Antiretroviral Therapy Switch in HIV-Infected Adults from a Regional HIV/AIDS Center in NE Romania.

Background and Objectives: Antiretroviral therapy (ART) has revolutionized the management of HIV infection, transforming it from a once-debilitating disease to a chronic, manageable condition. However, challenges such as treatment resistance, medication side effects, and long-term tolerability persist, prompting the exploration of novel therapeutic approaches. We aimed to highlight the characteristics and related comorbidities of HIV/AIDS cases in which the antiretroviral therapy was modified. Material and Methods: A cross-sectional clinical investigation was conducted on adults diagnosed with HIV/AIDS who were hospitalized at the "St. Parascheva" Clinical Hospital of Infectious Diseases in Iasi in the Northeastern region of Romania. The timeframe under investigation was 1 January 2023 to 30 June 2023. Results: In the Northeastern part of Romania, from a total of 1692 patients in the active records, there were a total of 148 recorded cases of antiretroviral therapy switch in HIV-infected patients. The main reason for the ART switch was the simplification of the ART regimen (82 cases, 55.40%), viro-immunological failure (16 cases, 10.66%), other disturbances correlated to the ART regimen, dyslipidemia (34 cases 22.97%), depression (3 cases, 2.02%), suicide attempt (1 case, 0.67%), new situations, including the appearance of pregnancy (3 cases 2.02%), and tuberculosis (9 cases, 6.08%). ART before the switch was represented by protease inhibitors that accounted for 84 cases (56.75%) of the ART switch. Following the therapy switch, integrase inhibitor-based ART single-tablet regimens accounted for 43.91% (65 cases) of all changeovers, with non-nucleoside reverse transcriptase inhibitor regimens coming in second, in 63 cases, 42.66%. Conclusions: ART switch as an experimental therapy offers a promising approach to optimizing HIV treatment outcomes. By focusing on viral suppression and immune reconstitution, addressing treatment challenges, and exploring novel ARV agents, ART switch strategies aim to improve the overall health and well-being of individuals living with HIV.

Characteristics of Tuberculous Meningitis in HIV-Positive Patients from Northeast Romania.

BACKGROUND AND OBJECTIVES: One of the most severe forms of extrapulmonary tuberculosis (EPTB) is tuberculous meningitis (TBM), which is linked to significant morbidity and high mortality. It is well recognized that human immunodeficiency virus (HIV)-positive people are more likely to develop EPTB, including TBM, especially if they have severe immunodeficiencies. We aim to highlight the profile and the characteristics of TBM in HIV-infected patients. MATERIAL AND METHODS: We conducted a retrospective clinical study based on hospital medical records of patients diagnosed with HIV/AIDS (acquired immunodeficiency syndrome) and TBM in Northeast Romania, hospitalized at "St. Parascheva" Clinical Hospital of Infectious Diseases of Iasi from 1 January 2010 to 1 December 2022. RESULTS: From a total number of 1692 patients on record in our center, 195 had a HIV-tuberculosis (TB) coinfection, and 19 cases were HIV-TBM coinfected. Six cases were newly HIV-diagnosed late presenters, and thirteen patients' names were already found in the center's records with deficient immunological viral status (median CD4 lymphocyte level 47/mm3). The average age in the study group was 27 years old. The clinical manifestations and cerebrospinal fluid (CSF) variables were typical in most cases, despite the severe immunodepression of the patients. The Thwaites scoring system correctly identified 89.5% of the patients. The median admission period was 18 days; the lethality rate was 31.6%, despite access to ART and anti-TB drugs, and was associated with a more severe immunosuppression. No rifampicin resistance was detected. CONCLUSIONS: TBM appeared in a minority of our HIV cohort and affected severely immunodepressed patients; the clinical and CSF variables had a typical aspect in most cases, and the Thwaites scoring system performed well for this type of patient. The lethality rate was high and was correlated with a more severe immunodepression.

