Nutritional therapy of COVID-19 disease in Intensive care units

Since the beginning of 2020, SARS-CoV 2 (Severe Acute Respiratory Syndrome - Corona Virus 2) has been in the focus of scientific circles and beyond. Finding the most efficient therapeutic protocol in prevention and treatment of the new and unknown COVID - 19 (Corona Virus Disease - 2019) disease has been indentified as especially important. SARS-CoV 2 uses various mechanisms to lead patients to malnutrition, which is detected by a higher frequency of admission to hospital treatment, especially on admission to the Intensive Care Unit (ICU). Malnutrition has a negative impact on the course and outcome of the disease. In the pandemic, the number of patients on various types of oxygen therapy and mechanical ventilation increased, and in correlation with that, there has been a greater need for knowledge and education of staff to use different diagnostic and therapeutic modalities and different approaches in feeding critically ill patients. Nutritional therapy is the basis for maintaining body weight, supporting respiratory function, as well as helping in the overall recovery of patients. Omega 3 fatty acids, vitamins C and D have shown potentially beneficial effects against COVID-19 diseases. The aim of this paper is to consolidate the current knowledge and recommendations in the field of nutritional therapy in patients with COVID-19 treated in the Intensive Care Unit.

Risk assessment for diabetes type 2 conditions for nature in nutrition in adolescents

This paper will present the results of a study on dietary habits in adolescents. The high school or adolescent era is a time of great physical and psychological changes, which cause instability and oscillations in the mood and behavior of high school students. Results obtained by interviewing secondary school students about eating habits and results obtained using a standardized questionnaire for the risk of type 2 diabetes were analyzed using a reliable statistical tool IBM SPSS Statistical, which offers a range of reliable analyzes and statistical tests. Previous research has shown that for each person with type 2 diabetes, one person finds out who does not know it. Discovery of pre-diabetes, in new potential patients, is necessary at the earliest age, when a number of factors affect lifestyles, such as irregular nutrition and obesity, physical inactivity, stress, and others become important for the development of this disease. Detection of risk levels in potential patients is important for both the individual and public health, and everyday clinical practice. After determining the degree of risk for a particular sample, a set of measures for a particular adolescent population will be recommended, so that the disease does not occur, or its onset will move for a later period of life.

Fulminant hepatitis B: A case report

Introduction: Fulminant hepatitis is a severe acute liver disease. It occurs due to massive necrosis of hepatocytes. The disease progresses to lethal outcome within a few days. The most common causes of this disease are toxic substances, autoimmune and viral hepatitis. The aim of the study was to present a lethal case of fulminant hepatitis caused by hepatitis B virus in a patient with treated bladder cancer. Case Outline: A 63-year-old patient was admitted for treatment due to weakness, nausea and decreased diuresis. She had surgery to remove her bladder, which was affected by a malignant process, two years earlier. On admission, she had a subicteric, orderly auscultatory finding. The abdomen was palpably painful below the right costal arch, without organomegaly. The ureterostomy was functional. The diagnosis of acute HBV infection was made by evidence of HBsAg, HBeAg and antiHBc IgM antibody titer. Laboratory findings indicated an increase in transaminases, urea, creatinine, total and conjugated bilirubin, decreased albumin values and coagulation disorders. The patient was treated with hepatoprotective therapy, antibiotics and antiviral therapy. Hemodialysis was performed as needed. Encephalopathy developed on the third day with further progression.The disease progressed with gastrointestinal bleeding and cardiac disorders and ended in death on the ninth day. Conclusion: Fulminant liver damage caused by hepatitis B virus is a severe disease that can be complicated by acute renal failure. The prognosis of the disease is often unfavorable, so optimal treatment requires a liver transplant.

