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Abstract

Aortic stenosis is the most common acquired valvular heart disease. Aortic stenosis has growing prevalence in people older than 75 years and natural course of disease is characterized by high mortality rate. According to epidemiological data all patients with aortic stenosis will die after 2–5 years from the first signs of disease if not undergo aortic valve replacement. However, even 40% of patients do not have surgery because of comorbidities related to advanced age. This was the main reason why in 80- and 90-ties of XX century there were intensive attempt to developed an alternative, less invasive treatment methodology for people with aortic stenosis and comorbidities and at high surgical risk. Transcatheter aortic valve implantation (TAVI) was introduced by Dr Alain Cribier in February 2nd, 2002 in Rouen, France. Since that day different aortic transcatheter bioprostheses were used in many randomized clinical trials comparing their safety and effectiveness versus surgical aortic valve replacement. Gradually, it became clear that in all older patients in all risk groups TAVI was equally or even more safe and effective than surgery. Complications after TAVI are relatively rare, but some of them are life-threatening. Heart Team plays a key role in patients selection to TAVI.

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Adam Witkowski
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Abstract

Introduction: Clostridium difficile (C. difficile) is a Gram-positive, anaerobic rod-shaped bacteria, widely spread in the human environment. In the last decade, the frequency and severity of Clostridium difficile infection (CDI) have been increasing, making this particular disease one of the most significant nosocomial infections. The aim of our study was an analysis of CDI risk factors, its course and consequences.

Materials and Methods: Medical documentation of the patients treated for CDI in the University Hospital in Cracow and St Anne’s Hospital in Miechów has been analysed. The analysis focused on epidemiological data, blood parameters, comorbidities, recurrence rate, and complication rate (deaths included). As part of risk factors analysis, antibiotic use or hospitalisation in a period of 3 months before the episode of infection was considered relevant. Blood tests have been performed using routinely employed, standard methods.

Results: We evaluated data of 168 people infected with C. difficile, out of which there were 102 women (61%) and 66 men (39%). Th e median age of the patients was 74 years for the entire population with 76 years for women and 71 years for male patients. One hundred thirteen people (67%) had been previously hospitalised, and 5 person was a pensioner of a nursing home. 99 people (59%) were treated with antibiotics within 3 months before the first episode of infection. An average length of the hospital stay because of CDI was 11 days. One hundred thirty persons (77%) experienced only 1 episode whereas 38 people (23%) had more than 1 episode of infection. The person with the largest number of recurrences had 9 of them.

Conclusions: The development of CDI is an increasing problem in a group of hospitalised persons, particularly of an old age. The general use of beta-lactam antibiotics is the cause of a larger number of infections with C. diffi cile. Vast majority of patients have had at least one typical risk factor of CDI development.

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Authors and Affiliations

Mirosław Dróżdż
Grażyna Biesiada
Anna Piątek
Magdalena Świstek
Mateusz Michalak
Katarzyna Stażyk
Aleksander Garlicki
Jacek Czepiel

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