Hospital In Belgrade Research Articles

Perception of stress among healthcare workers in hospitals in Belgrade during COVID-19 pandemic

Abstract Background The COVID-19 pandemic has affected healthcare institutions and workers, exposing them to unfamiliar and hazardous conditions, increased workloads, and changing directives. This has led to work-related stress, resulting in burnout, depression, anxiety disorders, and other health issues among healthcare workers. Methods This cross-sectional study utilized an anonymous questionnaire with closed-ended questions. To assess stress levels among healthcare workers, a Likert-type scale was used. Over 6.000 healthcare workers completed the questionnaire in 2022. The relationship between the dependent variable (perceived stress level) and predictors was modelled using generalized ordinal univariate and multivariate logistic regression. Results Almost a third (30.7%) of respondents felt a very high amount of tension, stress, or pressure while performing their jobs under the conditions of the COVID-19 epidemic, while 422 (6.8%) did not feel tension, stress, or pressure at all. In the multivariate logistic regression model, statistically significant predictors of higher levels of perceived stress in the conditions of the COVID-19 epidemic include female sex (OR = 0,80), older age (OR = 1.19), being in a managerial position (OR = 1.32), lower satisfaction with available work time (OR = 0.82), patient relations (OR = 0.81), financial compensation (OR = 0.83), and cooperation with colleagues (OR = 0.93). Conclusions Through the identification of potential stress predictors, valuable insights are gained to aid policymakers in the planning and enhancement of healthcare personnel’s work during pandemics, as well as in situations characterized by heightened stress levels. Key messages • These findings emphasize supporting healthcare workers during the pandemic. • Strategies for reducing stress should be directed towards healthcare professionals who experience higher stress levels.

Surgical Site Infection after Primary Open Surgery for Laryngeal Cancer in a Tertiary Hospital in Belgrade, Serbia: A 10-Year Prospective Cohort Study.

Surgical site infection (SSI) in laryngeal cancer (LC) patients significantly increases morbidity and may postpone adjuvant therapy. Additionally, SSI can prolong hospitalization, thus representing a burden for the healthcare system. Most of the published studies refer to SSI after salvage laryngectomy. The present prospective cohort study aimed to clarify the incidence and factors associated with SSI in patients after primary open surgery for LC. Through regular hospital surveillance of patients who underwent primary partial or total laryngectomy, we gathered 24 putative factors and identified SSI from 2013 to 2022. Patients with SSI were compared with patients without SSI. SSI was observed in 21 (6.6%) of 319 patients. ULRA showed that the occurrence of SSI was significantly associated with the American Society of Anesthesiologists (ASA) score, other postoperative healthcare-associated (HAI) infection, T classification, N classification, advanced clinical stage (III-IV), length of stay (LOS), duration of drainage, and the National Healthcare Safety Network (NHSN) risk index. Multivariate logistic regression analysis identified two independent factors associated with SSI occurring in these patients: duration of drainage (RR (relative risk) 1.593; 95% CI 1.159-2.189; p = 0.004) and LOS (RR: 1.074; 95% CI: 1.037-1.112; p < 0.001). Our study provided insight into the burden of SSI in LC patients, highlighting several priority areas and targets for quality improvement.

Evolution of Impaired Renal Function in Children After Continent Vesicostomy

Abstract The aim of this study was to determine whether early commencement of clean intermittent catheterisation can improve impaired kidney function in children with continent vesicostomy as well as to analyse the effect of different types of continent vesicostomy and the observed outcome. All children with continent urinary derivation performed at the University Children’s Hospital in Belgrade, Serbia, during the period 1990-2016, were included in this retrospective-prospective study. The participants were divided into three groups with respect to type of continent vesicostomy (appendicovesicostomy, preputial continent vesicostomy, and vesicostomy using distal ureter). Clean Intermittent Catheterisation with continent vesicostomy, oxybutynin, and antibiotic prophylaxis were used in a standard way. Renal function was monitored by the value of glomerular filtration rate taken before the start of the therapy and three years afterward. The significance of differences was tested by the paired-samples t-test and ANOVA test. We analysed 74 patients aged 3 to 10 years (5.5-y average) of which 80% were boys. Renal function improved in 60.5% patients. A highly significant improvement in kidney function three years after the commencement of combined treatment was shown irrespective of the performed method of vesicostomy (p&lt;0.01). Using the ANOVA test, we have proved that there is no difference in the efficiency of therapy between particular groups (p= 0,256). The timely started therapy lead to significant kidney function improvement. The type of continent vesicostomy did not affect kidney function.

