Hippocrates’ name is synonymous with the ''Father of Medicine.'' Although much time has passed since the great physician treated patients, wrote prescriptions, and mentored junior doctors, relatively little has changed. Modern medical branches - such as infectious diseases, microbiology, and epidemiology - work alongside public health institutions to continuously fight what we now refer to as infections. It is essential to recognize that his contributions to today's medical world cannot be contained in a single article. Nonetheless, several critical aspects must be emphasized to appreciate Hippocrates' significance in modern times. Despite being spoken of since ancient times, his echo remains relevant. By laying the foundation for crucial steps in patient care, namely anamnesis (history taking, from Greek: aná, "open" and mnesis, "memory") and clinical examination, Hippocrates’ legacy still endures today. His oath is as significant as the day it was written; his words act as a lighthouse in the darkest hours, and his teachings encourage every physician to prioritize life above all else. In a rapidly evolving and future-oriented world, one must first strive to organically understand our shared past before embracing a progressive mindset.
This short communication synthesizes current understanding of subacute thyroiditis (SAT) in the context of the SARS-CoV-2 pandemic. SAT, a typically self-limiting, virally induced thyroid inflammation, has been increasingly recognized as a complication of COVID-19. The article highlights the pathophysiological basis for this association, noting susceptibility to direct viral cytotoxicity and, additionally, post-viral inflammatory mechanisms, including cytokine storm phenomena. Subacute thyroiditis associated with COVID-19 can manifest atypically during active infection or, more conventionally, weeks post-recovery, potentially influenced by HLA predisposition. A significant challenge discussed is the potential for underdiagnosis, as SAT symptoms may overlap with systemic COVID-19 manifestations or be masked by commonly used treatments like NSAIDs and corticosteroids. Despite millions of COVID-19 cases globally, relatively few SAT cases have been formally reported, which further suggests diagnostic masking or a true rarity. The complex interplay between thyroid function and COVID-19 severity is also touched upon. Ultimately, this review highlights the importance of maintaining a high clinical suspicion for SAT as an extrapulmonary manifestation of SARS-CoV-2 infection. Timely diagnosis and appropriate management, guided by disease severity as per standard SAT protocols, are crucial, even amidst the complexities of concurrent or recent COVID-19 illness. The findings consolidate SAT's position within the spectrum of COVID-19-related endocrine dysfunction.
In this review, we examine the potential use of antimicrobial peptides (AMPs) to combat the emergence of multidrug- and extensively drug-resistant bacterial strains. We present selected examples of bacteriocins that have been extensively studied and could be suitable for human application, such as bacteriocins AS-48, microcin C, and other bacteriocins produced by lactic acid bacteria, as well as the lab-engineered BAC100. This review also discusses some of the main known mechanisms by which other bacterial species develop bacteriocin resistance, including the acquisition of resistance genes such as bceA, mcdK, and mccF, as well as mutations in lagD.
Extrapulmonary tuberculosis (TB) is a sporadic disease, affecting mainly people in countries with low socio-economic levels. In Romania, the global incidence of TB (new cases and relapses) is the highest in the EU. Through this presentation, we are going to display the clinico-biological aspects and the difficulty of diagnosing a case of extrapulmonary TB in a 37-year-old female patient coming from an urban area, a former smoker, who presented to the emergency room with diffuse abdominal pain, marked weight loss, deterioration of the general condition, and fever up to 38.3 degrees Celsius. After establishing the diagnosis, anti-TB treatment was initiated, and its duration was guided by the patient's clinical-biological evolution and imaging, as no national guidelines for this type of pathology were available.
In 1980, Wassermann reviewed the development and use of certain corpuscular Pseudomonas spp. vaccines in different countries, including the Romanian Cantacuzino autovaccine [1]. He emphasized the effectiveness of the Romanian vaccine and a mixed corpuscular vaccine against Staphylococcus and Pseudomonas infections, which the Pasteur Institute in Paris prepared. These vaccines were utilized to prevent and treat burn patients (Wassermann et al., 1979), resulting in very positive outcomes: a notable decrease in positive Pseudomonas aeruginosa hemocultures within the vaccinated group (9% compared to 37% in the nonvaccinated group) and a reduction in sepsis deaths caused by P. aeruginosa from 5% in the nonvaccinated patients to 0.7% in the vaccinated individuals.
Biological threats are an undeniable reality, and biosecurity plays a vital role in protecting biological resources against theft and unauthorized use. Biosecurity risk management strategies must be based on a careful assessment of these risks.
A 71-year-old female patient with a history of poorly controlled insulin-dependent type 2 diabetes mellitus (lasting over 15 years), obesity, dyslipidemia, and severe uncontrolled bronchial asthma (lasting over 10 years) on triple inhalation therapy, as well as hypertension, was admitted to the hospital with expiratory dyspnea, wheezing, productive cough, mucopurulent sputum, a sensation of chest tightness, perioral and extremity cyanosis, and dry mouth.
Bloodstream infections (BSIs) and antimicrobial resistance are two important concepts that can be found in almost any clinical setting. Regardless of clinical specialty, a medical practitioner may often encounter such a case where a patient’s well-being depends on understanding bacterial infection and the importance of proper antimicrobial treatment. In this letter, we describe a clinical case we have recently observed in our Oncology Department at the Rambam Health Care Campus. A 72-year-old patient presented to our center after being referred from a primary care center with fever, jaundice, elevated enzyme levels, and an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) diagnosis of pancreatic adenocarcinoma.
Antimicrobial resistance (AMR) has long been acknowledged as a global public health threat with potentially far-reaching economic consequences. However, no previous literature review has focused exclusively on national-level estimates of the AMR economic burden. Four electronic databases were searched for studies published between 01 January 2010 and September 2023 that reported original, national- or supra-national estimates of AMR economic burden. Additionally, reference lists of previous reviews and online reports were searched. Bibliographic and methodological characteristics of the included studies were extracted and summarized narratively. Thirty studies were included, reporting estimates of economic burden for 67 distinct countries combined, most of them high-income. The United States has the richest evidence base, with 13 studies in total. There was significant variation in terms of study designs, comparators, and uncertainty analysis. The overwhelming majority of studies quantified the economic impacts of AMR in terms of direct healthcare costs, with less than half the studies estimating the indirect costs of AMR and only one study estimating non-health economic impacts on trade and poverty. Further efforts are needed to improve the availability of national-level data on infection economics and to produce guidance for capturing the economic burden of AMR if such studies are to be useful to decisionmakers.
On August 16, 2023, a 66-year-old patient with a history of pulmonary tuberculosis, cured with pulmonary fibrotic sequelae and left-sided pachypleuritis, severe Chronic Obstructive Pulmonary Disease (COPD), was admitted with hemoptysis, fever (38.9 °C), expiratory dyspnea, a sensation of chest tightness, perioral and extremity cyanosis.
This research study explored the diversity and prevalence of SARS-CoV-2 genetic lineages in wastewater samples collected from the Chişinău wastewater treatment plant in the Republic of Moldova between September and November 2024. A total of 23 samples were analysed using Illumina sequencing technology. Although the overall quality of the sequencing data was suboptimal due to limited genomic coverage, the analysis identified 32 genetic lineages based on the Pango Lineages classification. The most common variants detected included B.1.177.66, B.1.1.243, and B.1.160.32. The study emphasises the importance of optimising the RNA extraction process from wastewater to improve genome coverage and data accuracy. These findings provide a foundation for future investigations involving sequencing genetic material obtained from environmental samples, suggesting the applicability of wastewater surveillance to other types of pathogens or assessing the resistome through metagenomic technology.
