Medicina

Research

17 pages, 1620 KiB

Open AccessArticle

Beyond the Acute Phase: Long-Term Impact of COVID-19 on Functional Capacity and Prothrombotic Risk—A Pilot Study

by Doina-Clementina Cojocaru, Florin Mitu, Maria-Magdalena Leon, Lucia Corina Dima-Cozma, Cristina Andreea Adam, Carmen Marinela Cumpăt, Robert D. Negru, Alexandra Maștaleru and Viviana Onofrei

Medicina 2024, 60(1), 51; https://doi.org/10.3390/medicina60010051 - 27 Dec 2023

Cited by 1 | Viewed by 1690

Abstract

Background and Objectives: Assessment of the prothrombotic, proinflammatory, and functional status of a cohort of COVID-19 patients at least two years after the acute infection to identify parameters with potential therapeutic and prognostic value. Materials and Methods: We conducted a retrospective, [...] Read more.

Background and Objectives: Assessment of the prothrombotic, proinflammatory, and functional status of a cohort of COVID-19 patients at least two years after the acute infection to identify parameters with potential therapeutic and prognostic value. Materials and Methods: We conducted a retrospective, descriptive study that included 117 consecutive patients admitted to Iasi Pulmonary Rehabilitation Clinic for reassessment and a rehabilitation program at least two years after a COVID-19 infection. The cohort was divided into two groups based on the presence (n = 49) or absence (n = 68) of pulmonary fibrosis, documented through high-resolution computer tomography. Results: The cohort comprises 117 patients, 69.23% females, with a mean age of 65.74 ± 10.19 years and abnormal body mass index (31.42 ± 5.71 kg/m²). Patients with pulmonary fibrosis have significantly higher levels of C-reactive protein (CRP) (p < 0.05), WBC (7.45 ± 7.86/mm³ vs. 9.18 ± 17.24/mm³, p = 0.053), neutrophils (4.68 ± 7.88/mm³ vs. 9.07 ± 17.44/mm³, p < 0.05), mean platelet volume (MPV) (7.22 ± 0.93 vs. 10.25 ± 0.86 fL, p < 0.05), lactate dehydrogenase (p < 0.05), and D-dimers (p < 0.05), but not ferritin (p = 0.470), reflecting the chronic proinflammatory and prothrombotic status. Additionally, patients with associated pulmonary fibrosis had a higher mean heart rate (p < 0.05) and corrected QT interval (p < 0.05). D-dimers were strongly and negatively correlated with diffusion capacity corrected for hemoglobin (DLCO corr), and ROC analysis showed that the persistence of high D-dimers values is a predictor for low DLCO values (ROC analysis: area under the curve of 0.772, p < 0.001). The results of pulmonary function tests (spirometry, body plethysmography) and the 6-minute walk test demonstrated no significant difference between groups, without notable impairment within either group. Conclusions: Patients with COVID-19-related pulmonary fibrosis have a persistent long-term proinflammatory, prothrombotic status, despite the functional recovery. The persistence of elevated D-dimer levels could emerge as a predictive factor associated with impaired DLCO. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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11 pages, 636 KiB

Open AccessArticle

Clinical Characteristics and Diagnostic Prediction of Severe Fever with Thrombocytopenia Syndrome and Rickettsiosis in the Co-Endemic Wakayama Prefecture, Japan

by Kan Teramoto, Shinobu Tamura, Kikuaki Yoshida, Yukari Inada, Yusuke Yamashita, Masaya Morimoto, Toshiki Mushino, Daisuke Koreeda, Kyohei Miyamoto, Nobuhiro Komiya, Yoshio Nakano, Yusaku Takagaki and Yusuke Koizumi

Medicina 2023, 59(11), 2024; https://doi.org/10.3390/medicina59112024 - 17 Nov 2023

Cited by 2 | Viewed by 1845

Abstract

Background and Objectives: The Wakayama prefecture is endemic for two types of tick-borne rickettsioses: Japanese spotted fever (JFS) and scrub typhus (ST). Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne hemorrhagic viral disease with a high mortality rate and is often [...] Read more.

