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Papers by Genel Sur

Life

Viral infections are a key issue in modern medicine. SARS-CoV-2 infection confirms that we are no... more Viral infections are a key issue in modern medicine. SARS-CoV-2 infection confirms that we are not sufficiently prepared for these unforeseen infections. The COVID-19 pandemic has cultivated a great sense of fear and distrust in patients. If viral infections, in this case, SARS-CoV-2, overlap with another infection, the symptoms are prolonged and worsened, and complications may occur. Starting from an objective clinical finding of a patient they had in follow-up and treatment, the authors present the problems of the diseases the patient suffered from. These are described as reviews so that readers can get an idea of the clinical methods of expression and the therapeutic possibilities. Therefore, this article describes Lyme disease and post-treatment Lyme disease syndrome, SARS-CoV-2 infection, and multisystem inflammatory syndrome in children (MISC-C), as the patient suffered from an incomplete form of Kawasaki disease. During the treatment for Lyme disease, the patient also contrac...

Journal of Clinical Medicine, Sep 6, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Allergologia et Immunopathologia

Atopic dermatitis (AD) is mainly considered an allergy, exacerbated by allergic factors. Is there... more Atopic dermatitis (AD) is mainly considered an allergy, exacerbated by allergic factors. Is there evidence to suggest the existence of autoimmune components in the pathophysiology of the illness? Studies in the literature that dealt with the occurrence of autoimmunity in children with AD were analyzed. We followed the studies published in PubMed for 10 years, from 2001 to 2021. Clinical signs and symptoms were similar to other autoimmune diseases, having periods of remission and relapses. Other correlations between AD and autoimmune diseases have been described, and patients with AD can also present with a wide range of autoimmune comorbidities. Three major factors contribute to the pathogenesis of AD: damage of the skin barrier, disorders of the immune response, and imbalances of the skin microbiome—all based on genetic changes and influenced by environmental factors. Predominant activation of Th 2 cells, with the increase of Th 1, Th 17, and Th 22 subsets, promotes skin inflammati...

Romanian Journal of Neurology, 2021

The pathology of Dravet syndrome is of particular importance in children. In this article we anal... more The pathology of Dravet syndrome is of particular importance in children. In this article we analyze the involvement of the SCN1A gene in Dravet syndrome, we approach the new treatment strategies in Dravet syndrome.

Background: Itching is one of the major and mandatory signs of atopic dermatitis (AD) in children... more Background: Itching is one of the major and mandatory signs of atopic dermatitis (AD) in children. Interleukin 31 (IL-31) is strongly involved in the genesis of pruritus. In our study, 68 patients aged 0-18 years with proven AD were followed clinically. The role of IL-31 in pruritus as clinical manifestation of AD is known but its etiopathogenetic mechanism is not well known. Methods: Serum was collected from 31 patients with moderate and severe forms of AD to determine IL-31 and its correlation with activity and severity of the disease. We also studied 30 healthy patients to compare the results of determinations. The IL-31 value was determined using the sandwich enzyme-linked-immunosorbent serologic assay (two antibodies assay). The IL-31 values were expressed as picograms per milliliter (pg/mL) and compared with activity and severity of the disease. Results: The IL-31 value was much higher in patients with AD compared to the control group. The mean value of findings was 1600 pg/mL compared to the control group with an average of 220 pg/mL. The IL-31 values were positively correlated with the severity and activity of the disease. Conclusions: The results of our pediatric study established the involvement of IL-31 in the pathophysiology of AD. IL-31 could be a marker of AD track.

S. Afr. j. diabetes vasc. dis, 2014

Children, 2022

The three types of neurofibromatosis, namely type 1, type 2, and schwannomatosis, are generally a... more The three types of neurofibromatosis, namely type 1, type 2, and schwannomatosis, are generally associated with various benign tumors affecting the skin and the nervous system. On rare occasions, especially in patients with neurofibromatosis type 1 (NF1), malignant neoplasms may also be present, several of them possessing a more aggressive course than in individuals without this syndrome. As such, a clear delineation between the three variants of neurofibromatosis is crucial to establish the correct diagnosis and management, as well as predict the neoplasm-related outcomes. Neurofibromin, the principal product of the NF1 gene, is a potent inhibitor of cellular proliferation, having been linked to several key signaling pathways involved in tumor growth. Therefore, it may provide a useful therapeutic target for tumor management in these patients. In this article, we want to present the association between deficiency of neurofibromin and the consequences of the lack of this protein lea...

