The major practical advantage of the direct oral anticoagulants (DOACs), comprising the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban, edoxaban, and rivaroxaban, over vitamin K antagonists is their fixed dosing without the need for laboratory monitoring. With the recent, rapid introduction of the DOACs for the treatment of acute venous thromboembolism (VTE), clinicians are now faced with various questions regarding the efficacy and safety of these compounds overall and in specific high-risk populations. The collective evidence from 6 large clinical trials involving 27,000 patients has demonstrated that DOACs are as effective as vitamin K antagonists (VKA) in preventing recurrent VTE while being associated with a significantly lower risk of major bleeding. These findings are consistent in subgroups of patients with pulmonary embolism, the elderly, and those patients with a high body weight or moderate renal insufficiency, making these agents suitable for a broad spectrum of patients with VTE. DOACs are also an attractive treatment option in patients with VTE and concomitant cancer, thrombotic antiphospholipid syndrome, or heparin-induced thrombocytopenia, but the currently available clinical data is insufficient to make evidence-based recommendations on the use of DOACs in these settings. Several studies evaluating the efficacy and the safety of DOACs in these high-risk populations are underway.
Behcet's disease is a rare and poorly understood condition with multiple systemic manifestations. The disease causes inflammation in blood vessels throughout the body which leads to numerous symptoms that may appear and disappear unpredictable. Case presentation A 33 year old woman was admitted (interned) to our clinic. Her family medical history reveals – multiple strokes (father) and autoimmune thyroiditis (sister). The onset of her symptomatology was in 2013 and it consisted of fever (39-40 Celsius degrees) sicca syndrome and persistent headaches, recurrent oral and genital ulcerations. An important event is essential to be mentioned -the patients has suffered an episode of upper gastrointestinal bleeding (hemoglobin has dropped to 2.5g/dl which has led to cardiac arrestresuscitated). The lab tests showed: C3 hypocomplementemia, Anti-centromere antibodies (-), anti-b2gp1 antibody (+), lupus anticoagulant (+), U1RNP(-). We started to administrate cyclophosphamide to the patient, thus his condition has improved after the 2nd dose. At the 12-month evaluation we were able to see a significant clinical and biological improvement. Conclusions In order to be able to talk about “evidence based medicine” for the management of Bechet’s disease, a large number of clinical trials is required to provide to the attending physicians the necessary data for diagnosis and treatment.
Introduction: Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the axial skeleton and peripheral joints associated with HLA B27 antigen and with the predominance of the male gender (with an average between 20 and 30 years old). Case presentation A 48 years old male patient was admitted to our clinic, having a long history regarding this disease since he was 16. This patient has switched 3 therapies with anti TNF alpha agents until now, and we hope to obtain a good response for a long time. During the treatment with Etanercept he presented an acute anterior uveitis which had a good response to therapy. Conclusion: The ankylosing spondylitis management is complicated when we have the possibility to choose only three anti TNF alpha agents. If a patient does not respond to the first or second agent we are constrained to follow the last one. Therefore the principal problem regarding this special case is that the patient is non responder at the last agent. So the question that arises is witch will be the next therapy for this patient? INTRODUCTION Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the axial skeleton and peripheral joints – asymmetric. Its major characteristic is the early damage of the sacroiliac joint, ascending to ankylosis. The incidence is increased for males between 20 and 30 years old, thus most of the patients are associating a HLA B27 antigen. The existence of cardiovascular risk due to inflammatory rheumatic diseases for decades but the real significance and therapy designed to control this risk has been recently evaluated. is known Systemic inflammatory rheumatic diseases accelerates atherosclerosis and inflammation because of destabilizes plaque of atheroma, contributing to an increased frequency of fatal cardiovascular events such as myocardial heart attacks and strokes. The ankylosing spondylitis cardiovascular events include: aortic damage (dilatation/hypertrophy), nerve impulse conduction disorders, accelerated atherosclerosis. heart muscle insufficiency, pericarditis, and Anti TNF-alpha therapy leads to a decrease of the disease activity score the nonspecific inflammatory syndrome. (BASDAI) and also The anti TNF approved drugs which are currently in clinical practice are: 1 Carol Davila Central University Emergency Military Hospital, Bucharest 39
