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The pedological resources of a territory lay at the basis of agricultural potential, because they have a direct influence on the favorability or restrictiveness of a territory for a certain use. Therefore, the study of the physical-chemical and morphological characteristics of soils becomes very important when one proposes economically viable agricultural crops. The restrictive climatic and morphological factors may have isolated or cumulative negative effects on the agricultural sector in a certain territory, but the pedological risks are most difficult to mitigate. The purpose of this study is to analyze the distribution of pedological risk classes across Romania, assessing the scientific literature in the field, and to highlight the regions comprising the largest areas affected by soil-related risks.

Objective. Analyzing the dynamycs of global antibiotic resistance of some bacterial species isolated from patients admitted to the „Dr. V. Babes” Hospital for Infectious and Tropical Diseases, between the years 2000 to 2015. Material and methods. Antibiotic resistance profiles of bacteria isolated from inpatients, were identified by the standard diffusion method and MIC values by VITEK2C and E-test methods. (CLSI and EUCAST standards). Screening of carbapenemases – producing isolates were performed by phenotipic methods, and the confirmation by RealTimePCR: “MasterPure™ Complete DNA and RNA Purification Kit” (Epicentre), „Primer Design™ Kit” (blaOXA48; blaKPC, blaNDM, blaVIM)/ LightScanner 32 Instrument/LS32 (Idaho Technology), and GeneXpert. Internal quality control: Staphylococcus aureus ATCC29213, Streptococcus pneumoniaeATCC49619, E. coli ATCC25922, Pseudomonas aeruginosa ATCC27853. Results. The incidence of St. aureus meticilino-rezistent (MRSA) highlights an increase from 12.2% (2002) to 40.4% (2015). In the past 3 years SVB microbiology lab found a sharp increase in the incidence of erytromycin resistant strains of Streptococcus pyogenes. In 2015 we registered 20.3% of macrolide resistant strains. Global resistance to penicillin G for Str. pneumoniae (non-meningeal infections) was 45.3%- 54.5% until 2009, and 2.7% in 2013. Enterococcus faecium strains showed 0% resistance to vancomycin between 2000 and 2012. A significant growth was recorded in 2015 of 11%. Isolation rate of Klebsiella pneumoniae ESBL producing strains has increasewd progressively from 17.6 in 2000 to 57% in 2015. Carbapenems – resistant K. pneumoniae isolated strains were 18,8% in 2015. Carbapenemases types identified by phenotypic and genetic methods where: 35/ Oxa48, 8 KPC and 21/MBL (NDM-1). Resistance to carbapenems recorded an upward trend: 23.9% in 2004 to 37.9% in 2015, and for Acinetobacter baumannii 69%. Conclusions. Antibiotic resistance of bacteria is a major challange for public healts. Therapeutic solutions are extremely limited.

Marginal Areas of the Romanian Banat. Banat region is historically located between the rivers Danube, Tisa and Mureș, on three sides, and the Carpathians. This analysis focuses only on the Romanian Banat. After the December 1989 Revolution which started in Timișoara, the regional capital of Banat, the transition to the market economy and the recent economic crisis has severely struck the pillars of local economy in many parts of the region: agriculture and mining. According to a number of wellknown criteria, the paper identifies and analyzes the marginal areas of the region: rural isolated areas such as Lipova Hills and Almăj Land, mining and industrial regions like Reșița-Bocșa-Anina, Poiana Ruscă Mountains and Bistra Valley. The rural areas lack accessibility and have an autarchic economy based on agriculture. The former industrial regions are characterised by high rates of unemployment and a decline in the living standards. The consequences are mainly the same: emigration, low birth rates, demographic ageing, socio-economic instability.

The diapir anticline microdepression of Ocna Şugatag underwent an accelerated transformation immediately after the end of salt mining (at the beginning of the 1960s). During this period of over 50 years of evolution, lake basins formed and disappeared, either naturally, in small sinkholes, or mostly due to the collapse of salt mine adits or chambers, which led to the creation of large-sized lake basins. There is an accelerated dynamics of these basins, as indicated by the sliding of part of the banks at a pace of 0.5-1.5 meters/year. The collapse of the mines is far from over, because the largest mines (Mihai and Dragoş) are partly affected and the pillars supporting the ceiling of the adits have a small diameter. Given the present conditions, when the underground brine is used for bathing and treatment purposes, in short time it is possible that new lakes emerge, even larger than the already existing ones. From the point of view of the lake potential, there are important differences, according to the degree of salinity of the water and the more or less accelerated dynamics of the lake basins. The latest two years witnessed an important development of the tourism infrastructure in the analysed area, as well as arrangements of the lakes, which determined a significant increase in the number of tourists searching for outdoor bathing, especially during week-ends.

