Epidemiological Predictors of Positive SARS-CoV-2 Polymerase Chain Reaction Test in Three Cohorts: Hospitalized Patients, Healthcare Workers, and Military Population, Serbia, 2020.

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resulting coronavirus disease 2019 (COVID-19) has caused a fast-moving pandemic. Diagnostic testing, aimed to identify patients infected with SARS-CoV-2, plays a key role in controlling the COVID-19 pandemic in different populations. (2) Methods: This retrospective cohort study aimed to investigate predictors associated with positive polymerase chain reaction (PCR) SARS-CoV-2 test results in hospitalized patients, healthcare workers (HCWs), and military personnel (MP) during 2020, before the widespread availability of COVID-19 vaccines. Persons with a positive test result were compared with persons with a negative test result in three cohorts during the study period. (3) Results: A total of 6912 respondents were tested, and 1334 (19.3%) of them had positive PCR SARS-CoV-2 test results. Contact with a known COVID-19 case within 14 days (p < 0.001; OR: 1.48; 95% CI: 1.25-1.76), fever (p < 0.001; OR: 3.66; 95% CI: 3.04-4.41), cough (p < 0.001; OR: 1.91; 95% CI: 1.59-2.30), headache (p = 0.028; OR: 1.24; 95% CI: 1.02-1.50), and myalgia/arthralgia (p < 0.001; OR: 1.99; 95% CI: 1.65-2.42) were independently associated with positive PCR SARS-CoV-2 test results in the cohort of MP. Furthermore, fever (p < 0.001; OR: 2.75; 95% CI: 1.83-4.13), cough (p < 0.001; OR: 2.04; 95% CI: 1.32-3.13), headache (p = 0.008; OR: 1.76; 95% CI: 1.15-2.68), and myalgia/arthralgia (p = 0.039; OR: 1.58; 95% CI: 1.02-2.45) were independently associated with positive PCR SARS-CoV-2 test results in the cohort of HCWs. Moreover, independent predictors of positive PCR SARS-CoV-2 test results in hospitalized patients were contact with a known COVID-19 case within 14 days (p < 0.001; OR: 2.56; 95% CI: 1.71-3.83), fever (p < 0.001; OR: 1.89; 95% CI: 1.38-2.59), pneumonia (p = 0.041; OR: 1.45; 95% CI: 1.01-2.09), and neurological diseases (p = 0.009; OR: 0.375; 95% CI: 0.18-0.78). (4) Conclusions: According to data gathered from cohorts of hospitalized patients, HCWs, and MP, before the widespread availability of COVID-19 vaccines in Serbia, we can conclude that predictors of positive PCR SARS-CoV-2 test results in MP and HCWs were similar. Accurate estimates of COVID-19 in different population groups are important for health authorities.

Femoral artery blowout syndrome following radical vulvectomy and radiation therapy.

Arterial blowout syndrome has mostly been described in carotid arteries and has been attributed to factors associated with head and neck neoplasia, radical resection, and a history of irradiation. Only sporadic cases have been described in other arteries. Herein we present a case of the femoral artery blowout syndrome, six months after radical surgery of the vulva and radiation therapy.

AIRWAY MANAGEMENT IN LAPAROSCOPIC CHOLECYSTECTOMY - A COMPARATIVE ANALYSIS.

In this study, we aimed to compare supraglottic airway devices (Supreme and i-gel laryngeal mask) with tracheal tube with respect to airway control and efficiency in ventilation and oxygenation. The study included 325 patients of ASA I-II who underwent laparoscopic cholecystectomy. In group 1, the airway was secured using endotracheal intubation (115 patients). In group 2 (103 patients), LMA Supreme was applied, whereas i-gel mask was used for airway management in group 3 (107 patients). Monitoring parameters were recorded and compared using t-test, analysis of variance (ANOVA), Tukey's test and χ2-test. The following parameters were monitored: insertion time, number of attempts for device placement, oropharyngeal seal pressure, etc. Insertion time was longest in group 1 (14.7±1.65 s) as compared to group 2 (15.5±1.05 s) and group 3 (14.1±1.27 s); ANOVA test yielded a statistically significant difference (p<0.01). Insertion success rate was almost identical in all three groups (p=0.907, χ2-test). Comparison of oropharyngeal seal pressure between group 2 (35.95±2.92 cm H2O) and group 3 (36.47±1.43 cm H2O) yielded no statistical difference (p=0.314, t-test). Endotracheal tube, Supreme and i-gel laryngeal masks were shown to be equally efficient in airway management in laparoscopic cholecystectomy. All three devices enabled efficient ventilation and oxygenation despite certain pathophysiological changes associated with laparoscopy.

