People living with human immunodeficiency virus have increased cardiovascular risk due to a highe... more People living with human immunodeficiency virus have increased cardiovascular risk due to a higher prevalence of traditional and particular risk factors such as chronic inflammation, immune dysregulation, endothelial dysfunction, coagulation abnormalities and antiretroviral therapy. In developed countries, coronary artery disease has become the most frequent cardiovascular disease and an important cause of mortality in these patients. The symptomatology of an acute coronary syndrome can be atypical, and the prevalence of each type of acute coronary syndrome is reported differently. Regarding coronary artery disease severity in people living with HIV, the literature data indicates that the presence of single-vessel disease is akin to that of HIV-negative patients, and their short-term prognosis is unclear. This study aims to assess the clinical characteristics, biological parameters, angiographical features and short-term prognosis of acute coronary syndrome in a cohort of Romanian p...
Quantum information studies quantum systems from the perspective of information theory: how much ... more Quantum information studies quantum systems from the perspective of information theory: how much information can be stored in them, how much the information can be compressed, how it can be transmitted. Symmetric informationally-Complete POVMs are measurements that are well-suited for reading out the information in a system; they can be used to reconstruct the state of a quantum system without ambiguity and with minimum redundancy. It is not known whether such measurements can be constructed for systems of any finite dimension. Here, dimension refers to the dimension of the Hilbert space where the state of the system belongs. This thesis introduces the notion of alignment, a relation between a symmetric informationally-complete POVM in dimension d and one in dimension d(d-2), thus contributing towards the search for these measurements. Chapter 2 and the attached papers I and II also explore the geometric properties and symmetries of aligned symmetric informationally-complete POVMs. ...
Lesions commonly associated with HIV infection include oral candidiasis, herpes simplex infection... more Lesions commonly associated with HIV infection include oral candidiasis, herpes simplex infection, oral Kaposi’s sarcoma, hairy leukoplakia, periodontal diseases (linear gingival erythema and necrotizing ulcerative periodontitis), xerostomia, human papillomavirus-associated warts, aphthous ulcers, non-Hodgkin’s lymphoma, histoplasmosis, carcinoma, exfoliative cheilitis, and HIV salivary gland disease. Non-Hodgkin’s lymphoma (NHL) is the most common cancer in people living with HIV (PLWH), and the incidence is increased for aggressive B-cell NHL. Plasmablastic lymphoma (PbL) is a rare and aggressive B-cell malignancy that is often unresponsive to chemotherapy and usually has a poor prognosis. We hereby present the case of a patient with a recent history of COVID-19 infection who was diagnosed with HIV and NHL, with manifestations in the oral cavity and a favorable evolution after the introduction of antiviral therapy, specific chemotherapy, and radiotherapy. Dental expertise is neces...
Infective endocarditis represents a rare complication among patients infected with severe acute r... more Infective endocarditis represents a rare complication among patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2); it is often a nosocomial infection and the symptomatology can be masked by respiratory failure symptoms from SARS-CoV-2 bronchopneumonia. Management of patients with severe forms of SARS-COV-2 infection who also have associated infective endocarditis is very difficult, especially in mono-specialty hospitals (such as infectious diseases hospitals) where access to cardiological investigations is limited. The current study presents the case of a 73-year-old woman with increased cardiovascular risk (high blood pressure, diabetes mellitus and obesity), with uninvestigated ischaemic heart disease, who was admitted to the Department of Infectious Diseases in the Clinical Infectious Diseases Hospital (Constanta, Romania) due to SARS-CoV-2. Although the evolution was initially favorable, the condition of the patient significantly deteriorated on the 14th day of hospitalization due to the development of Enterococcus faecium infective endocarditis. Despite the therapy, the evolution was fulminant. Infection with coronavirus disease 2019 can result in numerous comorbidities, which cause higher mortality rates than in the general population.
Emery–Dreifuss muscular dystrophy (EDMD) is a rare genetic disease that affects the musculoskelet... more Emery–Dreifuss muscular dystrophy (EDMD) is a rare genetic disease that affects the musculoskeletal system, including the heart, causing rhythm disorders and cardiomyopathy, sometimes requiring an implantable cardioverter-defibrillator (ICD) or heart transplantation due to severe heart damage. The case described herein concerns a 16-year-old girl, with grade II obesity, without other known pathological antecedents or cardiac pathology diagnosis given an annual history of cardiological investigations. She was admitted to the Infectious Diseases Department with SARS-CoV-2 virus infection. The anamnesis showed that the cardiological investigations performed in the past were completed due to the medical history antecedents of her sister, who had been diagnosed with dilated cardiomyopathy, having undergone the placement of an ICD and a heart transplant. Numerous investigations were performed during hospitalization, which revealed high levels of high-sensitive cardiac troponin I (hs-cTnI)...