Limb lengthening and deformity correction in patients with severe fibular hemimelia: experience of the children's university hospital in Belgrade

Background Fibular hemimelia (FH) is a congenital disease manifested by valgus deformity and instability of the knee joint, shortening and deformity of the tibia, hypoplasia and deformities of the foot and ankle.The aim of this paper was to determine the efficacy of the strategy of separate reconstruction of the foot along with correction of tibia deformity, and then tibial lengthening in patients with FH of types 3 and 4 according to Paley.Methods This retrospective study is based on an analysis of the treatment of 12 children with severe FH. The patients, aged no older than 24 months, were treated for foot reconstruction along with correction of tibial deformity followed by a separate stage of tibial lengthening. Tibial lengthening was performed in the age 4.6 ± 1.2 years. The long-term result of treatment was evaluated at least 1 year after the end of tibial lengthening. Evaluation criteria after tibia lengthening were external osteosynthesis index, amount of lengthening, assessment of outcomes according to Lascombes. Walking ability was assessed using Gillette questionnaire.Results The approach we used gave excellent and good results in 83 % of cases after the first reconstructive stage. Complications and recurrences of deformities encountered during the first stage were eliminated during subsequent planned limb lengthening. The average magnitude of lengthening was 6.4 ± 2.4 cm (37.2 ± 12.4 % of the initial segment length). The index of external osteosynthesis was 22.9 ± 12.2 days/cm. Monofocal distraction osteosynthesis was used in 9 cases and bifocal osteosynthesis in three cases. The results of lengthening were classified by Lascombes as IA in 7 cases, IB in four cases, 2B in one case.Discussion In severe FH, the question of reconstruction or early amputation remains open. There are two opinions on the staging of reconstructive orthopedic surgery and tibial lengthening in young children with severe FH.Conclusion The strategy of reconstruction of the foot and ankle joint at an early age (16-24 months) in children with severe FH followed by lengthening of the lower leg (at the age of 4-6 years) proved to be effective and can be used when it is chosen by the patient's parents. In 3C type cases, the use of external fixation to correct the deformity and simultaneously lengthen the tibia at the first stage is an alternative reasonable strategy option.

Histopatološki nalaz u enteričkim nervnim pleksusima kod dece sa poremećajima intestinalnog motiliteta - iskustvo jednog centra

Introduction/Aim: The aim of the study was to determine the frequency of various histopathological findings in biopsies of children with intestinal hypomotility and the incidence and characteristics of Hirschsprung disease (HD). Methods: Biopsies of colon and rectum taken due to intestinal hypomotility and chronic constipation at the Department of Pediatric Surgery of the University Children's Hospital in Belgrade over the 10-year period (from 2009 to 2018) were reviewed using pathology reports from the archive of the Institute of pathology, Faculty of Medicine, University of Belgrade. Results: A total of 287 patients with intestinal motility disorder were identified, with 554 biopsy samples. Of the total number of patients, 56% (161/287) were without any morphological changes in enteric nervous system (ENS). The most common histopathological findings were HD (69/287; 24%) and immaturity of ganglion cells (29/287; 10%). Isolated hypoganglionosis of ENS was found in 5 (2%) cases. Heterotopia of ganglion cells was the only finding in 8 (3%) cases. Rare causes of intestinal dysmotility were: eosinophilic proctitis/colitis (EPC) (4/287), neuronal intestinal dysplasia B (2/287), unclassified disganglionoses (3/287). Rectosigmoid variant of HD was the most frequent HD variant (80.3%). Acetylcholinesterase method and immunohistochemical staining were used in 19.5% cases. Conclusions: HD and immaturity of ganglion cells were the most common pathological findings in ENS of constipated children. It is important to differentiate EPC from other lesions of enteric plexuses due to different natural history and therapy.

Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units.

Intensive care units (ICUs) are expert hospital areas that provide treatment and 24 h care for people who are very sick. Sepsis represents a serious, severe condition and it can lead to septic shock and multiple organ dysfunction syndromes and is one of the most common reasons for patients' hospitalization in ICUs. We wanted to explore the prognostic values of interleukin (IL) 33, soluble suppression of tumorigenicity 2 (sST2), IL 27, and galectin 3 in critically-ill patients. We assumed that these parameters in combination or alone could predict mortality in ICU patients. This research represents a clinical non-randomized prospective study, performed at the Medical Military Academy, a tertiary care hospital in Belgrade, Serbia. The patients were divided in four groups: patients with sepsis (peritonitis, pancreatitis, trauma) and patients without sepsis (trauma). Total number of patients enrolled in the study was 151 and average years of patients were 56.48. The values greater than the cut-off were the predictors of mortality. The IL-33, IL-27 as well as galectin-3 can successfully predict the outcome of critically-ill patients in ICUs. The sST2, cannot predict death in critically-ill patients as a single prognostic factor. However, the combination of at least two biomarkers: IL-33, sST2, IL-27, and galectin-3, gives very significant results in predicting the outcome in patients admitted to ICUs.

Oligoelements in serum and intestinal tissue of pediatric IBD patients

IntroductionInflammatory bowel disease (IBD) develops through complex interplay of genetic, microbial, immune, and environmental factors. Trace elements alterations are commonly present in IBD and may have influence on IBD development. Heavy metal pollution is one of the major environmental issues nowadays and IBD incidence is rising in countries where industry starts to develop. Metals are implicated in processes that are connected to IBD pathogenesis. AimThe aim of this study was to investigate toxic and trace element levels in pediatric population of IBD patients both in serum and intestinal mucosa. Materials and methodsThis prospective study enrolled children newly diagnosed with IBD in University children’s hospital in Belgrade. Concentrations of thirteen elements: Al, As, Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Se and Zn in serum and intestinal mucosa of 17 newly diagnosed children with IBD (10 Crohn’s disease (CD) and 7ulcerative colitis (UC)) and 10 controls were assessed using inductively coupled plasma mass spectrometry (ICP-MS). Intestinal mucosa samples were taken from terminal ileum and six different colon segments (cecum, ascending colon, colon transversum, descending and sigmoid colon and rectum). ResultsThe results demonstrated significant alterations in serum and intestinal mucosa concentrations of investigated elements. Serum iron was significantly decreased in IBD and CD group, compared to controls while serum Cu significantly differed between three investigated groups with highest concentration observed in CD children. Serum manganese was the highest in the UC subgroup. Terminal ileums of IBD patients contained significantly lower amount of Cu, Mg, Mn and Zn with Mn being significantly decreased also in CD patients compared to control. IBD patients’ caecum contained significantly less Mg and Cu while colon transversum tissue samples from IBD and Crohn’s patients contained significantly more chromium than controls. Moreover, sigmoid colon of IBD patients were poorer in Mg than controls (p < 0.05). Colon Al, As and Cd were significantly reduced in IBD, and UC children compared to control. Correlations of investigated elements in CD and UC groups were different from controls. Biochemical and clinical parameters showed correlation with element concentrations in intestines. ConclusionSera of CD, UC and control children significantly differ in Fe, Cu and Mn levels. Serum manganese was the highest in the UC subgroup creating the most prominent and only significant difference between UC and CD subgroups. Terminal ileum of IBD patients contained significantly lower amount of majority of investigated essential trace elements and toxic elements were significantly reduced in colon of IBD and UC patients. Investigation of macro- and microelement alterations in children and adults has potential to further elucidate IBD pathogenesis.

