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Retroviral infections have been an important cause of preoccupation of research and medical systems in the past decades. The discovery of human immunodeficiency virus (HIV) as the etivological factor of acquired immunodeficiency syndrome (AIDS) marked a turning point in the conceptual framework and medical management. Retrospective diagnosis has permitted the discovery of infections after 20- 30 years from the date of death. The transmission chains are still undefined and are still under study. Given that, the United Nations HIV/AIDS (UNAIDS) targets for 2020 and 2030 are ambitious. To reach these goals, in spite of the overwhelming material costs to healthcare and socio-medical systems, and different kinds of “psychological pressure”, attention and support to combat HIV/AIDS infection need to remain a first‑line problem for governments and contemporary society. We propose a review of the defining moments in the natural history and their impact on the global medical systems of HIV/AIDS in the 1981-1990 period and to underline the most important information up to 2017 in our country. [ABSTRACT FROM AUTHOR]

Enterococci are one of the important causes of urinary tract infections and are inherently resistant to many antimicrobials, including penicillin, clindamycin, trimethoprimsulfamethoxazole and low levels of aminoglycosides. Moreover, they are poorly responsive to cephalosporins in vivo. The study was carried out in “Cantacuzino” National Research Institute on samples received from community. In order to detect resistance in Enterococcus species, a total of 102 Enterococcus species samples were included in the study. Although Enterococcus faecalis (98.03%) was one of the most common species associated with urinary tract infections, we also identified Enterococcus faecium (1.97%), showing the necessity of species level identification in laboratory settings. There were also isolated enterococci from mixture of two or three bacteria. E. faecalis was sensitive to vancomycin (94.10%), ampicillin (50.98%), penicillin (50.98%), linezolid (97.06%), nitrofurantoin (96.07%), levofloxacin (62.74%), ciprofloxacin (62.74%), chloramphenicol (89.22%) and tetracycline (17.65%), and resistant to gentamycin - high level resistance (25%). [ABSTRACT FROM AUTHOR]

In the context of excessive, often abusive use of antibiotics and chemotherapeutic agents, further studies are needed to elucidate to what extent this problem is present in our country, followed by the development of a program to prevent and control the extension of this damaging, worrisome phenomenon, damaging both for the patient and for public health and healthcare system in general. There are recommendations on how these therapeutic resources should be properly utilized. However, noting that recommendations are rarely respected and given the fact that replacing drugs that can be "lost" due to the increase in microbial resistance requires on average two decades of study, we support the view of personalities in the field regarding a possible solution: avoiding errors most commonly encountered in the practice of antibiotic therapy. We presented some suggestive examples in this regard and we recommend the study of the bibliographic resources on the bases of which we wrote this material and that the concepts be applied in everyday practice. [ABSTRACT FROM AUTHOR]

Dermatological disorders are common in patients infected with HIV (Human Immunodeficiency Virus), being present in all stages of progression. Skin manifestations provide useful clues to diagnose the infection. Moreover, these pathologies may reveal the presence of an associated systemic disease or may suggest the progression of immunosuppression. Dermatological manifestations are more severe in these patients compared to the general population and do not respond to conventional therapies, relapses being frequent. These lesions have an important psychological impact on patients, representing a real stigma, affecting the quality of life. The clinical picture of HIV patients varies significantly, depending upon the geographic region or upon the different groups of risk. In this article I attempted to highlight the most common skin manifestations of HIV-infected patients and to describe their main features, as pointed out in recent scientific papers. [ABSTRACT FROM AUTHOR]