Ophthalmological Manifestations in People with HIV from Northeastern Romania.

Background and Objectives: Although ocular disorders can occasionally impact people with HIV over the course of their illness, HIV/AIDS is unmistakably a multisystem disorder. A physician can rule out a wide range of ophthalmic problems with the assistance of an ophthalmologist, from adnexal disorders to posterior segment diseases, including those affecting the optic tract and optic nerve. Materials and Methods: Based on patient medical data from the "St. Parascheva" Clinical Hospital of Infectious Diseases in Iasi, we carried out a retrospective clinical investigation on patients with HIV/AIDS and ophthalmological conditions who were hospitalized in northeastern Romania. We seek to draw attention to the characteristics and ophthalmological comorbidities of HIV/AIDS patients. The studied period was between 1 January 1991 and 31 December 2022. Results: There were a total of 38 recorded cases of ophthalmological manifestations in the HIV-infected patients. The research group's average age was 37.31 years old (standard deviation 9.5693917). Males were primarily impacted, having lower total CD4+ T-lymphocyte levels based on sex and CD4+ T-lymphocyte levels overall. The HIV viral load was 999 268.13 copies/mL on average (standard deviation 1,653,722.9). Of all the patients, we found out that 17 had congenital eye diseases (44.73%) and the others (21, 55.26%) developed ophthalmological diseases. CMV Retinitis was found most frequently, in eight patients (21.05%), followed by Myopia in seven patients (18.42%). Conclusions: The key to the management of HIV-positive patients is a multidisciplinary approach and access to antiretroviral therapy. Anyone who is HIV-positive and experiences ocular symptoms at any time should be directed to seek professional ophthalmologic treatment as soon as feasible. A therapeutic holdup could result in irreversible vision loss. Long-term coordination is required to combat this disease, improving communication between the ophthalmology and infectious disease fields.

Demographic and Clinical Characteristics of the Full 2015-2018 Cohort of Romanian Fabry Disease Patients.

BACKGROUND: Fabry disease (FD) is a rare genetic lysosomal disease with an estimated prevalence of 1:100000. Mutations on the GLA gene lead to alpha-galactosidase deficiency and multiorgan involvement due to sphingolipid accumulation. Our aim was to present and analyze the demographic and clinical characteristics of the Fabry patients in Romania. METHODS: All known Fabry patients in Romania between 2015-2018 were prospectively included in the study. Data on personal history, family history and clinical parameters were collected and statistically analyzed. RESULTS: The study included 42 patients with a mean age of 47±15 years, of which 19 (45%) were men and 23 (55%) women. Women were significantly older (52±15 years vs. 40±13 years, p=0.006) and presented similar prevalence of cardiac, renal, neurologic, ophthalmologic and otologic burden. The majority of patients presented organ damage, most prevalent being cardiac (48%), cutaneous (45%) and neurologic (52%) involvements. There were 20 families in total, comprising on average of 2.1 members each. Of the 20 families, only two had the same pathogenic GLA mutation. CONCLUSION: FD patients in our country show a significant degree of multiorgan involvement with important psychological and social impact on the patients and their families. Women with Fabry disease show similar disease burden as men, but at a later age.

PREVALENCE OF OVERWEIGHT AND OBESITY IN A ROMA POPULATION FROM SOUTHERN ROMANIA - CALARASI COUNTY.