Staphylococcal biofilm on wedding rings worn by laboratory workers.

Hands of healthcare workers play essential role in the spreading of antimicrobial-resistant microorganisms in and out of the healthcare settings. Less is known about the role of laboratory workers (LWs). The aim of our study was to evaluate the presence of biofilm-forming staphylococci on the surface of jewelry rings of LWs and their antimicrobial susceptibility pattern.A total of 79 LWs from eight different microbiology laboratories that process and analyze specimens from the tertiary care hospitals in Belgrade, Serbia participated in the study. The study was reviewed and approved by the institutional review boards at hospitals. Samples were taken after hand washing. Bacteria on LWs wedding rings were detected with the rolling method, and further analyzed in order to determine the number of colony forming unit (CFU) per ring, species of bacteria and their antimicrobial susceptibility pattern, methicillin resistance and biofilm-producing capacity in vitro.Staphylococci were recovered from 60.8% of wedding rings. All strains produced biofilm (25% weak, 56.2% moderate and 18.8% large amount), with significant difference between species (P < 0.001). Staphylococcus aureus and Staphylococcus epidermidis formed the largest amount of biofilm and had the largest number of CFU per ring. Staphylococci were most commonly resistant to penicillin (66.7%), tetracycline (50.0%), and erythromycin (45.8%); 41.7% of isolates was multidrug resistant and mecA gene was detected in five strains. All strains were susceptible to linezolid, vancomycin, teicoplanin and tigecycline.Staphylococci colonize LWs wedding rings, form biofilm on it, have multidrug resistant phenotype and/or carry mecA gene, representing a significant reservoir for the spreading of microorganisms and resistance. As far as we know, our study is the first that address this topic in laboratory workers.

Primena magnetne angiografije kod dece sa arterijskom hipertenzijom - iskustvo jednog centra

Introduction: Renal blood vessel (RBV) stenosis is the cause of secondary arterial hypertension (AH) in 10% of children. Digital subtraction angiography (DSA) is the gold standard in diagnosing RBV stenosis. Many authors suggest Mr angiography (MRA), a non-invasive method without radiation, as an adequate diagnostic method. Our aim was to analyze the experience of our center in using MRA in children with AH. Method: This retrospective study included 148 patients hospitalized at the University Children's Hospital in Belgrade, due to AH. After initial examination, patients underwent DSA and/or MRA. Results: According to the current guidelines, DSA was performed in patients with highly suspected RBV stenosis, and the diagnosis was confirmed in 13/29 (45%). Diagnostic MRA was done in 116/119 (97.5%) patients, and control MRA was done after therapeutic revascularization in 3/119 (2.5%). In 4/116 (3.5%) patients, the findings indicated RBV stenosis, and in 44/116 (38%) it indicated some other abnormality of the kidney parenchyma and the urinary tract or RBV varieties. After MRA, DSA was performed in 7/116 (6%) patients (4 with RBV stenosis on MRA and 3 with clinical suspicion of RBV stenosis), but all findings were normal. Conclusion: According to the results, it is justified to perform a diagnostic MRA before DSA in children with highly suspected RBV stenosis, in order to avoid DSA which is an invasive procedure with radiation, in some patients with normal findings. Also, over time, we would have a clearer view of the sensitivity and specificity of MRA as a diagnostic method in RBV stenosis in children.

