Spatio-Temporal Pattern of Tuberculosis Distribution in Romania and Particulate Matter Pollution Associated With Risk of Infection.

The study proposes a dynamic spatio-temporal profile of the distribution of tuberculosis incidence and air pollution in Romania, where this infectious disease induces more than 8,000 new cases annually. The descriptive analysis for the years 2012-2021 assumes an identification of the structuring patterns of mycobacterium tuberculosis risk in the Romanian population, according to gender and age, exploiting spatial modeling techniques of time series data. Through spatial autocorrelation, the degree of similarity between the analyzed territorial systems was highlighted and the relationships that are built between the analysis units in spatial proximity were investigated. By modeling the geographical distribution of tuberculosis, the spatial correlation with particulate matter (PM2.5) pollution was revealed. The identification of clusters of infected persons is an indispensable step in the construction of efficient tuberculosis management systems. The results highlight the link between the distribution of tuberculosis, air pollution and socio-economic development, which requires a detailed analysis of the epidemiological data obtained in the national tuberculosis surveillance and control program from the perspective of geographical distribution.

Osteoporotic Hip Fracture Incidence Rates in the Main Urban Area of Romania.

CONTEXT: Estimation of osteoporotic hip fracture incidence and Romanian FRAX model were based on nationally reported hospital ICD 10 coding admissions of all hip fractures (without a validation process). OBJECTIVE: We aimed to calculate, based on individual hospital charts analysis, the incidence of osteoporotic hip fracture in the main urban area of Romania and compare it with data reported to the National Institute of Public Health (NIPH). DESIGN: We retrospectively analyzed the charts of all patients (>40 years old) admitted for hip fracture in a 12-month period in hospitals with an Orthopedic Department in Bucharest and surrounding Ilfov County (11.8% of Romania population). SUBJECTS AND METHODS: All ICD 10 fracture and event/fall codes were validated against the charts. We calculated the age and sex adjusted incidence of osteoporotic hip fracture and used the national reported hip fracture data base for comparison. RESULTS: There were 2203 hip fractures of which 1997 (90.65%) were fragility fractures. The crude incidence of low-energy hip fractures was 171/100,000 (225/100,000 in women, 103/100,000 in men). The incidence rose with age to a maximum rate of 1902/100,000 in women >85 years. The NIPH-reported incidence of hip fracture was 181/100,000 for the region of interest and 176/100,000 at the national level. CONCLUSION: The incidence of osteoporotic hip fracture was lower than the incidence based on hip fractures reported codes in the national database, but the incidence of fragility fractures calculated by our group was higher than the incidence reported in previous national studies. Nationwide studies are warranted.

Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis.

The European, multicentre, quarterly point-prevalence study of community-acquired diarrhoea (EUCODI) analysed stool samples received at ten participating clinical microbiology laboratories (Austria, Finland, France, Germany, Greece, Ireland, Italy, Portugal, Romania, and the UK) in 2014. On four specified days, each local laboratory submitted samples from ≤20 consecutive patients to the Austrian Study Centre for further testing with the FilmArray GI Panel (BioFire Diagnostics, Salt Lake City, UT, USA). Of the 709 samples from as many patients received, 325 (45.8%) tested negative, 268 (37.8%) yielded only one organism, and 116 (16.4%) yielded multiple organisms. Positivity rates ranged from 41% (30 of 73 samples) in France to 74% (59 of 80 samples) in Romania. With the exception of Entamoeba histolytica and Vibrio cholerae, all of the 22 targeted pathogens were detected at least once. Enteropathogenic Escherichia coli, Campylobacter species, toxigenic Clostridium difficile, enteroaggregative E. coli, norovirus and enterotoxigenic E. coli were the six most commonly detected pathogens. When tested according to local protocols, seven of 128 positive samples (5.5%) yielded multiple organisms. Overall, the FilmArray GI Panel detected at least one organism in 54.2% (384/709) of the samples, as compared with 18.1% (128/709) when testing was performed with conventional techniques locally. This underlines the considerable potential of multiplex PCR to improve routine stool diagnostics in community-acquired diarrhoea. Classic culture methods directed at the isolation of specific pathogens are increasingly becoming second-line tools, being deployed when rapid molecular tests give positive results. This optimizes the yield from stool examinations and dramatically improves the timeliness of diagnosis.

