Anca-Ruxandra Negru

Correlation between inflammatory biomarkers and metabolic disorders in HIV infected patients undergoing antiretroviral therapy

Correlation between inflammatory biomarkers and metabolic disorders in HIV infected patients undergoing antiretroviral therapy Raluca Mihăilescu, Victoria Aramă, Cătălin Tiliscan, Daniela Munteanu, Viorica Leoveanu, Mihaela Rădulescu, Adriana Hristea, Cristina Popescu, Ruxandra Moroti, Violeta Molagic, Raluca Năstase, Loredana Benea, Ana Maria Tudor, Mihai Lazăr, Anca-Ruxandra Negru, Irina Lăpădat, Ligia Ionescu, Mirela Cernat, Georgeta Jugănaru, Doina Cristea, Adriana Manea, Adrian Streinu-Cercel, Daniela Adriana Ion, Sorin Ștefan Aramă

Toxoplasmosis: a rare cause of IRIS in HIV infected patients. Case series

Results Three patients, one male and 2 women, aged 55 years old, respectively 41 and 42 year-old, all 3 diagnosed concomitantly with HIV infection (as very late presenters) and cerebral toxoplasmosis, with a CD4 count of 6, 6 and 7/cmm respectively, viral loads (VL) of 254,000, 57,000 and 156,000 copies/mL respectively, and CSF viral load below the plasmatic VL in all 3 cases. We recorded minimal abnormalities of CSF analysis regarding the number of cells and biochemical exams; all had positive PCR for Toxoplasma gondii in the CSF and positive serology (IgG). All 3 had intracerebral lesions (abscesses) and all were biopsied at the neurosurgery department for diagnostic purpose before knowing their HIV-positive status. They received high doses of oral trimethoprim/sulfamethoxazole (T/S) for toxoplasmosis and antiretroviral therapy in the first 2 weeks after the diagnosis. They repeated cerebral imagery (MRI) after 3 weeks of T/S and had no regression of the size of lesions (although with the decreasing of perilesional edema) and new lesions, in two cases without having corresponding symptoms; in all 3 cases the CD4 count increased in the first month more than 100%. The search for another cause for the augmentation of their brain lesions was negative. Maintaining the same medication, the next imagery exams showed improvement in 2 out of 3 cases, in which the outcome was favorable with almost complete neurological recovery. In the remaining case the evolution was unfavorable (death).

Tumor necrosis factor alpha – an useful biomarker in a combined predictive model for liver fibrosis staging in patients with chronic HCV infection

Background Staging liver fibrosis in chronic HCV infection represents an important step for an individualized management. In the last decade the liver biopsy was less used for fibrosis staging due to its invasive nature and risk of complications. Multiple non-invasive methods were developed for the evaluation of liver fibrosis, none of these being an ideal one. The aim of this study was to evaluate the diagnostic accuracy of a new non-invasive method designed to differentiate patients with significant liver fibrosis from those without. (F2-F4 vs. F0-F1).

Metabolic syndrome, insulin resistance and the risk of cardiovascular disease in HIV patients undergoing antiretroviral therapy

We enrolled 103 patients, including 60 males (58.3%) and 43 females (41.7%). The mean age was 32.3±13.3 years (range: 13-65 years). The median Framingham score was 1.2% (IQR=5.8%). Most patients (81.63%) had a low CVR (below 10%) and 18.37% had Framingham score values above 10%. MS and IR prevalences were 16.9% and 61.2%, respectively. CVR in the general population is primarily dependent on age. This observation was valid for our group: the median age was 24 years in people with low CVR, compared with 50 years for those with Framingham score above 10% (p=0.000). None of the antiretroviral drug classes significantly influenced CVR.

Clinical and epidemiologic features of community versus hospital-acquired Clostridium difficile infection

Methods We enrolled all CDI patients admitted to the Adults III department of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, between January – July 2014. Stool culture, toxin EIA and Cepheid Gene Xpert C. difficile test were used for CDI diagnosis. The subjects were divided into two groups: CA-CDI patients (Group 1) and HA-CDI patients (Group 2). Our objective was to describe the clinical, epidemiologic features and outcome of CA-CDI compared to hospital-associated CDIs (HA-CDI) including the ATLAS bedside severity scoring system. Statistical analyses were performed using SPSS Statistics package v.17.

Spondylodiscitis in Romania – between the risks of prolonged antimicrobial therapy and the poor access to neurosurgery

Background Spondylodiscitis defines both vertebral osteomyelitis and discitis. Two important etiologies are involved in the pathogenesis of spondylodiscitis: Mycobacterium tuberculosis (TB-S) and pyogenic bacteria such as Staphylococcus aureus (NTB-S). Diagnosis and treatment of spondylodiscitis are constantly delayed because the symptomatology is non-specific. There are controversial opinions regarding the optimal antimicrobial therapy duration. Aims: To overview the diagnosis and therapeutic difficulties in patients with spondylodiscitis.

Q fever in urban area – an emerging zoonosis

Background Q fever is a zoonosis with reported outbreaks in rural areas, related to farms and farm animals. In the urban area, the source of infection is almost always unknown and can be related to windborne spread of Coxiella burnetii. Objective: To emphasize the importance of Coxiella burnetii etiology in prolonged febrile syndrome. We want to point out that Q fever can become a real threat even in the urban area.

Coxiella burnetii endocarditis – a real threat in the context of Q fever re-emergence

Background Q fever is a disease with worldwide distribution. The real number of patients with this disease is underestimated due to its nonspecific symptoms and because of the difficulties associated with serological diagnosis. Some of the patients diagnosed in the first stage with Q fever later develop chronic disease. Endocarditis is the most frequent and severe form of chronic Q fever. In the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” the number of patients diagnosed with Q fever has significantly increased in the last few years. The number of cases from the first half of 2014 almost exceeded the whole number recorded in 2013. In these circumstances we expect that the number of cases of endocarditis with Coxiella burnetii will rise.

HBV reactivation under immunosuppressive treatment – a case series

Background Inactive HBV carriers, under immunosuppressive treatment for malignancies or rheumatologic diseases, have an increased risk for HBV reactivation. HBV reactivation under immunosuppression has a high rate of acute liver failure and death. HBV screening is mandatory for patients with hematological malignancies or rheumatologic diseases who are due to receive immunosuppressive treatment.

The cost-effectiveness of treatment in chronic HBV non-cirrhotic hepatitis – finite versus long-life therapy.

Background Although the ideal end point of chronic HBV hepatitis therapy is HBsAg loss, a realistic end point is the induction of sustained virological remission. The definitions of virological responses vary according to therapeutic regimen: viral load <2000 IU/mL after interferon (IFN) regimens and undetectable HBV-DNA during nucleoside/nucleotide analogues (NNA) regimens. Objective: To compare the direct costs of medication between two therapeutic strategies: NNA versus NNA after IFN in non-cirrhotic patients without contraindications for IFN.