In recent years, antibiotic resistance has risen to dangerously high levels. With antibiotics becoming less effective, developing alternatives has become a global priority. Natural products such as plant extracts and essential oils (EOs) represent one of the most investigated strategies due to their active chemical compounds with antimicrobial properties that generally do not cause resistance. In this study, essential oils of Thymus capitatus and Satureja thymbra, two main components of these essential oils, namely carvacrol and thymol, and also ethanol extract and ethyl acetate extract of Thymus capitatus, were tested against microbial growth and biofilm formation in Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 25923, and Candida albicans ATCC 10231 reference strains. An adapted antibiotic susceptibility assay assessed the qualitative antimicrobial effect, and the Minimum Inhibitory Concentration (MIC) was established for every sample by an adapted microtiter method in liquid media. Biofilm inhibition by the tested natural products was investigated using the binary dilution method in 96–well multiplates after 24, 48, and 72 hours of incubation. Modulation of some virulence factors' expression was also evaluated after incubation of Pseudomonas aeruginosa and Staphylococcus aureus strains with sub-inhibitory concentrations of essential oils, thymol, and carvacrol. The results revealed that the tested compounds presented antimicrobial activity and impacted microbial virulence. Although further research is needed, the results are promising and demonstrate the potential of these compounds as an alternative to antibiotics, particularly for biofilm-associated infections.
Despite advances in drug development, many treatments remain ineffective or have serious side effects. Nanotechnology has emerged as a promising tool in addressing these issues, offering innovative solutions for disease prevention, treatment, and detection [1]. In recent years, the convergence of nanotechnology and immunology research has opened new avenues for preventive and therapeutic interventions in the realm of cancer, infections, and immune disorders treatment, as well as the development of novel vaccines.
The aim of this paper was to underline the great importance of maintaining an eubiotic state of normal microbiota, including the oral one, and to bring into discussion aspects regarding a common dental biofilm pathobiont, respectively Porphyromosa gingivalis that is also an extremely aggressive periodontopathogenic species, with local, but also remote effects. Dental plaque is a model of polymicrobial biofilm with cyclic evolution, intensively studied due to its accessible sampling, but especially to its implication in local (cariogenesis, gingivitis, periodontitis) and other remote conditions. Oral microbiome is a crucial factor for maintaining local and systemic host health, depending on its status: eubiosis vs. dysbiosis status. In a certain favorable niche provided by the host environment (improper local hygiene and/or genetic susceptibility), the eubiosis status is broken and allows the periodontopathogens to establish in this altered niche. These late colonizers become aggressive, inactivating innate immune effectors, modulating adaptive immune response, and promoting an inflammatory response. Dysbiosis and inflammation coevolve, and the changed environmental factors select a pathobiotic community. Among pathobionts, the anaerobic Gram negative species Porphyromonas gingivalis has attracted the attention of researchers by its high virulence (e.g. gingipains - specific proteases) and capacity to disseminate, as entire cells or outer membrane vesicles (OMVs), a feature of bacterial chronic infections; these floatting OMVs are not destroyed by antimicrobials and continue to stimulate the local and systemic inflammation, delivering soluble virulence factors. Considering the chronic and distructive evolution, but also the remote complications of periodontal disease, many teams are involved in research of this multifactorial and complex infectious and inflammatory disease, aiming to discover innovative, combined, and more efficient strategies than existing ones.
The following clinical images were obtained during the investigation of a case involving a 57-year-old female patient who, nine years ago, underwent surgery for a uterine fibroid. Post-surgery, she developed a wound infection along with wound dehiscence and eventration. Multidrug-resistant Staphylococcus aureus was identified. Antibiotic treatment was initiated, and over time, the patient underwent several surgical interventions to correct the dehiscence and address the recurrent S. aureus infection.
Lactoferrin (Lf) is an iron-chelating glycoprotein present in the whey protein fraction in the milk of the majority of mammals. Since identifying bovine Lf (bLf) 85 years ago, the interest in this molecule has grown significantly. Thus, apart from its iron-binding and related antioxidant mechanisms, Lf was described as implicated in protecting the human organism by its immune-promoting, antimicrobial, and anti-carcinogenic mechanisms. Since the intrauterine period and throughout life, Lf ensures a balance between innate and adaptative immunity and can inhibit the growth of pathogenic microorganisms and tumor metastasis. This paper summarizes the aforementioned mechanisms of this multivalent molecule involved in innate immunity.