Gastroenterology and hepatology from bed to bench, 2016

Early studies have not revealed a link between Helicobacter pylori and iron deficiency (1). A rec... more Early studies have not revealed a link between Helicobacter pylori and iron deficiency (1). A recent study from your journal revealed a significant association between H. pylori infection and iron deficiency anemia in patients with celiac disease. But the conclusion of this study was that H. pylori infection and iron deficiency anemia is

Objectives: To identify how severe is inflammation in metabolic syndrome using as inflammatory ma... more Objectives: To identify how severe is inflammation in metabolic syndrome using as inflammatory markers: C-reactive protein and leukocytes. To asses these markers considering the diversity of metabolic syndrome elements. Material and method: We performed a study that enrolled 258 patients registered to a family physician and diagnosed with metabolic syndrome. The subjects included in the study were divided in two groups: group A-137 subjects diagnosed with metabolic syndrome that was defined by 3 elements: abdominal obesity+arterial hypertension+diabetes mellitus; group B-121 patients diagnosed with metabolic syndrome based on 5 elements: abdominal obesity+arterial hypertension+diabetes mellitus+decreased high density lipoprotein cholesterol (HDL-C)+increased triglycerides. Results: We observed increased values of CRP and leukocytes for group B in comparison to group A: 0.9±0.8 mg/dl vs 0.79±0.8 mg/dl (p=0.02, significantly statistic). Leukocytes value was higher for group B, but not...

MAEDICA – a Journal of Clinical Medicine, 2014

To identify how severe is inflammation in metabolic syndrome using as inflammatory markers: C-rea... more To identify how severe is inflammation in metabolic syndrome using as inflammatory markers: C-reactive protein and leukocytes. To asses these markers considering the diversity of metabolic syndrome elements. We performed a study that enrolled 258 patients registered to a family physician and diagnosed with metabolic syndrome. The subjects included in the study were divided in two groups: group A-137 subjects diagnosed with metabolic syndrome that was defined by 3 elements: abdominal obesity+arterial hypertension+diabetes mellitus; group B-121 patients diagnosed with metabolic syndrome based on 5 elements: abdominal obesity+arterial hypertension+diabetes mellitus+decreased high density lipoprotein cholesterol (HDL-C)+increased triglycerides. We observed increased values of CRP and leukocytes for group B in comparison to group A: 0.9±0.8 mg/dl vs 0.79±0.8 mg/dl (p=0.02, significantly statistic). Leukocytes value was higher for group B, but not significantly statistic. Inflammation in ...

Juvenile hemochromatosis represents a rare entity, caused by mutation of HFE2 gene-situated on ch... more Juvenile hemochromatosis represents a rare entity, caused by mutation of HFE2 gene-situated on chromosome 1 or HAMP gene-situated on chromosome 19, that, characteristically occurs in the first up to the third decade of life. Cardiomyopathy is frequent in these patients and sometimes is the path to diagnose the disease. Also, it represents the main cause of death. The authors expose the case of a patient diagnosed with juvenile hemochromatosis, with multiple organic involvement.The disease debuted with dilatative cardiomyopathy, involving the excitoconductor system (complete atrioventricular block with syncope). Despite all adequate therapeutic measures clinical outcome was severe, with patients death. Cuvinte cheie: hemocromatoza primitivă juvenilă, cardiomiopatie Rezumat: Hemocromatoza juvenilă reprezintă o entitate rară, cauzată de mutaţia genei HFE2-situată pe cromozomul 1 sau a genei HAMP-situată pe cromozomul 19, care, în mod caracteristic, se manifestă în prima până în treia d...