Introduction: Staphyloccocus aureus is a conditionally pathogenic bacterium and represents a common cause of skin infections, such as abscesses or respiratory and intestinal infections. An estimated 20% of the human population carries S. aureus for long term. Case presentation: We present the case of a 54-year-old woman who presented to the gynecological examination for menstruation associated with skin rash. Genital clinical and ultrasound examinations were normal. The abdominal and axillary skin examination revealed disseminated tumors with a diameter between 1 and 5 cm with celsiene signs and spontaneous exteriorization of a gray-white creamy liquid and other tumors containing chocolatte-like creamy. The presumed diagnosis was a Staphylococcus skin infection and a possible cutaneous endometriosis. There was collected biological product from the pustules and Staphylococcus aureus was isolated. It was developed the autovaccine for the patient. One month after the administration of the vaccine the pustules were in almost complete remission. Conclusions: Staphylococcus aureus skin infection may have different clinical presentations. In the current situation it was manifested as a papular rash with relapses and spontaneous remissions correlated to the menstrual cycle phases. Thus, the appearance of lesions and the patient history made possible the differential diagnosis with cutaneous endometriosis. [ABSTRACT FROM AUTHOR]

In the literature, there are few publications which present data related to the infections of the urinary tract infections (UTI) of the patients who suffer from HiV/AIDS, although they represent an important cause which causes the death of these patients. The prevalence of the etiological agents differs according to the studied area. The urological complications in the case of HIV/ AIDS patients are often the result of a bacterial, parasitic, viral or fungal infections. The antiretroviral therapy increases the life span but, at the same time, it represents a favourable factor for infections, for exam pie, through the urolithiasis which they can produce. We set ourselves to review aspects related to UTI at this group of patients, having as a future objective the evaluation of this correlation in Romania. [ABSTRACT FROM AUTHOR]

Wastewater treatment plants (WWTP) are considered to be an important reservoir of antibiotic resistance genes (ARGs) and antibiotic resistant bacteria (ARB) that may contribute to an increase release of resistance into environment, which menace human and animal health. The resistance selection processes of ARB and ARGs transfer that occurs into WWTP are poorly understood and studies are required to advance our current knowledge in the field and thus optimizing wastewater treatment for the removal of ARB and ARGs. The aim of this paper is to summarize methods used for analyzing the antibiotic resistance in environmental samples, providing information that can be used by professionals to improve the wastewater treatment for the removal of ARB and ARGs. [ABSTRACT FROM AUTHOR]

Most of fungal infections are superficial and relatively easy to treat. Nevertheless, millions of invasive fungal infections have also been reported. Considering that most of the time the presence of this fungus represents colonization, the challenge is to differentiate between colonization and infection. The objective is to summarize the Candida spp. virulence factors and to highlight their clinical relevance. We have selected the most pertinent articles from the recent medical literature regarding this subject using Google Academic and Pubmed databases. The first virulence factors involved in the infection are adhesion proteins (e.g., the fungal protein gpm1 interacts with vibronectin, leading to fungal adhesion to keratinocytes, endothelial cells and monocytes). In order to invade, the fungus penetrates the epithelium/endothelium using hydrolytic enzymes - aspartyl proteases (encoded by SAP genes), phospholipases and lipases. Candida albicans could induce its own endocytosis by the epithelial cells, process governed by Efg1p and Tpk2p proteins. Penetration is favored by the yeast-hyphae conversion, pleomorphism being essential in pathogenicity. It is triggered by various factors including pH and temperature changes, hormonal variations etc. The fungus is very versatile, having the capacity to survive within a wide range of environmental conditions. It can cause co-infections with different bacteria such as Pseudomonas aeruginosa, Klebsiella pneumoniae etc. The virulence factor with the most important clinical significance is the capacity of biofilm formation. A significant role in biofilm formation is played by the adhesion proteins codified by ALS and EAP Candida albicans genes. Biofilm presence on medical instruments leads to antifungal resistance. The study of the Candida spp. virulence factors is a continually developing field. Understanding these mechanisms has a major clinical importance when comes to correct evaluation of a positive Candida spp. sample and correct treatment administration. It could also lead to new therapeutic approaches if we consider the increase of antifungal resistance in the last years. We highlight the importance of collaboration between the clinician and the laboratory physician. [ABSTRACT FROM AUTHOR]

