Delay in diagnosis and treatment of patients with cases of imported malaria in Poland : one center’s experience

Background . Increasingly, Polish citizens are traveling to malaria endemic regions; thus, physicians, especially primary care physicians, should be educated to recognize and treat malaria. Diagnosis and treatment of malaria encounters many difficulties in Poland. Objectives . The aim of the study was to analyze malaria chemoprophylaxis, the time from first symptoms to hospitalization and the process of diagnosis and treatment of patients with malaria. Material and methods . The medical records of patients diagnosed with malaria, hospitalized between 2012 and 2016 in the Department of Infectious Diseases of the University Hospital, Cracow, Poland, were analyzed. Results . 37 subjects with a median age of 32 years (interquartile range IQR: 28–40), mostly returning from Africa (78%, n = 29), were studied. Proper chemoprophylaxis was used in 6 cases (16%). The median length of stay in malaria endemic countries was one month. Plasmodium falciparum was the most frequent species (74%). The mean time to treatment after symptom onset was 5 days (range: 1–27 days). Conclusions . The clinical presentation of malaria in the study group was usually typical. Diagnostic delay resulted from not taking malaria into consideration during the initial differential diagnosis of fever. Few travelers use chemoprophylaxis, hence the awareness of malaria in individuals who have traveled to endemic zones should be enhanced. In a patient presenting with fever, malaria should always be considered in a differential diagnosis if there is a history of travel to a malaria-endemic zone

Percutaneous management of long and diffused coronary lesions using newer generation drug-eluting stents in routine clinical practice : long-term outcomes and complication predictors

Long and diffuse coronary lesions (LDCLs) are routinely subjected to percutaneous management, but long‑term clinical outcomes and complication predictors with the use of contemporary stents and techniques remain undetermined. Long and diffuse coronary lesion was defined as a lesion requiring an implantation of 30 mm or longer total stent(s) length (TSL) into one coronary artery (bailouts excluded). There were 290 LDCL interventions with the use of newer generation drug‑eluting stents (DESs cobalt chromium everolimus- or zotarolimus-eluting stents) performed between January 2013 and January 2016. The mean (SD) TSL was 55.5 (16.8) mm. The use of intravascular ultrasound / optical coherence tomography was 17.1%, rotablation, 6.9%, and noncompliant balloon, 88.9%. The median (range) follow‑up duration was 831 (390-1373) days. All‑cause mortality and cardiac death rates were 11.7% and 6.9%, respectively. The myocardial infarction (MI) rate was 6.6%, including target‑vessel MI in 4.1%. The rate of clinically‑driven repeat revascularization was 13.8%, and of definite or probable LDCL stent thrombosis, 7.2%. Overall patient‑oriented adverse event rate (any death, MI, or repeat revascularization) was 25.5%, and device‑oriented rate (cardiac death, target vessel‑MI, or target lesion restenosis), 13.4%. Adverse outcome predictors were chronic kidney disease, acute coronary syndrome as an indication for the procedure, chronic heart failure with reduced left ventricular ejection fraction, multivessel disease, and coexisting peripheral artery disease, but not lesion‑related factors, such as bifurcation, calcification, chronic total occlusion, or TSL. Adverse outcomes following contemporary LDCL management using newer generation DESs in routine clinical practice are associated with clinical patient characteristics rather than lesion characteristics or TSL. We identified high‑risk patient cohorts that may benefit from enhanced surveillance

Clostridium difficile infection: review.

Clostridium difficile (C. difficile) is a Gram-positive, spore-forming, anaerobic bacillus, which is widely distributed in the intestinal tract of humans and animals and in the environment. In the last decade, the frequency and severity of C. difficile infection has been increasing worldwide to become one of the most common hospital-acquired infections. Transmission of this pathogen occurs by the fecal-oral route and the most important risk factors include antibiotic therapy, old age, and hospital or nursing home stay. The clinical picture is diverse and ranges from asymptomatic carrier status, through various degrees of diarrhea, to the most severe, life threatening colitis resulting with death. Diagnosis is based on direct detection of C. difficile toxins in feces, most commonly with the use of EIA assay, but no single test is suitable as a stand-alone test confirming CDI. Antibiotics of choice are vancomycin, fidaxomicin, and metronidazole, though metronidazole is considered as inferior. The goal of this review is to update physicians on current scientific knowledge of C. difficile infection, focusing also on fecal microbiota transplantation which is a promising therapy