Clinical Aspects of Visceral Leishmaniasis in Albanian Adults

Visceral Leishmaniasis is still a public health concern in Albania, a former communist country in Southeast Europe which is undergoing a rapid transition from a rigid centralized system towards a market-oriented economy. VL in Albania has been very widespread and known before World War II, but data were scarce. To the general public the disease is known as "spleen disease". Aim of this study is to evidence clinical manifestation of VL and epidemiological evaluation for referral, early diagnosis and treatment of the diseases. Methods: We analized clinical aspects using descriptive statistics included reporting of minimal and maximal values, ranges, mean values, standard deviations and standard errors. T-test and chi-square tests were employed to compare respectively the mean values or the proportions between groups. Upon hospitalization in our study, the disease was mainly manifested with full signs, which means that generally our cases were hospitalized during the second period of the VL that is the anemic phase, considering late. Results: The study highlighted that clinical manifestation of VL in adults are fever in 100% of cases, pancytopenia in 97.3% , anaemia in 100%, The study showed that VL in adult clinically manifested by fever in 100% of cases, anemia in 100% of cases, 73.9% weight loss, sweating 84.9%, enlargement of the abdomen 89.04%, enlarge the liver and spleen in 100% of cases, phenomena hemorrhagic 21.9%, body weakness 90.4%, paleness 75.3%, oedema 5.4%, lymphadenopathy 24.6%, 27.3%, gastrointestinal disorders, chills 61%.Keywords: V.L. (Visceral Leishmaniasis), Leishmania Donovani, sand fly, Albania

Therapeutic efficacy of perfloxacin in treatment of ampicillin-resistant typhoid fever in 7 days versus 10 days

AbstractObjective: Typhoid fever is endemic in Albania and is becoming increasingly resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. Perfloxacin has been shown to have significant activity in vitro against Salmonella species. the authors studied its therapeutic efficacy in patients with typhoid fever.Methods: Thirty patients with ampicillin-resistant typhoid fever, who were admitted to the Infectious Disease Clinic at the University Hospital Center of Tirana, were enrolled in this prospective, nonblinded clinical trial. Patients were treated with oral perfloxacin at 400 mg twice daily. They were randomized to receive treatment for either 7 days (group I) or 10 days (group II).Conclusions: Excellent therapeutic responses were observed in all patients in both groups. In every case, there was significant clinical improvement with defervescence and sterile blood cultures by day 4 and three consecutive negative urine and stool cultures at the end of treatment. Perfloxacin was highly effective in treatment of typhoid fever. Treatment for 7 days appeared to be as effective as treatment for 10 days. In both groups, bile cultures at the end of treatment and at 2 months follow-up were sterile, suggesting that both regimens were effective in preventing a chronic carrier state

Remdesivir and three other drugs for hospitalised patients with COVID-19: final results of the WHO Solidarity randomised trial and updated meta-analyses.

BACKGROUND World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19). METHODS We randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry. RESULTS At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration. CONCLUSIONS These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.)

Cytokines as biomarkers of Crimean-Congo hemorrhagic fever

Crimean-Congo hemorrhagic fever (CCHF) is a potentially severe disease caused by CCHF virus. As in other viral hemorrhagic fevers, it is considered that the course and outcome of the disease depend on the viral load and the balance among the immune response mediators, and that a fatal outcome is the result of a cytokine storm. The level of 27 cytokines was measured in serum samples taken from 29 patients during the acute phase of the disease. Two cases were fatal. Among survivors, significant differences between severe and non-severe cases were observed in the levels of IP-10, and MCP-1, while the levels of IL-1b, IL-5, IL-6, IL-8, IL-9, IL-10, IL-15, IP-10, MCP-1, TNF-, and RANTES differed significantly between fatal and non-fatal cases (P<0.05). RANTES was negatively correlated with the outcome of the disease. A striking similarity with the cytokine patterns seen in Ebola virus disease was observed. A weak Th1 immune response was seen. The viral load was positively correlated with IL-10, IP-10, and MCP-1 levels, and negatively correlated with the ratio IL-12/IL-10. Especially IP-10 and MCP-1 were significantly associated with the viral load, the severity and outcome of the disease, and they could act as biomarkers and, probably, as potential targets for treatment strategies design. J. Med. Virol. 88:21-27, 2016. (c) 2015 Wiley Periodicals, Inc

Crimean-Congo hemorrhagic fever with hepatic impairment and vaginal hemorrhage: a case report