The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency v... more The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency virus (HIV) is complex. Coronary artery disease (CAD) has become an important cause of mortality in these patients. They often have atypical symptoms, leading to frequently missed diagnoses. We report a case of a 51-year-old male undergoing antiretroviral therapy who was admitted for acute coronary syndrome. He had severe coronary artery disease that involved difficult management.
Romanian Archives of Microbiology and Immunology, 2021
The incidence of Mycobacterium avium Complex (MAC) Disease in HIV-infected individuals has signif... more The incidence of Mycobacterium avium Complex (MAC) Disease in HIV-infected individuals has significantly decreased in recent years due to the introduction of Highly Active Antiretroviral Therapy (HAART) and the initiation of Clarithromycin prophylaxis. We present the case of a patient with advanced AIDS, with generalized lymphadenopathy and digestive symptoms, diagnosed with disseminated MAC, a diagnosis which was based on the results obtained from axillary lymph node and intestinal biopsies. Considering the time of the MAC diagnosis in relation to the recent introduction of antiretroviral (ARV) therapy, we considered immune reconstitution inflammatory syndrome (IRIS) with good evolution under azithromycin, ethambutol and moxifloxacin treatment.
Algebraic number theory relates SIC-POVMs in dimension d > 3 to those in dimension d(d − 2). W... more Algebraic number theory relates SIC-POVMs in dimension d > 3 to those in dimension d(d − 2). We define a SIC in dimension d(d − 2) to be aligned to a SIC in dimension d if and only if the squares of the overlap phases in dimension d appear as a subset of the overlap phases in dimension d(d − 2) in a specified way. We give 19 (mostly numerical) examples of aligned SICs. We conjecture that given any SIC in dimension d there exists an aligned SIC in dimension d(d − 2). In all our examples the aligned SIC has lower dimensional equiangular tight frames embedded in it. If d is odd so that a natural tensor product structure exists, we prove that the individual vectors in the aligned SIC have a very special entanglement structure, and the existence of the embedded tight frames follows as a theorem. If d − 2 is an odd prime number we prove that a complete set of mutually unbiased bases can be obtained by reducing an aligned SIC to this dimension.
Climate change creates new challenges for preventing and protecting human health against differen... more Climate change creates new challenges for preventing and protecting human health against different diseases that could appear and propagate. The Aedes albopictus mosquito species is an important vector for different diseases like dengue fever or zika. Although this species is not “indigenous” in Europe, its presence is noticed in many countries on the continent. The Ae. albopictus establishment is conditioned by the species’ characteristics and environmental factors. To assess the possible spread of Ae. albopictus in the Dobrogea region (situated in the Southeast of Romania), we conducted the following analysis: (1) Investigation of the current distribution and climatic factors favoring Ae. albopictus’ establishment in Europe; (2) Analysis of climate dynamics in Dobrogea in terms of the parameters identified at stage (1); (3) Testing the hypothesis that the climate from Dobrogea favors Ae. albopictus’ establishment in the region; (4) Building a Geographic Information System (GIS)-ba...
Pulmonary arterial hypertension associated with HIV infection is a separate entity. The prevalenc... more Pulmonary arterial hypertension associated with HIV infection is a separate entity. The prevalence is up to one thousand times higher than in general population. The mechanisms are multifactorial and incompletely elucidated. Echocardiography can suggest the diagnosis, but the gold standard method of diagnosing pulmonary arterial hypertension is right heart catheterization. We present clinical and paraclinical findings (NYHA, 6MWD, sPAP, RVGLS) and follow-up in two patients living with HIV, who are included in the Romanian National Program of Pulmonary Arterial Hypertension. In patients, the possible thromboembolism or left heart dysfunction were excluded. Each case has its own particularities, but both of them responded to treatment with sildenafil and improved clinical and paraclinical parameters. Mortality is high, usually due to right heart failure and pulmonary arterial hypertension is considered an independent predictor of death in HIV-infected patients. Co-management with both...