Background and Objectives: The Wakayama prefecture is endemic for two types of tick-borne rickettsioses: Japanese spotted fever (JFS) and scrub typhus (ST). Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne hemorrhagic viral disease with a high mortality rate and is often difficult to differentiate from such rickettsioses. SFTS cases have recently increased in Wakayama prefecture. For early diagnosis, this study aimed to evaluate the clinical characterization of such tick-borne infections in the co-endemic area. Materials and Methods: The study included 64 febrile patients diagnosed with tick-borne infection in Wakayama prefecture between January 2013 and May 2022. Medical records of 19 patients with SFTS and 45 with rickettsiosis (JSF, n = 26; ST, n = 19) were retrospectively examined. The receiver operating curve (ROC) and area under the curve (AUC) were calculated to evaluate potential factors for differentiating SFTS from rickettsiosis. Results: Adults aged ≥70 years were most vulnerable to tick-borne infections (median, 75.5 years; interquartile range, 68.5–84 years). SFTS and rickettsiosis occurred mostly between summer and autumn. However, no significant between-group differences were found in age, sex, and comorbidities; 17 (89%) patients with SFTS, but none of those with rickettsiosis, experienced gastrointestinal symptoms such as vomiting, abdominal pain, and diarrhea. Meanwhile, 43 (96%) patients with rickettsiosis, but none of those with SFTS, developed a skin rash. The AUCs of white blood cells (0.97) and C-reactive protein (CRP) levels (0.98) were very high. Furthermore, the differential diagnosis of SFTS was significantly associated with the presence of gastrointestinal symptoms (AUC 0.95), the absence of a skin rash (AUC 0.98), leukopenia <3.7 × 10⁹/L (AUC 0.95), and low CRP levels < 1.66 mg/dL (AUC 0.98) (p < 0.001 for each factor). Conclusions: Clinical characteristics and standard laboratory parameters can verify the early diagnosis of SFTS in areas where tick-borne infections are endemic. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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15 pages, 3471 KiB

Open AccessArticle

Evaluation and Performance of a Positive Airway Pressure Device (CPAP-AirFlife™): A Randomized Crossover Non-Inferiority Clinical Study in Normal Subjects

by Héctor A. Tinoco, Luis Perdomo-Hurtado, Joismer A. Henao-Cruz, José F. Escobar-Serna, Oscar Jaramillo-Robledo, Oscar D. Aguirre-Ospina, Mateo Hurtado-Hernández and Juliana Lopez-Guzman

Medicina 2023, 59(8), 1372; https://doi.org/10.3390/medicina59081372 - 27 Jul 2023

Viewed by 1962

Abstract

Background and Objectives: During the COVID-19, the demand for non-invasive ventilatory support equipment significantly increased. In response, a novel non-invasive ventilatory support model called CPAP-AirFlife™ was developed utilizing existing technologies. This model offers technological advantages, including an aerosol-controlled helmet suitable for high-risk [...] Read more.

Background and Objectives: During the COVID-19, the demand for non-invasive ventilatory support equipment significantly increased. In response, a novel non-invasive ventilatory support model called CPAP-AirFlife™ was developed utilizing existing technologies. This model offers technological advantages, including an aerosol-controlled helmet suitable for high-risk environments such as ambulances. Additionally, it is cost-effective and does not require medical air, making it accessible for implementation in low-level hospitals, particularly in rural areas. This study aimed to assess the efficacy of CPAP-AirFlife™ by conducting a non-inferiority comparison with conventional ventilation equipment used in the Intensive Care Unit. Materials and Methods: A clinical study was conducted on normal subjects in a randomized and sequential manner. Parameters such as hemoglobin oxygen saturation by pulse oximetry, exhaled PCO₂ levels, vital signs, and individual tolerance were compared between the CPAP-AirFlife™ and conventional equipment. The study population was described in terms of demographic characteristics and included in the analysis. Results: It was shown that the CPAP-AirFlife™ was not inferior to conventional equipment in terms of efficacy or tolerability. Hemoglobin oxygen saturation levels, exhaled PCO₂ levels, vital signs, and individual tolerance did not significantly differ between the two models. Conclusions: The findings suggest that CPAP-AirFlife™ is a practical and cost-effective alternative for non-invasive ventilatory support. Its technological advantages, including the aerosol-controlled helmet, make it suitable for high-risk environments. The device’s accessibility and affordability make it a promising solution for implementation in low-level hospitals, particularly in rural areas. This study supports using CPAP-AirFlife™ as a practical option for non-invasive ventilatory support, providing a valuable contribution to respiratory care during the COVID-19 pandemic and beyond. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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14 pages, 880 KiB

