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INTRODUCTION: Nowadays, chronic viral hepatitis represents one of the most common pathological entities with over 400 million cases worldwide, with high diagnosis and treatment cost, severe complications in late stages and an annual death-rate around 1 million. The purpose of this study was to identify noninvasive ultrasound markers in order to establish an early diagnosis in asymptomatic chronic hepatitis. METHODS: We enrolled in a prospective study 111 patients diagnosed with asymptomatic chronic hepatitis: 53 patients with hepatitis B (group A) and 58 patients with hepatitis C (group B). All patients underwent ultrasound exam; we evaluated the dimensions of the left hepatic lobe, right hepatic lobe, caudate lobe, portal vein, liver stiffness, presence of hepatic hilar lymph nodes, number and dimensions of the adenopathies. RESULTS: Increased liver size was found in over 16% of patients in group A and over 20% of patients in group B. We registered an enlarged portal vein in 3.77% of patients in group A and in 3.45% of patients in group B. Adenopathies were found in 64.16% of group A and 82.76% of group B. Using long adenopathic axis as marker, we obtained a NPV over 0.9, PPV of 0.5 in the detection of chronic hepatitis B and a PPV of 0.9 in the detection of chronic hepatitis C in asymptomatic patients, a specificity of 0.98 for both chronic hepatitis B and C, a sensitivity of 0.81 for group B and 0.64 for group A. CONCLUSIONS: The presence of hilar liver adenopathies represents an important marker in detecting asymptomatic chronic viral hepatitis.

BACKGROUND Aging of persons with human immunodeficiency virus (HIV) resulted in high rates of osteopenia and osteoporosis. Multiple cohort studies have reported an increased prevalence of bone demineralization among HIV-infected individuals. The aim of this study was to evaluate bone mineral density (BMD) and risk factors for osteopenia/osteoporosis among HIV-positive patients attending the National Institute for Infectious Diseases "Prof.Dr. Matei Balș", Bucharest, Romania. METHODS We performed a cross-sectional study that enrolled 60 patients with HIV. The association between BMD and lifestyle habits (smoking), body mass index (BMI), nadir cluster of differentiation 4 (CD4) cell count, current CD4 cell count, HIV viral load and history of combination antiretroviral therapy (cART) were investigated. The BMD was measured at the lumbar spine, hips and total body using dual-energy X-ray absorptiometry (DEXA). RESULTS In the present study, DEXA evaluation showed an overall prevalence of osteoporosis of 16.66% (ten patients) and a prevalence of osteopenia of 48.33% (29 patients). In men, low BMI and cigarette smoking showed significant association with the diagnosis of lumbar spine demineralization (p=0.034 and p=0.041, respectively). Duration of exposure to cART classes in relation to BMD was also evaluated. The use of non-nucleoside reverse-transcriptase inhibitors (NNRTIs) was associated with low lumbar spine BMD in all patients (p=0.015). Reduced BMD was significantly associated with protease inhibitors (PIs)-containing treatment (p=0.043) in women. CONCLUSION At lumbar spine DEXA, male gender was statistically associated with reduced BMD. At the left hip Ward's area, decreased BMD T scores were significantly associated with aging. The reduced BMD was higher in patients receiving PI- or NNRTI-containing regimens.

BACKGROUND: Leptin is an adipokine with complex metabolic, neuroendocrine and immune functions. Our objective was to evaluate leptin serum levels in a cohort of Romanian HIV-infected patients undergoing antiretroviral therapy in relation to their immune-virological status, lipid and glucose metabolic abnormalities and the presence of metabolic syndrome (MS). METHODS: We enrolled consecutive non-diabetic HIV-infected patients aged 18 and over on stable cART for at least 6 months. Blood samples were tested for: leptin, CD4 T cells count, HIV viral load and lipid panel. RESULTS: A total of 90 HIV-infected patients were included in the study: 50 males (55.6%) with a mean age of 33.3 years and 40 females with a mean age of 30.4 years. Most patients (74.4%) had HIV viral load below the limit of detection and the median CD4 count for the cohort was 476 (410) cells/cmm. More than one third of the patients (41.1%) had hypoleptinemia. The prevalence of MS was 13.3%. Hypoleptinemia was significantly more frequent in men. In a subset of patients with undetectable HIV viral load, the median leptin value was 0.6 (6.07) ng/mL in patients with poor immune recovery (CD4 count ≤ 200/cmm) compared to 2 (3.07) ng/mL for those with better immune response (CD4 count > 200/cmm), without statistical significance. The median values of leptin were similar for persons with and without MS criteria. HDL-cholesterol values were positively correlated to leptin values in a linear regression model. CONCLUSION: A significant proportion of patients in our study presented low levels of leptin; this finding was not associated with immune and virological parameters or the presence of MS. Hypoleptinemia was significantly correlated with lower levels of HDL-cholesterol, a key cardiovascular risk factor.

