Increased Susceptibility for Thromboembolic Events versus High Bleeding Risk Associated with COVID-19.

The infection with the SARS-CoV-2 virus is associated with numerous systemic involvements. Besides the severe respiratory injuries and cardiovascular complications, it became obvious early on that this disease carries an increased risk of thromboembolic events, but a higher propensity for bleedings as well. We researched the medical literature over significant PubMed published articles debating on the prevalence, category of patients, the moment of occurrence, and evolution of venous thromboembolism (VTE), but also of venous and arterial "in situ" thrombosis (AT), and hemorrhagic events as well. Most researchers agree on an increased prevalence of thromboembolic events, ranging between 25 and 31% for VTE, depending on the analyzed population. For AT and hemorrhagic complications lower rates were reported, namely, about 2-3%, respectively, between 4.8 and 8%, occurring mostly in older patients, suffering from moderate/severe forms of COVID-19, with associated comorbidities. It is important to mention that patients suffering from hemorrhages frequently received thromboprophylaxis with anticoagulant drugs. As a consequence of thromboembolic and hemorrhagic complications which are both important negative prognostic factors, the evolution of patients infected with the SARS-CoV-2 virus is aggravated, determining an augmented morbidity and mortality of this population.

A comparative study on the biological activity of essential oil and total hydro-alcoholic extract of Satureja hortensis L.

Satureja hortensis L. presents an increased interest due to its chemical composition, abundant in monoterpenes, aglyconic and glycosylates flavonoids, and phenolic acids, leading to important biological activity. The present study compared the biological activity of volatile oil (VO) and total hydro-alcoholic extract (TE) of Satureja hortensis L. in terms of: i) antioxidant activity; ii) antimicrobial activity; and iii) viability, migration and proliferation on two healthy cell lines (keratinocytes-HaCaT and fibroblasts-1BR3) and two melanoma cell lines (human-A375 and murine-B164A5). Antioxidant activity of VO and TE showed maximal values around 72%. Antimicrobial screening highlighted the inhibitory capacity of VO against all seven tested bacteria strains, with the most pronounced effect against S. aureus and C. albicans, while TE exerted only a slight activity against three bacteria strains. VO showed greater efficacy than TE on both tumor cell lines (A375 and B164A5), the activity of the compounds was higher when low concentrations were used (5, 10 and 25 µM) while at high concentrations (50 and 100 µM) the percentages of viability were increased.

Clinical and morphological aspects of lateral femoral condyle status after an osteochondral fracture. A case report.

Although osteochondral fractures of the lateral femoral condyle are uncommon, fixation of the fragments is recommended, mostly when is about young athletes with such post-traumatic pathology. We present a case of a professional handball player teenager female, with a lateral femur condylar osteochondral fracture after a fall with the right knee in extension and in internal rotation. Magnetic resonance imaging (MRI) showed an osteochondral fracture of the lateral femoral condyle, 34.6 mm on long axis, impossible to manage arthroscopically, because of the size and the location of the detached fragment. The solution was the lateral knee arthrotomy allowing the evacuation of the hemarthrosis and preparation of the fracture site, then reduction and fixation of the fracture with absorbable cannulated pins. This procedure is of choice only when is enough bone in the detached fragment to permit the internal fixation and bone-to-bone healing with cartilaginous tissue stabilization through the fibro-cartilaginous rim that would seal the cartilage surface. Postoperative MRI proves that the fragment is settled in its hooked position with repairing of the articular congruity, so the recovery exercises program allow the regaining of the knee mobility with a restart of her sportive activity later.

Morphometric analysis of bone vascular channels during the biointegration of autologous bone grafts.

Vascularization of the transplanted bone tissue is a key factor for success and precedes the formation of bone tissue. Vascularized bone grafts have been widely used in bone transplantation for their efficiency. Maturation of the bone tissue at the place of the transplant involves the change in the vascular patterning, from plexiform irregular vascular networks, to regular, polygonal networks following the structure of osteons. Seven dogs were performed bone transplantation and intravenous injection with China ink in order to highlight the network of blood vessels during bone formation at the place of the transplant. The area occupied by blood vessels increased during osteogenesis, and their length decreased in evolution, suggesting a maturation of the vascular pattern.

Microdensity and morphometric analysis of autologous bone grafts cells.