Supplemental Digital Content is available in the text Abstract Microbiota plays an important role... more Supplemental Digital Content is available in the text Abstract Microbiota plays an important role in many diseases including inflammatory bowel diseases. Inflammatory bowel disease patients can have concurrent irritable bowel syndrome symptoms similar to those associated with a flare. The potential role of gut dysbiosis in the pathogenesis of inflammatory bowel disease provides a rationale for treating such patients with rifaximin. This study aimed to assess the efficacy of rifaximin in the management of irritable bowel syndrome-like symptoms (bloating, abdominal pain, stool consistency) and quality of life in patients with Crohn's disease in remission. The present study included 86 patients with Crohn's disease in remission (fecal calprotectin <50 μg/g, C-reactive protein <0.5 mg/dL, simple endoscopic score for Crohn's disease <2) and associated irritable bowel syndrome-like symptoms (bloating, abdominal pain, diarrhea). These patients were randomly assigned to rifaximin treatment group (44 patients) and the control group (42 patients). Besides the baseline inflammatory bowel disease treatment and antispasmodics (as needed), patients in the rifaximin treatment group received 3 repeated courses of treatment, each course being represented by 1200 mg/d of rifaximin for 10 days and 20 days free of treatment (3 months consecutively); patients in the control group also received antispamodics as needed and were observed for 3 months. Monthly analyses of bloating score, abdominal pain score, stool consistency score, and quality of life score showed significant improvement after treatment in the rifaximin group in contrast with control group. Significantly more patients in the rifaximin group than in the control group met the criteria for adequate improvement of bloating score after 3 months of treatment (59.09% vs 19.04%, P = .01), adequate improvement of abdominal pain score (54.5% vs 21.4%, P = .04), stool consistency score (34.09% vs 14.2%, P = .03), and quality of life score (70.4% vs 21.4%, P < .001). Rifaximin in a dose of 1200 mg/d, 10 d/mo, 3 months consecutively is an effective medication for concurrent irritable bowel syndrome-like symptoms in patients with Crohn's disease in remission.
&amp;amp;quot;The study aims to compare different screening methods that are currently being ... more &amp;amp;quot;The study aims to compare different screening methods that are currently being used to confirm a cervical intraepithelial lesion (CIN) underlying the inherent advantages of the varied examination procedures. In this study we are looking at the quality contrast of the different paraclinical examinations relative to the cost, invasiveness and cultural acceptance of such procedures. Every year, more than 100,000 women in EU countries are diagnosed with cervix uteri cancers (CCU). This type of cancer can be prevented if precancerous cells are detected and treated. HPV is found in over 90% of cervix uteri cancers. In Europe, more than half of the countries have implemented screening programs for cervical cancer, and most European countries now have national HPV vaccination programs, however target populations vary depending on the epidemiological evidence and the budgetary level of each countries health system. In this study we evaluated and compared the current and modern techniques used for cervix cellular diagnostics. Also, this study helps improve the understanding on the economic and social implications of screening among female population and the impact it has on healthcare system relieving. Romania recorded an incidence of 22.6 cases of cervix uteri cancers / 100.000 women (age standardized rate), and a mortality of 9.6 / 100.000, ranking second highest in the EU zone.&amp;amp;quot;
Journal of Gastrointestinal and Liver Diseases, 2014
The simultaneous occurrence of two rare conditions in a single patient is uncommon. We report the... more The simultaneous occurrence of two rare conditions in a single patient is uncommon. We report the case of a patient with rectal actinomycosis covering an anorectal melanoma (both infrequent conditions), the last one being later recognized, only after surgical excision. We underline here the role of thinking "outside the box" when an unusual situation is experienced.
Introduction The life expectancy of HIV-infected patients has been increased by highly effective ... more Introduction The life expectancy of HIV-infected patients has been increased by highly effective therapies. People living with HIV (PLWH) in Romania are exposed to age-related comorbidities occurring earlier than in uninfected individuals. Multidisciplinary care is required to maintain the general health and quality of life in these patients. Currently, the communication among different specialties needs to be enhanced and formalized. Methods A panel consisting of 8 Romanian experts in infectious diseases, cardio-metabolic, bone, and kidney diseases and psychology met in May 2019 in Bucharest Romania to discuss the need to evaluate and monitor the most prevalent comorbidities in PLWH. The meeting resulted in practical guidance on the management of several non-infectious associated diseases. The algorithms were endorsed by the Society for Infectious Diseases and HIV/AIDS, Romania. Results The consensus statement offers practical guidance on how to assess and monitor associated diseases in adult PLWH. The recommendations are grouped for each cluster of comorbidities and are based on international guidelines and clinical experience, including landmarks for referral of PLWH to cardiology, endocrinology, nephrology specialist or clinical psychologist for additional investigations and adequate treatment. Specific indications for diagnosis or treatment were beyond the scope of this consensus. Conclusions Screening for associated diseases and adequate management are required to maintain the overall health status of PLWH. When implemented in clinical practice, the recommended algorithms should be used in addition to diagnosis and treatment guidelines and protocols. The infectious diseases specialist plays a key role in coordinating the overall treatment strategy and working within the multidisciplinary team.
