Oana Săndulescu

Microbiologic Safety of the Transareolar Approach in Breast Augmentation

BACKGROUND In aesthetic breast augmentation, especially by the transareolar approach, there is increasing concern regarding the occurrence of capsular contracture and its potential correlation with intraoperative implant contamination from putative endogenous breast flora of the nipple and lactiferous ducts. However, detectable bacteria cannot be considered synonymous with established resident microflora. OBJECTIVES The authors sought to elucidate the existence of endogenous breast flora and assess the microbiologic safety of transareolar breast augmentation. METHODS In this prospective study (BREAST-MF), the authors collected microbiologic samples from the breast skin, ductal tissue, and parenchyma of 39 consecutive female patients who underwent breast procedures in a plastic surgery clinic. Swabs collected pre-, intra-, and postoperatively were processed for bacterial and fungal growth. Positive cultures underwent identification through VITEK and MALDI-TOF, as well as antimicrobial susceptibility testing. RESULTS Staphylococcus species accounted for 95 of 106 (89.6%) positive results from native breast skin, 15 of 18 (83.3%) positive results from decontaminated breast skin, and 4 of 4 (100%) positive results from the breast parenchyma. Methicillin resistance was present in 26.4% of S. epidermidis, 25.3% of S. hominis, and 71.4% of S. haemolyticus strains. CONCLUSIONS During transareolar breast augmentation, in the nipple-areola region it is more likely to find bacteria populating the skin, rather than endogenous breast flora, as previously considered. Appropriate preoperative decontamination is essential for minimizing the risk of postoperative infections. LEVEL OF EVIDENCE 3: Risk.

Response to “Commentary on: Microbiologic Safety of the Transareolar Approach in Breast Augmentation”

We thank Dr Bartsich for providing valuable input on our previously reported work1 and we agree with her conclusion: the breast cannot be considered a sterile site.2 As the human body includes 10 times more bacterial cells than human cells,3 it is virtually impossible for any particular bodily compartment which communicates with the exterior to be sterile.4 Therefore, we agree that flora from the surrounding skin can transiently colonize the nipple ducts, as we have …

Comparison of Kaposi disease outlines in patients with and without HIV infection in two tertiary care hospitals in Bucharest, Romania

Methods A retrospective study on KD was performed in two academic centers, tertiary-care hospitals with national addressability in Romania. Two groups were comparatively studied: HIV-infected patients diagnosed in the National Institute for Infectious Diseases “Prof.Dr. Matei Bals” (HIV-positive group), and non-HIV patients diagnosed in the first Clinic of Dermatology, Colentina Clinical Hospital (HIV-negative group). The statistical analysis was performed using IBM SPSS Statistics v.22 (Chicago, USA).

Screening for osteo-renal involvement in the Romanian HIV cohort

Background When assessing comorbidities in HIV-infected patients, the bone and the kidney represent important target organs that can potentially be affected by both virus and antivirals. Given the particular characteristics of the Romanian HIV cohort [1], most of the patients have experienced HIV infection in childhood and have received multiple therapeutic regimens since the advent of antiretroviral (ARV) therapy. Thus, the need to screen for osteo-renal impairment in these patients is high on the priority list [2].

Non-invasive quantification of liver fibrosis regression following successful treatment of chronic hepatitis C with direct acting antivirals

Abstract Introduction. The past years have revolutionized the treatment of hepatitis C virus (HCV) infection, with high rates of sustained virologic response (SVR). Furthermore, liver fibrosis has recently been redefined as a dynamic, reversible process. Methods. We performed a prospective cohort study to assess the role of laboratory evaluations and non-invasive measurement of liver stiffness in establishing the right time for starting treatment and in assessing the regression of liver fibrosis in Romanian patients treated with direct acting antivirals (DAA) for genotype 1b chronic hepatitis C. Results. We present the results for 102 patients, with a mean age of 58.5 years, and a rate of SVR of 100%. Our study has ruled out older age (p=0.628), IL28B non-CC genotype (p=0.693), baseline viral load above the cutoff of 600,000 IU/mL (p=0.353), and the presence of diabetes mellitus (p=0.272) or baseline steatosis (p=0.706) as factors potentially influencing the regression of liver fibrosis following DAA treatment of HCV infection with the 3D regimen. The quantitative regression of liver stiffness was inversely correlated with the duration of HCV infection (p=0.017), suggesting that timely treatment might associate better outcomes in terms of liver fibrosis. Conclusion. Our study’s results point towards the need to start DAA treatment earlier in patients with HCV infection.

Anti-biofilm Agents

Biofilms are microbial communities with enhanced interbacterial communication and cooperation. A good knowledge of anti-biofilm options is essential to ensuring correct management and treatment of biofilm-driven infections, with two main interest areas, namely prevention of biofilm formation and eradication of mature biofilm. Wounds can become infected with a wide array of germs, and among frequently encountered pathogens are Staphylococcus aureus and Pseudomonas aeruginosa, either separately or in microbial consortia. Depending on the type of wound, different techniques can be used to prevent, reduce, or eradicate biofilms, including mechanical options, surgical wound care, use of specific absorbent dressings, antiseptic soaks, or administering antibiotics either systemically or locally. Antimicrobial associations may be useful alternatives to single-agent therapy for biofilms, but they should be thoughtfully chosen, to ensure synergy. When dealing with S. aureus biofilms, fifth-generation cephalosporins, lipoglycopeptides, lipopeptides, oxazolidinones, or glycylcyclines may display important anti-biofilm effect, and the same is true for the association of rifampin or gentamicin to other active anti-S. aureus agents. For P. aeruginosa biofilm-driven infections, options include fluoroquinolones such as levofloxacin and ciprofloxacin, potentially associated with colistin. Bacteriophages are gradually gaining more important roles in the armamentarium of anti-biofilm agents, and so are engineered peptides or natural products extracted from plants or bacteria.

