Providing prevention, diagnosis, and treatment of patients after COVID-19 using artificial intelligence.

OBJECTIVE: The aim of this research was to investigate the prevention, diagnosis, and treatment of patients after COVID-19 with the possibility of using artificial intelligence and virtual reality in combination with traditional approaches to patient rehabilitation. MATERIALS AND METHODS: Statistical methods were used to evaluate the situation of COVID-19 worldwide and in Slovakia until March 2022. We investigated the rehabilitation options of breathing exercises, upper and lower limb rehabilitation, and cognitive tasks in patients with post-COVID syndrome who met the criteria for a combined rehabilitation program using virtual reality. Using artificial intelligence, we can predict in advance the evolution of the pandemic according to the records of infected patients and the evolution of the pandemic in the world, taking into account nearby territories. In the treatment of post-COVID syndrome, parameters have been identified that can be measured to objectively assess the improvement of the patient's condition and to continue personalizing individual rehabilitation scenarios. RESULTS: In the patients who underwent the combined rehabilitation method, we observed progress in their ability to improve breathing, limb motor skills and also cognitive function of the patients. We identified different categories of parameters that can be evaluated by artificial intelligence methods, and we evaluated different scenarios using the exterior of nature and the interior of the room of the rehabilitation method of virtual reality, as well as the key elements of the "WOW" effect creating emotional changes in the patient for their motivation. CONCLUSION: We showed that artificial intelligence and virtual reality methods have the potential to accelerate rehabilitation and increase motivation in patients with post-COVID syndrome.

Etiology, Risk Factors and Outcome of 1003 Cases of Infective Endocarditis from a 33-year National Survey in the Slovak Republic: An increasing proportion of elderly patients.

BACKGROUND: Infective endocarditis (IE) is still a significant cause of mortality in European hospitals, despite of the fact, that large nationwide studies were performed in last twenty years and pathogens are well known. The aim of the study was to assess risk factors, mortality, etiology and proportion of elderly patients within a longitudinal nation wide survey of infectious endocarditis in Slovakia. PATIENTS AND METHODS: Etiology, risk factors and outcome of 1003 cases of infective endocarditis (IE) in Slovakia over the last 33 years have been assessed. RESULTS: The majority of IE were caused by Staphylococci (28.3%), 15.6% were due to Viridans streptococci, 10% due to Enterococci, 8.2% by gram-negative bacteria, Acinetobacter baumannii and Pseudomonas aeruginosa, 3.7% by other organisms and 31.0% of all cases were culture negative. The following risk factors were recorded: age > 65 (36.8%), rheumatic fever (15.3%), dental surgery (8.7%), previous non-cardiological surgery (8.2 %), neoplasia (8.1%), diabetes (7.8%), any endoscopy (8.5%) and dialysis (4.6%). All patients were treated with antimicrobials, 507 (51%) also with surgery. Survival rate at day 60 after diagnosis was 88.1% (n=883). Only age >65 (34.3% vs. 49.5%, p=0.045) and persistent bacteremia (with three or more positive blood cultures 15.7% vs. 34.5%, p=0,001) were significantly associated with higher attributable mortality. Concerning risk factors, etiology and therapeutic strategies, rheumatic fever and neoplasia showed decrease in tendency. Dental surgery and tonsillitis were less frequent as well (26.7% vs. 2%, p<0,001 and 16% vs. 1%, p<0.001). There was a significant shift in etiology after 1997: culture-negative endocarditis was surprisingly more frequently observed in the 2007-2017 period than before and represented 10.7% of all cases in 1984-1990 in comparison to 25.1-25.6% in 2007-2010 and 2011-2017. Staphylococci decreased from 48% to 29.6% (2007-2017), but are still major pathogens. Persistent bacteremia (3 or more positive blood cultures 5.3% vs. 24.7%, p<0,001) was less commonly observed within the 1st period (1984-1990) in comparison to 2007-2010. More patients in the 1st period (1984-1990) had embolization complications of IE than in the fifth and sixth period (2007-2017) (76 vs. 16.3% p<0.001). CNS embolization decreased from 14% to less than 5% (p<0.003). Attributable mortality was lower too (26.7% vs. 9.5%, p<0.001) because of increased proportion of cardiac surgery in the treatment of IE in 2007-2017 in comparison to 1984-1990. CONCLUSIONS: Study has showed significant shifts in etiology, risk factors and complications over the observed time periods in Slovakia.

