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Diarrhoea represents a significant public health concern worldwide and is responsible for an increase in mortality and morbidity, especially among children but also among adults. Cryptosporidium, one of the most common intestinal protozoan parasites, is the etiological agent of cryptosporidiosis, an acute infection with self-limiting evolution, but that can evolve into severe diarrhoea in children and immunosuppressed hosts. The main species that cause human cryptosporidiosis are C. parvum and C. hominis. Despite the progress made in order to control and monitor cryptosporidiosis at the global level, numerous outbreaks have been reported with the source of infection being food or water. Using Promedmail.org we have performed a review of Cryptosporidium related outbreaks reported in the last 10 years over the world. [ABSTRACT FROM AUTHOR]

Predecessors in the Romanian School of Microbiology established several golden guidelines for the clinical integration of the microbiology laboratory, the clinical rationale behind the infectious disease patients, and the antibiotic administration. However, without a determined mind to continue, strengthen, and nurture the work they have undertaken, professors Ion Cantacuzino, Victor Babes, and Matei Bals' expertise would have vanished [1-3]. Professor Angelescu proved to be the ideal individual right when he was most needed, determined to carry on their legacy, to further advance antibiotic knowledge, and a patient, father-like figure to his younger colleagues. He answered the invitation to become a leading authority at a time when advances in the science of antibiotics had doctors puzzled. The "Angelescu's Guide" was intended to be a lifeline for what would soon become one of the major challenges of the twenty-first century: antibiotic resistance in delicate clinical settings. Actual, achievable strategies for the care of an infectious illness patient are provided below, as are pertinent research recommendations for younger and fresher medical minds. [ABSTRACT FROM AUTHOR]

Despite the global economic development, diarrhoea remains an important health concern worldwide. The epidemiological importance of Shigella spp. infections is very high, being the leading cause of bacterial diarrhoea. Clinically, shigellosis can manifest as watery diarrhoea or dysentery, with bloody stool, accompanied by fever and abdominal pain. Children and the elderly are most susceptible to developing severe forms. In this review, we highlight the rise of antibiotic-resistant Shigella spp. strains and provide an overview of recent shigellosis outbreaks. Shigellosis is an infectious disease that should not be neglected, as evidenced by the many outbreaks reported throughout the world. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV) poses a medical, social, and economic problem. In Romania since 2002, the prevention of HIV transmission and the care for HIV-positive people have been overseen by Governmental Law. HIV infection in Romania has some particularities, such as the high number of HIVinfected patients under treatment and the high percentage of long-term survivors. Romania reported its first case of AIDS to the World Health Organization in 1985, and its first case in the pediatric population in 1989. A year later, a new case definition, based on local possibilities was formulated together with the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC, Atlanta, GA). According to the latest report of the Compartment for Monitoring and Evaluation of HIV/AIDS in Romania, the cumulative number of HIV cases registered between 1985-2021 was 26,171, while the number of people living with HIV at the end of December 2021 was 17,271. [ABSTRACT FROM AUTHOR]

Providential personalities have been writing history since the beginning of times - personalities that could be found within and across Romania's borders [1]. In medicine, such brilliant figures have healed patients through diligence, dedication, and professionalism, but have also passed significant teachings to the next generations. They have rigorously respected an authentic professor's definition, a figure that teaches and prepares specialists for the future. The great medical personalities, Ion Cantacuzino and Victor Babeș, have been mentored by famous professors, have also become famous professors on their own, and they have educated doctors and professors who have carried on their research and medical teaching legacies. Through study, through diligence, and an impressive personal development, their students have also become proficient figures in medicine [1-2]. They have trained personalities in the medical field that could have reached higher peaks, were it not for the political and social climate of their country. Among those, now we shall bring into discussion professor Matei Balș, a remarkable man and teacher, whose contribution focused the necessity of employing strict and correct means of practice, tying together in an organic way the clinical and the laboratory work, a dogma which he has passed on to his students. He has funded the "School of Infectious Diseases" at Colentina Hospital and has formulated teachings that stand the test of time; his working approach is still appropriate and praised today. The current generation as well as future ones not only have the obligation to recognise the exceptional achievements of our ancestors in history, but to also keep them alive and develop upon them, in the interest of the Romanian people, Romania itself, but also for the public health system at an international level [1]. [ABSTRACT FROM AUTHOR]