Carbapenems are last resort antibiotics used in infections caused by multidrug-resistant bacteria. Carbapenem-resistant Enterobacteriaceae infections are an increasingly global threat, especially because carbapenemase production is more frequent than other resistance mechanisms and is encoded by genes located on transferable genetic structures. The production of classes A (KPC), B (IMP, VIM, NDM) and D (OXA-48 and its variants) of carbapenemases has important clinical consequences and is a constant pool of resistance. This review tries to show the diversity of carbapenemases and to underline their importance. [ABSTRACT FROM AUTHOR]

The production of carbapenemases is one of the most important mechanisms that lead to carbapenem resistance. At the same time, the carbapenemases present on extracromosomial genetic material (plasmids) are transmitted between various bacteria. Although the genes Klebsiella, Enterobacter and Escherichia are most commonly involved in infections, the identification of carbapenemases in other genes may be very important for controlling infections. In this article, we will review a recent study published in the Morbidity and Mortality Weekly Report, which evaluated the production of carbapenemases in enterobacteria belonging to genes less commonly involved in clinical practice. All strains of enterobacteria transmitted to the Center for Disease Control (CDC) in Atlanta and the Public Health Laboratory of the Minnesota Health Department (MDH) from 1 January 2014 to 30 September 2017 were screened for the identification of five carbapenemases (KPC, NDM, OXA-48, IMP, and VIM). Among these, the results for the genera Klebsiella, Enterobacter and Escherichia were excluded. CDC received 1039 EPC-RC isolates during the study, of which 63 (6.1%) of the infrequently identified genera. Over the same period, 149 (12%) of the 1241 CREs were producing carbapenemases. Although in small numbers, isolates from more infrequent genera of enterobacteria that produce carbapenemases may be an important reservoir for dissemination to other bacteria. Additionally, we will add suggestions for current, cost-effective methodological solutions that can improve the knowledge of carbapenemase production in our country. [ABSTRACT FROM AUTHOR]

Globally, more than 50% of HIV infected people are women. HIV infection in women has its particularities, especially because of pregnancy and because of the adverse effects of antiretroviral therapy. Heterosexual contact is the most frequent way of HIV transmission in women. Some gynecological infections like vaginal candidiasis seem to be more persistent and more severe as compared to uninfected female patients. Also, HIV infected women have a higher risk for cervical dysplasia and cancer as compared to uninfected women. The risk of mother-to-child transmission of the virus has dropped significantly in the last decades because of the implementation of routine HIV screening testing in pregnancy, counseling regarding prevention and the large access to antiretroviral treatment. Today, because of the diversity of the therapeutic options and using good prophylactic measures, HIV infected women can have a normal life. [ABSTRACT FROM AUTHOR]

Food poisoning outbreaks comprise a large group of diseases that occur sporadically or epidemic, caused by ingestions of contaminated food with pathogenic microorganisms and / or their toxins. Staphylococcal food poisoning are caused by ingestion of preformed enterotoxins in foods by certain strains of staphylococci, most commonly Staphylococcus aureus and represent one of the most common forms of food toxinosis. In Romania, Staphylococcus aureus ranks second after Salmonella spp., in the etiology of food poisoning, the real incidence of this disease being statistically underestimated. Staphylococcal food poisoning history begins many years before, the first descriptions of diseases, with epidemic episodes arising from the consumption of food, dating from 1860-1880 period. Microorganisms or preformed toxins represents a special threat to public health due to their pathogenicity, facility to spread and their potential as bioterrorism agents. Public health system has a critical role in preventing and controlling food poisoning outbreaks. This involves an active surveillance both locally and nationally, which requires a close collaboration between clinicians, epidemiologists and laboratory physicians [ABSTRACT FROM AUTHOR]