Prevalence of non-pathogenic types of gastrointestinal protozoa in population in Slovakia and their potential importance in the aspect of public health.

The aim of the research was to determine the prevalence of non-pathogenic protozoa circulating in the human population of Slovakia. We particularly focused on the socially deprived areas with poor sanitation conditions, as they are one of the factors affecting the transmission of these infections. Within this study, 2760 people were coprologically screened for the presence of protozoan cysts. The analyzed group comprised 1173 men and 1587 women from different regions of Slovakia. The total prevalence (2.03%) of non-pathogenic protozoa species was determined. The prevalence of Entamoeba coli was 0.80%, the prevalence of Endolimax nana 0.58%, and the prevalence of Blastocystis hominis was 0.65%. The presence of non-pathogenic protozoa was more frequent in women than that in men, in all age groups. The highest incidence of Entamoeba coli was found in children aged one month - seven years (0.79%), the lowest in the age group of 19-88 years (0.66%). Endolimax nana was most frequent in 8-18 year-olds (0.95%), where the statistical significance was found (p<0.05). The prevalence of Blastocystis hominis by the age group ranged from 0.39 to 0.95%. We did not find any statistical significance (p>0.05) for Entamoeba coli, and similarly for Blastocystis hominis associated with the sex and age. Although the circulation of non-pathogenic protozoa in the human population is far from being limited to the developing countries, their occurrence is also frequent in the population of developed countries. Despite their controversial pathogenicity, they should not be neglected, particularly in the patients with gastrointestinal symptoms.

Decision and cost analysis of empirical antibiotic therapy of acute sinusitis in the era of increasing antimicrobial resistance: do we have an additional tool for antibiotic policy decisions?

OBJECTIVE: No previous analyses have attempted to determine optimal therapy for upper respiratory tract infections on the basis of cost-minimization models and the prevalence of antimicrobial resistance among respiratory pathogens in Slovakia. This investigation compares macrolides and cephalosporines for empirical therapy and look at this new tool from the aspect of potential antibiotic policy decision-making process. METHODS: We employed a decision tree model to determine the threshold level of macrolides and cephalosporines resistance among community respiratory pathogens that would make cephalosporines or macrolides cost-minimising. To obtain information on clinical outcomes and cost of URTIs, a systematic review of the literature was performed. The cost-minimization model of upper respiratory tract infections (URTIs) treatment was derived from the review of literature and published models. RESULTS: We found that the mean cost of empirical treatment with macrolides for an URTIs was €93.27 when the percentage of resistant Streptococcus pneumoniae in the community was 0%; at 5%, the mean cost was €96.45; at 10%, €99.63; at 20%, €105.99, and at 30%, €112.36. Our model demonstrated that when the percentage of macrolide resistant Streptococcus pneumoniae exceeds 13.8%, use of empirical cephalosporines rather than macrolides minimizes the treatment cost of URTIs. CONCLUSIONS: Empirical macrolide therapy is less expensive than cephalosporines therapy for URTIs unless macrolide resistance exceeds 13.8% in the community. Results have important antibiotic policy implications, since presented model can be use as an additional decision-making tool for new guidelines and reimbursement processes by local authorities in the era of continual increase in antibiotic resistance.

Misdiagnosing of malaria as RTI decreased after introduction of RDTs in rural areas of Kenya.

BACKGROUND: Clinical presentation of malaria is highly variable and can be mistaken for number of other diseases, including respiratory tract diseases, which are associated with significant morbidity and mortality. However, presumptive management of fever as malaria can result in significant overdiagnosis, even in high-risk areas. Quality microscopy services for the diagnosis of malaria are not widely available in rural areas of Sub-Saharan Africa as well as in substandard conditions of low-income settings and the accuracy of microscopy is usually poor. MATERIAL AND METHODS: The aim of the study was to determine how introduction of RDTs influenced diagnostics of malaria in high risk area of Eldoret, Kenya. Documentation of every patient was screened for data of current disease and diagnostic tools used. In patients with suspected malaria, either microscopy, or RDT or both were done to confirm the diagnosis. RESULTS: Initially, incidence of malaria was very high, about 50-70% of all visits in OPD due to any infectious condition. In 2010, when rapid diagnostic tests became available in Eldoret, decrease in incidence of malaria from 49% (2010) to 29% (2011) and further to 5.3% (2016) was noted. At the same time, increased incidence of upper and especially lower respiratory tract infections was noted. CONCLUSION: Results suggest that upper and lower respiratory tract infections were formerly diagnosed and treated as malaria. Other contributing factors, such as improvement of infrastructure and malaria preventive and treatment programs also play a role in decreasing malaria incidence in rural areas of Kenya, however, RDTs play a key role in proper diagnostics of malaria.

