Perkutana dilatacijska traheostomija u bolesnika s COVID-19 u jedinici intezivnog liječenja: iskustvo COVID bolnice Kliničkog centra Vojvodine

Patients with acute respiratory distress syndrome due to COVID-19 require intensive care unit (ICU) admission with consecutive endotracheal intubation and invasive mechanical ventilation. In patients with long-term mechanical ventilation, percutaneous dilatational tracheostomy (PDT) may be considered. This retrospective analysis includes clinical data on patients treated at the ICUs of the COVID Hospital of the Clinical Center of Vojvodina in the period from September 3, 2021 to May 1, 2022, and underwent PDT. Patients were predominantly male (n=48; 65.8%). Weaning from mechanical ventilation was achieved in 31 (42.5%) and decannulation in 25 (34.2%) patients. The mean time from polymerase chain reaction SARS CoV-2 positivity until PDT was 15.59±6.85 days. The mean time of endotracheal intubation before the PDT procedure was 7.37±4.89 days. The mean weaning time from mechanical ventilation was 10.45±7.92 days. Twenty-five (34.2%) patients were decannulated at the mean time of 19.60±11.81 days. The complications were tracheostomy related bleeding (2 patients), pneumothorax (4 patients), subcutaneous emphysema (1 patient) and cricoid cartilage injury (1 patient). PDT is a simple, safe, and effective procedure performed in COVID-19 patients in the ICU.Bolesnici sa sindromom akutnog respiracijskog distresa zbog COVID-19 zahtijevaju prijam u jedinicu intenzivnog liječanja (JIL) s posljedičnom endotrahealnom intubacijom i invazivnom mehaničkom ventilacijom. U bolesnika na produženoj mehaničkoj ventilaciji potrebno je razmotriti perkutanu dilatacijsku traheostomiju (PDT). Ova retrospektivna analiza uključuje kliničke podatke bolesnika koji su liječeni u jedinici intenzivnog liječenja u COVID bolnici Kliničkog centra Vojvodine u razdoblju od 3. rujna 2021. do 1. svibnja 2022. i koji su bili podvrgnuti PDT-u. Bolesnici su pretežito bili muškarci (n=48; 65,8%). Odvajanje od mehaničke ventilacije je postignuto u 31 (42,5%) i dekanilacija u 25 (34,5%) bolesnika. Srednje vrijeme od dokazanog pozitiviteta PCR testom na SARS CoV-2 do PDT je bilo 15,59±6,85 dana. Srednje vrijeme endotrahealne intubacije prije postupka PDT je bilo 7,37±4,89 dana. Srednje vrijeme odvajanja od mehaničke ventilacije je bilo 10,45±7,92 dana. Dekanilirano je bilo 25 (34,5%) bolesnika, a srednje vrijeme je bilo 19,60±11,81 dana. Komplikacije su bile krvarenje povezano uz traheostomu (2 bolesnika), pneumotoraks (4 bolesnika), subkutani emfizem (1 bolesnik) i ozljeda krikoidne hrskavice (1 bolesnik). PDT je jednostavan, siguran i učinkovit postupak u bolesnika s COVID-19 u JIL-u

Case Study of Healthcare Organization Improvement with Lean Concept

The goal of each company today is to improve business and increase profit through the reorganization and simplification of its processes, decrease of costs and resources utilization etc. Improving the business is usually implemented through different techniques and methodologies that have been developed. One of the ways to improve service processes, and health system processes also, is the implementation of the lean concept. This study shows benefits from using Lean tools value stream mapping (VSM) and simulations to simplify the laboratory work process. Using the VSM and simulation in department of clinical biochemistry authors showed significant improvement of the clinical processes such as eliminating non-value added times (NVAT) by minimum 30 working days/year, increasing number of laboratories analyses by approximately 80.000 analyses/year, eliminating unnecessary movement of 39,000 - 52,000 meters/year for samples and 78,000 - 104,000 meters/year for stuff and decreasing patient waiting times from average 70 to 20 min/patient

