Effect of Covid-19 pandemic on influenza burden

Flu or influenza is a contagious viral disease that most often occurs in the autumn and winter months with symptoms that are typical for infections of the upper and lower respiratory tract. According to the World Health Organization, lower respiratory tract infections are the fourth leading cause of death in the world. Due to the huge mortality (about 290 000 to 650 000 annually), especially among vulnerable populations with acute heart failure, chronic pulmonary disease, diabetes etc; as well as the increased incidence of acute complications: myocarditis, encephalitis, myositis, respiratory and kidney failure; and worsened long-term medical conditions, information regarding the burden with respiratory viruses, in the direction of public health protection are very important. There are several types of influenza viruses (A, B, C and D), of which the most common in humans are viruses type A (H3N2, H1Npdm09), known as a cause of outbreaks and pandemic, and type B (B/Yamagata or B/Victoria lineage). During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, a significant global decrease in influenza cases was recorded. It is believed that the restrictive measures taken to reduce the transmission of SARS-CoV-2, such as: social distancing, wearing masks and increased hygiene measures, as well as restrictions on travel and movement, are the main factors that caused a decrease in the influenza burden and probably had a huge impact in preventing the spread of influenza and other respiratory pathogens The aim of this research is to make a retrospective analysis of detected influenza virus before, during and after the SARS-CoV-2 pandemic, and to determine the impact of SARS-CoV-2 on the burden and occurrence of influenza in the R. N Macedonia. The analysis is conducted on reported influenza cases and samples tested with Reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2, influenza type A and B at the Institute of Public Health in the period January 201 - June 2023. Out of 129,114, total reported cases from 2016 – 2023, 15 379 cases were reported during the SARS-CoV-2 pandemic seasons with the lower number of 1127 reported cases in the 2020/21 season and 3690 in the 2021/22. Lower number of samples tested (only 35) and the smallest positivity rate for influenza of 5,71% was observed 2020/2021, in comparison with positivity rate before pandemic from 37,21 – 50,29%. Different serotypes dominate during the analysed seasons. Influenza e A(H3N2) is dominantly detected in 3 seasons (2016/17, 2018.19 and 2021/22), although there are seasons with domination of A(H1N1) pdm09. From the analyzed seasons, a decreased number of reported influenza cases during the period of highest SARS-CoV-2 activity and adherence to restrictive measures is observed

Y-chromosome haplogroup architecture confers susceptibility to azoospermia factor c microrearrangements: a retrospective study

Aim To assess the association between azoospermia factor c microrearrangements and semen quality, and between Y-chromosome background with distinct azoospermia factor c microrearrangements and semen quality impairment. Methods This retrospective study, carried out in the Research Center for Genetic Engineering and Biotechnology “Georgi D. Efremov,” involved 486 men from different ethnic backgrounds referred for couple infertility from 2002- 2017: 338 were azoospermic/oligozoospermic and 148 were normozoospermic. The azoospermia factor c microrearrangements were analyzed with sequence tagged site and sequence family variant markers, quantitative fluorescent polymerase chain reaction, and multiplex ligation probe amplification analysis. The Y-haplogroups of all participants were determined with direct single nucleotide polymorphism typing and indirect prediction with short tandem repeat markers.Results Our participants had two types of microdeletions: gr/gr and b2/b3; three microduplications: b2/b4, gr/gr, and b2/b3; and one complex rearrangement gr/gr deletion + b2/b4 duplication. Impaired semen quality was not associated with microrearrangements, but b2/b4 and gr/ gr duplications were significantly associated with haplogroup R1a (P < 0.001 and P = 0.003, respectively) and b2/b3 deletions with haplogroup E (P = 0.005). There were significantly more b2/b4 duplication carriers in Albanians than in Macedonians with haplogroup R1a (P = 0.031). Conclusion Even though azoospermia factor c partial deletions/duplications and Y-haplogroups were not associated with impaired semen quality, specific deletions/ duplications were significantly associated with distinct haplogroups, implying that the Y chromosome background may confer susceptibility to azoospermia factor c microrearrangements