Analzyed mainly from a natural perspective, the tourism potential of the area shows important characteristics providing favourable premises for tourism planning and development. The morphological, climatic bioclimatic, hydrological and biogeographical features of Iara-Hăşdate Basin are investigated in order to create a detailed inventory of the natural resources with a specific tourism potential and to identify different types and forms of tourism which can be developed.

The National Structure of the Romanian Population at the 20th of October 2011 Census. This is the third study regarding the national structure of the population of Romania. The first two approached the 1992 and 2002 censuses and were published in Studia UBB, Geographia, 2 (1991) and the Romanian Review of Political Geography (2004)2. On the census day, Romania had 20,121,641 inhabitants, of which 83.45% (16,792,868) are Romanians, while the other 16.55% belong to: Hungarians 6.10% (1,227,623 inhabitants), Gypsies 3.09% (621,573 people), other 18 national minorities (Ukrainians, Germans, Turks, Russian-Lipovans, Tartars, Serbs, Slovaks, Bulgarians, Croats, Greek, Italians, Jews, Czechs, Poles, Chinese, Armenians, Csangos, Macedonians) and the category “other national groups” have together only 1.21% (242,767 inhabitants). There is also a category of people for which the information was ”unavailable”, totaling 6.15% (1,236,810 people) of the Romanian population (fig. 1). As requested to assess the essential issues of such a subject, one needs to analyze the distribution of the national minorities across Romania, at the level of the counties and the eight geographical-historical provinces of Romania: Transylvania, Moldavia, Dobrudja, Muntenia, Oltenia, Banat, Crişana and Maramureş. Generally, regarding the presence of the Romanian population, one notices the following situation at the level of the counties: in 18 counties of the total of 41 in Romania, the weight of the Romanian population is over 90%, including all the eight Moldavian counties (Bacău, Botoşani, Galaţi, Iaşi, Neamţ, Suceava, Vaslui, Vrancea), six out of the ten counties of Muntenia (Argeş, Brăila, Buzău, Dâmboviţa, Prahova, Teleorman) and four out of five counties of Oltenia (Dolj, Gorj, Olt, Vâlcea). The highest weight of Romanians is recorded in the counties of Gorj (94.17%) and Botoşani (94.08%). A weight between 80 and 90% was recorded in five out of the ten counties of Transylvania (Alba, Bistriţa-Năsăud, Braşov, Hunedoara, Sibiu), in both counties of Dobrudja (Constanţa, Tulcea), in four out of ten counties of Muntenia (Călăraşi, Giurgiu, Ialomiţa, Ilfov), one in Oltenia (Mehedinţi), two in Banat (Caraş-Severin, Timiş), and in the city of Bucharest. The other nine counties have a weight of 70-80% of Romanian population (Cluj, Arad, Maramureş), 60-70% (Sălaj, Bihor, Maramureş) and under 60% (Covasna 21.41%, Harghita 12.61%, Mureş 50.35%). The Hungarian national group has a weight of 6.10 % at national level and is present most of all in Transylvania, where it represents 21.56% of the population of this province (858,454 locuitori). The highest weight has been registered in the counties of Harghita (82.90%), Covasna (71.53%), Mureş (36.46%), Sălaj (22.36%) and Cluj (14.99%). Values above 15% have been also recoreded in the counties of Satu Mare (32.69%) and Bihor (24.02%). Compared to the situation of the counties in the center and western Romania, in the East, South-East and South the Hungarians are almost completely absent, as their weight is largely below 1%. The Gypsy population represents 3.09% (621,573 people) of the Romanian population and is present in all the 42 administrative units. One remarks a rather homogeneous distribution of the Gypsies, as their weight is higher than 5% in only a number of counties: Mureş (8.52%), Sălaj (6.69%), Dâmboviţa (5.27%), Giurgiu (5.41%), Ialomiţa (5.21%), Bihor (6.02%) and Satu Mare (5.05%). In all other counties, as well as at the level of provinces, the Gypsies have weights below 5%. All the other national minorities have together a weight of only 1.21% (242,767 people) of the Romanian population.They have weights between 1% and 7% in only ten of the Romanian counties: Sibiu, Suceava, Constanţa, Tulcea, Arad, Caraş-Severin, Timiş, Bihor, Satu Mare and Maramureş, and in four provinces out of eight. The analyzed census presents a peculiarity which did not exist before, the column entitled “Unavailable information”. For 6.15% of the Romanian population (1,236,819 people) the information regarding ethnicity was unavailable. At the level of the counties, in 14 cases this group represented less than 5%, in all other counties it represented between 5% and 10% while in the city of Bucharest the information was unavailable for 11.68% of the population.

