The objective of this paper was to present basic clinical characteristics and outcomes of treating Covid 19 patients during the second wave of the pandemic. In the retrospective study for the period from September 2020 to February 2021 it was analyzed disease history data and radiological lung changes, time from the initial start of the disease until hospitalization, parameters of blood gas analysis, comorbidities, and the outcome. The research covered 409 patients, out of which 263 (64.3%) were males. Average age was 67.07± 12.44 years (min. 20; max. 93). A high comorbidities prevalence (82.9%) was noticed out of which arterial hypertension (69.2%), diabetes mellitus (37.7%) and obesity (24.7%). On the radiological lung scan the most noticed changes were consolidation (46.2%), “ground glass” (41.3%) and interstitial changes (13%). Bilateral lung infiltration was noticed in 91.9% of the patients. Average oxygen saturation was 84.29%±10.28% (min. 35; max. 98; med. 87%). In patients with unilateral lung infiltration, average oxygen saturation was 85.09%±8.60% (med. 89%, min.61% max 98%), while in patients with bilateral lung infiltration average was 84.22%±10.42% (med. 87%, min. 35%, max. 98%). From the total all patients’ death was noticed in 35.7% cases. Morbidity of patients with unilateral lung infiltration was 27.3% and in patients with unilateral infiltration 36.4%. Hospital admission in the first week of the disease indicates the severity of the clinical condition and can be a predictor of poor outcome. Bilateral pulmonary infiltration, obesity and diabetes mellitus are risk factors for high mortality.

Introduction: Preoperative carbohydrate oral (CHO) drinks attenuate the surgical stress response; however, the effects of CHO supplementation on the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory and immunology-based predictor remain unclear. This study evaluated the effects of preoperative CHO loading on NLR values and complications following open colorectal surgery compared with a conventional fasting protocol. Methods: Sixty eligible participants having planned for routine and open colorectal cancer surgery from May 2020 to January 2022 were prospectively and randomly allocated to either the control (fasting) group, whose members discontinued oral intake beginning the midnight before surgery, or the intervention (CHO) group, whose members consumed a CHO solution the night before surgery and 2 h prior to anaesthesia. NLR was assessed at 06:00 h before surgery (baseline) and at 06:00 h on postoperative days 1, 3, and 5. The incidence and severity of postoperative complications were assessed by Clavien-Dindo Classification up to postoperative day 30. All data were analysed using descriptive statistics. Results: Postoperative NLR and delta NLR values were significantly higher in controls (p < 0.001; p < 0.001). Control group participants also demonstrated grade IV (n = 5; 16.7%, p < 0.01) and grade V (n = 1; 3.3%, p < 0.313) postoperative complications. There were no major postoperative complications in the CHO group. Conclusion: Preoperative CHO consumption reduced postoperative NLR values and the incidence and severity of postoperative complications following open colorectal surgery, compared with a preoperative fasting protocol. Preoperative carbohydrate loading may improve recovery following colorectal cancer surgery.

Aim: The aim of the study was to compare the analgesic effects of ketamine over fentanyl combined with propofol in analgesia-based elective colonoscopy with purpose of patient safety and satisfaction. Methods: This is a double-blinded prospective randomized controlled trial. Ninety patients were included and randomized to either fentanyl-propofol (Group FP, n: 30), ketamine-propofol (Group KP, n: 30) or propofol-control group (Group C, n: 30). Group FP patients received fentanyl and propofol, Group KP received ketamine and propofol and Group C, propofol. In all groups, incremental doses of propofol were used to maintain a Ramsay sedation score (RSS) of 5. Respiratory depression and hemodynamic parameters were monitored for the first minute and every 5 min during endoscopy. Fifteen minutes after the procedure, the degree of pain was assessed using a visual analog scale (VAS), the quality of recovery according to the Aldrete score (ARS), complications during and after the procedure and additional doses of propofol were recorded. Results: Mean arterial pressure (MAP) at 5 and 30 min (p < 0.05), heart rate (HR) at 15, 25 and 30 min (p < 0.05) and peripheral oxygen saturation (SpO2) at 30 min (p < 0.05) were statistically significant for Group FP. Desaturation (*p = 0.033), and weakness (*p = 0.004) was also significant for Group FP at 20, 25 and 30 min (p < 0.05). Pain was lower assessed for the Group KP according to the VAS (**p = 0.025). Conclusion: In analgesia-based colonoscopy, ketamine provides appropriate analgesia and less incidence of complications compared to fentanyl.

