Antibiotherapy is the main determinant of Clostridium difficile infection due to the imbalance determined in the intestinal flora. Clostridium difficile infection can be considered a current public health problem, given the increased incidence, both as a nosocomial infection as well as at community level, by excessive, uncontrolled and unjustified use of antibiotics, high contagiousness, negative influence on health systems in the increased number of days of hospitalization and implicitly increased costs, and last but not least, the substantial deterioration of the quality of the patient�s life. The retrospective study over a 12-month period over a group of 106 patients revealed the following profile of the patient affected by Clostridium difficile infection: females, aged 66.75 � 15.66, from the urban area, hospitalized in the medical section, who had diarrhea more than 2 days after admission, but up to 28 days after this event, due to prolonged antibiotic therapy with ceftriaxone, associated with a gastric secretion inhibitor, on a background of multiple associated pathologies. It is very important for all health systems to control this phenomenon and this is only possible by applying effective measures to prevent the onset of CDI, of relapses and contamination, thus identifying the judicious use of antibiotics.

Background. Gangliosides are Nacetyl -neuraminic -acid containing glycosphyngolipids that modulate several cellular functions.Objective. The present study confirmed the presence of cellular gangliosides in melanocytic tumors with neuroectodermal origin. These molecules showed large quantitative and structural variability in melanocytic cells.Methods. The spectrum and levels of gangliosides were performed from 1991 until 2010, in 411 specimens of melanoma, 108 cutaneous metastases of melanoma, 206 nevocellular and dysplastic nevus and 130 specimens of normal skin.

Diabetic foot is a current public health problem and a late consequence of diabetes. Morbidity and mortality are significant, seriously affecting the patient�s quality of life. Treatment of the diabetic foot is a long-lasting, highly resource-consumption process. Using negative pressure therapy leads to shorter hospitalization periods, better functional outcomes, significantly contributes to decreasing the number of amputations and improving patient�s quality of life. 49 year-old patient is hospitalized with necrotizing at right foot and shank, neglected type II diabetes. It is performed amputation of atypical necessity, right leg, transtarsal, open stump. After successive debridements, negative pressure therapy is installed for a period of 24 days. This favors the formation of the granular bed, the remission of the infection, allowing grafting. The graft is partially integrated and plantar reconstruction is performed with sural reversal flap. The local and functional results are satisfactory, with the flap viability and the possibility of moving with support on the right leg, preventing the amputation of the shank. Negative pressure therapy has a multitude of advantages, it is preferable to conventional therapies, and it can have higher costs, but accelerates healing and improves the quality of life of the patient.

Two familial forms of colorectal cancer (CRC), Lynch syndrome (LS) and familial adenomatous polyposis (FAP), are caused by rare mutations in DNA mismatch repair genes (MLH1,MSH2,MSH6,PMS2) and the genes APC and MUTYH, respectively. No information is available on the presence of high‐risk CRC mutations in the Romanian population. We performed whole‐genome sequencing of 61 Romanian CRC cases with a family history of cancer and/or early onset of disease, focusing the analysis on candidate variants in the LS and FAP genes. The frequencies of all candidate variants were assessed in a cohort of 688 CRC cases and 4567 controls. Immunohistochemical (IHC) staining for MLH1,MSH2,MSH6, and PMS2 was performed on tumour tissue. We identified 11 candidate variants in 11 cases; six variants in MLH1, one in MSH6, one in PMS2, and three in APC. Combining information on the predicted impact of the variants on the proteins, IHC results and previous reports, we found three novel pathogenic variants (MLH1:p.Lys84ThrfsTer4, MLH1:p.Ala586CysfsTer7, PMS2:p.Arg211ThrfsTer38), and two novel variants that are unlikely to be pathogenic. Also, we confirmed three previously published pathogenic LS variants and suggest to reclassify a previously reported variant of uncertain significance to pathogenic (MLH1:c.1559‐1G>C).

The effectiveness of pharmacological therapies is supported and guaranteed by medical protocols, which are the result of long-lasting experiments and scientific research, of course adapted to the level of competence and functional capacity of the healthcare provider. Besides pharmacological effectiveness, the therapeutic regimens should be evaluated from the point of view of economic efficiency, by assessing the financial impact of drug consumption, in correlation with other indicators specific to medical management. A retrospective comparative study of drug used in a surgical section with a capacity of 25 beds, from a county hospital is described. Study objective was to identify the relationship of influence and determination between costs with drugs and other economic and financial indicators and the use of services; objectively evaluate the effectiveness of the protocols used to limit the development of antibiotic resistance, avoiding polypharmacy and improving costs related to drug use, but especially to determine the existence of deviations from these and generating causes. The implementation of medical protocols has led to a decrease in drug costs. Tracking drug use is an effective tool to increase the quality of medical services by avoiding polypharmacy, therapeutic errors and preventing the development of antibiotic resistance. All these aspects are supported by the implementation of medical protocols and, thus, drug use can be appreciated as a valid indicator of their effectiveness and efficiency.