Dynamics of Brâglez Riverbed (Someşan Plateau). The main left tributaries of Someş along Surduc – Jibou sector (Brâglez, Almaş and Agrij), are characterized by the presence of obvious processes of lateral and vertical erosion at the level of the riverbeds. The field observations, as well as the position of these rivers and their catchment areas in the neighborhood of the lower Someş subsidence area, would easily be grounds for explaining the riverbed processes as caused by an unstable fluvial base level. More precisely, this base level would be moving downwards under the influence of subsidence movements of Tisa Plain or even because of the subsidence affecting Guruslău Basin. Starting from these more or less speculative deductions, this paper aims at checking and confirming the above-mentioned explanations or finding other causes for the dynamics of riverbed processes. In this sense, we analysed a correlation between the drainage in the catchment area and at the level of the riverbeds, on one hand, and the riverbed geomorphological processes, on the other hand. Brâglez River (in western Someşan Plateau) will be considered as a study case, as it provides an accelerated dynamics of riverbed processes. This situation will be compared with the one in the eastern part of the same plateau, where rivers like Borşa, Luna or Lujerdiu do not present obvious riverbed processes despite the similar climatic and geological conditions.

Affective flexibility is defined as a complex executive function which enables individuals to successfully alternate between distinct emotional and non-emotional features of a given situation in order to attain a specific goal. A large body of research has focused exclusively on flexibility in a non-emotional context, although most of our interactions with our environment are emotionally satiated. Our main aim was to propose a hierarchical framework to describe this construct from a macro-level perspective to a more nuanced and micro-level perspective, including three different levels of affective flexibility: elementary, shifting, and generative. Next, we employed this hierarchical framework to examine the role played by affective flexibility in typical development and different forms of developmental psychopathology. Lastly, we discuss how this knowledge could inform future prevention and intervention programs aimed at reducing cognitive vulnerability to developmental psychopathology., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Ischemic heart condition is one of the most prevalent causes of death that can be treated more effectively and lead to fewer fatalities if identified early. Heart muscle fibrosis affects the diastolic and systolic function of the heart and is linked to unfavorable cardiovascular outcomes. Cardiac magnetic resonance (CMR) scarring, a risk factor for ischemic heart disease, may be accurately identified by magnetic resonance imaging (MRI) to recognize fibrosis. In the past few decades, numerous methods based on MRI have been employed to identify and categorize cardiac fibrosis. Because they increase the therapeutic advantages and the likelihood that patients will survive, developing these approaches is essential and has significant medical benefits. A brand-new method that uses MRI has been suggested to help with diagnosing. Advances in deep learning (DL) networks contribute to the early and accurate diagnosis of heart muscle fibrosis. This study introduces a new deep network known as FibrosisNet, which detects and classifies fibrosis if it is present. It includes some of 17 various series layers to achieve the fibrosis detection target. The introduced classification system is trained and evaluated for the best performance results. In addition, deep transfer-learning models are applied to the different famous convolution neural networks to find fibrosis detection architectures. The FibrosisNet architecture achieves an accuracy of 96.05%, a sensitivity of 97.56%, and an F1-Score of 96.54%. The experimental results show that FibrosisNet has numerous benefits and produces higher results than current state-of-the-art methods and other advanced CNN approaches.

Background: The interplay between vitamin K (vitK) (as carboxylation cofactor, partially produced by the gut microbiota) and short-chain fatty acids (SCFAs), the end-product of fiber fermentation in the gut, has never been assessed in mother-newborn pairs, although newborns are considered vitK deficient and with sterile gut., Methods: We collected venous blood from 45 healthy mothers with uncomplicated term pregnancies and umbilical cord blood from their newborns at birth. The concentrations of total SCFAs and hepatic/extra-hepatic vitK-dependent proteins (VKDPs), as proxies of vitK status were assayed: undercarboxylated and total matrix Gla protein (ucMGP and tMGP), undercarboxylated osteocalcin (ucOC), undercarboxylated Gla-rich protein (ucGRP), and protein induced by vitK absence II (PIVKA-II)., Results: We found significantly higher ucOC (18.6-fold), ucMGP (9.2-fold), and PIVKA-II (5.6-fold) levels in newborns, while tMGP (5.1-fold) and SCFAs (2.4-fold) were higher in mothers, and ucGRP was insignificantly modified. In mother-newborn pairs, only ucGRP (r = 0.746, p < 0.01) and SCFAs (r = 0.428, p = 0.01) levels were correlated. Conclusions: We report for the first time the presence of SCFAs in humans at birth, probably transferred through the placenta to the fetus. The increased circulating undercarboxylated VKDPSs in newborns revealed a higher vitamin K deficiency at the extrahepatic level compared to liver VKDPs.

