ABSTRACT
Introduction: Relevant clinical studies indicate a significantly poorer outcome in patients with advanced renal failure during Covid 19 probably due to significantly slower clearance of proinflammatory cytokines produced during infection but also in the presence of significantly higher cardiovascular comorbidity in these patients. Method(s): We present the characteristics of patients with chronic renal failure (CRF) who were treated for Covid 19 bronchopneumonia at the Temporary Covid 19 hospital "Stark Arena" Belgrade,during 2020/2021. In this period we have treated about 5200 patients with Covid 19 bronchopneumonia under limited conditions. Result(s): We analyzed a records of 466 patients with a history of CRF: 261 male (56.01%) and 67 female 67(43.99%), mean age 75 +/- 11.14 years (40-88 years), 297 of them (63.73%) suffered from high blood pressure, 154 patients (33,05%) suffered from diabetes mellitus and 114 patients (24,46%) had both diseases.The mean value of sO2 at admission was 92+/-4,45%, CRP 87+/-99.7mg/l, Interleukin-6 61+/-33.4 pg/ml, hemoglobin (Hgb)126+/-14.22g/l, urea 12+/-7,53 mmol /l, creatinine 137.43+/-121.22micromol/l, glomerul filtration rate (GFR) 47.44ml/min/1.73m2. Patients were treated according to the current protocol where 305 out of than (65,45%) also received an interleukin-6 receptor blocker (Tocilizumab 8-16 mg/kg). A total of 452 patients (96.99%) after successful treatment of bronchopneumonia were discharged for home treatment with average creatinine values of 116+/-31.32micromol/l and GFR 56.13ml/min/1.73m2,while 14 patients (3,01%) due to the worsening of their general condition, were transferred to a higher - level health institution, from where they were further discharged without necessity for chronic dialysis treatment. There were no lethal outcomes. Parameters on admission: [Formula presented] Parameters at discharge: [Formula presented] Conclusion(s): Advanced renal failure is a significant risk factor for adverse clinical outcome during Covid 19. In our group majority of patients were with moderate CRF who had a successful end-therapeutic outcome, but a significant percentage of them required the use of Tocilizumab (without adverse effects). The verified improvement of GFR at discharge is most likely a consequence of the remediation of factors (inflammation, dehydration, nephrotoxicity of drugs etc.) which led to worsening of preexistent CRF. Regardless of the existing degree, all patients with renal failure require serious monitoring during Covid 19. No conflict of interestCopyright © 2023
ABSTRACT
Healthcare systems worldwide are facing problems in providing health care to patients in a pandemic caused by the SARS-CoV-2 virus (COVID-19). The pandemic causes an extreme disease to spread with fluctuating needs among patients, which significantly affect the capacity and overall performance of healthcare systems. In addition, its impact on the sustainability of the entire economic and social system is enormous and certain sustainable management strategies need to be selected. To meet the challenges of the COVID-19 pandemic and ensure sustainable performance, national healthcare systems must adapt to new circumstances. This paper proposes an original multi-criteria methodology for the sustainable selection of strategic guidelines for the reorganization of a healthcare system under the conditions of the COVID-19 pandemic. The selection of an appropriate strategic guideline is made on the basis of defined criteria and depending on infection capacity and pandemic spread risk. The criteria for the evaluation of strategic guidelines were defined on the basis of a survey in which the medical personnel engaged in the crisis response team during the COVID-19 pandemic in the Republic of Serbia participated. The Level-Based Weight Assessment (LBWA) model and Measuring Attractiveness by a Categorical-Based Evaluation Technique (MACBETH) method were used to determine the weight coefficient criteria, while a novel fuzzy Ranking of Alternatives through Functional Mapping of Criterion Subintervals into a Single Interval (RAFSI) model was used to evaluate the strategic guidelines. The proposed multi-criteria methodology was tested in a case study in the Republic of Serbia. The validity of the proposed methodology is shown through the simulation of changes in input parameters of Bonferroni aggregation functions and through a comparison with other multi-criteria methodologies.
ABSTRACT
In this paper we approach the COVID-19 pandemic through the genealogical analysis of biopolitics. We recognize two key discontinuities in the genealogy of biopolitics. First, we have the transformation of the “old biological regime” and the emergence of the gaze as a technology of power/knowledge. This was essentially the epoch of the birth of biopolitics, and the period when life “entered” the sphere of politics. We then note the emergent discontinuity in biopolitical technologies today, during the pandemic of COVID-19, as we are witness to the transformations of biopolitical measures on the global scale. We also recognize important lessons from the genealogy of biopolitics as a “history of the present”. During just one historical epoch, biopolitics emerged as the power over life. That was the period of the so called “epistemic break” and the emergence of life as the new dynamic force of productivity, power, trade, cities, urbanization, population, and capitalism. This is how the risk that was once the base of “life function” instability became the central problem of biopolitics. It is the same concern of biopolitics today, but in completely novel social settings. © 2020, Sociological Association of Serbia. All rights reserved.