DSpace Community: Moldovan Journal of Health Sciences

Predictors of community-acquired pneumonia severity in patients with chronic heart failure

2026-01-01T00:00:00Z

Title: Predictors of community-acquired pneumonia severity in patients with chronic heart failure Authors: Cașcaval, Virginia; Dumitraș, Tatiana; Fetco-Mereuță, Diana; Grib, Livi; Matcovschi, Sergiu; Talmaci, Cornelia; Caproș, Natalia; Bivol, Elena Abstract: Introduction. Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality, particularly in patients with chronic heart failure (CHF), who are at increased risk of adverse outcomes. Identifying reliable predictors of disease severity in this population is essential for timely risk stratification and optimization of therapeutic strategies. Aim of the study. Assessment of clinical and disease-course characteristics, oxidative stress, and predictors of CAP severity in patients with CHF. Materials and methods. A total of 210 patients were enrolled in the study and divided into two groups: group 1 (n = 105) – patients with community-acquired pneumonia associated with chronic heart failure and group 2 (n = 105) – patients with community-acquired pneumonia without chronic heart failure. The research was conducted based on clinical examination of patients, daily monitoring of the inflammatory process, assessment of comorbidities, and paraclinical investigations. Statistical analysis of the collected data was performed using a wide range of methods, including descriptive statistics, correlational analysis, and regression models. Results. The age of patients in the study group ranged from 50 to 92 years, with a mean of 70.6 ± 8.89 years (95% CI [68.8–72.3]), (F = 18.109; p = 0.205). In Group 1, the proportion of women was 57 (54.3%; 95% CI [44.8-64.1]), and that of men was 48 (45.7%; 95% CI [35.9-55.2]). In Group 2, the proportion of men was higher than that of women: 54 (51.4%; 95% CI [42.3-61.0]) men and 51 (48.6%; 95% CI [39.0-57.7]) women, respectively (χ2 = 0.686; df = 1; p = 0.407). Ischemia- modified albumin values were higher in patients in Group 1 compared to Group 2: 236.60 ± 57.23 μM/L and 229.77 ± 64.35 μM/L, respectively, (F = 0.660; p = 0.045). The IMA threshold value of 218.98 μM/L was determined for patients with CHF and severe CAP. The mean NT-proBNP values in Group 1 patients were 1371.88 ± 498.91 pg/ml, compared to Group 2: 58.19 ± 48.22 pg/ml, (F = 721.54; p < 0.0001). The NT-proBNP threshold value of 1665.73 pg/ml was identified for severe CAP in CHF patients. A method which allows early detection in 87.0% of cases of patients with CHF at high risk of severe community-acquired pneumonia was developed. Conclusions. Our hypothesis that community-acquired pneumonia in patients with chronic heart failure is more frequently associated with a severe clinical course was confirmed. The proposed NT-proBNP and ischemia-modified albumin threshold values, together with our risk estimation formula, may improve early therapeutic intervention to prevent severe complications.

Non-immune fetal hydrops and intestinal obstruction: rare manifestations of congenital syphilis

2026-01-01T00:00:00Z

Title: Non-immune fetal hydrops and intestinal obstruction: rare manifestations of congenital syphilis Authors: Neagu, Anastasia; Crivceanscaia, Larisa Abstract: Introduction. Fetal hydrops is defined as the pathological accumulation of extracellular fluid in at least two fetal anatomical compartments, including skin edema (> 5 mm thickness), pericardial effusion, pleural effusion, and ascites. Non-immune fetal hydrops (NIHF) accounts for over 90% of all fetal hydrops cases and has a heterogeneous etiology. Congenital infections contribute to approximately 6–7% of NIHF cases and are associated with a severe neonatal prognosis. Case presentation. A preterm newborn was delivered from a pregnancy complicated by untreated maternal primary syphilis. The fetus had been diagnosed antenatally with NIHF, heart failure, and massive ascites. Postnatally, the infant required early ascitic drainage and subsequently underwent surgery for congenital intestinal obstruction in the context of ileal stenosis. Neonatal serological testing revealed a positive rapid plasma reagin (RPR) and a reactive Treponema pallidum Hemagglutination Assay (TPHA). Management of congenital syphilis was carried out according to the standardized national clinical protocol. The collected data were compared with those reported in the existing literature to assess clinical significance. Results. The neonate showed a favorable clinical evolution following multidisciplinary management, including intensive care support, anti-infective therapy, and surgical correction of the intestinal obstruction. Progressive improvement allowed successful postoperative recovery and discharge in satisfactory condition. Conclusions. Early identification of the infectious etiology of fetal hydrops is essential for the implementation of appropriate management and the improvement of neonatal outcomes. Close collaboration between maternal–fetal medicine, neonatology, and pediatric surgery is crucial in managing such complex cases.

