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Kovacevic P, Milakovic D, Kovacevic T, Barisic V, Dragic S, Zlojutro B, Miljkovic B, Vucicevic K, Rizwan Z. Thrombocytopenia risks in ARDS COVID-19 patients treated with high-dose linezolid during vvECMO therapy: an observational study. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03136-1. [PMID: 38713258 DOI: 10.1007/s00210-024-03136-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
Patients treated with ECMO are at great risk of nosocomial infections, and around 10% of isolates are gram-positive pathogens. Linezolid (LZD) is effective in the treatment of these infections but appropriate dosing is challenging. The aim was to evaluate the occurrence of thrombocytopenia during ECMO when treated with LZD. An LZD trough concentration of 8 mg/L was set as the cutoff value for thrombocytopenia occurrence among critically ill patients who received parenteral LZD therapy at a dose of 600 mg every 8 h during ECMO. Eleven patients were included in this prospective observational study. Median LZD trough concentrations were 7.85 (interquartile range (IQR), 1.95-11) mg/L. Thrombocytopenia was found in 81.8% of patients. Based on the median LZD trough concentrations cutoff value, patients were divided into two groups, 1.95 (IQR, 0.91-3.6) and 10.3 (IQR, 9.7-11.7) mg/L, respectively. Median platelet values differed significantly between groups on admission, ECMO day 0, ECMO day 1, and LZD sampling day [194 and 152.5, (p < 0.05)], [113 and 214, (p < 0.05)], [76 and 147.5, (p < 0.01)], and [26 and 96.5, (p < 0.01)], respectively. Duration of LZD therapy was similar between the groups. Significant platelet reduction was observed in both groups, emphasizing the need for closer monitoring to prevent LZD-associated thrombocytopenia.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina.
| | - Dragana Milakovic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Vedrana Barisic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Branislava Miljkovic
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade Faculty of Pharmacy, Vojvode Stepe 40, 11221, Belgrade, Republic of Serbia
| | - Katarina Vucicevic
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade Faculty of Pharmacy, Vojvode Stepe 40, 11221, Belgrade, Republic of Serbia
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Deininger C, Wichlas F, Necchi M, Deluca A, Deininger S, Trieb K, Tempfer H, Kriechbaumer L, Traweger A. Enhancing Cranio-Maxillofacial Fracture Care in Low- and Middle-Income Countries: A Systematic Review. J Clin Med 2024; 13:2437. [PMID: 38673709 PMCID: PMC11050981 DOI: 10.3390/jcm13082437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs.
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Affiliation(s)
- Christian Deininger
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Florian Wichlas
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Marco Necchi
- Department of Surgery and Orthopaedics, Hospital Sterzing, Margarethenstraße 24, 39049 Sterzing, Italy;
| | - Amelie Deluca
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
| | - Susanne Deininger
- Department of Urology and Andrology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria;
| | - Klemens Trieb
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
- Department for Orthopaedics and Traumatology, Center for Clinical Medicine, Faculty of Medicine and Dentistry, Danube Private University, 3500 Krems, Austria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
| | - Lukas Kriechbaumer
- University Clinic for Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (F.W.); (K.T.); (L.K.)
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, 5020 Salzburg, Austria; (A.D.); (H.T.); (A.T.)
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Kovacevic P, Malic J, Kovacevic T, Dragic S, Zlojutro B, Jandric M, Momcicevic D, Cancarevic-Djajic B, Skrbic R, Rizwan MZ. Comparative Efficacy of High-Dose Dexamethasone Versus Methylprednisolone in Coronavirus Disease 2019 (COVID-19)-Associated Acute Respiratory Distress Syndrome. Cureus 2024; 16:e55725. [PMID: 38586644 PMCID: PMC10998658 DOI: 10.7759/cureus.55725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE This retrospective (matched paired) clinical trial aimed to compare the efficacy of dexamethasone vs. methylprednisolone at equipotent (high) doses in patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS). METHODS A total of 347 patients with moderate and severe COVID-19-associated ARDS were administered either a high (equipotent) dose of dexamethasone (32 mg) or methylprednisolone (180 mg) for a duration of up to 10 days. All participants received the standard of care for critically ill COVID-19 patients. RESULTS The primary outcomes included length of stay in the ICU, ICU mortality, and discharge from the hospital. Based on the obtained results, a tendency towards more favorable clinical outcomes concerning the length of stay in the ICU (in the group of patients treated with non-invasive mechanical ventilation (NIV), p<0.05), ICU mortality, and discharge from the hospital (in the group of patients who were intubated, p<0.05) in patients receiving the high dose of dexamethasone compared to those receiving methylprednisolone was observed. CONCLUSION It appears that severe cases of COVID-19, especially intubated ones, treated with high doses of dexamethasone have a more favorable clinical outcome than the use of equipotent doses of methylprednisolone. However, larger multicenter studies are needed to validate our observations.
