Non-covid Patients during the Period of Pandemic in Serbia

The paper considers a problem at the intersection of sociology, anthropology, law and multidisciplinary public health research - health care accessibility during a sudden social crisis. The authors test the theoretical assumptions on the example of the covid-19 pandemic in Serbia, trying to understand the specific position of non-covid patients suffering from chronic non-communicable diseases and their perceptions regarding health care accessibility during the period of the pandemic. The empirical data on which the analysis was performed was collected with the help of focus group interviews. The sample consisted of interviewees - representatives of the association of patients suffering from chronic non-communicable diseases that burden the population of Serbia the most, who live on the territory of the Republic of Serbia without Kosovo and Metohija. The analysis shows that access to health care during the pandemic was limited and that the protocols that the state and the health care system were setting up in the process did not take into account the specific needs of this socially vulnerable group of patients. This, due to the impossibility for them to go through certain diagnostic procedures in time, receive adequate therapy and/or rehabilitation, in a large number of cases resulted in the deterioration of the clinical picture of the chronic disease from which they suffer. The paper presents theoretical and practical conclusions, which aim to show how important it is to incorporate theoretical and empirical insights from the social sciences and humanities in the conceptualization and future implementation of public health protocols for future social crises in order to reduce their potential syndemic effect.

Agranulocytosis following intravenous immunoglobulin administration in a patient with Guillain-Barre Syndrome triggered by COVID-19: A case report

Neutropenia during recovery after coronavirus disease 2019 (COVID-19), as well as neutropenia after intravenous immunoglobulin (IVIG) administration are very rare hematological abnormalities. We report the first case of agranulocytosis following IVIG administration in patients with Guillain-Barre syndrome (GBS) triggered by COVID-19. A 62-year-old female patient was admitted to the Emergency Department due to progressive limb weakness and sensory disturbances that began two weeks before admission. Five weeks before admission she was treated for COVID-19 and has fully recovered. She was diagnosed with Guillain-Barre syndrome (GBS), and treatment with IVIG was started. Twenty hours after the first dose of IVIG, blood analysis showed neutropenia and thrombocytopenia, and after the fifth dose she developed agranulocytosis followed by mild increase in body temperature. Granulocyte colony-stimulating factor (G-CSF) was administered and after 12 hours the leukocyte lineage recovered. According to the previous findings, neutropenia after IVIG administration might be related to CD11b, and COVID-19 is associated with an increase in immature neutrophil populations in the later stages of the disease defined by their expression of CD11b. Meanwhile, some finding suggests that corticosteroid pretreatment prevent neutropenia after IVIG administration, which might be important because many patients with post-COVID GBS have been treated with corticosteroids for COVID-19. Copyright © 2022, ASEAN Neurological Association. All rights reserved.

Public Procurement of Innovative and Technological Solutions in the EU

Smart cities should identify and procure the best technical solutions for their communities and companies while at the same time demonstrating the local economic benefits of public procurement. Whenever possible, the procurement process should increase innovation in sustainability. Public procurement of innovative solutions can contribute to the economic recovery of the EU, especially after the crisis caused by COVID-19 with the help of better and more technologically accessible public investments. It is a means of stimulating the transformation of European economies into digital economies. This paper seeks to explain the use and advantages of public procurement of innovative solutions. The contracting authority acts as the first customer (launch customer) of innovative goods or services that are not yet widely available commercially and are technologically acceptable. Instead of buying a finished product, service or process, the contracting authority acts as the first user and buys a product, service or process that is new to the market and has significant new features in terms of innovation and technological achievements. Therefore, this paper will try to identify how various stakeholders can use innovative and technology-aware public procurement systems procedures and contribute to the accelerated development of digitalization mandated by the European Commission. © 2022 Croatian Society MIPRO.

THE COVID-19 EPIDEMIC IN SERBIA - THE CHALLENGES OF FINDING AN APPROPRIATE BASIS FOR RESPONDING TO A HEALTH CRISIS

The World Health Organization declared the Covid-19 pandemic on 11 March, 2020. Serbia declared a State of Emergency (SoE) on 15 March, just days after the country's first official case, part of an unprecedented global wave of emergency responses, with states reacting differently to the threat of the virus. Decision makers in Serbia opted to declare a SoE, followed by a series of governmental decrees and ministerial orders. This paper examines the Serbian government's initial response. The legislation in force in March 2020 is analysed to explore what possibilities and instruments could have been used, with particular focus on legislation regarding infectious diseases and disaster responses, which allowed for the declaration of an emergency situation, and the introduction of legitimate restrictions to fight the outbreak. The paper concludes that the full potential of all available measures and instruments was not exhausted, especially regarding legislation relating to an emergency situation.