INTRODUCTION: The prevalence of obesity has reached alarming levels in the European Union, including in Romania. Data on the prevalence of obesity is only available at the national populational level, but this may hide the increased levels in disadvantaged groups. The purpose of this study was to evaluate the prevalence of overweight and obesity in the Roma population in Southern Romania. MATERIAL AND METHOD: This cross-sectional, epidemiological, non-interventional study was conducted from March 2014 to May 2017 in several settlements from Calarasi County. Screening procedures included interviews about medical history, lifestyle, anthropometric and clinical measurements and fasting capillary glucose. RESULTS: The study population consisted of 1120 adult subjects, of which 735 Roma. In Roma population group, the prevalence of underweight, normal weight, overweight and obesity was 4.5% (n=33), 25% (n=184), 25.3% (n=186) and 45.2% (n=332) respectively. In Romanian Caucasians group, the prevalence of underweight, normal weight, overweight and obesity was 2.3% (n=9), 20% (n=77), 33.8% (n=130) and 43.9% (n=169) respectively. Among the Romanian Caucasians significant predictors of obesity were a sedentary lifestyle and current smoking. The odds of being obese in Roma population were higher in sedentary lifestyle persons and lower in current smokers, with primary education, and in those living in rural settlements. The family history of obesity had a significant association with obesity only in Roma population. CONCLUSIONS: Our results confirm the need to implement prevention programs in high-risk populations due to the double burden of malnutrition, lack of medical education and preventive healthcare, low socio-economic level.

Diabetes in the hospitalized patients with urological diseases.

BACKGROUND: Diabetes and urological diseases are widespread health problems, whose incidence increases with age. The aim of this observational, retrospective study was to analyze the particularities of urinary disorders, which appeared in patients with diabetes, admitted in a urology ward. MATERIAL AND METHODS: A total of 6910 patients admitted in "Th. Burghele" Hospital from January 2013 to July 2014 were analyzed. Only admissions in urology wards and the first hospitalization of the patient were elements that were taken into account. Data was taken from the Hipocrate medical information system and Easy Medical Pro laboratory medical software. Study variables were age and sex of patients, the main discharge diagnosis, the number of days of hospitalization and the laboratory analyses collected on the day of admission. The data of the whole lot was analyzed and then an analysis on subgroups of patients was done. RESULTS: There were 16.52% (n=1142) patients with diabetes in the total group of analyzed patients. Urinary stones were the most frequent cause of hospitalization, both in patients with diabetes and in patients without diabetes (28.5%, respectively 37.5%). The average age was 60.01 years and the mean duration of hospitalization was 6.52 days. Patients with diabetes hospitalized for urinary stones, renal cancer, and infectious pathology were significantly older than patients without diabetes. The presence of diabetes prolonged hospitalization in the case of patients with kidney stones, kidney cancer and in those with infectious pathology. The most common malignancy was bladder cancer in both groups of patients. Malignancies were more common in diabetics (19.08% vs. 15.98%) and diabetes was a risk factor for malignancy in our study. In particular, patients with diabetes had a significantly increased risk of bladder cancer. In the analyzed group, diabetes was positively associated with prostate adenoma, genital infections, and prostate infections. CONCLUSIONS: Diabetes increased the risk for certain urological diseases (bladder cancer, prostate adenoma, prostate and genital infections), it prolonged hospitalizations, and it was associated with certain features of laboratory analysis (leukocytosis, decreased glomerular filtration rate).

Medical nutrition therapy in non-alcoholic fatty liver disease--a review of literature.

BACKGROUND AND AIM: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide, with a prevalence of 20%-40% in Western populations. The purpose of this article is to review data related to lifestyle changes in patients with NAFLD. METHOD: We searched a public domain database (PubMed) with the following categories: disease (NAFLD, fatty liver, and non-alcoholic steatohepatitis [NASH]) and intervention (lifestyle intervention, diet, nutrition) with each possible combination through 25 September 2014, for relevant articles. Review of articles was restricted to those published in English. We selected the studies involving adult patients only. CONCLUSION: There is no consensus as to what diet or lifestyle approach is the best for NAFLD patients. However, patients with NAFLD may benefit from a moderate- to low-carbohydrate (40%-45% of total calories) diet, coupled with increased dietary MUFA and n-3 PUFAs, reduced SFAs. More CRT are needed to clarify the specific effects of different diets and dietary components on the health of NAFLD patients. ABBREVIATIONS: NAFL = Non-alcoholic fatty liver, NAFLD = non-alcoholic fatty liver disease, NASH = non-alcoholic steatohepatitis, HCC = hepatocarcinoma, BEE = basal energy expenditure, CRT = A small clinical randomized trial showed that short-term carbohydrate restriction is more efficacious in reducing intrahepatic triglyceride, IHT = intrahepatic triglyceride, VLCD = Very low calorie diets, AST = aspartate aminotransferases, SFAs = saturated fatty acids.