The number of pulmonary and extrapulmonary infections due to nontubercuious mycobacteria (NTM) is increasing worldwide in the immunocompromised patients and immunocompetents ones. Treatment decisions taken by the clinicians depends by the clinical symptomatology at presentation, Rx chest radiography and isolation of NTM by the laboratory. The differentiation between NTM and M. tuberculosis complex (MTC) depend also on mycobacterioiogy laboratory. The management of infections due to NTM include antibiotic therapy, surgical resection or only observation and must be done for a relatively long period of time. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus, one of the most important human pathogens, secretes an impressive number of virulence factors that may cause a range of community or nosocomial infections with varying severity as well as toxinoses. The main function of the toxins is to inhibit the host immune response against S. aureus, but each toxin exerts specific biological functions, responsible for particular manifestations. So far there have been identified over 20 staphylococcal enterotoxins that are part of the superantigens family. Staphylococcal enterotoxin B, the most intensively studied of these, is involved frequently in the production of food poisoning. Staphylococcal enterotoxin B is part of the group B of bioterrorism agents classified by CDC (Centers for Disease Control and Prevention), being easily to spread and difficult to diagnose/identify in the initial stages. [ABSTRACT FROM AUTHOR]

Uncontrolled growth of multidrug-resistant pathogens becomes an important public health problem, due to their ability to develop life-threatening disease. The decrease in the number of newly discovered antibiotics is an incentive for prioritizing the introduction of new agents into modern medical practice. The history of bacteriophages dates back 100 years, when they were discovered by Frederick Twort; subsequently they were used worldwide until the introduction of antibiotics. Later, they continued to be used by the former Soviet Union countries. The chapter on bacteriophages reopens nowadays because of their long term applicability in some countries and the new interest manifested by the USA and Western Europe, having the potential to become a rescue therapy for patients with limited therapeutic options. [ABSTRACT FROM AUTHOR]

Antibiotic resistance is a growing phenomenon and a cause of global concern due to the widespread use and misuse of antibiotics in humans and animals. The main goal of this study is the identification of risk factors for infection with resistant bacteria. Materials and methods. A number of 61 patients were enrolled in this study and their charts were analyzed regarding their history of chronic disease, immunosuppression or prior antibiotic use. Results. Odds ratio for each potential risk factor was analyzed and the values of p and confidence interval were calculated using Fisher's t test. Discussions. Prior antibiotic use appears to be a risk factor for both resistant and multi-drug resistant bacteria infection, a finding which is in concordance with existing literature and fundamental research. [ABSTRACT FROM AUTHOR]

Despite significant advances in antiretroviral treatment (ARV) and HIV infection prevention, about 400 children worldwide are still diagnosed daily with HIV infection, most cases due to perinatal transmission. It is estimated that the knowledge and rigorous application of prophylactic measures to reduce the vertical transmission of infection would significantly reduce this risk to less than 1%. We report the case of a 5 months old infant coming from a pregnancy with HIV risk and multiple risk factors for transmission of the vertical infection, who did not receive postnatal testing and treatment. The diagnosis was established during infancy, falling into the AIDS stage by cytomegalovirus (CMV) disease with retinal sequelae occlusion. ARV treatment was initiated late, but from the moment of diagnosis, requiring further changes due to drug interactions, lack of availability and resistance to TARV. Although the patient’s progression was marked by severe comorbidities: sequelae of CMV disease, mixed HIV and CMV encephalopathy, pulmonary tuberculosis, repetitive respiratory and digestive opportunistic infections, the evolution of immunological parameters was slowly favorable under treatment. Proper implementation of prophylactic measures in the newborn and the pregnant woman could have significantly reduced the risk of HIV transmission to the patient, with a high probability that she would not have been infected. The case reported reflects the failure of strategies to prevent HIV / AIDS infection in pregnant women and newborns; conclusions must be drawn to avoid similar situations. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV) infection continues to be an important public health issue. Immunosuppression is responsible for the development of much comorbidity among HIV-infected patients. Of these, malignancies play an important role in the prognosis of the disease. Cancers diagnosed in HIV-infected patients can be divided into two main categories: AIDS-defining cancers and non-AIDS-defining cancers. In the second category, skin cancers represent an important subgroup, the most common being basal cell carcinoma, squamous cell carcinoma and melanoma. [ABSTRACT FROM AUTHOR]