Kawasaki-like syndrome associated with COVID-19: clinical characteristics of mild to moderate forms of a disease

Introduction: In setting of global pandemic of coronavirus disease 19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cases resembling Kawasaki disease (KD) were repeatedly reported. Soon afterwards it began to be considered as separate entity named multisystem inflammatory syndrome in children (MIS-C). In addition to this newly recognized syndrome which has overlapping features with KD and is still occasionally described as its from, during COVID-19, a high incidence of Kawasaki-like syndrome (KLS) with mild to moderate symptoms was also noted. Recently, it was proposed that even such cases should, in clinical context, be treated as MIS-C if appropriate criteria are met. On the other hand, clear distinction of the two entities can help researchers to answer the question of its etiology and pathogenesis and could direct the clinicians what to expect during the course of the disease. Objectives: The aim was to describe main epidemiologic and clinical characteristics of KLS during the first year of COVID-19 pandemic. Methods: This retrospective study included analysis of medical documentation of patients treated for KLS at Clinic of Pediatrics, University Clinical Center Niš, between March 2020 and 2021. Inclusion criteria was fulfillment of KD or KLS criteria, based on CDC1 or WHO2 recommendation. Severe form of the disease with signs of a shock was exclusion criteria. The results were elaborated with the statistical method of descriptive and quantitative analysis. Results: A total of 21 subjects fulfilled the criteria for KLS during the study period. The cumulative incidence was 8.48 per 105 minors. Male to female ratio was 2:1 and mean age at diagnosis was 6.5 years (min. 8 months;max. 17 years). In fourteen cases current or recent COVID-19 infection or confirmed COVID-19 exposure was observed. When only these patients are analyzed average age was 8.2 years. Antibodies against SARS-CoV-2 were confirmed in seven patients, three had positive PCR test for COVID-19 and one had close contact with someone who has COVID-19 but COVID-19 was not proved. Interestingly, three patients that were antigen positive had respiratory organ involvement. In the reaming seven cases all the other possible causes of symptoms were ruled out and possible contact with SARS-CoV-2 was assumed. In addition to prolonged fever, that was present in all patients, polymorphous rash (95%) was the most common clinical feature flowed by bilateral nonpurulent conjunctivitis (47%). Gastrointestinal tract involvement was the most common internal organ manifestation. Treatment included corticosteroids (15 patients), intravenous immunoglobulin (1 patient) and two patients received nonsteroidal anti-inflammatory drug in anti-inflammatory dose, while the rest were only treated symptomatically. Favorable outcome was achieved in all patients with no morphological changes observed on echocardiography during the hospitalization and 2 weeks after discharge. Conclusion: Our findings suggest connection between infection and occurrence of the disease in susceptible children. Yet, a large portion of the population had contact with SARS-CoV-2, thus the exact role of infectious agent and pathophysiological mechanisms have to be determined. Gender distribution with male dominance among our patients is expected. Still, average age at diagnosis was bit higher than what is usually observed in classic KD and is more in line with characteristics of MIS-C. Further research are to be done in order to define what determine progression of the disease and are there any signs that may point in which way it will develop. Only in that way the clinicians would made right choices regarding the patients treatment.

The e-scooter potential to change urban mobility—belgrade case study

As we witness a global change occurring with the advent of e-scooters (electric scooters), it is clear that adequate measures need to be taken for the implementation of this means of transport. Bearing in mind that the user should be the focus of the proposed measures, the aim of this paper encompasses the analysis of e-scooter users’ travel patterns, as well as standard scooter users’ willingness to switch to e-scooters for different hypothetical scenarios, and the determination of factors that have an influence on the users’ willingness to switch. The scenarios include the availability of various infrastructure capacities for the city of Belgrade, namely, a separate infrastructure for e-scooters, or sharing the existing infrastructure with cyclists, pedestrians and motor vehicles. Standard methods of descriptive statistics, the McNemar–Bowker test of paired samples, and multinomial logistic regression were used in this paper. The results showed that there was a statistically significant difference in users’ willingness to use an e-scooter, depending on the available infrastructure. The results of multinomial logistic regression showed that the mode of transport used before and during the COVID-19 pandemic, as well as the average distance traveled, had a statistically significant impact on the users’ willingness to switch to e-scooters if they were allowed to use the cycling infrastructure. This paper also identifies additional factors that have a positive (environmental benefits, congestion avoidance) and negative (safety issues, lack of infrastructure, etc.) impact on users’ willingness to switch, which can be of use to decision-makers as a basic guideline for the adequate implementation of e-scooters in transport systems. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.