Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections and an important cause of morbidity and mortality worldwide. The objective of the study was to identify the predictive factors for unfavorable evolution and deaths among patients with CDI. Materials and methods: We conducted a retrospective, observational, non-randomized study on 202 patients diagnosed with CDI in the Clinical Emergency Hospital of Bucharest, Romania, for a period of two years. For the statistical analysis, the R program was used, with p-values <0.05 being considered statistically significant. Results: The average age of the patients included in the study was 70.8 years, the average duration of hospitalization was 18.4 days, and the mortality rate was 25.7%. During the follow-up period, only 5% of the patients presented a recurrence of CDI. Multiple binomial logistic regression defined as independent risk factors for death among CDI patients: advanced age, comorbidities such as chronic obstructive pulmonary disease (p=0.008), chronic kidney disease (p=0.007), or COVID-19 (p=0.036), leukocytes ≥ 16,755/mm3 (p=0.009) and serum albumin < 2.83 g/dL (p<0.001). Conclusions: The identification of certain negative prognostic factors in patients with CDI requires a careful follow-up of the patients, for an early identification of complications and adaptation of therapeutic management.
Fever of unknown origin (FUO) is a diagnosis that describes a prolonged febrile illness without an established cause, despite investigations. From the first definition of the medical condition (given by Petersdorf and Beeson in 1961) the diagnostic criteria have changed over time, intending to improve the management and outcome of these patients. The main causes of FUO fall into 4 categories: infectious, non-infectious (inflammatory), neoplastic and diverse causes. The etiology of FUO has changed over time, due to ever-changing disease patterns and the development of diagnostic techniques. A significant percentage of patients with FUO remain without an etiologic diagnosis, despite advanced diagnostic tests. Gathering potentially diagnostic clues through history, physical examination and nonspecific key paraclinical abnormalities is the basis for the diagnosis of FUO.
Gastrointestinal infections are among the most common infectious diseases found all over the world, varying depending on the etiological agent. Symptoms usually include diarrhea, vomiting, and abdominal pain. Water and electrolyte imbalance is the main consequence of gastrointestinal infections. Most of them are cured or self-limited in few days, but at the same time, for a specific population such as immunocompromised, elderly patients or new-borns, these infections are potentially severe. In this context, it is very important to identify the etiological agents of acute diarrhea for the appropriate treatment and infection control measures. While routine laboratory diagnosis of parasitic diarrhea still depends largely on microscopic examination of fecal samples, immunological and molecular methods are becoming increasingly commercially available and, in well-resourced settings, will ultimately displace traditional methods. The present paper presents some of the most common and well-known pathologies of this type, being a brief presentation of the variety of gastrointestinal diseases, each with characteristic clinical manifestations and diagnosis.
Background and aim. The presence of acute kidney injury (AKI) in subjects diagnosed with acute coronary syndromes (ACS) represents a major predictor of a negative outcome.The purpose of this study is to reveal the incidence of AKI in ACS subjects and to illustrate the prognosis of these subjects, using special models for mortality prediction, based on the creatinine values and the presence of acute heart failure (AHF). Methods. Using multiple linear regression, several models were designed to predict the mortality including: comorbidities of the subjects, initial and highest value of the serum creatinine (sCr) during hospitalization, presence of theAHF and Killip class compared with sCr values, the last model illustrating the influence of all the previous variables. Results. AKI had a significant incidence in the chronic kidney disease (CKD) group (53.11%). The mortality rate and the hospital readmission were higher in the CKD subjects (41.14%) versus the patients with normal kidney function (21.23%, p<0.01). The association of AKI and AHF, known as cardio-renal syndrome, was related to a negative outcome in the CKD group. The models for prediction of mortality emphasize that the age, dyslipidaemia, worst sCr, Killip class and AHF presence can be used to assess the mortality risk of patients with AKI and ACS. Previous pathological conditions such as diabetes, peripheral artery disease, coronary artery disease (CAD) and obesity, failed to achieve statistically significance for prediction of death. Conclusions. AKI represents a serious pathological condition with a high prevalence in subjects with CKD; the association with AHF increases the risk of hospital readmission and fatal outcome.
Metformin was a revelation in the treatment of patients with type 2 diabetes, being widely used, with remarkable outcomes. Lately, research has greatly expanded the indications of metformin treatment, which can be used not only in diabetes but also in many other conditions. Although still debatable, several studies have shown the beneficial effects of metformin treatment in patients with psoriasis. This article is a review of the latest data of scientific literature about the effects of metformin administration in patients with diabetes and psoriasis, but also in nondiabetic patients with psoriasis