International Journal of Celiac Disease, 2016

Introduction. Celiac disease has a prevalence of 1% of the global population and it is increasing... more Introduction. Celiac disease has a prevalence of 1% of the global population and it is increasing every year. Viral infections such as hepatitis C and hepatitis B are the most common liver diseases and studies show that may be a link between them and celiac disease. Recent studies show attempts to find a link between viral infections and celiac disease. We focused our study on the association between viral infections and celiac disease. Material and Method. We studied 63 articles from the Pub Med Database that revealed a possible connection between viral infections and celiac disease. Results. Since it is more frequent, hepatitis C is associated with the development of celiac disease, but celiac disease is not the autoimmune manifestation of hepatitis C. Patients with celiac disease have a significantly decreased response to hepatitis B vaccine. Other viruses that are associated with celiac disease are: rotavirus, adenovirus, eterovirus and Epstein-Barr virus. Conclusions. The serol...

Cureus, 2021

In this report, we present the case of a one-year-old female patient with a history of febrile se... more In this report, we present the case of a one-year-old female patient with a history of febrile seizures, which was characterized by multiple seizures during hot baths and more than one episode of status epilepticus. Dravet syndrome was suspected due to the clinical context of the seizures and was confirmed by genetic testing. The brain MRI was found to be normal. Throughout the course of disease progression, the patient showed no signs of neurological degradation. The patient was found to have a mutation in the SCN1A gene with a peculiar course, which had not been reported previously. The normal psychomotor development, as seen in this case, highlights the different possibilities related to disease progression in Dravet syndrome.

International Journal of Celiac Disease, 2016

Celiac disease percentage is continuously increasing in recent years. Helicobacter pylori infecti... more Celiac disease percentage is continuously increasing in recent years. Helicobacter pylori infection is found in more than 50% of the population. Recent studies have attempted to discover a link between celiac disease and H. pylori infection. We analyzed the main immunopathological aspects of celiac disease associated with H. pylori infection. If celiac disease is associated with H. pylori infection, clinical evidence can occur: gastric lymphocytosis, duodenal lymphocytosis.

Gastroenterology and Hepatology From Bed to Bench, 2017

Celiac disease (CD) was initially a real enigma. There were many questions about what immunogenet... more Celiac disease (CD) was initially a real enigma. There were many questions about what immunogenetics markers could influence the immune response (1). Immunogenetic studies provided important contributions to improve the understanding of critical pathogenetic factors at molecular levels (DQ2, DQ8) (2). An important discovery was the recognition of more precise serological markers for CD, specifically anti-endomysial and anti-tissue transglutaminase antibodies leading to an exploration of their increasingly important role in clinical diagnosis of CD (3). Our aim is to explore new and old challenges with unanswered questions in CD diagnosis. The last Prague consensus report challenges Re-evaluation of CD diagnostic with intestinal biopsy is required in this consesus (4). However, many patients with CD are still inaccurately diagnosed (or remain undiagnosed), even in referral populations whom were evaluated at tertiary care centers: the diagnosis of CD was confirmed in only 64 patients ...

International Journal of Celiac Disease, 2020

Autoimmune diseases have a constellation of immunological changes that make possible the appearan... more Autoimmune diseases have a constellation of immunological changes that make possible the appearance of clinical manifestations. There are often similarities of clinical manifestations in these autoimmune diseases as possible associations of them during evolution.

Maedica, 2021

Background: The depressive syndrome is commonly found in children suffering from chronic diseases... more Background: The depressive syndrome is commonly found in children suffering from chronic diseases, which is also present in patients with juvenile idiopathic arthritis (JIA). Objective: This study proposed to analyze depression's incidence in children with JIA. We also monitored the evolution of depression with the improvement of the disease under treatment. Material and methods: We followed 145 patients suffering from JIA according to ILAR and Edmonton classification in 2001. The study was conducted over three years between 2015 and 2017. The assessment of depression was made using the Hamilton scale adapted for children by us. This scale consists of 11 fields with multiple questions, the evaluation was made by counting the score. The scale assesses overall depression intensity. It has a maximum score of 28 points, and one with eight points defines depression. Results: The results obtained using the Hamilton scale showed that, from the total of 145 patients suffering from JIA, ...

International Journal of Celiac Disease, 2017

Autoimmune diseases in children are a big challenge for doctors. These diseases have a long evolu... more Autoimmune diseases in children are a big challenge for doctors. These diseases have a long evolution over time and can be associated with other autoimmune disorders. Patient transfer from pediatric to adult health care service should be done with great responsibility in order to offer quality care to patients. Juvenile idiopathic arthritis and celiac disease are two of autoimmune diseases that can have an important impact on child development.

