rss_2.0Romanian Journal of Internal Medicine FeedSciendo RSS Feed for Romanian Journal of Internal Medicine Journal of Internal Medicine 's Cover risk scores for prediction of mortality and hemorrhages in atrial fibrillation patients<abstract> <title style='display:none'>Abstract</title> <p><bold>Background</bold>: Atrial fibrillation (AF) is an emerging epidemic worldwide, responsible for a twofold increase in mortality, independent of other risk factors. Stroke prevention is the cornerstone of AF management. However, oral anticoagulation imposes an increased risk of bleeding. Several risk scores have been developed for estimating both the thromboembolic and the bleeding risks. The aim of the study was to determine the usefulness of different stroke risk scores as predictors of mortality and hemorrhagic events in AF patients.</p> <p><bold>Methods:</bold> We retrospectively enrolled 211 AF patients hospitalized in the Cardiology Ward of our tertiary hospital. The primary endpoints were mortality and non-minor bleeding events. The mean follow-up period was 378 days for bleeding events and 5 years and 1 month for mortality. For each patient, we evaluated the following stroke risk scores: CHADS2, CHA2DS2-VASc, R2CHADS2, ABC, ATRIA, GARFIELD.</p> <p><bold>Results</bold>: The mean age in our cohort is 66, with a slight predominance of women (52.2%). For a CHA<sub>2</sub>DS<sub>2</sub>-VASc ≥ 4 as well as for a score of 2-3, 5-year survival was worse than for patients with a score of 0-1(chi-squared=8.13; p=0.01). Similarly, all subgroups of patients with an ABC &lt;2%, had a worse 5-year survival when compared with an ABC score of ≥2% (chi-squared=12.85; p=0.005). C-statistics show a modest predictive value for mortality, for all stroke scores except Garfield, with similar AUCs, the highest being for CHA<sub>2</sub>DS<sub>2</sub>-VASc (AUC 0.656; p=0.0001). CHA<sub>2</sub>DS<sub>2</sub>-VASc also correlates with bleeding events, having a good predictive ability (AUC 0.723; 95%CI 0.658-0.782, p=0.001), mildly superior to HAS-BLED (AUC 0.674; 95% CI 0.523-0.825; p = 0.04) and very close to Garfield-bleeding (0.765; 95%CI 0.702-0.80; p=0.0001).</p> <p><bold>Conclusions</bold>: CHA<sub>2</sub>DS<sub>2</sub>-VASc is comparable to HAS-BLED and Garfield-bleeding in predicting bleeding events in AF patients. CHA<sub>2</sub>DS<sub>2</sub>-VASc and ABC correlate directly and consistently with mortality rate. For CHA2DS2-VASc, the AUCs for our endpoints are similar to the ones for stroke prediction, highlighting the potential of extending its applicability to various outcomes.</p> </abstract>ARTICLE2022-06-10T00:00:00.000+00:00Lung cancer and combined pulmonary fibrosis and emphysema with anti-ARS antibody<abstract> <title style='display:none'>Abstract</title> <p>A 59-year-old man who had smoked for 23 pack-years was admitted to our hospital because of two-month history of back pain. The chest computed tomography scan demonstrated combined pulmonary fibrosis and emphysema (CPFE) and an irregular shaped nodule in the left lower lobe of the lung. A biopsy obtained from samples from subcarinal lymph nodes revealed non-small cell lung cancer. Anti-aminoacyl-tRNA synthetase (ARS) antibody was elevated up to 166 U/mL, although he had no symptoms suggestive connective tissue diseases. It is well known that most of CPFE patients are current or former heavy smokers, and some researchers described the relationship between CPFE and connective tissue diseases. To our best knowledge, this was the first report of lung cancer in patient with anti-ARS antibody-positive CPFE. In some anti-ARS antibody-positive patients, smoking might have a relationship with development of CPFE and lung cancer.</p> </abstract>ARTICLE2022-05-22T00:00:00.000+00:00A Pilot Study of Changes in Urinary Podocalyxin Levels during Normal Pregnancy and Labor<abstract> <title style='display:none'>Abstract</title> <p><italic>Introduction</italic>. Increased urinary podocalyxin, a surrogate marker of podocyte detachment, has been shown in preeclampsia and eclampsia, but there is a paucity of data of the effect of normal pregnancy on its urinary excretion. We aimed to describe these changes in this pilot study.