The Clinical Form of COVID-19 and the Impact on the Course and Outcome of the Disease: Experiences from Tuzla Canton, Bosnia and Herzegovina.

Background: Covid-19 primarily manifests itself as a respiratory disease, but also with numerous extrapulmonary symptoms and complications. The clinical form of the disease before hospitalization, has a great influence on the further course and occurrence of complications of the disease. Objective: To analyze the clinical and laboratory characteristics of patients with moderate and severe clinical form of the disease, the complications that developed in these patients during hospitalization and the outcome of the disease. Methods: The retrospective study included 520 patients from the Tuzla Canton, treated in the COVID-19 Hospital at University Clinical Center Tuzla in the period from March 27 to October 1, 2020. The source of data were the medical records of hospitalized patients. The clinical and laboratory characteristics of patients with moderate and severe clinical form of the disease. and the complications that developed in these patients during hospitalization were analyzed. Results: The number of hospitalized men was statistically significantly higher, p=0.000. Most patients were in the age group of 60-69 years: 152 (29.3%), then in the age group of 50-59 years: 119 (22.9%). Women <70 years had more often a moderate, and women >70 years more often a severe clinical form of the disease, p<0.01. Patients with hypertension, diabetes mellitus, chronic lung diseases, cardiovascular diseases, hematological diseases and tumors of solid organs, with leukopenia and lymphopenia, elevated LDH, CRP, transaminases and serum ferritin, significantly more often had a clinically severe form of the disease (p<0.01). Patients with a severe clinical form of the disease on admission to the hospital had more frequent complications and death as outcome (p<0.01). Conclusion: Patients who were hospitalized with a severe form of COVID-19 had significantly more frequent disease complications and death as outcome.

Challenges in diabetic foot treatment during pandemic of COVID-19.

OBJECTIVES: To avoid hospital spread of Coronavirus-2019 (COVID-19) and to analyze out of hospital outcomes after amputation. METHODS: Prospective analysis of data obtained from 60 diabetic patients in 2020 was performed at Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina. Personal protection equipment included double surgical mask, glasses, disposable surgical coats, and surgical masks for patients. Swabs were used to take samples from wounds. We randomly divided patients in 2 groups of 30 patients each. In pre-operative treatment, we used local anesthesia lidocaine hydrochloride 2% (Belupo, Koprivnica, Croatia) in group A and systemic analgesia intravenous tramadol chloride 100 mg intravenous (Krka, Novo Mesto, Slovenia) in group B. Wounds were surgically treated each day and heal spontaneously. Periodical control exams were performed. RESULTS: Wound healing did not present any statistically significant differences between groups (group A: 69±21.97 and B: 61±22.13 days, t=-1.22; p=0.11). No statistically significant differences (p<0.05) between groups A and B in wound healing regarding to gender or cigarette use was noted. CONCLUSION: No significant differences in amputation treatment between the 2 comparative groups were noted. No confirmed COVID-19 infections in medical staff who performed surgical interventions or in treated patients were detected.

Restrictive versus Standard Fluid Regimen in Elective Minilaparotomy Abdominal Aortic Repair-Prospective Randomized Controlled Trial.

Objective Elective minilaparotomy abdominal aortic aneurysm (AAA) repair is associated with a significant number of complications involving respiratory, cardiovascular, gastrointestinal, and central nervous systems, with mortality ranging up to 5%. In our study, we tested the hypothesis that intra- and postoperative intravenous restrictive fluid regimen reduces postoperative morbidity and mortality, and improves the outcome of minilaparotomy AAA repair. Methods From March 2009 to July 2013, 60 patients operated due to AAA were included in a prospective randomized controlled trial (RCT). About the administration of fluid during the operation and in the early postoperative period, all the patients were randomized into two groups: the group of standard fluid administration (S-group, 30 patients) and the group of reduced fluid administration (R-group, 30 patients). The verification of the treatment success was measured by the length of intensive care unit (ICU) stay, duration of hospitalization after the procedure, as well as the number and type of postoperative complications and mortality. This prospective RCT was registered in a publicly accessible database ClinicalTrials.gov with unique Identifier ID: NTC01939652. Results Total fluid administration and administration of blood products were significantly lower in R-group as compared with S-group (2,445.5 mL vs. 3308.7 mL, p = 0.004). Though the number of nonlethal complications was significantly lower in R-group (2 vs. 9 patients, p = 0.042), the difference in lethal complications remained nonsignificant (0 vs. 1 patient, p = ns). The average ICU stay (1.2 vs. 1.97 days, p = 0.003) and duration of postoperative hospital stay (4.33 vs. 6.20 days, p = 0.035 for R-group and S-group, respectively) were found to be significantly shorter in R-group. Conclusion Intra- and postoperative restrictive intravenous fluid regimen in patients undergoing minilaparotomy AAA repair significantly reduces postoperative morbidity, and shortens ICU and overall hospital stay. Even though incidence of lethal complication was lower in R-group, the difference did not reach statistical significance. Therefore, we may assume that this study was probably underpowered to estimate the differences in mortality between R- and S-groups. Further multicentric, sufficiently powered RCTs are needed to confirm these findings and to clarify effect of restrictive fluid management on mortality.

