PSYCHOLOGICAL EFFECTS OF "DOUBLE CRISIS" (COVID-19 PANDEMIC AND EARTHQUAKES) ON CROATIAN MEDICAL STUDENTS

Introduction: In 2020. the COVID-19 pandemic presented an additional source of stress and anxiety not just to the general population but also to medical students who are, even under normal circumstances, constantly under pressure due to demanding student duties. In addition, they experienced a series of devastating earthquakes in and around the Zagreb region which altogether could have had compromised their psychological well-being. The aim of this review was to evaluate the psychological effects of these two natural disasters on the mental health of Croatian medical students. Results: According to standardized questionnaires for depression and anxiety evaluation, 75.3% of students were anxious and 65.2% were depressive during to outcomes was observed regarding genders, but it was found that first year students had a significantly higher anxiety score than older ones. Conclusion: In such stressful situations, we should emphasize the importance of mental health not just of healthcare workers, but also of medical students in order to prevent serious psychological consequences and to alleviate the negative motivation and their educational process

PSYCHOLOGICAL EFFECTS OF "DOUBLE CRISIS" (COVID-19 PANDEMIC AND EARTHQUAKES) ON CROATIAN MEDICAL STUDENTS

Introduction: In 2020. the COVID-19 pandemic presented an additional source of stress and anxiety not just to the general population but also to medical students who are, even under normal circumstances, constantly under pressure due to demanding student duties. In addition, they experienced a series of devastating earthquakes in and around the Zagreb region which altogether could have had compromised their psychological well-being. The aim of this review was to evaluate the psychological effects of these two natural disasters on the mental health of Croatian medical students. Results: According to standardized questionnaires for depression and anxiety evaluation, 75.3% of students were anxious and 65.2% were depressive during to outcomes was observed regarding genders, but it was found that first year students had a significantly higher anxiety score than older ones. Conclusion: In such stressful situations, we should emphasize the importance of mental health not just of healthcare workers, but also of medical students in order to prevent serious psychological consequences and to alleviate the negative motivation and their educational process

Laser treatment of pilonidal sinus: Our first experience at the Day Surgery Unit in a University Hospital Centre Zagreb

INTRODUCTION There are limited data available concerning laser treatment of pilonidal disease. Our study demonstrates a single institution first experience with SiLaC® (Sinus Laser-Assisted Closure, Biolitec, Germany) and analyzes outcomes of this novel approach in pilonidal sinus management.   METHODS In a prospective study, we analyzed the first 12 patients who underwent laser treatment of pilonidal disease. The aim was to determine the success of pilonidal sinus healing and one-year outcomes (recurrence rate, complications and cosmetic result).   RESULTS The study analyzed 12 patients treated in a University Hospital, at the Day Surgery Unit over a follow-up period of 12 months. None of the patients had earlier excisional procedure done, but five patients had previous urgent drainage of acute pilonidal abscess. Local anesthesia was used in 8 and general in 4 patients. Patients were discharged on the same day between 4-8 hours postoperatively. One year recurrence rate was 8% (1/12) and complications occurred in just one patient presenting as abscess formation on postoperative day 3, which was successfully treated by incision, drainage and antibiotic therapy. The mean duration of complete orifice closure was 28 days (range 12-41 days).The majority of patients (11/12) were very satisfied with overall cosmetic result after 1 year.   CONCLUSION SiLaC® is a promising minimally invasive alternative to other methods of pilonidal disease management and it could represent a first-line therapy for less extensive disease. Quick recovery, possibility to utilize local anesthesia and acceptable cosmetic result are main advantages of this technique, but future larger clinical studies are required to evaluate long term results of this procedure

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

BACKGROUND: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. METHODS: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. RESULTS: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. CONCLUSIONS: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands