Search

Introduction: There were 13 protocols for the COVID-19 infection treatment in Serbia. All protocols emphasize the importance of not giving antibiotics routinely, especially in patients who were treated at the primary healthcare level. Use of antibiotics was widely spread in the treatment of COVID-19 patients, all around the world. Objective. We aimed at examining the incidence, type, and combination of used antibiotics and antivirals in COVID-19 patients. Method: Observational retrospective cross-sectional study on the prescription of antibiotics and antivirals in patients who were treated in the COVID clinic of the Golubac Primary Healthcare Center in the period from 7/17/2020. until 10/31/2022. The data were obtained from the electronic health records of the participants. The sample consisted of 2709 respondents. The variables we used were sex and age. We used the statistical package SPSS17 for data processing. For statistical methods, we used descriptive statistics frequency (%) and, the X2 test. Results: The research included 2,709 patients. In total, 1590 people were prescribed antibiotics. Concerning the total number of patients, examined in the COVID clinic, this represents 58.7%. The highest percentage of patients who were prescribed an antibiotic was in the period November 2020 - May 2021. Depending on the study period, cephalosporin and azithromycin are the most frequently prescribed antibiotics (70-89% of the total number of prescribed antibiotics). The most commonly prescribed antibiotic combination is a cephalosporin-fluoroquinolone. Conclusion. The use of antibiotics in the treatment of COVID-19 patients was higher than recommended in the protocols and guidelines.

Introduction Age and lymph node ratio have been attributed as independent predictors for survival and recurrence in carcinoma of unknown primary (CUP).

Introduction. Successful implementation of all activities, especially in the area of preventive medicine, healthcare institutions may accomplish only if their employees are highly motivated and properly rewarded for their work. The best motivational system should be designed so the employees get the rewards that matter to them. That is why research into the motives and needs of employees appears as a necessary prerequisite for the effectiveness of motivation. Objective. We aimed at examining the most important motivational factors for preventive activities in healthcare workers. Method. The research was conducted, as a case study, in the Primary Healthcare Center (PHC), Golubac from December 2019 to December 2020. We analyzed the results of the preventive activities of healthcare workers from the PHC Golubac during project activities in 2020 and compared them to the results from 2018. Employees' attitudes towards motivational factors were analyzed based on the conducted individual interviews and surveys. Results. The results of preventive actions in 2020, through project activities, were significantly better than those in 2018. The diabetes screening response was 42%, the realization of blood pressure measuring in diabetic patients was 58%, and HbA1c was measured in 34% of diabetics in 2020. In 2018 screening realization was 15%, blood pressure was measured in 50% of diabetics, and HbA1C in 10%. The most important motivational factors for healthcare workers were the importance of preventive activities for the people's health, the participation of the manager as the project leader, the equipment gained during the project that will improve their work, clearly defined goals, and personal responsibility for the project's success. Conclusion. The motivation of healthcare workers is of great importance for the successful implementation of preventive activities. Our research provides information for healthcare managers on ways to improve their employees' motivation.

Introduction. There are approximately 17.000 new cases of diabetes mellitus type 2 (DM2) in Serbia each year. A third of the newly diagnosed already has some late disease complications and almost half of them are over 65. Objective. We aimed at determining the level and risk factors for DM2 in respondents of different gender, age, and lifestyle in the Municipality of Golubac. Method. The study was conducted using the DM2 questionnaire. The sample had 404 participants who were screened in the Municipality of Golubac. Significant statisti-cal methods were used in the study: frequency, t-test, ANOVA test, and correlation analysis. Results. The study showed the majority of participants (40.1%) had slightly elevated risk for DM2, high risk was found in 14.9%, and very high risk in 3.2%. Moderate risk was found in 27.5% of the participants and 14.4% had low risk. Women had a higher percentage of high and very high risk for DM2 than men but no statistically significant difference was found between men and women concerning the risk of developing the disease. With age, as well as obesity, the risk for DM2 increases. The participants who practiced regular physical activity, as well as those who regularly consumed fruits and vegetables, had a lower risk for DM2. Conclusion. The study showed almost every fifth participant had a high or very high risk for DM2, 81.7% were overweight, and 75% had previously diagnosed cardiovascular problems. Registration of persons with an elevated risk for DM2 and further follow-up is a very important task for GPs (general practitioners).