Celiac disease is an autoimmune disease caused by gluten in genetically predisposed persons. The ... more Celiac disease is an autoimmune disease caused by gluten in genetically predisposed persons. The prevalence of the disease in is about 1%. Early diagnosis of celiac disease is important because it allows the onset of gluten free diet that will prevent the occurrence of gastrointestinal cancers. Considering that the symptoms of the disease do not always include typical manifestations, diagnosis may not always be easily supported. This disease can evolve in various forms - masks of celiac disease - including: classic form, non-classical, subclinical and potential form. The risk of complications, especially cancer, increases with delay in diagnosis.

The celiac disease screening with IgA tissue transglutaminase antibodies depends on the cut-off r... more The celiac disease screening with IgA tissue transglutaminase antibodies depends on the cut-off reaction, therefore many patients with values less but close to the cut-off may be undiagnosed. Material and Method. We conducted the CD screening with IgA tissue transglutaminase antibodies in a group of 1616 children during 2014 at a cut-off of 25 U/ml and at a cut-off of 10 U/ml. We also wanted to compare our results with IgA tissue transglutaminase antibodies prevalence from other countries. Results. We found a IgA tissue transglutaminase antibodies prevalence rate of 3% for values higher 25 U/ml and a IgA tissue transglutaminase antibodies prevalence rate of 1.6% for values between 10-25 U/ml. A prevalence of 13.6% for IgA tissue transglutaminase antibodies was observed in , and . Conclusions. We observed a 4.6% IgA tissue transglutaminase antibodies prevalence at a cut-off of 10 U/ml. Prevalence of IgA tissue transglutaminase antibodies from Romania is lowered compared with other Eu...

Life

Journal of Clinical Medicine, Sep 6, 2022

Allergologia et Immunopathologia

Romanian Journal of Neurology, 2021

S. Afr. j. diabetes vasc. dis, 2014

Children, 2022

Gastroenterology and hepatology from bed to bench, 2016

MAEDICA – a Journal of Clinical Medicine, 2014

International Journal of Celiac Disease, 2016

Cureus, 2021

International Journal of Celiac Disease, 2016

Gastroenterology and Hepatology From Bed to Bench, 2017

International Journal of Celiac Disease, 2020

Maedica, 2021

International Journal of Celiac Disease, 2017

Celiac disease is an autoimmune disease caused by gluten in genetically predisposed persons. The ... more Celiac disease is an autoimmune disease caused by gluten in genetically predisposed persons. The prevalence of the disease in Western Europe is about 1%. Early diagnosis of celiac disease is important because it allows the onset of gluten free diet that will prevent the occurrence of gastrointestinal cancers. Considering that the symptoms of the disease do not always include typical manifestations, diagnosis may not always be easily supported. This disease can evolve in various forms-masks of celiac disease-including: classic form, non-classical, subclinical and potential form. The risk of complications, especially cancer, increases with delay in diagnosis.

Celiac disease remains one of the most challenging pathologies of the small intestine. It involve... more Celiac disease remains one of the most challenging pathologies of the small intestine. It involves multiple pathogenic pathways and there are no disease-changing pharmacological agents available against it yet. The term microbiota refers to the community of microorganisms that inhabit a particular region of the body. Normal gut microbiota has a vital role in maintaining the intestinal homeostasis and promoting health. Celiac disease is associated with microbiota alteration, especially with an increase in the number of Gram-negative bacteria and a decrease in the number of Gram-positive bacteria. There is a strong relationship between intestinal dysbiosis and celiac disease, and recent studies are aimed at determining whether the celiac disease is a risk factor for dysbiosis or dysbiosis is for celiac disease. Therefore, the aim of this review was to assess the latest findings regarding the gut microbiota and its impact on the celiac disease, including therapeutic aspects.

Celiac disease is still under diagnosed, although many diagnostic tests are available. Serologica... more Celiac disease is still under diagnosed, although many diagnostic tests are available. Serological tests revealed many clinical aspects of celiac disease. We will discuss in this review the most important findings in terms of diagnosis of celiac disease.