</p> <p><italic>Methods</italic>. Urine podocalyxin levels were measured in 115 pregnant women. Of these, 12 women were in the second trimester of gestation, 57 in the third trimester and 46 women were in labor.</p> <p><italic>Results</italic>. The median [IQR] urinary podocalyxin levels were 0.81 [0.27, 3.68], 0.92 [0.44, 5.49] and 64.7 [30.5, 106.3] ng/mg creatinine in the second trimester, third trimester, and during labor, respectively (p&lt;0.0001). Patients with hematuria during labor had higher levels of urinary podocalyxin (128.6 [79.8, 169.6] ng/mg creatinine. There was a moderate correlation between gestational age and urinary podocalyxin levels (r=0.63, p&lt;0.0001).</p> <p><italic>Conclusion</italic>. Urinary podocalyxin levels were low in normal pregnancies and increased significantly during labor and with hematuria.</p> </abstract>ARTICLE2022-05-06T00:00:00.000+00:00Epidermal Growth Factor Receptor immunohistochemical expression in hepatocellular carcinoma without Epidermal Growth Factor Receptor exons 18–21 mutations<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction:</bold> EGFR targeted therapies, have been proved beneficial for patients with HCC, nevertheless additional research on EGFR immunoexpresion and EGFR mutations is still needed, especially in population in which it has not been done yet. The aim of this study is to evaluate EGFR immunoexpression in HCC without EGFR exons 18-21 mutations and to evaluate its influence on survival in HCC patients in North Macedonia.</p> <p><bold>Methods</bold>: We studied 31 cases of HCC for EGFR immunohistochemical expression and EGFR exons 18–21 mutations. The following clinical parameters were analyzed: Hepatitis B and C virus infection, presence of cirrhosis, tumor size, enlarged lymph nodes, metastases, alpha fetoprotein level and overall survival. Presence of the EGFR immunosignal (membranous and cytoplasmic) and the percentage of positive tumor cells in the entire tumor tissue specimen were semi-quantitatively determined.</p> <p><bold>Results:</bold> Hepatitis B and C virus infection, tumor size, metastatic disease and EGFR immunoexpression have influence on patient’s survival. No EGFR exons 18–21 mutations were detected in this group of HCCs. EGFR expression of 61%-80% in tumor tissue significantly influenced survival of the patients (p &lt; 0.01). Multiple Cox regression confirmed tumor size of 5-10cm (p &lt; 0.05), tumor size &gt; 10 cm (p &lt; 0.01) and EGFR expression in range of 61% to 80% (p &lt; 0.05) as independent survival predictors in patients with HCC.</p> <p><bold>Conclusion:</bold> EGFR overexpression in range of 61% to 80% was an independent survival predictor in patients with HCC, implying that these patients could benefit from EGFR inhibition. However, the absence of EGFR mutations in exons 18-21 in any of the cases of this study suggest that single drug EGFR targeted therapy in patients with HCC may be insufficient.</p> </abstract>ARTICLE2022-04-27T00:00:00.000+00:00Validation of Salivary Glucose as a Screening Tool of Diabetes Mellitus<abstract> <title style='display:none'>Abstract</title> <p><bold>Background:</bold> Improved prognosis and delay of clinical complications in Diabetes mellitus can be ensured by early screening and regular monitoring after diagnosis. This requires venipuncture at regular intervals of time causing anxiety and discomfort to the patient. Hence, development of a painless, non-invasive procedure is desirable for which saliva is a potential tool. Also, this would provide an easy and cost-effective means for large scale screening and epidemiological intervention.</p> <p><bold>Aim:</bold> To measure fasting plasma glucose (FPG) and compare and correlate with salivary glucose levels in normal and diabetic individuals. Also, the correlation between glycated hemoglobin (HbA1c) and salivary glucose is studied in the diabetics and controls.</p> <p><bold>Methods:</bold> Blood and salivary glucose was estimated by GOD-POD method and glycated hemoglobin by HPLC. Statistical analysis was done on SPSS 16. Mean, Standard deviation, independent t test, ANOVA (f test), Pearson’s correlation coefficient along with regression analysis was carried out and comparison was done between the control and diabetic groups and the different subgroups within the diabetic group.