Open AccessArticle

Fungal Infections Identified with Multiplex PCR in Severe COVID-19 Patients during Six Pandemic Waves

by Iulia Bogdan, Akash Reddy Reddyreddy, Aditya Nelluri, Ram Kiran Maganti, Felix Bratosin, Roxana Manuela Fericean, Catalin Dumitru, Paula Irina Barata, Gianina Tapalaga and Iosif Marincu

Medicina 2023, 59(7), 1253; https://doi.org/10.3390/medicina59071253 - 5 Jul 2023

Cited by 3 | Viewed by 2154

Abstract

Background and Objectives: With an increasing number of severe COVID-19 cases presenting with secondary fungal infections, this study aimed to determine the prevalence of fungal co-infections in severe COVID-19 patients across the six waves, identify the most common fungal pathogens associated with [...] Read more.

Background and Objectives: With an increasing number of severe COVID-19 cases presenting with secondary fungal infections, this study aimed to determine the prevalence of fungal co-infections in severe COVID-19 patients across the six waves, identify the most common fungal pathogens associated with severe COVID-19, and explore any potential links between patient characteristics, therapeutic strategies, and the prevalence and type of fungal infection. Materials and Methods: A retrospective analysis was conducted on severe COVID-19 patients admitted to the Infectious Diseases and Pulmonology Hospital, “Victor Babes”, Romania, between March 2020 and August 2022. Samples were collected from respiratory specimens, blood, and urine, after which a standard nucleic acid extraction protocol was employed. Patients were divided into groups with and without fungal infections, identified using multiplex PCR. The groups were compared based on demographic data, comorbidities, pandemic wave number, and clinical outcomes. Results: Out of 288 patients, 96 (33.3%) had fungal infections, with Candida spp. being the most common. Patients with fungal infections had higher rates of obesity (35.4% vs. 21.4%, p = 0.010) and a higher Charlson comorbidity index (CCI > 2) (37.5% vs 25.0%, p = 0.027). Ventilator use was significantly higher in the fungal infection group (45.8% vs. 18.8%; p < 0.001), as was ICU admission (39.6% vs. 26.6%; p = 0.024) and mortality (32.3% vs 12.0%; p < 0.001). The distribution of different fungal species varied across the pandemic waves, with no statistical significance (p = 0.209). The mortality risk notably increased with the degree of drug resistance (OR for three or more drug resistances = 6.71, p < 0.001). The second, fourth, and fifth pandemic waves were significantly associated with higher mortality risk (OR = 3.72, 3.61, and 4.08, respectively, all p < 0.001). Aspergillus spp. and Mucor spp. infections were significantly associated with increased mortality risk (OR = 4.61 and 6.08, respectively, both p < 0.001). Conclusions: Our study indicates a significant presence of fungal co-infections among severe COVID-19 patients that is associated with increased morbidity and mortality, particularly in patients with drug-resistant infections. These findings underline the necessity for comprehensive diagnostic approaches and tailored treatment strategies in managing COVID-19 patients, especially during specific pandemic waves and in patients with particular fungal infections. Further research is required to understand the implications of these co-infections and their management. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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18 pages, 356 KiB

Open AccessArticle

COVID-19 Biomarkers Comparison: Children, Adults and Elders

by Ionut Dragos Capraru, Dan Dumitru Vulcanescu, Iulia Cristina Bagiu, Florin George Horhat, Irina Maria Popescu, Luminita Mirela Baditoiu, Delia Muntean, Monica Licker, Matilda Radulescu, Ion Cristian Mot, Mircea Mihai Diaconu and Catalin Marian

Medicina 2023, 59(5), 877; https://doi.org/10.3390/medicina59050877 - 3 May 2023

Cited by 8 | Viewed by 2601

Abstract

Background and Objectives: this study aimed to research links between C-reactive protein (CRP), lactate dehydrogenase (LDH), creatinekinase (CK), 25-OH vitamin D (25-OHD), ferritin (FER), high-density lipoprotein cholesterol (HDL)cholesterol and clinical severity in patients from the western part of Romania, and compare their potential [...] Read more.