Proinsulin and age in general population.

OBJECTIVE: The objective of this study was to assess the relationship between fasting proinsulin (PI) and age in general population and to determine whether there are differences regarding this association in obese and non-obese persons. METHODS: A random population-based sample (n=656) of Romanians (26-80 years) living in Bucharest, Romania was studied; 432 persons had diabetes and they were not analyzed in this paper. Circulating levels of fasting plasma glucose (FPG), fasting plasma insulin (FPI), fasting plasma proinsulin (FPP), fasting plasma C-peptide, HbA1c, lipid profile, creatinine, urea were measured. The homeostasis model assessment of insulin resistance (HOMA-IR), HOMA-B, and Quicki index were also calculated. RESULTS: For all participants proinsulin was the highest in the third quartile of the age group (59-67 years), with a median proinsulin of 5.8 pmol/L. Subsequently, proinsulin increased with age, from 2.6 pmol/L for participants aged 20-51 years, to 4.7 pmol/L for participants aged 51-59 years; proinsulin levels decreased in the upper quartile 4.8 pmol/L for those aged over 67 years. In sex-specific analyses, proinsulin increased with age for both men and women, except for those in the upper quartile. The prevalence of the obesity was 30.4% (n=68); obesity prevalence did not increase with age (p=0.26). Fasting proinsulin levels significantly increased with body mass index (BMI) category from lean (n=67, 2.9 pmol/L) to overweight (n=89, 4.5 pmol/L) and obese (n=69, 6.63 pmol/L) (p<0.0001). CONCLUSIONS: Our study has demonstrated a close association between age and elevated proinsulin and proinsulin/insulin ratio in general population.

Questionnaire about psychology/disease correlation-I.

RATIONALE: The existing personality inventories are exploring too general psychological features so that the possible psychology/disease associations might be leveled out. OBJECTIVE: We attempt to build a tool to explore the possible correlation between certain psychological features and the most common internal disorders. METHOD: We have used two questionnaires containing many pairs of synonymous items (necessary for assessing the consistency of the answers). The items are divided into four main domains: preoccupation for the basal conditions of existence (health/ disease/ death, fear, money, lodging); interaction with other people; action, will/ volition, self-assertion; and preoccupation with the exterior. In this first article we are presenting the correlations between items of the first domain, based on the answers from our first 3138 respondents. RESULTS AND DISCUSSION: The concern about health is best reflected by general formulations. The desire for security is best expressed by items combining the worry about money and dwelling, and worst by items reflecting the eagerness to gain, keep or judiciously spend money. Among the various fears, those of future, darkness, and loneliness are better indicators of security concern. In assessing the anxiety about safety/ security, specific worries are more revelatory than the general ones. Precaution and inclination for order are the best indicators for the aspiration to stability. Poorer ones are the desire for cleanliness and the tendency to attachment. Health and security concerns seem to be consistently linked. The consistency evaluating system will be based upon pairs of synonymous items correlated with a10(-200) or less error probability.

The impact of morphology upon the radiation hardness of ZnO layers.