</p> <p><bold>Results:</bold>A significant difference between the salivary glucose levels in subjects indicating that a deranged glycemic status is reflected in saliva. Also, salivary glucose increases in proportion to an increase in the FPG and HbA1C of the diabetics. The regression coefficient was calculated and a formula was derived for prediction of FPG and HbA1c using salivary glucose.</p> <p><bold>Conclusion:</bold> Saliva can be used as a screening tool for diabetes. Standardization of the technique and setting up a reference range will also make it useful in diagnosing diabetes mellitus.</p> </abstract>ARTICLE2022-04-11T00:00:00.000+00:00Acute myelogenous leukemia – current recommendations and approaches in molecular-genetic assessment<abstract><title style='display:none'>Abstract</title><p>Acute myelogenous leukemia is a multi-step hematological malignancy, affecting function, growth, proliferation and cell cycle of myeloid precursors. Overall assessment of patients with the disease requires among everything else, a comprehensive investigation of the genetic basis through various methods such as cytogenetic and molecular-genetic ones. This clarification provides diagnostic refinement and carries prognostic and predictive value in respect of essential therapeutic choices.</p><p>With this review of the literature, we focus on summarizing the latest recommendations and preferred genetic methods, as well as on emphasizing on their general benefits and limitations. Since none of these methods is actually totipotent, we also aim to shed light over the often-difficult choice of appropriate genetic analyses.</p></abstract>ARTICLE2022-06-14T00:00:00.000+00:00Systematic approach to celiac disease: a comprehensive review for primary providers<abstract><title style='display:none'>Abstract</title><p>Celiac disease is an immune-mediated illness to gluten exposure in genetically susceptible patients. It is characterized by chronic lymphocytic inflammation of the small bowel leading to villous atrophy and its associated complications. The global prevalence of celiac disease is increasing, due in part to improved screening tests and simplified diagnostic criteria. Novel therapies are being developed and include proteolytic enzymes, sequestering agents, and immunotherapies. A strict gluten-free diet, however, remains the mainstay of treatment. In this comprehensive review, we discuss the epidemiology, definitions, diagnosis, and treatment of celiac disease.</p></abstract>ARTICLE2022-06-14T00:00:00.000+00:00Anti-cyclic citrullinated peptide antibody-positive rheumatoid arthritis caused by bacterial organizing pneumonia in a patient with Sjogren’s syndrome<abstract><title style='display:none'>Abstract</title><p>A 58-year-old woman with a history of Sjogren’s syndrome was admitted to our hospital with cough, decreased right lung breath sounds and arthralgia in both thumbs. Chest computed tomography showed consolidation with air bronchogram in the right lung. Levels of anti-cyclic citrullinated peptide antibody and rheumatoid factor levels were significantly elevated. She was diagnosed with rheumatoid arthritis induced by bacterial organizing pneumonia. Treatment with salazosulfapyridine was added for rheumatoid arthritis and arthralgia gradually improved. This case highlights that respiratory infections could lead to anti-cyclic citrullinated peptide antibody-positive rheumatoid arthritis in patients with Sjogren’s syndrome.</p></abstract>ARTICLE2022-06-14T00:00:00.000+00:00Peculiar encounter of sarcoidosis and solid pseudopapillary tumor of the pancreas<abstract><title style='display:none'>Abstract</title><p><bold>Objective:</bold> Current literature indicates a connection between sarcoidosis and malignancy, prompting advanced screening in uncertain cases. Solid pseudopapillary tumors (SPT) of the pancreas are rare entities that can be confirmed by adding imaging results to immunohistochemistry staining. The aim of this article is to describe a rare association of sarcoidosis and SPT.</p><p><bold>Materials and methods:</bold> Case report.