Background and Objectives: this study aimed to research links between C-reactive protein (CRP), lactate dehydrogenase (LDH), creatinekinase (CK), 25-OH vitamin D (25-OHD), ferritin (FER), high-density lipoprotein cholesterol (HDL)cholesterol and clinical severity in patients from the western part of Romania, and compare their potential use as biomarkers for intensive care units (ICU) admission and death in children, adults and elders. Materials and Methods: this study is a retrospective cohort study, performed on patients positively diagnosed with COVID-19. Available CRP, LDH, CK 25-OH vitamin D, ferritin, HDL cholesterol and clinical severity were recorded. The following were assessed: median group differences, association, correlation and receiver operating characteristic. Results: 381 children, 614 adults and 381 elders were studied between 1 March 2021 and 1 March 2022. Most children and adults presented mild symptomatology (53.28%, 35.02%, respectively), while most elders presented severe symptomatology (30.04%). ICU admission was 3.67% for children, 13.19% for adults and 46.09% for elders, while mortality was 0.79% for children, 8.63% for adults and 25.1% for elders. With the exception of CK, all other biomarkers showed some significant associations with clinical severity, ICU admission and death. Conclusions: CRP, LDH, 25-OH vitamin D, ferritin and HDL are important biomarkers for COVID-19 positive patients, especially in the pediatric population, while CK was mostly within normal ranges. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

8 pages, 627 KiB

Open AccessArticle

Evaluation of Early Warning Scores on In-Hospital Mortality in COVID-19 Patients: A Tertiary Hospital Study from Taiwan

by Weide Tsai, Chun Chen, Szu-Yang Jo, Chien-Han Hsiao, Ding-Kuo Chien, Wen-Han Chang and Tse-Hao Chen

Medicina 2023, 59(3), 464; https://doi.org/10.3390/medicina59030464 - 26 Feb 2023

Cited by 2 | Viewed by 2403

Abstract

Coronavirus disease 2019 (COVID-19) remains a global pandemic. Early warning scores (EWS) are used to identify potential clinical deterioration, and this study evaluated the ability of the Rapid Emergency Medicine score (REMS), National Early Warning Score (NEWS), and Modified EWS (MEWS) to predict [...] Read more.

Coronavirus disease 2019 (COVID-19) remains a global pandemic. Early warning scores (EWS) are used to identify potential clinical deterioration, and this study evaluated the ability of the Rapid Emergency Medicine score (REMS), National Early Warning Score (NEWS), and Modified EWS (MEWS) to predict in-hospital mortality in COVID-19 patients. This study retrospectively analyzed data from COVID-19 patients who presented to the emergency department and were hospitalized between 1 May and 31 July 2021. The area under curve (AUC) was calculated to compare predictive performance of the three EWS. Data from 306 COVID-19 patients (61 ± 15 years, 53% male) were included for analysis. REMS had the highest AUC for in-hospital mortality (AUC: 0.773, 95% CI: 0.69–0.85), followed by NEWS (AUC: 0.730, 95% CI: 0.64–0.82) and MEWS (AUC: 0.695, 95% CI: 0.60–0.79). The optimal cut-off value for REMS was 6.5 (sensitivity: 71.4%; specificity: 76.3%), with positive and negative predictive values of 27.9% and 95.4%, respectively. Computing REMS for COVID-19 patients who present to the emergency department can help identify those at risk of in-hospital mortality and facilitate early intervention, which can lead to better patient outcomes. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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16 pages, 1584 KiB

Open AccessArticle

The Assessment of Antimicrobial Resistance in Gram-Negative and Gram-Positive Infective Endocarditis: A Multicentric Retrospective Analysis

by Camelia Melania Budea, Marius Pricop, Ion Cristian Mot, Florin George Horhat, Kakarla Hemaswini, Raja Akshay, Rodica Anamaria Negrean, Andrada Licinia Oprisoni, Cosmin Citu, Bogdan Andrei Bumbu, Abduljabar Adi, Ibrahim Khan, Adelina Mavrea, Iulia Bogdan, Adrian Vasile Bota, Roxana Manuela Fericean and Iosif Marincu

Medicina 2023, 59(3), 457; https://doi.org/10.3390/medicina59030457 - 24 Feb 2023

Cited by 4 | Viewed by 3126

Abstract

Background and Objectives: Multidrug-resistant microorganisms have made treating bacterial infections challenging. Resistance to antibiotics is expected to overcome efforts to produce new, effective antibacterial medication that is lifesaving in many situations. Infective endocarditis (IE) is a life-threatening infection that affects 5–15 per 100,000 [...] Read more.