Background: The COVID-19 pandemic has caused morbidity and mortality, particularly among vulnerable populations. We aimed to assess social and demographic characteristics associated with COVID-19 severity among symptomatic participants during pregnancy., Methods: The International Registry of Coronavirus Exposure in Pregnancy is a multinational, longitudinal observational cohort study of adult participants tested for SARS-CoV-2 or who received clinical diagnosis of COVID-19 during pregnancy (NCT04366986). Disease severity status of mild, moderate, or severe was determined based on symptoms and healthcare utilization. Stratified by current versus recent pregnancy at enrollment, univariate mixed-effects logistic regression modeling was used to characterize association between social and demographic characteristics with COVID-19 severity, using a cumulative mixed effect model with country as a random effect., Results: The odds of developing more severe COVID-19 (odds ratio [95% confidence interval]) were higher among participants with lower socioeconomic status (poor: 2.72 [2.01,3.69]; lower-middle class: 2.07 [1.62,2.65] vs wealthy), among participants with lower educational attainment (high school: 1.68 [1.39,2.03]; < high school (1.77 [1.25,2.51] vs graduate education). Participants over 25 years of age had lower odds of severe COVID-19 versus participants < 25 years (25-34: 0.69 [0.56,0.85]; 35-50: 0.62 [0.48,0.80]). Employment in food services was also associated with increased odds of more severe COVID-19, whereas employment in healthcare and within home, and primiparity were associated with lower severity., Conclusions: Findings suggest that employment setting and economic status have strong associations with COVID-19 severity, which warrants considering social determinants of health in the context of assessing risk factors of more severe COVID-19 during pregnancy., Trial Registration: IRCEP was registered with the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) [EUPAS37360] and clinicaltrials.gov [NCT04366986]., (© 2022. The Author(s).)

Objective: We conducted literature reviews to uncover differential effects of sex on sequelae from coronavirus disease 2019 (COVID-19) and on long COVID syndrome., Methods: Two authors independently searched OvidSP in Embase, Medline, Biosis, and Derwent Drug File. Publications reporting original, sex-disaggregated data for sequelae of COVID-19 (published before August 2020) and long COVID syndrome (published before June 2021) were included in the reviews. The association between COVID-19 sequelae (i.e. lasting <4 weeks after symptom onset) and sex, and between long COVID syndrome (i.e. lasting >4 weeks after symptom onset) and sex, was determined by odds ratio (OR) and 95% confidence interval (CI) (statistical significance defined by 95% CI not including 1)., Results: Of 4346 publications identified, 23 and 12 met eligibility criteria for COVID-19 sequelae and long COVID syndrome, respectively. COVID-19 sequelae in the categories of psychiatric/mood (OR = 1.80; 95% CI: 1.35-2.41), ENT (OR = 1.42; 95% CI: 1.39-1.46), musculoskeletal (OR = 1.15; 95% CI: 1.14-1.16), and respiratory (OR = 1.09; 95% CI: 1.08-1.11) were significantly more likely among females (vs. males), whereas renal sequelae (OR = 0.83; 95% CI: 0.75-0.93) were significantly more likely among males. The likelihood of having long COVID syndrome was significantly greater among females (OR = 1.22; 95% CI: 1.13-1.32), with the odds of ENT (OR = 2.28; 95% CI: 1.94-2.67), GI (OR = 1.60; 95% CI: 1.04-2.44), psychiatric/mood (OR = 1.58; 95% CI: 1.37-1.82), neurological (OR = 1.30; 95% CI: 1.03-1.63), dermatological (OR = 1.29; 95% CI: 1.05-1.58), and other (OR = 1.36; 95% CI: 1.25-1.49) disorders significantly higher among females and the odds of endocrine (OR = 0.75; 95% CI: 0.69-0.81) and renal disorders (OR = 0.74; 95% CI: 0.64-0.86) significantly higher among males., Conclusions: Sex-disaggregated differences for COVID-19 sequelae and long COVID syndrome were observed. Few COVID-19 studies report sex-disaggregated data, underscoring the need for further sex-based research/reporting of COVID-19 disease.

