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Introduction. Risk stratification is an important aspect of COVID-19 management, especially in patients admitted to ICU as it can provide more useful consumption of health resources, as well as prioritize critical care services in situations of overwhelming number of patients. Materials and Methods. A multivariable predictive model for mortality was developed using data solely from a derivation cohort of 160 COVID-19 patients with moderate to severe ARDS admitted to ICU. The regression coefficients from the final multivariate model of the derivation study were used to assign points for the risk model, consisted of all significant variables from the multivariate analysis and age as a known risk factor for COVID-19 patient mortality. The newly developed AIDA score was arrived at by assigning 5 points for serum albumin and 1 point for IL-6, D dimer, and age. The score was further validated on a cohort of 304 patients admitted to ICU due to the severe form of COVID-19. Results. The study population included 160 COVID-19 patients admitted to ICU in the derivation and 304 in the validation cohort. The mean patient age was 66.7 years (range, 20–93 years), with 68.1% men and 31.9% women. Most patients (76.8%) had comorbidities with hypertension (67.7%), diabetes (31.7), and coronary artery disease (19.3) as the most frequent. A total of 316 patients (68.3%) were treated with mechanical ventilation. Ninety-six (60.0%) in the derivation cohort and 221 (72.7%) patients in the validation cohort had a lethal outcome. The population was divided into the following risk categories for mortality based on the risk model score: low risk (score 0–1) and at-risk ( score > 1 ). In addition, patients were considered at high risk with a risk score > 2 . By applying the risk model to the validation cohort ( n = 304 ), the positive predictive value was 78.8% (95% CI 75.5% to 81.8%); the negative predictive value was 46.6% (95% CI 37.3% to 56.2%); the sensitivity was 82.4% (95% CI 76.7% to 87.1%), and the specificity was 41.0% (95% CI 30.3% to 52.3%). The C statistic was 0.863 (95% CI 0.805-0.921) and 0.665 (95% CI 0.598-0.732) in the derivation and validation cohorts, respectively, indicating a high discriminative value of the proposed score. Conclusion. In the present study, AIDA score showed a valuable significance in estimating the mortality risk in patients with the severe form of COVID-19 disease at admission to ICU. Further external validation on a larger group of patients is needed to provide more insights into the utility of this score in everyday practice.

Introduction. Mortality among critically ill COVID-19 patients remains relatively high despite different potential therapeutic modalities being introduced recently. The treatment of critically ill patients is a challenging task, without identified credible predictors of mortality. Methods. We performed an analysis of 160 consecutive patients with confirmed COVID-19 infection admitted to the Respiratory Intensive Care Unit between June 23, 2020, and October 2, 2020, in University Hospital Center Bezanijska kosa, Belgrade, Serbia. Patients on invasive, noninvasive ventilation and high flow oxygen therapy with moderate to severe ARDS, according to the Berlin definition of ARDS, were selected for the study. Demographic data, past medical history, laboratory values, and CT severity score were analyzed to identify predictors of mortality. Univariate and multivariate logistic regression models were used to assess potential predictors of mortality in critically ill COVID-19 patients. Results. The mean patient age was 65.6 years (range, 29–92 years), predominantly men, 68.8%. 107 (66.9%) patients were on invasive mechanical ventilation, 31 (19.3%) on noninvasive, and 22 (13.8%) on high flow oxygen therapy machine. The median total number of ICU days was 10 (25th to 75th percentile: 6–18), while the median total number of hospital stay was 18 (25th to 75th percentile: 12–28). The mortality rate was 60% (96/160). Univariate logistic regression analysis confirmed the significance of age, CRP, and lymphocytes at admission to hospital, serum albumin, D-dimer, and IL-6 at admission to ICU, and CT score. Serum albumin, D-dimer, and IL-6 at admission to ICU were independently associated with mortality in the final multivariate analysis. Conclusion. In the present study of 160 consecutive critically ill COVID-19 patients with moderate to severe ARDS, IL-6, serum albumin, and D-dimer at admission to ICU, accompanied by chest CT severity score, were marked as independent predictors of mortality.