Infection with human immunodeficiency virus (HIV) results in multisystem involvement, depending on the degree of immunosuppression. Liver involvement is one of the leading causes of mortality and morbidity in HIV-positive patients, and it can take many forms, such as increased plasma levels of liver enzymes up to liver failure, liver cirrhosis, metabolic dysfunction-associated fatty liver disease (MAFLD), metabolic dysfunctionassociated steatotic liver disease (MASLD), hepatocellular carcinoma (HCC). Liver involvement may occur in HIV-infected patients in the absence of co-infection with other hepatitis viruses, association with parasitic or mycobacterial infections, tumors, or antiretroviral medication. For this reason, a current topic of debate is whether it occurs secondary to HIV infection and is related to the degree of immunodeficiency.
Yeasts, opportunistic agents that can cause infections, usually in patients with severe immunosuppression, have become one of the biggest problems of contemporary medicine, primarily due to their resistance to antifungal agents and capacity to form biofilm. This study aimed to characterize the virulence factors that mediate their success as pathogens and to prove that cinammon essential oil has antifungal activity. The study included 20 strains of fungi isolated from intensive care units. Taxonomic identification was done using classical microbiological methods. Adhesion and cytotoxicity were analyzed through inoculation of strains on HEp-2 cell cultures. The production of soluble virulence factors was evaluated by streaking the strains on different supplemented Sabouraud media to detect different enzymes. According to this study, all strains produced at least one phenotypic virulence factor, the most frequent being either proteinase or phospholipase. Cinnamon essential oil's antibiofilm activity was demonstrated for all strains. Considering all virulence factors and the adherence capacity of fungal species, the central role they play in the pathology of immunocompromised patients is emphasized once again.
Often, in urgent care, a non-contrast CT scan of the head is considered a routine investigation for any suspicion of stroke (ischemic or hemorrhagic) that might manifest as a neurological deficit, confusion, altered mental status, or intense headache. Most of the time, anamnestic information is hard to obtain in an acute setting of symptoms. Therefore, the clinician often relies on other investigations, such as imagistic and paraclinical, for accurate diagnosis. This case study also emphasizes the importance of a multidisciplinary approach, ultimately leading to the correct diagnosis and treatment and saving the patient’s life.
Tracking the circulating variants of the SARS-CoV-2 virus and identifying new genetic variations provide a high-resolution perspective with many advanced applications, ranging from developing diagnostic tests and vaccines to real-time data for public health measures. This study aimed to investigate and assess the genetic variants of SARS-CoV-2 circulating in the Republic of Moldova to improve COVID-19 response strategies. A retrospective descriptive study was carried out in the National Public Health Agency virology laboratory. The study analysed 417 biological samples collected from patients infected with COVID-19, with SARS-CoV-2 presence confirmed by molecular biology techniques (Reverse transcription polymerase chain reaction (RTPCR)). Viral fragment sequencing was performed via the Ion Torrent Genexus sequencer, Pangolin, and GISAID (Global Initiative on Sharing All Influenza Data) software. The Omicron variant underwent multiple genetic changes throughout 2022. Thus, these changes were divided into four distinct periods of SARS-CoV-2 genome evolution. The first period (January–March) was characterized by the predominance of BA.1* and its subvariants; the second period (March–June) by the predominance of the BA.2* sublineage and its subvariants; the third period (June–October) by the predominance of BA.4*/BA.5* and their subvariants; and, finally, in the fourth-period various sublineages, including BQ.1*, BN.1*, CC.1*, and XBB.1.5, became predominant. In conclusion, the implementation of advanced SARS-CoV-2 genome sequencing technologies in the Republic of Moldova has proven the importance of detecting novel viral mutations and their impact on the epidemic progression of the COVID-19 infection.