The risk associated with extreme hydrological processes (flash floods, floods) is more present than ever, taking into account the global climatic changes, the expansion of inhabited areas and the changes emerging as a result of inadequate land management. Of all the hydrological risks, slope flash floods represent the processes that have the highest impact because of the high speed of their development and their place of origin, which makes them difficult to predict. This study is performed in an area susceptible to the emergence of slope flash floods, the Valea Rea catchment area, spatially located in Northwest Romania, and exposed to western circulation, which favours the development of such processes. The entire research is based on a methodology involving the integration of spatial databases, which indicate the vulnerability of the territory in the form of a weighted average equation to highlight the major impact of the most relevant factor. A number of 15 factors have been used in raster spatial databases, obtained by conversion (land use, soil type, lithology, Hydrologic Soil Group, etc.), derived from the digital elevation model (slope, aspect, TWI, etc.) or by performing spatial analysis submodels (precipitation, slope length, etc). The integration of these databases by means of the spatial analysis equation based on the weighted average led to the vulnerability of the territory to FFPI, classified on five classes from very low to very high. The final result underlines the high and very high vulnerability (43%) of the analysed territory that may have a major impact on the human communities and the territorial infrastructure. The results obtained highlight the torrential nature of the analysed catchment area, identifying several hotspots of great risk, located mainly within the built-up areas of intensely inhabited regions; a fact which involves a major risk and significant potential material damage in the territory. The model was validated by directly comparing the results obtained with locations previously affected, where the flood effects have been identified, highlighting the fact that the model may be taken into account to be applied in practice, and also to be implemented in territories that share the same features.

Background and Aim: Acute gastrointestinal bleeding carries poor outcomes unless prompt endoscopic hemostasis is achieved. Mortality in these patients remains significant. Hemospray is a novel intervention that creates a mechanical barrier over bleeding sites. We report the largest dataset of patient outcomes after treatment with Hemospray from an international multicenter registry., Patients and Methods: Prospective data (Jan 2016-May 2018) from 12 centers across Europe were collected. Immediate hemostasis was defined as endoscopic cessation of bleeding within 5 min after application of Hemospray. Rebleeding was defined as subsequent drop in hemoglobin, hematemesis, persistent melena with hemodynamic compromise post-therapy., Results: Three hundred and fourteen cases were recruited worldwide (231 males, 83 females). Median pretreatment Blatchford score was 11 (IQR: 8-14) and median complete Rockall score (RS) was 7 (IQR: 6-8) for all patients. Peptic ulcer disease (PUD) was the most common pathology (167/314 = 53%) and Forrest Ib the most common bleed type in PUD (100/167 = 60%). 281 patients (89.5%) achieved immediate hemostasis after successful endoscopic therapy with Hemospray. Rebleeding occurred in 29 (10.3%) of the 281 patients who achieved immediate hemostasis. Seven-day and 30-day all-cause mortality were 11.5% (36/314) and 20.1% (63/314), respectively (lower than the predicted rates as per the RS). Similar hemostasis rates were noted in the Hemospray monotherapy (92.4%), combination therapy (88.7%) and rescue therapy (85.5%) groups., Conclusions: These data show high rates of immediate hemostasis overall and in all subgroups. Rebleeding and mortality rates were in keeping/lower than predicted rates., (© 2019 Japan Gastroenterological Endoscopy Society.)

Insulin resistance (IR) and cardiometabolic disorders are the main consequences of today's alimentary behavior. This study evaluates the effects of a chronic-discontinuous treatment with alpha-lipoic acid (AL), an antioxidant substance that improves glycemic control associated with diabetes mellitus, on metabolic disorders and plasma oxidative stress induced by fructose intake, in rats. Sprague-Dawley rats (48 animals) were randomized into two series ( n = 24): rats fed with standard chow or with standard chow supplemented with 60% fructose. In each of the two series, for 2 weeks/month over 12 weeks, a group of rats ( n = 12) was intraperitoneally injected with NaCl 0.9%, and a second group ( n = 12) received AL 50mg/kg/day. Body weight, glycemia, and systolic blood pressure were monitored throughout the study. After 12 weeks, IR, plasma lipoproteins, uric acid, transaminase activities, and oxidative stress markers were assessed. The high fructose-enriched diet induced cardiometabolic disorders (hypertension, hyperglycemia, IR and dyslipidemia), an increase in uric acid concentration, transaminase activities and C-reactive protein level. This diet also enhanced plasma products of lipid and protein oxidation, homocysteine level, and decreased GSH/GSSG ratio. In this field, there is evidence to indicate that oxidative stress plays an important role in the etiology of diabetic complications. AL discontinuous treatment prevents the metabolic disorders induced by fructose intake, reduced plasma lipid and protein oxidation-products, and restored the GHS/GSSG ratio. Our study proves a promising potential of the chronic-discontinuous treatment of AL and highlights the pleiotropic effects of this antioxidant substance in metabolic disorders such as diabetes., Competing Interests: The authors declare no conflict of interest.