Background: Sinonasal malignancies with orbital invasion have dismal prognosis even when treated with orbital exenteration (OE). Sugawara et al. developed a surgical strategy called "extended‐OE (EOE)," showing encouraging outcomes. We hypothesized that a similar resection is achievable under endoscopic guidance through the exenterated orbit (endoscopic‐EOE). Methods: The study was conducted in three institutions: University of Vienna; Mayo Clinic; University of Insubria; 48 orbital dissections were performed. A questionnaire was developed to evaluate feasibility and safety of each step, scoring from 1 to 10, ("impossible" to "easy," and "high risk" to "low risk," respectively), most likely complication(s) were hypothesized. Results: The step‐by‐step technique is thoroughly described. The questionnaire was answered by 25 anterior skull base surgeons from six countries. Mean, median, range, and interquartile range of both feasibility and safety scores are reported. Conclusions: Endoscopic‐EOE is a challenging but feasible procedure. Clinical validation is required to assess real‐life outcomes. [ABSTRACT FROM AUTHOR]

Introduction Parapharyngeal space tumors with complex anatomy and diverse histology have remained a challenging phenomenon for treating physicians. Objectives We have conducted a comprehensive web search on the PubMed, Web of Science, EMBASE, Cochrane Library, Biomedical Literature Database (CBM), and Clinicaltrials.gov databases to determine the factors that are associated with postoperative complications in parapharyngeal space tumors. Data Synthesis Two researchers reviewed all identified articles independently with a third reviewer for adjudication. Patient demographics and other clinicopathological characteristics were explored. The systematic review has identified 631 benign parapharyngeal space tumors with neurogenic and salivary tissue histology in 13 studies, with a mean age of 42.9 ± 7.76 years old and a median follow-up of 40.98 ± 19.1 months. Salivary gland (50.8%) and neurogenic (49.1%) tumors were the most common histological entities. Tumor size, location, histology, deep parotid lobe involvement, and proximity to great vessels or to the skull base were the deciding factors in selecting the surgical approach. The factors considered to select the surgical approach do not seem to have a correlation with the outcome in terms of neurological sequalae (p = 0.106). Tumors with neurogenic histology have significantly increased chances of developing neurological complication (OR 6.07; p = 0.001). Conclusion Neurologic complications are significantly associated with neurogenic benign tumors rather than surgical approach.

Background: The study aimed to evaluate the diagnostic efficacy of routine follow‐up in detecting recurrent disease in hypopharyngeal carcinoma. Methods: Data from 76 patients with a total of 620 follow‐up visits, 367 radiological studies, and 126 panendoscopies were retrospectively assessed regarding the diagnosis of recurrent disease based on the results of (I) radiological studies, (II) clinical examinations, and (III) clinical symptoms. Results: All locally relapsed patients became symptomatic, and new onset of dysphagia (p < 0.001) was the most frequent complaint. The sensitivity for detecting local recurrences was 100% for both patients' symptom assessments and clinical examinations. The highest overall accuracy was found for clinical examinations (93.4%), followed by symptom assessments (80.5%), and radiological studies (73.8%). The risk of false positive radiological reports and subsequent panendoscopies was 2.2 times higher after previous radiotherapy (32.0% vs. 14.6%; p < 0.001). Conclusion: Symptom assessments and clinical examinations are highly efficient for detection of local failures. [ABSTRACT FROM AUTHOR]

BackgroundWe aimed to determine the prognostic significance of pretreatment plasma fibrinigen in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC).MethodsA cohort of 183 patients with locally advanced OOSCC receiving preoperative chemoradiotherapy was retrospectively examined. Using ROC curve analysis, a pretreatment plasma fibrinogen cutoff value of 447mg/dL was determined. The primary endpoints were overall survival and recurrence-free survival. A secondary endpoint was to determine whether pretreatment plasma fibrinogen could predict treatment response to neoadjuvant chemoradiotherapy. Cox regression models and Kaplan-Meier curves were used for survival analyses.ResultsSeventy-one patients had an elevated pretreatment plasma fibrinogen (fibrinogen >447mg/dL). Patients with high fibrinogen showed significantly higher pathologic stages after neoadjuvant treatment than those with low fibrinogen (p = 0.037). In univariate analysis, elevated fibrinogen was associated with poor overall survival (p = 0.005) and recurrence-free survival (p = 0.008) Multivariate analysis revealed that elevated fibrinogen remained an independent risk factor for death (hazard ratio 1.78, 95% CI 1.09-2.90, p = 0.021) and relapse (hazard ratio 1.78, 95% CI 1.11-2.86, p = 0.016).ConclusionElevated pretreatment plasma fibrinogen is associated with lack of response to neoadjuvant chemoradiotherapy and reduced OS and RFS in patients with OOSCC. Thus, plasma fibrinogen may emerge as a novel prognostic indicator and a potential therapeutic target in OOSCC.

Dog-bite injuries are regularly treated in emergency departments. Every bite wound is unique, and thus requires a customized treatment plan. Here, we report the case of a 27-year-old woman who was transferred to the main hospital of Vienna due to a facial dog-bite injury. Primary closure of the wound was possible. The patient received amoxicillin–clavulanate as antimicrobial therapy, and was vaccinated against tetanus, polio, pertussis and diphtheria due to her unknown immunization status. At 183 days after the attack, the aesthetic outcome and nasal ventilation were satisfactory. Based on the reconstructive ladder for wound closure, more severe injuries may require skin or composite grafts, distant or local flaps and microsurgical procedures. Anti-infective therapy against tetanus, rabies and other bacteria also represents a central pillar of dog-bite injury treatment. This case report adds to the knowledge about dog-bite injuries and the required individual multidisciplinary treatment approach.