Celiac disease is a clinical entity that is not difficult to diagnose when it shows the classic s... more Celiac disease is a clinical entity that is not difficult to diagnose when it shows the classic symptoms. It was found that there are other forms of celiac disease that are difficult to diagnose because of atypical manifestations. The aim of this study is to describe the prevalence of different forms of celiac disease in accordance with 'The Oslo definitions for celiac disease and related terms' and therapeutic perspectives of this disease.

Central European Journal of Immunology, 2014

autoimmune diseases have become a major medical problem of recent years. celiac disease is an aut... more autoimmune diseases have become a major medical problem of recent years. celiac disease is an autoimmune disease model. The aim of our study was to follow the changes in the clinical autoimmunity picture of the celiac disease from recent years. The study of autoimmunity in celiac disease has focused on associated diseases with the aforementioned disease: type 1 diabetes mellitus, thyroid autoimmunity disease, Graves' disease, Hashimoto's disease, systemic lupus erythematosus, systemic sclerosis, spondyloarthritis, hyperprolactinemia, Turner syndrome, Addison's disease, sensory neuronopathies. immune reactivity to tissue transglutaminase targeted autoantibodies and other autoantigens, including transglutaminase 3, actin, ganglioside, collagen, calreticulin or zonulin which have been reported in the celiac disease. new research directions given by celiac disease autoimmunity, interleukin 1, interleukin 2, protein tyrosine phosphatase non-receptor type 22, cD4+cD25+ T lymphocytes, cytotoxic T-lymphocyte antigen 4, infection with necator americanus and definitive identification of pathogenic T cell epitopes, seem to provide a solution in celiac disease treatment.

Celiac disease has become extensively studied. What could be the cause? Increasing the accuracy o... more Celiac disease has become extensively studied. What could be the cause? Increasing the accuracy of diagnostic tests for celiac disease has led to more discovered cases. Serological diagnosis of celiac disease has undergone important changes in recent years. Application of serological tests has reflected the diagnostic performance of tissue transglutaminase antibody and endomysial antibody as screening tests for celiac disease but also the progress of new serological tests as the antibodies against synthetic deamidated gliadin peptides. Serological tests are largely responsible for the recognition that celiac disease is not a rare disease. The Consensus in celiac disease from 2008 conducted under the aegis of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition jointly with North American Society of Pediatric Gastroenterology, Hepatology and Nutrition which agreed that “Celiac disease is an immune-mediated enteropathy that can affect any system or organ and that can present itself with a wide range of clinical manifestations of variable severity” was confirmed. But increasing prevalence of this disease has led to the need for new methods of treatment among patients with celiac disease. Studies on quality of life of patients with celiac disease have questioned the gluten-free diet. As such new therapies, like TG2 inhibitors, the copolymer P (HEMA-co-SS) and other new experimental therapies, have emerged in celiac disease. The new therapies in celiac disease are based on new investigations in gluten toxicity screening, like K562(S)-cell agglutination, A1 and G12 monoclonal antibodies and proteomics. In this paper we want to present the investigative developments in celiac disease. We also want to find whether a new treatment in celiac disease is necessary.

HIV infection in Romania remains an important public health problem. In this paper we aimed to an... more HIV infection in Romania remains an important public health problem. In this paper we aimed to analyze the current situation of HIV infection in Romania in sociopolitical context, in terms of laboratory diagnosis. HIV epidemic in the years 1980-1990 had serious consequences on the Romanian society. After a period of decline of the infection, the development of new HIV cases in 2011 provided a warning to the Romanian society. The problem can be solved through the close cooperation of all social classes, from health professionals to politicians.

