Burnout syndrome among employees in a clinical center in Montenegro during COVID-19.

OBJECTIVE: Burnout syndrome occurs as a result of the influence of stressors in the workplace. The chronic disproportion between the demands placed on the worker and the resources available to fulfill the demands makes a significant contribution to the development of this syndrome. The occurrence of burnout syndrome has been shown to occur in a wide range of jobs, and it is taking on epidemic proportions among healthcare workers. So far, there have been no large-scale studies dealing with burnout syndrome in healthcare workers in Montenegro. SUBJECTS AND METHODS: The research was conducted as a cross-sectional study. All full-time employees of the Clinical Center of Montenegro who participated in the treatment of patients with COVID-19 during 2020 and 2021 were included in the research. Questionnaires used in the research were: a general questionnaire for collecting socio-demographic data, a questionnaire for the assessment of burnout syndrome at work - Maslach Burnout Inventory and a COVID-19 stress scale. RESULTS: The prevalence of burnout syndrome was 16.8% among employees who were engaged around COVID-19 patients. Predictors of burnout syndrome identified were occupation (nurses/technicians have a 2.8 times higher chance of burnout syndrome than doctors as a reference category), confirmed COVID-19 infection (subjects with confirmed COVID-19 infection have more than 2 times higher chance for burnout syndrome), higher CSS scores (subjects with high CSS score have a 3% higher chance of developing burnout syndrome). CONCLUSIONS: In order to reduce losses due to reduced productivity of employees and prevent long-term detrimental consequences on the mental health of employees, evidence-based preventive measures are needed.

Oxidative stress and inflammation parameters-novel biomarkers for idiopathic pulmonary fibrosis.

OBJECTIVE: The pathophysiological mechanisms of idiopathic pulmonary fibrosis (IPF) are not well elucidated. It is assumed that oxidative stress and inflammation are the key underlying culprits for its onset and progression. To gain deeper insight into these processes, we have evaluated several oxidative stress parameters, inflammation markers [i.e., high sensitivity C-reactive protein (hsCRP), serum amyloid A1 (SAA1)], soluble programmed cell death-ligand 1 (sPD-L1), and 25-hydroxyvitamin D [25(OH)D] in IPF patients. PATIENTS AND METHODS: Biochemistry analyses were done in 30 consecutive IPF patients and 30 age and gender-matched healthy control group (CG). RESULTS: IPF patients had significantly higher advanced oxidation protein products (p<0.001), pro-oxidant-antioxidant balance (p=0.010), total oxidative status (p<0.001), and ischemia modified albumin (p<0.001) compared to CG. Lower total antioxidant status and total sulfhydryl groups (tSGH) and significantly higher sPD-L1, hsCRP (p<0.001 for all), SAA1 proteins (p=0.014) and [25(OH)D] severe deficiency [11.0 (9.6-15.1) nmol/L] in IPF patients compared to CG were observed. Paraoxonase 1 activity and hsCRP level were lower, while tSHG and sPD-L1 were higher in IPF patients with more severe disease (i.e., II+III stage compared to I stage, p<0.05 for all). CONCLUSIONS: IPF patients are in a state of profound oxidative stress compared to healthy people. The inflammatory component of the disease was confirmed by higher hsCRP and SAA1, but lower [25(OH)D] in IPF than in healthy people. Also, higher levels of sPD-L1 in patients with IPF compared to healthy individuals suggest that sPD-L1 may have a significant role in immune response in IPF.

Total costs of inpatient treatment for COVID-19 in a tertiary hospital in Serbia.