HPV infection affects a significant number of individuals in the general population. HPV is a DNA virus with tropism for skin and mucous membranes; up to date, more than 200 types have beeen identified. HPV infection causes various disorders, cutaneous and anogenital warts accounting for a large number of cases. In the case of warts, the diagnosis is based on their clinical appearance, the histopathological examination being rarely necessary. Many therapeutic modalities, with variable efficacy, are available. Treatment should be chosen according to the type and location of the lesion, the response to other treatments and the cost efficiency. In addition to conventional therapies (keratolytic agents, cryotherapy), modern therapies such as photodynamic therapy and immunotherapy have been developed, the results being encouraging. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a chronic condition characterized by abdominal pain and changes in bowel habits. Traditionally, it has been regarded as a multifactorial functional disorder of visceral hypersensitivity. In its pathogenesis, stress was playing an important role. Nowadays, there are more and more evidences for the role of intestinal microbiota in the pathogenesis of IBS. Therefore, irritable bowel syndrome became today as an accumulation of chronical symptoms, dominated by pain and irregular bowel habits, but resulting from the alteration of the intestinal microbiota, being closely correlated with changes in the parietal immune response and increased sensitivity of the intestinal wall. Following this paradigm shift, new therapeutic options should be considered. [ABSTRACT FROM AUTHOR]

Introduction. Resistance to carbapenems represents a public health across the world. Screening for carbapenem resistance can be done starting from the antibiogram, but confirmatory methods are usually performed in reference centers. Methods for rapid identification of carbapenemase activity are required to empower laboratories to detect carbapenemases and raise signals for infectious disease physicians, antibiotic stewardship teams and hospital hygiene specialists. Materials and methods. Eppendorf tubes containing Klebsiella pneumoniae strains with carbapenemase activity (KPC-1, NDM-1, OXA-48) and others with no carbapenemase activity (K. pneumoniae ATCC 700603 and E. coli ATCC 25922), as well as positive and negative controls were incubated at 37 °C with varying concentrations of Meropenem. After incubation, samples were spun down until a pellet formed and the supernatant was used to challenge an exponentially growing E. coli culture. This second culture was followed with nephelometric measurements every half hour. Experiments were carried out in three technical replicates. The statistical analysis was done with R (version 3.3.3) and graphs generated in RStudio (version 1.0.136) with ggplot2 (version 2.1.0). Mann Whitney U Test with the assumption of independent samples was used to analyse the results. Results. The doses of Meropenem were chosen after dose ranging experiments and multiple incubation times (from 30 minutes to two hours) were tested in order to evaluate the robustness of the method. In the cases where the antibiotic was first incubated with strains that had carbapenemase activity, the growth of Escherichia coli ATCC 25 922 was non-hindered, matching that of controls. In the absence of carbapenemase activity and in the case of negative controls, the growth indicator strain was inhibited. Statistically significant differences were identified for 0.3, as well as a 0.5 McFarland index as early as 1.5 hours total work time. Conclusions. The discovery of carbapenem resistance has direct clinical, as well as epidemiological implications. Among the mechanisms implicated in resistance to carbapenems, the presence of a carbapenemase is one of the most worrying from an epidemiological standpoint. This new tool we describe herein can be performed in all clinical microbiology laboratories, with no extra expense (as opposed to CarbaNP and BlueCarba tests). [ABSTRACT FROM AUTHOR]

Introduction. Many epidemiological, clinical and experimental studies have sugested a possible role of infectious agents in the etiopathogenesis of lichen planus. In this paper, the authors performed a retrospective analysis for the presence of hepatitis B (HBV) and C (HCV) viruses in patients with lichen planus, between 2004-2016. Material & Method. The serological screening was realised for 157 patients with lichen planus in order to detect anti-HCV antibodies and HBs antigen. In the case of a positive result for anti-HCV antibodies, confirmatory tests were performed. Results. Among patients with lichen planus diagnosed based on clinical and histopathological aspects, it was found that 12 patients were infected with HCV (7.6%), 4 patients were infected with HBV (2.6%) and 1 patient with HBV/HCV coinfection (0.6%). Conclusions. Based on these results, the authors do not consider that hepatitis viruses play an essential role in the pathophysiology of lichen planus. However it should be noticed the high percentage of cases of HCV infection among these patients. Early identification and treatment of these infections in patients with lichen planus could influence in a positive way the course of the cutaneous disease. [ABSTRACT FROM AUTHOR]