[Etiological factors of community acquired urinary tract infections in hospitalized patients]. / Etioloske karakteristike akutnih infekcija mokracnog sistema stecenih u zajednici kod odraslih hospitaliziranih bolesnika.

INTRODUCTION: Etiological factors of community-acquired urinary tract infections (UTI) are specific for age, gender, season, complication of UTI and type of UTI. Their prevalence and susceptibility to antimicrobial agents shows geographic and time variability. PURPOSE: To evaluate etiological characteristics of acute community-acquired UTI in hospitalised patients. PATIENTS AND METHODS: This retrospective-prospective study included 200 adult patients with community-acquired UTI who were, in view of the serious clinical picture and unsuccessful ambulatory treatment, hospitalised in the Clinic for Infectious Diseases in Tuzla, for a period of two years (2006 and 2007). The data concerning the age, gender, season, complication of UTI and type of UTI were collected from the patient's records. Urine analysis was done following standard microbiological methods, and the antibiogram was done following standard disc-diffusion method on the Mueller-Hinton agar. WORK RESULTS: The dominant etiological factors of UTI were: E. coli (73.5%), Klebsiella spp. (8.5%), Proteus mirabilis (5.5%), Pseudomonas aeruginosa (4.5%) and Enterococcus faecalis (3%). The predominant etiological factor of this UTI was E. coli (P < 0.0001). E. coli was significantly more frequent etiological factor of UTI in females (P < 0.0001). There was no significant difference in the frequency between etiological factors of UTI for different age groups of patients (P = 0.173), or for different seasons (P > 0.05). All etiological factors are significantly more frequent during warmer periods of the year (P < 0.05). E. coli is a significantly more frequent etiological factor in complicated and non-complicated pyelonephrytis and cystourethritis (P < 0.05), but there was no significant difference of frequency between etiological factors of prostatitis (P = 0.7163). By analyzing the susceptibility for antimicrobials, we found that E. coli has good susceptibility for Cephalosporins of the third generation, for Gentamycin, Nitrofurantoin, Norfloxacin, Ciprofloxacin and Pipemidin acid (susceptibility higher than 88.7%), Klebsiella spp. for Imipenem and Meropenem (susceptibility 100%), Proteus mirabilis for Imipenem (susceptibility 100%) and relatively for Amikacin (susceptibility 81.8%), Pseudomonas aeruginosa for Imipenem (susceptibility 100%) and for Meropenem (susceptibility 87.5%) and Enterococcus faecalis for Vancomycin (susceptibility 100%) and relatively for Ampicillin, Amoxicillin, Ciprofloxacin, Doxicyclin and Nitrofurantoin (susceptibility 83.4%). CONCLUSION: Etiological characteristics of UTI are specific for different regions. Evaluation of these characteristics in our region is the basis for empirical antimicrobial therapy of UTI, which is necessary for a timely and successful treatment of UTI.

[Immune response to Engerix-B vaccine in employees at the Clinic for Infectious Diseases in Tuzla]. / Imuni odgovor na Engerix-B vakcinu uposlenika Klinike za infektivne bolesti u Tuzli.

The adults died more frequents from the diseases that could be prevented by vaccinae. To data from WHO HBV infection numbers the nineth place on the list for causes of death. The paper from 1980 proved that chronic HBV carriers have 5-100 folds higher risk for liver carcinoma than noninfected persons lived in the same areas and had the same occupations. In the group of higher risks for HBV infection the medical employees are on the first place. The aim of our paper was to show the high risk of HBV diseased at the Clinic of infectious Diseases and to point HBV vaccina in relation to prevention of HBV infection and HBV chronical carriers. During 2002 we've tested on markers of HBV et HCV all employees of the Clinical Center and among them 84 persons of the Clinic of Infectious Diseases in Tuzla. Tests were done by ELISA in the Department of Transfusiology in University Clinical Center in Tuzla. From total 84 persons 41 (56.9%) were vaccinated before and at 17 (23.6%) the seroconversion weren't done. They most receive 1 booster-dosis. The others with negative markers of HBV were 30 (35.7%) vaccinated by "Engerix B" vaccina (GlaxoSmithKline), that we're had in the beginning of our project. 27 persons (32.0%) have been in contact with HBV virus during the long term duty in the Clinic. They've had HBs antibodies. At 3 (4.1%) members of medical employees that were recovered from severe HBV diseases after accidental injury by winkles the seroconversion HBsAg to HBs antibodies were happened. Among the to have been in contact with HBV virus proved the true of high risk of diseased from hepatitis in the Clinic of Infectious Diseases.