Superantigens represent a group of proteins that are able to activate a large number of different... more Superantigens represent a group of proteins that are able to activate a large number of different T lymphocytes
clones. Superantigens are potent activators of CD4+ T cells, causing rapid and massive proliferation of cells and
cytokine production. Superantigen administration is able to significantly enhance ineffective anti-tumor immune
responses, resulting in potent and long-lived protective anti-tumor immunity. Superantigens are more well-known
for the role they play in diseases. Some studies argue that in multiple sclerosis superantigens can induce severe
relapses and activate auto-reactive T cells not involved in the initial bout of disease. Superantigens are produced by
pathogenic microbes (bacteria, viruses and mycoplasma) into the cells and then are released outside the cells as
mature toxins. There are two types of super-antigens: endogenous (viral) and exogenous (bacterial). They escape
intracellular processing by binding directly to MHC II, outside the conventional site where antigens bind. Interaction
of super antigens with T lymphocyte can produce the inhibition of the cellular response to energy. Superantigens
may be involved in T cell apoptosis. Best known super-antigens are: staphylococcus aureus enterotoxins A and B
and the streptococcus exotoxins A-G, streptococcus wall M protein, exotoxins produced by Clostridium perfringens,
Yersinia enterocolitica. Recently it was ascertained that super-antigens play an important role in human pathology,
with a dramatic effect on the immune system. These molecules are involved in various diseases, such as: Toxic
shock syndrome, Kawasaki disease, Eczema, Guttate psoriasis, Rheumatoid arthtritis, Diabetes mellitus, Scarlet
fever, Nasal polyps.

The prevalence of gluten-related diseases is increasing in an alarming rate. The studies regardin... more The prevalence of gluten-related diseases is increasing in an alarming rate. The studies regarding wheat allergy in the Southeastern and Central Europe are few. The aim of our study was to discuss the effectiveness of serological tests in detecting the prevalence of specific allergens.

Correct treatment of anaphylaxis in emergency events is a key point to prevent death and subseque... more Correct treatment of anaphylaxis in emergency events is a key point to prevent death and subsequent events.
Anaphylaxis can be quickly diagnosed if we recognize respiratory and circulatory manifestations and we correctly
assess mental status. The first and most important treatment is epinephrine. After successful therapy, the clinician’s
attention must be directed toward preventing recurrences- biphasic anaphylaxis and to elucidate the causes. The
patient will need to be explained the importance of preventing relapse and needs to be equipped with epinephrine,
which to use in critical situations. There are differences concerning therapeutic approach, recognition of symptoms
and patient education, depending on physician’s experience, on patient’s education level and on socio-economic
level of their country.

Urticaria is common in pathology. Urticaria and angioedema with persistent symptoms have a signif... more Urticaria is common in pathology. Urticaria and angioedema with persistent symptoms have a significant effect
on quality of life and activity. Typical manifestations of urticaria are not difficult to diagnose. Association of urticaria
with angioedema is relatively common, about 50% of cases. This association can be life-threatening requiring
intensive care. Urticaria treatment is not easy and when angioedema associated therapeutic measures should be
complex. Etiological treatment is the most desirable option for physician and patient, but in many cases the cause
cannot be identified. Non-sedating H1
-antihistamines are considered first-line treatment of urticaria.

Urticaria and angioedema are common diseases in children and adults. Erythematous swelling of the... more Urticaria and angioedema are common diseases in children and adults. Erythematous swelling of the deeper
cutaneous and subcutaneous tissue is called angioedema. Urticaria is characterized as the appearance of
erythematous, circumscribed, elevated, pruritic, edematous swelling of the upper dermal tissue. Urticaria may occur
in any part of the body, whereas angioedema often involves face, extremities or genitalia. Urticaria is considered
acute if symptoms are present for less than 6 weeks. In chronic urticaria symptoms are longer than 6 weeks. Acute
urticaria has been reported to be the common type in childhood and chronic urticaria is more frequent in adults.
Urticaria and angioedema are a frequent cause of emergency room visit but few patients need to be admitted.
The basic mechanism involves the release of diverse vasoactive mediators that arise from the activation of cells or
enzymatic pathways. Histamine is the best known of these substances, and response consisting of vasodilatation
(erythema), increased vascular permeability (edema) and an axon reflex that increases reaction. The most common
etiological factors for angioedema and urticaria have been identified as infection, physical urticaria, food allergy, drug
adverse reaction, parasitic infestation and papular urticaria. The aim of this study is to define, describe and discuss
etiology, diagnostic, treatment and severity.

Journal of Biomolecular Research & Therapeutics, 2012

Our immunological system is every day under threat from different bacteria, viruses and disease. ... more Our immunological system is every day under threat from different bacteria, viruses and disease. One of those many diseases is celiac disease. Once this disease affects the metabolism, it produces an imbalance of the electrolyte in blood. Therefore diagnostic tests are very important.