The cervical inlet patch is an island of heterotopic gastric mucosa, most commonly found in the proximal oesophagus. Its importance as a cause of throat symptoms has been recognised, particularly chronic globus sensation. This has led to a change in the Rome IV criteria for globus management, with emphasis on ruling out the condition. Proton pump inhibitors are often ineffective in resolving symptoms. Endoscopic studies on the use of ablative techniques, most recently radiofrequency ablation (RFA), have shown promise in reversing the CIP to mormal squamous mucosa, with subsequent symtpomatic resolution. The aim of this review is to update on the investigation and management of the CIP., Competing Interests: Competing interests: None declared.

Objective: Retinal dehydrogenase 1 (RALDH1) is a cytosolic enzyme which acts both as a source of retinoic acid (RA) and as a detoxification enzyme. RALDH1 has key functions in the midbrain dopaminergic system, which influences motivation, cognition, and social behavior. Since dopamine has been increasingly linked to autism spectrum disorder (ASD), we asked whether RALDH1 could contribute to the autistic phenotype. Therefore, we investigated for the first time the levels of RALDH1 in autistic patients. To further assess the detoxification function of RALDH1, we also explored 4-hydroxynonenal protein adducts (4-HNE PAs) and reduced glutathione (GSH) levels. Moreover, considering the effect of testosterone on RALDH1 expression, we measured the second to fourth digit ratio (2D:4D ratio) for both hands, which reflects exposure to prenatal testosterone., Methods: Male patients with ASD (n=18; age, 62.9±4.3 months) and healthy controls (n=13; age, 78.1±4.9 months) were examined. Erythrocyte RALDH1, serum 4-HNE PAs and erythrocyte GSH levels were measured using colorimetric assays, and digit lengths were measured using digital calipers., Results: We found significantly lower (-42.9%) RALDH1 levels in autistic patients as compared to controls ( p =0.032). However, there was no difference in 4-HNE PAs levels ( p =0.368), GSH levels ( p =0.586), or 2D:4D ratios ( p =0.246 in the left hand, p =0.584 in the right hand) between healthy controls and autistic subjects., Conclusion: We concluded that a subset of autistic patients had a low RALDH1 level. These results suggest that low RALDH1 levels could contribute to the autistic phenotype by reflecting a dopaminergic dysfunction.

Unlabelled: Backround: Coupling nebulization with noninvasive ventilation (NIV) has been shown to be effective in patients with respiratory diseases. However, a breath-synchronized nebulization option that could potentially improve drug delivery by limiting drug loss during exhalation is currently not available on bilevel ventilators. The aim of this in vitro study was to compare aerosol delivery of amikacin with a vibrating mesh nebulizer coupled to a single-limb circuit bilevel ventilator, using conventional continuous (Conti-Neb) and experimental inspiratory synchronized (Inspi-Neb) nebulization modes., Methods: Using an adult lung bench model of NIV, we tested a vibrating mesh device coupled with a bilevel ventilator in both nebulization modes. Inspi-Neb delivered aerosol only during the whole inspiratory phase, whereas Conti-Neb delivered aerosol continuously. The nebulizer was charged with amikacin solution (250 mg/3 mL) and placed at two different positions: between the lung and exhalation port and between the ventilator and exhalation port. Inhaled, expiratory wasted and circuit lost doses were assessed by residual gravimetric method. Particle size distribution of aerosol delivered at the outlet of the ventilator circuit during both nebulization modes was measured by laser diffraction method., Results: Regardless of the nebulizer position, Inspi-Neb produced higher inhaled dose (p < 0.01; +6.3% to +16.8% of the nominal dose), lower expiratory wasted dose (p < 0.05; -2.7% to -42.6% of the nominal dose), and greater respirable dose (p < 0.01; +8.4% to +15.2% of the nominal dose) than Conti-Neb. The highest respirable dose was found with the nebulizer placed between the lung and exhalation port (48.7% ± 0.3% of the nominal dose)., Conclusions: During simulated NIV with a single-limb circuit bilevel ventilator, the use of inspiratory synchronized vibrating mesh nebulization improves respirable dose and reduces drug loss of amikacin compared with continuous vibrating mesh nebulization.