Bone transplantation as a mean to reduce the fracture healing time in large defects was attempted for the first time more than 300 years ago, with nowadays several techniques and methods of assessment of its efficacy. The bone graft was longtime thought as initiating the osteogenesis from the recipient, but new data show that cells from the graft contribute to osteogenesis and to its incorporation into newly formed bone. There is no accurate assessment of the microdensity of bone graft cells in evolution so far, the only studies published recently referring to newly formed bone area. We have performed bone transplantation on seven dogs and have analyzed the microdensity and the morphometric features of bone graft cells. We have found that the cellular microdensity increases both in the graft and in the recipient bone, simultaneously with a decrease of cell size and circularity during maturation.

[Risk factors involved in multiresistant infections with strains of Enterobacteriaceae]. / Factorii de risc implicati în infectiile cu tulpini de Enterobacteriaceae multirezistente.

OBJECTIVE: The present study aims to analyse the risk factors involvement in the cross infectious pathology determined by multiresistant Enterobacteriaceae, in hospitalised patients in the Intensive Care Unit at the County Emergency Clinical Hospital in Timisoara. MATERIAL AND METHOD: We carried out a case-control study with 3 groups of adult inpatients--200 patients with no superadded infectious pathology, 100 patients infected with Enterobacteriaceae strains resistant to 3 classes of antibacterial chemotherapeutic agents and 100 infected with multiresistant strains. Identification of bacterial germs was performed using API ID 20 E manual galleries (BioMérieux) and the inclusion in the resistance phenotypes was done using the Osiris Evolution (BioRad) analyser. RESULTS: Subjects infected with multiresistant strains are mostly male, (p=0.020, OR=1.8 [1.06-3.07], RR=1.49, [1.05-2.11]), with the mean age younger than that of the control group (p=0.011). The mean Charlson Comorbidity Index was 3.34 in Group III and 4.06 in Group I (p=0.027). The logistic regression application keeps as well as independent risk factors for multiresistance--the mechanical ventilation, consciousness impairment, prolonged hospitalization and the higher number of days of antibiotherapy. CONCLUSIONS: In this study, the nosocomial factors and basic pathology prevail to the detriment of other intrinsic risk factors.

[Gram-positive cocci isolated from urocultures of ambulatory and hospitalized patients with surgical risk]. / Coci Gram-pozitivi izolati din uroculturi provenite din ambulator si sectii cu risc chirurgical.

OBJECTIVES: We propose a comparative study of sensitivity to antibiotics of Gram-positive germs isolated in urocultures from patients in ambulatory and two wards with surgical risk (urology and obstetrics-gynaecology), and also to establish the resistance phenotypes of these strains. MATERIAL AND METHOD: 124 strains of Gram-positive cocci were studied: 28 S. aureus strains, 24 strains of coagulase-negative staphylococcus (CNS), 23 Streptococcus aglactiae strains, 1 Streptococcus anginosus strain and 48 Enterococcus spp. strains. The isolated strains came from 4398 urocultures (1889--ambulatory, 1871--urology, 629--obstetrics-gynaecology). Testing of antibiotic sensitivity was performed through Kirby-Bauer disk-diffusion method, with automatic phenotyping (Osiris Evolution system). RESULTS: In ambulatory, the wild phenotype was predominant in all isolated strains (33.33% S. aureus, 50% CNS, 100% Streptococcus aglactiae, 60% Enterococcus spp.). In the urology ward, the following multiresistant strains were isolated: 9 MRSA strains (47.36%), 1 MRSE strain (100%), 1 VRE strain (4.34%). In the obstetrics-gynaecology ward, 7 strains showed multiple antibiotic resistance: 4 MRSA strains (66.66%), 2 MRSE strains (50%), 1 VRE strain (6.66%). CONCLUSIONS: Multiresistant strains were isolated in hospital environment, which can be explained by the improper use of antibiotics, the instrumental approach of the urinary tract, and the existence of risk factors in the patients admitted in the above-mentioned wards. Enforcement of efficient nosocomial infection control measures is advisable, as well as a policy for rational antibiotic use.

[Aminoglycoside resistance of enterobacteria isolated from urinary infections in surgical departments]. / Rezistenta la aminoglicozide a enterobacteriilor izolate din infectii urinare în sectii cu profil chirurgical.

The aim of the study was to determine the aminoglycosides resistance of Enterobacteriaceae strains isolated from urocultures. Identification of the germs was performed by the API system (BioMerieux) and susceptibility tests was performed by disk-diffusion test (CLSI standards) and with API strips. For detecting the resistance to aminoglycosides we used gentamicin, tobramycin, netilmicin and amikacin. From 2500 urine samples we isolated 673 microbial strains, from which 531 were Enterobacteriaceae, especially E. coli, 57.62% and Klebsiella pneumoniae pneumoniae, 27.68% strains. We observed natural maintained sensibility to aminoglycosides at 55.17% from all the strains we have studied The high prevalence of aminoglycosides resistance of Enterobacteriaceae strains is explained by prolonged antibiotic therapy of patients with invasive diagnostic and therapeutic procedures. A rational policy in prescribing antibiotics in this department is therefore mandatory.