Introduction. Triple-positivity (TP) or double-positivity (DP) for serum-specific immunoglobulin E (sIgE) antibodies against hornet venom (HV), wasp venom (WV) and/or honeybee venom (BV) causes significant problem in a selection of appropriate venom immunotherapy. However, DP/TP can be caused by cross-reactions resulting either from partial sequence identity of protein allergens in the venoms, or may be related to cross-reacting carbohydrate determinants (CCDs). Case report. A 60-year-old man was stung by a wasp and two days later by hornet. In both cases, within 15 minutes he developed hypotension and generalized urticaria and he was successfully treated with epinephrine, corticosteroids and fluids. After eight weeks, the examination revealed the negative skin prick test for all three venoms, but the sIgE-determination (ELISA, Biopharm) showed triple sensitization to native BV (0.55 IU/mL), WV (3.35 IU/mL) and HV (0.37 IU/mL). He was receiving the venom immunotherapy with venom mixtures for one year. In order to distinguish true multiple sensitization from cross-reactivity, the molecular-allergy testing by ImmunCAP with the CCD-free recombinant major allergens was performed. A high sensitization to Antigen 5-rVes v5 of WV (31.4 kU/L) was demonstrated while sIgE to phospholipase A2-rApi m1 of BV (0.15 kU/L) was negative; sIgE to CCDMUXF3- bromelain (0.75 kU/L) explained the sIgE-positivity for native BV. After these findings, a venom immunotherapy only with WV was initiated. Conclusion. In our patient, triple-IgE-positivity to native venoms detected by the ELISA was caused by cross-reactivity to CCDs. We recommend the molecular-allergy testing with the nonglycosylated recombinant allergens before starting the venom immunotherapy in patients with multiple-sIgE-positivity to native Hymenoptera venoms.

Introduction. The aim of this work was to present a rare case of spontaneous regression of a herniated cervical disc in a patient with myelopathy. Case outline. A 31-year-old women presented with two weeks? history of neck pain associated with numbness in her body and all four extremities. Magnetic resonance imaging (MRI) of the cervical spine showed a large posterior medial disc extrusion at the C5?C6 spinal segment, causing myelopathy. The patient refused discectomy that was recommended. She received symptomatic treatment in the form of analgesics, a muscle relaxant, and a hard cervical collar. A follow-up MRI of the cervical spine, performed after 11 months, revealed almost complete regression of disc herniation. The patient?s symptoms subsided completely after one year. Conclusion. In some cases of cervical disc herniation with myelopathy, especially in patients with mild neurological deficit, symptomatic therapy should be considered.

Surgery is the best option (when feasible) for patients with pharmacoresistant focal epilepsy. Meticulous presurgical evaluation is essential in order to achieve successful surgical results. The rationale for surgical management of pharmacoresistant focal epilepsies is to eliminate or significantly reduce the patient's propensity for spontaneous seizures by removing the epileptogenic focus. Candidates for resective epilepsy surgery should have verified intractable focal epilepsy in distinctive cerebral region with feasible surgical resection. Main goals of presurgical evaluation are to determine proper candidates for surgical treatment define eplieptogenic region and select optimal surgical technique with acceptable complication risk and good recovery after surgery.

Backround/Aim. Anismus is paradoxal pressure increase or pressure decrease less than 20% of external anal sphincter during defecation straining. This study analyzed the presence of anismus as within a group of patients with the positive Rome III criteria for functional constipation. We used anorectal manometry as the determination method for anismus. Methods. We used anorectal water-perfused manometry in 60 patients with obstructive defecation defined by the Rome III criteria for functional constipation. We also analyzed anorectal function in 30 healthy subjects. Results. The presence of anismus is more frequent in the group of patients with obstructive defecation compared to the control group (a highly statistically significant difference, p