Background and Objectives: Multidrug-resistant microorganisms have made treating bacterial infections challenging. Resistance to antibiotics is expected to overcome efforts to produce new, effective antibacterial medication that is lifesaving in many situations. Infective endocarditis (IE) is a life-threatening infection that affects 5–15 per 100,000 patients annually and requires rapid antibiotic therapy to prevent morbidity and mortality. Materials and Methods: The present research assessed IE cases over five years, from a multicentric database, with the main objective of determining the degree of antibiotic resistance in these patients, stratified by Gram-positive and Gram-negative bacteria. Results: Bad oral hygiene was present in 58.6% of patients from the Gram-negative group (vs. 38.7% in the Gram-positive group). Non-valvular heart disease was identified in approximately 40% of all patients, and valvopathies in approximately 20%. It was observed that 37.9% of Gram-negative IE bacteria were resistant to three or more antibiotics, whereas 20.7% were susceptible. Among Gram-positive infections, S. aureus was the most commonly involved pathogen, with a multidrug-resistant pattern in 11.2% of patients, while Acinetobacter baumannii had the highest resistance pattern of all Gram-negative pathogens, with 27.4% of all samples resistant to three or more antibiotics. Patients with Gram-negative IE were 4.2 times more likely to die. The mortality risk was 4 times higher when bacteria resistant to two or more antibiotics was involved and 5.7 times higher with resistance patterns to three or more antibiotics than the reference group with no antibiotic resistance. Peripheral catheters were the most common cause of multi-resistant IE, followed by heart surgery, dental procedures, and ENT interventions. Conclusions: Even though Gram-positive infections were the most frequent (83.0% of all cases), Gram-negative IE infections are substantially more deadly than Gram-positive IE infections. However, it was also observed that patients with Gram-negative infections were more likely to have underlying comorbidities, be institutionalized, and be underweight. Although the Gram-negative infections were more severe, their resistance patterns were similar to Gram-positive bacteria. As resistance patterns increase, more efforts should be made to prevent a healthcare catastrophe. At the same time, careful prophylaxis should be considered in patients at risk, including those with central catheters, undergoing dental procedures, and with poor oral hygiene. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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Review

Jump to: Research, Other

14 pages, 648 KiB

Open AccessReview

Concurrent Sphingomonas paucimobilis and Mycobacterium tuberculosis Meningitis in an Immunocompromised Patient: A Rare Case Report and Comprehensive Review of Literature

by Iosif Marincu, Felix Bratosin, Iulia Bogdan, Catalin Dumitru, Carmen Nicoleta Stoica, Andrei Nicolae Csep, Narcisa Mederle, Roxana Manuela Fericean, Alexandru Ovidiu Mederle, Reshmanth Prathipati, Gratiana Nicoleta Chicin, Adelina Mavrea, Paula Irina Barata and Adrian Vasile Bota

Medicina 2023, 59(4), 687; https://doi.org/10.3390/medicina59040687 - 30 Mar 2023

Cited by 1 | Viewed by 3330

Abstract

Sphingomonas paucimobilis is a gram-negative bacillus that is widely distributed in the environment but rarely causes infections in humans. Meningitis caused by S. paucimobilis is an extremely rare clinical entity with very few reported cases in the literature. The clinical presentation and management [...] Read more.

Sphingomonas paucimobilis is a gram-negative bacillus that is widely distributed in the environment but rarely causes infections in humans. Meningitis caused by S. paucimobilis is an extremely rare clinical entity with very few reported cases in the literature. The clinical presentation and management of S. paucimobilis meningitis are not well established, and further research is needed to better understand this rare infection. Therefore, the goal of this study was to present probably the only case of meningitis caused by co-infection with S. paucimobilis and Mycobacterium tuberculosis and to describe the diagnostic and therapeutic challenges encountered, in correlation with the other very few reported cases of S. paucimobilis meningitis. A 64-year-old male farmer residing in a rural area was admitted with symptoms of severe headache, somnolence, and confusion. He had several comorbidities, including adrenal insufficiency, duodenal ulcer, and hypercholesterolemia. Lumbar puncture showed elevated leukocyte counts, glucose, and a marked rise of cerebrospinal fluid (CSF) proteins, indicating bacterial meningitis, which was confirmed by CSF culture that isolated S. paucimobilis and Mycobacterium tuberculosis. Antituberculosis therapy was initiated with isoniazid (300 mg/day), rifampicin (600 mg/day), pyrazinamide (2000 mg/day), and streptomycin (1 g/day). Ceftriaxone was introduced nine days later, after CSF culture grew S. paucimobilis, and was discharged without complications after 40 days of hospitalization. The literature search revealed a total of 12 published cases of S. paucimobilis meningitis in patients ranging from two months old to 66 years old. Among these cases, eight (66%) reported a favorable outcome, while two (17%) cases resulted in a poor outcome, and two (17%) were fatal. It was observed among the 13 identified cases (including ours) that the CSF white blood cell count had an average of 178.9 × 10³/mm³, an average glucose level of 33.0 mg/dL, and an average protein count of 294.2 mg/dL. Most cases improved appropriately under antibiotic therapy with intravenous ceftriaxone, Meropenem, and Vancomycin. In conclusion, although extremely rare, S. paucimobilis meningitis has good outcomes even in immunocompromised patients with appropriate antibiotic therapy and close monitoring, while the diagnosis should not be excluded even in immunocompetent patients. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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13 pages, 1492 KiB