[Antibiotic resistance patterns in Acinetobacter spp. strains isolated from hospital environment]. / Pattern-uri de rezistenta la antibiotice ale unor tulpini de Acinetobacter spp. izolate din mediul spitalicesc.

INTRODUCTION: The Acinetobacter species are ubiquitary germs isolated more and more frequently, Acinetobacter baumannii being currently considered the second strictly aerobic microorganism involved in the ethiology of severe nosocomial infections. Acinetobacter baumannii is usually encountered in surgery and intensive care units, especially in patients with depressed immunity, in which various locations are possible, the most frequvent being the respiratory tract infections, urinary tract infections and bacteriemia. MATERIAL AND METHOD: The study used 52 strains of Acinetobacter spp. isolated from 1131 biological samples (bronchial aspirat, urine, wound secretion, blood, pus, CFS) obtained from the patients of the Timisoara Country Hospital. Identification of germs was performed using the API (BioMerieux) system, and the antibiotics sensitivity testing was made by disk diffusion testing (Kirby-Bauer), with automatic reading and phenotyping through the Osiris Evolution (BioRad) system. RESULTS: The study of resistance to beta-lactamines has pointed out the predominance of penicillinase and cephalosporinase producing strains, 55.77% of the tested ones being part of this phenotype. 90.38% of the strains were resistant to one or more aminoglycosides. Of the tested strains 76.93% were resistant to fluoroquinolones, 86.54% to trimethoprim-sulphamethoxazole, and only 21.15% to tethracycline. CONCLUSIONS: Among the emerging pathogens involved in the nosocomial infections, Acinetobacter baumannii strains have become, in the past decades, a real health issue, due to the variety and seriousness of clinical symptoms. Through the constant increase of the cases number, and the difficulty of applying an effective treatment, the above-mentioned strains showed a multiple resistance to antibiotics.

[Phenotypic characterization of Streptococcus agalactiae strains isolated from urocultures]. / Caracterizarea fenotipica a unor tulpini de Streptococcus agalactiae izolate din uroculturi.

UNLABELLED: The aim of this study was to determine the antibiotic resistance of Streptococcus agalactiae strains isolated from urocultures in order to obtain new data regarding circulating phenotypes in Urology Department. METHODS: For identifications of Streptococcus agalactiae strains we used Pastorex Strep (BioRad). The sensitivity of isolated germs to antimicrobials was tested using standardised Kirby-Bauer technique. RESULTS: We isolated 21 Streptococcus agalactiae strains from 1871 urocultures. Analyzing the extended antibiograms we categorized these germs according with their resistance phenotypes and we remarked a high percentage of wild type phenotype Streptococcus agalactiae strains (80.95%). CONCLUSIONS: Streptococcus agalactiae strains are more rarely isolated from hospital acquired urinary tract infections, that's way we can explain the low resistance of these strains.

[Phenotype characterisation of Enterococcus spp. strains isolated from urocultures]. / Caracterizarea fenotipica a unor tulpini de Enterococcus spp. izolate din uroculturi.

OBJECTIVES: Our aim is to comparatively study the susceptibility to antibiotics of Enterococcus spp. strains isolated from urocultures of patients admitted in the urology department, as well as from ambulatory patients, and also to establish the resistance phenotypes of these strains. MATERIALS AND METHODS: We studied 33 strains of Enterococcus spp.: 10 isolated from a total of 1889 urocultures from ambulatory patients (of which 431 positive) and 23 isolated from 1871 urocultures from patients admitted in the urology department (of which 462 positive). The antibiotic susceptibility was realised by Kirby-Bauer disk-diffusion tests. Statistical analysis of the antibiograms and determining of the resistance phenotypes were performed with automatic reading methods (Osiris--Bio Rad Laboratories), according to the CLSI/NCCLS standard. RESULTS: The wild phenotype was present in 60% of the strains isolated from ambulatory patients, and only in 39.13% in patients admitted in the urology department. In the urology department a multiresistant strain was isolated, displaying Van A (VRE) phenotype, to which was added resistance to beta-lactams, aminoglycosides, macrolides, tetracycline and nitrofurans. CONCLUSIONS: In the past decades urinary tract infections with Enterococcus spp., especially the nosocomial ones, have become serious health issues because of the increasing number of cases and the difficulty of treatment of infections caused by multi-resistant strains. In order to limit the spread of these strains, especially VRE strains, in the hospital environment, efficient measures must be instituted for the control of nosocomial infections, accompanied by policies for the rational use of antibiotics.

