Browsing by Author "Savic, Predrag (57272197000)"

Background/Objectives: Perforations represent rare but serious complications in ERCP. Although several therapeutic algorithms have been proposed to properly address these potentially life-threatening events, there is still no clear consensus on their management. We conducted a single-center retrospective study in order to assess the incidence of ERCP-related perforations and their management, as well as clinical outcomes. Methods: The hospital’s electronic database was searched in order to identify all the patients who developed ERCP-related perforations in the period 1 October 2018–30 June 2023. Perforations were classified according to the Stapfer classification. Conservative management included frequent abdominal examinations, the monitoring of vital signs, white blood cell count, complete bowel rest, nasogastric tube placement, and the administration of intravenous fluids and antibiotics. Endoscopic management included biliary stent placement and/or closing observed defects with clips. Results: We recorded eight (1.29%) cases of ERCP-related perforations out of the 619 procedures conducted. We observed six (75%) Stapfer type II and two (25%) type IV perforations. In all but one patient (87.5%), the indication for ERCP was bile duct stones. Seven patients (87.5%) were subjected to sphincterotomy (87.5%) and three (37.5%) to “pre-cuts”. All but one patient was treated conservatively (87.5%), with two of them—in which type II perforations were recognized intraprocedurally—also receiving endoscopic treatment with stent placement. On the day of ERCP, one patient with a type II perforation was operated on; suturing of the duodenum followed by duodenal exclusion was applied. Management was successful in all the patients, with a mean hospitalization time of 16.6 ± 4.78 days. Conclusions: Conservative and endoscopic management appear to be associated with good outcomes in Stapfer type II perforations. Nevertheless, an individual multidisciplinary approach involving endoscopists and a hepatobiliary surgeon is essential in order to properly guide the treatment. © 2024 by the authors.

[No abstract available]

Problem considered: Having cardiovascular, pulmonary and metabolic illnesses increases the likelihood of developing critical COVID-19. As the global population is aging, people with chronic illnesses may have high demands for health care, including critical care, in future health crises. The purpose of this research was to examine whether presence of different pre-existing chronic illnesses were associated with the onset of respiratory failure among patients who were treated and discharged from the intensive care unit. Methods: A retrospective cohort study was conducted at the University Hospital “Dr Dragiša Mišović-Dedinje” in Belgrade (Serbia) during the January–March 2021 epidemic wave, which had the highest mortality rate in Serbia. The study included COVID-19 patients who were treated and discharged from the intensive care unit (ICU). Data on chronic illnesses and clinical parameters regarding COVID-19 were retrieved from the electronic medical records. Results: Of 299 surviving ICU-treated patients during the study period, 47.5 % required mechanical ventilation. The adjusted logistic regression models adjusted for body mass index (BMI), platelet count, C-reactive protein, interleukin-6, lactate dehydrogenase, urea, oxygen saturation on admission and CT score showed that diabetes, neurological disorders (predominantly stroke), and recent injuries/fractures were independently associated with the onset of respiratory failure. Patients who had respiratory failure also had a higher BMI, laboratory parameters, and CT severity scores on admission. Conclusion: People with pre-existing diabetes, neurological disorders (especially stroke), and recent injuries/fractures are at higher risk of respiratory failure in COVID-19 and should strictly adhere to COVID-19 prevention measures to minimize the risk of getting infected. © 2024 The Authors

Background: The COVID-19 pandemic revealed an unexpected pattern known as the “smoker’s paradox”, with lower rates of severe disease among smokers compared to non-smokers, highlighting the need for the specific investigation of disease progression in non-smoking populations. Objective: To identify early mortality predictors in non-smoking patients with severe COVID-19 through the evaluation of clinical, laboratory, and oxygenation parameters. Methods: This retrospective observational cohort study included 59 non-smokers hospitalized with COVID-19 between November and December 2020. Clinical parameters, laboratory findings, and respiratory support requirements were analyzed on Days 1 and 7 of hospitalization. ROC curves were constructed to assess the predictive value of the parameters. Results: The overall mortality rate was 54.2%. The seventh-day SOFA score showed the strongest predictive value (AUC = 0.902, p = 0.004), followed by pCO2 (AUC = 0.853, p = 0.012). Significant differences between survivors and non-survivors were observed in acid–base parameters, oxygenation indices, and hematological markers. Mortality rates varied significantly with ventilation type: 84.6% for IMV and 50% for NIMV, with no deaths in HFNC patients. Conclusions: Multiple parameters measured on Day 7 of hospitalization demonstrate significant predictive value for mortality in non-smoking COVID-19 patients, with the SOFA score being the strongest predictor. The type of respiratory support significantly influences outcomes, suggesting the importance of careful ventilation strategy selection. © 2025 by the authors.

Background: The COVID-19 pandemic revealed an unexpected pattern known as the “smoker’s paradox”, with lower rates of severe disease among smokers compared to non-smokers, highlighting the need for the specific investigation of disease progression in non-smoking populations. Objective: To identify early mortality predictors in non-smoking patients with severe COVID-19 through the evaluation of clinical, laboratory, and oxygenation parameters. Methods: This retrospective observational cohort study included 59 non-smokers hospitalized with COVID-19 between November and December 2020. Clinical parameters, laboratory findings, and respiratory support requirements were analyzed on Days 1 and 7 of hospitalization. ROC curves were constructed to assess the predictive value of the parameters. Results: The overall mortality rate was 54.2%. The seventh-day SOFA score showed the strongest predictive value (AUC = 0.902, p = 0.004), followed by pCO2 (AUC = 0.853, p = 0.012). Significant differences between survivors and non-survivors were observed in acid–base parameters, oxygenation indices, and hematological markers. Mortality rates varied significantly with ventilation type: 84.6% for IMV and 50% for NIMV, with no deaths in HFNC patients. Conclusions: Multiple parameters measured on Day 7 of hospitalization demonstrate significant predictive value for mortality in non-smoking COVID-19 patients, with the SOFA score being the strongest predictor. The type of respiratory support significantly influences outcomes, suggesting the importance of careful ventilation strategy selection. © 2025 by the authors.