The gut microbiota is an important part of the body, it has numerous functions and at the same time, through the imbalances that occur at its level, is involved in some pathologies. The gut microbiota composition begins to be established even before birth. Further, it is influenced by various factors such as mode of delivery, feeding, breastfeeding or with formula milk. At around 2-3 years, the microbiota stabilizes and resembles with the one of an adult. Changes may occur in the adult period also, either due to the type of food, vegetarian or not, hypo- or normocaloric, because of the medications, or because of the environment where he lives. The microbiota has different roles, from the synthesis of compounds to the intervention in the metabolism of substances, endo- or exogenous. The alteration that may arise in the functioning of the microbiota affects many systems. Studies reveal imbalances of the gut microbiota in various diseases such as ankylosing spondylitis, Alzheimer's disease and others. [ABSTRACT FROM AUTHOR]

The increased incidence of Clostridium difficile associated diarrhea and the severity of diarrhea caused by enterohemorrhagic Escherichia coli involve the need of greater attention from the health professionals dealing with these infections. They are required to detect the disease on time, to diagnose, treat appropriately and implement preventive measures to limit outbreaks. C. difficile colonizes the intestinal tract after the normal microbiota at that level has been modified during sistemic antibiotic therapy. This pathogen causes pseudomembranous colitis, actually one of the most common nosocomial infections, too. Enterohemorrhagic E. coli, a Shiga-like toxin-producing strain, causes bloody diarrhea and its complications become extremely serious in children and elderly people (hemolytic-uremic syndrome). For the both forms of severe diarrhea, based on last data published, issues related to epidemiological data, clinical manifestations, diagnosis and treatment will be reviewed. [ABSTRACT FROM AUTHOR]

In daily practice physicians meet with different situations in which they must use their knowledge and in order to make the best possible choices, it is necessary for them to know the new findings and at the same time to practice continuously. The sources of information most commonly used are the textbooks, journals, particularly those available on the internet, or information obtained from various conferences, but very important, besides knowledge and experience, are the discussions with colleagues. The way they choose the information is influenced by the availability, how easy can be obtained, especially its quality and how useful it is for medical practice. Infecțio.ro readers mentioned that its scientific level is high or very high, providing information with an important applicability in their daily practice. They were especially interested in clinical cases presented, but also in the original studies and synthesis. In terms of graphics, this was considered to be professionally done or very professional. Continuing medical education is a good way to maintain a high level for the offered medical services. Lately, it is increasingly obvious how important is the way it addresses doctors and also the information transmitted. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory tract infections (upper and lower) represent one of the most frequent problems that lead to community medical visits, according to official data. In the hospital environment, the treatment of infections requiring inpatient care needs to be carried out in accordance with institutional guidelines, adapted to local antimicrobial resistance patterns. Information about the spectrum of bacterial resistance is often absent. Materials and methods: A retrospective study of the antibiogram registry of the Bacteriology Laboratory of the “Marius Nasta” National Institute of Pneumophtysiology (NIP) in Bucharest. The most frequent microorganisms isolated from pulmonary samples of adult inpatients in 2015 were analyzed. Results: The resistance of Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus spp., Klebsiella spp., Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa was analyzed. We reported the total number of isolates, the number of analyzed isolates (the ones that come from patients who meet the inclusion criteria) and the absolute and proportion figures for resistant, intermediate and sensitive strains. Resistance is described for each of the microorganisms. Special cases of resistance (like methicillin resistant staphylococci and carbapenem resistant enterobacteriaceae; CRE) have been highlighted because of the need to monitor their evolution over time as well as the importance to approach them systemically (prevention and treatment). Discussions: The spectrum of resistance varies according to the ward where the patient was cared for. The isolates from the medical wards were, in general, less resistant than those from the ICU/surgery wards. Conclusions: Due to the high variability in the spectrum of bacterial resistance of the most frequent isolates from medical practice, heightened attention is required in choosing the appropriate empiric antibiotic coverage and adherence to sampling and diagnostic procedures. The present article helps to better characterize the epidemiology of infections and antibiotic resistance in the “Marius Nasta” Institute; it identifies the difficulties faced in gathering and analyzing the data and can be considered as a reference point to improve medical practice policies with regards to the use of antibiotics. [ABSTRACT FROM AUTHOR]