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Affiliation(s)
- Pedja Kovacevic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Jovana Malic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Tijana Kovacevic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Sasa Dragic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Biljana Zlojutro
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Milka Jandric
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Danica Momcicevic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Branka Cancarevic-Djajic
- Critical Care Medicine, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Ranko Skrbic
- Hospital-Based Medicine, Faculty of Medicine, University of Banja Luka, Banja Luka, BIH
| | - M Zeeshan Rizwan
- Critical Care Medicine, Mayo Clinic Alix School of Medicine, Rochester, USA
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Kliot T, Holloway A, Spillman K, Moss J, Davis NL, Ayalew A, Bhutta A, Ejigu YM. Remote Didactic Education Effectively Increases Cardiac Critical Care Nursing Staff Knowledge in Low-Resource Settings. World J Pediatr Congenit Heart Surg 2024; 15:74-80. [PMID: 37654191 DOI: 10.1177/21501351231186419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: While progress has been made to decrease mortality in children under age five, there continues to be a need for improvement in the treatment of children with congenital heart disease. Many of these patients require surgical correction and live in areas without the expertise of surgical teams. Research has shown that appropriate training is critical to ensure the best clinical outcomes. The Ethiopian government has identified the need for increased training of health care professionals as a method to improve hospital outcomes. Methods: Twenty-five cardiac critical nurses participated in a remote didactic education curriculum over the course of multiple months. We used a pre- and post-test model to evaluate knowledge acquisition and retention after the curriculum. Nurses completed post-tests at 1-, 3-, 6-, and 12-month intervals to monitor knowledge retention over time. Results: We found a significant increase in nursing knowledge that was retained over the course of 12 months. Nursing knowledge on pre- and post-tests was impacted by experience level. However, after completion of the curriculum experience was not a significant factor. Conclusion: Virtual curriculum delivered via remote didactic education is an inexpensive and effective way to increase nursing knowledge in cardiac critical care. It encourages bidirectional learning and allows the sharing of expertise from individuals who may otherwise be limited by travel or finances. Our approach is generalizable and further research needs to be done to evaluate the effectiveness of this type of curriculum in other environments.
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Affiliation(s)
- Tamara Kliot
- Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Adrian Holloway
- Division of Critical Care Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Katherine Spillman
- Division of Critical Care Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Julianne Moss
- Division of Critical Care Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Natalie Louise Davis
- Division of Neonatology, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Abebech Ayalew
- Children's Cardiac Center of Ethiopia, Addis Abba, Ethiopia
| | - Adnan Bhutta
- Division of Critical Care Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
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Kovacevic P, Meyer FJ, Gajic O. Challenges, obstacles, and unknowns in implementing principles of modern intensive care medicine in low-resource settings: an insider's perspective. Intensive Care Med 2024; 50:141-143. [PMID: 38095698 DOI: 10.1007/s00134-023-07270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/07/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, dvanaest beba bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
- Faculty of Medicine, University of Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
| | - F Joachim Meyer
- München Klinik gGmbH and Medical Faculty, Lung Center Munich, University of Heidelberg, Heidelberg, Germany
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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6
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Kovacevic P. Can the terms "low resource setting" and "low-income country" be used interchangeably in the context of intensive care medicine? Intensive Care Med 2023; 49:1274-1275. [PMID: 37642671 DOI: 10.1007/s00134-023-07203-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, dvanaestbeba bb, 78000, Banja Luka, Bosnia and Herzegovina.
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina.
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Kovacevic P, Djajic V, Momcicevic D, Zlojutro B, Jandric M, Kovacevic T, Latinovic M, Seranic A, Bokonjic D, Skrbic R, Dragic S. Boosting ICU capacity during the COVID-19 pandemic in the western Balkan region, The Republic of Srpska experience. J Public Health Res 2023; 12:22799036231151762. [PMID: 36718459 PMCID: PMC9880146 DOI: 10.1177/22799036231151762] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023] Open
Abstract
Background Response to the outbreak of poliomyelitis in mid-1950 led to recognition and consequent development of critical care. Seventy years later the humankind was struck by COVID-19, another major challenge for critical care medicine which was especially big in Low-Resources-Settings where more than two thirds of the world population live, including the population of the Republic of Srpska (RS). Design and methods The main aim was to show an overview of all interventions in order to boost hospitals' capacities to the level which is sufficient to manage high amount of critically ill COVID-19 patients in the RS. A before-after cohort study design was conducted to evaluate the effects of interventions for increase in preparedness and capacity of ICUs for admission and treatment of COVID-19 critically ill patients in nine hospitals in the RS. Results: Following interventions, the biggest and university affiliated hospital in the RS has increased ICU capacities: total number of ICU beds increased by 38% and number of ventilators by 114%. Availability of machines for veno-venous extracorporeal membrane oxygenation (vvECMO) increased by 100%. Number of doctors who were involved in treatment of critically ill patients increased by 47% and nurse/patient's ratio reached 1:2.5. Similarly, all other hospitals experienced boosting of ICU beds by 189% and ventilators by 373% while number of doctors increased by 108% and nurse/patient's ratio reached 1:4. Conclusion All interventions implemented during COVID-19 pandemic outbreak in the RS resulted in increasing capacity for treatment of critically ill patients, but the education of health care professionals was identified as the most important conducted intervention.