Our experience with smartphone and spherical lens for the eye fundus examination during humanitarian project in Africa.

To present the experience of eye fundus photo documentation by using the plus 20 diopters spherical Volk lens and a smartphone with 4.2 Mpix camera and LED flash within the screening project of eye disorders in countries where the standard ophthalmology equipment is not available. Totally 241 patients underwent ophthalmology screening examination. The documentation of the eye fundus included patients with Burkitt lymphoma, Kala Azar, malnutrition with unknown etiology, tuberculosis, HIV positive patients, Usher syndrome and hypertension. This technique as an alternative way of screening will become a standard within examination of patients with eye disorders in outfield regions of developing countries.

First report of New Delhi metallo-ß-lactamase-1-producing strains in Slovakia.

Occurrence of carbapenemase-producing organisms, including New Delhi metallo-ß-lactamase-1 (NDM-1) is increasingly reported worldwide. The aim of this study was to assess the distribution of carbapenemase producers among multidrug-resistant Gram-negative bacteria isolated from blood cultures. All carbapenem-resistant strains collected from December 2011 to December 2012 were analyzed. Presence of carbapenemases was assessed with combined disc test and Carba NP test followed by polymerase chain reaction for carbapenemase genes. Altogether, 30 strains were detected, of which 7 were positive for VIM (23.3%), 6 for NDM-1 (20%), 5 for IMP (16.7%), and KPC was present in one isolate (3.3%). Four Pseudomonas aeruginosa strains were found to produce more than one carbapenemase. We also present the case report of a patient with Acinetobacter baumannii ventilator-associated pneumonia, followed by sepsis due to Enterococcus faecalis and pan-resistant NDM-1-producing P. aeruginosa. Despite the inappropriate therapy, the patient was successfully treated. This is the first report of NDM-1-producing strains in Slovakia and it contributes to a number of studies mapping the distribution of carbapenemase producers in Europe.

[New antibiotics: do we need new molecules or new strategies?]. / Nové antibiotiká: potrebujeme nové molekuly, alebo nové stratégie?

UNLABELLED: Even though the situation in the field of research and development of new antimicrobial agents is not ideal, the years of stagnation, especially among anti-gramnegative agents, seem to be over. During the years 2011-2012 we have witnessed a movement towards a development of some new antibiotic agents not only with anti-gramposi-tive activity but with anti-gramnegative too, as well as new antituberculotics and antifungals. Here we present some of these new antiinfectives, presented in conferences during the last year, of which many are being shifted to the level of clinical trials of phase II-III, while others are in stage of preclinical studies. KEYWORDS: antibiotics - antimycotics - antituberculotics.

Detection of protein homolougs with HIV-1 antigens in bacteria of positive patients - phase II.

OBJECTIVES: Human immunodeficiency virus type 1 is widely accepted as the cause of AIDS (Acquires Immunodeficiency Syndrome) but it is necessary to consider other factors, not only HIV, which may be involved in AIDS process. It is apparent that a viral reservoir persists in virtually all infected individuals receiving HAART. Reservoirs were detected in macrophages and other cells of the blood system, in which even very effective HAART was not able to eliminate the virus. Over the last period of time AIDS research has been focused on the gut and other mucosal tissue as the major site of HIV infection and CD4+ T cells loss. Intestinal bacteria and cells associated with GIT are in close vicinity and so has been raised the idea that bacteria may be involved in AIDS pathogenesis. Matherial/Methods: Bacteria and yeast isolated from a cohort of 67 Cambodian and Kenyan HIV positive children and from a cohort of 62 Slovak and American AIDS patients were analyzed for detection of expression of HIV-1 antigens p17, p24, p55, gp41 and gp120 (Abcam, UK). RESULTS: By monoclonal antibodies against HIV-1 proteins p17 and p55 was detected protein with molecular weight of 45-55 kDa. In samples of Cambodian and Kenyan HIV positive children was found 35 kDa protein using MAb against HIV-specific protein p17. By using MAbs against p24 was found protein of 55-60 kDa in Cambodian and Kenyan samples but, suprisingly, no proteins were detected in bacterial extracts of American and Slovak AIDS patients by this MAbs. Using monoclonal antibodies against HIV-1 specific protein gp41 was positive signal identified in 30-35% of samples from both cohorts of patients from Kenya and Cambodia and in 75% of samples from American and Slovak patients. The protein of about 75-85 kDa was detected by MAbs against gp120 only in protein extracts obtained from yeasts Candida sp. of Cambodian and Kenyan HIV positive children. CONCLUSION: The molecular weight of 55 kDa protein was detected by MAbs anti HIV p24, p17+p55. Its molecular weight is comparable to gag-encoded Pr55Gag precursor. Surprisingly, such proteins were not found in bacterial extract from samples of American and Slovak patients by using the MAbs against HIV-specific protein p24. The protein of about 75-85 kDa was detected only in Candida species protein extracts of Cambodian and Kenyan HIV positive children by the MAbs against gp120. In Slovak and American samples, protein reacting with MAbs anti gp120 was not found. These results suggest that there are specific differences between Slovak and American HIV positive patients bacterial proteins on one side and Cambodian and Kenyan on the other. These differences may suggest a diverse bacterial evolution in various geographical areas.