We prove that as conjectured by Acín et al. [Phys. Rev. A 93, 040102(R) (2016)], two bits of rand... more We prove that as conjectured by Acín et al. [Phys. Rev. A 93, 040102(R) (2016)], two bits of randomness can be certified in a device-independent way from one bit of entanglement using the maximal quantum violation of Gisin's elegant Bell inequality. This suggests a surprising connection between maximal entanglement, complete sets of mutually unbiased bases, and elements of symmetric informationally complete positive operator-valued measures, on one side, and the optimal way of certifying maximal randomness, on the other.
Journal of Physics A: Mathematical and Theoretical, 2019
Alignment is a geometric relation between pairs of Weyl–Heisenberg SICs, one in dimension d and a... more Alignment is a geometric relation between pairs of Weyl–Heisenberg SICs, one in dimension d and another in dimension , manifesting a well-founded conjecture about a number-theoretical connection between the SICs. In this paper, we prove that if d is even, the SIC in dimension of an aligned pair can be partitioned into (d − 2)2 tight d 2-frames of rank and, alternatively, into d 2 tight (d − 2)2-frames of rank . The corresponding result for odd d is already known, but the proof for odd d relies on results which are not available for even d. We develop methods that allow us to overcome this issue. In addition, we provide a relatively detailed study of parity operators in the Clifford group, emphasizing differences in the theory of parity operators in even and odd dimensions and discussing consequences due to such differences. In a final section, we study implications of alignment for the symmetry of the SIC.
Medical treatment in cystic echinococcosis is limited; albendazole remains the gold treatment for... more Medical treatment in cystic echinococcosis is limited; albendazole remains the gold treatment for patients with low hydatid cysts or those with inoperable echinococcosis. Due to uncommon side effects, administration may be continuous (cycles of 28 days with a break of 14 days between courses) as well as discontinuous over long periods of time. In recent years, there have been many concerns for the testing of various substances and drugs against Echinococcus granulosus, both in vitro and in vivo, on the animal model, but the results have not been satisfactory. New clinical trials are required, as well as the development of an effective vaccine to limit the spread of echinococcosis in endemic areas.
European Journal of Clinical Microbiology & Infectious Diseases, 2019
Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illn... more Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulasenegative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042).
Background: Accurate assessment of esophageal diameter is necessary for effective esophageal stri... more Background: Accurate assessment of esophageal diameter is necessary for effective esophageal stricture dilation, a common therapy for eosinophilic esophagitis (EoE). Endoscopic assessment frequently underestimates the presence of strictures. The Functional Luminal Imaging Probe (FLIP) utilizes impedance planimetry to determine cross-sectional areas and can assist in diameter assessment. We compared the measurement of esophageal luminal diameter by FLIP to the presence of mucosal disruption following therapeutic dilation among a cohort of patients with EoE. Methods: We prospectively enrolled adults with EoE undergoing endoscopic evaluation by EGD and FLIP with anticipated dilation. Demographics, disease history, and symptoms were collected. Real-time assessment of esophageal endoscopic characteristics was recorded prior to performance of FLIP. FLIP was performed according to standardized protocol in both the proximal and distal esophagus. Incremental esophageal dilation was performed with identification of the diameter at which mucosal disruption occurred. If no disruption occurred, the maximum dilator size was recorded as the esophageal diameter. T-test analysis and Pearson correlation coefficients were used to compare the narrowest diameter as determined by FLIP compared to the diameter at which mucosal disruption occurred. Results: 45 patients were consented and enrolled in the study. 9 patients were excluded as they did not undergo FLIP and/or dilation according to protocol and 6 patients were excluded due to inadequate FLIP catheter positioning during EGD. A total of 30 patients were used for analysis. The average age of patients was 40 and 70% (n= 21) were male. History of stricture was present in 80% (n=24) of patients and 57% (n=17) had previously undergone dilation. Endoscopic visual assessment was notable for: edema (60%), rings (97%), exudates (33%), furrows (63%), and strictures (87%). The mean difference between esophageal diameter measurement by FLIP and mucosal disruption was 1.8 mm. There was no difference in mean esophageal luminal diameter by FLIP as compared to mucosal disruption (14.6 ± 3.1 mm vs. 15.3 ± 2.1 mm, P=0.12). There was a strong and significant correlation between esophageal diameter measurements by FLIP and mucosal disruption (r=0.67, P<0.001). Conclusion: In a cohort of EoE adults, FLIP provides an accurate assessment of esophageal diameter when compared to mucosal disruption during esophageal dilation. FLIP testing during endoscopy may improve the accuracy of stricture identification and severity assessment and thereby improve therapeutic dilation decision making.
