Although basal cell carcinoma is a well-known tumor with confirmed clinical and histopathology traits, prognosis factors and treatment options, new facets of this tumor emerge as innovative approach methods develop. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) allow a basal cell carcinoma’s in vivo analysis of its depth of invasion, tumor margins prior to surgical approach and the tumor’s response to a non-invasive treatment, evaluating simultaneously the tumor’s vasculature. By RCM and OCT analysis, basal cell carcinoma has registered a groundbreaking discovery regarding a small (but with predictive factor potential) trait – the cleft, developing in between the tumor islands/nodules/chords and the surrounding tumor stroma; it was considered to date as a consequence of the tissue’s histopathology processing. RCM and OCT revealed that the “clefting artifact”, as it is frequently found in the medical literature, is not actually an artifact of laboratory processing, but a tumor trait found in vivo, with apparent mucin deposits. This review aims at merging the methods of evaluating basal cell carcinoma, both non-invasive (dermoscopy, RCM, OCT) and invasive ones (histopathology – with newly proposed classification), with special emphasis on the cleft issue – its assessment with the aforementioned techniques, with potential implications in the patient’s prognosis.
Enterococci cause infections with various localizations, the most common being urinary infections. The purpose of the study was to identify the profile of the antimicrobial resistance of enterococci species (AMRE) isolated from patients hospitalized in three hospitals in Romania. We evaluated AMRE retrospectively (2019–2021) in various biological samples. The microbiological diagnosis was sustained by classical methods of bacteria culture and automatic identification. The sensitivity testing was performed by the Kirby–Bauer method, and the antibiotic minimum inhibitory concentration was tested by the automated Vitek system. We analyzed 86 strains of Enterococcus spp., identifying the following species: 47.7% E. faecalis, 47.7% E. faecium, 3.55% E. gallinarum, and 1% E. hirae. Most of the bacterial strains were isolated from urocultures (38.4%) and hemocultures (32.6%). Overall, the rate of vancomycin resistance was 5.8% for E. faecalis and 15.1%. for E. faecium. The prevalence of multidrug-resistant (MDR) strains was found to be 100% in E. gallinarum, 75.6% in E. faecium, and 21.9% in E. faecalis. The results confirm the high level of AMRE, which creates difficulties with adequate antibiotic prescriptions. The continuous monitoring of AMRE is essential for updating the local diagnostic and treatment protocols for enterococcal infections.
Background Sepsis affects over 30 million people worldwide each year, causing approximately 6 million deaths. Challenges in clinical diagnosis and the need for an early diagnosis to prevent mortality due to sepsis have led to dependence on inflammatory biomarkers like Procalcitonin (PCT), C-reactive protein (CRP), and Interleukin-6 (IL-6). Objective This study was performed to observe the contribution of inflammatory biomarkers in the diagnosis and prognosis of patients with surgical sepsis. Methods We performed a retrospective observational study in a Clinical Emergency Hospital, which included a number of 125 patients with surgical sepsis admitted between January 2020 and December 2021. The patients were included in the study based on the Sepsis-3 definition. PCT, CRP, IL-6, Sepsis-related Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index (CCI), the time up to surgery, the days of treatment in Intensive Care Unit (ICU) and the total days of hospitalization had been statistically analyzed. Results The mean age of all patients was 65.14 years. The mean value in all patients for PCT was 20.08 ng/mL, for CRP was 175.42 mg/l, and for IL-6 was 799.6 pg/mL. The strongest correlation between biomarkers was between CRP and IL-6 (r = 0.425; p < 0.0001). Of all biomarkers, the CRP correlated the strongest with patient outcomes (r = 0.544; p < 0.0001). The area under curve (AUC) for the mean values of the inflammatory biomarkers was calculated and the best diagnostic performance was for CRP with 0.816 (95% CI: 0.744–0.887). Conclusion CRP and IL-6 were the most efficient in sepsis diagnosis. The association of PCT, CRP and IL-6 has increased the range of certainty in sepsis diagnosis. CRP was the most efficient biomarker in the prognosis of sepsis.
Acute peritonitis accounts for 1% of inpatient surgical emergencies and is the second leading cause of sepsis in patients in intensive care departments. Diagnosis through laboratory analysis in bacterial peritonitis focuses mainly on the biomarkers, procalcitonin and C-reactive protein. A 73-year-old male patient presented with meteorism, diarrhea, vomiting, fever, and hypotension. Laboratory investigations showed very high procalcitonin and C-reactive protein values, and abdominal radiography revealed paraumbilical hydroaerial levels, which suggested septic shock of intra-abdominal origin. Emergency laparotomy was performed, which revealed agglutinated intestinal loops in the right iliac fossa with false membranes, purulent fluid, overdistended jejunum and ileum with an occlusive appearance, acute gangrenous appendicitis with perforation, and suppurative omentitis. The intraoperative diagnosis was acute neglected peritonitis in the occlusive phase owing to acute gangrenous appendicitis with perforation and suppurative omentitis. Laboratory analysis in conjunction with imaging provides important information in the early diagnosis of infectious pathology in elderly patients, even if these methods do not accurately identify the cause. The combination of procalcitonin and C-reactive protein biomarker levels successfully contributed to the diagnosis in this case. Notably, the patient’s white blood cell counts were inconsistent with the severity of the infection.
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