New anticoagulant therapy aspects to the COVID-19 patients: From prophylaxis to complications treatment therapy

COVID-19 patients have a high risk of thrombosis of the arterial and venous systems due to extensive systemic inflammation, platelet activation, endothelial dysfunction, and stasis. D-dimer is an important prognostic marker of mortality caused by COVID-19 patients and its increased values indicate tissue damage and inflammation. The incidence of venous thromboembolism (VTe) is between 16 and 49% as a complication of more severe forms of COVID-19 infection in patients hospitalized in intensive care units. Prophylactic doses of low molecular weight heparin (lMWH) should be given to all hospitalized patients with COVID-19 infection in the absence of active bleeding. The safest way is to adjust the low molecular weight heparin (lMWH) dose according to body weight, especially in obese patients. Unfractionated heparin (UFH) is used in patients with a creatinine clearance of less than 30 ml/min. The therapeutic dose of anticoagulation should be discontinued if the platelet count is <50 × 109 /l or fibrinogen <1.0 g/l. Clinically significant bleeding events are higher in those who received therapeutic doses compared to those with standard thromboprophylaxis doses. Thrombolytic therapy is recommended in patients with proven pulmonary embolism (Pe) and hemodynamic instability or signs of cardiogenic shock, who are not at high risk of bleeding. In hospitalized COVID-19 patients with a high clinical risk of developing venous thromboembolism (VTe) and D-dimer values greater than 2600 ng/ml, the use of therapeutic doses of lMWH in doses adjusted to the patient's body weight should be considered, in the absence of a higher risk of bleeding.

Pulmonary thromboembolism and pericardial effusion as cardiovascular complications of COVID-19 infection

Systemic activation of coagulation and pulmonary thrombo-inflammation with local vascular damage caused by SARS-CoV-2 infection increases the risk of developing thromboembolic complications: stroke, pulmonary arterial thrombosis (pulmonary thromboembolism) and deep vein thrombosis. Myopericarditis may occurs in COVID-19 patients as part of or after the onset of respiratory symptoms. Minor pericardial effusions up to 1 cm that accompany pericardial involvement are common. In our patient during hospitalization due to bilateral pneumonia caused by SARS-Cov-2 virus during a routine control of D-dimer, elevated values 2.3 fold higher than the reference range were observed, with elevated biomarkers of inflammation. She had symptoms of a respiratory infection and no pronounced clinical symptoms that would indicate pulmonary thromboembolism. MSCT pulmonary angiography was performed and low-risk thromboembolism was confirmed. Anticoagulant therapy was started - therapeutic doses of low molecular weight heparin (enoxaparin), which was extended after discharge from the hospital with DOAC (Rivaroxaban) according to the protocol for the treatment of pulmonary thromboembolism. At the control examination after 3 weeks, pericarditis with moderate pericardial effusion was determined. Anticoagulant therapy (DOAC) was extended with the inclusion of colchicine in the therapy according to the protocol for the treatment of pericarditis with effusion. After 3 months of hospitalization in our patient with mild respiratory symptoms, bronchopneumonia of the right lung developed with slightly elevated biomarkers of inflammation and normal values of D-dimer. With prescribed antibiotic therapy and current therapy (DOAC and colchicine), there was a withdrawal of symptoms and regression of pericardial effusion and a reduction in right ventricular overload. At the follow-up examination 5 months after hospitalization, complete regression of pericardial effusion was confirmed with normal biomarkers of inflammation and D-dimer values. It is advisable to exclude anticoagulant therapy (DOAC) with continued low-dose aspirin therapy.

Significance/role of family medicine physicians in early detection of secondary hypertension

SUMMARY - Introduction: Secondary arterial hypertension has an identifiable underlying cause. Routine screening is not indicated given the low prevalence of the disease (5-10% arterial hypertension), longterm and costly diagnostic evaluation. Case report: An outpatient family medication presents a 34-year-old patient due to worsening, by then stable, arterial hypertension. She was found 12 months ago when reported to a private healthcare facility where she was allowed perindopril / amlodipine 4/5 mg, 1x1 tablet. So far healthy, it negates diseases of relevance to inheritance. Smoker. 24hour outpatient blood pressure monitoring checks for elevated diastolic blood pressure levels in 59,3% of measurements during the day and 59,2% of measurements during the night. Thyroid ultrasound checks for inhomogeneous structure, right flap 40x15x16 mm, left flap 42x15x16 mm. Abdominal ultrasound reduces left kidney, bilateral thinning cortex, left ventricular moderate hydronephrosis. The laboratory contains large amounts of tyrosimulating hormone as well as antibodies to thyroid peroxidase, decreased levels of free thyroxine and a slight increase in albumin in 24 hours of urine. The patient is referred for a consultative examination by a nephrologist and a nuclear medicine specialist. Same indicative hygiene dietary regimen and introduction of levothyroxine sodium tablets 100 mcg 1x 1 ¼ tablets (125 mcg). Antihypertensive therapy was discontinued at most months later, while levothyroxine sodium replacement therapy was reduced to 1 x 100 mcg. Conclusion: The work of a selected family physician in accordance with good clinical practice guidelines allows for the early detection, normalization or increase in the number of secondary hypertension, the reduction of the possibility of accommodation of irreversible changes in blood vessels, and coexisting essential hypertension.