People living with human immunodeficiency virus have increased cardiovascular risk due to a highe... more People living with human immunodeficiency virus have increased cardiovascular risk due to a higher prevalence of traditional and particular risk factors such as chronic inflammation, immune dysregulation, endothelial dysfunction, coagulation abnormalities and antiretroviral therapy. In developed countries, coronary artery disease has become the most frequent cardiovascular disease and an important cause of mortality in these patients. The symptomatology of an acute coronary syndrome can be atypical, and the prevalence of each type of acute coronary syndrome is reported differently. Regarding coronary artery disease severity in people living with HIV, the literature data indicates that the presence of single-vessel disease is akin to that of HIV-negative patients, and their short-term prognosis is unclear. This study aims to assess the clinical characteristics, biological parameters, angiographical features and short-term prognosis of acute coronary syndrome in a cohort of Romanian p...
Quantum information studies quantum systems from the perspective of information theory: how much ... more Quantum information studies quantum systems from the perspective of information theory: how much information can be stored in them, how much the information can be compressed, how it can be transmitted. Symmetric informationally-Complete POVMs are measurements that are well-suited for reading out the information in a system; they can be used to reconstruct the state of a quantum system without ambiguity and with minimum redundancy. It is not known whether such measurements can be constructed for systems of any finite dimension. Here, dimension refers to the dimension of the Hilbert space where the state of the system belongs. This thesis introduces the notion of alignment, a relation between a symmetric informationally-complete POVM in dimension d and one in dimension d(d-2), thus contributing towards the search for these measurements. Chapter 2 and the attached papers I and II also explore the geometric properties and symmetries of aligned symmetric informationally-complete POVMs. ...
Lesions commonly associated with HIV infection include oral candidiasis, herpes simplex infection... more Lesions commonly associated with HIV infection include oral candidiasis, herpes simplex infection, oral Kaposi’s sarcoma, hairy leukoplakia, periodontal diseases (linear gingival erythema and necrotizing ulcerative periodontitis), xerostomia, human papillomavirus-associated warts, aphthous ulcers, non-Hodgkin’s lymphoma, histoplasmosis, carcinoma, exfoliative cheilitis, and HIV salivary gland disease. Non-Hodgkin’s lymphoma (NHL) is the most common cancer in people living with HIV (PLWH), and the incidence is increased for aggressive B-cell NHL. Plasmablastic lymphoma (PbL) is a rare and aggressive B-cell malignancy that is often unresponsive to chemotherapy and usually has a poor prognosis. We hereby present the case of a patient with a recent history of COVID-19 infection who was diagnosed with HIV and NHL, with manifestations in the oral cavity and a favorable evolution after the introduction of antiviral therapy, specific chemotherapy, and radiotherapy. Dental expertise is neces...
Infective endocarditis represents a rare complication among patients infected with severe acute r... more Infective endocarditis represents a rare complication among patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2); it is often a nosocomial infection and the symptomatology can be masked by respiratory failure symptoms from SARS-CoV-2 bronchopneumonia. Management of patients with severe forms of SARS-COV-2 infection who also have associated infective endocarditis is very difficult, especially in mono-specialty hospitals (such as infectious diseases hospitals) where access to cardiological investigations is limited. The current study presents the case of a 73-year-old woman with increased cardiovascular risk (high blood pressure, diabetes mellitus and obesity), with uninvestigated ischaemic heart disease, who was admitted to the Department of Infectious Diseases in the Clinical Infectious Diseases Hospital (Constanta, Romania) due to SARS-CoV-2. Although the evolution was initially favorable, the condition of the patient significantly deteriorated on the 14th day of hospitalization due to the development of Enterococcus faecium infective endocarditis. Despite the therapy, the evolution was fulminant. Infection with coronavirus disease 2019 can result in numerous comorbidities, which cause higher mortality rates than in the general population.
Emery–Dreifuss muscular dystrophy (EDMD) is a rare genetic disease that affects the musculoskelet... more Emery–Dreifuss muscular dystrophy (EDMD) is a rare genetic disease that affects the musculoskeletal system, including the heart, causing rhythm disorders and cardiomyopathy, sometimes requiring an implantable cardioverter-defibrillator (ICD) or heart transplantation due to severe heart damage. The case described herein concerns a 16-year-old girl, with grade II obesity, without other known pathological antecedents or cardiac pathology diagnosis given an annual history of cardiological investigations. She was admitted to the Infectious Diseases Department with SARS-CoV-2 virus infection. The anamnesis showed that the cardiological investigations performed in the past were completed due to the medical history antecedents of her sister, who had been diagnosed with dilated cardiomyopathy, having undergone the placement of an ICD and a heart transplant. Numerous investigations were performed during hospitalization, which revealed high levels of high-sensitive cardiac troponin I (hs-cTnI)...