Transferable fluoroquinolone resistance in Enterobacteriaceae and Pseudomonas aeruginosa isolated from hemocultures.

BACKGROUND: The main mechanisms causing high-level resistance to fluoroquinolones (FQ) are encoded chromosomally; that includes mutations in genes coding DNA-gyrase, but overexpression of efflux pumps contributes to increased minimum inhibitory concentration (MIC) of FQ as well. However, genes responsible for FQ-resistance may be harboured in transferable/conjugative plasmids. For some time, there was an assumption that resistance to FQ cannot be transferable in conjugation due to their synthetic origin, until 1998, when plasmid-mediated resistance transmission in Klebsiella pneumoniae was proved. We aimed to detect the occurrence of transferable FQ-resistance among Gram- negative bacteria isolated from patients in Czech and Slovak hospitals. METHODS: In this study, we tested 236 clinical isolates of Gram-negative bacteria for transferable resistance. Among relevant isolates we performed PCR detection of transferable fluoroquinolone genes (qnr). RESULTS: We have observed transfer of determinants of cephalosporin-resistance, aminoglycoside resistance as well as FQ-resistance (in 10 cases; 4.24%) not only intra-species but inter-species too. The presence of qnr gene was detected in two isolates of forty tested (5%). We have also observed that determinants of cephalosporin-resistance and aminoglycoside-resistance were linked to those of FQ-resistance and were transferred en block in conjugation. CONCLUSION: We have proved that resistance to fluoroquinolones can be transferred horizontally via conjugation among Gram-negative bacteria of different species and is associated with resistance to other antibiotics.

Nasopharyngeal bacterial colonisation in HIV-positive children in Cambodia.

OBJECTIVE: To determine patterns of nasopharyngeal colonisation in HIV-positive children. METHODS: Nasopharyngeal, nasal and ear swabs were prospectively taken from all children living in two paediatric nursing homes for HIV-positive orphans in Cambodia from 2004 to 2011. RESULTS: A total of 882 swabs were taken, of which 586 tested positive for bacteria. Staphylococcus aureus was the most frequently isolated species (178 isolates; 30.4%) followed by Streptococcus pneumoniae (103 isolates; 17.6%) and Klebsiella pneumoniae (99 isolates; 16.9%). The rate of S. pneumoniae decreased in 2009 when a vaccination programme was introduced. CONCLUSIONS: The respiratory tract of HIV-positive children receiving highly active antiretroviral therapy is commonly colonised by S. aureus and S. pneumoniae, while other species normally found in the respiratory tract, such as Moraxella catarrhalis, are far less frequent.

Cerebral malaria complicated with coma, multiorgan failure and psychosocial sequellae observed among non-immune travelers to Benin, Sudan and Madagascar.

OBJECTIVE: Severe malaria represents less than 10% of all malaria cases and is associated with significant mortality. The aim of this case series was to review severe malaria cases in travelers within the last 10 years in Slovakia. METHODS: All cases of severe malaria in travelers reported within last 10 years from the Inpatient Department in Slovakia to the Slovak Tropical Institute (STI) are reviewed. Only those traveling as tourist to Sub-Saharan Africa were included. RESULTS: During the last 10 years, eight (n=8) cases of cerebral malaria were reported, of which only one died (12.5%). Seven of all 8 cases had deep coma (87.5%), 4 (50%) required ventilator support, 4 (50%) required dialysis, 5 (62.5%) had liver failure and 6 (75%) had severe acidosis. CONCLUSION: Severe malarial cases were rarely detected among travelers returning to Slovakia within last 10 years. In survivors usually no sequellae remained. One patient treated with quinine alone died.