BACKGROUND: Our study aimed to identify the total costs of inpatient treatment for coronavirus disease 2019 (COVID-19) in a tertiary institution in Serbia, an upper-middle-income country in Southeast Europe. METHODS: An observational, retrospective, cost-of-illness study was performed from the perspective of the National Health Insurance Fund and included a cohort of 78 females and 118 males admitted to the COVID-19 ward units of a tertiary center during the first wave of the pandemic. RESULTS: The median of the total costs in the non-survivors subgroup (n =43) was 3,279.16 Euros [interquartile range (IQR): 4,023.34; range: 355.20-9,909.61) which is higher than in the survivors (n =153) subgroup 747.10 Euros (IQR: 1,088.21; 46.71-3,265.91). The cut-off value of 156.46 Euros regarding the total costs per day was estimated to have 95.3 % sensitivity and 91.5 % specificity for predicting patients' dismal prognosis, with the area under the curve (AUC) of 0.968 (95 % confidence interval: 0.940-0.996, p <0.001). CONCLUSIONS: Direct medical inpatient treatment costs for COVID-19 represent a significant economic burden. The link between increased costs and an ultimate unfavorable outcome should be further explored.HIPPOKRATIA 2022, 26 (2):62-69.

Source tracking using microbial community fingerprints: Method comparison with hydrodynamic modelling.

Urban estuaries around the world are experiencing contamination from diffuse and point sources, which increases risks to public health. To mitigate and manage risks posed by elevated levels of contamination in urban waterways, it is critical to identify the primary water sources of contamination within catchments. Source tracking using microbial community fingerprints is one tool that can be used to identify sources. However, results derived from this approach have not yet been evaluated using independent datasets. As such, the key objectives of this investigation were: (1) to identify the major sources of water responsible for bacterial loadings within an urban estuary using microbial source tracking (MST) using microbial communities; and (2) to evaluate this method using a 3-dimensional hydrodynamic model. The Yarra River estuary, which flows through the city of Melbourne in South-East Australia was the focus of this study. We found that the water sources contributing to the bacterial community in the Yarra River estuary varied temporally depending on the estuary's hydrodynamic conditions. The water source apportionment determined using microbial community MST correlated to those determined using a 3-dimensional hydrodynamic model of the transport and mixing of a tracer in the estuary. While there were some discrepancies between the two methods, this investigation demonstrated that MST using bacterial community fingerprints can identify the primary water sources of microorganisms in an estuarine environment. As such, with further optimization and improvements, microbial community MST has the potential to become a powerful tool that could be practically applied in the mitigation of contaminated aquatic systems.

Potential Influence of Selenium, Copper, Zinc and Cadmium on L-Thyroxine Substitution in Patients with Hashimoto Thyroiditis and Hypothyroidism.

Background: Besides genetic factors, it is known that some trace elements, as Selenium, Copper, and Zinc are essential for thyroid gland fuction and thyroid hormone metabolism. Moreover, there were some metals effect that suggested patterns associated with overt thyroid disease. Aim of study: Hashimoto thyroiditis (HT), chronic autoimune inflamation of thyroid gland with cosequtive hipothyroidism, is common disease in Serbia, and we thought it is worthwile to explore potential effects of essential and toxic metals and metalloides on thyroid function and ability to restore euthyroid status of them. Results: This cross-sectional, case-control, study investigated the status of essential elements (Selenium,Copper,and Zinc) and toxic metals and metalloides (Al, Cr, Mn, Co, As, Cd, Sb, Ba, Be, Pb and Ni) from the blood of 22 female, patients with Hashimoto thyroiditis and overt hypothyroidism, and compared it with those of 55 female healthy persons. We tried to establish the presence of any correlation between previous mentioned elements and thyroid function in hypothyroid patients and healthy participants. Conclusions: The results of our study suggested that the blood concentration of essential trace elements, especially the ratio of Copper, and Selenium may influence directly thyroid function in patients with HT and overt hypothyroidism.Thus, our findings may have implication to life-long substitution therapy in terms of l-thyroxine dose reduction. Furthermore, for the first time, our study shown potential toxic effect of Cadmium on thyroid function in HT patients, which may implicate the dose of l-thyroxine substitution.

Focal epileptic seizures, electroencephalography and outcome of sepsis associated encephalopathy-A pilot study.

