used as additional parameters, along with TNF-α and IL-6, that can provide the clinician a better picture of the inflammatory process, disease activity, and structural damage in patients with RA. Our data can certainly constitute a start point for future research and extended studies with multicenter involvement, to support the selection of individualized and accurate therapeutic management strategies for our patients.

Prevalence of Multidrug-Resistant Pathogens Causing Bloodstream Infections in an Intensive Care Unit.

Introduction: Bloodstream infections are the most severe infections that cause the highest mortality rate, especially in patients admitted to the intensive care unit (ICU). In this study, we aimed to analyze the distribution, resistance patterns and prevalence of MDR (multidrug-resistant) pathogens isolated in blood samples collected from patients with severe invasive infections hospitalized in the ICU. Methods: A retrospective study of bacterial pathogens was performed on 490 patients admitted to the ICU between 2017 and 2020. The resistance patterns were analyzed using Vitek 2 Compact system. Results: In total, 617 bacterial isolates were obtained. Four hundred and twenty-seven isolates (69.21%) were Gram positive and 190 isolates (30.79%) were Gram negative bacteria. The most frequently isolated micro-organisms identified in the blood samples for the entire period (2017-2020) were Coagulase-negative staphylococci (CoNS) (318-51.54%), followed by Klebsiella pneumoniae (70-11.34%), Methicillin-Resistant Staphylococcus aureus (MRSA) (58-9.40%), Acinetobacter baumannii (45-7.29%) and Enterococcus faecalis (42-6.80%). The number of Klebsiella pneumoniae strains significantly increased in 2020, compared to the previous year (p < 0.05). The Acinetobacter baumannii prevalence was significantly higher in the age group of 20-64 years (10.89%) and over 65 years (3.53%) (p < 0.001). The difference between the prevalence of CoNS in the elderly (67.84%) and in adults (20-64 years) (52.47%) was also statistically significant (p < 0.001). High rates of MDR were found for Acinetobacter baumannii (97.77%), Pseudomonas aeruginosa (65%), Klebsiella pneumoniae (50%), Enterococcus faecalis (47.61%) and MRSA (46.55%). More than 60% of the Klebsiella pneumoniae strains were found to be resistant to carbapenems. Conclusion: The study revealed an alarming prevalence of MDR strains isolated in blood samples of the patients admitted to the ICU, indicating the necessity of consistent application of the measures to control.

TEM,CTX-M,SHV Genes in ESBL-Producing Escherichia coli and Klebsiella pneumoniae Isolated from Clinical Samples in a County Clinical Emergency Hospital Romania-Predominance of CTX-M-15.

BACKGROUND: CTX-M betalactamases have shown a rapid spread in the recent years among Enterobacteriaceae and have become the most prevalent Extended Spectrum Beta-Lactamases (ESBLs) in many parts of the world. The introduction and dissemination of antibiotic-resistant genes limits options for treatment, increases mortality and morbidity in patients, and leads to longer hospitalization and expensive costs. We aimed to identify the beta-lactamases circulating encoded by the genes blaCTX-M-15, blaSHV-1 and blaTEM-1 in Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) strains. Furthermore, we established the associated resistance phenotypes among patients hospitalized in the Intensive Care Unit (ICU) from County Clinical Emergency Hospital of Craiova, Romania. METHODS: A total of 46 non-duplicated bacterial strains (14 strains of E. coli and 32 strains of K. pneumoniae), which were resistant to ceftazidime (CAZ) and cefotaxime (CTX) by Kirby-Bauer disk diffusion method, were identified using the automated VITEK2 system. Detection of ESBL-encoding genes and other resistance genes was carried out by PCR. RESULTS: E. coli strains were resistant to 3rd generation cephalosporins and moderately resistant to quinolones, whereas K. pneumoniae strains were resistant to penicillins, cephalosporins, and sulfamides, and moderately resistant to quinolones and carbapenems. Most E. coli strains harbored blaCTX-M-15 gene (13/14 strains), a single strain had the blaSHV-1 gene, but 11 strains harbored blaTEM-1 gene. The mcr-1 gene was not detected. We detected tet(A) gene in six strains and tet(B) in one strain. In K. pneumoniae strains we detected blaCTX-M-15 in 23 strains, blaSHV-1 in all strains and blaTEM-1 in 14 strains. The colistin resistance gene mcr-1 was not detected. The tetracycline gene tet(A) was detected in 11 strains, but the gene tet(B) was not detected in any strains. CONCLUSIONS: The development in antibiotic resistance highlights the importance of establishing policies to reduce antibiotic use and improving the national resistance surveillance system in order to create local antibiotic therapy guidelines.