ABSTRACT Two cases are presented with coronavirus disease 19 (COVID-19)-related hiccups: one during initial presentation and one 10 days after COVID-19 diagnosis. Hiccups in both patients were resistant to treatment and responded only to chlorpromazine. COVID-19 patients may present with hiccups and also may have hiccups after treatment. Resistant hiccups without any underlying disease other than COVID-19 should be considered in association with COVID-19 and may respond well to chlorpromazine.

Introduction: Carcinoembryonic antigen (CEA) is used for monitoring of disease progression and treatment response in cancer patients. The aim was to compare the performance of chemiluminescent microparticle immunoassay with electrochemiluminescence immunoassay for CEA. Methods: A total of 115 samples were collected during routine diagnostic, prognostic, and therapy monitoring procedures in patients with colorectal and pancreatic cancer. We used Architect i2000SR and Cobas E601 for CEA analysis in sera samples. Results: The correlation coefficient of 0.984 (95% confidence interval [CI]: 0.972–0.991) for results obtained on both platforms was observed for CEA ≤10 ng/mL group. Moreover, intercept of 0.9027 (95% CI: 0.705–1.099) and slope 0.8076 (95% CI: 0.765–0.8498) (p < 0.0001) were observed in this group. In CEA >10 ng/mL group, we observed slope = 1.1986 (95% CI: 1.1474–1.2498) (p < 0.0001), intercept = –11.69 (–17.53–−5.84), and correlation coefficient = 0.985 (95% CI: 0.976–0.9914). Mean differences between assays in group ≤10 ng/mL and >10 ng/mL were 0.2066 (95% CI: 0.0019–0.4113) and –2.66 (95% CI: −10.10–4.76) ng/mL, respectively. Conclusion: Although there were differences, based on 20 days’ precision tests, overall results showed a good analytical performance and correlation between CEA assays on Architect i2000SR and Cobas E601 platforms. Reference intervals appropriate for the method of CEA measurement should be used. The standardization and harmonization of serum CEA concentration assays are needed.

Introduction: Carcinoembryonic antigen (CEA) is used for monitoring of disease progression and treatment response in cancer patients. Our aim was to compare the performance of chemiluminescent microparticle immunoassay (CMIA) with electrochemiluminescence immunoassay (ECLIA) for CEA. Methods: A total of 115 samples were collected during routine diagnostic, prognostic and therapy monitoring procedures in patients with colorectal and pancreatic cancer. We used ARCHITECT i2000SR and Cobas E601 for CEA analysis in sera samples. Results: The correlation coefficient of 0.984 [95% CI: 0.972 to 0.991] for results obtained on both platforms was observed for CEA≤10 ng/mL group. Moreover, intercept of 0.9027 [95% CI: 0.705 to 1.099] and slope 0.8076 [95% CI: 0.765 to 0.8498]  (p < 0.0001) was observed in this group. In CEA >10 ng/mL group we observed slope = 1.1986  [95%CI: 1.1474 to 1.2498]  (p < 0.0001), intercept = -11.69 [-17.53 to - 5.84] and correlation coefficient of 0.985 [95% CI: 0.976 to 0.9914]. Mean differences between assays in group ≤10 ng/mL and >10 ng/mL were 0.2066 (95% CI: 0.0019 to 0.4113) and –2.66 (95% CI: -10.10 to 4.76) ng/mL, respectively. Conclusion: Although there were differences, based on 20 days precision tests, overall results showed a good analytical performance and correlation between CEA assays on ARCHITECT i2000SR and Cobas E601 platforms. Reference intervals appropriate for the method of CEA measurement should be used. The standardization and harmonization of serum CEA concentration assays are needed.