Providential personalities are an essential, unifying, element across cultures, omnipresent in the world's history [1]. Professor Victor Babeș, a distinguished figure in pathology, microbiology and virology, attended high school in Budapest and pursued his higher medical education in Budapest and Wien. He lectures at the pathology department of the University of Budapest at only 18 years of age. In 1885, he co-authored the first Bacteriology Treaty in Paris alongside Cornil. In 1887, he went on to establish the pathology and bacteriology departments at the Faculty of Medicine, in Bucharest. He contributed to the medical world literature with over 1000 papers, written in different languages. Professor Victor Babeș studied bacteria, viruses, parasites and influenced preventive medicine. Overall, he discovered more than 50 new microbes. An entire book may be devoted just to his pathological discoveries (cancer, leprosy, tuberculosis, diphtheria, actinomycosis, anthrax, syphilis, plague, rabies, etc.). In 1912 he published (in Paris) a vast treaty on rabies; he dedicated 90 of his best works to rabies. Victor Babeș National Institute of Research and Development in Pathology and Biomedical Sciences has been founded on the 28th of April 1887 by Professor Victor Babeș. Initially constituted as a "Bacteriology and Pathology Institute", it was able to comply with one of the most demanding medical needs of the time and it has contributed to finding realistic solutions regarding medical organization. In terms of importance and activity, the institute represented a prefiguration of the future Ministry of Health [2]. Professor Babeș's life should be remembered for his works that marked the opening of new horizons and for a personality whose genius echoes to this day. [ABSTRACT FROM AUTHOR]

Providential personalities are an essential, unifying, element across cultures, omnipresent in the world's history. They are one of a kind, born every century or even more than a hundred years apart, and their emergence is conditioned by specific factors and even circumstances. Among Romania's historical personalities, Professor Cantacuzino's name and achievements could not be contained within the country's borders. His genius has left its mark not only on the Romanian public health system, or even the nearby Balkan area, but has echoed way further than Europe at that time. The conscious effort he made to offer more than he had previously received stemmed from his exceptional personal development work. A multifaceted persona like few have been, he has managed to acquire great insights into many subjects and, more importantly, he had the character and strength to establish a Healthcare Legacy and an Institute that will soon celebrate 100 years of existence. The current generation and the ones to come should learn their history and praise the achievements of their ancestors, while also preserving and further cultivating them, for the good of Romanian citizens, Romania and the global health system. [ABSTRACT FROM AUTHOR]

Difficult-to-treat infections produced by Pseudomonas aeruginosa have a long evolution with a great impact not only in regard to the patient's health, but also to his well-being, the public health and economy. Considering that not only the antimicrobial resistance, but other characteristics of these strains may be involved in the longue and difficult evolution of this infections; we evaluated the ability to produce biofilm on inert substrate through a microdilution method. We evaluated 25 strains of P. aeruginosa isolated from infections with a longue evolution. Most of the strains produced an important biofilm, especially at 48 hours, presenting an interesting architecture, suggesting the ability to persist. These findings highlight the impact of biofilm production in P. aeruginosa, and underline the importance of finding alternative therapies and a personalised approach. [ABSTRACT FROM AUTHOR]

Introduction: Risk reduction of TORCH congenital infections mainly involves prevention of infection prepregnancy and during pregnancy by educating the target population. We developed and tested a support system for women who would like to conceive and for pregnant women. Objectives: We assesed the usability of www.torch.ro website and MAMI smartphone application in a group of adult women of fertile age (18-49 years old). Our second aim was to asses the knowledge gain following their use in a group of pregnant women. Methods: We evaluated the usability, credibility, loyalty and appearance using Standardized User Experience Percentile Rank Questionnaire (SUPR-Q) which was completed online by 171 women of childbearing age. For knowledge evaluation, we developed a test-questionnaire and distributed to 61 pregnant women. Results: The participants had a good experience, as reflected by SUPR-Q of 4.47 out of 5. 74% of users have qualified as promoters, which imply that they are likely to recommend the website/app; the best scoring categories were trust, credibility and loyalty - score of 4.49/5. Majority (59.6%, n = 102) answered that they will definitely apply the measures of prevention of TORCH infections acquired in case of a next/future pregnancy and 28.7% (n = 49) said they will probably do so. There was an increase in the number of correct answers for almost all the questions, with a maximum increment of 21.3% for individual questions. Overall, there was a difference of plus 86 correct answers after exposure which represents 16% increase compared to initial number of correct answers of 535. Conclusion: End-user experience of website and smartphone app MAMI was evaluated as positive by the participants. The tools are trustworthy, credible and women who have used them are very likely to recommend them hence increasing the awareness about TORCH infections prevention. [ABSTRACT FROM AUTHOR]