It is shown that ZnO nanorods and nanodots grown by MOCVD exhibit enhanced radiation hardness against high energy heavy ion irradiation as compared to bulk layers. The decrease of the luminescence intensity induced by 130 MeV Xe(23+) irradiation at a dose of 1.5 × 10(14) cm(-2) in ZnO nanorods is nearly identical to that induced by a dose of 6 × 10(12) cm(-2) in bulk layers. The damage introduced by irradiation is shown to change the nature of electronic transitions responsible for luminescence. The change of excitonic luminescence to the luminescence related to the tailing of the density of states caused by potential fluctuations occurs at an irradiation dose around 1 × 10(14) cm(-2) and 5 × 10(12) cm(-2) in nanorods and bulk layers, respectively. More than one order of magnitude enhancement of radiation hardness of ZnO nanorods grown by MOCVD as compared to bulk layers is also confirmed by the analysis of the near-bandgap photoluminescence band broadening and the behavior of resonant Raman scattering lines. The resonant Raman scattering analysis demonstrates that ZnO nanostructures are more radiation-hard as compared to nanostructured GaN layers. High energy heavy ion irradiation followed by thermal annealing is shown to be a way for the improvement of the quality of ZnO nanorods grown by electrodeposition and chemical bath deposition.

[Is partial cystectomy a justified intervention in the treatment of bladder tumors?]. / Este cistectomia partiala o interventie justificata în tratamentul tumorilor vezicale?

The authors present their experience of 122 partial cystectomy cases made on a number of 288 vesical tumors in our clinic, during 5 years (1986-1991) from which 23 are superficial tumors and 99 are infiltrative ones. The treatment of vesical tumors can be done in many ways; this partial cystectomy must be completed with an other therapeutic method: irradiation on chemotherapy in conformity with the anatomo-pathological form, the steady and tumoral grading.

[A practical study of the absorbed doses at the level of the organs at risk during the radiotherapy of bronchopulmonary cancer]. / Studiul practic al dozelor absorbite la nivelul organelor de risc, în cursul radioterapiei cancerului bronhopulmonar.

The radiotherapy of lung cancer with curative total doses (56-60 Gy), is limited by the presence of critical organs (esophagus, spinal cord). The use of computed TPS (Therapy Planning System) allows to the radiotherapist to calculate the values and to obtain dose distribution to the organs at risk, in the limit of biological tolerance levels. In our work, we present the calculation of the absorbed doses of Co60, at the spinal cord, at a patient with a cancer of the right lung, during irradiation.

[The therapeutic approach in superficial epithelial tumors of the bladder. Apropos 98 cases]. / Atitudinea terapeutica în tumorile epiteliale superficiale ale vezicii urinare. Consideratii pe marginea a 98 de cazuri.

Between 1985 and 1990, superficial epithelial tumors of gallbladder were found in 98 patients. Peculiar aspects such as age, sex, symptoms, clinical and laboratory diagnosis, surgical treatment, additional interventions, postoperative treatment, anatomo-pathological examination, pTNM classification and tumoral grading, postoperative recurrences, occurring after the primary and adjuvant treatment, were analysed. After some general comments, the authors point out that in their experience the lowest rate of postoperative recurrences was obtained by a multimodal treatment, that is surgery and vesical instillations with cytostatics or B.C.G. vaccine, according to EORCT scheme.

[Cases of thyroid cancer irradiated at the Iasi Radiology-Oncology Clinic (1984-1988)]. / Comentariu la cazuistica de cancer tiroidian iradiat în Clinica radiologie-oncologie Iasi (1984-1988).

The study is based on 35 cases of thyroid cancer treated by external radiotherapy. The analysis of these cases and especially their grouping on clinical stages according to the recent TNM classification reveal the prognostic importance of such factors as the patients' age, histopathological form and the loco-regional and at distance spread.

[Epidemic focus of Q fever in a rural location in the Suceava district]. / Focar epidemic de febra Q într-o locatitate rurala din judetul Suceava.

A Q fever epidemic focus with 46 cases was detected in a rural locality among the workmen of livestock farms. In 33 cases, the subclinical and inapparent form of the disease was detected by serologic tests, performed in the focus. Complement fixation antibody titers persisting in very high titers, a retrospective diagnosis of infection may be established even 3-4 months after the onset of the disease.