Shima Mehrabian,1 Larissa Schwarzkopf,2 Stefanie Auer,3 Iva Holmerova,4 Milica G Kramberger,5 Marina Boban,6 Elka Stefanova,7 Catalina Tudose,8 Natalia Bachinskaya,9 Tibor Kovács,10 Petr Koranda,11 Todor Kunchev,1 Latchezar Traykov,1 Janine Diehl-Schmid,12 Katrina Milecka,12 Alexander Kurz12On behalf of the Danubian Network for Dementia Education Care (DANDEC) Consortium1UH “Alexandrovska”, Department of Neurology, Medical University Sofia, Sofia, Bulgaria; 2Helmholtz-Centre Munich, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Munich, Germany; 3Department for Clinical Neurosciences and Preventive Medicine, Danube University Krems, Krems, Austria; 4CELLO Faculty of Humanities, Charles University, Prague, the Czech Republic; 5University of Ljubljana, Department of Neurology, Ljubljana, Slovenia; 6University of Zagreb, Department of Cognitive Neurology, Zagreb, Croatia; 7School of Medicine, University of Belgrade, Neurology Clinic, Belgrade, Serbia; 8University of Medicine and Pharmacy Carol Davila, Department of Clinical Neurosciences, Bucharest, Romania; 9Acacdemy of Medical Sciences Kiev, Department of clinical physiology and pathology of the central nervous system, Kiev, the Ukraine; 10Department of Neurology, Semmelweis University, Budapest, Hungary; 11MEDIWARE corp., Prague, the Czech Republic; 12Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, GermanyCorrespondence: Alexander KurzCentre for Cognitive Disorders at the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar; Technische Universität München, Ismaninger Strasse 22 Munich 81675, GermanyTel +49 894 140 4285Email a.kurz@tum.deBackground: Dementia is a particularly severe societal challenge in several countries of the Danube Region due to higher-than-average increment in population longevity, disproportionate increase of the old-age dependency ratio, and selective outward migration of health care professionals. A survey was conducted among dementia experts to obtain a deeper understanding of the dementia care structures and services in this geographical area, and to identify the educational needs of health care professionals, and the availability of assistive technology.Subjects and methods: A standardized questionnaire was sent out to 15 leading dementia experts/clinicians in 10 Danube Region countries inquiring about professional groups involved in dementia care, availability and reimbursement of services, inclusion of dementia in professional education and training, acceptability of Internet-based education, and availability of assistive technology. The authors are the survey respondents.Results: The majority of individuals with dementia receive care in the community rather than in institutions. The roles of medical specialties are disparate. General practitioners usually identify dementia symptoms while specialists contribute most to clinical diagnosis and treatment. Health care professionals, particularly those who work closely with patients and carers, have limited access to dementia-specific education and training. The greatest need for dementia-specific education is seen for general practitioners and nurses. An Internet-based education and skill-building program is considered to be equivalent to traditional face-to-face but offer advantages in terms of convenience of access. Assistive technology is available in countries of the Danube Region but is significantly underused.Conclusion: Dementia care in the Danube Region can be improved by an educational and skill-building program for health care professionals who work in the frontline of dementia care. Such a program should also attempt to enhance interdisciplinary and intersectorial collaboration, to intensify the interaction between primary care and specialists, and to promote the implementation of assistive technology.Keywords: dementia, Danube Region, expert survey, dementia care structures, education, assistive technology

BackgroundThe aim of this study was to evaluate whether surgeons´ experience and perioperative single-shot antibiotic prophylaxis affect outcome of patients undergoing stapes surgery.Patients and methodsWe retrospectively evaluated audiological outcomes and postoperative complications of 538 consecutive patients who underwent stapes surgery at a single tertiary referral center between 1990 and 2017. Effects of different clinical variables, including single-shot antibiotic prophylaxis and surgeons' experience on outcome were assessed.Results538 patients underwent 667 stapedotomies and postoperative complication rate was 7.5% (n = 50). Air conduction and air-bone gap closure improved significantly after surgery (14.2 ± 14.8 dB, p = 0.001; 14.5 ± 12.8 dB, p = 0.001). Multivariate analysis revealed that 6 years or less of surgical experience was independently associated with a higher incidence of persisting or recurrent conductive hearing loss (p = 0.033, OR 5.13) but perioperative application of antibiotics had no significant effect on outcome.ConclusionFirst, clinical outcome regarding persisting or recurrent conductive hearing loss caused by incus necrosis and prosthesis luxation is linked to surgical performance. This underlines the need for a meticulous training and supervision of less experienced surgeons performing stapes surgery. Second, our results do not support the need for perioperative antibiotic prophylaxis in stapes surgery. Potential standard limitations of retrospective cohort studies (selection bias, confusion bias etc.) could play a role in interpreting our results. However, the probability for these limitations is minimized due to the large patient sample.