Travelers' diarrhea (TD) is the most common condition seen among people who are travelling, especially from developed to developing countries, its prevalence reaching almost 70%. Even though, in most cases, TD is a non-aggressive, self-limited disease and there are effective treatment methods available, prevention measures are worth being taken, because, by controlling the risk of infection and its post-infectious complications, the traveler's health would not be affected either during the trip, or after. TD prevention consists in three main types of measures, often requiring a combination of all of them adjusted to the destination and traveler's risk factors: education on food and beverage safety/hygiene, chemoprophylaxis and immunoprophylaxis. Because bacterial infection is the most frequent cause of TD (up to 90%), it becomes rationale, not only for curative, but for prophylactic purposes too, the usage of a non-absorbable bactericide wide spectrum antibiotic like Rifaximin-α which also has a low rate of resistance patterns. Due to its pharmacokinetic and pharmacodynamics advantages along with its favorable results from several clinical trials, Rifaximin-α is now probably the best and safest prophylactic (but curative, too) option in case of TD. [ABSTRACT FROM AUTHOR]

Significant progress has been made in the therapy of hepatitis C, but many things are still unknown about its pathogenesis. The course of hepatitis C is influenced by both host and virus characteristics. More and more studies highlight the role of oxidative stress in the pathogenesis of hepatitis C. Core protein plays a key role in the generation of reactive oxygen species. In addition, the most important complications of the infection, cirrhosis and hepatocellular carcinoma, seem to be related to the presence of oxidative stress. In this context antioxidants could be a useful adjuvant therapy. [ABSTRACT FROM AUTHOR]

Influenza is a contagious respiratory illness caused by influenza virus types A, B or C. Clinical manifestations are nonspecific, such as fever, cough, sore throat, headache, myalgia, symptoms identified in other respiratory infections as well. For these reasons the clinical diagnosis could be difficult. Evolution is usually mild, but certain groups of people such as the elderly, pregnant women or people with associated comorbidities are at risk to develop complications. Antiviral treatment is recommended especially to people from the risk groups, the ones hospitalized, the ones with a severe evolution, and the ones with complications or risk of developing complications. The best way to prevent influenza remains annual vaccination. The components of the vaccine are chosen based on reports from previous seasons on circulating influenza virus types and their mode of transmission. [ABSTRACT FROM AUTHOR]

Travellers' diarrhea is one of the most frequent diseases, which affects 30-70% of the persons who are travelling from high developed to less developed areas, its prevalence depending on the region and season. The risk of developing this condition involves both the host's susceptibility, but also its behaviour; for example, younger people and those with achlorhydria or immunocompromised persons are more prone to this pathology than the general population. Also, the consumption of certain food, insufficiently prepared or improperly stored or cooked can be the source of the pathogen. The clinical manifestations have an abrupt onset and are most commonly represented by diarrhea with or without blood, abdominal pain, nausea and sometimes fever. Taking into consideration the often short period of the travelling and the fast symptom onset, a rapid diagnosis could be only clinically established, based on epidemiological circumstances and clinical patient features. Due to a very frequent bacterial etiology (80-90%), the treatment consists of empirical administration of antibiotics associated with symptomatic medication and hydroelectrolyte rebalancing formulas which all together shorten the healing process. Recommended antibiotics are those less absorbable or the non-absorbable ones, like rifaximine-α. [ABSTRACT FROM AUTHOR]

