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Original Papers

REGIS – Romanian National Registry for Interstitial Lung Diseases and Sarcoidosis: launch of the website and building-up the database

Irina Strâmbu1,2
1. Institutul de Pneumoftiziologie „Marius Nasta“ București 2. Universitatea de Medicină și Farmacie „Carol Davila“ București Disciplina de Pneumologie

Interstitial lung diseases (ILD) comprise about 200 different diseases with low prevalence, some evolving towards irreversible lung fibrosis. The diagnostic of each disease involves complex investigations (high resolution CT scan, broncho-alveolar lavage, complex lung function testing, surgical biopsy), but the main element is the expertise of the clinician and the multidisciplinary diagnostic approach.
The creation of a national registry for ILD and sarcoidosis allows putting together in the same database numerous cases, now spread around the country. REGIS is the initiative of a group of physicians from "Marius Nasta" Institute of Pulmonology Bucharest and from the Pulmonology Dept. of "Victor Babeș" Infectious Diseases Hospital, Timișoara. REGIS is an online registry, available at, consisting of several components: 1. The registry per se, in which the accredited physicians will be able to feed information about their patients, by filling-in a questionnaire 2. Educational platform, containing a collection of clinical cases organized according to diagnosis, which is generated anonymously from the data from the registry 3. Patients' page, with information on ILD in general and on the most frequent diseases in the group.
Expected results are: increasing the physicians' knowledge on ILDs, informing correctly the patients, bringing up to light new cases previously not diagnosed, building up a database for research (prevalence studies, risk factor studies, selection of patients for clinical trials), creating a base for a future national health programme dedicated to idiopathic pulmonary fibrosis patients, preparing future projects for development of a Romanian centre for lung transplantation.

Keywords: interstitial lung diseases, registry, diagnosis, educational platform

Metabolic profile in obese patients with obstructive sleep apnea. A comparison between patients with insulin resistance and with insulin sensitivity

Ștefan Dumitrache-Rujinski1,2, Ioana Dinu3, George Călcăianu2, Ionela Erhan2, Alexandru Cocieru2, Dragoș Zaharia1,2, Claudia Lucia Toma1,2, Miron Alexandru Bogdan1,2
1. Universitatea de Medicină și Farmacie „Carol Davila“ București Disciplina de Pneumologie 2. Institutul de Pneumoftiziologie „Marius Nasta“ București 3. Spitalul Județean Bacău

Background: Obstructive sleep apnea syndrome (OSAS) may induce metabolic abnormalities through intermittent hypoxemia and simpathetic activation. It is difficult to demonstrate an independent role of OSAS in the occurrence of metabolic abnormalities, as obesity represents an important risk factor for both OSAS and metabolic abnormalities.
Aim: to assess the relations between insulin resistance (IR), insulin sensitivity (IS), OSAS severity and nocturnal oxyhaemoglobin levels in obese, nondiabetic patients with daytime sleepiness.
Material and methods: We evaluated 99 consecutive, obese, nondiabetic patients (fasting glycemia < 126 mg/dL, no hypoglycemic or hypolipemiant medication) diagnosed with OSAS (AHI > 5/hour and daytime sleepiness) by an ambulatory six channel cardio-respiratory polygraphy. Hight, weight, serum triglycerides (TG), high density lipoprotein-cholesterol (HDL-C) levels were evaluated. Correlations between Apneea Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), average and lowest oxyhaemoglobin saturation (SaO2), body mass index (BMI) and insulin resistance or sensitivity were assesed. IR was defined as a TG/HDL-C ratio > 3, and insulin sensitivity (IS) as a TG/HDL-C ratio < 2.
Results: 64 patients (out of 99) had IR and 18 IS. In the IR group (44 men and 20 women), the mean age was 52 ± 10,6 years, mean BMI: 38,54 ± 6,67 Kg/m2 (30-60), TG/HDL-C: 5, 27 ± 2,03 (3,02-11,1), mean AHI: 49,65 ± 25,55/hour (7-110), mean ODI: 47,69 ± 24,95/hour (4-98), mean average SaO2: 89,42 ± 4,6 and mean lowest SaO2: 68,4% ± 13,8% (32-88%). 48 patients had severe, 7 moderate and 9 mild OSAS.
In the IS group (10 men and 8 women), the mean age was 58,4 ± 8,2 years, mean BMI: 35,4 ± 4,29 Kg/m2 (30-46), TG/HDL-C: 1,64 ± 0,29 (1.13-1,95), mean AHI: 45,8 ± 30,3/hour (9-131), mean ODI: 39,9 ± 32,2/hour (2-133), mean average SaO2: 90,8 ± 8,2 (81-95) and mean lowest SaO2: 74% ± 10,8% (52-87%). 12 patients had severe, 3 moderate and 3 mild OSAS.
Insulin sensitivity positively correlated with mean average SaO2 (r: 0,49; p: 0,037) and negatively with ODI (r: - 0,56; p: 0,014). Insulin resistance negatively correlated with mean lowest SaO2 (r: - 0,25; p: 0,045). Mean lowest SaO2 values were significant lower in patients with IR than in those with IS (p: 0,042). No statistically significant difference was found for BMI, AHI or ODI between IR and IS patients.
Conclusions: nocturnal oxyhaemoglobin levels rather than OSAS severity (expressed as AHI or ODI) may be involved in the occurrence of metabolic abnormalities in obese nondiabetic patients. Preserving insulin sensitivity is more likely when oxyhaemoglobin levels are higher and ODI is lower. Mean lowest nocturnal SaO2 levels seems to be independently involved in the development of insulin resistance as no statistically significant differences were found for BMI between the two groups.

