The emergence of multi-drug-resistant bacteria causing healthcare-associated infections in COVID-19 patients: a retrospective multi-centre study.

INTRODUCTION: We evaluated the prevalence, aetiologies and antibiotic resistance patterns of bacterial infections in hospitalized patients with laboratory-confirmed SARS-CoV-2. We also investigated comorbidities, risk factors and the mortality rate in COVID-19 patients with bacterial infections. METHODS: This retrospective observational study evaluated medical records of 7249 randomly selected patients with COVID-19 admitted to three clinical centres between 1st January 2021 and 16th February 2022. A total of 6478 COVID-19 patients met the eligibility criteria for analysis. RESULTS: The mean age of the patients with SARS-CoV-2 and bacterial infections was 68.6 ± 15.5 years (range: 24-94 years). The majority of patients (68.7%) were older than 65 years. The prevalence of bacterial infections among hospitalized COVID-19 patients was 12.9%, most of them being hospital-acquired (11.5%). Bloodstream (37.7%) and respiratory tract infections (25.6%) were the most common bacterial infections. Klebsiella pneumoniae and Acinetobacter baumannii caused 25.2% and 23.6% of all bacterial infections, respectively. Carbapenem-resistance in Enterobacterales, A. baumannii and Pseudomonas aeruginosa were 71.3%, 93.8% and 69.1%, respectively. Age >60 years and infections caused by ≥3 pathogens were significantly more prevalent among deceased patients compared with survivors (P<0.05). Furthermore, 95% of patients who were intubated developed ventilator-associated pneumonia. The overall in-hospital mortality rate of patients with SARS-CoV-2 and bacterial infections was 51.6%, while 91.7% of patients who required invasive mechanical ventilation died. CONCLUSIONS: Our results reveal a striking association between healthcare-associated bacterial infections as an important complication of COVID-19 and fatal outcomes.

A non-invasive method for estimating the severity of liver steatosis and the risk of fibrosis in non-obese type 2 diabetes patients with NAFLD.

Context: Prognostic considerations include assessing the risk of liver fibrosis in people with non-alcoholic fatty liver disease (NAFLD). Objectives: This study evaluates the use of hematologic and metabolic parameters regarding liver steatosis and fibrosis scores (FLI and Fib-4) in non-obese type 2 diabetes mellitus (t2DM) patients with NAFLD. Methods: Subjects underwent abdominal ultrasound examinations, and FLI and Fib-4 scores were calculated to evaluate liver steatosis and the risk of liver fibrosis non-invasively: 61 non-obese NAFLD subjects with t2DM were included in the cohort study and were divided into 2 groups depending on the t2DM treatment regimen. Results: Fib-4 and WBC count demonstrated a significant inverse correlation (OR = 0.509, p = 0.007). WBC count had an R2 of 0.237, indicating that this marker could account for up to 23.7% of a variation in Fib-4. Fib-4 and FFA had positive correlation which did not achieve statistically significant prediction (OR=7.122, p=0.062). Additionally, a significant prediction of HbA1c (OR=1.536, p=0.016) and haemoglobin (OR=1.071, p=0.020) for FLI was revealed. Conclusion: HbA1c and other haematological and metabolic parameters, such as haemoglobin and WBC, may be another non-invasive tool for determining whether non-obese NAFLD patients with t2DM are at risk of developing liver steatosis and fibrosis.

[Risk factors in chronic ischemic pancolitis].

Ischaemia of the colon wall leads to lesions that are gathered under entity of ischaemic colitis. Acute or chronic tissue hypoxia is caused by various vascular disorders which could be divided into two large groups: occlusive or non-occlusive. Chronic ischaemic colitis is manifested with necrosis of colon wall, with consequent stenosis of the affected area. Clinically, it is manifested with increased number of bloody stools and abdominal pain. Treatment of choice is surgery, and resection of the affected segment is often life saving. We present a case of a patient with chronic ischaemic pancolitis, due to atheromathosis of upper and lower mesenterial arthery branches, corelated with age, cardiovascular diseases, chronic opstipation and drug-intake.

