The study evaluated the evolution of the incidence of infections with Klebsiella in the County Clinical Emergency Hospital of Craiova (SCJUC), Romania. Also, we monitored antibiotic resistance over more than two years and detected changes in resistance to various antimicrobial agents. Our study included 2062 patients (823 women and 1239 men) hospitalised in SCJUC during the period 1st of September 2017 to 30 June 2019. In 458 patients (22.21%) from the 2062 total patients, the collected samples (1116) were positive and from those, we isolated 251 strains of Klebsiella spp. We conducted a longitudinal analysis of the prevalence of Klebsiella spp. over calendar months, which showed a prevalence in surgical wards that ranged between 5.25% and 19.49% in June 2018, while in medical wards the variation was much wider, between 5.15% and 17.36% in April 2018. Klebsiella spp. strains showed significant resistance to Amoxicillin/Clavulanate, Aztreonam and Cephalosporins such as Ceftriaxone, Ceftazidime and Cefepime. We examined the possible link with the consumption of antibiotics in the same month by performing a multiple linear regression analysis. The evolution of antibiotic resistance in Klebsiella was correlated with the variation of resistance in other bacteria, which suggests common resistance mechanisms in the hospital environment. By performing the regression for dependency between antibiotic resistance and antibiotic consumption, we observed some correlations between antibiotic consumption and the development of antibiotic resistance after 1, 2 and even 3 months (e.g., resistance to meropenem was influenced by the consumption in the hospital ward of imipenem 1 month and two months before, but only 1 month before by the consumption of meropenem). The clustering of strains showed filiation between multiresistant Klebsiella spp. strains isolated from specific patients from the ICU. The evolution of prevalence and antibiotic resistance in Klebsiella correlated with the resistance in other bacteria, which suggest common resistance mechanisms in the hospital environment, and also with the consumption of antibiotics.
(1) Background: The new SARS-COV-2 pandemic overwhelmed intensive care units, clinicians, and radiologists, so the development of methods to forecast the diagnosis’ severity became a necessity and a helpful tool. (2) Methods: In this paper, we proposed an artificial intelligence-based multimodal approach to forecast the future diagnosis’ severity of patients with laboratory-confirmed cases of SARS-CoV-2 infection. At hospital admission, we collected 46 clinical and biological variables with chest X-ray scans from 475 COVID-19 positively tested patients. An ensemble of machine learning algorithms (AI-Score) was developed to predict the future severity score as mild, moderate, and severe for COVID-19-infected patients. Additionally, a deep learning module (CXR-Score) was developed to automatically classify the chest X-ray images and integrate them into AI-Score. (3) Results: The AI-Score predicted the COVID-19 diagnosis’ severity on the testing/control dataset (95 patients) with an average accuracy of 98.59%, average specificity of 98.97%, and average sensitivity of 97.93%. The CXR-Score module graded the severity of chest X-ray images with an average accuracy of 99.08% on the testing/control dataset (95 chest X-ray images). (4) Conclusions: Our study demonstrated that the deep learning methods based on the integration of clinical and biological data with chest X-ray images accurately predicted the COVID-19 severity score of positive-tested patients.
Due to complex interplay between host and viral factors, pathogenesis of chronic hepatitis C (CHC) is considered a challenging issue. Infection with hepatitis C virus (HCV) is not confined only to liver but can induce disturbances in many other organs and systems. Our primary aim for this study was to evaluate biological response rates and sustained virological response (SVR) in patients diagnosed with CHC, treated with Interferon-alpha (IFN-α), Pegylated (PEG)-IFN-α2a or -α2b plus Ribavirin. The second aim of the study was the identification of predictive factors for a favorable response to antiviral therapy in patients diagnosed with CHC. We enrolled in this study 210 patients diagnosed with CHC who have accomplished all inclusion and exclusion criteria, treated with PEG-IFN plus Ribavirin. Patients' recovery progress has been evaluated by determining: age, gender; biochemical tests: alanine aminotransferase (ALT), aspartate aminotransferase (AST); serological assays -detect anti-HCV antibody and molecular assays -detect, quantify and/or characterize hepatitis C viral load (ribonucleic acid) (HCV-RNA); liver histopathological (HP) examination. According to their response to treatment, they were classified into responders (n=145) and non-responders (n=65). Liver biopsies were histopathologically evaluated for necroinflammatory grade and fibrosis stage according to the modified Ishak and Metavir scoring systems for chronic hepatitis. Demographic, laboratory, and HP results were introduced in statistical analysis. These parameters were included in area under curve (AUC) analysis in order to estimate their degree of influence on getting early virological response (EVR) and SVR. Our study demonstrates that factors connected to treatment failure in CHC are linked to older age, high hepatitis C viral load, and impaired glucose tolerance at beginning of treatment [high fasting glucose and insulin, high homeostatic model assessment of insulin resistance (HOMA-IR) index] and also to liver histology features (high fibrosis score, liver steatosis, iron infiltration, and more or less high necroinflammatory activity). Analyzing results of our study shows that HOMA-IR index, serum insulin levels, baseline HCV-RNA, baseline mean blood glucose and HP score like Ishak fibrosis score, steatosis score and liver iron score may have a predictive value for obtaining an EVR in patients diagnosed with CHC.