OUR INITIAL EXPERIENCE WITH LAPAROSCOPIC RADICAL CYSTECTOMY

Background and objectives: In this era of minimally invasive surgeries, at the University Clinic for Urologic Surgery in Skopje, the laparoscopic radical cystectomy (LRS) was performed in 11 patients for the first time. In this paper, we have evaluated and summarized the anesthesia management, features and complications of LRC. Material and method: In a retrospective manner, we evaluated all patents who underwent LRC at our Clinic over a one-year period. We noted and analyzed the following parameters: patients’ demographic data, preoperatively and postoperatively, laboratory data, intraoperative fluid volume, estimated blood loss, allogeneic transfusion requirements. Respiratory parameters including arterial blood gas data, anesthesia time, surgical time, time of oral intake, admission to ICU, hospital stay and any adverse events during the whole period of hospitalization were also analyzed. Results: This evaluation included 11 patients who were successfully operated and their data were analyzed. Patients had similar demographic characteristics. Estimated intraoperative blood loss was 472 ml and decreased transfusion requirement was noticed. Due to prolonged surgical time and CO2 pneumoperitoneum, hypercarbia was observed in few patients. Patients had shorter period of bowel dysfunction and rapid oral intake, shorter hospital stay and fewer complications. Conclusion: We believe that these data from our initial experience with newly performed minimally invasive radical cystectomy will reflect to our daily routine practice in radical cystectomy surgery towards laparoscopy. However, some larger prospective evaluation is to be made for summarizing the overall conclusions. Key words: anesthesia consideration, laparoscopy, radical cystectom

Excess Mortality in a Nephrology Clinic during First Months of Coronavirus Disease-19 Pandemic: A Pragmatic Approach

BACKGROUND: Excess mortality is defined as mortality above what would be expected based on the non-crisis mortality rate in the population of interest. AIM: In this study, we aimed to access weather the coronavirus disease (COVID)-19 pandemic had impact on the in-hospital mortality during the first 6 months of the year and compare it with the data from the previous years. METHODS: A retroprospective study was conducted at the University Clinic of Nephrology Skopje, Republic of Macedonia. In-hospital mortality rates were calculated for the first half of the year (01.01–30.06) from 2015 until 2020, as monthly number of dead patients divided by the number of non-elective hospitalized patents in the same period. The excess mortality rate (p-score) was calculated as ratio or percentage of excess deaths relative to expected average deaths: (Observed mortality rate–expected average death rate)/expected average death rate *100%. RESULTS: The expected (average) overall death mortality rate for the period 2015–2019 was 8.9% and for 2020 was 15.3%. The calculated overall excess mortality in 2020 was 72% (pscore 0.72). CONCLUSION: In this pragmatic study, we have provided clear evidence of high excess mortality at our nephrology clinic during the 1st months of the COVID-19 pandemic. The delayed referral of patients due to the patient and health care system-related factors might partially explain the excess mortality during pandemic crises. Further analysis is needed to estimate unrecognized probable COVID-19 deaths

Arterial blood gas alterations in retroperitoneal and transperitoneal laparoscopy

Background: Due to its numerous benefits laparoscopic surgery become very popular among physicians, hospitals and patients nowadays. In the urologic pathology laparoscopy can be performed with retroperitoneal or transperitoneal approach. Insufflation of CO2 for achieving visibility in both of the approaches can be absorbed in the vessels and can lead to alterations in arterial blood gasses. Material and Method: Study population was elective urologic patients scheduled for laparoscopic surgery. Investigated arterial blood gas variables were determined in three time points: T0 before induction – basal, T1 after one hour of CO2 insufflation, and T2 at the end of the surgery. Results: Alterations in arterial blood gasses were seen in T1 and T2 for PaO2 in retroperitoneal vs transperitoneal group 173.3 ± 19 vs 196.6 ± 29 (p < 0.003) and 95.5 ± 5.4 vs 101.1 ± 8.2 (p < 0.001). The PaCO2 was also statistically significant in second observed time point T1 in retroperitoneal vs transperitoneal group 45.9 ± 4.1 vs 38.2 ± 0.3 (p < 0.002). Conclusion: The findings that we have presented can suggest that both approaches are safe although hypercarbia is observed in retroperitoneal group. Key Words: arterial blood gasses, retroperitoneal laparoscopy, transperitoneal laparoscopy, urologic laparoscopy. Corresponding author: Aleksandra Gavrilovska-Brzanov, University Clinic for Anesthesia, Reanimation and Intensive Care, Skopje, Republic of North Macedoni

