[Prognostic score in infective endocarditis--innovative and useful predictibility factor for disease's evolution]. / Scorul prognostic în endocarditele infectioase--nou factor de predictibilitate în evolutia bolii.

AIM: Evaluate the potential of evolution in infective endocarditis (IE) according to patient's personal parameters (biological, clinical and paraclinical), and Carmeli score, as purpose in establishing an appropiate antibiotherapy. MATERIAL AND METHODS: Clinico-therapeutic observations concerning a cohort of 868 patients admitted between 1995 and 2008 in three hospital services of Iasi. The following guide marks were included in the study: age, sex, previous state of heart, left/right sided IE, number of valves implicated, presence of major complications, health care associated IE/nosocomial IE, major associated diseases, type of microorganism implicated/negative blood cultures. According to their importance, the score varied for each between 0 and 2, resulting a global minimum of 1 and a maximum of 10. All scores obtained were correlated with mortality and Carmeli score. RESULTS: Patients with score 1-4 had a mild evolution, > 4 - < 7 usual trends of evolution with mortality close to medium rate, and 7-10 severe, mortality growing at every point with 15-18%. Carmeli score 1 was associated with 1-4 new score, 2 with > 4 - < 7, and 3 with 7-10 score. Antibiotic regimens changed usually during therapy, higher succes rates being obtained in IE with isolated pathogen. CONCLUSIONS: As new score may vary during patient's evolution, there is an important connection (especially at the time of admission)--but not similarity--between this new factor and Carmeli score, therapy being highly related to guide proposed regimens. However, antibiotherapy in IE should be applied using a mix of these scores, as there are important interferences due to major prognostic factors proposed in the new score, often needing next level's Carmeli score related antibiotherapy.

Tuberculosis meningo-encephalitis with positive csf for KB and slowly favourable evolution. Case report.

BACKGROUND: Meningoencephalitis produce by Koch bacillus is a disease including various symptoms, with often atypical onset and evolution, and with an etiological diagnosis being rarely established. It therefore remains a disease with severe prognosis, despite adequate treatment. CASE REPORT: a 47 years old male from Neamt County, with chronic otitis in his recent medical history, comes to the emergency room for fever, severe headache, confusion, equilibrium disorders, influenced health status, and meningeal irritation signs. Given his otitis and antibiotic therapy received in recent medical history, the patient was initially diagnosed and treated for beheaded bacterial meningitis (348 elements/mm3, 89% lymphocytes, 5% granulocytes, proteinorrhachia 1.54 g/l). Clinical and paraclinical evolution was poor with persistent fever and headache, impaired mental state, and the spinal puncture showed increased pleocytosis (725 elements/mm3), lymphocytosis (78%), increased proteinorrhachia (2.12 g/l), and low levels of glycorrhachia and chlorurorrhachia. Tuberculosis meningoencephalytis was suspected (confirmed after 3 weeks through cultures on Lowenstein-Jensen medium: positive for Mycobacterium tuberculosis), and a tuberculostatic treatment associating four drugs and intravenous Ciprofloxacin was started. Although the treatment included substances against cerebral edema and neurotrophic agent, his evolution showed persistent headache syndrome. We noticed very slow decrease in CSF pleocytosis (after a month) of treatment the patient still had 240 elements/mm3, 85% lymphocytesand 15% granulocytes. Moreover, due to hepatic toxicity a reduction of the tuberculostatic doses was needed. CONCLUSIONS: The beginning of the tuberculosis infection symptoms is often surprising, with clinical signs regarding secondary determinations (meningoencephalitis) association with another infection (otitis--wrong diagnosis). as well as persistent yet slowly favorably evolving symptoms, both clinically and paraclinically (CSF parameters). The etiological agent is extremely rarely isolated, due to a very slow growth of the Koch bacillus on special culture mediums and also because such diagnosis is not often considered before starting the treatment.

Tuberculous meningitis--clinical and epidemiological considerations (a retrospective study 2008-2011).

UNLABELLED: Tuberculous meningitis represents one of the most severe forms of tuberculosis and is often a difficult diagnostic and therapeutic problem. The objective of this study is to analyze the cases of tuberculous meningitis in our region. MATERIAL AND METHODS: We retrospectively analyzed 76 observation sheets of patients aged 4 months to 84 years, diagnosed with tuberculous meningitis, admitted to Infectious Diseases Hospital Iasi during 2008 to 2011. RESULTS: Tuberculous meningitis has affected mostly males (65.7%). Only a small proportion of patients (23.68%) had tuberculosis in their personal history. 26.2% were diagnosed also with other localization of tuberculosis (mostly pulmonary). Fever was identified in only 43.4% of cases; 40% of patients had an altered conscience at admission. The outcome was favorable in all cases. CONCLUSIONS: Tuberculous meningitis predominantly affects males, almost equally affects patients with other focuses of TB and those with a history of tuberculosis disease.

[The effect of cardioversion in sinus rhythm on the systolic dynamics in atrial fibrillation and flutter]. / Influenta cardioversiei în ritm sinusal asupra dinamicii sistolice în fibrilatia si flutterul atrial.

In 60 cases of atrial fibrillation and flutter the systolic time intervals, haemodynamic ratios (PEj/PPE, PPE/PEj and PEj/TCIV) and ejection fraction before and after cardioversion in sinus rhythm were determined. The cardiac performance was markedly improved in all cases regardless the etiology and the degree of ventricular efficiency, pleading for the use of cardioversion anytime there is a chance to restore and maintain the sinus rhythm. The persistence of anticreased venous pressure, as well as the absence or late resumption of atrial mechanic activity usually indicate that arrhythmia soon recurs. In atrial fibrillation and atrial flutter, the inclusion in calculation only of those systoles preceded by R-R higher than 800 ms permits a better estimation of the degree of cardiac performance deterioration consecutive to the existing cardiopathy, the obtained data being very close to the postconversion values.

[The streptococcal and staphylococcal toxic shock syndrome. Comments on 4 cases]. / Sindromul socului toxic streptococic si stafilococic. Consideratii asupra a 4 cazuri.

Between 1989 and 1995 in the Hospital of Infectious Diseases from Iasi have been diagnoses 4 cases of streptococcal/staphylococcal toxic syndrome. Three patients have been grown up and one child. Two of them were immunocompromised hosts (cirrhosis, lung tuberculosis, alcoholism). The gate of entry was cutaneous in 3 cases and probably mucous in the 4th case. The clinical symptoms were fever, generalized erythematous rush followed by desquamation, low arterial pressure with oliguria, tachycardia, jaundice moderate, elevated ALAT. The bacteriological diagnosis was confirmed by isolating the pathogen agent from the erysipelatous placard and from blood culture. The evolution of the illness was nefavourable in 2 cases. The cause of the death was the MSOF (multiple systemic organic failure).