Acute and chronic heart failure can lead to acute or chronic liver injury through various mechanisms. Treatment in these cases should primarily target heart disease. Patients with advanced liver disease may experience various manifestations at the cardiac level, mainly cardiomyopathies (dilatation cardiomyopathy of alcoholic aetiology, hypertrophic cardiomyopathy). These conditions involve hemodynamic changes, systolic function impairment, diastolic dysfunction, reduced cardiac output (low left ventricular ejection fraction-LVEF) and electrophysiological abnormalities (rhythm disturbances, QT prolongation, driving disturbances). Patients with liver cirrhosis usually have rhythm disturbances (tachycardia, bradycardia). The inability to maintain a high heart rate may later contribute to a reduced cardiac output, insufficient to meet the needs of systemic circulation. Beta-blockers (NSBB) are a class of drugs that are extremely important because of their use in various conditions. Their discovery dates back more than 100 years ago when researchers have launched the idea that the pharmacological action of catecholamines consists in the selective binding of certain receptors for which they have a high selectivity. Beta-blockers with intrinsic sympathomimetic action reduce heart rate at rest, lower than propranolol or metoprolol, but interfere with maintaining adequate heart rate under stress or physical effort. Rezumat Insuficiența cardiacă acută și cronică poate duce la leziuni hepatice acute sau cronice prin diferite mecanisme. Tratamentul în aceste cazuri trebuie să vizeze în primul rând patologia cardiacă. Pacienții cu boală hepatică avansată pot prezenta diverse manifestări la nivel cardiac, în principal cardiomiopatii (cardiomiopatie de dilatare de etiologie alcoolică, cardiomiopatie hipertrofică). Aceste afecțiuni implică modificări hemodinamice, afectarea funcției sistolice, disfuncție diastolică, debit cardiac redus și anomalii electrofiziologice (tulburări de ritm, prelungirea QT, tulburări de conducere). Pacienții cu ciroză hepatică au de obicei tulburări de ritm (tahicardie, bradicardie). Incapacitatea de a menține o frecvență cardiacă ridicată poate contribui ulterior la reducerea debitului cardiac, insuficientă pentru a răspunde nevoilor circulației sistemice. Be ta-blocantele sunt o clasă de medicamente care sunt extrem de importante datorită folosirii lor în diferite condiții. Descoperirea lor datează de mai bine de 100 de ani, când cercetătorii au lansat ideea că acțiunea farmacologică a catecolaminelor constă în legarea selectivă a anumitor receptori pentru care au o selectivitate ridicată. Beta-blocanele cu acțiune simpatomimetică intrinsecă reduc ritmul cardiac în repaus, într-o măsură mai mică decât propranololul sau metoprololul, dar interferă cu menținerea ritmului cardiac adecvat sub stres sau efort fizic.
Anterior STEMI (ST-segment elevation myocardial infarction) is associated with the worst prognosis of all infarction locations. We report the case of a 37-year-old male patient who presented for two hours of severe chest pain and was diagnosed with Killip I anterior STEMI in the emergency room. The emergency coronary angiogram revealed acute thrombotic ostial LAD (left anterior descending artery) occlusion and acute thrombotic ostial ramus intermedius (RI) near-occlusion. Thrombus aspiration for the LAD occlusion was performed and a large thrombus was extracted, followed by the artery’s reperfusion. However, we noticed that there was a large diagonal branch providing septal perforating arteries and that there was a distal LAD occlusion. We implanted a drug-eluting stent on the site of the proximal LAD lesion, but we could not obtain any flow in the distal occluded LAD. The patient underwent dual antiplatelet and unfractionated heparin treatment, and, 8 days later, we performed another coronary angiogram. To our surprise, there was very few residual thrombi in the previously occluded LAD segment, and there was no more thrombus in the RI. We noticed TIMI 3 flow in all coronary arteries and an increase in the patient’s left ventricular ejection fraction was also recorded.
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