The biomedical and therapeutic importance of chitosan and chitosan derivatives is the subject of interdisciplinary research. In this analysis, we intended to consolidate some of the recent discoveries regarding the potential of chitosan and its derivatives to be used for biomedical and other purposes. Why chitosan? Because chitosan is a natural biopolymer that can be obtained from one of the most abundant polysaccharides in nature, which is chitin. Compared to other biopolymers, chitosan presents some advantages, such as accessibility, biocompatibility, biodegradability, and no toxicity, expressing significant antibacterial potential. In addition, through chemical processes, a high number of chitosan derivatives can be obtained with many possibilities for use. The presence of several types of functional groups in the structure of the polymer and the fact that it has cationic properties are determinant for the increased reactive properties of chitosan. We analyzed the intrinsic properties of chitosan in relation to its source: the molecular mass, the degree of deacetylation, and polymerization. We also studied the most important extrinsic factors responsible for different properties of chitosan, such as the type of bacteria on which chitosan is active. In addition, some chitosan derivatives obtained by functionalization and some complexes formed by chitosan with various metallic ions were studied. The present research can be extended in order to analyze many other factors than those mentioned. Further in this paper were discussed the most important factors that influence the antibacterial effect of chitosan and its derivatives. The aim was to demonstrate that the bactericidal effect of chitosan depends on a number of very complex factors, their knowledge being essential to explain the role of each of them for the bactericidal activity of this biopolymer.

(1) Background: SARS-CoV-2 infection, which appeared as an isolated epidemic outbreak in December 2019, proved to be so contagious that, within 3 months, the WHO declared COVID-19 a pandemic. For one year (pre-vaccination period), the virus acted unhindered and was highly contagious, with a predominantly respiratory-oriented aggression. Although this lung damage, responsible for the more than 3,090,025 deaths, has provided sufficient data to facilitate the understanding of pathogenic mechanisms, other observation data, which meet the quality of emerging clinical aspects, such as rashes, remain without well-defined etiopathogenic support or a well-contoured clinical framework. (2) Methods and Results: We followed the occurrence of cutaneous manifestations in patients hospitalized during the second and third outbreak of SARS-CoV-2 in the main clinics of infectious diseases of our county, Timis, and recorded laboratory investigations and clinical evolution for five suggestive cases. (3) Conclusions: The presented cases, added to many other present and future clinical observations, will allow for better knowledge and understanding of SARS-CoV-2 infection, a requirement that has become a global priority for the entire medical and scientific community.

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BackgroundAcinetobacter baumannii is one of the main causes of morbidity and mortality in critical condition patients. The pathogen’s ability to survive under a wide range of environment conditions and to persist for long periods of time on areas represents a frequent cause of endemic infection hotbeds especially in the Intensive Care Unit.The objectives of the study are: determining the 5-year incidence of A. baumannii infection in patients admitted in the ICU which needed mechanical ventilation; the analysis of these cases regarding pathological antecedents; processing the data regarding these cases; gradual analysis of the susceptibility/resistance of isolated A. baumannii strains; observing the emergence of A. baumannii infection in patients transferred into the ICU.MethodsWe have performed an observational retrospective study regarding the incidence of Acinetobacter baumannii infections in the Intensive Care Unit of the Hospital of Infectious Diseases and Pneumophtisiology “Victor Babes” Timisoara, Clinic II Infectious Diseases, during June 2011 – June 2015.ResultsWe have identified a high prevalence of Acinetobacter baumannii infection, with an average period of 6 days. Bronchial suction was the most common pathological product in the study (90 % of the cases). Resistance to antimicrobials has been determined: the lowest resistance was recorded for ampicillin + sulbactam (81.1 %), and the highest resistance rate was recorded for ceftazidime and imipenem (94.6 % each). When comparing resistance to third generation cephalosporins, the difference was not statistically significant (94.6 % for ceftazidime vs. 86.5 % for cefoperazone, p = 0.117). Within the present study we were able to observe a significantly high resistance of the germ to carbapenems, with a good sensitivity to aminoglycosides, and to colistin. Only one strain of Acinetobacter baumannii was resistant to all classes of tested antibiotics.ConclusionsGenerally, carbapenems represented the elective treatment in severe infections; however, the number of carbapenem-resistant Acinetobacter baumannii strains is growing, dramatically reducing therapeutic options, fact that brings back to our attention reusing colistin, although the administration of this antibiotic has been limited due to new antibiotics classes.