Aim To investigate the association of parameters of lipid profile and estimated glomerular filtration rate (eGFR) p<60 ml/min/1.73m2 calculated by the Modification of Diet in Renal Disease (MDRD) in non-dialysis kidney patients. Methods The observational, case-control study enrolled patients (n=117) recruited from the Nephrological Counselling Centre of the University Clinical Centre Sarajevo and divided into two groups: group 1 eGFR (15-59 mL/min/1.73 m2 ), and group 2 (control) eGFR ≥ 60 mL/min/1.73 m2 . Concentration of lipids, lipoproteins and apolipoproteins was measured, and atherogenic index of plasma (AIP; log(TG/HDLc)) was calculated. Results High density lipoprotein cholesterol (HDLc) and apolipoprotein E (APOE) concentrations in serum were reduced [(1.02 (0.94-1.29) vs 1.15 (1.1-1.4) mmol/L; p=0.009 and 0.035 (0.026-0.04) vs 0.041 (0.034-0.05) g/L; p=0.002, respectively)], while AIP was higher in group 1 than in group 2 (0.19±0.03 vs 0.09±0.04; p=0.013). Values less than 1.09 mmol/L and 0.038 g/L for HDLc and APOE, or higher than 0.165 for AIP (p< 0.05) were associated with the eGFR below 60 ml/min/1.73 m2. The age [OR = 1.1; 95% CI (1.05-1.17)] and AIP [OR = 8.7; 95% CI (1.18- 65.0)] were independent positive predictors, while APOE was a negative predictor of eGFR reduction rate (OR=0.01; 95% CI (0.001-0.033; p<0.001). Conclusion Changes in parameters such as HDLc, APOE and AIP are associated with CKD. The study results imply the need of the AIP calculation as routine laboratory work due to its role along with the age and APOE in the prediction of renal function decline.

Objective: To determine the incidence of systemic inflammatory response of the organism in surgical patients and its impact on the outcome of treatment. Methods: A prospective study was conducted on 60 patients undergoing abdominal surgical procedures, between January 2014 and December 2015 in the Surgery Clinic at the University Clinical Center Tuzla. Two groups of thirty were formed by the method of consecutive sampling. The first group consisted of subjects who were prepared for elective abdominal surgery (laparoscopic cholecystectomy), and the second group subjects underwent an emergency surgery due to acute abdomen (laparoscopic cholecystectomy). Results The body temperature difference was statistically significant between the two investigated groups in all stages (c2: t0=3,486; t1=3,098; t2=2,453, t: t0=-11,210; t1=-7,360; t2=-4,927, p < 0,05). Non-elective surgery group had a statistical significant difference of the heart rate at all stages (c2: t0=3,873; t1=3,357; t2=3,227, t: t0=-16,524; t1=-10,407; t2=-9,842, p < 0,05). There is a statistically significant difference in the pCO2 values in all stages between groups (c2: t0=2,582; t1=1,678; t2=1,162, t: t0=4,323; t1=2,653; t2=2,229, p < 0,05). The SIRS score has a good positive correlation with the length of treatment, while the correlation with the outcome of treatment has no statistical significance. Conclusion Inflammation scores monitoring in surgical patients is important for the surgical treatment success analysis. By modifying the therapy and influencing the inflammatory response, the results of treatment are improved.

Background: One of the complications aneurysms subarachnoid hemorrhage is the development of vasospasm, which is the leading cause of disability and death from ruptured cerebral aneurysm. Aim: To evaluate the significance of previous comorbidities on early outcome of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm in the prevention of vasospasm. Patients and methods: The study had prospective character in which included 50 patients, whose diagnosed with SAH caused by the rupture of a brain aneurysm in the period from 2011to 2013. Two groups of patients were formed. Group I: patients in addition to the standard initial treatment and “3H therapy” administered nimodipine at a dose of 15-30 mg / kg bw / h (3-10 ml) for the duration of the initial treatment. Group II: patients in addition to the standard initial treatment and “3H therapy” administered with MgSO4 at a dose of 12 grams in 500 ml of 0.9% NaCl / 24 h during the initial treatment. Results: Two-thirds of the patients (68%) from both groups had a good outcome measured with values according to GOS scales, GOS IV and V. The poorer outcome, GOS III had 20% patients, the GOS II was at 2% and GOS I within 10% of patients. If we analyze the impact of comorbidity on the outcome, it shows that there is a significant relationship between the presence of comorbidity and outcomes. The patients without comorbidity (83.30%) had a good outcome (GOS IV and V), the same outcome was observed (59.4%) with comorbidities, which has a statistically significant difference (p = 0.04). Patients without diabetes (32%) had a good outcome (GOS IV and V), while the percentage of patients with diabetes less frequent (2%) with a good outcome, a statistically significant difference (p = 0.009). Conclusion: The outcome of treatment 30 days after the subarachnoid hemorrhage analyzed values WFNS and GOS, is not dependent on the method of prevention and treatment of vasospasm. Most concomitant diseases in patients with SAH which, requiring additional treatment measures are arterial hypertension and diabetes mellitus. The best predictors in the initial treatment of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm has the presence of comorbidity, which has statistical significance.