Quantitative phase imaging with partially coherent illumination.

In this Letter, we formulate a mathematical model for predicting experimental outcomes in quantitative phase imaging (QPI) when the illumination field is partially spatially coherent. We derive formulae that apply to QPI and discuss expected results for two classes of QPI experiments: common path and traditional interferometry, under varying degrees of spatial coherence. In particular, our results describe the physical relationship between the spatial coherence of the illuminating field and the halo effect, which is well known in phase-contrast microscopy. We performed experiments relevant to this common situation and found that our theory is in excellent agreement with the data. With this new understanding of the effects of spatial coherence, our formulae offer an avenue for removing halo artifacts from phase images.

Epi-illumination diffraction phase microscopy with white light.

We demonstrate the first reflection-based epi-illumination diffraction phase microscope with white light (epi-wDPM). The epi-wDPM system combines the off-axis, common-path, and white light approaches, in a reflection geometry enabling sub-nanometer spatial and temporal noise levels, while providing single-shot acquisition for opaque samples. We verified the epi-wDPM results by measuring control samples with known dimensions and comparing them to measurements from other well-established techniques. We imaged gold-coated HeLa cells to illustrate the tradeoffs between epi-wDPM with low and high spatial coherence.

The relevance of the psychological evaluation in drug dependence.

Psychological interventions are considered a central part of the individual psychotherapy in the rehabilitation counseling of psychiatrically symptomatic drug-dependent patients during methadone maintenance treatment in community programs. The need for psychological counseling should be evaluated for each individual patient. Medication is an important part of the treatment and individual psychotherapy focuses on the reduction or total cessation of drug use. The Recipient is G.M. 31, sentenced to a seven-year term of imprisonment for trafficking and use of and high-risk drugs, diagnosed on admission with opioid and methadone dependence, withdrawal syndrome. Following the observation and psychological evaluation, psychiatric and clinical examination, initiation of methadone substitution treatment was recommended, according to the following regimen: twelve 2.5 mg tablets for the first 2 days, followed by increase with about 5 mg per week until the complete remission of withdrawal symptoms, stabilization of the dose but not exceeding 200 mg methadone hydrochloride per day. Specialist monitoring, specialized counseling and individual and group psychotherapy were provided.

Use of benzodiazepines and detoxification with methadone.

RATIONALE: Benzodiazepines are used as anti anxiety drugs, as well as in adjunct treatment for a range of neurological and psychiatric disorders. Abusive patterns of use were increasingly reported and building evidence points to prevalence of benzodiazepines abuse, on one hand as well as to their common abuse in combination with other drugs such as opioids, most frequently. OBJECTIVE: The main objective of this research is to conduct a systematic study on the behavior profile of a patient admitted to a prison hospital, who is a benzodiazepines user consecutive to admission into a methadone administration program. METHODS AND RESULTS: Statistic values have been taken into account describing the distribution and the distribution form of the various variables studied to find the normality degree of distributions, regarding three measurements at the three moments: before the administration of methadone, immediately after its completion and two months after completion. CONCLUSIONS AND DISCUSSIONS: The statistic results obtained speak of a strong positive correlation, allowing the support of the fact that persons diagnosed with prescribed/ unprescribed benzodiazepine, use the display association with the admission into a methadone administration program, based on the assumption which concerns a significant positive association between the use of reported benzodiazepine and the administration of methadone in the questioned patients on admission. As far as the second premise regarding the administration of methadone is concerned it brings about an improvement in the level of benzodiazepines used in research patients, which one may assert that, according to the results obtained, the initiation of methadone therapy in the detoxification program is conducive to the reduction of benzodiazepines use.

Diagnosis and treatment of limb fractures associated with acute peripheral ischemia.