</p><p><bold>Results</bold>: A young female patient with no prior medical history presents with shortness of breath and fatigue. The diagnosis of pulmonary and hepatic sarcoidosis is placed upon laboratory and radiographic changes. Intermittent abdominal pain prompts an MRI that shows the presence of a tumoral mass in the tail of the pancreas. Surgical resection of the mass is performed and histological examination indicates a SPT, subsequently confirmed by immunohistochemistry.</p><p><bold>Conclusion:</bold> This is the third reported case of concomitant sarcoidosis and solid pseudopapillary tumor of the pancreas.</p></abstract>ARTICLE2022-06-14T00:00:00.000+00:00New markers of oxidative stress in lichen planus and the influence of hepatitis C virus infection – a pilot study<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Lichen planus (LP) is a mucocutaneous T-cell mediated disorder of unknown etiology. There is growing evidence that oxidative stress is an important player in the pathogenesis of LP. Therefore, we have investigated oxidative stress markers in LP and the influence of hepatitis C virus (HCV) infection, a frequently associated condition, on oxidative stress in LP patients.</p> <p><bold>Method.</bold> We have determined the serum levels of 4- hydroxynonenal (4-HNE) and symmetric dimethylarginine (SDMA), as markers of oxidative stress, and total antioxidant capacity (TAC), as a marker of the antioxidant defence, in 4 groups: group A – HCV positive patients with LP (n=12), group B – HCV positive patients without LP (n=12), group C – HCV negative patients with LP (n=31) and group D – control group (n=26).</p> <p><bold>Results.</bold> In LP patients, we have identified an increased level of lipid peroxidation (4-HNE – group A – 8.41±1.11 μg/mL, group B - 7.97±2.17 μg/mL, group C – 7.81±1.96 μg/mL and group D – 6.15±1.17 μg/mL) and alterations in arginine methylation (SDMA – group A – 1.10±0.24 μmol/L, group B – 1.03±0.16 μmol/L, group C – 0.84±0.19 μmol/L and group D – 0.50±0.06 μmol/L) associated with a diminished antioxidant defence (TAC – group A – 234.50±49.96, μmol/L group B – 255.83±41.41 μmol/L, group C – 269.83±43.33 μmol/L and group D – 316.46 ±29.33 μmol/L), processes augmented by the association with HCV infection.</p> <p><bold>Conclusion.</bold> There is an imbalance between oxidants and antioxidants in patients with LP, an imbalance that is augmented by the presence of HCV infection. SDMA could be regarded as a novel biomarker of oxidative stress among these patients. To the best of our knowledge this is the first study to investigate the influence of HCV infection on oxidative stress in LP patients.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Carnitine palmitoyltransferase-II deficiency: case presentation and review of the literature<abstract> <title style='display:none'>Abstract</title> <p>Carnitine palmitoyltransferase-II deficiency, an autosomal recessive disorder, is the most common cause of recurrent rhabdomyolysis in adults. Recognition and avoidance of triggers, such as heavy exercise and stress, is key in prevention of further episodes; however, even with preventative measures, many patients will continue to experience periodic symptoms, including rhabdomyolysis. Avoidance of renal failure, correction of electrolyte disturbances and halting further muscle breakdown are the goals of treatment. It is essential for clinicians to recognize the signs and symptoms of acute disease in CPT-II deficiency. We present a case of recurrent rhabdomyolysis requiring hospitalization in a patient with CPT-II deficiency and review the literature for common clinical manifestations, diagnostics, and treatment strategies.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Clinical risk scores for the prediction of incident atrial fibrillation: a modernized review<abstract> <title style='display:none'>Abstract</title> <p>Atrial fibrillation (AF) is considered the most common sustained arrhythmia. Major cardiovascular risk factors that have been identified to initiate and perpetuate AF include age, sex, arterial hypertension, heart failure, valvular heart disease and diabetes mellitus. In the literature, several studies aimed to formulate easily – applied and accurate risk stratification scores, based on antecedent cardiovascular events, comorbidities and biomarkers for the prediction of new-onset AF. The present narrative review addresses the most universally accepted and efficient clinical scores, with an extended applicability in different populations and ages, particularly scores derived from the Framingham Heart Study, the Atherosclerosis Risk in Communities, the Malmo Diet and Cancer Study, as well as the CHARGE-AF, the CHADS2, CHA2DS2-VASc, HATCH and CH2EST scores. Identification of incident AF can be challenging, thus dictating for utilization of validated clinical instruments in everyday clinical practice.