OBJECTIVES: Sepsis associated encephalopathy (SAE) represents a diffuse and/or multifactorial cerebral dysfunction during response to systemic infection. Study aim was to compare clinical and electroencephalogram (EEG) characteristics and intrahospital survival rate among SAE patients. PATIENTS AND METHODS: A prospective study, during 42 months' period, included 39 SAE patients assigned in two groups according the outcome (survival: 19, and death: 20 patients). All the patients' features were registered: demography, neurological status, infection type, seizure appearance, brain computerized tomography (CT), EEG, EEG reactivity, Glasgow Coma Score (GCS) and Acute Physiology and Chronic Health Evaluation II (APACHE II) Score. The analysis included EEGs obtained during patients' consciousness change (improvement or deterioration) and the level of consciousness during and at the end of hospitalization. RESULTS: SAE was detected in 29.5% of patients with encephalopathy (2.8% of all patients hospitalized). Patients with lethal outcome were more likely to be female (p=0.0011), to have focal seizures (p=0.034), lower values of GCS during hospitalization (p<0.05) and longer lasting nosocomial infections (p=0.029). At the time of clinical exacerbation, patients were more likely to have suppression on EEG and less likely theta activity. Delta waves, TW waves and suppression of EEG activity were the most common findings 24h prior to death (p=0.0004). The lack of EEG reactivity was associated with death (p=0.00043). CONCLUSION: Presence of focal seizures, EEG suppression at the time of exacerbation in SAE elderly patients, particularly women, with longer infection duration and lower values of GCS, is associated with intrahospital death.

Quantitative structure-activity relationship analysis of substituted arylazo pyridone dyes in photocatalytic system: Experimental and theoretical study.

A series of arylazo pyridone dyes was synthesized by changing the type of the substituent group in the diazo moiety, ranging from strong electron-donating to strong electron-withdrawing groups. The structural and electronic properties of the investigated dyes was calculated at the M062X/6-31+G(d,p) level of theory. The observed good linear correlations between atomic charges and Hammett σp constants provided a basis to discuss the transmission of electronic substituent effects through a dye framework. The reactivity of synthesized dyes was tested through their decolorization efficiency in TiO2 photocatalytic system (Degussa P-25). Quantitative structure-activity relationship analysis revealed a strong correlation between reactivity of investigated dyes and Hammett substituent constants. The reaction was facilitated by electron-withdrawing groups, and retarded by electron-donating ones. Quantum mechanical calculations was used in order to describe the mechanism of the photocatalytic oxidation reactions of investigated dyes and interpret their reactivities within the framework of the Density Functional Theory (DFT). According to DFT based reactivity descriptors, i.e. Fukui functions and local softness, the active site moves from azo nitrogen atom linked to benzene ring to pyridone carbon atom linked to azo bond, going from dyes with electron-donating groups to dyes with electron-withdrawing groups.

Spectroscopic and quantum chemical investigations of substituent effects on the azo-hydrazone tautomerism and acid-base properties of arylazo pyridone dyes.

A series of 5-(4-substituted arylazo)-6-hydroxy-4-methyl-3-cyano-2-pyridone dyes was synthesized and the structure of the dyes was confirmed by UV-Vis, FT-IR, (1)H NMR and (13)C NMR spectroscopic techniques. The azo-hydrazone tautomeric equilibrium was found to depend on the substituents as well as on the acidity and basicity of the media. Ionization constant, pKa, of the dyes was determined by UV-Vis spectroscopy and correlated with the Hammett substituent constants, σp and σI. The interpretation of the effect of different substituent in phenyl ring of arylazo pyridone dyes on their spectroscopic and structural properties was based on quantum chemical calculations performed by the density functional theory (DFT/M06-2X) method. The DFT calculations confirmed the existence of two forms in water solution: hydrazone form in acidic and neutral media and anionic form in basic media. The different contribution of azo and hydrazone canonical forms of anionic form is observed for dyes with electron-donating and dyes with electron-withdrawing groups. The dependence of absorption spectra and determined pKa values to the substituent type seems to be mostly due to azo/hydrazone canonical structure ratio in their anionic form.

