Determinants of late presentation of HIV positive individuals: a study in Kosovo.

BACKGROUND: In recent years, the global response to the HIV/AIDS pandemic has encountered significant challenges, impeding the collective aim of eliminating AIDS as a public health threat by 2030. A major concern undermining this goal is the delayed presentation (late presentation - LP) of individuals diagnosed with HIV/AIDS. METHODOLOGY: This study includes 85 HIV positive individuals with available CD4 count and viral load (VL) data at the time of HIV diagnosis, out of 169 registered people living with HIV in Kosovo. Employing descriptive and frequency statistics, Chi-square tests, non-parametric Mann-Whitney tests, and logistic regression analyses using SPSS Version 29, we generated statistical results with 95% confidence intervals. RESULTS: The prevalence of LP in HIV positive individuals included in the study was 50.59%, with 30.59% classified as very late presenters (VLP). Determinants associated with LP included male gender, young adulthood, MSM mode of transmission, and a high viral load (log10 4.1-5.0 copies/mL). Comparative analysis with studies on this subject indicated similar patterns of LP in adults, males, and viral load, but different transmission mode patterns. CONCLUSION: This research illuminates the specific determinants of LP in Kosovo, offering valuable insights for tailoring interventions to enhance timely diagnosis and access to care for people living with HIV/AIDS.

Baló Concentric Sclerosis Mimicking Encephalitis with Seizures and Progressive Aphasia in a 26-Year-Old Woman: A Challenging Diagnostic Dilemma.

Introduction: Baló's concentric sclerosis (BCS) is a rare subtype of multiple sclerosis characterized by inflammatory demyelination within the central nervous system. Case Presentation: This case report presents a challenging diagnostic scenario involving a 26-year-old woman diagnosed with BCS. Despite treatment, her condition did not ameliorate, and magnetic resonance imaging (MRI) findings remained unchanged. A subsequent stereotactic biopsy revealed tumefactive Balo disease, highlighting the intricate diagnostic and therapeutic issues surrounding BCS. Conclusion: The juxtacortical location of the BCS lesion, as observed in our case, suggests an unfavourable prognosis due to treatment-resistant seizures.

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.

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.

Does Dexamethasone Helps in Meningococcal Sepsis?

PURPOSE: Prompt recognition and aggressive early treatment are the only effective measures against invasive meningococcal disease (IMD). Anti-inflammatory adjunctive treatment remains controversial and difficult to assess in patients with IMD. The purpose of this study was to evaluate the effect of dexamethasone (DXM) as adjunctive treatment in different clinical forms of IMD, and attempt to answer if DXM should be routinely used in the treatment of IMD. METHODS: In this non-interventional clinical study (NIS), 39 patients with meningococcal septicaemia with or without of meningitis were included, and compared regarding the impact of dexamethasone (DXM), as an adjunctive treatment, on the outcome of IMD. SPSS statistics is used for statistical processing of data. RESULTS: Thirty (76.9%) patients with IMD had sepsis and meningitis, and 9 (23.1%) of them had sepsis alone. Dexamethasone was used in 24 (61.5%) cases, in both clinical groups. The overall mortality rate was 10.3%. Pneumonia was diagnosed in 6 patients (15.4%), arthritis in 3 of them (7.7%), and subdural effusion in one patient (2.6%). The data showed a significant statistical difference on the length of hospitalization, and WBC normalization in groups of patients treated with DXM. CONCLUSION: The use of DXM as adjunctive therapy in invasive meningococcal disease has a degree of proven benefits and no harmful effects. In fighting this very dangerous and complex infection, even a limited benefit is sufficient to recommend the use of DXM as adjunctive treatment in invasive meningococcal disease.

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.

Dexamethasone as adjuvant therapy in the treatment of invasive meningococcal diseases.

PURPOSE: With this study we want to evaluate the role of dexamethasone adjuvant treatment in different clinical forms of invasive meningococcal diseases. WORK METHODS: This was a randomized, open label trial that was conducted in 147 individuals with meningococcal sepsis. All of the cases have been divided in two groups: (1) Cases with meningococcal disease and CNS infection, and (2) Cases with meningococcal disease and no affection of the CNS. Cases from both groups were treated with dexamethasone, 0.15 mg/kg, every 6 h, for 4 (four) days, as adjuvant therapy. Cases which were not treated with dexamethasone were used as control group. WORK RESULTS: From overall number of cases, in 130 of them, the meningococcal disease was accompanied with meningitis; in other 17 cases only signs of sepsis were present. In both clinical forms, the dexamethasone was used in 92 cases. The higher mortality rate is registered among the cases without meningitis, 17.65%, compared with 6.92% which is registered among cases with meningitis. The overall mortality rate among all cases was 8.2%. The significant difference was recorded only on CSF sugar level between two groups (treated or not with dexamethasone) on the day 1-4 of the hospitalization. DISCUSSION: Our epidemiological data are in correlation with data from other epidemiological studies. Most of the cases 69.4%, were more than 12 hours sick at home before the hospitalization, 7.5 % of cases were hospitalized within 12 hours from the onset of the diseases, while 23.1% of cases data are missing. This is in correlation with similar data from other studies. CONCLUSION: Dexamethasone has a limited effect on outcome of the invasive meningococcal disease. Dexamethasone had some effect only during the days of administration in cases with clinical form of sepsis with meningitis, by normalizing the values of CSF sugar earlier.

Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital.

BACKGROUND: Abdominal surgical site infections (SSI) cause substantial morbidity and mortality for patients undergoing operative procedures. We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo (UCCK). METHODOLOGY: Prospective surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006. CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance (HELICS) protocol. RESULTS: A total of 253 surgical interventions in 225 patients were evaluated. The median age of patients was 42 years and 55.1% of them were male. The overall incidence rate of SSI was 12%. Follow-up was achieved for 84.1% of the procedures. For patients with an SSI, the median duration of hospitalization was 9 days compared with 4 days for those without an SSI (p < 0.001). Surgical procedures were classified as emergent in 53.3% of cases. Superficial incisional SSI was most common (55%). Clinical infections were culture positive in 40.7% of cases. Duration of operation, duration of preoperative stay, wound class, ASA score > 2, use of antibiotic prophylaxis and NNIS class of > 2 were all significant at p < .001. The SSI rates for the NNIS System risk classes 0, 1 and 2-3 were 4.2%, 46.7% and 100%, respectively. CONCLUSIONS: SSI caused considerable morbidity among surgical patients in UCCK. Appropriate active surveillance and infection control measures should be introduced during preoperative, intra-operative, and postoperative care to reduce infection rates.

Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital.

BACKGROUND: Abdominal surgical site infections (SSI) cause substantial morbidity and mortality for patients undergoing operative procedures. We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo (UCCK). METHODOLOGY: Prospective surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006. CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance (HELICS) protocol. RESULTS: A total of 253 surgical interventions in 225 patients were evaluated. The median age of patients was 42 years and 55.1% of them were male. The overall incidence rate of SSI was 12%. Follow-up was achieved for 84.1% of the procedures. For patients with an SSI, the median duration of hospitalization was 9 days compared with 4 days for those without an SSI (p2, use of antibiotic prophylaxis and NNIS class of >2 were all significant at p < .001. The SSI rates for the NNIS System risk classes 0, 1 and 2-3 were 4.2%, 46.7% and 100%, respectively. CONCLUSIONS: SSI caused considerable morbidity among surgical patients in UCCK. Appropriate active surveillance and infection control measures should be introduced during preoperative, intra-operative, and postoperative care to reduce infection rates.