Primary hydatid disease of the transverse abdominal muscle A case report.

INTRODUCTION: Echinococcus is a parasitic disease that affects all organs and tissues. The most commonly affected are liver (70-80%) and lungs (10-25%), while very rarely, in about 5% of cases, it can be found in the spleen, kidneys, brain, heart, pancreas, muscles and skeleton. CASE REPORT: Although localization of hydatid cyst in muscle is rare, it is important to consideredPORT it in the differential diagnosis of a cystic mass in the muscle. Clinical diagnosis of cystic echinococcosis is based on general ultrasound imaging, CT, MRI, differentiation of Echinococcus-Ag, ELISA testing, immunoelectrophoresis (IEP), counterimmunoelectrophoresis (CIE). DISCUSSION: Surgery is the primary treatment for muscle hydatidosis. We present our experience in treating the case of an infected hydatid cyst on transverse abdominal muscle, with infection extending to the right diaphragm and subcutaneous tissue of abdomen and thorax between the transverse abdominal and internal sternal abdominal muscles. CONCLUSION: The goal of the surgical treatment is total evacuation of the parasite, "sterilization" of the residual cavity and handling of intraoperartive complications. The post-operative course was normal and the patient was discharged to home care ten days after surgery in good general and local condition. KEY WORDS: Abscess, Echinococcus, Infection, Muscle.

Severe Anaphylactic Reaction to Diclofenac during Intravenous Anesthesia for In Vitro Fertilization.

We present a case of a severe anaphylactic reaction to diclofenac, administered as an intravenous infusion in a 45-year-old patient, during intravenous anesthesia for in vitro fertilization. During the preoperative clinical examination and obtaining of anamnestic data, the patient denied symptoms of allergies to medicines and other substances. The dominant clinical manifestations of anaphylactic reaction were: hypotension, tachycardia, angioedema, bronchospasm, and delayed awakening following anesthesia. No visible changes in the appearance of the skin, such as erythema or urticaria have been observed. Proper clinical observation and adequate intraoperative monitoring led to rapid diagnosis and significantly reduced the time interval from the onset of anaphylaxis to the beginning of treatment and reanimation procedures.

Non-traumatic myositis ossificans of the thigh. A case report.

INTRODUCTION: Myositis ossificans (MO) is an ectopic ossification characterized by an appearance of bone formation predominantly in muscle tissue. Trauma is the most common etiological factor, observed in almost 60-75% of cases, whereas a non-traumatic MO is rarely described in the literature. A diagnosis is based on clinical and radiological findings. PRESENTATION OF CASE: A 75-year old female patient has been admitted to our clinic with a localized swelling of the posterior femoral compartment, presented on magnetic resonance as a calcification in the biceps femoris muscle. Laboratory test results were within the normal range. Surgical procedure consisted of excision of the tumor mass with primary wound reconstruction and drainage. The post-operative period was uneventful, and the patient was discharged from hospital on the seventh postoperative day. The pathohistology findings have shown the MO. DISCUSSION: A non-traumatic MO is scarcely described in the literature. A chronic microtrauma, tissue ischaemia and inflammation are listed as causal mechanisms of a non-traumatic MO. MO non-traumatica occurs more often in patients with a parallel, subdural or epidural haemorrhage and a hip surgery. Our case did not present any family history, trauma or associated anomalies of hands or fingers. CONCLUSION: Myositis ossificans should be considered as the differential diagnosis of all soft tissue tumor masses, even if known risk factors are not present in the anamnesis. Surgery is a reasonable therapeutic strategy in the presence of a tumor mass in soft tissues, and definite diagnosis can be set only based on pathohistological findings. KEY WORDS: Ectopic ossification, Non traumatic myositis, Surgery.

Effectiveness of Augmented Reality Mobile Simulator in Teaching Local Anesthesia of Inferior Alveolar Nerve Block.

The aim of this study was to evaluate the effectiveness of a mobile augmented reality simulator for local anesthesia training with dental students who are administering inferior alveolar nerve block (IANB) for the first time. Participants in this prospective study conducted in 2016 were 41 fourth- and fifth-year students randomly divided into two groups: a control group with 19 students and an experimental group with 22 students. In addition to theoretical instruction and exercises, students in the experimental group used the mobile augmented reality simulator in a dental office 2h weekly for four weeks. The Sony SmartBand-2 was used to measure all students' heart rate five minutes before and during anesthesia administration. After anesthesia, students in both groups completed a post-clinical questionnaire evaluating their knowledge and skills. The experimental group had a higher average score and/or a more limited range of responses on each item of the questionnaire than the control group. The average time for performing IANB in the experimental group was 50.0±14.3 seconds, while the control group's average was 68.4±25.5 seconds. In addition, the group that used the augmented reality simulator had an anesthesia success rate of 90.9% compared to 73.7% for the control group. Students in both groups had a statistically significant increase in heart rate while performing anesthesia. Overall, the students who used the mobile simulator in addition to their education in augmented reality carried out anesthetic procedures for IANB in a shorter period of time and had greater success than the students who used only the conventional educational methods.