The purpose of this review is to carry out an overall evaluation of the scientific literature on the selection of the best candidate as an animal translation model. We used the PubMed/MEDLINE, Web of Science Core Collection and medRxiv/BioRxiv (preprint materials) databases for original research published in English to September 2020. Review research was conducted in accordance with the preferred reporting elements for systematic reviews and meta-analysis (PRISMA). The inclusion criteria were: establishing animal models (mouse, ferret, dog, cat, primates, etc.) for SARSCoV-2, prophylaxis, therapy and vaccines. The exclusion criteria were: books, guidelines and protocols, population genetics. This review highlights the distinct advantages and limitations of each animal model, which should be taken into account in the design of studies, the interpretation of pathogenic mechanisms or extrapolation of the results of therapy or vaccines in humans. In order to generate results that are consistent, reproducible and comparable between studies, it is necessary to harmonize the protocols for experimentation on animal models. [ABSTRACT FROM AUTHOR]

In the context of increasing resistance to antimicrobials, therapeutic alternatives must be developed, one of which may be the administration of autologous bacterial vaccine. There are few studies in the literature reporting the immune and clinical response to autologous vaccine administration. In this study we tried to evaluate the clinical effect of the administration of the autologous bacterial vaccine to people with dermatological diseases for which the classical therapy did not bring the desired results. [ABSTRACT FROM AUTHOR]

Botulism occurs by ingestion of canned food contaminated with Clostridium botulinum. In most cases, the incriminated canned foods are homemade; commercial products only occasionally produce the disease, due to improper handling and storage after purchase. In Romania, the most common sources of food botulism are homemade pork products (ham, bacon, salami, meat and sausages preserved in lard). The disease occurs in small outbreaks. Out of several serotypes of C. botulinum, the predominant serotype in our country is type B. The Laboratory of Anaerobic and Zoonotic Infections in Cantacuzino Institute performs in vivo reference laboratory diagnosis of botulinum food poisoning, using the mouse lethality assay for detection of the toxin in the sample and for toxin typing. Between 2003 and 2017, our laboratory tested 576 biological samples for the diagnosis of botulism: patient blood serum samples (80%), food samples (19.02%) and autopsy fragments from deceased patients (0.8%). Type B botulinum toxin was detected in 50% of the total number of blood serum samples received for testing and a single serum was positive for type E toxin. 5% of the tested food samples were positive for type B toxin. Until 2007, the geographic origin of positive samples that we received for testing showed high incidence of food botulism in the center and west of the country. Starting 2007, we received more samples from several eastern counties, many of them being confirmed as positive. Until mid 2009, we frequently received insufficient amounts of patient serum, and we could not determine the toxin serotype. [ABSTRACT FROM AUTHOR]