Determination of systemic inflammatory biomarkers in multiple sclerosis

Background: Multiple sclerosis (MS) is one of the most common demyelinating diseases of the central nervous system. We aimed to investigate serum and cerebrospinal fluid levels of different laboratory inflammatory biomarkers in patients with MS. Methods: A total of 120 subjects participated in the study, 60 of whom were diagnosed with MS, 30 with the final diagnosis of non-inflammatory diseases of the central nervous system (CNS), and 30 healthy subjects representing the control group. Regarding the progression of radiological findings after 2 years from the initial diagnosis, the MS group was divided into stationary radiological findings (n=30) and radiologically proven disease progression (n=30). In all patients, we analyzed levels of laboratory inflammatory biomarkers: C reactive protein (CRP), Neutrophil-to-lymphocyte ratio (NLR), Growth differentiation factor 15 (GDF15) in serum samples, and neurofilaments (NFs) in cerebrospinal fluid (CSF). NFs and GDF15 were analyzed initially, while CRP and NLR values were analyzed initially and after two years. Results: We found statistically lower GDF15 values and initial CRP values in the MS group regarding the group with non-inflammatory diseases of the CNS (p<0.0001). On the other side, we determined a significant elevation of laboratory markers CRP and NLR, initially and after a two-year period, in the MS subgroup with the progression of magnetic resonance imaging (MRI) findings (p<0.0001 and p=0.050, respectively). Also, we found a positive correlation between CRP and NFs (r=0.243, p=0.04), as well as a positive correlation between CRP and GDF15 in patients with MS (r=0.769, p<0.0001). Conclusions: We found a significant elevation of laboratory markers of systemic inflammation, CRP, and NLR in MS patients who developed disease progression based on MRI findings. There is a need for further studies to validate current parameters to be considered as useful markers of MS activity and disability

Association between vitamin D hypovitaminosis and severe forms of COVID-19

Objective: Hypovitaminosis D may be associated with an increased susceptibility to infection, more severe COVID-19 forms, and a higher risk of death. The objective of this study was to investigate any possible connections between vitamin D status [as measured by serum 25-hydroxyvitamin D (25(OH)D) levels] and COVID-19 severity. Patients and methods: In 2021, a cross-sectional study of consecutive adult COVID-19 patients was conducted. Anthropometric data, comorbidities, hospital setting, length of stay, respiratory support, outcome data, and vitamin D status were all evaluated. Results: The length of hospitalization among participants (n = 74; mean age 57.64 ± 17.83 years, 55.4% male) was 18.58 ± 10 days, the majority of the hospital setting was a medical ward (67.6%), and the respiratory support in the form of mechanical ventilation was represented by 12.2%. Hypertension (54.1%), obesity (64.9%), and overweight (64.9%) were the most common cardiometabolic risk factors. In the study group, 44.6% of participants had severe vitamin D deficiency (< 30 nmol/l), while 8.1% had vitamin D insufficiency (50 - 74.9 nmol/l). Furthermore, patients with severe COVID-19 (semi-intensive care unit, intensive care unit) had significantly lower serum 25(OH)D levels (32.9 vs. 20.5 nmol/l; p = 0.007). Participants with severe vitamin D deficiency were older and had more prevalent hypertension, requiring mechanical ventilation; 24.2% experienced a fatal outcome. Conclusions: Severe vitamin D deficiency may contribute significantly to the influence of other cardiometabolic risk factors in COVID-19

Traditional food products on the local market - consumption conditional on the characteristics of management and restaurant facilities in tourism of Vojvodina (Serbia)

The research dealt with traditional food products (TFP) observed on the local hospitality-touristic market, from the point of view of 300 restaurant workers employed in managerial positions, as important subjects in preservation of tradition in hospitality and touristic industry of Vojvodina (Republic of Serbia). The research examined the management’s views on TFP, as well as whether there are differences based on the features of the respondents as well as the restaurant facility. In order to obtain data that would provide additional guidelines for acting on the hospitality and tourism market, the procurement and consumption of TFP was also examined. In order to determine set differences the non-parametric Kruskal-Wallis test was applied. In order to establish statistically significant differences between the observed groups, the Dunn’s post hoc test was applied. In the second part of the research, a binary logistic regression model was applied in order to determine which of the observed variables has a significant impact on the respondents’ decision to acquire TFP from their field. The research showed that the level of education and the field of management education significantly influence the attitudes about the offer of TFP in the hospitality and tourism market, as well as the type of restaurant offer and the development of the field of business

Validation of the STANDARD Q COVID-19 antigen test in Vojvodina, Serbia.

BackgroundSince COVID-19 pandemic is a global crisis, tests with high sensitivity and specificity are crucial for the identification and management of COVID-19 patients. There is an urgent need for low-cost rapid antigen COVID-19 test with a good diagnostic performance. Although various antigen rapid detection tests are widely available, strong evidence of their usefulness in clinical practice are still limited. Therefore, our aim was to evaluate clinical performance of STANDARD Q COVID-19 Ag Test (SD Biosensor, Gyeonggi-do, South Korea).MethodsThe performance of the STANDARD Q COVID-19 Ag Test for the detection of SARS-CoV-2 antigen was evaluated in comparison to RT-qPCR results in 120 symptomatic patients (median age 49, IQR 36-70) who presented to health care facility in Novi Sad, Vojvodina, Serbia.ResultsTwenty five out of 120 samples have been tested positive using STANDARD Q COVID-19 Ag Test, and all of them were also positive on RT-qPCR. Overall, the STANDARD Q COVID-19 Ag Test showed sensitivity of 58.1% (95% CI 42.1-73.0) but it was higher in the early days of disease, when the highest viral loads were detected. During the first five days after the symptom onset, the sensitivity ranged from 66.7% to 100% and the pooled accuracy and Kappa values were high (0.92 and 0.852).ConclusionsA strong agreement between performance of STANDARD Q COVID-19 Ag Test and RT-qPCR was observed during the first five days of illness, suggesting that this rapid antigenic test can be very useful for COVID-19 diagnosis in the early phase of disease