Catheter-associated urinary tract infection in a surgical intensive care unit.

BACKGROUND/AIM: Because patients in intensive care units usully have an urinary catheter, the risk of urinary tract infection for these patients is higher than in other patients. The aim of this study was to identify risk factors and causative microrganisms in patients with catheter-associated urinary tract infection (CAUTI) in the Surgical Intensive Care Unit (SICU) during a 6-year period. METHODS: All data were collected during prospective surveillance conducted from 2006 to 2011 in the SICU, Military Medical Academy, Belgrade, Serbia. This case control study was performed in patients with nosocomial infections recorded during surveillance. The cases with CAUTIs were identified using the definition of the Center for Disease Control and Prevention. The control group consisted of patients with other nosocomial infections who did not fulfill criteria for CAUTIs according to case definition. Results. We surveyed 1,369 patients representing 13,761 patient days. There were a total of 226 patients with nosocomial infections in the SICU. Of these patients, 64 had CAUTIs as defined in this study, and 162 met the criteria for the control group. Multivariate logistic regression analysis identified two risk factors independently associated to CAUTIs: the duration of having an indwelling catheter (OR = 1.014; 95% CI 1.005-1.024; p = 0.003) and female gender (OR = 2.377; 95% CI 1.278-4.421; p = 0.006). Overall 71 pathogens were isolated from the urine culture of 64 patients with CAUTIs. Candida spp. (28.2%), Pseudomonas aeruginosa (18.3%) and Klebsiella spp. (15.5%) were the most frequently isolated microorganisms. CONCLUSIONS: The risk factors and causative microrganisms considering CAUTIs in the SICU must be considered in of planning CAUTIs prevention in this setting.

Ejection experience in Serbian Air Force, 1990-2010.

BACKGROUND/AIM: Ejection injuries are the problem for air forces. The present risk for injuries is still too high, approximately 30-50%. The aim of this study was to determine factors responsible for and contributing to injuries in the Serbian Air Force (SAF) in the last two decades. METHODS: All ejection cases in the SAF between 1990 and 2010 were analyzed. The collected data were: aircraft type, ejection seat generation, pilots" age and experience, causes of ejection, aeronautical parameters, the condition of aircraft control and types of injuries. For ease of comparison the US Air Force Safety Regulations were used to define major injuries: hospitalization for 5 days or more, loss of consciousness for over 5 min, bone fracture, joint dislocation, injury to any internal organ, any third-degree burn, or second-degree burn over 5% of the body surface area. RESULTS: There were 52 ejections (51 pilots and 1 mechanic) on 44 airplanes. The ejected persons were from 22 to 46 years, average 32 years. Major injuries were present in 25.49% cases. Of all the ejected pilots 9.61% had fractures of the thoracic spine, 11.53% fractures of the legs, 3.48% fractures of the arms. Of all major injuries, fractures of the thoracic spine were 38.46%. None of the pilots had experienced ejection previously. CONCLUSION: Our results suggest that taking preventive measures is obligatory. Namely, magnetic resonance imaging (MRL) scan must be included in the standard pilot selection procedure and procedure after ejection, physical conditioning of pilots has to be improved, training on ejection trainer has to be accomplished, too.

Pandemic influenza H1N1 outbreak in the military school.

BACKGROUND/AIM: The first cases of the pandemic pH1N1 influenza virus infection was observed in the Unated States and Mexico in April 2009 and the first laboratory confirmed case in Serbia was registered in June 2009. The aim of this paper was to report on the investigation of the first confirmed outbreak of the 2009 pandemic H1N1 influenza in Serbia and to describe the clinical and epidemiologic findings from this investigation. METHODS: Descriptive and analytical epidemiological methods were used. Data were collected from medical records of the Military School students and epidemiological questionnaire. Pandemic H1N1 infection was initially confirmed by the RT-PCR assay in nasopharyngeal and oropharyngeal swabs and subsequently by the complement fixation test in serum samples. RESULTS: The attack rate of acute respiratory illness was 70.8% (204/288). Pandemic H1N1 virus infection was confirmed in 44 of 82 tested cases of acute respiratory illness (53.7%) The most common clinical manifestations of pandemic influenza H1N1 were fever (88.6%/), cough (61.4%/o), malaise (38.6%/), runny nose (36.4%), headache (29.60/%), sore throat (20.50/%) and muscle pain (15.9%). CONCLUSION: The findings from this investigation suggest that pandemic H1N1 influenza in a high military school was widespread but did not cause severe illness.