One of the main concerns of the medical community during the COVID-19 pandemic has been the management of the immunosuppression accompanying the disease, particularly in ICU (Intensive Care Unit) patients. More recently, the focus has shifted towards the management of the persistent immunosuppression post-acute COVID-19 and its complications. The rate of healthcare-associated infections (HAIs) had been declining before the pandemic, but has since started to increase once more. Due to multiple factors - unnecessary antibiotherapy, disorganized medical facilities, inadequate personal protection equipment etc. - there have been increasing reports of coinfections and secondary infections with multidrug-resistant bacteria in COVID-19 patients. We present a case report of a patient with no history of clinically overt immunosuppression before developing critical SARS-CoV-2 pneumonia. The patient had no need for antibiotic treatment during his hospitalization and was discharged in a stable state, being consequently readmitted multiple times for different healthcare-associated multidrug-resistant infections, over time developing other hospital-related complications. The case raises a discussion about the bidirectional relationship between post-COVID immunosuppression and the possible inadvertent excess in antibiotic therapy that has accompanied the pandemic. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 infection increases the risk of multi-organ systemic complications and venous and arterial thromboembolism. The development of vaccines has proven to be an effective method to combat severe forms of infection. Adverse effects reported after COVID-19 vaccination consisted of local injection site reaction, fatigue, myalgia, or fever as well as sporadic cases of vaccine-induced thrombotic immune thrombocytopenia, especially viral vector vaccines. Objectives: The aim of the study was to evaluate the repeated dose toxicity of a candidate vaccine against SARS- CoV-2, a test in which several parameters were analyzed, including coagulation factors. Materials and methods: The test included 120 rats, of both sexes, divided into six groups (main group, recovery group and control group) at which the human dose, 10X human dose and 1 control adjuvant were tested. The vaccine was administered intranasally, 4 times every two weeks. The final day was after the last administration to the main group and another 30 days from the last administration to the recovery group. On day 0 and the final day, blood was collected for hematological, biochemical, immunological examinations and coagulation tests (Fibrinogen, Prothrombin Time-PT, Activated Partial Thromboplastin Time-aPTT and Thrombin Time-TT). Results: Fibrinogen, in the case of all groups, increased on the final day, except for females from the recovery groups where this parameter decreased by 25%. PT, aPTT and TT, regardless of group or sex, had low values compared to the initial time of the study. On day 0, the values of the coagulation factors were homogeneous, the fibrinogen being between 155- 347mg / dL, PT 25.5-57.8 sec, aPTT 61.9-120 sec and TT values of 53-60 sec. On the final day, the group analysis also showed unit values. Fibrinogen increased between 90-116%, PT decreased by 48-71%, aPTT decreased by 59-80%, and TT had values lower by 10-14% compared to the initial day. Conclusions: Increased fibrinogen associated with decreased PT and aPTT is common in human clinical pathology. Fibrinogen, PT, aPTT and TT are the standard parameters of blood clotting assessed in toxicity tests. The results obtained in the study represent a preliminary phase which, corroborated with the results of the other tests, supports the conclusion that the candidate vaccine does not have toxicological potential, the coagulation factors not being influenced after its repeated administration. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting intertriginous skin areas of young adults. Although HS was historically defined as an infectious disease, the role of microorganisms in its pathogenesis is now controversial. We investigated the lesion microbiota of a recently diagnosed 24-year-old male patient with axillary HS, who shared features of the metabolic syndrome. The microbiological analysis of the patient's lesion was indicative of colonization with bacteria including aerobes - Staphylococcus (S.) aureus, S. lugdunensis, S. epidermidis, anaerobes - Anaerococcus (A.) octavius, and microaerophiles - Cutibacterium (C.) acnes; this last one was also isolated in monoculture from a patient's healthy skin control sample. In vitro antibiotic susceptibility evaluation revealed Methicillin-resistant S. aureus (MRSA) and highly susceptible S. lugdunensis and S. epidermidis. Profiles of A. octavius and C. acnes showed that both strains were susceptible to Vancomycin, Clindamycin, Doxycycline and Linezolid; the anaerobe was Benzylpenicillin-resistant and Tetracycline and the microaerophile was intrinsically Metronidazole-resistant. We conclude that the intralesional microbial diversity in this case shows low variety of species and similarities to healthy skin microbiota, although the presence of S. aureus, particularly MRSA, S. lugdunensis or C. acnes - frequently involved in chronic skin pathologies - may be relevant for the disease severity. MRSA carriage in the patient's lesion represents a significant epidemiological risk for the healthcare environment. Antibiotic treatment in the early stages of HS should be administered with caution. Extended studies of HS microbiota could identify relevant colonization patterns for the outcome of the disease and offer important keys for selecting personalised, efficient therapeutic schemes. [ABSTRACT FROM AUTHOR]

Recent research has highlighted the role of oxidative stress in the pathogenesis of HPV-related lesions, especially in neoplastic diseases. Oxidative stress and chronic inflammation are the most important cofactors that HPV requires to persist and induce a malignant process. Data on the role of oxidative stress in benign lesions associated with HPV infection, such as genital and non-genital warts, is scarce and further research is needed. We have determined markers of oxidative stress in the serum of 26 patients with palmoplantar warts and 28 healthy subjects. We have investigated representative markers for the four main molecular targets of oxidative stress, nucleic acids - 8-hydroxy-2'-deoxyguanosine (8-OHdG), lipids - 4-hydroxynonenal (4-HNE), carbohydrates - pentosidine, and proteins - thiol-disulfide homeostasis parameters (TDHP): total thiol (TT), native thiol (NT), and disulfides (DS). The serum levels of oxidative stress markers, 4-HNE, 8-OHdG, and pentosidine, were statistically significantly higher in patients with warts in comparison to the control group (p < 0.01). Regarding TDHP, we have found that TT levels were statistically significantly higher in the patient group compared to the control one (p < 0.05). Even though NT and DS levels were reported to be higher in the patient group compared to the control one, no statistical significance was established (p > 0.05). Our results show enhanced oxidative stress damage in patients with palmoplantar warts and provide valuable data in understanding the molecular mechanisms involved in the pathogenesis of HPV infection. To the best of our knowledge, this is the first study to evaluate both 4-HNE and pentosidine in patients with palmoplantar warts. [ABSTRACT FROM AUTHOR]