Surgical care vesicovaginal fistulas in women with malignant gynecological disease.

Vesicovaginal fistulae (VVF)represents one of the most frequent complications of various gynecological and obstetric procedures. In presence of a gynecological malignant tumor, fistula could be the outcome of surgical complications, radiotherapy or consequence of the tumor process. Reparation of these fistulae is a very complex problem. Our aim was to analyze the results of surgical care VVF-s occurred in women with malignant gynecological disease which was treated surgically or with radiotherapy. Out of the 48 surgically treated patients with primary VVF, in 28 of them fistula occurred after hysterectomy, and in 20 patients after radiotherapy. In 15 patients (31.25%) transvaginal approach was applied, and in 33 patients (68.75%) abdominal approach was applied, with the interposition of a well vascularized lobe being used in 25 patients. All the VVFs that occurred after radiotherapy were repaired by using the abdominal approach. The efficiency of surgical treatment of VVFs after hysterectomy due to a malignant disease was 78.5%, and after radiotherapy 65%. In patients that have not been subjected to radiotherapy, depending on the characteristics of the fistula, transvaginal or abdominal approach is applicable in VVF reparation, while the abdominal approach remains a golden standard in post-radiation fistula treatment, despite the fact that it has not solved the problem after the first medical treatment in as far as 35% of patients.

Radioiodine therapy accelerates apoptosis in peripheral blood lymphocytes of patients with differentiated thyroid cancer.

Both apoptosis and micronuclei formation reflect cytogenetic damage in cells and could contribute to cell homeostasis. The aim of this study was to evaluate apoptosis in peripheral blood lymphocytes (PBLs) of patients with differentiated thyroid cancer (DTC) before and after 131-iodine (131-I)-therapy and its correlation with micronuclei (MN) frequency. The study population included 18 DTC patients and 18 healthy donors. Apoptotic cells were detected using the Annexin V-FITC/7-AAD kit and MN frequency by cytokinesis-block MN assay. The difference between early apoptosis in PBLs of DTC patients before therapy and controls (9.88 ± 4.99% vs. 6.64 ± 2.07%, p = 0.003) was significant, as well as between early apoptosis in PBLs of DTC patients before and after 131-I-therapy (9.88 ± 4.99% vs. 13.53 ± 6.57%, p = 0.008). The MN frequency and early apoptosis in PBLs of DTC patients was positively correlated before (r = 0.540, p= 0.021) and after 131-I-therapy (r = 0.585, p= 0.014). Thyroid cancer patients had a significantly increased early apoptosis in PBLs, which further increased after 131-I-therapy in association with MN frequency.

Synergic adsorption of Pb2+ and reactive dye--RB5 on two series of organomodified bentonites.

Two series of organobentonites (OBs) were synthesized from Na(+)-exchanged bentonite clay from Bogovina, Serbia. In the first series the starting material was modified using hexadecyltrimethylammonium (HDTMA(+)) ion in the amounts corresponding to 0.2, 0.5, 1.0 and 2.0 of the CEC value. The second series was obtained using quaternary alkyl ammonium cations (QAACs) with different alkyl chain lengths: hexadecyltrimethylammonium (HDTMA(+)), dodecyltrimethylammonium (DDTMA(+)) and tetramethylammonium (TMA(+)) ions. The synthesized OBs were characterized. The adsorption of anionic reactive dye Reactive Black 5 (RB5) and Pb(2+) from single component solutions and their bi-component solution was investigated for both series of OBs. The adsorptive properties of the OBs were correlated to the amount and type of incorporated QAACs. The correlation was tested using different mathematical models and best fits were found. Experimental results showed that simultaneous adsorption of RB5 and Pb(2+) exhibited synergic effect. The adsorption capacity for both RB5 and Pb(2+) was higher in their bi-component solution than in single-component solutions. These results indicate the creation of new adsorption sites during the simultaneous adsorption.

Preoperative skin tumours thickness determination by high-frequency ultrasound on head and neck region.