A new threat from an old enemy: Re­emergence of coronavirus (Review).

The new outbreak of coronavirus from December 2019 has brought attention to an old viral enemy and has raised concerns as to the ability of current protection measures and the healthcare system to handle such a threat. It has been known since the 1960s that coronaviruses can cause respiratory infections in humans; however, their epidemic potential was understood only during the past two decades. In the present review, we address current knowledge on coronaviruses from a short history to epidemiology, pathogenesis, clinical manifestation of the disease, as well as treatment and prevention strategies. Although a great amount of research and efforts have been made worldwide to prevent further outbreaks of coronavirus­associated disease, the spread and lethality of the 2019 outbreak (COVID­19) is proving to be higher than previous epidemics on account of international travel density and immune naivety of the population. Only strong, joint and coordinated efforts of worldwide healthcare systems, researchers, and pharmaceutical companies and receptive national leaders will succeed in suppressing an outbreak of this scale.

Study of antimicrobial effects of functionalized silver nanoparticles.

In recent decades, the study of nanoparticles (NPs) has gained a great scientific interest, due to a wide range of potential applications, in different fields: electronic, optical and biomedical. Some of the most studied effects of NPs are antibacterial ones, because the large, sometimes unjustified and uncontrolled administration of antibiotics has led to the emergence of multidrug-resistant (MDR) bacterial strains. In our study, starting from silver nitrate (AgNO3), we made approximately 30 nm spherical AgNPs that were coated with a thin layer of ethylene glycol (EG) or EG and polyvinylpyrrolidone (PVP). The microbial culture study showed that AgNPs have antibacterial effects, depending on the dose of the NPs and the type of bacteria.

Antimicrobial resistance in bacterial pathogens among hospitalised patients with severe invasive infections.

The most severe infections are invasive infections, due to the fact that the germs can accumulate in multiple sites and produce a body-wide infection known as sepsis. Septic shock has the highest mortality rate among non-traumatic medical conditions. In this study, we aimed to evaluate the incidence and prevalence of invasive infections in a hospital environment. Another second objective was to establish the aetiology of invasive infections in our hospital and the antibiotic resistance profile of the germs involved, which are both important for determining the therapeutic approach for the treatment of these infections. The study included 505 hospitalized patients from which we collected a total of 974 blood cultures. For the analysis of the blood cultures, we used an automated incubator. The bottles flagged as positive were subcultured on blood agar, and the grown colonies were identified using an identification system. Invasive infections had a prevalence rate of 27.72% in our hospital. From the 974 blood cultures, we isolated 170 bacterial strains: Staphylococcus aureus (SA; 63 strains, 37.06%), Klebsiella spp. (27 strains, 15.88%), coagulase-negative staphylococci (CoNS; 18 strains, 10.59%), Enterococcus spp. (17 strains, 10.00%), Escherichia coli (12 strains, 7.06%), Streptococcus spp. (11 strains, 6.47%) and other bacterial species. The prevalence of methicillin-resistant SA (MRSA) in our study was 36.51% from the SA strains. The MRSA prevalence differed significantly according to age (37.50% in adults vs. 28.57% in children, P=0.047) and ICU admission (42.42% in ICU patients vs. 30.00% in non-ICU patients, P=0.018). We performed a multivariate analysis of the invasive infection risk which detected as significant predictors the admission into the cardiology ward and plastic surgery ward. On the whole, the findings of this study indicate that the high prevalence of Gram-positive cocci in blood cultures, mostly SA, with multidrug resistance has important consequences for the management of invasive infections.