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Imaging characteristics of nontuberculous mycobacterial pulmonary nodules<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Nontuberculous mycobacteriosis (NTM) of the lungs can develop nodules. In order to clarify some of the characteristics of lung NTM nodules, we examined volume doubling time (VDT) and maximum standardized uptake value (SUVmax) in positron emission tomography (PET) of pathologically diagnosed NTM nodules.</p> <p><bold>Methods</bold>. From November 2012 to August 2018, clinical and radiological information were retrospectively investigated in eight patients who were surgically resected and diagnosed as NTM. These eight patients were followed up until November 2020 and were confirmed to have no appearance of lung cancer or reappearance of lung NTM nodules. The VDT was calculated using the Schwartz formula.</p> <p><bold>Results.</bold> The median maximum diameter of the nodule at the time of the first CT scan was 16.0 (range: 9.9–20.0) mm. The median maximum diameter of the nodule on CT performed before the surgical biopsy was 18.8 (range: 10.4–32.8) mm. The median doubling time calculated from these results was 203 (range: 20–568) days. Caseous granulomas and acid-fast bacilli were histologically confirmed in all eight patients. Culture of excised nodules revealed <italic>Mycobacterium intracellulare</italic> in five patients and <italic>Mycobacterium avium</italic> in three patients. Six patients received PET, and median SUVmax was: 7.0 (range: 3.3–21.0). Median VDT was around 200 days. Some patients had irregular-shaped nodules.</p> <p><bold>Conclusions.</bold> CT/PET-CT characteristics of lung nodules are not reliable in differentiating lung NTM nodules from malignant ones. To avoid unnecessary resection, it may be better to collect various information on imaging findings in the nodule itself and in opacities other than the nodule.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Spontaneous bacterial peritonitis: update on diagnosis and treatment<abstract> <title style='display:none'>Abstract</title> <p>Spontaneous bacterial peritonitis (SBP) is a common complication in patients with liver cirrhosis, with an increased risk of mortality. For this reason, a diagnostic paracentesis should be performed in all patients with ascites and clinical features with high diagnostic suspicion. Although literature data abound in identifying new diagnostic markers in serum or ascites, they have not yet been validated. The final diagnosis requires the analysis of ascites and the presence of &gt; 250 mm<sup>3</sup> neutrophil polymorphonuclear (PMN) in ascites. If previous data showed that the most common microorganisms identified were represented by gram-negative bacteria, we are currently facing an increase in gram-positive bacteria and multidrug-resistant bacteria. Although prompt and effective treatment is required to prevent outcomes, this becomes challenging as first-line therapies may become ineffective leading to worsening prognosis and increased in-hospital mortality. In this paper we will make a brief review of existing data on the diagnosis and treatment of SBP.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00The relationship of vitamin D deficiency with severity and outcome of acute stroke<abstract> <title style='display:none'>Abstract</title> <p><bold>Background.</bold> There are currently conflicting results regarding the link between vitamin D deficiency and the increased risk for stroke and its poor prognosis. The present study aimed to assess the relationship between vitamin D deficiency and prognosis of acute stroke.