Introduction: Nosocomial infections (NI) are frequent complications in neonatal intensive care units (NICU) which result in high morbidity and mortality. Aim: To determine and analyze the incidence, risk factors and etiologic agents of NI in newborns admitted in the NICU to help plan-ning future surveillance and prevention strategies. Materials and methods: A prospective cohort study was carried out at the NICU of St George University Hospital, Plovdiv, Bul-garia from January 1, 2017 to June 31, 2018. The number of neonates included in the study was 507. Descriptive statistics such as count, percent, mean and standard deviation was used. Chi-square test was performed to prove associations. Odds ratios, with 95% confidence intervals, were computed from the results of the binominal logistic regression analyses. Results: Of the 507 hospitalized newborns in NICU, 48 presented with 54 NI. The incidence and the density incidence rates were 9.5% and 7.67 per 1,000 patient-days, respectively. Nosocomial infections were detected in neonates from all birth weight (BW) classes, but it was low BW and premature neonates that were at major risk to acquire them. The most common infection sites were ventilator-asso-ciated pneumonia (VAP) (67.27%), bloodstream infection (23.64%) and conjunctivitis (9.09%). Major pathogens were Gram-negative such as Klebsiella pneumoniae, E. coli, Pseudomonas aeruginosa and Acinetobacter baumannii. In the multivariate logistic regression analysis NIs were strongly associated with intubation, presence of a venous catheter, the duration of antibiotic treatment and increased CRP> 10 mg/l. Conclusions: This report highlights the burden of NIs, identifies the major focus for future NI control and prevention programs.
Vulvovaginal candidiasis (VVC) is the most common vaginal infection. It is considered to be the reason for 15%-30% of all vulvovaginal symptoms. A diagnosis based only on clinical signs and/or on a syndrome-based approach, recommended by some authors and health institutions, is in many cases incorrect. There is no indisputable diagnostic method that guarantees high specificity, sensitivity and predictive value. There is no pathognomonic clinical feature of VVC. The aim of the present study was to assess the role of selected clinical and mycological indicators in the diagnosis of VVC using the standard complex scoring system. The research is retrospective and was conducted in several stages to give a more precise and detailed assessment of the examined clinical and microbiological indicators. Clinical, microbiological and statistical methods were used. The results showed the lowest level of compliance between clinical and laboratory diagnosis in VVC: 67.65%. We did not observe a statistically significant relation between the density of the vaginal smear, inflammation, odour test and VVC (p > 0.05). The results showed a moderate association between the positive yellow swab test and VVC (p < 0.05). A significant positive association was established between VVC and presence of microscopic signs of invasiveness (p < 0.001). The most common isolate was Candida albicans: 72.81% of all vaginal Candida isolates.
BACKGROUND: Angioneurotic oedema (AE) is an unpredictable and dangerous disease directly threatening the patient's life due to a sudden onset of upper respiratory tract obstruction. The disease is associated with various causes and triggering factors, but little is known about the conditions that accompany AE. AIM: The study aims to determine the age-specificities and the spectrum of concomitant diseases in patients with AE. MATERIAL AND METHODS: The subjects of observation were 88 patients (53 women and 35 men) with angioneurotic oedema who underwent diagnostics and treatment in the Department of Occupational Diseases and Clinical Allergology of University hospital “Saint George”-Plovdiv. RESULTS: The highest level of disease prevalence was found in the age group over 50 years, both in males (45.71%) and females (54.72%). We found that the most often concomitant diseases in our patients with AE are cardiovascular (33%). On second place are the patients with other accompanying conditions outside of the target groups (27.3%). Patients with AE and autoimmune thyroiditis were 14.8%, and those with AE and skeletal-muscle disorders-10.2%. Given the role of hereditary factors in this disease, the profession of the patients is considered insignificant. CONCLUSION: Angioedema occurs in all age groups, but half of the cases are in people over 50 years of age. The most common concomitant diseases in angioedema are cardiovascular diseases.
BACKGROUND:Allergic contact dermatitis (ACD) is common in clinical practice, but the aetiology of this disease is quite varied. A leading pathogenetic mechanism is a cell-mediated immunity. The combinations of ACD with other allergic and systemic autoimmune diseases are relatively rare, but these conditions are undoubtedly a professional challenge for practitioners.CASE REPORT:We present a case of ACD combined with other immune-allergic conditions. Aetiology and pathogenesis in these cases are not well understood.CONCLUSION:Based on the data from the general and targeted allergic history, patient’s subjective complaints, clinical picture, allergenic status, paraclinical results, and the presented photo material, the final diagnosis is as follows: Contact allergic dermatitis-acute form.
Hereditary Angioedema (HAE) is a rare disease, and its incidence varies across different populations. HAE belongs to a group of congenital immune deficiencies in the complement system. Deficiency of the C1-Esterase Inhibitor (C1-INH) is leading in the pathogenesis of type I HAE; in type II, which is less common, the level of C1-INH is normal or increased, but an incomplete inhibitor is produced. Various provoking factors can trigger a cascade of reactions leading to activation of the kinin system. Consequently, the clinical picture of angioedema unfolds. There is a wide range of swelling-inducing factors-e.g., mechanical, pharmacological, physical, occupational, toxic. However, according to the literature, there is insufficient clarity about the combination of HAE type II with other allergic diseases, specifically with bronchial asthma. In the current study, we present a clinical case that is expected to enrich the knowledge base and contribute to the specification of the diagnostic/therapeutic algorithm in such patients with combined immuno-allergic pathology.
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