[Considerations regarding the nosocomial potential of surgical wards]. / Consideratii referitoare la potentialul nosocomial al sectiilor de chirurgie.

PURPOSES: The aim of our study was to determine the prevalence of multiresistant germs with nosocomial potential and their main resistance phenotype and genotype patterns in surgical departments. METHODS: Identification of germs was performed by the API system (BioMerieux France) and susceptibility tests by disk-diffusion tests, (CLSI standards) with automatic reading methods (Osiris-Bio Rad Laboratories). ESBL producing E. coli and Klebsiella pneumoniae strains have been also genotyped. RESULTS: From 190 samples (urines, wound secretions, blood, etc.); we isolated 106 microbial strains with nosocomial potential. 56 (52.83%) from these strains were represented by enterobacteria, 26 (24.52%) by Gram negative non-fermentative rods, and 24 (22.64%) by Gram positive cocci. CONCLUSIONS: We noticed a high prevalence of multidrug resistant germs (ESBL, MRSA, etc). The majority of them were involved in nosocomial surgical site and urinary tract infections.

The establishment of resistance phenotypes for bacteria isolated from outpatients in urine cultures.

From 1911 outpatients, who addressed a Timisoara private clinical laboratory, from January to December 2005, we collected 1,889 urine cultures, 431 being positive. Bacteria identification was generally done using morphological, cultural, biochemical characters and pathogenicity tests. Sensitivity testing to antimicrobial medical drugs was done by using the classical diffusion Kirby-Bauer method and the automatic analyzer Osiris, also. The main bacteria involved in the etiology of these infections were represented by Enterobacteriaceae, head of the list being Escherichia coli (81.21%), followed by Klebsiella pneumoniae (8.35%) and Proteus mirabilis (3.02%). We also isolated Gram positive cocci (in a much smaller proportion), mainly represented by Enterococcus faecalis (1.16%), Staphylococcus aureus (0.93%), Streptococcus agalactiae, and also Gram negative non-fermentative bacilli, such as Pseudomonas aeruginosa (0.93%) or Acinetobacter baumanii (0.23%). As soon as we performed the sensitivity tests, we divided them in resistance phenotypes: Most of the Enterobacteriaceae were integrated in the wild phenotype, followed by the penicillinase producing phenotype. An E. coli strain (0.29%) and 3 Klebsiella pneumoniae strains (8.33%) were integrated in the large spectrum, multidrug resistant, beta-lactamase producing phenotype, also associated with resistance to fluoroquinolones and aminoglycosides; Non-fermentative bacilli did not present special resistance problems, the four Pseudomonas aeruginosa strains were integrated in the wild phenotype (secreting induced chromosomal cephalosporinase). As for Staphylococcus aureus it was identified a strain having fluoroquinolone resistance, two strains secreting penicillinase and having a K (Nm) phenotype and a strain secreting penicillinase only. Antibiotic resistance represents a major concern for patients, physicians, healthcare managers, and policymakers. The use of antibiotics is closely linked with the development of acquired antibiotic resistance.

[Monitoring of resistance to chemotherapeutics of enterobacteria strains isolated from urocultures from out-patients]. / Monitorizarea rezistentei la chimioterapicele antiinfectioase a enterobacteriilor izolate din uroculturi provenite de la pacienti din ambulator.

The importance of urinary tract infections relies in their relatively high incidence, as well as in their numerous and complicated problems of diagnosis and treatment. Considering the high incidence of urinary infections we made a study in order to determine the antibiotic susceptibility of Enterobacteriaceae strains isolated from urocultures of ambulatory patients and to precise the resistance phenotypes of these strains. We studied enterobacteriaceae strains isolated from 1889 urocultures of ambulatory patients between January - December 2004. From 1889 urocultures 431 were positive, the most common strains were E. coli - 350 strains (81.21%). We observed a constant lowering of the sensitivity of E. coli strains to many antimicrobial agents which draws attention to on the importance of monitoring antibiotics prescriptions. We must draw a signal about the presence of some ESBL (beta-lactamase with extended spectrum) strains (1 E. coli strain and 3 Klebsiella pneumoniae strains), which are usually isolated in hospital, due to empiric, irrational and abusive usage of antibiotics, without doing the antibiograms.