</p> <p><bold>Methods.</bold> This bi-center cross-sectional study was performed on 140 consecutive patients who referred to two general hospitals in Iran with the diagnosis of acute stroke. The levels of 25-hydroxy vitamin D were evaluated by Electrochemiluminescence (ECL) technique. Clinical severity of stroke on admission as well as on discharge time were evaluated using the National Institutes of Health Stroke Scale (NIHSS) or Modified Rankin (mRS) tools.</p> <p><bold>Results.</bold> Mean serum level of vitamin D was 25.51 ± 18.87 ng/mL, ranging from 3.0 to 98.6 ng/ml. There was a significant difference between the two groups (with and without vitamin D deficiency) in terms of stroke severity and disability, as reflected by mRS (P=0.003) and NIHSS evaluation (14.24 ± 9.23 versus 9.73 ± 7.36, P=0.003). Also, regarding patients’ clinical condition, the mean NIHSS score in those with deficient and normal levels of vitamin D was 14.24 ± 9.23 and 9.73 ± 7.36, respectively with NIHSS score &gt; 5 in 76.1% and 61.5%, respectively (P = 0.003).</p> <p><bold>Conclusion.</bold> According to the results of study, vitamin D status can be related to the severity of stroke. However, considering the cross-sectional design of our study, it could not point out the causality between vitamin D deficiency and acute stroke and further studies are warranted. It is not possible to draw any conclusions in terms of causality. Further studies are required in order to assess the relationship between the serum vitamin D levels and stroke severity.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Acute heart failure in pregnancy: importance of a timely multidisciplinary approach to recognition and management<abstract> <title style='display:none'>Abstract</title> <p>Increased cardiovascular demands of pregnancy may unmask occult diseases, such as dilated cardiomyopathy or valvular stenosis, or precipitate peripartum cardiomyopathy. We report a case of the emergency management and delivery of a young pregnant woman who presented with acute decompensated heart failure that was not immediately recognized. An emergency transfer to a tertiary care institution was arranged. Once diagnosed, the patient received multidisciplinary care shared between cardiologists, obstetricians, cardiac anesthetists, a neonatologist, and a midwife, resulting in good maternal and fetal outcomes.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Evaluation of oxidative stress markers in hospitalized patients with moderate and severe COVID-19<abstract> <title style='display:none'>Abstract</title> <p><bold>Background.</bold> Clinical evidence suggests increased oxidative stress in COVID-19 patients and this worsened redox status could potentially contribute to the progression of the disease.</p> <p><bold>Objectives.</bold> To investigate the oxidative stress we have measured oxidative stress parameters, namely, PAT (total antioxidant power, iron reducing) and d-ROMs (plasma peroxides). Additionally we have investigated their correlation with the most frequently used clinical parameters CRP, LDH, and NLR in serum from moderate and severe COVID-19 patients hospitalized in a tertiary hospital.</p> <p><bold>Methods.</bold> PAT and d-ROMs were determined by analytical photometric metric method in serum from 50 hospitalized patients. For each of them, two samples were collected and analyzed immediately after collection seven days apart.</p> <p><bold>Results.</bold> All patients at admission had a much higher value for plasma peroxides and a significant correlation between oxidative stress parameters and CRP, LDH, and NLR. (p&lt;0.05), except for OS index (OSI) vs CRP in the severe group. At discharge, plasma peroxides were reduced and OSI was improved in the moderate group.</p> <p><bold>Conclusion.</bold> We consider that using OSI at the beginning of COVID-19 disease presents a valuable starting point for the general assessment of oxidative stress and hence enabling a better triage of the patients in terms of disease severity.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Hashimoto’s thyroiditis is associated with elevated serum uric acid to high density lipoprotein-cholesterol ratio<abstract> <title style='display:none'>Abstract</title> <p><bold>Background.