Abnormalities of Magnesium Homeostasis in Obesity

Obesity is one of the most important modifiable risk factors for the non-communicable diseases (cardiovascular disease, cancer and diabetes), and is often associated with magnesium (Mg) deficiency. In this study we have analysed the characteristics of the anthropometric measures, blood pressure and glucose level, according to the cut off of serum Mg < 0.8 mmol/L (median of the sample) separately in male and female individuals. In this representative sample of obese, mostly middle aged adults, we have observed different pattern of analysed variables associated with classes of obesity and lower Mg levels

Evaluation of lipid parameters and bioindices in patients with different stages of chronic renal failure

Background/Aim. Cardiovascular morbidity and mortality are markedly increased in chronic renal failure (CRF). The aim of this study was to evaluate lipid parameters and bioindices in patients with different stages of CRF. Methods. In 46 hemodialysed (HD), 50 CRF patients with II, III and IV stage of CRF (non-HD) and 48 control subjects triglycerides (TG), total cholesterol (C), HDL-C, urea, creatinine, creatinuria (standard biochemical methods), apolipoprotein (apo) AI, apo B, lipoprotein(a), cystatin C (immunoturbidimetric method) were evaluated, and LDL-C, non-HDL-C, LDLC/ HDL-C, non-HDL-/HDL-C, TG/HDL-C, and new bioindices, LTI (lipid tetrad index), logLTI, LPI (lipid pentad index), logLPI, AIP (atherogenic index of plasma), and creatinine clearance were calculated. Results. There were significant differences in the levels of TG, HDL-C, LDL-C, non- HDL-C, total C and apo A-I between the HD and non-HD patients, and the HD patients and the controls. LTI and LPI were significantly higher in the HD and non-HD patients compared to the controls (p &lt; 0.05), without a good separation by the Box-Whisker plots. The values of TG/HDL-C ratio and AIP were significantly higher in the HD and non- HD-patients compared to the controls (p &lt; 0.05), and significantly higher in the HD compared to non-HD patients (p &lt; 0.05). AIP &gt; 0.11 was found in 71.7% of the HD, 56% of non-HD and 31.3% of the controls. Conclusion. Among lipid parameters and indices, AIP and TG/HDL-C ratio are most suitable for evaluation of lipid disturbances in different stages of CRF. In addition to, non-HDL-/HDL-C, and apoB/A-I ratios, apo A-I, HDL-C and TG are important markers in HD patients. Non-HDL-C is not a suitable marker. LTI and LPI need to be further investigated

Serum magnesium level in the first trimester of pregnancy as a predictor of pre-eclampsia – a pilot study

Objectives: The aim of this study was to evaluate the importance of serum concentration of magnesium (Mg) in the first trimester of pregnancy for predicting pre-eclampsia (PE). Methods: This prospective study included 403 pregnant women over 18, with singleton pregnancy (from 11 to 14 weeks of pregnancy). The subjects were divided into a group who subsequently developed PE (PEKT) (n = 61), and a group of healthy pregnancies with no complications and with normal outcomes (TNT) (n = 342). In the first trimester, urea, creatinine, uric acid, Mg, free beta subunit of human chorionic gonadotrophin, plasma protein A related to pregnancy, and C-reactive protein were determined. We followed all subjects until the end of pregnancy. Results: Serum Mg is significantly lower in PEKT than in TNT group (p < 0.001). The serum first trimester Mg level cutoff at ≤0.81 mmol/L had a sensitivity of 77.0% and specificity of 71.6% for the detection of women with PEKT. The level of serum Mg has the strongest significant positive correlation (p < 0.05) with the week of gestational outcomes (R = 0.442), weight (R = 0.416), and Apgar score (R = 0.343) of the newborns, and the strongest significant negative correlation with the number of miscarriages (R = −0.413), serum creatinine (R = −0.471), and the number of pregnancies (R = −0.326). The week of gestational outcome is predicted with the greatest reliability by the serum Mg. Conclusions: Serum Mg level during the first trimester of pregnancy is a significant prediction tool for PE and could also play an important role in predicting the week of gestational outcome and birth weight of newborns