[Treatment of chronic Wilson's disease in 2 patients using plasmapheresis--clinico-biochemical observations]. / Lecenje dva hronicna bolesnika od Vilsonove bolesti pomocu plazmafereze--klinicko-biohemijska zapazanja.

INTRODUCTION: The introduction of penicillamine in the treatment of Wilson's disease (hepatolenticular degeneration) was a historical event [1]. D-pericillamine (d-PAM) showed some potential side effects such as myasthenia, kidney toxicity, etc. In previous decade the treatment of Wilson's disease (WD) with zinc sulphate started successfully [4]. Danks [7] described the use of exchanged transfusions, peritoneal dialysis and plasmapheresis in the treatment of young patients with WD in acute liver failure. These patients had acute copper poisoning. The results of this study were beneficial. MATERIAL AND METHODS: Therapeutic plasmapheresis (PF) has been used in many diseases in which immunological mechanisms are proved [8, 9]. We started with using PF in the treatment of two young chronic patients with Wilson's disease. The clinical picture of patients became worse, probably due to the decrease in cupriuretic effect of d-PAM. One patient (1) did not take d-PAM regularly. In this study PF was performed with the use of haemonetics V-50 and filter 704. During the treatment with PF, 2000 ml of plasma was always exchanged, i.e. removed. During the treatment with PF the patients were hospitalized at the Department of Neurology and Psychiatry of Children and Young People. CASE REPORT AND RESULTS: Patient No. 1. A 24-year-old man, born in 1965, came with a coarse tremor. He has been diagnosed as WD at the age of 18. Kayser-Fleischer rings were found in the cornea by slit-lamp examination. The disease began when he was 15 years old with polymorphous difficulties. In time tremor became more severe. It was apparent when the patient made any movement. The first treatment with PF (1) lasted from February 13 to March 16, 1989. The patient had 10 PF without any side effect. During the treatment with PF the patient felt better. After PF-tremor was reduced significantly, and subjective and objective condition ameliorated. The patient (1) was readmitted to the hospital on June 24, 1991 for continuation of the treatment with PF. Anamnestic data and neurological examination revealed progression of the disease. His condition became worse, especially tremor. He could not write a single letter (Figures 1-5) and walk without help of the others. His tremor became the severest when he made any kind of voluntary movement. The second treatment with PF started on June 25, 1991 and finished on July 16, 1991. He received 9 PF in this series. The treatment was without side effects. Tremor was reduced approximately by 15%. Plasma copper examined before and after 9 PF showed different values (Table 2). This difference (2.79 mumol/l; 23.70%) in plasma copper level was removed from circulation. Patient No. 2. A 23-year-old man, born in 1966, came to the hospital with acute exacerbation of WD. At the age of 16 latent psychosis was diagnosed. One year later diagnosis of WD was established in the hospital when he was 17 years old. Kayser-Fleischer rings were found in the cornea by slit-lamp examination. The treatment with d-PAM and other drugs (BAL, symptomatic therapies, sedatives, antidepressants, etc.) has been accompanied with good and long-term remissions and short exacerbation. A few years later exacerbation became longer and longer and worse and worse. He was admitted to the hospital on November 28, 1989 with acute relapse of WD. His condition was very difficult, completely bedridden. The treatment with PF started on December 26, 1989 and lasted to January 25, 1990. The treatment with PF was without d-PAM. He was only given symptomatic therapies. After a few PF he demonstrated side effects with nausea, sometimes vomiting, face sweating, pulse rate of about 120/min while blood pressure was normal. Therefore he was given human albumin in the next day, and no side effects were observed. The removal of little plasma copper from blood circulation correlated well with a small improvement in clinical symtpomatology. The rigidity was reduced and voluntary movements bec

[Treatment of patients with acute myeloid leukemia--use of Toronto criteria in evaluation of success in therapy]. / Lecenje bolesnika sa akutnom mijeloidnom leukemijom--primena Toronto kriterijuma u proceni uspeha lecenja.