Soluble interleukin-2 receptor in pediatric patients investigated for hemophagocytic lymphohistiocytosis: A single-center, 10-year-long experience

Introduction/Objective Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory condition characterized by fever, splenomegaly, and cytopenias. Diagnosis of HLH requires at least five of the eight criteria set by the Histiocyte Society and poses a significant challenge to physicians. HLH-2004 criteria include measurement of plasma levels of soluble receptor for interleukin-2 (sIL-2R), an invaluable tool in the diagnosis of HLH, particularly because it can be measured swiftly and inexpensively. Methods We retrospectively analyzed medical records of 45 pediatric patients (28 boys and 17 girls, median age 8.1 years) who were investigated for suspected HLH in University Children?s Hospital in Belgrade, during the period from 2012 to 2022. Results Ten children were diagnosed with HLH, while 35 did not have HLH. All 10 HLH patients had secondary HLH: eight suffered from infection or inflammatory condition, one from an autoimmune disease, and one from malignancy. Level of sIL-2R was above the HLH-2004 cutoff value of 2400 IU/ml in 9/10 patients with HLH (sensitivity 90%) and 9/35 of patients who did not have HLH (specificity 74.2%). Conclusion Soluble IL-2 receptor measurement is valuable in children suspected to have HLH. Sensitivity and specificity of this analysis can be further improved by strict patient selection and a comprehensive diagnostic approach.

Upravljanje zdravstvenim radnicima za vreme pandemije COVID 19

After having dealt with the growing number of infected health workers in the province of Hubei in China, it was concluded that the most important link in the fight against SARS-CoV-2 infection was the proper and responsible management of health personnel. The aim of the paper is to is to determine whether, during the pandemic, human resources were well managed in state health institutions. Discovering the critical points of health workers management is very important in order to raise the overall quality of health services in the future emergency situations. A total of 150 respondents employed in COVID hospitals in Belgrade and Loznica took part in this research. The results of the research obtained using the chi-square test, showed that the received necessary information at the beginning of the pandemic, training courses on the use, removal, putting on and disposal of protective equipment, and psychological support of the authorities significantly related with the perception of the safety of health workers in state health institutions. Management of health workers should be at a high level, with a special emphasis on improving the management of the health of employees and their safety at work.

Predominance of t355/ST152/SCCmec V clonal type among PVL-positive MRSA isolates in a tertiary care hospital in Belgrade, Serbia.

Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is continually changing. Frequency of genotypes typical for community-associated MRSA (CA-MRSA) is increasing in hospitals, as well as resistance to antimicrobial agents. Moreover, different clones predominate in different geographic regions, and temporal shifts occur in the predominant clonal type. The aim of this study was to estimate the prevalence of MRSA, CA-MRSA and PVL-positive MRSA isolates from patients hospitalised in the Military Medical Academy (MMA) and from outpatients, and to perform genotyping of PVL-positive MRSA isolates. MRSA isolates were obtained by standard microbiological techniques. PVL-positive MRSA were detected by single PCR. Determination of SCCmec types in MRSA isolates was done using multiplex PCR and genotyping of PVL-positive MRSA by PFGE, MLST and spa typing. The prevalence of MRSA among S. aureus isolates from different clinical specimens was 43.4%. In outpatients the prevalence of MRSA was 3.2%. SCCmec types specific for CA-MRSA were found in 26% of MRSA isolates from hospitalised patients. In groups, hospitalised patients and outpatients, the prevalence of PVL-positive MRSA isolates was 4%, and all of them harboured SCCmec type V genetic element. PFGE revealed minor differences between four groups of PVL-positive MRSA isolates, but all of them belonged to ST152, and all except one were of the t355 spa type. High prevalence of MRSA and CA-MRSA in MMA, especially the presence of PVL-positive CA-MRSA, represent a serious health threat for patients. Genotype t355/ST152/SCCmec V is the dominant MRSA clone among PVL-positive CA-MRSA.

The Magnetic Resonance Imaging Pattern of the Lesions Caused by Knee Overuse in the Pediatric Population.