Abstract Background Crimean-Congo hemorrhagic fever is a tick-borne disease described in more than 30 countries in Europe, Asia, and Africa. Albania is located in the southwestern part of the Balkan Peninsula. In 1986, the first case of Crimean-Congo hemorrhagic fever was registered, and cases of patients with hemorrhagic fever are rising, and most of them present in a serious condition, when the mortality rate is very high. In districts like Mirdite, Lezhe, Gjirokaster, Skrapar, Erseke, and Kukes, there is delineated human-to-human transmission. Case presentation We report the case of a 32 year-old Albanian woman from a rural area of Albania. She was hospitalized at the Infectious Diseases Service, for a severe influenza-like illness of 4 days duration. Our patient had been bitten by a tick while working in her garden. She presented with nausea, vomiting, headache and muscle pain. A physical examination found a high fever of 40 °C, an enlarged liver, petechia, and vaginal bleeding; flapping tremor and fetor hepaticus were found as a sign for hepatic encephalopathy; and confusion and disorientation were observed in her neurological examination. Her platelet and white blood cell counts were very low, while her aspartate aminotransferase and alanine aminotransferase levels were very high. She was transferred to the intensive care unit because of her worsening condition. Serological and C-reactive protein test results for Crimean-Congo hemorrhagic fever were positive. She was treated with oral ribavirin and discharged with normal parameters. Conclusions People in high-risk professions in the endemic areas should be informed and trained on the risk of Crimean-Congo hemorrhagic fever as a matter of urgency. Vaginal bleeding is not always a gynecological problem. In Albania, these places are the mountainous areas, so people who have traveled to these areas and who have symptoms after a tick bite are advised to contact their doctors

Maternal and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019: Data from a University Hospital Setting in Tirana, Albania, May 2020 to November 2021

Scientific evidence suggests an increased risk of maternal and obstetric complications in pregnant patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study is aimed at evaluating perinatal and maternal outcomes among patients with coronavirus disease 2019 (COVID-19) in a university hospital setting. This was a prospective cohort study of 177 pregnant women with confirmed SARS-CoV-2 infection at a tertiary hospital between May 2020 and November 2021. Both symptomatic and asymptomatic women with a positive reverse transcription-polymerase chain reaction test result at any time during pregnancy were included in this study. For the purpose of this study, we classified COVID-19 cases into two groups: mild and severe cases. The two groups were then compared to predict how the clinical presentation of COVID-19 affected adverse maternal and perinatal outcomes. Gestational age≥20 weeks at the time of infection was significantly associated with the occurrence of severe forms of the disease (relative risk (RR) 3.98, p=0.01). Cesarean section was the preferred mode of delivery, with 95 women (62.1%) undergoing surgery. A total of 149 neonates were delivered to women who had confirmed SARS-CoV-2 infection at any time during the course of pregnancy of which thirty-five (23.5%) were admitted to the neonatal intensive care unit (NICU). Severe forms of COVID-19 increased the risk of premature delivery (RR 6.69, p<0.001), emergency cesarean delivery (RR 9.4, p<0.001), intensive care hospitalization (RR 51, p<0.001), and maternal death (RR 12.3, p=0.02). However, severe forms of SARS-CoV-2 infection are not directly responsible for low birth weight or the need for neonatal resuscitation. Our findings suggest that pregnant women presenting with severe COVID-19 disease are at an increased risk of adverse maternal and perinatal outcomes, such as premature delivery, cesarean section, admission to the ICU, and maternal death. Infection after the 20th week of gestation increases the risk of developing severe forms of the disease

Severity and Mortality Predictors of COVID-19 Patients with Thrombotic Events-Evidence from the &ldquo;COVID-One&rdquo; Hospital in Albania

COVID-19 vaccination leads to lower infection, morbidity, and mortality rates. However, COVID-19 infection leads to the development of coagulopathy-related manifestations in the form of both venous and arterial thromboembolism. This study aimed to assess the severity and mortality predictors of COVID-19 patients with thrombotic events in hospitalized patients in Albania. This is a retrospective study conducted in the &ldquo;Mother Tereza&rdquo; University Hospital of Tirana. Data were retrieved from the electronic databases of the hospital and only COVID-19 cases admitted to the infectious department during August&ndash;December 2020 were selected. Patients who, at admission, had a C-reactive protein (CRP) (mg/L) more than double and a D-dimer (ng/mL) more than triple according to international standards were included in the study. We performed univariate and multivariable logistic regression analysis, calculating unadjusted and adjusted odds ratios (ORs). A p-value &lt; 0.05 was considered statistically significant. The study population included 60 hospitalized persons with a mean age of 64.4 years. Increased lactate dehydrogenase (LDH) (OR = 2.93; 95% CI = 0.82&ndash;10.42, p-value = 0.1) and increased creatine kinase (CK) (OR = 2.17; 95% CI = 0.63&ndash;7.46, p-value = 0.22) were related with increased probability of death. Moreover, a decreased number of lymphocytes was associated with increased mortality but with no statistical significance (OR = 0.40; 95% CI = 0.11&ndash;1.40, p-value = 0.15). The survival rate was higher for patients without comorbidities (p = 0.045). These results could serve as a baseline and as a reference for healthcare personnel who provides services to hospitalized patients with COVID-19. Further studies should take into consideration the vaccination of the population as well as including more hospitals and patients