Healthcare-associated bloodstream infections in children: epidemiology, risk factors and prevention strategies

2026-01-01T00:00:00Z

Title: Healthcare-associated bloodstream infections in children: epidemiology, risk factors and prevention strategies Authors: Marga, Irina Abstract: Introduction. Health care-associated bloodstream infections represent a major public health concern, significantly impacting morbidity, mortality, and the overall cost of pediatric medical care. Materials and methods. A literature review was conducted based on systematic searches in PubMed, SCOPUS, and Web of Science, following PRISMA guidelines. Results. The incidence of healthcare-associated bloodstream infections ranges from 2 to 25 cases per 1,000 central venous catheter days, with higher rates reported in pediatric and neonatal intensive care units, where patients are frequently exposed to risk factors such as central venous catheter use, mechanical ventilation, and immunosuppression. Pediatric patients with health care-associated bloodstream infections experience significantly longer hospital stays compared to those without infection (25 vs. 7 days, P < 0.0001). In pediatric intensive care units, the average length of hospital stay due to these infections varies between 11.40 and 21.10 days, while in neonatal intensive care units, it ranges from 4 to 27.80 days. Mortality associated with these infections among children varies between 15% and 50%, depending on the severity of infection and underlying comorbidities. Additionally, health care-associated bloodstream infections lead to increased use of medical resources and generate substantial additional costs for the healthcare system-costs that are, in fact, largely preventable. Conclusions. Evidence-based strategies, such as strict hand hygiene and standardized protocols for medical device use, can significantly reduce the incidence of these infections.

Tick-borne mix infection diagnosis, challenges, and current practices

2026-01-01T00:00:00Z

Title: Tick-borne mix infection diagnosis, challenges, and current practices Authors: Sofronie, Olga; Bălan, Greta Abstract: Introduction. Tick-borne infections (TBIs) are increasingly recognized as a public health concern in North America and Europe, with Lyme disease being the most notable. The Centers for Disease Control and Prevention (CDC) acknowledges that official statistics likely underestimate the true incidence of TBIs due to diagnostic challenges and underreporting. Co-infections, where multiple pathogens are transmitted through a single tick bite or multiple bites, complicate diagnosis and treatment, leading to more severe symptoms and longer illness durations. Studies indicate a significant percentage of Lyme disease patients also have co-infections, with babesiosis being a common co-infection. Materials and methods. A comprehensive narrative literature review was conducted using PubMed and Scopus, resulting in 52 manuscripts. Additional reports from the CDC and European Centre for Disease Prevention and Control (ECDC), as well as relevant academic books, were included to meet the study’s objectives. The Elicit platform was utilized to enhance reference identification and information synthesis. Results. The paper provides an overview of tick-borne co-infections, emphasizing the diagnostic challenges posed by overlapping and nonspecific symptoms. It discusses various diseases, including Lyme disease, babesiosis, anaplasmosis, ehrlichiosis, Rocky Mountain spotted fever, and tick-borne encephalitis, detailing their causative organisms, vectors, clinical features, and common co-infections. The review critically examines diagnostic methods such as serological tests, molecular tests, and blood smears, highlighting issues like the „window period” false negatives/positives, and differentiating active from past infections. It also explores emerging technologies and biomarkers, including multiplex assays and next-generation sequencing, which enhance detection capabilities but face challenges in data analysis and standardization. Conclusions. Accurate diagnosis is crucial to manage these infections effectively, particularly in vulnerable populations. The rise in co-infections and inadequate testing presents a significant public health challenge, necessitating improved surveillance and diagnostic approaches.