Background and Objectives: Excessive use of the knee in patients with immature locomotor systems leads to a whole spectrum of morphological changes with possible consequences in adulthood. This study aimed to examine the morphological pattern in magnetic resonance imaging (MRI) that is associated with recurrent pain due to increased physical activity in children. Materials and Methods: This was a retrospective study conducted among pediatric patients treated at the University Children’s Hospital in Belgrade in 2018 and 2019. MRI findings of patients who reported recurrent pain in the knee joint during physical activity and who were without any pathological findings on both clinical examination and knee radiographs were included in the study. Results: MRI findings of 168 patients (73 boys and 95 girls, mean age 14.07 ± 3.34 years) were assessed. Meniscus and cartilage lesions were the most commonly detected morphological findings: meniscus lesions in 49.4%, cartilage ruptures in 44.6%, and cartilage edema in 26.2% of patients. The medial meniscus was more often injured in girls (p = 0.030), while boys were more prone to other joint injuries (p = 0.016), re-injury of the same joint (p = 0.036), bone bruises (p < 0.001), and ligament injuries (p = 0.001). In children older than 15 years, tibial plateau cartilage edema (p = 0.016), chondromalacia patellae (p = 0.005), and retropatellar effusion (p = 0.011) were detected more frequently compared to younger children. Conclusions: Children reporting recurrent knee pain due to increased physical activity, without any detected pathological findings on clinical examination and knee radiography, may have morphological changes that can be detected on MRI. Timely diagnosis of joint lesions should play a significant role in preventing permanent joint dysfunction in the pediatric population as well as in preventing the development of musculoskeletal diseases in adulthood.

Anxiety in patients treated in a temporary hospital in Belgrade, Serbia, during the first epidemic wave of COVID-19

BackgroundIt has been reported that COVID-19 patients in general often experience anxiety, depression and stress, but those problems in patients of temporary COVID-19 hospitals seem to have attracted less attention. MethodsThe study included 87 SARS-Cov-2 infected subjects accommodated and treated in a temporary hospital in Belgrade, Serbia, during the first epidemic wave of COVID-19. The patients' level of anxiety was assessed on two occasions (at admission to the temporary hospital, and 2 weeks after discharge) using the Hamilton Anxiety Rating Scale (HAM-A). Demographic and clinical data were obtained through questionnairesor retrieved from patients' medical records. ResultsA multiple linear regression model revealed that sex, age, the severity of COVID-19 symptoms (COVID-19_SS) and the family history of psychiatric disorder (FHPD) remain significant predictors of the level of anxiety at hospital admission (F (4, 82) = 14.916, p < 0.0001), wih an R2 of 0.421. Participants' predicted level of anxiety at admission to the temporary COVID-19 hospital can be calculated as 0.931–0.708 × SEX +0.029 × AGE +0.674 × COVID-19_SS + 1.491 × FHPD, where SEX is coded as 1 for male and 0 for female, AGE is measured in years, COVID-19_SS is coded as 0 for asymptomatic, 1 for mild, 2 for moderate and 3 for severe, and FHPD as 0 for negative and 1 for positive. Comparison between individual HAM-A score at admission to the temporary hospital (median (IQR): 7.00 (2.00–11.75)) and 2 weeks after discharge (median (IQR): 0.00 (0.00–1.00)) revealed significant reduction in the level of anxiety among study participants (Z = −7.53, p < 0.001). ConclusionThese data indicate that psychological changes exist in those hospitalized in temporary hospitals, but that they regress soon after they leave.

111 Fluid levels of estradiol and CA 125 from ovarian cystic masses in young girls

Objective: Needle aspiration of ovarian cystic masses and measurement of fluid levels of estradiol and CA 125 can be successfully used in pretreatment or intraoperative diagnosis and choice of treatment method. Study design: The present study determined the levels of estradiol and CA 125 in the adnexal cysts fluid of 122 patients aged newborn to 19 attending the Department of children and adolescent gynecology of Pediatric Hospital and ST Medica Hospital in Belgrade between January 2006 and December 2019.