[The sensitivity of some strains of Klebsiella spp. collected in a neonatal department]. / Sensibilitatea unor tulpini de Klebsiella izolate într-o sectie de nou-nascuti.

In order to analyse the evolution of the sensitivity to antibiotics of same strains with nosocomial potential such as Klebsiella isolated in a hospital, we took into study a number of 976 samples, collected in a new-born care department of the "Dr. D. Popescu" hospital Timisoara. The study took place between November-December 2002. The collected samples were pharyngeal swabs, nasal swabs, gastric aspirates, ocular and umbilical secretions, vernix, urines, faeces and blood. From all these samples 803 strains with nosocomial potential were isolated, 84 strains being Klebsiella spp. Most of the isolated strains presented multiple phenotypes of resistance to antibiotics.

[Incidence and sensitivity to antibiotics of germs isolated from surgical wound infections]. / Studiu privind incidenta si sensibilitatea la antibiotice a germenilor izolati din infectii postoperatorii de plaga chirurgicala.

We studied 119 bacterial strains isolated from postoperative infected wounds. All these strains were considered to be strains that derived from the same number of nosocomial infections, all the postoperative infections of the wounds being nosocomial infections. Regarding their frequency, we isolated the following strains: E. coli--68 strains (57%), S. aureus--37 strains (31%), Pseudomonas spp.--9 strains (8%) and Proteus spp.--5 strains (4%). We performed the bacteriological study of these strains and some correlations between them and the surgical diagnosis. In order to help the surgical therapy of the overinfected wounds, we tested the drug sensitivity of all these strains. The results regarding the drug sensitivity show that these strains have different types of resistance to antibiotics, the Pseudomonas strains being the most resistant. We noticed a continuous decrease of the sensitivity of the isolated strains to certain antimicrobial drugs, and this focuses the attention on the necessity of monitoring the antibiotic prescriptions in hospitals. Taking into account the results obtained after this study, we should reconsider the concept of nosocomial infections control through prevention activities, in order to reduce the incidence and to identify the potential causes that can lead to nosocomial infections.

[Evaluation of the sensitivity to meropenem of some bacterial strains with nosocomial potential]. / Evaluarea sensibilitatii la meropenem a unor tulpini bacteriene cu potential nosocomial.

This study analyzes the sensitivity to meropenem of 880 bacterial strains isolated from hospitalized patients in various medical units of County Hospital No. 1 Timisoara. As a result, a high sensitivity of gram-negative pathogens to meropenem (82.01%) has been noticed. Among Enterobacteriaceae, 93.17% of Escherichia coli and 71% of Klebsiella sp. were susceptible to meropenem. For Pseudomonas aeruginosa strains, a high susceptibility was noticed to meropenem (91%), more than 70% to imipenem, but piperacillin + tazobactam had 42% resistance rates.

[Bacterial strains isolated in high nosocomial risk departments]. / Tulpini microbiene izolate din sectii cu risc nosocomial crescut.

We collected 312 samples from hospitalized patients in two hospitals in Timisoara between September-December 2003. We isolated 83 strains with nosocomial potential. Identification of the germs was performed using the automatic API system, and the susceptibility tests were performed using disc-diffusion and the agar dilution test. By analyzing the extended antibiograms we categorized the germs considering their phenotypes of resistance and we remarked a high percentage of E. coli, Klebsiella pneumoniae pneumoniae and S. aureus with multiple resistance to antibiotics.

[Resistance phenotypes circulating in nosocomial high risk departments]. / Fenotipuri de rezistenta circulante în sectii cu risc nosocomial crescut.

OBJECTIVES: Between November 2001-January 2002 we collected 406 samples from patients hospitalized in Intensive Care adults and new-borns Unit (ICU). The aim was to observe the colonization and infection status with bacteria that may have nosocomial potential and to establish circulating phenotypes in ICUs. METHODS: The identification was performed by API (bioMerieux) method, and we have performed the antimicrobial susceptibility tests by both: API method and by Kirby-Bauer disc-diffusion test. RESULTS: We isolated 295 strains with nosocomial potential: 34 MRSA strains, 23 MRCNS strains, 29 ESBL producing gram negative rods, etc. CONCLUSIONS: We observed the presence of multiple drug resistant bacteria which play an important roll in both: massive colonization of patients and in the etiology of nosocomial infections. This leads us to the conclusion that antibiotic resistance pattern should be interpreted by the bacteriologist and a consistent policy concerning the use of antimicrobial drugs in hospital settings should be instituted.