Background and Objectives: In Coronavirus Disease 2019 (COVID-19), which is caused by the infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the clinical manifestations are primarily related to the pulmonary system. Under 10% of cases also develop gastrointestinal events such as diarrhea, nausea, vomiting and abdominal pain. Materials and Methods: We conducted an observational, retrospective study in the Infectious Diseases Clinic of ‘’Victor Babes’’ Hospital, Timis County, in order to assess the incidence, outcome and risk factors for Clostridium Difficile infection (CDI) in COVID-19 patients. Results: Out of 2065 COVID-19 cases, hospitalized between 1st September 2020 and 30th April 2021, 40 cases of CDI were identified with 32 cases of hospital-onset of CDI and eight cases of community-onset and healthcare-associated CDI. By randomization, polymerase chain reaction ribotyping of Clostridium Difficile was performed in six cases. All the randomized cases tested positive for ribotype 027. The percentage of cases recovered with complications at discharge was higher among COVID-19 patients and CDI (p = 0.001). The in-hospital stay, 36 days versus 28 days, was longer among COVID-19 patients and CDI (p = 0.01). The presence of previous hospitalization (p = 0.004) and administration of antibiotics during the hospital stay, increased the risk of CDI among COVID-19 patients. The mean adjusted CCI at admission was lower among controls (p = 0.01). In two cases, exitus was strictly CDI-related, with one case positive for 027 ribotype. Conclusions: CDI has complicated the outcome of COVID-19 patients, especially for those with comorbidities or previously exposed to the healthcare system. In the face of the COVID-19 pandemic and the widespread, extensive use of antibiotics, clinicians should remain vigilant for possible CDI and SARS-CoV-2 co-infection.

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Since the initial documentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late December 2019, the coronavirus disease 2019 (COVID-19) pandemic has become a leading cause of morbidity and mortality worldwide. Under these circumstances, the present study aimed to analyze the characteristics of hospitalized cases, according to the progression and severity of the disease, to reveal the main independent risk factors for death by COVID-19 in the western Romanian population. Patients and Methods: This retrospective study included 936 patients admitted to Victor Babes Clinical Hospital of Infectious Diseases Timisoara, with COVID-19 between 1 February 2020 and 31 January 2021. The patients were divided into three subsamples based on disease severity: subsample I (n = 344), comprising patients with mild forms of the disease; subsample II (n = 475) comprising patients with moderate disease; and subsample III (n = 117) for patients with severe disease. Biochemical analysis and assessment of disease severity were performed on all patients. Results: The mean age was 48.76 years (two months to 94 years). The median values for age, number of hospitalization days, and disease duration days before hospital admission varied with high statistical significance between the three subsamples (p < 0.001). A statistically significant difference was also observed regarding body mass index (BMI), with higher values in subsample III (p < 0.001). The in-hospital fatality rate was zero in subsample I, 3.58% in subsample II, and 71.79% in subsample III (p < 0.001). Of the deceased patients, 69.31% were over the age of 65 years, 29.70% were aged 36-64 years, and 0.99% were aged 19-35 years. Cumulated comorbidities were recorded in 92.08% of the deceased patients. Conclusion: Older age, the number of disease duration days before hospital admission, BMI, and renal pathology are independent risk factors for mortality in COVID-19 and can help clinicians to identify patients with poor prognosis and who are at high risk for mortality at an early stage.

Purpose Romania is one of the European countries that has been hit the hardest by the severe acute respiratory syndrome caused by the new coronavirus SARS-CoV-2, with over 1.91 million reported cases and over 59,257 deaths. The aim of this study was to identify the main predictors of death in hospitalized patients. Patients and Methods In the period from 1 March 2020 to 30 June 2021, an observational, retrospective, randomized, case-control study was conducted, which included a sample of 139 patients who died in hospital and another sample of 275 patients who had been discharged in an improved or healed condition. Confirmation of COVID-19 cases was performed by RT-PCR from nasopharyngeal and oropharyngeal exudates. Statistical data were analyzed by logistic regression, Cox regression and a comparison of survival curves by the log-rank (Mantel-Cox) test. Results The most powerful logistic regression model identified the following independent predictors of death: history of coagulopathy HR = 30.73 [1.94–487.09], p = 0.015; high percentage of neutrophils HR = 1.09 [1.01–1.19], p = 0.027; and decreased blood-oxygenation HR = 53881.97 [1762.24–1647489.44], p < 0.001. Cox regression identified the following factors that influenced the evolution of cases: history of coagulopathy HR = 2.44 [1.38–4.35], p = 0.000; O 2 saturation HR = 0.98 [0.96–0.99], p = 0.043; serum creatinine HR = 1.23 [1.08–1.39], p = 0.001; dyspnea on admission HR = 2.99 [1.42–6.30], p = 0.004; hospitalization directly in the ICU HR = 3.803 [1.97–7.33], p < 0.001; heart damage HR = 16.76 [1.49–188.56], p = 0.022; and decreased blood-oxygenation HR = 35.12 [5.92–208.19], p < 0.001. Conclusion Knowledge of the predictors of death in hospitalized patients allows for the future optimization of triage and therapeutic case management for COVID-19.