Introduction: Vaccines represent one of the most effective and cost-saving public health interventions. Still, this measure continues to be underused all over the world. Immunization averts an estimated 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles. Although globally the proportion of children who receive recommended vaccines has remained steady for the past few years, we observed during our clinical practice that the vaccination coverage in Romania might be lower than the needed immunization rate. The objective of this study is to test this hypothesis and to highlight the causes of low vaccination rates in Romania. Materials and methods: We collected data regarding different variables such as vaccination status, living area, mothers' age from the patient charts of all the infants (278) hospitalized in the Clinical Hospital “Dr Victor Gomoiu” during a three-month period (1st of August - 31st of October). We determined the frequencies and analysed the differences between vaccinated and unvaccinated children regarding the above mentioned variables using EpiInfo 7.1.5.2. Results and discussion: Of the 278 infants, 15 (5.9%) were excluded because of missing data, 194 (69.79%) were completely vaccinated and 69 (24.8%) were unvaccinated or incompletely vaccinated. We found that unvaccinated or incompletely vaccinated infants are more likely to have adolescent mothers than vaccinated children (24.64 % compared to 10.82%). Children who live in rural areas have lower immunization rates. In our study, we observed that vaccination rate is higher among children living in urban areas (78.8%) than among children living in rural areas. Conclusions: The immunization rate in Romania is lower than the recommended immunization rate. Child neglect, difficulty to reach health providers, and lack of information could be some of the causes. Whether the true responsible for this issue is the children's caregiver, the Health Ministry, or both, immunization coverage represents an important public health issue and it should be further and thoroughly investigated in the search for a solution. [ABSTRACT FROM AUTHOR]

Cases of multidrug resistant tuberculosis are on the rise in many regions; therefore prevention programs are fundamental to reduce the incidence of tuberculosis. Knowledge of the risk factors and understanding of the mechanisms which underlie the acquired resistance of Mycobacterium tuberculosis strains can contribute to the implementation of prevention and control strategies. This paper reviews the main risk factors and mechanisms involved in the acquisition of resistance to first and second line anti-tuberculosis drugs. [ABSTRACT FROM AUTHOR]

Traveler's diarrhea (TD) is a major public health problem affecting the activities of the individual, as well as through the possibility of spreading the disease in the population. This pathology has most commonly bacterial etiology, such as Enterotoxigen Escherichia coli, Enteroaggregative Escherichia coli, Campylobacter jejuni, Shigella spp. and Salmonella spp. Parasites involved in traveler's diarrhea are Giardia lamblia, Entamoeba histolytica and Cryptosporidium spp., and in terms of viruses, most commonly are the Noroviruses. Depending on epidemiological data, patient's symptoms and onset of the disease, the clinical suspicion of the diagnosis can turn towards one of the three etiologies, and just in specific cases will move toward additional appropriate microbiological diagnostic methods in order to establish a more accurate diagnose and to recommend the appropriate therapy. In most of the cases of TD, diagnose should be based on clinical data and treatment recommendations should be empiric (specific and nonspecific). Nevertheless, it is mandatory that each practitioner be aware and well informed that only through judicial epidemiologic and fundamental microbiologic analyses (taking into consideration their limits) there have been developed nowadays, simplified methods for diagnosing and treating TD, but very well adapted to each high risk region. [ABSTRACT FROM AUTHOR]

Chronic venous leg ulcers (CVLU) account for the final outcome of a far wider disease spectrum referred to as chronic venous disease. Physiological wound healing involves a three-stage process, with the coagulation/ inflammatory, granulation and epithelialization phases occurring successively. In the case of chronic wounds, such as CVLUs, the tissue damage and repair are misbalanced, resulting in the ulcer's lodging in a particular wound stage - the inflammation or granulation stage -, consequently impairing progression towards wound healing. Failure to rebuild the skin integrity may be due to a large number of factors, either endogenous - host factors determining or maintaining breaches in the protective barrier of the skin -, or exogenous, such as microbial biofilm infections. The future research should focus upon the study of wound microenvironment. The detection of specific biomarkers of chronic wound healing, as well as the discovery of therapeutic agents that target molecules involved in the pathogenic cascade would change the course of the disease. [ABSTRACT FROM AUTHOR]