Over the period from January 1, 1972 to January 1, 1982, a total of 320 patients with acute myeloblastic leukaemia (AML) was registered in our institution. Only 289 case histories were suitable for analysis. In this paper we present the distribution of patients according to the risk group denomination prepared by the Toronto Leukaemia Study Group of Canada. The effect of such stratification of patients with AML is evaluated in our patients. The results are here with discussed. 160 male (median age = 57.7 yr.) and 128 female (median age = 58.0 yr.) patients are presented. Distribution of these patients according to the age is compared to the distribution of similar patients included in the British AML-8 trials and with the total incidence of newly diagnosed AML in England and Wales, in one year (1983). It is shown that the cohort of patients, included in the recognized foreign trials, is not representative of the natural population with respect to morbidity and mortality from AML--similar conclusion concerns this group of patients which comprises the largest single-centre series reported hitherto in the Yugoslavia literature. Thus, the success of therapy of AML as reported in available literature from this country and elsewhere is necessarily, and perhaps incautiously, inflated and statistically distored. The number of complete remissions and the median survival-time of the patients presented varied significantly in our study in accordance with the exclusion steps performed. Without the exclusion of risk groups the percentage of complete remissions was 35.3 per cent and the median survival was 3.0 months. With all the substractions these values were 51.72 per cent and 7.0 months, respectively.

[Work on the Haemonetics 30 blood cell separator]. / Neki aspekti rada na separatoru celija krvi tipa Haemonetics 30.

Our experience with cell separator led us to the conclusion that platelet concentration is rather high (6,94 X 10(11)/L), especially in the part of separated blood which contains significant percentage of erythrocytes. A considerable amount of leukocytes (1,6 X 10(10)/L) can be separated as well. It should be mentioned that leukocyte concentrations are significantly higher when Dexan is administered intravenously and Plasmasteril is used. Therapeutic plasmapheresis requires different approach which varies from the usual work with blood donors, since complications can be expected. Appropriate choice of plasma substituents should be made, as well as constant monitoring of electrocardiographic changes in patients.

Human red cell glutamic-pyruvic transaminase polymorphism in Serbia, Yugoslavia.

The polymorphism of red cell glutamic-pyruvic transaminase (GPT) was studied in 277 unrelated voluntary blood donors from the population of Serbia (Yugoslavia). The following phenotype frequencies were observed: GPT 1 0.309, GPT 2-1 0.454 and GPT 2 0.206, while gene frequencies were: GPT1 0.556 and GPT2 0.454.

[The quality of preserved blood]. / Kvalitet konzervisane krvi.

The examinations of 30 blood samples each preserved with three Yugoslav different ACD-solutions were performed. The blood samples were stored at 2-6 degrees C and examinations were performed at the day of blood donation and after on the 7th, 14th and 21st day during the storage. Differences in hematocrit (well known dilution effect of the ACD-solutions used) and intensive morphological and chemical changes were found in all blood samples regardless the type of ACD-solution used. It was shown that the permanently increasing number morphologically altered erythrocytes (echinocytes and spherocytes) and the excessive release of hemoglobin and potassium from erythrocytes were occurred during the storage of blood samles. Too, there were noticed significant decrease of pH values enormous accumulation of ammoniac and other metabolic producta.

[Biochemical characteristics of concentrated and rinsed erythrocytes]. / Biohemijske karakteristike koncentrovanih i ispranih eritrocita

The biochemical characteristics of concentrated and rinsed out erythrocytes in time function have been analysed. It has been concluded that five days after conservation and during the same day of preparing there was no evidence of significant differences between complete blood erythrocytes and concentrated and rinsed out erythrocytes. In course of preparing concentrated erythrocytes the number of leucocytes declined rapidly, but not completely. By triple rinsing of erythrocytes the number of leucocytes is somewhat less than in the samples of concentrated erythrocytes, but some leucocytes are left.

[Case of Rh E and Kell antigen sensitization by blood transfusion]. / Slucaj senzibilizacije na RhE i Kell antigen transfuzijom krvi

The case of a woman patient has been described. The patient suffered from trombocytopenia and hemorrhagic diathesis and was treated, apart of other therapy, with fresh blood transfusion. As the compatibility tests with some blood samples have shown positive results, a detailed immunohaematic analysis of the patient's blood and blood samples ready for transfusion has been carried out. It has been concluded that the patient was immunized with E Rh and Kell antigen that resulted in a positive compatibility test.