AIM To investigate effects of post-sampling analysis time, a type of blood samples and collection tubes on blood gas testing. METHODS This study included 100 patients at the Clinic for Pulmonary Diseases, Clinical Centre Sarajevo. The partial pressure of oxygen (pO2) and carbon dioxide (pCO2), and the oxygen saturation level of hemoglobin (sO2) were analyzed in the arterial blood samples (ABS) and capillary blood samples (CBS) by a potentiometric method using a blood gas analyzer ABL 555 (Radiometer, Copenhagen, Denmark). Paired measurements of ABS were performed within 15 minutes and after 60 minutes from sampling and compared. The results of CBS obtained within 15 minutes were compared with matching ABS results, as well as the results obtained from CBS within 15 minutes taken into glass and plastic tubes. RESULTS pO2 and sO2 values were significantly lower after 60 minutes compared to those within 15 minutes in ABS (9.20±1.89 vs. 9.51±1.95 and 91.25±5.03 vs. 92.40±4.5; p<0.01, respectively). Values of pO2 and sO2 in CBS were significantly lower than values obtained in ABS (8.92±2.07 vs. 9.51±1.95 and 91.25±4.86 vs. 92.40±4.50; p<0.01, respectively). Obtained pO2 and sO2 values in CBS in the plastic tubes were higher than those in the glass tubes (8.50±1.98 vs. 7.89±2.0 and 89.66±11.04 vs. 88.23±11.22, p<0.01 respectively). pCO2 blood values were not influenced significantly (p>0.05). CONCLUSION The length of post-sampling analysis time, a type of blood samples and collection tubes have significant impact on blood oxygen parameters. Analysis within 15 minutes after blood sampling is considered as appropriate.

ABSTRACT Introduction: Central Venous Catheters (CVC) are essential in everyday medical practice, especially in treating patients in intensive care units (ICU). The application of these catheters is accompanied with the risk of complications, such as the complications caused during the CVC insertion, infections at the location of the insertion, and complications during the use of the catheter, sepsis and other metastatic infections. Patients and methods: This study is a retrospective-prospective and it was implemented in the period 1st January 2011- 31st December 2012. It included 108 examinees with CVC placed for more than 7 days. Results: The most common complications occurring in more than 2 attempts of CVC applications are: hearth arrhythmias in both groups in 12 cases, 7 in multi-lumen (12.72%) and 5 in mono-lumen ones (9.43%). Artery puncture occurs in both groups in 7 cases, 5 in multi-lumen (9.09%) and 2 in mono-lumen ones (3.77%). Hematoma occurred in both groups in 4 cases, 3 in multi-lumen CVCs (5.45%) and 1 in mono-lumen ones (1.88%). The most common complication in multi-lumen catheters was heart arrhythmia, in 20 cases (36.37%). The most common complications in mono-lumen CVCs was hearth arrhythmias, in 20 cases as extrasystoles and they were registered in 16 catheter insertions (30.18%). Out of total number of catheters of both groups, out of 108 catheters the complications during insertion occurred in 49 catheters (45.40%). The most common complications in both groups were heart arrhythmias, artery punctures and hematomas at the place of catheter insertion.