Introduction: Hyperhomocysteinemia is considered an independent risk factor for cardiovascular disease. Oxidative stress is one of the major pathogenic mechanisms in non-alcoholic fatty liver disease and atherosclerosis., Aim: Our study aimed to evaluate serum homocysteine levels and oxidative stress in patients with biopsy-proven non-alcoholic steatohepatitis and possible association with cardiovascular risk measured by carotid artery intima-media thickness (c-IMT)., Patients and Methods: 50 patients with non-alcoholic steatohepatitis and 30 healthy controls, age and gender matched, were recruited. Lipid profile, liver biochemical markers, serum homocysteine, vitamins B6 and B12, folic acid, glutathione (reduced and total), erythrocyte superoxide dismutase, whole blood glutathione peroxidase, malondialdehyde and carotid intima-media thickness were assayed., Results: Patients had an altered lipid profile and liver biochemical markers; carotid intima-media thickness and serum homocysteine levels were significantly higher compared to controls, but there were no differences in folate, B12 and B6 vitamins levels. Patients had significantly lower levels of glutathione peroxidase activity, total and reduced glutathione and higher levels of malondialdehyde, but unchanged superoxide dismutase activity compared to control group. Also, serum homocysteine level showed significant positive correlation with waist circumference, body mass index, free cholesterol, triglycerides, LDL-cholesterol, amino transferases and negative correlation with reduced and total glutathione, superoxide dismutase and γ-GT., Conclusion: Non-alcoholic steatohepatitis is an independent cardiovascular risk factor, associated with elevated homocysteine levels, oxidative stress and c-IMT. c-IMT could be used as an indicator of early atherosclerotic changes initiated by dyslipidemia and oxidative stress, while higher level of homocysteine might be an effect of liver damage., (Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Unlabelled: Hyperhomocysteinemia, an established cardiovascular risk factor, has been recently associated with deep venous thrombosis., Material and Method: A matched case-control study was designed to assess homocysteinemia as well as the acquired risk factors in deep venous thrombosis (DVT). We enrolled 227 subjects, 127 with DVT confirmed by Doppler ultrasonography and 100 controls. Homocysteinemia was measured using reverse-phase high pressure liquid chromatography., Results: We found a significant association between hyperhomocysteinemia and DVT; the associated risk was weak (p = 0.025, OR: 1.7). Other risk factors significantly associated with DVT were: obesity (p = 0.04, OR for DVT: 2.9), varicose veins (p = 0.023, OR: 3.13), prolonged immobility (p = 0.015, OR: 3.1), history of DVT (p = 0.01, OR: 5.59). All these factors were found to be independent risk factors using multivariate logistic regression., Conclusion: hyperhomocysteinemia is an independent risk factor for DVT; the risk is not associated with the severity of hyperhomocysteinemia.

Purpose of the Study: to compare the acute effect of ACEI and ARB's upon the plasmatic endothelin level in heart failure patients., Methods: There were studied 30 patients with congestive heart failure, III-IV functional NYHA class, that were not under ACEI or ARB's treatment. In all the patients the endothelinl-21 plasmatic level was determined. After this, 20 patients, representing group I, received a single dose of 1 mg trandolapril, and 10 patients, representing group II, received a single dose of 40 mg telmisartan. After 24 hours, the plasmatic endothelin 1-21 level was determined again., Results: The mean endothelial plasmatic level was similar in both groups (group I: 0.358+/-0.04 fmol/ml; group II: 0.345+/-0.038). After 24 hours, the endothelin level decreased to 0.295+/-0.03 fmol/ml for group I (p<0.05) and to 0.287+/-0.029 fmol/ml for group II (p<0.05), suggesting that both ACEI and ARB's are equally efficient in decreasing endothelin. The initial endothelinl-21 level was inversely correlated with LVEF (r = -0.989), and the degree of the decrease of endothelinl-21 after both ACEI and ARB's is directly correlated with the initial endothelinl-21 level (r =0.64)., Conclusion: The acute administration of ACEI and ARB's in heart failure patients decreases the endothelin level, both categories of drugs having the same effects.

In asymptomatic infertility patients, no significant relationship was found between the presence of antisperm antibodies (ASA) in serum and in semen samples (IgG and/or IgA ASA), differentiated with the mixed antiglobulin reaction (MAR), and the microbial colonization of ejaculates covering a broad spectrum of microorganisms. Likewise, there was no significant association of ASA with microbial findings in patients' female partners, who also presented without symptoms of genital tract infection and were screened at the same time. Furthermore, ASA in semen (IgG and IgA) were not significantly related to several potential markers of subclinical male sexual gland infection or inflammation (leukocytes, PMN elastase, albumin, C3c) evaluated in aliquots of the same ejaculates used for immunological testing.

