The aim of this study was to examine how ibuprofen and paracetamol prevent pain after cold-steel extracapsular tonsillectomy in children. Also, we examined the relation between age, gender, nausea, postoperative bleeding, antibiotic use, type of diet, and postoperative pain intensity and the type of administered analgesic. A prospective study was conducted on 147 children (95 males and 52 females, aged 7-17 years) who underwent tonsillectomy in the Clinical-Hospital Center “Dragiša Mišović” from January 1 to June 30, 2016. The degree of pain was measured using a visual analog scale (VAS). We did not observe any significant differences in postoperative nausea, hospitalization rate postoperative bleeding, and antibiotic use between the paracetamol and ibuprofen groups. A test of within-patient effects showed that VAS scores changed significantly during the postoperative follow-up period ( P = .00), but there were no significant differences between the groups ( P = .778). After 12 hours, 29.3% of the patients on paracetamol and 21.8% on ibuprofen were transferred to a soft diet; after 24 hours, 84.8% of the paracetamol group and 85.5% of the ibuprofen group were on a soft diet (χ2 test, P < .05). There was a statistically significant correlation between VAS scores measured 4 hours after the surgery and the time of transference to the soft diet (Spearman ρ test, P < .001). The transfer to soft and normal diets was not significantly different between the 2 groups as assessed by the VAS scores (Pearson χ2 test, P = .565).There is still no consensus on the most effective postoperative pain-control regiment after tonsillectomy. This study showed that satisfactory pain management was achieved equally with both paracetamol and ibuprofen.

Objective In emergency airway management, the occurrence of surgical tracheotomy complications is increased and may be fatal for the patient. However, the factors that play a role in complication occurrence and lead to lethal outcome are not known. The objective of this study was to determine predictors associated with the occurrence of complications and mortality after emergency surgical tracheostomy. Study Design Retrospective study with a systematic review of the literature. Setting Tertiary medical academic center. Subjects and Methods We included 402 adult patients who underwent emergency surgical tracheostomy under local anesthesia due to upper airway obstruction. Demographic, clinical, complication occurrence, and mortality data were collected. For statistical analysis, univariable and multivariable logistic regression methods were used. Results In multivariable analysis, significant positive predictors of complication occurrence were previously performed tracheotomy (odds ratio [OR] 3.67, 95% confidence interval [CI], 0.75–17.88), neck pathology (OR 2.05, 95% CI 1.1–1.77), and tracheotomy performed outside the operating room (OR 5.88, 95% CI, 1.58–20). General in-hospital mortality was 4%, but lethal outcome as a direct result of tracheotomy complications occurred in only 4 patients (1%) because of intraoperative and postoperative complications. Conclusion The existence of neck pathology and situations in which tracheotomy was performed outside the operating room in uncontrolled conditions were significant prognostic factors for complication occurrence. Tracheotomy-related mortality was greater in patients with intraoperative and early postoperative complications. Clinicians should be aware of the increased risk in specific cases, to prepare, prevent, or manage unwanted outcomes in further treatment and care.

Backround/Aim. Laryngeal carcinomas make 1-3% of all head and neck malignancies.Treatment outcome and survival rates depend greatly on established stage of the disease. The purpose of this paper was to examine the survival of the patients with advanced laryngeal carcinoma depending on gender, age, common risk factors (tobacco and alcohol use), primary tumor localization, histopathological tumor grade, clinical TNM stage and surgical treatment of the disease. Methods. Retrospective study included 252 patients treated surgically for advanced squamocellular carcinoma of the larynx in a threeyear period with five-year follow up. Patients included in the study were treated primary with surgery, with postoperative radiotherapy and chemotherapy depending on the stage of the disease, intraoperative findings and tumor resection borders. Overall survival and disease-specific five-year survival of patients was calculated for demographical and clinical characteristics of the patients. Results. Overall 5-year survival for patients with operable advanced laryngeal cancer included in the study was 86.14% and disease-specific survival 86.51%. Lower overall and disease-specific survival was associated with age, higher histological tumor grade and more extensive neck dissections. Conclusion Primary total laryngectomy results in higher survival outcomes in cases of transglottic T3 and T4a laryngeal tumors. Patients should be informed of the likely increased mortality risks tied to the choice of surgical resection and treatment modality before their decision. Running title: Survival in advanced laryngeal cancerApstrakt Uvod / Cilj. Karcinomi larinksa čine 1-3% svih maligniteta glave i vrata. Terapijski rezultati i preživljavanje umnogome zavisi od stadijuma bolesti. Cilj rada bio je da se ispita preživljavanje pacijenata hirurški lečenih od odmaklih karcinoma larinksa u zavisnoti od starosti, pola, uobičajenih faktora rizika (pušenje, konzumiranje alkohola), primarne lokalizacije tumora, histopatološkog stadijuma bolesti, TNM stadijuma bolesti, I primenjene hirurške terapije bolesti. Metode. Retrospektivna studija je sprovedena na 252 pacijenata hirurški lečenih od odmaklih sa periodom praćenja od 5 godina. Pacijenti uključeni u studiju su primarno lečeni hirurški, sa sprovođenjem postoperativne radioi hemioterapije, u zavisnosti od lokalne I regionalne proširenosti bolesti, intraoperativnog nalaza i linija resekcija granica. Petogodišnje ukupno preživljavanje I preživljavanje bez znakova bolesti je kalkulisano u zavisnosti od demografskih I kliničkih karakeristika pacijenata. Rezultati. Ukupno petogodišnje preživljavanje pacijenata sa odmaklim karcinomima larinksa je iznosilo 86.14%, a petogodišnje preživljavanje bez znakova bolesti 86.51%. Smanjeno preživljavanje je bilo značajno povezano sa starošću pacijenata, višim histloškim gradusom tumora I opsežnijim disekcijama vrata. Zaključak. Primarna totalna laringektomija rezultira dužim preživljavanjem u slučajevima transglotisnih T3 i T4a tumorima larinksa. Pacijenti, pre donešenja ...

