Aim: To present the etiology of bacteremic syndromes and antibiotic susceptibility of blood culture isolates from a Romanian county hospital, as well as their distribution within different wards.
Methods: We retrospectively analyzed the blood culture data collected from patients hospitalized in the County Emergency Clinical Hospital of Tirgu Mures over a period of two years. We followed aspects regarding the identified bacterial species, their distribution by sex, age groups and wards, the spectrum of resistance to antibiotics and main resistance phenotypes.
Results: Most positive samples came from ICU, nephrology and urology. The most isolated bacteria were coagulase-negative staphylococci, Escherichia coli, and Staphylococcus aureus. All isolates showed a high resistance to most classes of antibiotics, staphylococci being susceptible to glycopeptides, oxazolidinones and glycylcyclines, and the enterobacteria to aminoglycosides and carbapenems. The resistance in non-fermentative bacilli exceeded 80% to most classes of antibiotics. The methicillin-resistance was 36% for coagulase-negative staphylococci and 82% for Staphylococcus aureus; the percentage of extended-spectrum beta-lactamase producing strains was 30%.
Conclusions: The etiology of bacteremic syndromes is specific to the ward profile, the Staphylococcus spp. being primarily isolated from wards where invasive procedures are frequently performed, while the enterobacteria from urology and nephrology wards. The level of antibiotic resistance is higher in surgery and ICU wards, with also higher percentage of resistance phenotypes than in medical wards.
To produce realistic test specimens with realistic flaws, it is necessary to develop appropriate procedure for corrosion flaw production. Tested specimens are made from steels commonly used in power plants, such as carbon steels, stainless steels and their dissimilar weldments. In this study, corrosion damage from NaCl water solution and NaCl water mist are compared. Specimens were tested with and without mechanical bending stress. The corrosion processes produced plane, pitting and galvanic corrosion. On dissimilar weldments galvanic corrosion was observed and resulted to the deepest corrosion damage. Deepest corrosion flaws were formed on welded samples. The corrosion rate was also affected by the solution flow in a contact with the specimens, which results in a corrosion-erosive wear. Produced flaws are suitable as natural crack initiators or as realistic corrosion flaws in test specimens.
The introduction of antipsychotic medication in the 1950s forever changed the outlook on the treatment of schizophrenia, although there is still a large proportion of patients who do not reach functional recovery. At least 30% of patients do not respond to clozapine, the tricyclic dibenzodiazepine with complex pharmacological actions, which was proven to be more effective than any other antipsychotic in the treatment of schizophrenia. According to most of the therapeutic guidelines for schizophrenia, clozapine is the third line therapy for patients who did not respond to other antipsychotics. Large inter-individual variability exists for clozapine bioavailability and plasma steadystate concentrations and clearance. Clozapine is metabolized by the cytochrome P450 oxidase enzyme family (CYP450). Cytochrome P450 1A2 (CYP1A2), which is polymorphically expressed in humans, is the main enzyme of clozapine metabolism. This case report addresses the influence of CYP1A2*1F genetic polymorphism on cloza - pine metabolism, explains the primary non-response of a young patient with schizophrenia due to increased gene expression in homozygous genotype *1F/*1F (increased metabolism of clozapine) and underlies the importance of personalizing schizophrenia treatment by means of genetic and other molecular tools, at least in the cases of »treatment resistance«.
Background. Tumor tissue-associated KLKs (kallikrein-related peptidases) are clinically important biomarkers that may allow prognosis of the cancer disease and/or prediction of response/failure of cancer patients to cancerdirected drugs. Regarding the female/male reproductive tract, remarkably, all of the fifteen KLKs are expressed in the normal prostate, breast, cervix uteri, and the testis, whereas the uterus/endometrium and the ovary are expressing a limited number of KLKs only.
Conclusions. Most of the information regarding elevated expression of KLKs in tumor-affected organs is available for ovarian cancer; depicting them as valuable biomarkers in the cancerous phenotype. In contrast, for breast cancer, a series of KLKs was found to be downregulated. However, in breast cancer, KLK4 is elevated which is also true for ovarian and prostate cancer. In such cases, selective synthetic KLK inhibitors that aim at blocking the proteolytic activities of certain KLKs may serve as future candidate therapeutic drugs to interfere with tumor progression and metastasis.
Psychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes.
This is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families.