Seroprevalence in health care workers during the later phase of the second wave: Results of three hospitals in Serbia, prior to vaccine administration

BackgroundSince the COVID-19 pandemic has started, Serbia has faced problems in implementing proper public health measures in the population, including non-pharmaceutical interventions, as well as protecting health care workers (HCWs) from disease, like all other countries. This study aimed to estimate COVID-19 seroprevalence and evaluate the risk perception of COVID-19 among HCWs in three different hospitals in Belgrade, Serbia: non-COVID hospital, Emergency Center (EC), and dedicated COVID hospital. MethodsA cross-sectional study was conducted in three hospitals during the second wave of the outbreak in Serbia, from June to early October. All staff in these hospitals were invited to voluntarily participate in blood sampling for IgG antibodies against SARS-CoV-2 and questionnaire testing. The questionnaire included socio-demographic characteristics, known exposure to COVID-19 positive persons, previous signs and symptoms related to COVID-19 infection since the outbreak had started in our country, and SARS-CoV-2 PCR testing. ResultsThe overall prevalence of SARS-CoV-2 antibody among 1580 HCWs was 18.3 % [95 % CI 16.4–20.3 %]. Significantly higher prevalence of HCWs with positive results for the serum IgG antibody test was observed in COVID hospital (28.6 %, 95 %CI: 24.0–33.6 %) vs. prevalence in the EC (12.6 %, 95 %CI: 10.1–15.4 %), and in the non-COVID hospital (18.3 %, 95 %CI: 15.2–26.7 %). The prevalence adjusted for declared test sensitivity and specificity would be 16.8 %; that is 27.4 % in COVID-19 hospital, 10.9 % in EC, and 16.8 % in non-COVID hospital. In multivariate logistic regression analysis, the independent predictors for seropositivity were working in COVID-hospital, the profession of physician, and the presence of the following symptoms: fever, shortness of breath, and anosmia/ageusia. ConclusionsWe found an overall seropositivity rate of 18.3 % and 16.0 % of the adjusted rate that is higher than seroprevalence obtained in similar studies conducted before vaccinations started. The possibility that patients in non-COVID dedicated hospitals might also be infectious, although PCR tested, imposes the need for the use of personal protective equipment also in non-COVID medical institutions.

Primarijus dr Milun Mitrović (1901-1978) - prvi dečji hirurg u Nišu

Primarius Dr. Milun Mitrović (1901, Trnanje, Serbia - 1978, Niš, SFR Yugoslavia) was the first pediatric surgeon in Niš, and the fifth in Yugoslavia. He graduated from the Medical Faculty in Graz in 1928. He received the title of primarius in 1959. He won the award of the Liberation of the City of Niš for merits in the work and development of health care for the population of Niš (1960). He spoke German fluently. He worked in the Department of Pediatric Surgery at the Orthopedic Department of the General State Hospital in Belgrade until January 1, 1945, when he moved to the Surgical Department of the State Hospital in Niš, where on March 9, 1953. formed the Department of Pediatric Surgery and Orthopedics, which has two rooms and 16 beds and became the first head of this institution. The creative and visionary spirit of Primarius Dr. Milun Mitrović is reflected in the creation of the Institute for Bone and Joint Diseases of Children in Sokobanja (30 beds; October 20, 1959), the formation of the Department of Pediatric Surgery of the Serbian Medical Association (1966), the Association of Children's surgeon of Yugoslavia, formulates the magazine "Children's Surgery" (printed in Niš) and others. Primarius Dr. Milun Mitrović remained "remembered by the people of this region as a great expert, a great friend of children and a great bohemian" - according to the record of prof. Dr. Radoslav Živić in the book "Greats of Niš Medicine".

Kvalitet upravljanja zdravstvenim radnicima tokom COVID-19 pandemije na različitim nivoima zdravstvene zaštite

Emergencies occur unexpectedly, abruptly, and they set tasks for managers that are different from the usual way of work of the organization. The organization is then faced with the challenge to respond to the new situation with the available funds and following specially prescribed procedures, which can be very demanding for the management. At the moment, in the conditions of a pandemic caused by the SARS-CoV-2 virus, the problem is the fact that most health systems don't have enough health workers who can take care of a large number of infected patients. As their number is small, and at the same time they are in great danger of being easily infected with the virus, it is clear that special attention must be paid to their management and protection. The paper presents the results of research on the quality of management of employees in state health institutions that had the status of COVID hospitals in Belgrade and Loznica according to the level of health care service and highlights critical points that should be improved in the future.

