Anaphylaxis Caused by Taking Pantoprazole: Case Series.

Introduction: Pantoprazole is one of the most widely used proton pump inhibitors, but anaphylaxis occurs rarely during its use. The purpose of reporting these two cases is to show that pantoprazole is not a drug without problems; it can also cause anaphylactic reactions. Cases description: A 42-year-old woman presented to the emergency department due to dyspeptic complaints. Immediately at the end of the infusion of pantoprazole, there started to be numbness of the tongue, itching all over the body, and difficulty in breathing. Half an hour after taking a pantoprazole 40 mg capsule, a 58-year-old woman started to experience redness of the face, thickening of the tongue, itching, bloating, and dizziness. Arterial pressure was 80/60 mmHg, pulse 150/minute, while saturation had dropped to 88%. In both cases, fluids, adrenaline, antihistamines, methylprednisolone, and calcium were immediately started. After the improvement of their general conditions, both patients were discharged home. Discussion: The first case relates to anaphylaxis after the intravenous administration of pantoprazole, and the second case relates to the appearance of anaphylaxis after its oral administration. Conclusion: Health workers need to be informed about the possibility of anaphylaxis in patients taking both oral and parenteral pantoprazole. LEARNING POINTS: PPIs are generally safe, with a low percentage of side effects of 1-3%.Although hypersensitive reactions to PPIs are rare, cases of anaphylactoid reactions have also been reported in the literature.Anaphylaxis caused by taking pantoprazole should be considered in the differential diagnosis of anaphylaxis in both oral and parenteral administration of the drug.Doctors and pharmacists should be very careful when prescribing pantoprazole and other PPIs, especially to the elderly.

Facial Cellulitis Caused by Candida Guilliermondi in an Immunocompetent Patient: A Rare Case Report.

Background: Candida cellulitis is a rare disease, primarily reported in immunocompromised patients. Atypical Candida spp. infections are increasing, largely due to the growing number of immunocompromised patients. This case report describes a 52-year-old immunocompetent patient with facial cellulitis caused by Candida guilliermondi. Candida guilliermondi has not previously been reported as a cause of facial cellulitis in either immunocompromised or immunocompetent patients. Case presentation: A 52-year-old, otherwise healthy, male patient presented with facial cellulitis that did not respond to intravenous antibiotics. Culture of the drained pus revealed Candida guilliermondi. The patient was successfully treated with intravenous fluconazole. Conclusion: This case highlights the possibility of atypical Candida spp. causing deep facial infections in immunocompetent patients. Candida guilliermondi has not been previously reported as a cause of facial cellulitis in either immunocompromised or immunocompetent patients. Healthcare providers should consider atypical Candida spp. infections in the differential diagnosis of deep facial infections in both immunocompromised and immunocompetent patients. LEARNING POINTS: Candida guilliermondi can cause facial cellulitis in immunocompetent patients. This has not been previously reported.Atypical Candida spp. infections should be considered in the differential diagnosis of deep facial infections in both immunocompromised and immunocompetent patients.Healthcare providers should be aware of the increasing incidence of non-Candida albicans Candida species infections, especially in immunocompromised patients.

Visceral leishmaniasis in Kosovo: A case of misdiagnosis and diagnostic challenges.

Introduction: Visceral leishmaniasis (VL) is a parasitic disease caused by various Leishmania species and is a potentially life-threatening condition. The disease is highly endemic in several regions, including the Balkans, yet information regarding its prevalence in Kosovo is limited. Case presentation: In this case presentation, a 62-year-old man was admitted to a hospital in Kosovo due to a persistent high fever, and after extensive evaluations and treatments, he was diagnosed with fever of unknown origin (FUO) and transferred to a hospital in Turkey. An abscess of the psoas muscle caused by MRSA was found, however, pancytopenia persisted despite antibiotic treatment. Six months later, the patient was hospitalized again due to fever, chills, and night sweats. Microscopic examination and serological tests revealed the presence of Leishmania infantum in the bone marrow. Liposomal amphotericin B treatment resulted in a significant improvement in the patient's condition. Discussion: The diagnosis of VL can be challenging, and it can easily be misdiagnosed as other diseases, resulting in diagnostic delays and potentially fatal outcomes. In endemic regions such as the Balkans, it is crucial for physicians to be aware of this infection to avoid misdiagnosis or diagnostic delay. Early diagnosis and prompt treatment of VL are essential in preventing morbidity and mortality. Conclusion: This case highlights the significance of considering VL as a possible diagnosis in patients presenting with febrile illnesses accompanied by pancytopenia and splenomegaly, especially in endemic regions.

Twin Brothers and a Sister With CD: A Case Report.

Crohn's disease (CD) has an unknown etiology, but it has a genetic component. Many cases of familial CD have been reported. We describe a Kosovar Albanian family with 6 children, of whom 3 have CD: monozygotic twins and their sister. As far as we know, this is the first such report of CD within a Kosovar family.