BACKGROUND: High-frequency ultrasound is non-invasive imaging method for examination of skin tumours. OBJECTIVE: The aim of our study was to examine validity of 20-MHz ultrasound in preoperative determination of skin tumour thickness localized on head and neck region as a potentially useful tool for planning of the surgical intervention. METHODS: Seventy-three different skin tumours were preoperatively examined using Dermascan C (Cortex Technology, Denmark) 20-MHz ultrasound equipment. Maximal vertical thickness of tumours was preoperatively determined by ultrasound, and after surgical excision of tumours, on pathohistological preparations using Nippon-Kogaku ocular micrometre. All patohistological specimens were controlled for presence of tumour cells on specimens' margins. RESULTS: Obtained correlation was very high, r = 0.82, without significant statistical difference (P < 0.01) between dimensions determined by 20-MHz ultrasound and histometry. There were no pathohistological specimens with tumours cells found on margins. CONCLUSION: Examination of skin tumours by 20-MHz ultrasound gives reliable additional information about tumour dimensions, sometimes important for therapeutic strategy.

One-stage transanal surgical technique for Hirschsprung's disease: is the age of a patient a limiting factor?

Hirschsprung's disease in the adolescent is a rare and often misdiagnosed cause of lifelong refractory constipation. In this particular case, a male patient spent 13 years with an unrecognized illness that was eventually diagnosed as Hirschsprung's disease. The age of the patient is considered a limiting factor due to over-distention and hypertrophy of the rectosigmoid colon that has to be pulled through a muscular cylinder in a limited operative field. This report of a successfully treated teenage boy using a one-stage transanal endorectal approach without conversion to laparotomy, his uneventful recovery and excellent functional results supports the opinion that practically all patients with Hirschsprung's disease can be treated using this technique, regardless of age and size of colon, on condition that the operation is performed by experienced surgeons familiar with classic operative procedures to avoid possible operative pitfalls.

Phenol determination on HDTMA-bentonite-based electrodes.

The partial and complete substitution of cations in the interlayer region of clay with different amounts of hexadecyl trimethylammonium bromide (HDTMABr) was performed. The aim was to synthesize organo-bentonites to be used as constituents of porous electrodes for the electrooxidation of phenol. Domestic clay from Bogovina was subjected to a common procedure of the production of organo-bentonites. It included the following steps: grinding, sieving, Na-exchange, cation exchange and drying. The samples were characterized by X-ray diffraction (XRD) analysis, while the textural properties were evaluated by nitrogen physisorption. The multisweep cyclic voltammetry was applied to analyze the behavior of the clay modified glassy carbon electrode. The influences of the surfactant loading and pH of the support electrolyte were investigated. Rapid deactivation of electrodes occurred in an acidic environment, while good stability of the investigated electrodes was obtained in alkaline medium.

Gallbladder emptying in patients with major depression: a case series.

INTRODUCTION: Although several adverse effects of antidepressants on the gastrointestinal tract have been described (bleeding, constipation, dolichocolon), their influence on gallbladder motility was not investigated.The aim of our study was to investigate the effects of selected antidepressants on gallbladder emptying in patients with major depression. METHODS: The study was set up as an open clinical trial, with the same intervention (ingestion of test meal provoking gallbladder emptying) undertaken in 112 patients with major depression. There were 30 patients not taking antidepressants (the control group), 25 patients taking amitriptyline, 30 patients taking maprotiline, and 27 patients taking fluoxetine. The volume of gallbladder in the study patients was measured by ultrasonography before the test meal, and 15, 30, 45 and 60 min after the meal. RESULTS: 1 h after ingestion of the study meal, the amitriptyline group showed incomplete gallbladder emptying (F=10.829, df=3, p=0.000; mean residual volume 11.0±6.1 mL), while in the control, maprotiline and fluoxetine groups emptying of gallbladder was complete (mean residual volumes 5.0±3.3 mL, 5.6±3.7 mL and 5.7±2.3 mL, respectively). DISCUSSION: In patients with cholecystitis, it would be wise to use antidepressants which do not impair gallbladder emptying, like maprotiline or fluoxetine, and to avoid amitriptyline.