Acute Peripheral Ischemia (API) is the most severe acute complication after both open and closed fractures, as ischemia compromises not only the vitality of the affected limb, but also the patient's life, because metabolic anaerobic changes following ischemia have serious local and general consequences. These explain why early diagnosis of API is very important for the prognosis of the traumatized limb.The authors analyse cases when API was not diagnosed immediately after trauma, but some time after the first examination, due to either low systolic BP or to late onset of API. The patients were analysed concerning the type of the fracture, the reason for delayed diagnosis of API, the moment of API diagnosis and the arterial injury. In all those cases, surgery was performed immediately after API diagnosis, in order to identify and treat the complex injuries(bone and vascular).

Epidemiology of hepatitis D in patients infected with hepatitis B virus in bucharest: a cross-sectional study.

Epidemiological analyses indicate a decreasing level of hepatitis D (HDV) infections in most developed countries during the last 15 years. Romania, however, is one of the European countries that still has high morbidity from HDV; this study was performed in order to estimate the HDV prevalence in the Bucharest area. Three thousand four hundred sixty-one hepatitis B (HBV) infected patients were invited to participate and 1,094 were recruited. Serum anti-HDV IgG was detected in 223 patients indicating a hepatitis D seroprevalence of 20.4% (95% CI = 18.1-22.9) in patients chronically infected with HBV, less than that seen in previous studies. Seroprevalence was not gender related, but patients over 40 years were more likely to have anti-HDV antibodies, RR = 1.9 (1.2; 3.0). Detectable hepatitis D viraemia was found in 67.7% of the patients who were positive for anti-HDV. The HDV genotype was characterized for 40 isolates; all were very similar and belonged to genotype 1. Serum HBV-DNA was detectable less frequently in patients positive for anti-HDV than in patients infected with HBV alone: 68.5% versus 89.3%, OR 3.9 (1.7; 10.0), but the extent of this HDV replicative dominance varies with the sensitivity of the HBV-DNA detection. 19.3% of the subjects who tested positive for anti-HDV IgG had a HBV-DNA level higher than four logs. This high prevalence prompts the need for better HBV vaccination coverage and measures to prevent super infection with HDV in patients infected with HBV.

Acute pancreatitis: the onset digestive manifestation, in a patient with adult T-cell leukemia/lymphoma.

UNLABELLED: Acute pancreatitis is a common complication, which occurs with patients suffering from vesicular biliary lithiasis or chronic alcoholism. Hypercalcemia may determine acute pancreatitis, its causes being multiple: primary or secondary hyperparathyroidism, metabolic diseases of the bone, metastatic bone neoplasm, as well as lymphoproliferative syndromes caused by the HTLV-1 virus-adult T-cell leukemia/lymphoma (ATLL). ATLL is a malignant and aggressive lymphoproliferation with the T-cell, associated with the infection caused by the HTLV-1 retrovirus. Organomegaly, cutaneous conditions, and hypercalcemia represent the main characteristics of the disease. From a hematologic point of view, we can notice the atypical lymphocytes (also known as flower cells, due to the shape of their nucleus), with a distinct CD4+ CD25+ phenotype. There have been reported few cases of patients who showed acute pancreatitis in the onset of the disease. We will describe the case of a patient whose diagnosis has not been an easy one, as it showed multiple complications from a very early stage. CONCLUSIONS: The atypical onset of ATLL with acute pancreatitis is rarely reported. Its etiology seems to be hypercalcemia but pancreatic infiltration with ATLL cells cannot be ruled out. An attentive investigation of the peripheral blood sample and flow-cytometric tests of peripheral and medullar blood smear are very important for diagnosis. The patient showed from the very beginning severe neurological manifestations which developed to a coma. Causes could have been metabolic as well as CNS infiltration (as shown by the CT examination).

Spinal involvement with spinal cord compression syndrome in hematological diseases.