Use of antibiotics in COVID-19 ICU patients.

INTRODUCTION: The role of antibiotics in the treatment in COVID-19 cases has not yet been adequately defined, and no criteria have been established for antibiotic treatment, type and duration. METHODOLOGY: This paper reports the results of an observational study on the extent of antibiotic use in 52 randomly selected patients in the intensive care unit (ICU) at the University Hospital in Pristina, Kosovo with severe forms of COVID-19. RESULTS: Antibiotics were prescribed in all the cases (52; 100%). Of the 52 patients, 1) 13 (25%) were given antibiotics before hospitalisation, 2) 49 (94.2%) during treatment in the ward and 3) 52 (100%) during treatment in the ICU. Most often, empirical antibiotics were administered in 32 cases (61.5%) to treat methicillin resistant Staphylococcus aureus (MRSA) infections, and in 23 patients (44.2%) to treat atypical pathogens. The most prescribed antibiotics were ceftriaxone/cefotaxime plus macrolide in (17 cases; 32.7%), ceftriaxone/cefotaxime in (15 cases; 28.8%), ampicillin/amoxicillin plus clavulanic acid or sulbactam (five cases; 9.6%), and quinolones (five cases; 9.6%). Imipenem was the most frequently used antibiotic in the ICU (30 cases; 57.7%), followed by ceftriaxone (28 cases; 53.8%), and piperacillin/tazobactam and fluoroquinolone (17 cases; 32.7%). In 18 cases (34.6%), three antibiotics were given simultaneously; two antibiotics in 29 cases (55.8%) and in five cases (9.6%) only one antibiotic was given. The mean duration of antibiotic treatment was 12.71 days (3-22 days; SD 4.026). CONCLUSIONS: The study showed unrestricted use of broad-spectrum antibiotics in the treatment of severe cases with COVID-19.

Smoking and COVID-19 in ICU Patients.

BACKGROUND: Case studies revealed an astonishingly low number of current among patients suffering from symptomatic COVID-19 compared to general population, leading to the conclusion that smoking/nicotine uptake might have a preventive effect. OBJECTIVE: This study aims to show the relation between smoking habits, present and past, and severity and outcome in COVID-19 patients hospitalized in the ICU of the University Hospital in Pristina. METHODS: This paper reports the results of possible association between smoking habits and severity and outcome of COVID-19. Data on smoking habits, present and past, among 73 patients with severe COVID-19 hospitalized at ICU are analysed and presented. RESULTS: Smokers (active and ex-smokers) in total were 16 (21.9%) cases (P<0.0001); active smokers were 5 (6.8%) cases (P<0.0001), ex-smokers 11 (15.1%) cases (P<0.0001), and non-smokers were 57 (78.1%) of the cases. From 16 cases (21.92%) identified as active smoker and ex-smoker, 8 of them ended with death, and other 8 cases survived; while 40 cases (54.79%) from the non-smoker group died, while 17 cases (23.29%) from this group survived (95% CI: 0.2881 to 1.5430, P=0.3792). Out of 5 (6.85%) cases of active smokers, 3 (4.11%) of them ended with death (95% CI: 0.1692 to 2.6846, P=0.855); while from 11 (15.07%) of ex-smokers, 5 (6.85%) died (95% CI: 0.1995 to 1.6412, P=0.3561). OR for death among smoker group of cases (active and ex-smokers) was 0.4250 (95% CI: 0.1370 to 1.3189, P=0.1386); for active smokers 0.2550 (95% CI: 0.0547 to 1.1892, p=0.0820), and 0.3542 (95% CI: 0.0950 to 1.3199, P=0.1220) for ex-smokers. Data on the influence of smoking on incidence and severity of COVID-19 ICU cases are conflicting. CONCLUSION: A protective effect of smoking in COVID-19 should not be inferred.

Brucellosis associated with deep vein thrombosis.

Over the past 10 years more than 700 cases of brucellosis have been reported in Kosovo, which is heavily oriented towards agriculture and animal husbandry. Here, brucellosis is still endemic and represents an uncontrolled public health problem. Human brucellosis may present with a broad spectrum of clinical manifestations; among them, vascular complications are uncommon. Hereby we describe the case of a 37-year-old male patient with brucellosis complicated by deep vein thrombosis on his left leg.

Clinical outcomes of nonvariceal upper gastrointestinal bleeding in Kosova.

