[In patients with community acquired pneumonia associated sepsis, there are emerging frequently hematopoietic changes and disturbed haemostasis of varying severity as a part of the multiorgan dysfunctions. Bet­ween 2012 and 2020, we diagnosed community acquired pneumonia in 1826 patients. Among them, we recognised 218 cases of developing sepsis with typical symptoms and laboratory changes. In these septic patients, we registered the frequency and severity of anaemia, the quantitative and qualitative changes of leucocytes, the numerical abnormalities of platelets, and the pathologic haemostasis. The septic patients’ most frequent hematopoietic dis­orders were anaemia (n=159) and leucocytosis (n=151). Extremely severe leucocytosis (white blood cell count >50000/microlitre) was diagnosed in six patients. De­crea­sed leucocyte count (leucopenia, agranulo­cytosis) was detected in 34 cases. There were three cases of leukemoid reaction: in prevalent leucocytosis we observed myelocytes, metamyelocytes and some atypical myeloid cells in the peripheral blood. In one patient crista biopsy was performed with Jamshidi technic, due to severe pan­cytopenia in the peripheral blood count. The histology of the crista biopsy revealed myelodysplastic bone marrow characteristics. In our patients with sepsis, concerning the number of platelets, the thrombocytopenia dominated (n=82).   ]

[The combination of a beta-lactam and an aminoglycoside antibiotic is widely accepted in the treatment of severe nosocomial infections. In our study we compared two antibiotic regimens: the clinical efficacy of ceftriaxon + netilmicin once-a-day vs ceftazidim + netilmicin twice a-day. Patients: suffering from severe nosocomial infections and characterized by APACHE II, sepsis and injury scores. Dosage: Group | (n=30) – ceftriaxon 2 g iv. + netilmicin (2–7 mg/kg/bw) in one single dose. Group II (n=30) – ceftazidime 2 g bid + netilmicin (2–7 mg/kg/bw) divided in two doses. Laboratory parameters, netilmicin concentrations and cochlear function were checked regularly. 70% of pneumonias were cured or improved, while in the other infections (urinary tract, abdominal, soft tissue) the response rate was 90%. The lowest response rates were observed in Pseudomonas infections in both groups. Response rate in bacteremia was slightly higher in Group I. (5/7 vs 4/8). Four of 7 patients with Staphaureus infections failed to respond in Group II. Both methods of netilmicin administration proved to be safe. Both antibiotic regimens are effective in the treatment of severe nosocomial infections, however once-a-day administration is more convenient for the patients and saves cost.]

[Objective - In this prospective observational study we investigated electrophysiological alterations in the early phase of critical illness and correlated electrophysiological findings with the clinical picture and outcome. Methods - We enrolled 21 critically ill surgical patients having ≥12 Acute Physiology and Chronic Health Evaluation (APACHE) II scores on admission. Routine non-invasive bilateral electroneurography (ENG) examination of median and ulnar nerves was done on five consecutive days starting in two days after admission. Then weekly follow-up was performed. Motor and sensory nerve conduction indices were calculated and correlated with APACHE II and Simplified Acute Physiology Score II severity scores. Results - On the first examination 18/21 patients had >20% reduction in the motor and sensory nerve conduction indices. Severity score systems showed significant negative correlation with the daily change of CMAP and SNAP amplitudes and calculated nerve conduction indices (Spearman’s correlation, p<0,001). Mortality was higher in the patients with worse admission ENG and/or stagnant electrophysiological status or declining tendency in the first week. Conclusions - Electrophysiological alterations appeared soon after the development of critical illness. Early phase alterations showed a strong correlation with patients’ general condition and more severe electrophysiological alterations predisposed to higher mortality. In several cases early alterations proved to be reversible. ]

[Infectious diseases caused by bacteria have been treated successfully by antibiotic the rapy for the past half century, and a diversity of antibacterial agents with widely differing mechanisms of action has been developed by the pharmaceutical industry. However the selective pressure of antibiotic usage has inevitably led to the isolation of resistant bacteria and the rate of emergence of antibiotic resistance appears to be increasing rapidly, reducing the effectiveness of existing agents. Factors responsible for the wide dissemination of antibioticresistant bacteria in both community and hospital practice include the acquisition and spread of resistant genes by plasmids and transposons, inappropriate anti biotic usage and social factors. Mechanisms to controll the emergence of antibiotic resistance require optimal usage of antibiotics by clinicians, control programmes to improve hygiene and to reduce the transmission of resistant bacteria within and between communities, and the continued development of new antibacterial agents.]

[Aim of the research: The aim of my research is to show detailed analysis of clinical categorizing of sepsis and clarifying its diagnostic difficulties. The study shows the elements of diagnostic and monitoring methodology during attendance including the importance of triage. Research and sampling methods: The research was done in a III progressive level hospital in the capital at the Emergecy Department emphasizing one group of illness: sepsis. 81 patients were analysed according to the 2013 data turnover. The method of the research is based on different document analysis and data gathering. In parallel with it, in the following parts of the study I was examining the competences of nurses with different qualifications at the department who were doing triage activity during attendance.Evaluation of the summarized results was created by SPSS 14.0 programme. Results: It was proved from the summarized data that triage activity done by nurses with septic patients was not influenced neither by professional experience nor by qualification of the nurses. More than half of the patients at the departments was not given the correct classification so they were not given the therapy in time. Conclusions: Nurses at the emergency department do not have the necessary knowledge on classification system of triage , that is why each nurse at the department must have the opportunity to improve their knowledge on triage or those not having it must acquire both theoretical and practical knowledge. ]