UNLABELLED: Primary spinal involvement in hematological diseases is rare. PURPOSE: The purpose of this article is studying diagnostic and treatment strategies in patients with spinal cord primary hematologic tumors causing spinal cord compression syndrome. PATIENTS AND METHODS: We report two cases with spinal cord primary hematologic tumors causing spinal cord compression syndrome. One patient had a diffuse large B-cell non-Hodgkin's lymphoma located in the thoracic spine and the second patient had a plasmocytic plasmacytoma located in the thoraco-lumbar spine. RESULTS: Both patients underwent surgery, with resection of the intracanalar tumor and spinal cord decompression and adjuvant systemic and intrathecal chemotherapy. Neurological outcome was favorable with partial remission of spinal cord compression syndrome. Finally, patients developed secondary dissemination and succumbed due to progression of the hematological disease. CONCLUSIONS: Clinical onset and radiographic evaluation is uncharacteristic in early stages. Spinal MRI is mandatory in cases with rebel pain, unresponsive to conservative treatment. Surgery is indicated in all patients with spinal cord compression syndrome. Early diagnosis is associated with better prognosis. Recommended treatment is surgical resection and systemic and intrathecal chemotherapy adapted to histological form of each tumor. In selected cases, if indicated radiotherapy can also be associated.

Problems concerning diagnosis and treatment of compartment syndromes after lower limb trauma.

Compartment Syndrome (CS) is characterised by an imbalance produced by increased pressure in an inextensible space (called "the Compartment"). Without being specific for orthopaedics, CS has increasing frequency in modern traumatology. Microcirculation disturbances generate the syndrome's self-augmenting physiopathological character. The pathognomonic feature of the clinical panel in CS of the lower limbs is increased consistency of the muscular groups, while peripheral pulse maintainance does not exclude CS. Although positive diagnosis is based on measuring the intra-compartmental pressure, (ICP) clinical suspicion is crucial. The correct treatment is surgical, consisting in early and large decompressive fasciotomy. Without proper treatment, CS endangers not only the vitality of the limb (due to Acute Peripheral Ischemia with onset in microcirculation and centripetal extension), but also the patient's life, thus becoming a life-threatening disorder. The authors underline the importance of correct clinical evaluation and early treatment in order to prevent the serious local and general complications of the CS.

[Spleno-renal distal and proximal shunts for hypersplenism due to hepatic cirrhosis]. / Suntul spleno-renal distal si proximal pentru hipersplenismul datorat cirozei hepatice.

The secondary hypersplenism appears from 30-50% in liver cirrhosis with portal hypertension. The mechanism of the complication is the splenic congestion as the result of the progress of the portal hypertension. Between 1997-2005, 16 patients with hypersplenism due to liver cirrhosis were operated in the service. The aim of the operation was to decompress the portal hypertension, by spleno-renal shunt (Warren), in 6 patients, truncular shunts in 2 patients, and splenectomy with spleno-renal shunts in 8 patients. No postoperative death was noted on the series. The platelets number and the white blood cells, destroyed by the reticuloendothelial system of the spleen, were counted in the first month and the first year, as well as the spleen volume. In patients with non-splenectomy operations the improvement of the blood elements number was remarked in the first week, but the volume of the spleen remained increased during 1-6 month. In patients with splenectomy the platelets and the white cells dramatically increased, with the risk of coagulation disfunction. The survival rate at five years was 12 patients.

[Cervical anastomotic fistula in surgery of the esophagus]. / Fistulele anastomozelor cervicale din chirurgia esofagului.

Cervical anastomotic fistula are reported in the surgical literature in 10-30% of the patients, providing a much longer hospitalisation, a higher morbidity and in some cases even mortality. Between 1997-2003, 91 patients underwent surgical treatment for esophageal cancers and 14 patients for chemical burns. In the cancer group the rate of resection was 67,03% (61 patients). In 8 patients with non-resection tumours a retrosternal esophageal by-pass with stomach was carried out. Cervical anastomosis were performed in 68 patients, by hand sutures. Anastomotic fistula were noted in 9 patients (13,24%). In 6 cases temporarily fistula occurred, with spontaneous healing by local treatment, in 8-28 days. 2 patients required reoperation and one patient a definitive feeding jejunostomy. Most common causes of fistula are technical problems, ischemic gastric or colonic tube, postoperative respiratory failure, with prolonged hypoxia. An anastomosis in the neck results in less postoperative complications than one of the lower level.

Mechanism-based targeting of NMDA receptor functions.

