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Introduction/Objective. The main aim of this study was to assess COVID-19 vaccination effectiveness (VE) of BBIBP-CorV, Gam-COVID-Vac, BNT162b2, and ChAdOx1-nCoV-19 in Serbia during the first three months of rollout. Methods. The data from the Serbian National Immunization Registry, the Primary Health Centre Report, and the University Clinical Centre Report for Kragujevac, Serbia, for the period from January 1 to March 31, 2021 were used to compare COVID-19 vaccinated population to unvaccinated individuals in terms of laboratory confirmed SARS-CoV-2 infection, COVID-19-related hospitalization and intensive care unit (ICU) admission due to COVID-19. VE was estimated based on the incidence rate ratio, adjusted for age and sex. Results. Overall VE after the first dose reached 20.6%, 28.2%, and 56.1%, and 55.7%, 63.9%, and 79.8%, after the second dose for SARS-CoV-2 infection, COVID-19-related hospitalization, and ICU admission, respectively. BNT162b2 exhibited 96.7% VE against infection and no hospitalization after the second dose. Complete vaccination with BBIBP-CorV and Gam-COVID-Vac demonstrated VE of 43.2% and 78.6% against infection, 56.9% and 85.3% against hospitalization, and 82.3% and 52.7% against ICU admission, respectively. ChAdOx1-nCoV-19 after the first received dose showed VE of 10.3% and 74.7% against infection and hospitalization, with no ICU admission. Conclusion. COVID-19 vaccination in general, as well as each of the four studied vaccines, reduces the risk of SARS-CoV-2 infection, hospitalization due to COVID-19, and COVID-19-related ICU admission. Vaccine effectiveness significantly increases with the second received dose for all study outcomes.

Introduction/Objective. The duration of vaccine-induced protection against SARS-CoV-2 is shown to be limited. The aim of this study was to assess vaccine effectiveness (VE) of a third dose of four different COVID-19 vaccines during Delta variant predominance in Serbia. Methods. The data for the period from August 18, to October 1, 2021 were used to estimate the incidence rates (IR) of the SARS-CoV-2 infection, COVID-19-related hospitalization, and intensive care unit (ICU) admission. The study included 41,186 fully vaccinated subjects, of which 13,589 had received the third dose. VE was estimated based on the IR ratio following vaccination with three vs. two doses. Results. We found that a third dose of all investigated vaccines reduces the incidence of both SARS-CoV-2 infection and severe illness that requires hospitalization or ICU admission. The highest VE against infection demonstrated BNT162b2, followed by Gam-COVID-Vac and BBIBP-CorV. Third dose vaccination reduced the risk of hospitalization (IR = 0 for Gam-COVID-Vac and BBIBP-CorV), and ICU admission (IR = 0 for all vaccines). The hazard distributions for SARS-CoV-2 infection and hospitalization following vaccination with three versus two doses were significantly different. Conclusion. These findings indicate that an additional, third dose of studied vaccine boosters protection against all investigated outcomes.

Introduction. Early warning scoring systems are important for timely identification of the critically ill, but are they a relevant prognostic tool? Our objective was to test if Modified Early Warning Score (MEWS), lactate, and base excess (BE) have any prognostic value in high dependency unit patients. Methods. This was a prospective observational study that included 364 patients treated at a respiratory high dependency unit. The values of MEWS, lactate, and BE at admission were recorded with patients’ age, sex, and comorbidities. Negative outcome was defined as death or transfer to the intensive care unit. Independent predictors of negative outcome were identified with the use of multivariable logistic regression. Results. Of 369 patients, 203 (55%) were male. Mean age was 62 ± 16. There were 138 (37.4%) patients with negative outcome: 27.37% died, while 10.03% patients required intensive care unit transfer. The median length of hospital stay was 13 days (IQR 7–15). Patients with negative outcome had a significantly higher MEWS (3.68 ± 1.965 vs. 4.57 ± 2.33, p < 0.001), lower BE (-0.139 ± 7.48 vs. -3.751 ± 6.159, p < 0.001), and a higher lactate (2.299 ± 2.350 vs. 3.498 ± 3.578, p < 0.001). MEWS ≥ 4 (OR 1.90, CI 1.082–3.340, p = 0.026) was the only independent predictor of mortality. Area under the curve (AUC) for MEWS with regard to in-hospital mortality prediction was 0.633 (95% CI 0.569–0.697). When age was added to MEWS, the AUC was 0.76 (95% CI 0.707–0.814). Conclusion. Our findings support the prognostic value of MEWS for final outcome of patients admitted to the high dependency unit.

Introduction/Objective. Making a calculator that would recognize patterns of abnormal liver function tests and link them to the most probable etiology could help clinicians in their initial orientation towards a definitive diagnosis in patients with liver damage. The aim of our study was to design, construct, and validate a calculator that based on a pattern of abnormalities in liver function tests of a patient with liver damage would propose the most probable etiology. Methods. Patterns of abnormal liver function tests for certain etiology of liver damage were extracted from distributions of actual values taken from reports in medical literature about patients whose etiology of liver damage was proven by reliable diagnostic tests. After setting up the calculator with the patterns extracted, its diagnostic value was checked under real-life conditions, on a sample of patients with liver damage whose etiology was established by the gold standard of diagnostics (biopsy or else). The calculator validation study was carried out at the Military Medical Academy in Belgrade during a two-year period (2015–2016). Results. For all tested diagnoses, the calculator demonstrated a highly significant difference between the area under the receiver-operator curves’ values and the value of 0.5 (p < 0.001), and high level of sensitivity (more than 90%, except for the model for chronic hepatitis) as well as relatively high specificity (more than 75%) were noted, indicating good ability of the calculator to detect etiology of liver damage. Conclusion. New calculators showed satisfactory sensitivity and specificity for revealing major liver damage etiologies. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175007]

Introduction. Shortage of intensive care beds has led to more frequent use of noninvasive ventilation (NIV) outside respiratory units, and data on NIV efficacy and safety on general wards is lacking. Objective. The aim was to identify potential predictors for NIV failure. Methods. This was a retrospective analysis of patients treated with NIV at the Institute for Pulmonary Diseases of Vojvodina from 2009 to 2013. Demographics, blood gases, chest radiographs, setting, and outcomes were analyzed to identify predictors of NIV failure. Results. A total of 138 patients (65% men, mean age 66 ± 11 years) were treated with NIV. Indications for NIV were acute exacerbation of chronic obstructive pulmonary disease (85%) and cardiogenic pulmonary edema (7%), as well as respiratory insufficiency related to obesity and central hypoventilation (5%) and neuromuscular disease (3%). Rate of NIV failure was 34.8%. In 86 patients NIV was applied in the High Dependency Unit (HDU), while 52 received NIV on the general ward. Baseline characteristics in terms of gender, arterial blood gases, and the extent of consolidation on chest radiographs were similar. Patients treated in HDU were younger (64.4 ± 1.2 vs. 69.4 ± 1.5 years, p < 0.001). NIV on the general ward compared to HDU had higher rates of NIV failure (28/52 vs. 20/86, p < 0.001). Presence of consolidation involving two or more quadrants on chest radiograph (55% vs. 29%, p < 0.001) was associated with NIV failure. When adjusted for age and the extent of consolidation on chest radiograph, NIV failure was still less likely in patients treated in HDU (OR 0.23, 95% CI 0.10-0.50). Conclusion. Patients with consolidation on chest X-ray and patients treated with NIV outside of dedicated respiratory units are at a higher risk for NIV failure.