UNLABELLED Supracondylar fractures are the result of a fall on outstretched hand in more than 70% of cases, and more common in the non-dominant arm. Bauman's angle is used to determine the degree of displacement and angulation, and the quality of fracture reduction. Carrying angle is the clinical parameter ofvarus-valgus angulation with elbow fully extended and forearm completely supinated. PATIENTS AND METHODS The study was a retrospective-prospective and there were analyzed children under 14 years of age with supracondylar humerus fracture. They were analyzed by X-ray anteroposterior view of injured elbow, made before and after the surgery, with measuring Bauman's angle. Clinical examination was performed after completing physical therapy, when was measured carrying angle of the injured and healthy elbow using a goniometer. RESULTS AND DISCUSSION The results showed that there is a negative correlation Bauman and carrying angle of injured elbow (r = -0.543, p < 0.0001). Analyzing Bauman's angle deviation from value of 75 degrees and the loss of carrying angle there is noticed significant positive correlation between the Bauman angle deviation and loss of carrying angle. Bauman's angle correlates well with the carrying angle and can be used as an indicator of the potential cosmetic complications. CONCLUSION Carrying angle of uninjured elbow measured when reviewing a child who has suffered supracondylar fracture, can serve as a useful parameter in the assessment of real Bauman's angle, thereby the adequacy of fracture reduction on the injured arm. KEYWORDS supracondylar fracture,

UNLABELLED Assessment of depth of anesthesia is the basis in anesthesiologists work because the occurrence of awareness during general anesthesia is important due to stress, which is caused in the patient at that moment, and due to complications that may arise later. There are subjective and objective methods used to estimate the depth of anesthesia. The aim of this study was to assess the depth of anesthesia based on clinical parameters and on the basis bispectral index, and determine the part of bispectral monitoring in support to clinical assessment. MATERIAL AND METHODS Sixty patients divided into two groups were analyzed in a prospective study. In first group (group 1), the depth of anesthesia was assessed by PRST score, and in the second group (group 2) was assessed by bispectral monitoring with determination PRST score concurrently. In both groups PRST score was assessed in four periods, while bispectral monitoring is used continuously. For analysis were used the BIS index values from the equivalent periods as PRST scores. PRST score value 0-3, and BIS index 40-60 were considered as adequate depth of anesthesia. The results showed that in our study were not waking patients during the surgery. In the group where the depth of anesthesia assessed clinically, we had a few of respondents (13%) for whom at some point were present indicators of light anesthesia. Postoperative interview excluded the possibility of intraoperative awareness. In the second group of patients and objective and clinical assessment indicated at all times to adequate depth of anesthesia. CONCLUSION The use of BIS monitoring with clinical assessment allows anesthesiologists precise decision-making in balancing and dosage of anesthetics and other drugs, as well as treatment in certain situations.

UNLABELLED The use of central venous catheters (CVC) carries a risk from local and systemic infectious complications, with prevalence of 6% in patients in Intensive care unit. Microorganisms colonizing the CVC usually originate from patient's or staff member's skin, but the source can also be a contaminated infusion solution or hematogenous dissemination from a distant focus. The infective agents often show increased resistance to antibiotics, which is an additional therapeutic problem. There is no knowledge of the frequency of the colonization of CVC by microorganisms in hospitals in Bosnia and Herzegovina, neither of the types of microorganisms which usually colonize CVC, nor their sensitivity to antimicrobial agents. METHODS During the period 2004-2008, the analysis of 188 CVC samples was performed in patients in ICU at which the doubt for CVC connected infection was present. The microorganism identification was performed by standard microbiological antibiotics sensitivity methods. RESULTS Out of 188 checked samples, 101 (54%) had positive cultures and 87 (46%) were sterile. Out of 101 positive microbiological cultures, in 33 (32.67%) the gram-positive bacteria had been found, gram-negative in 62 (61.37%) and Candida albicans in 6 (5.94%) cultures. Gram-ne-gative bacteria were 93.55% sensitive to imipenem, and Gram-positive bacteria were sensitive to vancomycin. CONCLUSION Gram-negative bacilli and Coagulase-negative staphylococci are the most frequent micro-organisms which colonize the CVC. The increase of bacteria antibiotics resistance represents a big problem. All those facts leads to the need for bigger control and supervision over the CVC implantation, its proper maintenance and rational use.