NMDA receptors (NRs) are key signaling proteins in the central nervous system and represent important targets for drug development in several neurologic disorders. They are critically involved with fundamental brain processes, and thus indiscriminate pharmacological suppression of NR currents has seen only modest therapeutic success so far. Targeting harmful NR receptor activities while sparing the receptor's vital functions requires a better understanding of the complexity of NR activation reaction; of the range of mechanisms that modulate discrete receptor activities; and of the consequences of this modulation on specific receptor functions. A quantitative account of the NR activation pathway was recently proposed and validated. It describes the gating reaction as a sequential, multi-step process rather than a binary, on-off switch. Alongside isoform-specific modulators, state-specific modulators may represent sophisticated interventions with high potential for narrow, functional specificity. Here I review physiologic mechanisms that control NR responses; the salient features of the NR activation reaction; and discuss the model's validity and its implications for drug development and characterization.

A "true" polymicrobial endocarditis: Candida tropicalis and Staphylococcus aureus--to a drug user. Case presentation and literature review.

Polymicrobial endocarditis is more frequent in intravenous drug user (IVDU). Combined therapy--medical and surgical--represents the standard of care, but long-term suppressive therapy duration in fungal endocarditis is still debated. The polymicrobial endocarditis is rare: 1-3%. It is being observed with increasing frequency among drug users; a predominance of tricuspid valve involvement exists. We report a case of dual etiology infective endocarditis (IE) - Candida tropicalis and Staphylococcus aureus - in a IVDU; the treatment was combined, medical and surgical, and was followed by a suppressive antifungal therapy. We review the other published Candida tropicalis endocarditis cases and discuss their optimal management.

[Computer program for medical records of patients with diabetic retinopathy]. / Program de evidenta computerizata a pacientilor cu retinopatie diabetica.

The purpose of this study was to point out the advantages or the computerised evidence in patients with diabetic retinopathy examined in "Diabetic Eye Department" from Ophthalmology Clinic Craiova. This program represents a new national performance regarding the evidence of the diabetic patients clinic examination. The main characteristics of our program are the accessibility and the coherence; the utility of this program has been demonstrated by long term use and the big number of patents recorded.

[Multivisceral operations for carcinoma of the upper stomach and cardia]. / Operatii multiviscerale pentru cancerul gastric al polului superior si al cardiei.

In this study are noted technical problems regarding "en bloc" multiple organ resections and the anatomic and functional reconstruction for carcinoma of the upper stomach and cardia. From 1997 to 2002, a total of 264 patients with cancers of the stomach were operated in the service. 75 patients presented cancers localized at the proximal stomach and cardia (97.33% adenocc.). The rate of resectability was 27.77% (27 pt.). Types of operations in this series were: standard esophagogastrectomy in 7 patients; total gastrectomy with regional lymphadenectomy in 9 patients; 11 patients underwent "en bloc" multiple organ resection, with the removal of the stomach, partial or total esophagectomy and, occasionally, ablation of the spleen, pancreas, left hepatectomy, resection of the diaphragm and an extensive lymphadenectomy. Surgical mortality for the complex multivisceral resections was noted in 3 patients (8.88%). The global 5 years survival in the service is poor: 15.9%.

Treatment difficulties of a listerial rhombencephalitis in an adult patient allergic to penicillins.

Rhombencephalitis is not a rare presentation of listerial central nervous system infections in healthy adults. This report describes a case with several management difficulties linked to antibiotic related adverse events, pointing to alternative solutions to aminopenicillins. In addition, the role of dexamethasone in the management of inflammation and neurological symptoms is discussed.

Spectral anomalies at wave-front dislocations.

In a recent Letter, Gbur, Visser, and Wolf [Phys. Rev. Lett. 88, 013901 (2002)] predict that remarkable spectral changes can take place in the neighborhood of phase singularities of a diffracted focused wave. We report here the experimental observation of this anomalous spectral behavior and show that this is a general characteristic of optical vortices. Using a high-resolution interferometric technique, we are able to measure directly both the spectral intensity distribution and the spectral phase at the singular points of optical waves.