Surgical management of stab injuries of the heart.

UNLABELLED: ITRODUCTION: Cardiac injuries today are not rare and they present a significant group of pathological cardiac diseases, with a large number of the injured (60-90%) dying before being transported to the hospital. CASE REPORT: A patient with a stab wound of the right chamber, upper abdomen and pelvis, in a state of hemorrhagic shock, was successfully managed after being reanimated. CONCLUSION: Good health service organization in the field and urgent transport of the injured should be obligatory in the management of heart trauma.

Epidemiological characteristics of brucellosis in Serbia, 1980-2008.

AIM: To analyze the epidemiological characteristics of human brucellosis in Serbia from 1980 to 2008 and the most important factors affecting its emergence and spread. METHODS: Public sources of data on brucellosis were used, including official reports of infectious diseases and epidemics, as well as monthly and annual reports of the Serbia and Vojvodina Institutes of Public Health. RESULTS: From 1980 through 2008, there were 1521 human brucellosis cases in Serbia. The annual number ranged from 2 in 2000 to 324 in 1991. Infections occurred more often in men (67% of cases) than in women (odds ratio, 2.17; 95% confidence interval, 1.57-3.00; chi2=24.52, P<0.001). The largest number of patients over the entire study period (1184) was recorded in Kosovo and Metohija, which accounted for 78% of the total number of patients. The maximum incidence rate in Kosovo and Metohija was 12 per 100,000 in 1991. In Vojvodina, the first autochthonous human cases of brucellosis were recorded in 1999, and 101 affected persons were registered by the end of 2008. During the period 1994-2008, the largest number of patients in Serbia was recorded from June to September (310 of 623 cases, 50%). The disease was most prevalent among people aged 30-49 years, accounting for 81 of 177 (46%) of the cases in Serbia from 1999 to 2008. CONCLUSION: Brucellosis has been a significant public health concern in Serbia. This problem may be solved by joint efforts of all relevant factors, first of all human and veterinary medical services.

[Risk of Lyme disease development after a tick bite].

BACKGROUND/AIM: Despite numerous research of Lyme disease (LD), there are still many concerns about environmental of infectious agent of LD, as well as its prophylaxis, diagnosis and treatment. The aim of this work was to determine the risk of LD in relation to the way of removing ticks and duration of tick attachment. METHODS: In the period from 2000 to 2007 a prospective study was conducted including persons with tick bite referred to the Institute of Epidemiology, Military Medical Academy, and followed for the occurrence of early Lyme disease up to six months after a tick bite. Epidemiological questionnaire was used to collect relevant information about the place and time of tick bites, the way of a removing tick, duration of tick attachment, remnants of a tick left in the skin (parts of the mouth device) and the signs of clinical manifestations of LD. Duration of tick attachment was determined on the basis of size of engorged tick and epidemiological data. Removed ticks were determined by the key of Pomerancev. Professional removing of attached tick was considered to be removing of tick with mechanical means by healthcare personnel. Fisher's exact test, Chi squares test and calculation of the relative risk (RR) were used for data analysis. RESULTS: Of 3 126 patients with tick bite, clinical manifestations of LD were demonstrated in 19 (0.61%). In the group of subjects (n = 829) in which a tick was not removed professionally there were 17 (2.05%) cases with LD, while in the group of respondents (n = 2 297) in who a tick was removed professionally there were 2 (0.09%) cases with LD after tick bite (RR, 23.55; p < 0.0001). The disease was most frequent in the group of respondents with incompletely and unprofessionally removed ticks (2.46%). In the groups of patients with unprofessionally but completely removed ticks LD occurred in 0.89%, while in the group of subjects with a tick removed by an expert, but incompletely in 0.78% cases. The disease occurred rarely in the group with a tick removed completely and professionally (0.05%). There was no case of LD in the group of patients with a tick removed within 24 hours. The longer time of exposure after 24 hours, the higher absolute risk of disease was reported. CONCLUSION: In prevention of Lyme disease it is important to urgent remove a tick, to use a correct procedure of removing and to remove the whole tick without any remnants.