Discourse of Power from the Aspect of Interruption in Medical Encounters

The discourse of medical encounters is an excellent example of both institutional talk and the discourse of power and its prominent features can be analysed from various aspects. This paper deals with interruption as an important characteristic of both doctor-patient communication and institutional talk in general. The research is focused on comparing the ways doctors and patients interrupt each other and the amount of power they need for this. First, some previous research in this field has been reviewed – it is discussed how interruptions are different from overlaps, how typical it is for patients to interrupt their doctors, how and why doctors and patients interrupt each other and whether they have equal rights when it comes to interrupting their interlocutors. As we aimed at checking these results and investigating if, how and when patients interrupted their doctors, a corpus of 37 recordings made in a tertiary referral hospital in Belgrade, Serbia, in the department of pulmonology, has been analysed. Examples of interruptions by doctors and patients were analysed according to the principles of conversation analysis and critical discourse analysis. The obtained results confirmed an ever-present asymmetry in doctor-patient communication, although it was not as conspicuous as it had been stated in some previous research. Finally, the difference between the ways in which doctors and patients interrupt each other and the reasons behind these interruptions were emphasized.

4. Comparison of the Postoperative Analgesic Effects of Levobupivacaine Wound Instillation with a Placebo after Unilateral Inguinal Hernia Repair: a Randomized-controlled Trial

Objective − To compare the effectiveness and safety of wound instillation with levobupivacaine with a placebo, in children who underwent inguinal hernia repair, for pain relief. The secondary objective was to examine the frequency of postoperative analgesic mixture (paracetamol/ibuprofen) use. Methods − Single center randomized placebo-controlled trial. Paediatric teaching hospital in Belgrade, Serbia. This study included 100 children who underwent elective surgery for unilateral inguinal hernia. Children were randomized by simple randomization into two groups (N=50 in the experimental group, N=50 in the control group). A solution of 0.5% levobupivacaine, 0.5 mg/kg (0.1 ml/kg) was instilled into the wounds of children in the experimental group before suturing the abdominal fascia. The same amount of 0.9% saline was administered to the children in the control group. The primary outcome was the level of postoperative pain after coming round from general anesthesia (t0) and at 2h, 6h, 12h, 18h and 24h after surgery. The FLACC (Face, Legs, Activity, Cry, Consolability) scale was used to assess the level of pain. The secondary outcome was the frequency of paracetamol/ibuprofen use for pain relief after surgery. Results − Out of the total number of children (100), 70% were boys (70) and 30% were girls (30), and their average age was 3.5±1.9 years. The average duration of surgical intervention in both groups was 31.6±4.2 minutes. Significantly fewer children in the experimental group reported pain (FLACC ≥1) at 2h (P=0.032) and 6h (P=0.001) after surgery, compared to the children in the control group (8 vs. 17 at 2h after surgery; 4 vs. 14 at 6h after surgery). Significantly fewer children in the control group reported sensations of pain that required administration of analgesics 6h after surgery (FLACC &gt;3) compared to the control group (P=0.001) (1 vs. 14). Overall, significantly fewer children in the experimental group received a paracetamol/ibuprofen mixture for pain relief after surgery, compared to the children in the control group (P&lt;0.001) (4 vs. 50). The average daily amount of acetaminophen in the experimental group was 28±127 mg/kg/day and ibuprofen 5.6±1.8 mg/kg/day, while in control group, acytaminophen 42.5±7.7 mg/kg/day and ibprofen 11.5±4 mg/kg/day. The total amount of analgesics was highly statistically significantly lower in the experimental group (P&lt;0.001). Conclusion − Instillation of levobupivacaine before wound suturing in children who had undergone elective inguinal hernia surgery repair was effective in postoperative pain relief. Children who received levobupivacaine also received less of the paracetamol/ibuprofen mixture to relieve their pain over 24 hours after surgery.