Postoperative complications in patients undergoing thyroid surgery

Background and objectives: Postoperative complications from thyroid surgery are numerous and may be shown on different levels. Some of these complications may be detrimental for patients, so minimization of the risks should be always considered. We evaluated the postoperative complications in patients after surgery of the thyroid gland at the Clinic for Thoracic Surgery, Skopje. Material and method: In retrospective manner, all patients undergoing thyroid surgery during the one-year period (1. January- 31. December 2017) were evaluated. Patients were divided into two groups, whereas group ST included patients who underwent goiter removal and subtotal thyroidectomy while group TT included patients in who total thyroidectomy was done. In both groups we analyzed the demographic data and the occurrence of postoperative (in the first 48 hours) complications (stridor, hoarseness, hemorrhage, nerve dysfunction, tracheomalacia, hypocalcemia and the need for reintubation and tracheostomy). Results: Total data from 197 patients was evaluated. 120 patients had subtotal thyroidectomy while total thyroidectomy had 77 patients. Postoperative complications occurred in significantly larger number of patients in the TT group (64.9 vs. 40%). Hoarseness (8.4% vs. 18.5%), stridor (18.3% vs. 9.2%) tracheomalacia (5% vs. 1.2%) and hematoma (2.5% vs. 3.8%) occurred in respect to the groups. Hypocalcaemia occurred in significantly larger number of patients in TT group. Permanent nerve injury was found in one patient in the same group and tracheotomy was done only in one patient. Conclusion: Overall results from our study show that the complications after thyroid surgery occur in all patients who undergo thyroid surgery. However, more severe complications and outnumbered are complications in patients who undergo total thyroidectomy. Key words: complications, occurrence, thyroid surgery, total thyroidectomy

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Carboxyhemoglobin changes in relation to inspired oxygen fraction during general anesthesia

Measurement of carboxyhemoglobin could be a new method for evaluation of the severity of inflammatory airway disease, acute organ dysfunction, or stress by surgery and anesthesia. To use this measurement during mechanical ventilation, it is important to clarify the effects of factors that interfere with carboxy- hemoglobin levels. The aim of our study was to investigate the preoperative changes of carboxyhemoglobin to inspired oxygen fraction during general anesthesia and mechanical ventilation. Our second aim was to evaluate the effect of preoxygenation on the level of carboxyhemo- globin. Methods: The study included 30 patients scheduled for urologic surgery under general endotracheal anesthesia, aged 18-60 years, divided into two groups. The study group comprised patients who were smoking cigarettes or tobacco pipe, while the control group included non-smokers. In both groups carboxyhemoglobin levels were determined preoperatively, after preoxygenation, and one hour after induction in anesthesia. Results: carboxyhemoglobin levels were decreased after preoxygenation in both groups. One hour after induction in anesthesia under mechanical ventilation with inhaled fraction of a mixture of O2 (50%) and air (50%) the average values of carboxyhemoglobin between the two groups were different. The average values of carboxyhemoglobin between the two groups in all three time points were statistically significantly different (p=0.00). Conclusion: Changes in carboxyhemoglobin concentrations in arterial blood occur during general anesthesia and mechanical ventilation, although these amplitudes are small when compared to carbon monoxide intoxication. It is likely that organ perfusion and functions are affected by these monoxide gas mediators during surgery