Liver Fibrosis and Progression of Liver Disease in Patients with Hepatitis Delta - Results from a Retrospective Study in Romania

Introduction: Due to the relatively low prevalence of hepatitis delta in Europe, Romania is one of the main countries in the region that can provide data on long-term prognosis of patients with this condition. Methods: We performed a retrospective study to assess liver disease progression and to compare non-invasive methods for assessing liver fibrosis in patients with chronic hepatitis B and delta under current active surveillance at the National Institute for Infectious Diseases “Prof. Dr. Matei Balæ”, Bucharest, Romania. Results: The study group included 64 patients with a median age of 54 (IQR: 38, 59) years, and a male-to-female ratio of 0.7:1, accounting for 183.6 patient-years of follow-up. We identified a biphasic distribution of liver fibrosis in patients with hepatitis D from our cohort, with two peaks, one at mild to moderate fibrosis and the second at moderate to advanced liver fibrosis. We recorded a significant decrease in thrombocyte count from baseline to the third evaluation (mean decrease 17,000/μL, p=0.007, Z=-2.7), a pattern not seen when analyzing coagulation and liver function. We recorded no significant changes over time in terms of cytolysis, renal function, fasting plasma glucose, or lipid profile. We identified a moderate correlation between FibroTest and FIB-4 values (p=0.008, rs=0.40), and a weak correlation between FibroTest and APRI values (p=0.016, rs=0.36). We also identified a moderate correlation between ActiTest and FIB-4 values (p=0.006, rs=0.45), and for FibroTest and APRI (p=0.001, rs=0.56). Conclusions: We identified an accelerated decrease in thrombocyte counts in patients with hepatitis delta without advanced liver fibrosis, unparalleled by a decrease in liver function. FIB-4 might offer a more suitable estimate of liver fibrosis than APRI, while both FIB-4 and APRI scores appear to give a fair evaluation of the necroinflammatory activity in patients with hepatitis delta.

Kaposi Sarcoma in HIV Infected Patients

Abstract Objective: The aim of the study was to describe clinical and laboratory characteristics in HIV-infected patients with Kaposi sarcoma (KS). Methods: We retrospectively studied data on HIV-infected patients hospitalized in one tertiary care hospital in Bucharest, Romania, in whom Kaposi Sarcoma was diagnosed, between January 2008 and November 2013. Results: We identified 27 HIV-infected patients diagnosed with KS within 6 years. They had a median age of 42 years old and a median CD4 cell count of 101 cells per mm3 at the time of KS diagnosis. All patients received antiretroviral therapy (ART), with 18 patients (66%) already on ART at the time of KS diagnosis. Most patients (59%) were classified as ACTG poor-risk and 56% as Mitsuyasu stage I. The overall prognosis was poor, with 41% mortality, in a median time span of 6 months, significantly correlated with gastrointestinal involvement (p=0.019), poor-risk KS in ACTG classification (p<0.001) and stage IV Mitsuyasu (p=0.006). Conclusion: KS remains an important cause of morbidity and mortality in patients with HIV infection, especially in late presenters.

Sonication – further progress in the microbiological diagnosis in implant-associated infections

Sonication – further progress in the microbiological diagnosis in implant-associated infections Daniela Tălăpan, Raluca Mihăilescu, Olga Mihaela Dorobăț, Vlad Predescu, Rodica Marinescu, Olivera Lupescu, Florian Purghel, Marius Niculescu, Răzvan Ene, Alexandru Hera, Daniela Munteanu, Mariana Constantin, Emilia Căpraru, Angelica Tenita, Dana Jianu, Oana Săndulescu, Anca Streinu-Cercel, Monica Cârstoiu, Cătălin Cârstoiu, Victoria Aramă, Adrian Streinu-Cercel, Alexandru Rafila

Performance of shear-waves elastography in the non-invasive assessment of liver fibrosis in chronic hepatitis in the Romanian population

Results We have examined a total of 80 patients with chronic hepatitis, of which 58.8% had HCV infection, 16.3% HBV infection, 6.3% HBV + HDV coinfection, 2.5% ASH, 2.5% HIV infection and 13.8% had idiopathic liver involvement. The male-to-female ratio was 0.86:1, and the mean age was 48.6 ± 14.9 years. The mean duration of hepatic disease evolution was 7.6 ± 5.7 years, longer for HCV infection (mean 8.3 ± 5.9 years) than for HBV infection (4.75 ± 3.9 years, p = 0.028). The overall mean SWE liver stiffness was 9.6 ± 5.3 kPa, higher in patients with HCV infection (10.8 ± 5.9 kPa) than in those with HBV infection (6.98 ± 1.9 kPa, p = 0.009). Overall, 37.5% of patients were classified as F0-F1 on SWE, 25.0% F2, 8.8% F3 and 28.7% F4. Liver cirrhosis was present in 28.7% of patients and hepatocellular carcinoma had already been diagnosed in 6.3% of all patients and in 21.7% of all patients with cirrhosis (5 cases, of which 4 had been previously diagnosed with cirrhosis with HCV – 3 cases, and HBV +HDV – 1 case, and 1 had an idiopathic cause for liver involvement and a stiffness corresponding to F0-F1 on SWE).