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

Introduction/Objective. Overall number of emergency department visits, including otorhinolaryngology, has increased. Due to population growth, industry and traffic expansion, workload of the otorhinolaryngology emergency department is steadily on the rise. The objective of this study was to determine most common indications for emergency hospitalization in otorhinolaryngology department in secondary medical center. Also, we examined course of diagnostics and treatment upon admittance, outcome of hospitalization and possible referral to tertiary medical center. Methods. Retrospective study included patients who were urgently hospitalized on the Department of otorhinolaryngology and maxillofacial surgery in Djordje Joanovic General Hospital in Zrenjanin in a two-year period. The data were obtained by processing patients? medical charts. Results. The study included 428 patients who were urgently hospitalized on the Department of otorhinolaryngology of the secondary medical center in two-year period. 245 (57.2%) were male and were 183 (42.8%) female, with average age of 48.5 years. Patients were most frequently hospitalized because of tonsillopharyngitis and its? complications, followed by head and neck trauma. Most of the patients were treated conservatively with medication therapy (72%), and 28% underwent surgical or other invasive intervention. 27 (6.3%) patients were referred to tertiary medical center, which was correlated significantly with number of comorbidities and consultative exams. Conclusion. Otorhinolaryngology inflammatory/infectious diseases are the most frequent indication for urgent hospital admission in secondary medical center. Most of the patients were treated conservatively. Referral to tertiary medical center was significantly correlated to number of comorbidities and consultative exams.

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Introduction/Aim: The global COVID-19 pandemic has long been considered an emergency, with the number of cases growing exponentially, despite constant efforts to control the infection. Although the disease is caused by the SARS-CoV-2 virus, most patients are treated with antibiotic therapy. The long-term effects of such broad antibiotics use on antimicrobial resistance are still unknown and are a matter for concern. The aim of this paper is: to determine, based on the available literature, the impact of the COVID-19 pandemic on the use of antibiotics; to determine the global situation regarding antimicrobial resistance; to identify key areas where urgent changes are needed. Methods: A systematic review of the current literature on the use of antibiotics in COVID-19 treatment was conducted. The PubMed and MEDLINE databases were searched for papers published between March 2020 and September 2021. Results: Between 76.8% and 87.8% of patients with COVID-19 were treated with antibiotics. Antibiotics were less frequently prescribed to children, as compared to adults (38.5%, compared to 83.4%). The most commonly administered antibiotics were fluoroquinolones (20.0%), macrolides (18.9%), b-lactam antibiotics (15.0%), and cephalosporins (15.0%). Self-medication with antibiotics to prevent and treat COVID-19 has been identified as one of the important factors contributing to antimicrobial resistance. Conclusion: The impact of COVID-19 on global antimicrobial resistance is still unknown and is likely to be unevenly distributed in the general population. Although various antibiotics have been used to treat patients with COVID-19, their role and the need for their application in the treatment of this infection remains to be determined. For now, there are no reliable data as to whether the use of antibiotics in COVID-19 cases without associated bacterial infections has any effect on the course of the disease and mortality.