Open AccessReview

Post-COVID-19 Spondylodiscitis: A Case Study and Review of the Literature

by George-Cosmin Popovici, Costinela-Valerica Georgescu, Anca-Adriana Arbune, Mihaela-Camelia Vasile, Ionut Olteanu and Manuela Arbune

Medicina 2023, 59(3), 616; https://doi.org/10.3390/medicina59030616 - 20 Mar 2023

Cited by 3 | Viewed by 5502

Abstract

COVID-19 is currently a major health problem, leading to respiratory, cardiovascular and neurological complications, with additional morbidity and mortality. Spinal infections are rare, representing around 1% of all bone infections and comprising less than 2 per 10,000 of all hospitalizations in tertiary care [...] Read more.

COVID-19 is currently a major health problem, leading to respiratory, cardiovascular and neurological complications, with additional morbidity and mortality. Spinal infections are rare, representing around 1% of all bone infections and comprising less than 2 per 10,000 of all hospitalizations in tertiary care centers. Spondylodiscitis is a complex disease, with challenging diagnosis and management. We report the case of a 45-year-old man, non-smoker hospitalized for severe COVID-19 disease with respiratory failure. Post-COVID-19, in the 8th week after discharge, he was diagnosed by magnetic resonance imaging with spondylodiscitis, but etiology was not confirmed by microbiological investigations. Antibiotics were used, considering the identification of MRSA from cultures of pleural fluid and nasal swab, but surgical intervention was not provided. Clinic, biologic and imagistic were improved, but rehabilitation and long term follow up are necessary. We concluded that spondylodiscitis with spinal abscess is a rare but severe complication post-COVID-19 disease, due to dysbalanced immune response related to the respiratory viral infection, endothelial lesions, hypercoagulation and bacterial superinfection. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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Other

Jump to: Research, Review

10 pages, 668 KiB

Open AccessCase Report

Polymicrobial Bacterial Meningitis in a Patient with Chronic Suppurative Otitis Media: Case Report and Literature Review

by Andrei Vâţă, Erika Irimie-Băluţă, Florin Manuel Roşu, Ioana Maria Onofrei, Isabela Ioana Loghin, Mihaela Perţea, Andrei Nicolae Avădanei, Mihnea Miron, Luminiţa Rădulescu, Irina Eşanu and Cătălina Mihaela Luca

Medicina 2023, 59(8), 1428; https://doi.org/10.3390/medicina59081428 - 7 Aug 2023

Cited by 3 | Viewed by 2709

Abstract

Polymicrobial meningitis is a rare entity in the adult population, especially in the antibiotic era. However, disorders such as chronic suppurative otitis media (CSOM) or even poor oral hygiene are considered risk factors for the development of such cerebral infection. We report a [...] Read more.

Polymicrobial meningitis is a rare entity in the adult population, especially in the antibiotic era. However, disorders such as chronic suppurative otitis media (CSOM) or even poor oral hygiene are considered risk factors for the development of such cerebral infection. We report a case of polymicrobial meningitis associated with oto-mastoiditis in a 64-year-old female patient known to have CSOM. The patient presented atypical symptoms for community-acquired meningitis, showing subacute evolution of headache, without fever or neck stiffness. The aerobe microorganisms Streptococcus anginosus and Corynebacterium spp., sensitive to beta-lactamines, and the anaerobe Prevotella spp., resistant to penicillin and metronidazole, were isolated from CSF specimens, while Proteus mirabilis and Enterococcus faecalis were identified from the ear drainage. The diversity of pathogens identified in our case led us to the hypothesis of two different sources of meningitis: otogenic and/or odontogenic. Favorable evolution was obtained after a multi-disciplinary approach, combining surgery and broad-spectrum antibiotics. In addition, we performed a literature review that highlights the low incidence of polymicrobial mixed aerobe–anaerobe meningitis. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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22 pages, 1235 KiB

