Abstract: Objective: Evaluation of individuals with intravenous drug addiction who developed infective endocarditis (IE) is required for a better understanding of the management that can be applied in these cases. This study aimed to shed light on the complex interplay between intravenous drug use and IE with the ultimate goal of improving patient care and outcomes Method: The study examined the clinical outcomes of 43 patients admitted with infective endocarditis (IE) associated with injection drug use. Data was collected over an average follow-up period of 12 months, providing a substantial timeframe to assess the long-term effects of different treatment approaches. The research focused on comparing the outcomes between two distinct groups: patients who received medical treatment alone and those who underwent surgical intervention in addition to medical management. Results This study included 43 intravenous drug users who were diagnosed with infective endocarditis (IE). The mean age of the patient cohort was 31 ± 9 years with a predominance of males (74.4%). All cases involved native valve IE, with the aortic valve being the most commonly affected (62.9%), followed by the tricuspid (30.2%) and mitral valves (6.9 %). Multiple valve involvement was observed in 13.9% of the cases. The study population had a high prevalence of comorbidities, particularly HIV infection (65.1%) and hepatitis C infection (25.5%). The study also revealed that 19.3% of the patients had previously experienced IE. Mortality rates were slightly higher in patients with recurrent IE (23.2%) than in those who experienced their first episode. Transthoracic echocardiography proved to be a highly effective diagnostic tool for detecting vegetation in 95% of the cases. Microbiological analysis identified Staphylococcus aureus as the predominant causative organism, isolated from blood cultures in 55.8% of the cases. These findings highlight the complex nature of IE in intravenous drug users, emphasizing the importance of comprehensive management strategies that address both cardiac manifestations and underlying comorbidities in this high-risk population. Conclusions: Injection drug use–associated infective endocarditis presents a significant challenge in modern healthcare, with patients facing a high risk of complications and poor clinical outcomes despite current therapeutic approaches. This persistent issue underscores the complexity of treating individuals with both infectious diseases and substance use disorders. The multifaceted nature of these cases often involves immediate cardiac infection, as well as concurrent medical, psychological, and social challenges that can complicate treatment and recovery.

Background: Histological findings of infective endocarditis (IE) in mechanical valves present a complex diagnostic challenge owing to the lack of a precise definition. This ambiguity is further complicated by the natural degenerative processes that occur in the mechanical valves over time. Consequently, pathologists and clinicians face significant difficulties in distinguishing between genuine infective processes and normal wear and tear of mechanical valves. Methods: This retrospective study examined tissue samples from 93 patients who underwent surgical removal of mechanical heart valves, with 41 cases suspected of infective endocarditis and 52 cases of noninfective dysfunction. The researchers aimed to establish more precise histological criteria for distinguishing between these two conditions, focusing on three key features: vegetations, and inflammatory patterns. Results: IE in patients with prosthetic heart valves presents distinct histological features that aid in the diagnosis and differentiation of non-infective complications. Hallmark characteristics include vegetation and inflammatory infiltrates with neutrophils. Valve tissue specimens from patients whose mechanical valves were removed because of non-infectious complications showed a different histological profile. Inflammatory infiltrates were observed in approximately 26% of these cases; however, they were primarily composed of macrophages and lymphocytes rather than neutrophils. Conclusions: By emphasizing neutrophil-rich inflammation as a key indicator, clinicians and pathologists could more effectively distinguish between true infective endocarditis and non-IE that can occur in the mechanical valves. This distinction is crucial for appropriate patient management as the treatment strategies for infective and non-infective valve conditions differ significantly.

Histological evidence of active prosthetic valve endocarditis (PVE) in cardiac valve tissue is widely regarded as a criterion established by Duke to confirm the presence of this condition, although the histological characteristics of mechanical prosthetic valve endocarditis have not yet been definitively established. The primary objective of this study was to determine the histologic differences in mechanical PVE in individuals with either early- or late-onset PVE, with the aim of distinguishing the unique aspects of this rare condition. Histological analysis of mechanical cardiac valve tissue was conducted in 27 patients who underwent surgical valve removal, comprising individuals with early onset and late-onset PVE. The findings were compared between the two groups. Histopathologically, PVE in individuals with mechanical heart valves is typically associated with the formation of vegetation and considerable neutrophil-rich infiltrates. In cases of early onset PVE, the affected valve tissue displays intense inflammation predominantly consisting of lymphocytes. In contrast, valve tissue samples from patients with late-onset PVE exhibit extensive fibrosis and inflammation, comprising macrophages, which are specialized immune cells and calcifications.

Abstract: Background: Urinary tract infections (UTI) are a significant health concern, particularly in women, with almost half of them experiencing at least one UTI in their lifetime. This problem is further compounded by the high recurrence rate within 6-12 months. Postmenopausal women are especially vulnerable to recurrent UTI due to the natural decline in estrogen levels, which alters the urogenital epithelium and subsequently affects the urogenital microbiome. Methods: This study included 674 female patients that were admited at "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest over a period of 3 years. Results: Of the 674 women with urinary tract infection, 435 (79.3%) had more than one positive culture, and 239 (35.4%) experienced at least one recurrent urinary tract infection 6-12 months after the initial diagnosis. The mean age of women with urinary tract infection was 63 (± 15.61 years). Recurrent urinary tract infections were most prevalent in those aged 65-80 years (52%). Escherichia coli was detected in 71% of the positive cultures. Conclusions: The management of recurrent urinary tract infections in women presents a complex challenge that necessitates a multifaceted approach. The emerging understanding of the urobiome and its role in bladder health offers promising avenues for developing targeted interventions. As research in this field advances, it is imperative to integrate these new insights into clinical practice to balance traditional antibiotic treatments with novel strategies that consider the intricate microbial ecosystem of the urinary tract.

Objective: Evaluation of patients with prosthetic valves who developed infective endocarditis by comparing treatment outcomes in both early- and late-onset IE episodes following prosthetic valve replacement surgery. This study sought to conduct a comprehensive assessment of the efficacy of these methodologies. The insights derived from this assessment will be utilized to enhance the quality of care for individuals with infective endocarditis who have received prosthetic valve replacement surgery. Results: During the period of investigation (January 2018 - December 2022), 78 patients diagnosed with infective endocarditis (IE) on prosthetic valve were admitted to the Infectious Diseases Department of the "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest. In 28 cases (35.8%), the onset of PVE occurred within 12 months of surgery (early onset), whereas in 50 patients (64.2%), the onset occurred more than 12 months after surgery (late onset). The mortality rate was 35.9% (53.6% among the early onset patients and 26% among the late-onset patients). Among patients who received surgical and medical therapy, the mortality rate was 29.6%, whereas among those who underwent only medical therapy, a 39.2% mortality rate was reported. According to the extracted data, antibiotic therapy was successful in 72.6% of patients. In contrast, a combination of surgical and drug-based approaches resulted in a cure in 76.1% of the patients. The most common etiological agent was Staphylococcus aureus (38.5%), followed by Enterococcus faecalis (26.9%), and Streptococcus mitis (10.3%). The mortality rate of patients with S. aureus was 29.2%, indicating the severity of this infectious agent. Conclusions: Prosthetic valve endocarditis (PVE) is a serious condition associated with a high mortality rate both in the short and long term. Regardless of the therapy used, the risk of death remains high. All patients with PVE who survived received effective early treatment, highlighting the need for prophylactic measures.