Keywords: obstructive sleep apnea syndrome, metabolic abnormalities

Antibiotic resistance of Acinetobacter baumannii strains isolated from clinical specimens in the “Marius Nasta“ Pneumology Institute, Bucharest

Adriana Moisoiu, Monica Ionită, Lăcrămioara Sârbu, Corina Stoica, Liliana Grigoriu
Institutul de Pneumoftiziologie „Marius Nasta“, București

Acinetobacter baumannii (A. baumannii) is one of the leading causes of morbidity and mortality in patients who are in critical condition in hospitals and especially in intensive care units (ICU). Long time considered a bacterium with low virulence, A. baumannii has more recently become a cause for major concern in clinical practice due to its high level of antimicrobial resistance. The extend of infections with Acinetobacter baumannii in ICU is caused by multiple factors, such as mechanical ventilation, invasive procedures, the use of a large number of broad spectrum antibiotics and transmission through the hands of medical staff.
In this study we evaluated the resistance to antibiotics of 213 non-duplicated strains of A. baumannii isolated in the bacteriology laboratory of the "Marius Nasta" Institute of Pneumophtisiology (IPMN) from January 2012 to December 2013. These strains originated from patients in medical wards (56), ICU (143) and surgery (14). Strains identification was performed by classical methods on multitest media and with API kits (Bio Merieux). The antibiotic sensitivity was performed on Mueller-Hinton media in accordance with CLSI 2013.
Analysis of the resistance to antibiotics was the following: carbenicilin (87.3%), ceftriaxone (87.3%), cefoperazone with sulbactam (84.9%), ceftazidime (79.3%), carbapenems (imipenem and/or meropenem - 75.1%), fluoroquinolones (ciprofloxacin and/or levofloxacin - 73.7%), cefepime (66.6%), piperacilin with tazobactam (62.4%), amikacin (50.2%), netilmicin (45%), gentamicin (42.7%) and tobramycin (35.6%). In our study, we only found two strains of Acinetobacter baumannii with resistance to colistin and 70 (32.8%) strains sensitive only to colistin, but resistant to all other antibiotics tested.
A. baumannii is a pathogen with rapid spread and extended resistance to even newer antimicrobial agents. Due to its ability to survive in the hospital environment, A. baumannii has the immense potential to cause nosocomial infections.
We did not find significant differences between the antibiotic resistance of strains isolated from ICU patients and those obtained from medical or surgical wards.
This study has also shown that there is a high number of
A. baumannii strains with resistance to almost all antibiotics tested, notably with the exception of colistin, wich therefore becomes the antibiotic of choice in the treatment of these infections.
The marked increase in the number of multidrug resistant A. baumannii strains highlights the need for a more rational use of broad spectrum antibiotics, as well as for an immediate review of infections control protocols, so as to limit the spread of this pathogen.

Keywords: Acinetobacter baumannii, antimicrobial resistance, nosocomial infections