</bold> Hashimoto’s thyroiditis (HT) is an auto-immune condition characterized with lymphocytic and fibroblastic infiltration of the thyroid gland. The rate of uric acid and HDL cholesterol – so called as uric acid to HDL ratio (UHR) has been shown to be elevated in inflammatory conditions diseases. We aimed to compare UHR and other laboratory parameters of the patients with HT to those values in healthy controls.</p> <p><bold>Methods.</bold> The patients diagnosed with HT by medical history, physical examination, elevated thyroid autoantibodies in serum and characteristic sonographic findings in outpatient internal medicine clinics of our institution were enrolled to the present retrospective study. Age and sex matched healthy volunteers were enrolled as controls. UHR of the HT patients and control subjects were compared.</p> <p><bold>Results.</bold> The mean UHR of the HT group was 11% ± 4 %, while UHR of the control group was 8% ± 2% (p&lt;0.001). UHR was significantly and positively correlated with thyroid stimulating hormone (TSH) (r=0.26, p=0.01) and negatively correlated with free T4 (FT4) (r=−0.22, p=0.04) levels. The sensitivity and specificity of the UHR level were greater than 8.3%: were 74% and 52%, respectively (AUC: 0.74, p&lt;0.001, 95% CI: 0.64–0.84).</p> <p><bold>Conclusion.</bold> We suggest that UHR is a reliable and useful marker for HT. Therefore, it may be helpful in establishing the diagnosis of HT in addition to other diagnostic tools.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Healthcare-associated infection during the COVID-19 pandemic in a tertiary care hospital in Romania<abstract> <title style='display:none'>Abstract</title> <p><bold>Introduction.</bold> Information on healthcare-associated <italic>C.difficile</italic> infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic.</p> <p><bold>Methods.</bold> We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017–2018.</p> <p><bold>Results.</bold> We found 51 cases during 2020–2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017–2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days).</p> <p>Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment – mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group.</p> <p><bold>Conclusions.</bold> The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017–2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00Evaluation of severity scoring systems in patients with severe community acquired pneumonia<abstract> <title style='display:none'>Abstract</title> <p><bold>Background.</bold> The aim of this study was to evaluate the ability of severity scoring systems to predict 30-day mortality in patients with severe community-acquired pneumonia.</p> <p><bold>Methods.</bold> The study included 98 patients aged ≥18 years with community acquired pneumonia hospitalized at the Intensive Care Unit of the University Clinic for Infectious Diseases in Skopje, Republic of North Macedonia, during a 3-year period. We recorded demographic, clinical and common biochemical parameters. Five severity scores were calculated at admission: CURB 65 (Confusion, Urea, Respiratory Rate, Blood pressure, Age ≥65 years), SCAP (Severe Community Acquired Pneumonia score), SAPS II (Simplified Acute Physiology Score), SOFA (Sequential Organ Failure Assessment Score) and MPM (Mortality Prediction Model). Primary outcome variable was 30-day in-hospital mortality.</p> <p><bold>Results.</bold> The mean age of the patients was 59.08 ± 15.76 years, predominantly males (68%). The overall 30-day mortality was 52%. Charlson Comorbidity index was increased in non-survivors (3.72 ± 2.33) and was associated with the outcome. All severity indexes had higher values in patients who died, that showed statistical significance between the analysed groups. The areas under curve (AUC) values of the five scores for 30-day mortality were 0.670, 0.732, 0,726, 0.785 and 0.777, respectively.</p> <p><bold>Conclusion.</bold> Widely used severity scores accurately detected patients with pneumonia that had increased risk for poor outcome, but none of them individually demonstrated any advantage over the others.</p> </abstract>ARTICLE2021-11-20T00:00:00.000+00:00en-us-1