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Affiliation(s)
- Pedja Kovacevic
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina,Faculty of Medicine, University of
Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina,Pedja Kovacevic, Univeristy Clinical Centre
of the Republic of Srpska, Filipa Kljajica Fice 49, Banja Luka 78000, The
Republic of Srpska, Bosnia and Herzegovina.
| | - Vlado Djajic
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina,Faculty of Medicine, University of
Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Danica Momcicevic
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina,Faculty of Medicine, University of
Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Milka Jandric
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Milan Latinovic
- Ministry of Health and Social Welfare
of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and
Herzegovina
| | - Alen Seranic
- Ministry of Health and Social Welfare
of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and
Herzegovina
| | - Dejan Bokonjic
- Medical Faculty Foča, University of
East Sarajevo, Foča, The Republic of Srpska, Bosnia and Herzegovina
| | - Ranko Skrbic
- Faculty of Medicine, University of
Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Sasa Dragic
- Univeristy Clinical Centre of the
Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina,Faculty of Medicine, University of
Banja Luka, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
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Kovacevic P, Djajic V, Skrbic R, Milivojevic N, Jereb M, Gradisek P, Gorjup V. The role of high-income countries in the establishment and development of modern critical care in low resource settings: A Slovenian model. Technol Health Care 2023; 31:1949-1955. [PMID: 37125589 DOI: 10.3233/thc-230117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Critical care medicine is a young branch of medicine, of which the development was much faster in High Income Countries (HICs) than in Low Resources Settings (LRS). Slovenia, as one of the successor states of former Yugoslavia, passed the process of transition and joined the European Union successfully. On the contrary, Bosnia and Herzegovina (B&H) went through the extremely difficult process of transition (four years of civil war), which left a deep scar to the healthcare system, including critical care medicine. OBJECTIVE To examine the impact of HICs on the development of critical care in LRS. METHOD This review examined the process of growing up the first modern Medical Intensive Care Unit (MICU) in the Republic of Srpska. RESULTS The five-year process of transferring critical care knowledge from Slovenia to the health care system of Republic of Srpska has contributed to the existence of modern and state of the art MICU with tremendous social effects. CONCLUSION The model of using the impact of HICs for improving critical care in LRS can be extrapolated to other similar settings.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Vlado Djajic
- Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Ranko Skrbic
- Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Natasa Milivojevic
- Neurological Intensive Care Unit, University Clinical Centre of Ljubljana, Ljubljana, Slovenia
| | - Matjaz Jereb
- Infectology Intensive Care Unit, University Clinical Centre of Ljubljana, Ljubljana, Slovenija
| | - Primoz Gradisek
- Surgical Intensive Care Unit, University Clinical Centre of Ljubljana, Ljubljana, Slovenija
| | - Vojka Gorjup
- Medical Intensive Care Unit, University Clinical Centre of Ljubljana, Ljubljana, Slovenija
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Vukoja D, Jurić A, Erkapić Z, Pejić T, Zovko Ž, Juričić J, Pejić J, Ćorluka M. Beneficial Treatment Outcomes of Severe COVID-19 Patients Treated Entirely in Primary Care Settings With Dexamethasone Including Regimen-Case Series Report. Front Pharmacol 2021; 12:684537. [PMID: 34456719 PMCID: PMC8387596 DOI: 10.3389/fphar.2021.684537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/12/2021] [Indexed: 12/27/2022] Open
Abstract
Even in 2021, coronavirus disease 2019 (COVID-19) remains a major global health concern, especially in developing countries. The burden of this disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which affects not only primary respiratory but also other organ systems, keeps rising as the pandemic continues. Primary health care centers are the first line where COVID-19 patients are managed and should be able to manage the vast majority of them successfully. In this paper, we present a case series and concept of beneficial management of even deteriorating and severe patients treated entirely in our primary health center. The management is based on well-timed and rational dexamethasone use, as well as on various other pharmacological and nonpharmacological treatments and interventions, and is supported by provided statistical data. According to the presented experience and positive outcomes achieved, it seems that even deteriorating and severe COVID-19 patients can be treated successfully to some extent or even completely in primary care settings. This kind of approach could be particularly beneficial in conditions of overload of higher-level health care institutions.
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Affiliation(s)
- Damir Vukoja
- Grude Health Center, Grude, Bosnia and Herzegovina
| | - Andrea Jurić
- Institute for Public Health of West Herzegovina County, Grude, Bosnia and Herzegovina
| | | | - Tomislav Pejić
- Grude Health Center, Grude, Bosnia and Herzegovina.,Ministry of Health, Labor and Social Welfare of West Herzegovina County, Grude, Bosnia and Herzegovina
| | - Željko Zovko
- Grude Health Center, Grude, Bosnia and Herzegovina.,Department of Emergency Medicine, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | | | - Jelena Pejić
- Department of Dermatology and Venerology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Matea Ćorluka
- Department of Dermatology and Venerology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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