The tracheoesophageal fistula which occurred during oro-tracheal intubation of a patient in intensive care unit is a true challenge both in diagnostic and in therapeutic approach. The best treatment is prevention, by identifying risk factors but especially is important which the mechanism in the occurrence of tracheoesophageal fistula was. The occurrence of this complication in the evolution of hospitalized patients in ICU is accompanied by significant increase in mortality, contributing to negative prognostic. We have started a large multicentric study in April 2016 regarding all patients who required intubation longer than 7 days. The study will finish at the end of 2020. We are looking for a definite conclusion, in this moment we do not have enough data for a conclusion.[1, 2] INTRODUCTION fistula tracheoesophageal The is an abnormal communication between the esophagus and trachea. It can be congenital or acquired. Most of them are congenital with a frequency of 1 to 3500/ 6000 births. In this case usually are associated, or appear within, with other birth defects (trisomy 13, 18 or 21, tetralogy of Fallot, other digestive problems or muscle skeletal VACTERL Syndrome (Vertebral anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula and/or Esophageal atresia, Renal & Radial anomalies and Limb defects.). Then, there are the malignant ones which appear in the posterior infiltrating tracheal wall or the anterior wall of the esophagus. The last ones are those acquired, non- malignant [1, 3, 4]. maneuver, in the operating room but especially in ICU. The first fistula appeared after a prolonged period of intubation and was initially described in 1956 by d’Avignon [2, 4]. in involved factors are Several these serious complications during a prolonged period of intubation. The most important and most discussed about in recent years is represented by the cuff pressure of orotracheal tube. If the cuff is overinflated, it leads to compression on the rear wall membranous trachea, which in time leads to ischemia and necrosis, basically forming an abnormal communication between the trachea and esophagus. Other possible complication of a hyper-inflated cuff is tracheal stenosis or bleeding erosion of a significant blood vessel. Often, both The situations simultaneously. occur can They occur particularly after a prolonged period of intubation with or without mechanical ventilation. intubation Fistula can result from incidents of 1 Carol Davila Central University Emergency Military Hospital, Bucharest 2 Carol Davila University of Medicine and Pharmacy, Bucharest 3 University Emergency Hospital, Bucharest 35
Electroporation is considered a new start-up in the treatment of various tumors; currently, researches are being conducted in order to develop this technology with medical applications. The technique consists in the significant increase in the electrical conductivity and permeability of the plasma membrane of cells resulting from the application of an external electric field. It is routinely used in molecular biology to transform bacteria, yeast, protoplasts and is performed using the electroporators. Currently, the process seems to be a real solution that enables a targeted drug to act with maximum efficiency on cells and tissues requiring treatment, resulting in obtaining a good therapeutic effect without major side effects. Therefore, pharmaceutical companies are trying to demonstrate through preclinical studies the potential efficacy of this technology, succeeding in recent years to achieve important steps in this direction.
Late-life major depression is a high-incidence and difficult-to-treat affective disorder. Diagnosis of major depression in old age could also could be a challenge, due to aspects like (1) there is a higher vulnerability to the stigma of depression in this population, (2) hypochondriac ideation and somatic symptoms are the main symptoms, while depressive disposition or anhedonia are under-reported by such patients, (3) differential diagnosis includes various organic diseases, but also several psychiatric disorders, like neurocognitive disorders, organic affective disorders, drug induced affective disorders etc. Reduction of social relationships caused by retirement and loss of spouse and friends, as well as a decrease of personal income could precipitate or maintain depressive disorders during late-life. Quality of life in patients diagnosed with depressive major disorders is a rarely monitored parameter, although its importance for case management could not be overemphasized. A reduction of life quality correlates with a poorer functional prognosis, persistence of neglected residual symptoms, low adherence to treatment plan etc.
These days marks 30 years since the Chernobyl nuclear accident, followed by massive radioactive contamination of the environment and human in Belarus, Ukraine and Russia, and resulted in many deaths among people who intervened to decrease the effects of the nuclear disaster. The 26 April 1986 nuclear accident contaminated all European countries, but at a much lower level, without highlighted consequences on human health. In special laboratories, the main radionuclides (I-131, Cs-137, Cs-134 and Sr-90) were also analyzed in Romania from environmental samples, food, even human subjects. These radionuclides caused the population to receive a low dose of about 1 mSv in 1986 that is half of the dose of the natural background radiation (2.4 mSv per year). As in all European countries (excluding Ukraine, Belarus and Russia) this dose of about 1 mSv fell rapidly by 1990, reaching levels close to ones before the accident at the nuclear tests.
Military Medical Service is able for detection, identification and confirmation of biological agents; it is part of medical protection against CBRN weapons. We are specialized capabilities for in vitro tests, under construction, the maximum containment laboratory designed for work with Risk Group Microorganisms. An efficient primary containment system must be in place, consisting of one or a combination of the following: Class III safety cabinet laboratory, passage of two doors, suit laboratory, controlled access, controlled air system. Negative pressure in the facility, supply and exhaust air must be HEPA-filtered, decontamination of effluents, sterilization of waste and materials, airlock entry ports for specimens, materials and animals must be provided etc. Complementary is an Animal facility for in vivo tests. This is suitable for work with animals that are deliberately inoculated with microorganisms in Risk Group.
