Reasons for post-covid hospitalization- one year experience from Serbia

Introduction: The aim of the research was to define the reasons for the hospitalization of patients after the completion of outpatient/inpatient treatment of Covid-19 infection. Material(s) and Method(s): the study was conducted as a prospective cohort study and included 248 patients who met the criteria over a period of one year. Result(s): There were 156 men. The average age of the patients was 62 (SD=12.5). Most were unvaccinated (72%/178 patients). The most common comorbidities were arterial hypertension (60% / 148 patients), followed by other cardiovascular diseases (25%/ 61 patients), diabetes (23% / 56 patients). The average length of hospitalization was 11 days (SD=7.77). Vaccinated had a statistically significantly lower number of hospital days compared to unvaccinated (p<0,0001). The first diagnosis on discharge was pneumonia (36% / 89 patients), then newly diagnosed malignant lung tumors (18% / 45), pulmonary thromboembolism-PTE (17% / 43), pneumothorax (8% / 19), exacerbation of COPD/asthma (7% / 18), benign chest tumors (5% / 12), lung fibrosis (3% / 8). Respiratory failure was verified in 34% (84) patients. In 1% (25) of patients died. In 95% (235/248) of patients, elevated values of D dimer were registered. There is a statistically significant correlation between the number of days of hospitalization and the time elapsed since infection (p<0,0001). Conclusion(s): Most post-Covid hospitalizations occurred in the first 3 months after Covid-19 infection, due to pneumonia, PTE, or lung tumors. Vaccinated had fewer hospitalizations and fewer hospital days. D-dimer could be a prognostic marker of recovery.

The COVID19 pandemic may lead to the activation of the forgotten tuberculosis

Introduction: The Covid-19 pandemic has cast a shadow over many other diseases, including tuberculosis (TB). Once again, an infectious disease that was once quite active will most likely knock on our door. The purpose of this study was to determine if there were any differences in TB clinical characteristics in patients treated before and after the pandemic. Method(s): In this retrospective observational study, we looked at patients treated for TB at the Institute for Pulmonary Diseases in Vojvodina, Serbia, two years before the pandemic (2018/2019) and two pandemic years (2020/2021). Result(s): We examined 280 patients (159 in pre-pandemic years and 121 in pandemic years). The percentage of patients who had symptoms for more than 3 months before TB diagnosis in prepandemic years was 37.11%, while in pandemic years that percentage rose up to 48.76% (p=0.034). Direct microscopy was the most common method of diagnosis before and throughout the pandemic (p=0.638). Before the pandemic, it took 28.03 days to convert sputum;during the pandemic, it took 34.39 days (p=0.043). In these two groups, there was no deterioration in radiological presentation (p=0.676). Conclusion(s): The pandemic resulted in a fall in the number of diagnosed TB patients, and patients went to the doctor later despite TB symptomatology, potentially increasing the risk of TB transmission in the general population. Our experience shows that after periods of war, migrations, and epidemics of other infectious diseases, the incidence of TB increases. Taking all of this into account, we must intensify and systemise the approach to these patients in terms of early screening, particularly in vulnerable groups.

Influence of COVID19 pandemic on change of attitude about tuberculosis among patients with respiratory diseases in Serbia

Introduction: The COVID19 pandemic has changed the way of life all over the world, many diseases have started to reactivate and reappear. Tuberculosis (TB) can be among them despite the existence of effective measures and programs to control it. The aim of study was to establish patients' knowledge of TB at the time of the COVID19 pandemic. Method(s): The prospective study included patients with respiratory diseases who were interviewed (questionnaire with 27 questions) at the Institute of Pulmonary Diseases of Vojvodina (Serbia) in the period September-December 2021. Result(s): A total of 600 patients in two groups were surveyed (300 outpatient-AMB;300 in-hospital-HOS). Almost all patients in both groups knew that TB was a contagious disease (562, 93.6%, p=0.735);a curable disease (521, AMB-240, 80.0%, HOS-281, 93.7%, p=0.052). Less than 50% said bacteria was the causative agent (273 patients, AMB-149 patients, 49%, HOS-124, 41.3%, p=0.041). The 3/4 patients in both groups (521 patients, p=0.590) responded that cough was a way of transmission. Nearly 30% of all patients are unaware of the existence of TB vaccine (BCG), while 1/3 of patients believe that the vaccine cannot helps (204 patients, AMB-141, 47%, HOS-63, 21%, p=0.014). Conclusion(s): Patients showed mediocre knowledge of TB, especially with reference to TB immunization measures. The probable reason lies in the various informations in the media about immunization against COVID19 and the consequent rejection of the success of immunization against TB. It is necessary to intensify the education of the population about the positive effects of all types of immunization in order to prevent the disease.

The COVID-19 pandemic - related psychological distress and job burnout among Serbian pharmacy practitioners: a cross-sectional online study.

OBJECTIVE: The current COVID-19 pandemic has increased occupational stress for all healthcare providers, making job burnout one of the most common and largely unrecognized mental health issues among healthcare professionals. Besides physicians and nurses, pharmacy practitioners were "front-line" healthcare professionals with a critical and unique role in the public health crisis. Considering this, the aim of this study was to examine distress levels and the prevalence of job burnout among Serbian pharmacy practitioners in relation to the COVID-19 pandemic. SUBJECTS AND METHODS: This cross-sectional online study was conducted in April and May of 2020. A total of 176 pharmacy practitioners anonymously and voluntarily completed the two-section questionnaire, consisting of Copenhagen burnout inventory, CBI and 4DSQ Distress subscale. The two-section questionnaire was distributed online, among various social-media groups of pharmacy practitioners, as well as by personal contacts following the "snowball" sampling method. RESULTS: Results revealed moderately high burnout scores in our sample. The majority of the participants showed signs of personal-related job burnout, followed by work-related and client-related burnout. A strongly elevated distress level was obtained in almost two-thirds of study respondents. In addition, a significant and high correlation of all CBI subscales with distress was found, as well as medium correlations with sleep duration shortening as a mediator between distress and job burnout. CONCLUSIONS: Results of our study showed that job burnout significantly increased among pharmacy practitioners during the COVID-19 pandemic. Furthermore, we discovered that stress has an indirect impact on study participants' burnout via insufficient sleep.

COVID-19 associated pulmonary embolism with D-dimer values within the referent range: a case report and review of the literature

OBJECTIVE: COVID-19 is associated with an increased incidence of pulmonary embolism (PE). Elevated D-dimer levels are linked to an increased risk of PE and poor clinical outcome. We reported a case of PE in a COVID-19 patient with normal D-dimer levels and conducted a review of the literature on the subject. CASE REPORT: A 38-year-old man with no prior comorbidities returned to the COVID-19 outpatient clinic 36 hours after being discharged from the hospital, where he had been treated for COVID-19 pneumonia. He reported a sudden feeling of dyspnea and chest pain. The physical examination was unremarkable. No new changes were detected on the chest X-ray. D-dimer and cardiac-specific markers values were within the referent range. The patient underwent an urgent computerized tomography pulmonary angiography which revealed signs of bilateral arterial thrombosis. He was treated with a therapeutic dose of low molecular weight heparin and discharged after 15 days, with a recommendation to use a direct oral anticoagulant. CONCLUSIONS: Healthcare professionals should be aware that PE can occur as a late complication of COVID-19. Clinical suspicion of PE should lead physicians to use additional diagnostic methods to confirm or rule out PE, even if D-dimer levels are within the referent range.