Intravenous thrombolytic therapy in patients with stroke mimics: baseline characteristics and safety profile.

BACKGROUND: The decision to treat with intravenous (i.v.) rt-PA a patient with acute cerebral ischaemia is based on clinical and imaging criteria recorded in emergency. In such an emergency situation stroke mimics may sometimes be misdiagnosed, and lead to an erroneous prescription of rtPA. The objective of this study was to determine the baseline profile and the outcome in patients with stroke mimics who received i.v. rtPA. METHODS: We analysed clinical characteristics, and outcomes in patients diagnosed at discharge as having a stroke mimic who received rtPA in the university hospitals of Lille and Belgrade. RESULTS: Amongst 488 patients, seven (1.4%) were diagnosed at discharge with stroke mimics: four had somatoform disturbances, one had migraine aura, one had Bell palsy, and one had a probable Todd's palsy. Patients with stroke mimics were younger, and had milder deficits. Six were investigated by computed tomographic-scan and the only one who had an emergency magnetic resonance imaging, had no abnormality on diffusion weighted images. Five patients had a modified Rankin scale 0-1 and there was no case of intracranial bleeding. CONCLUSION: Patients with stroke mimics have a good safety profile when treated with rt-PA. In case of doubt, physicians should not postpone thrombolysis, because its potential benefit in confirmed ischaemic stroke might be higher than the risk of complications in stroke mimics. A combined analysis of such small series of cases would be useful to have a better delineation of the clinical profile of these patients.

Application of artificial neural networks in estimating predictive factors and therapeutic efficacy in idiopathic membranous nephropathy.

Idiopathic membranous nephropathy (IMN) is one of the most frequent causes of the nephrotic syndrome in adults and one of the most common cause of chronic renal failure among primary glomerular diseases. The aim of this study was to develop artificial neural networks (ANN) to investigate factors of poor outcome for IMN and to evaluate the efficacy of different therapeutic protocols. Data were collected retrospectively for 124 patients with IMN (82 males, mean based on the received therapy patients were divided into three groups: corticosteroids only (group 1), cyclophsophamide with corticosteroids (group 2), and so called Ponticelli protocol (group 3). After achieving satisfactory truthfulness of the transcription function of ANN through clustering, we have applied the efficacy analysis to all patients and then compared them to each group separately, and evaluated the influence of initial characteristics on disease outcome as well as the therapy efficacy. The greatest therapy inefficiency was recorded for isolated corticosteroid therapy (29.41%) and the smallest inefficiency for Ponticelli protocol, for which the greatest accuracy of prognosis was recorded (82.09%). The greatest negative prognostic influence had kidney insufficiency (22%), quantitative proteinuria (15%) and index of interstitial infiltration (14%). Based on our results, we can recommend that patients diagnosed with IMN with renal insufficiency, nephrotic syndrome or a high degree of interstitial infiltration at the time of diagnosis should be treated concomitantly with cytotoxic drugs and corticosteroids, particularly with the Ponticelli protocol.

[Blood replacement in severely injured patients].

Haemorrhage remains a leading cause of early death in injured and application of concentrated RBC transfusion in the treatment of multiple injuries is the basis and potential component of saving lives. The aim of this study was to analyze the received amount reimbursed blood in patients with severe trauma, depending on the outcome, severity and mechanism of injury. Collected data on gender, age and age as the mechanism of injury, amount of blood recovered intraoperatively and during the first six days of hospitalization, which were analyzed according to outcome of treatment, ISS, AIS, and APACHE II score. Results showed that patients with lethal outcome received a larger amount of blood, there is a statistically significant correlation with ISS and AIS score for extremity injuries, and that larger amount of blood received patients injured in the traffic accidents, as pedestrians and motorcycle riders/bike, and there is no correlation with APACHE II score. Based on the importance of this topic for further research are necessary in this area in order to more accurately define indications and dosage and method of reimbursement of blood in patient with severe trauma.