BACKGROUND/AIMS: The aim was to determine the sociodemographic and etiologic factors, endoscopic accuracy, treatment efficiency and clinical outcome of patients with nonvariceal upper gastrointestinal system bleeding in Kosova. MATERIALS AND METHODS: We retrospectively evaluated patients who had applied to our Gastroenterology Department between January 2006 and December 2010. RESULTS: There were 460 eligible cases with mean age 56.85+16.18 years, while male /female ratio was 2.71/1. The greatest occurrence was at age group of 60-69 years (27.1 %). The most common clinical symptom was melena (62.6%). Comorbid diseases were present in 57, 6% of the patients. The percentage of patients using acetylsalicylic acid and /or other non-steroidal anti-inflammatory drugs was 43.7%. Five point two percent were using anticoagulants. Peptic ulcer was the main cause of bleeding (82.2%) and most of them were Forrest III (41.6%). Endoscopic treatment was performed in 90 patients, primary hemostasis was achieved in 96.7% while rebleeding developed in 10% of these patients. The average length of hospital stay was 9.29+5.58 (1-35) days. Rebleeding was reported in 4.1% of all patients while the overall mortality rate was 5.7%. CONCLUSION: Age over 60 years, previous history of gastrointestinal bleeding, treatment with anticoagulants, low hemoglobin values at presentation (<7 g/dL), hematemesis, Forrest class, localization of lesion of bleeding, comorbidities, tachycardia, transfusion requirement>2 unit, type of treatment and time of endoscopy were predictors of poor outcome in study present.

The efficacy of levofloxacin-based triple therapy for first-line helicobacter pylori eradication.

INTRODUCTION: Because of the increasing resistance to clarithromycin and metronidazole, new therapeutic alternatives are needed. The purpose of this study was to compare the efficacy of 7- and 10-day triple therapy including omeprazole, levofloxacin and amoxicilline for Helicobacter pylori eradication as a first-line therapy. METHODS: One hundred and five patients with peptic ulcer disease and with non-ulcer dyspepsia infected with Helicobacter pylori were included in this study. Patients were randomized to receive either 7-day or 10-day therapy with omeprazole (20 mg b.i.d.), plus levofloxacin (500 mg o.i.d.) and amoxicilline (1000 mg b.i.d.). Eradication was assessed by negative histological analyses, negative H. pylori stool antigen or rapid urease test. RESULTS: In Group 1, the eradication rate was 86, 2%, while in group 2, eradication rate was 93,6%. There was no difference between groups (p=0.218). Adverse effects were reported in 5, 25% of the patients, including nausea and diarrhea. CONCLUSIONS: The levofloxacin-based regimen can be one effective therapy for the first-line anti-H. pylori treatment. However, a levofloxacin-based triple therapy is not generally recommended as first-line therapy at the moment due to concerns about the rising prevalence of quinolone-resistant strains in the first-line and second-line anti-H. pylori therapies.

Hepatitis B and C in dialysis units in Kosova.

BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important causes of morbidity and mortality of hemodialysis (HD) patients. This study aimed to investigate the epidemiological and clinical features of HCV and HBV infections in six different HD units in Kosova.Five hundred and eighty-three end-stage kidney disease (ESKD) patients on maintenance HD from six HD centers in Kosova (358 female, 225 male, mean age 54,8 years (16-66) were included in this study. Data from databank of the National Blood Bank in Prishtina, as well as the data from the databank of the Transfusion Centers in Regional hospitals in Prizren, Peja, Gjilan, Mitrovica and Gjakova were taken in this study. Clinical data such as age, sex, HBsAg and anti-HCV antibody and primary causes of ESKD were examined.Serological markers for HBV and HCV were determined with immunoenzymatic assay (ELISA). RESULTS: The T-test and x2 test were used to analyze the significance of the results. Among our HD patients HBsAg and anti-HCV antibody prevalence rate was 12%, respectively 43%. Chronic nephritis was a more frequent cause of ESKD among our HD patients. With unknown etiology were 23, 5% from them. CONCLUSION: HBV and HCV prevalence in our HD patients is still high. These data emphasize the need for stricter adherence to infection control, barrier precaution and preventive behaviors with all patients.

Prevalence of HBV and HCV among blood donors in Kosovo.

Hepatitis is disease of the liver caused by the infectious and non-infectious agents. The aim of study was to analyze the prevalence of HBV and HCV among voluntary blood donors in Kosovo, during 2000-2003. The data from National Center for Blood Transfusion of Kosovo were collected and analyzed through descriptive and comparative epidemiological method of retrospective study. All samples were tested by ELISA test. Out of 70348 samples of the blood donors, 3145 were positive. From overall positive samples, 2939 were HBV positive, 192 HCV positive while 14 samples were positive for both viruses. The HBV prevalence among the blood donors of Kosovo is 4.2%, which range Kosovo to the second zone according to the CDC classification of the geographical spread of the HBV infection. The HCV prevalence among the blood donors in Kosovo is 0.3%. Compared to the other European countries this level of prevalence is relatively low. Age group 30-39 years old was presented with 34.8% of cases. The higher number was among the workers, 842 or 26.8%. Based on the results we can conclude that Kosovo have the similar prevalence for HBV and HCV infections as other South East European countries.