The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency v... more The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency virus (HIV) is complex. Coronary artery disease (CAD) has become an important cause of mortality in these patients. They often have atypical symptoms, leading to frequently missed diagnoses. We report a case of a 51-year-old male undergoing antiretroviral therapy who was admitted for acute coronary syndrome. He had severe coronary artery disease that involved difficult management.
Romanian Archives of Microbiology and Immunology, 2021
The incidence of Mycobacterium avium Complex (MAC) Disease in HIV-infected individuals has signif... more The incidence of Mycobacterium avium Complex (MAC) Disease in HIV-infected individuals has significantly decreased in recent years due to the introduction of Highly Active Antiretroviral Therapy (HAART) and the initiation of Clarithromycin prophylaxis. We present the case of a patient with advanced AIDS, with generalized lymphadenopathy and digestive symptoms, diagnosed with disseminated MAC, a diagnosis which was based on the results obtained from axillary lymph node and intestinal biopsies. Considering the time of the MAC diagnosis in relation to the recent introduction of antiretroviral (ARV) therapy, we considered immune reconstitution inflammatory syndrome (IRIS) with good evolution under azithromycin, ethambutol and moxifloxacin treatment.
Algebraic number theory relates SIC-POVMs in dimension d > 3 to those in dimension d(d − 2). W... more Algebraic number theory relates SIC-POVMs in dimension d > 3 to those in dimension d(d − 2). We define a SIC in dimension d(d − 2) to be aligned to a SIC in dimension d if and only if the squares of the overlap phases in dimension d appear as a subset of the overlap phases in dimension d(d − 2) in a specified way. We give 19 (mostly numerical) examples of aligned SICs. We conjecture that given any SIC in dimension d there exists an aligned SIC in dimension d(d − 2). In all our examples the aligned SIC has lower dimensional equiangular tight frames embedded in it. If d is odd so that a natural tensor product structure exists, we prove that the individual vectors in the aligned SIC have a very special entanglement structure, and the existence of the embedded tight frames follows as a theorem. If d − 2 is an odd prime number we prove that a complete set of mutually unbiased bases can be obtained by reducing an aligned SIC to this dimension.
Climate change creates new challenges for preventing and protecting human health against differen... more Climate change creates new challenges for preventing and protecting human health against different diseases that could appear and propagate. The Aedes albopictus mosquito species is an important vector for different diseases like dengue fever or zika. Although this species is not “indigenous” in Europe, its presence is noticed in many countries on the continent. The Ae. albopictus establishment is conditioned by the species’ characteristics and environmental factors. To assess the possible spread of Ae. albopictus in the Dobrogea region (situated in the Southeast of Romania), we conducted the following analysis: (1) Investigation of the current distribution and climatic factors favoring Ae. albopictus’ establishment in Europe; (2) Analysis of climate dynamics in Dobrogea in terms of the parameters identified at stage (1); (3) Testing the hypothesis that the climate from Dobrogea favors Ae. albopictus’ establishment in the region; (4) Building a Geographic Information System (GIS)-ba...
Pulmonary arterial hypertension associated with HIV infection is a separate entity. The prevalenc... more Pulmonary arterial hypertension associated with HIV infection is a separate entity. The prevalence is up to one thousand times higher than in general population. The mechanisms are multifactorial and incompletely elucidated. Echocardiography can suggest the diagnosis, but the gold standard method of diagnosing pulmonary arterial hypertension is right heart catheterization. We present clinical and paraclinical findings (NYHA, 6MWD, sPAP, RVGLS) and follow-up in two patients living with HIV, who are included in the Romanian National Program of Pulmonary Arterial Hypertension. In patients, the possible thromboembolism or left heart dysfunction were excluded. Each case has its own particularities, but both of them responded to treatment with sildenafil and improved clinical and paraclinical parameters. Mortality is high, usually due to right heart failure and pulmonary arterial hypertension is considered an independent predictor of death in HIV-infected patients. Co-management with both...
