Romanian Journal of Military Medicine

2

Authors: Dan Mischianu

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4

Authors: Daniela Anghel, Lucian M. Ciobîcă, Silviu M. Stanciu, Ciprian V. Jurcuț, Gabriel D. Stoicescu, Ioana A. Răduță, Ancuţa Coca

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?

5

Authors: Diana M. Popescu, Marius Necșulescu, Lucia E. Ionescu, Simona N. Bicheru, Gabriela V. Dumitrescu, Viorel Ordeanu

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.

6

Authors: Cristina Vârlan, Florina Topliceanu, Lavinia Bârsan, Eduard Dănăilă, Mihai Șotcan

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

8

Authors: Ion Chiosila

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.