Are subinhibitory concentrations of antibiotics the only culprit of antibiotic resistance?

Evaluation of: Gullberg E, Cao S, Berg OG et al. Selection of resistant bacteria at very low antibiotic concentrations. PLoS Pathog. 7(7), e1002158 (2011). Subinhibitory concentrations of antibiotics and antifungals promote resistance. Antibiotic consumption including hospital use, and country use, including patients self-medications is one of the major drivers of antibiotic or antifungal resistance. However, consumption of antibiotics should be distinguished between the hospital and community. Hospital consumption, poor hospital hygiene and intrahospital transfer have been determined as major risk factors for development of resistance. The correlation between resistance and consumption in the community is not so clear. Therefore consumption of antibiotics and antifungals alone cannot explain the selection of resistant bacterial and fungal mutants and other factors have to be investigated.

Confirmation of HIV-like sequences in respiratory tract bacteria of Cambodian and Kenyan HIV-positive pediatric patients.

BACKGROUND: Bacteria and yeasts isolated from respiratory tracts of 39 Cambodian and 28 Kenyan HIV-positive children were tested for the presence of HIV-1 sequences. MATERIAL/METHODS: Bacteria and yeasts from the respiratory tract (nose, pharyngeal swabs) were isolated from 39 Cambodian and 28 Kenyan HIV-positive children. Bacterial chromosomal DNA was prepared by standard protocol and by Qiagen kit. The PCR specific for HIV sequences was carried out using HIV-1-specific primers.The analysis was performed by colony and dot-blot hybridization using HIV-1-specific primers which represent gag, pol and env genes of the virus. The sequencing of some PCR products was performed on the ABI 373 DNA Sequencer. RESULTS: The majority of microbes were characterized as Staphylococcus aureus, Klebsiella pneumoniae, and resp. Candida albicans. In some cases E. coli, Streptococcus pyogenes, Proteus mirabilis and Candida tropicalis were identified. Bacteria of 16 Cambodian (41%) and 8 Kenyan (31%) children were found to be positive in colony and dot-blot DNA hybridization. By the sequencing of PCR products synthesized on the template of patients' bacterial DNA using primers 68;69 for env HIV-1 gene, homology of greater than 90% with HIV-1 isolate HXB2 (HIVHXB2CG) was revealed. CONCLUSIONS: Bacteria and yeasts from the respiratory tract of 41% of Cambodian and 31% of Kenyan HIV-positive children bear HIV-like sequences. The role of bacteria in the HIV disease process is discussed.

Antibiotic stewardship and consumption: findings from a pan-European hospital study.

OBJECTIVES: Much has been written about antibiotic stewardship although less is known about the structure and content of antibiotic policies at hospital level. As part of the European Commission Concerted Action Antibiotic Resistance Prevention And Control (ARPAC) Project, data on antibiotic stewardship were collated and relationships investigated by antibiotic consumption in European hospitals. METHODS: A questionnaire survey on antibiotic stewardship factors was completed by 170 hospitals from 32 European countries. Data on committees, antibiotic formularies and policies addressing empirical therapy and prophylaxis were collated. Data on antibiotic use, expressed as defined daily doses per 100 occupied bed-days (DDD/100 BD), were provided by 139 hospitals from 30 countries, and 124 hospitals provided both data sets. Six key indicator stewardship variables were analysed by European region, case mix and antibiotic consumption. RESULTS: Hospitals from Northern and Western Europe were more likely to convene antibiotic committees or drugs and therapeutic committees compared with those from Southern and South-Eastern Europe (P < 0.001). One-fifth of hospitals had neither an antibiotic committee nor a policy. Hospital antibiotic policies commonly included recommendations on individual drugs, drug choices, dosage, duration and route but were less likely to contain information on side effects and cost. There were no significant differences by median total (J01) antibiotic consumption, although other antibiotic subgroups differed by stewardship indicators. CONCLUSIONS: Policies and practices relating to antibiotic stewardship varied considerably across European hospitals. These data provide a benchmark for newer European strategies tackling antibiotic resistance. More work is required to achieve harmonization of recommended practice, particularly in hospitals from Southern Europe.