Supplemental Digital Content is available in the text Abstract Microbiota plays an important role... more Supplemental Digital Content is available in the text Abstract Microbiota plays an important role in many diseases including inflammatory bowel diseases. Inflammatory bowel disease patients can have concurrent irritable bowel syndrome symptoms similar to those associated with a flare. The potential role of gut dysbiosis in the pathogenesis of inflammatory bowel disease provides a rationale for treating such patients with rifaximin. This study aimed to assess the efficacy of rifaximin in the management of irritable bowel syndrome-like symptoms (bloating, abdominal pain, stool consistency) and quality of life in patients with Crohn's disease in remission. The present study included 86 patients with Crohn's disease in remission (fecal calprotectin <50 μg/g, C-reactive protein <0.5 mg/dL, simple endoscopic score for Crohn's disease <2) and associated irritable bowel syndrome-like symptoms (bloating, abdominal pain, diarrhea). These patients were randomly assigned to rifaximin treatment group (44 patients) and the control group (42 patients). Besides the baseline inflammatory bowel disease treatment and antispasmodics (as needed), patients in the rifaximin treatment group received 3 repeated courses of treatment, each course being represented by 1200 mg/d of rifaximin for 10 days and 20 days free of treatment (3 months consecutively); patients in the control group also received antispamodics as needed and were observed for 3 months. Monthly analyses of bloating score, abdominal pain score, stool consistency score, and quality of life score showed significant improvement after treatment in the rifaximin group in contrast with control group. Significantly more patients in the rifaximin group than in the control group met the criteria for adequate improvement of bloating score after 3 months of treatment (59.09% vs 19.04%, P = .01), adequate improvement of abdominal pain score (54.5% vs 21.4%, P = .04), stool consistency score (34.09% vs 14.2%, P = .03), and quality of life score (70.4% vs 21.4%, P < .001). Rifaximin in a dose of 1200 mg/d, 10 d/mo, 3 months consecutively is an effective medication for concurrent irritable bowel syndrome-like symptoms in patients with Crohn's disease in remission.
&amp;amp;quot;The study aims to compare different screening methods that are currently being ... more &amp;amp;quot;The study aims to compare different screening methods that are currently being used to confirm a cervical intraepithelial lesion (CIN) underlying the inherent advantages of the varied examination procedures. In this study we are looking at the quality contrast of the different paraclinical examinations relative to the cost, invasiveness and cultural acceptance of such procedures. Every year, more than 100,000 women in EU countries are diagnosed with cervix uteri cancers (CCU). This type of cancer can be prevented if precancerous cells are detected and treated. HPV is found in over 90% of cervix uteri cancers. In Europe, more than half of the countries have implemented screening programs for cervical cancer, and most European countries now have national HPV vaccination programs, however target populations vary depending on the epidemiological evidence and the budgetary level of each countries health system. In this study we evaluated and compared the current and modern techniques used for cervix cellular diagnostics. Also, this study helps improve the understanding on the economic and social implications of screening among female population and the impact it has on healthcare system relieving. Romania recorded an incidence of 22.6 cases of cervix uteri cancers / 100.000 women (age standardized rate), and a mortality of 9.6 / 100.000, ranking second highest in the EU zone.&amp;amp;quot;
Journal of Gastrointestinal and Liver Diseases, 2014
The simultaneous occurrence of two rare conditions in a single patient is uncommon. We report the... more The simultaneous occurrence of two rare conditions in a single patient is uncommon. We report the case of a patient with rectal actinomycosis covering an anorectal melanoma (both infrequent conditions), the last one being later recognized, only after surgical excision. We underline here the role of thinking "outside the box" when an unusual situation is experienced.
Introduction The life expectancy of HIV-infected patients has been increased by highly effective ... more Introduction The life expectancy of HIV-infected patients has been increased by highly effective therapies. People living with HIV (PLWH) in Romania are exposed to age-related comorbidities occurring earlier than in uninfected individuals. Multidisciplinary care is required to maintain the general health and quality of life in these patients. Currently, the communication among different specialties needs to be enhanced and formalized. Methods A panel consisting of 8 Romanian experts in infectious diseases, cardio-metabolic, bone, and kidney diseases and psychology met in May 2019 in Bucharest Romania to discuss the need to evaluate and monitor the most prevalent comorbidities in PLWH. The meeting resulted in practical guidance on the management of several non-infectious associated diseases. The algorithms were endorsed by the Society for Infectious Diseases and HIV/AIDS, Romania. Results The consensus statement offers practical guidance on how to assess and monitor associated diseases in adult PLWH. The recommendations are grouped for each cluster of comorbidities and are based on international guidelines and clinical experience, including landmarks for referral of PLWH to cardiology, endocrinology, nephrology specialist or clinical psychologist for additional investigations and adequate treatment. Specific indications for diagnosis or treatment were beyond the scope of this consensus. Conclusions Screening for associated diseases and adequate management are required to maintain the overall health status of PLWH. When implemented in clinical practice, the recommended algorithms should be used in addition to diagnosis and treatment guidelines and protocols. The infectious diseases specialist plays a key role in coordinating the overall treatment strategy and working within the multidisciplinary team.