Open AccessSystematic Review

COVID-19 and the Use of Angiotensin II Receptor Blockers in Older Chronic Hypertensive Patients: Systematic Review and Meta-Analysis

by Miguel Quesada-Caballero, Ana Carmona-García, Sara Chami-Peña, Luis Albendín-García, Cristina Membrive-Jiménez, José L. Romero-Béjar and Guillermo A. Cañadas-De la Fuente

Medicina 2023, 59(7), 1200; https://doi.org/10.3390/medicina59071200 - 26 Jun 2023

Cited by 3 | Viewed by 2186

Abstract

Angiotensin II-converting enzyme inhibitors (ACEIs) and selective angiotensin II receptor antagonists (ARAIIs) are widely used antihypertensive agents. Their use has generated controversy due to their possible influence on the health status of chronic patients infected with COVID-19. The objective of this work is [...] Read more.

Angiotensin II-converting enzyme inhibitors (ACEIs) and selective angiotensin II receptor antagonists (ARAIIs) are widely used antihypertensive agents. Their use has generated controversy due to their possible influence on the health status of chronic patients infected with COVID-19. The objective of this work is to analyze the influence of COVID-19 on chronic hypertensive patients treated with ACEI and ARAII inhibitors. A systematic review and meta-analysis in the databases Pubmed, Pro-Quest and Scopus were carried out. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search equation descriptors were obtained from the Medical Subject Headings (MeSH) thesaurus. The search equation was: “Older AND hypertension AND (COVID-19 OR coronavirus) AND primary care” and its equivalent in Spanish. Nineteen articles were obtained, with n = 10,806,159 subjects. Several studies describe the COVID-19 association with ACEI or ARAII treatment in hypertension patients as a protective factor, some as a risk factor, and others without a risk association. In the case of ACEI vs. ARAII, the risk described for the former has an odds ratio (OR) of 0.55, and for ARAII, an OR of 0.59. Some authors talk about mortality associated with COVID-19 and ACEI with a half ratio (HR) of 0.97, and also associated ARAIIs with an HR of 0.98. It is recommended to maintain the use of the renin–angiotensin–aldosterone axis in the context of the COVID-19 disease. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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9 pages, 315 KiB

Open AccessStudy Protocol

A Study on the Contributions of Sonication to the Identification of Bacteria Associated with Intubation Cannula Biofilm and the Risk of Ventilator-Associated Pneumonia

by Ioana Roxana Codru, Mihai Sava, Bogdan Ioan Vintilă, Alina Simona Bereanu and Victoria Bîrluțiu

Medicina 2023, 59(6), 1058; https://doi.org/10.3390/medicina59061058 - 31 May 2023

Cited by 9 | Viewed by 1834

Abstract

Ventilator-associated pneumonia is one of the most severe complications of critically ill patients that need mechanical respiratory support, as it poses a significant risk of prolonging hospitalization, disability, and even death. This is why physicians worldwide target newer methods for prevention, early diagnosis, [...] Read more.

Ventilator-associated pneumonia is one of the most severe complications of critically ill patients that need mechanical respiratory support, as it poses a significant risk of prolonging hospitalization, disability, and even death. This is why physicians worldwide target newer methods for prevention, early diagnosis, and early target treatment for this condition. There are few methods for a quick etiological diagnosis of pneumonia, especially point of care, and most are only readily available in some intensive care units. This is why a new, simple, and cheap method is needed for determining the bacteria that might be infectious in a particular patient. The manner in question is sonication. Method: In this prospective, observational, single-center study, endotracheal cannula specimens will be collected from at least 100 patients in our intensive care unit. This specimen will be submitted to a specific sonication protocol for bacteria to dislodge the biofilm inside the cannula. The resulting liquid will be seeded on growth media, and then a comparison will be made between the germs in the biofilm and the ones in the tracheal secretion of the patient. The primary purpose is to determine the bacteria before the appearance of a manifest infection. Full article

(This article belongs to the Special Issue Diagnosis and Possible Therapeutic Options for COVID-19 and Other Infectious Diseases)

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