Liver hydatid cyst - cause of violent death. Case presentation.

Liver hydatid cyst represents one of the most frequent localizations of Echinococcus granulosus tapeworm in humans. The disease progresses symptom-free in most patients, due to a slow growth rhythm of the cyst. When it reaches large sizes, the hydatid cyst causes discomfort or pain in the liver bed, low appetite, phenomena of hepatitis or cholangitis. The patients are most often diagnosed with liver hydatid cyst after imagistic investigations (radiological or ultrasound) for symptoms that, most commonly, are not related to a hydatid cyst. We present the case of an 11-year-old girl, with no pathological history, who presented forme fruste symptoms, not acknowledged by her parents, and deceased after an anaphylactic shock caused by the rupture of a liver hydatid cyst.

Comparing the antifibrotic effect on the liver of Telmisartan and Pentoxifylline, in a Wistar rat experimental model.

Chronic liver diseases are characterized by higher or lower changes of the liver lobe architecture (parenchymatous and vacuolar), the accumulation of inflammatory and collagen infiltrates, mainly in the Kiernan spaces and a progressive evolution to liver cirrhosis. Despite the progresses made in knowing the mechanisms of liver fibrosis and the development of some antiviral drugs with a high potential, that can induce fibrosis regression, there still continues to exist the need for a specific antifibrotic treatment. In our study, we used four groups of Wistar rats: a reference group and three groups that received 40% carbon tetrachloride (CCl4), intraperitoneally, twice a week, for four weeks; after one week since starting the administration of CCl4, one of the three groups received, through oral gavage, Telmisartan (TS) 8 mg÷kg, and another received Pentoxifylline (PTX) 20 mg÷kg, dissolved in saline solution, for four weeks. The antifibrotic action of the two drugs was analyzed by evaluating the histopathological and immunohistochemical changes of hepatocytes, hepatic stellate cells (Ito cells) and macrophages (Kupffer cells). The study highlighted that in the group treated with TS, the process of fibrillogenesis was significantly reduced, in comparison to the group treated with PTX and with the reference group.

Urinary tract infection with Klebsiella pneumoniae in Patients with Chronic Kidney Disease.

Study Motivation: After assessing electronic databases of medical scientific literature, we have observed that the interrelation between urinary tract infections (UTIs) and chronic kidney disease (CKD) is poorly studied, especially when UTIs are caused by Klebsiella pneumoniae (K. pneumoniae). MATERIALS AND METHODS: K. pneumoniae was isolated in 14 urine samples from patients with CKD addmited in the Nephrology Department of the County Emergency Clinical Hospital Craiova. The isolated strains were statistically analyzed in the correlation with the different clinical and functional parameters (age, gender, CKD stage, comorbidities, biochemical parameters-serum urea, creatinine, uric acid and blood electrolytes). The degree of K. pneumoniae susceptibility to antibiotics from different pharmacodynamic classes was assessed. RESULTS: UTIs with K. pneumoniae in patients with CKD in the investigated period represented 0.51% from the total admissions in the clinic and 32.60% from cases of UTI. Eleven patients with this type of infection (78.56%) were in stage 4 and 5 CKD, and from them 4 also had diabetes mellitus type 2 (28.57%). We observed an increased level for serum creatinine (100%), blood urea (85.71%), and serum uric acid (45.45%). Two patients died after installation of cardiovascular changes in CKD, at advanced ages and in the presence of urinary infection. Multiple drug resistance occurred in 6 strains of K. pneumoniae correlated with the degree of kidney failure, advanced age, male gender, and diabetes mellitus. CONCLUSIONS: UTI with K. pneumoniae in patients with CKD is the second cause of urinary infection which raises problems of unfavorable evolution of CKD and also the recurrence of UTI with multiple drug resistance in CKD, which may lead to pharmacotherapeutical problems.