Connection between the disorder of the function of the thyroid gland and the appearance of the somatic symptoms with the patients

Introduction: The thyroid gland is one of the most important endocrine glands that has the function of releasing hormones that regulate metabolism in adults. Thyroid hormones act directly or indirectly on almost all systems in the body, so they can negatively affect the health of an individual, who have a high risk of developing disorders in psychosomatic symptoms. The occurrence of somatization in patients can be accompanied by a direct impact of thyroid disorders on certain organs and systems, but it can also be non-specific in relation to the disease itself. Objective: To examine the relationship between different disorders of the thyroid gland and the occurrence of somatic symptoms in patients, according to age, body mass index and length of treatment. Material and methods: The study was conducted as a cross-sectional study in 221 outpatients with thyroid disease at the Special Hospital for Thyroid Diseases and Metabolic Diseases "Zlatibor", from February to July 2018. In addition to the sociodemographic questionnaire, a four-dimensional symptom questionnaire subscale (4DSQ) was used in the study to assess the occurrence and level of somatization in subjects. Results: There is an association between different thyroid disorders and a high score on the somatization scale (16.05 ± 8.34), in 69.7% of subjects. In our subjects, the most pronounced somatic symptoms have subjects with hypothyroidism (M = 17.5; as = 16.44 ± 8.26), subjects over 61 years (19.29 ± 8.29). Musculoskeletal somatic symptoms were expressed in 72.4% of subjects. Pronounced somatization (19.40 ± 8.32) have subjects who have elevated body mass index values (35-39.9), as well as subjects who have been treated for thyroid disease for more than ten years (19.7 ± 8.7). Conclusion: This study showed that there is an association between thyroid disorders and the appearance of somatic symptoms in patients. In patients, there are moderate somatic symptoms that are associated with age, body mass index and length of treatment.

Primary intracerebral melanoma: A case report

Primary intracranial malignant melanoma is an extremely rare entity These aggressive tumors are derived from the melanocytes of leptomeninges or their precursor cells and can give metastasis to other organs. It effects mostly middle aged males and represents a very poor prognosis with median survival less than 1 year. For proper diagnosis, melanoma of other localization must be excluded. Giving the rarity of this tumor, treatment of choice in unclear. We report a case of 43 year old patient with primary intracranial melanoma treated by supramarginal resection followed by whole brain RT, with disease free period of three years following treatment. We strongly advocate for aggressive treatment approach, supramarginal resection whenever safe, adjuvant therapy and frequent check-ups. We also hope to inspire future studies on larger sample to in order to establish an adequate therapy protocols.

Evaluation of the impact of black carbon on the worsening of allergic rhinitis and asthma in the region of Uzice Serbia

Many epidemiological studies have shown a positive association between black carbon (BC) concentrations and exacerbation of allergic rhinitis and asthma. The aim of this study was to examine, for the first time in Serbia, the connection between visits to emergency services due to worsening of allergic rhinitis and allergic asthma and the concentration of BC in the air. Materials and methods: A time-stratified case crossover design was applied for emergency room visits due to allergic rhinitis and worsening asthma that occurred in the Užice region between 2012-2014. Data on visits were routinely collected at the Uzice Health Center. Results: A statistically significant association was observed between the worsening of allergic rhinitis and BC concentration two days before the visit to the emergency department (UO = 359, UO = 3.20 and UO = 3.24, depending on whether the analysis is not adjusted or adjusted for appropriate weather conditions). There was also a statistically significant association between worsening of allergic asthma and BC concentration two days before the emergency service visit (UO = 3.15, GP = 0.98-10.14) and three days before the emergency service visit (UO = 2.98; UO = 3.23 ; UO = 2.98). Conclusion: Exposure to soot, especially during the heating season, increases the risk of emergency services due to worsening of allergic rhinitis and asthma.