We prove that as conjectured by Acín et al. [Phys. Rev. A 93, 040102(R) (2016)], two bits of rand... more We prove that as conjectured by Acín et al. [Phys. Rev. A 93, 040102(R) (2016)], two bits of randomness can be certified in a device-independent way from one bit of entanglement using the maximal quantum violation of Gisin's elegant Bell inequality. This suggests a surprising connection between maximal entanglement, complete sets of mutually unbiased bases, and elements of symmetric informationally complete positive operator-valued measures, on one side, and the optimal way of certifying maximal randomness, on the other.
Journal of Physics A: Mathematical and Theoretical, 2019
Alignment is a geometric relation between pairs of Weyl–Heisenberg SICs, one in dimension d and a... more Alignment is a geometric relation between pairs of Weyl–Heisenberg SICs, one in dimension d and another in dimension , manifesting a well-founded conjecture about a number-theoretical connection between the SICs. In this paper, we prove that if d is even, the SIC in dimension of an aligned pair can be partitioned into (d − 2)2 tight d 2-frames of rank and, alternatively, into d 2 tight (d − 2)2-frames of rank . The corresponding result for odd d is already known, but the proof for odd d relies on results which are not available for even d. We develop methods that allow us to overcome this issue. In addition, we provide a relatively detailed study of parity operators in the Clifford group, emphasizing differences in the theory of parity operators in even and odd dimensions and discussing consequences due to such differences. In a final section, we study implications of alignment for the symmetry of the SIC.
Medical treatment in cystic echinococcosis is limited; albendazole remains the gold treatment for... more Medical treatment in cystic echinococcosis is limited; albendazole remains the gold treatment for patients with low hydatid cysts or those with inoperable echinococcosis. Due to uncommon side effects, administration may be continuous (cycles of 28 days with a break of 14 days between courses) as well as discontinuous over long periods of time. In recent years, there have been many concerns for the testing of various substances and drugs against Echinococcus granulosus, both in vitro and in vivo, on the animal model, but the results have not been satisfactory. New clinical trials are required, as well as the development of an effective vaccine to limit the spread of echinococcosis in endemic areas.
European Journal of Clinical Microbiology & Infectious Diseases, 2019
Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illn... more Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulasenegative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042).
Background: Accurate assessment of esophageal diameter is necessary for effective esophageal stri... more Background: Accurate assessment of esophageal diameter is necessary for effective esophageal stricture dilation, a common therapy for eosinophilic esophagitis (EoE). Endoscopic assessment frequently underestimates the presence of strictures. The Functional Luminal Imaging Probe (FLIP) utilizes impedance planimetry to determine cross-sectional areas and can assist in diameter assessment. We compared the measurement of esophageal luminal diameter by FLIP to the presence of mucosal disruption following therapeutic dilation among a cohort of patients with EoE. Methods: We prospectively enrolled adults with EoE undergoing endoscopic evaluation by EGD and FLIP with anticipated dilation. Demographics, disease history, and symptoms were collected. Real-time assessment of esophageal endoscopic characteristics was recorded prior to performance of FLIP. FLIP was performed according to standardized protocol in both the proximal and distal esophagus. Incremental esophageal dilation was performed with identification of the diameter at which mucosal disruption occurred. If no disruption occurred, the maximum dilator size was recorded as the esophageal diameter. T-test analysis and Pearson correlation coefficients were used to compare the narrowest diameter as determined by FLIP compared to the diameter at which mucosal disruption occurred. Results: 45 patients were consented and enrolled in the study. 9 patients were excluded as they did not undergo FLIP and/or dilation according to protocol and 6 patients were excluded due to inadequate FLIP catheter positioning during EGD. A total of 30 patients were used for analysis. The average age of patients was 40 and 70% (n= 21) were male. History of stricture was present in 80% (n=24) of patients and 57% (n=17) had previously undergone dilation. Endoscopic visual assessment was notable for: edema (60%), rings (97%), exudates (33%), furrows (63%), and strictures (87%). The mean difference between esophageal diameter measurement by FLIP and mucosal disruption was 1.8 mm. There was no difference in mean esophageal luminal diameter by FLIP as compared to mucosal disruption (14.6 ± 3.1 mm vs. 15.3 ± 2.1 mm, P=0.12). There was a strong and significant correlation between esophageal diameter measurements by FLIP and mucosal disruption (r=0.67, P<0.001). Conclusion: In a cohort of EoE adults, FLIP provides an accurate assessment of esophageal diameter when compared to mucosal disruption during esophageal dilation. FLIP testing during endoscopy may improve the accuracy of stricture identification and severity assessment and thereby improve therapeutic dilation decision making.
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Papers by Irina Dumitru