Present day increasing dependence on electricity, in both home and work environments, can lead, if the necessary precautions are not met, to a wide type of injuries, from cutaneous burns to important visceral lesions. We report the case of a 44 year-old male with cutaneous and severe visceral lesions, paresis and paresthesia of the right upper limb induced by a high energy electrical shock. No psychiatric manifestations were observed. This case followed an unusual course due to the particular evolution of the hepatic lesions, which included necrosis, abscesses, thrombosis and angiocholitis.

INTRODUCTION Several studies have reported that cytokines secreted by adipose tissue (adipokines) may be linked to HIV replication. The aim of the study was to evaluate the relationship between HIV replication and serum levels of adipokines, in a Caucasian HIV-infected population of men and women undergoing complex antiretroviral therapy. METHODS A cross-sectional study was conducted in an unselected sample of 77 HIV-1-positive patients. Serum adipokines levels were measured including circulating adiponectin, leptin, resistin, tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6). Patients were divided into two groups: Group 1 - with undetectable viral load and Group 2 - with persistent HIV viral replication. Differences between groups ? were tested using independent-sample t-test for Gaussian variables and Mann-Whitney-Wilcoxon test for non-parametric variables. Pearson's chi-squared test was used for correlation analysis. RESULTS A total of 77 patients (age range: 17-65, mean: 32.5 years) including 44 men (57.1% men, age range: 17-63 years, mean: 34.1 years) and 33 women (42.9% women age range: 19-65 years, mean: 30.3 years) were included in the study. TNF-alpha had significantly higher serum levels in patients with detectable viral load (16.89 vs. 9.35 pg/mL), (p=0.043), but correlation analysis lacked statistical significance. Adiponectin had median serum levels of 9.22 ig/mL in Group 1 vs. 16.50 ig/mL in Group 2 but the results lacked statistical significance (p=0.059). Higher leptin, IL-6 and resistin serum levels were noted in patients with undetectable HIV viral load, without statistical significance. CONCLUSIONS The present study reported higher TNF-alpha serum levels in patients with persistent HIV viral load. We found no statistically significant correlations between adiponectin, leptin, resistin and IL-6 and HIV viral load in our Caucasian HIV-positive study population, undergoing antiretroviral therapy.

November 12th 2014: the opening conference for the project “Doctoral and post-doctoral research – a priority of the Romanian postgraduate education system (Doc-Postdoc)” took place in Bucharest, Romania. The project aims to support doctoral and post-doctoral research in Romania, and is cofinanced by the European Social Fund through the Sectoral Operational Programme for Human Resources Development 2007-2013; priority axis 1. “Education and training in support for growth and development of a knowledge based society“; key area of intervention: 1.5. “Doctoral and post-doctoral programs in support of research”; contract code: POSDRU/159/1.5/S/137390. The Carol Davila University of Medicine and Pharmacy in Bucharest is the project beneficiary, partnering with two other major universities in Romania: The University “Politehnica” of Bucharest, and the University of Medicine and Pharmacy Târgu Mures. The conference presented the aims and objectives of the project, but it was also packed with scientific sessions where young PhD candidates and post-doctoral researchers had the opportunity to present the studies they are conducting within this project. The topics discussed spanned through the interdisciplinary fields of biomedicine and bioengineering. Of particular interest to the readers of the Journal GERMS, Dr. Catalin Tiliscan presented data on adipocyte dysfunction in HIV-positive patients undergoing antiretroviral therapy, his study showing that almost half of patients had hyporesistinemia, and resistin was correlated with the inflammatory profile. Also, an unfavorable immune status appeared to be inversely proportional to the values of monocyte chemoattractant protein-1 MCP-1, while leptin values were not correlated with CD4 cell count or virologic status, but rather with HDL-cholesterol and waist circumference. Dr. Ramona Popescu presented an interdisciplinary study protocol for determining the incidence of intercurrent and opportunistic infections in rheumatologic patients undergoing treatment with biologic agents. Dr. Oana Sandulescu presented the preliminary results of a study aimed to determine the capacity of staphylococcal species to adhere to and internalize in eukaryotic cells. By comparing two different types of bacterial strains, collected from patients with clinically-relevant infections and from asymptomatic nasal carriage, the study showed that despite a similar rate of internalization, staphylococci from the two groups displayed statistically significant differences regarding intracellular growth after internalization. Dr. Daniela Talapan presented significant data on the emergence of carbapenemase-producing Enterobacteriaceae, with Klebsiella spp. ranking first among bacteria with resistance to carbapenems, followed by E. coli, E. cloacae, and E. aerogenes, leaving a considerably low number of active antibiotics in play, namely colistin, tigecycline and fosfomycin. Based on the preliminary data presented at the conference, the research conducted within this project is bound to generate information with a significant clinical impact, leading to a better understanding of medical issues currently understudied, with the potential to reshape clinical practice.