The clinical significance of antichlamydial antibodies (Chlam Ab) was determined in a total of 1303 subfertile couples consulting for infertility investigation and treatment. Median age of the women was 30 (range 22-44) years and of the men 33 (range 21-53) years. The median duration of infertility was 4 (range 1-21) years. All patients were asymptomatic for genital tract infection. A comprehensive infertility investigation included examination of the endocrine, cervical, and tubal factor, and semen analysis, antisperm antibody (ASA) testing, sperm-mucus interaction testing in vitro using a standardized protocol, and post-coital testing (PCT). Screening for Chlam IgG Ab was performed in serum of both partners, obtained at the same time. Simultaneous microbial cultures in genital secretions of both partners included a broad spectrum of potentially pathogenic bacteria. Elevated titres of Chlam IgG Ab as seromarker for previous infection were found in 20.8% of all women, and in 12.6% of men. Chlam Ab were significantly more frequent in partners of seropositive patients (in 51.8% of women with a Chlam Ab positive partner, compared to 15.8% of the other women). Microbial screening outcome was not significantly related to results of chlamydial serology in both partners. In women, elevated titres of Chlam Ab were significantly associated with a tubal factor, but were not related to reduced quality of the endocervical mucus (CM), including the in-vitro penetrability of the CM (using partners' or donors' spermatozoa). In males, Chlam Ab were not significantly related to the outcome of semen analysis, including screening for ASA (IgG and/or IgA) in semen, and several parameters of sperm functional capacity. After exclusion of couples with tubal disease, subsequent male fertility did not significantly differ in males with or without Chlam Ab. The results suggest that during basic infertility investigation, positive chlamydial serology as an easy screening procedure indicates a higher risk for a tubal infertility factor. However, in asymptomatic patients, Chlam IgG Ab in serum are not associated with a cervical factor or with the male factor, using several determinants for evaluation of semen quality including subsequent fertilizing capacity.

During the summer of 1996 an unusual clustering of meningoencephalitis cases was recorded in the Capital City, Bucharest, and in some areas from South-East Romania. After an initial suspicion of an enteroviral etiology was discarded, the West Nile etiology was confirmed by specific antibodies demonstration through hemagglutination-inhibition and ELISA tests. This study included 251 patients with the diagnoses of West Nile acute encephalitis (166 cases), acute meningitis (57 cases) and acute febrile disease (33 cases). The patients' age ranged from 1 to 89 years (mean 51.1 years). The most frequent clinical manifestations were: fever (95.7% of cases), cephalalgia (92.6%), stiffness of the neck (89.1%), vomiting (62.5%), marked asthenia (46.5%), myalgia (28.9%). In addition, patients with encephalitis exhibited: alteration of consciousness (89.2% of cases), tremor of extremities (40.4%), ataxia (44%), paralysis (15.1%). The fatality rate was 15.1% in acute encephalitis, 1.8% in acute meningitis and 0% in the acute febrile disease.

Mycobacterium xenopi is infrequently recognized as a cause of pulmonary disease. During a 12-year survey (1978-89),. 108 strains of this Mycobacterium were isolated from 90 persons and 6 hot water samples. From 87 patients 89 occasional strains of M. xenopi were isolated, and 3 patients were diagnosed as having pulmonary mycobacteriosis caused by it. The treatment and the response in these three cases were variable, depending on clinical conditions and sensitivity to drugs. Most of the strains isolated came from patients hospitalized at the Barzilai Hospital, Ashkelon, therefore a local environmental contamination was suspected. The suspicion was confirmed by the isolation of this thermophile organism from the hot water samples of the above hospital.

The Mycobacterium avium-intracellulare (MAI) group comprised 10.5% of all nontuberculous mycobacteria isolated in the Mycobacterium Reference Laboratory, Tel Aviv, in an 11-year study period. From the Buirej Chest Hospital in Gaza, alone, 273 strains were isolated, representing 12.1% of the specimens from that hospital, while 149 strains (0.24% of all specimens) were isolated from all other institutions. Pulmonary disease was attributed to this organism in 22 patients, 17 of whom were hospitalized (initially for tuberculosis or another lung disease) in Buirej Hospital. The water was thought to be the source of contamination, since MAI strains, similar to those found in sputum, were isolated from it. In 1985, the water system was renovated and the MAI incidence in sputum from this hospital consequently declined.

The analysis of a group of 67 patients hospitalized for various bronchopneumopathies, in whom evidencing of the tuberculosis bacilli led to the diagnosis of pulmonary tuberculosis allows to emphasize the increased efficiency of bacteriological detection by repeated bacilloscopy and successive cultures. They also stress the necessity of increased attention for pneumopathies that develop over the age of 50 years. The frequency of errors, predominantly stemming from the base network (territorial polyclinics), most of the confusion being made with suppurative broncho-pneumopathies, makes necessary the dispensarization of this category of patients in antituberculous units. The 56 new cases and the 11 cases in whom re-positivation was detected illustrate the possibilities of the bacteriological diagnosis and the contribution of a section of pneumology in the detection of pulmonary tuberculosis.