In Romania, cervical cancer is the second most frequent neoplasm among women of 15 to 44 years of age, mainly due to a lack of prevention efforts. The purpose of this study is to assess the current knowledge and attitude towards HPV infection and immunization among medical students. Such information is vital in order to properly assess the current shortcomings of our medical system in the struggle of lowering cancer incidence. A cross-sectional questionnaire-based study was carried out in 2016 and in 2018 on a total of 1,133 participants (median age of 21.9 years, 572 students in 2016 and 562 in 2018). No statistical differences between males and females regarding knowledge of HPV vaccine were found (chi-square 0.046, df = 1, p = 0.83). Moreover, between the 2016 and the 2018 groups, no noticeable changes in HPV awareness and information were observed (2016: chi-square: 0.003, df = 1, p = 0.955; and 2018: chi-square: 0.061, df = 1, p = 0.805). Even though the participants have noted reliable media and medical staff as their main sources of information, our study revealed poor general knowledge, no improvement in perception, and a lack of prophylactic action. [ABSTRACT FROM AUTHOR]

In the context of SARS-CoV-2 infection, the identification of a vaccine has become vital for stopping the pandemic. The consortium formed by the OncoGen Center and the Cantacuzino Institute (CI) evaluates a candidate vaccine whose vaccine component is represented by a combination of peptides specifically recognized by the 2 components of the adaptative immune system. Each new vaccine must undergo mandatory tests, even if they are currently accelerated or overlapping, with the consent of the European Medicines Agency (EMA). One of the tests relates to repeated dose toxicity. The aim was to setup a protocol for repeated dose toxicity testing in rats, the results of which would allow the transition to the clinical phase I dossier. The protocol was designed based on EMA guidelines for vaccine safety testing and rat-human translation. The proposed human dose, route of administration and repeat administration were taken into account. Clinical signs, immunological and biochemical parameters will be analysed. Histological examination will be performed on 34 organs. The protocol was approved by the ethics committee of the CI and authorized by the competent authority. In order to evaluate the repeated dose toxicity of a vaccine candidate against COVID-19, we propose a robust, replicable, effective and translational study protocol. [ABSTRACT FROM AUTHOR]

Introduction: It is estimated that one in five pregnant women is affected by depression and the consequences of undiagnosed and unaddressed depression are detrimental for the future mother, her baby and ultimately the entire family unit [1]. Hepatitis B virus (HVB) infection is one of the TORCH infections (toxoplasmosis, other -HVB, etc., rubella, cytomegalovirus, herpes viruses), known as major contributors to prenatal infantile mortality and morbidity [2]. Case report: We report the case of a pregnant woman with multiple risk factors for depression, who was diagnosed during pregnancy with chronic HBV infection. Her personal background cumulated with her psychosocial situation led to severe depression late in the pregnancy which was recognised and addressed by the medical team involved in her care. Depression in pregnancy is reported to be associated with a risk for premature birth, intrauterine growth restriction and non-optimal neuromotor development; hence a new diagnosis of an infection associated with possible foetal complications was likely the last factor added to already a fragile psychic. The newborn had intrauterine growth restriction and received appropriate prophylactic measures to prevent HBV infection. The authors would like to emphasize that the role of the medical team involved in the care of pregnant women should not limit to delivering a healthy baby but the team should look into mother's psychological health as early recognition of depression impact the course of both medical and emotional health of the entire family. Furthermore, the authors are taking the opportunity to raise awareness among medical professionals in regard to the possible outcomes of a new diagnosis of infection in pregnancy on the psychological status of the pregnant woman. [ABSTRACT FROM AUTHOR]

Mother-to-child transmission of viral blood bome diseases (BBD) may be prevented with efficient measures of prophylaxis. Some of the most frequent viruses involved in mother-to-child transmission are HBV, HIV and HCV. Our main objectives were to assess the mother-to-child transmission of BBD - HBV, HCV and HIV, to evaluate the risk factors associated with these viruses transmission in a hospital from Romania, especially in childbearing women diagnosed at the moment of birth, along with defining the importance of midwives. We conducted a retrospective, descriptive study, from January 2017 to December 2018 at a District Hospital for Obstetric Gynecology in Romania. A total of 7,020 childbearing women were monitored. Only 73 childbearing women presented BBD (61 HBV infections, 7 HCV infections and 5 HIV infections). Mother-to-child transmission rate of BBD was 12.32% (N=9 newborns) and the most frequent BBD transmitted to newborns was HIV infection. There were no cases of HBV mother-to-child transmission. The most important risk factors for transmission of abovementioned viral infections were found to be episiotomy, cervical rupture and early membrane rupture. There is a need for joint effort of all healthcare providers including the midwives in order to improve the control of BBD transmission from pregnant women to their newborns. [ABSTRACT FROM AUTHOR]