Natalija Vukovic

Short bowel syndrome (SBS) develops when the remaining intestine is unable to sustain adequate nutrient and electrolyte absorption following extensive bowel resection. The condition is characterized by malabsorption and significant fluid losses which lead to dehydration and progressive weight loss, thus promoting patient dependence on parenteral fluids or nutrition. After an initial acute phase marked by accelerated intestinal transit and gastric hypersecretion, long-term clinical outcomes are largely determined by the capacity of the remaining bowel for intestinal adaptation—a sustained process of structural, functional, and molecular remodeling that enhances absorptive efficiency and restores fluid and nutrient homeostasis. This review summarizes the key histological and cellular features of the adaptive response, including crypt and villus remodeling, mucosal hyperplasia, and smooth muscle hypertrophy, and integrates emerging concepts in crypt biology that define the dynamic cross-talk between intestinal stem cells and the mesenchymal niche, together with their upstream regulatory pathways.

Gastrocutaneous fistulae can occur spontaneously or in the postoperative period. Postoperative fistulae represent more than 90% of all intestinal fistulae and they are always related to some of the main complications of surgery of the alimentary tract. We report a case of GF following a major operative procedure treated at our hospital. We emphasize the diagnostic tools and treatment options for this surgical complication, which, if left unaddressed, could pose life-threatening risks. Conservative management of patients with gastrocutaneous fistula is a crucial period during which careful individual control of each patient's nutritional status and replacement of fluid and electrolyte losses through high-output fistula, as well as prevention of sepsis and exclusion of the stomach from the digestive passage, can result in reduced morbidity and mortality from this complex problem. The decision regarding the timing of surgical intervention must be aligned with achieving optimal results of conservative management, which is a winning approach combination.

Editorial: Intensive care unit acquired weakness: potential role of medical nutrition treatment quantity, timing, and composition

Background: In the Resolution 70.7 in 2017, the World Health Assembly urged member states to integrate sepsis in their national health systems. In May 2022, the G7 Health Ministers reiterated the necessity to implement such resolution focusing on early detection, diagnosis, and therapy. Defining and implementing standards and established guidelines, infrastructure, laboratory capacity, and strategies should be fundamental elements of any sepsis plan. Up to now, no data exist describing the current state of care, the availability of diagnostics or the provision of training in sepsis within hospitals. Methods: A harmonised multidisciplinary cross-sectional questionnaire was used to explore sepsis care in acute care hospitals in Europe and worldwide. Eleven main indicators representing sepsis care in emergency departments, general wards, intensive care units (ICUs) and hospitals in general were assessed. Findings: Participants from 1087 hospitals in 73 countries took part. Measures for early recognition of sepsis were available in 61·9% (530/856) of the ICUs, 54·5% (429/787) of emergency departments and 47·8% (420/878) of the wards. Sepsis protocols or sepsis bundles were applied in 70·7% (597/845) of ICUs, 57·6% (452/785) of emergency departments and 45·5% (391/860) of the wards. 24-hour microbiological service providing 24/7 blood culture incubation, pathogen identification and communication of results, was available in 10·1% (106/1046), antibiotic stewardship programs existed in 68·3% (678/992) and quality improvement programs or sepsis training were provided in 31·3·% (272/868) of the hospitals. Interpretation: This study reports structures and measures of sepsis care in hospitals in Europe and worldwide for the first time. Although the results are not generalisable, this exploratory sample represents 609,650 curative care beds and, including almost a quarter of the total curative care bed capacity of the European Union and revealed significant room for improvement of sepsis care, availability of diagnostics and implementation of quality improvement programs. Trial Registration: Registered at ClinicalTrials.gov (Identifier: NCT05059808). Funding: The European Sepsis Care Survey was funded by the European Sepsis Alliance and an educational grant by Becton Dickinson S.A. (BD). Declaration of Interest: Christian S. Scheer discloses funding from European Sepsis Alliance for conducting the European Sepsis Care Survey and funding from Becton and Dickinson for technical realisation of the project. Evangelos J. Giamarellos-Bourboulis discloses grants, contracts and payment to the Hellenic Institute for the Study of Sepsis and National and Kapodistrian University of Athens from Abbott Products Operations, bioMérieux Inc, Johnson & Johnson, MSD, Sobi AB, AbbVie, InflaRx GmbH, Johnson & Johnson, Novartis, UCB Horizon 2020 grant ImmunoSep, Horizon Health Grant EPIC- CROWN-2 and RISKinCOVID; consulting fees with payment done to the National and Kapodistrian University of Athens from GSK, InflaRx GmbH, UCB, Sobi AB; Payment for lectures and presentation done to the National and Kapodistrian University of Athens from Abbott Products Operations AG, bioMérieux, Sobi AB. He is chairman of the European Sepsis Alliance (ESA). Ricard Ferrer has nothing to disclose. Evgeny A. Idelevich discloses a Institutional grant “Accelerated detection of antibiotic-resistant pathogens with epidemic potential (LAB-in-MOTION) - Determination, optimisation, and validation of test conditions for rapid tests to detect antibiotic-resistant pathogens from the German Federal Ministry of Education and Research (BMBF); An institutional grant “Rapid and sensitive detection of bacteria and fungi by direct microscopy.” from MetaSystems Hard & Software GmbH; An institutional grant “MALDI Biotyper Sirius IVD System – Project: Innovative Matrix-Assisted Laser Desorption Ionization - Time of Flight (MALDI-TOF) Mass Spectrometry Application Extensions” from the Federal state Mecklenburg-Western Pomerania through the European Regional Development Fund (ERDF); An institutional grant “MASTeR-test - Development of universal rapid tests for phenotypic antimicrobial resistance determination in microorganisms based on Matrix- Assisted Laser Desorption Ionization - Time of Flight Mass Spectrometry (MALDI-TOF MS) - Determination, optimization, and validation of test components and parameters from the German Federal Ministry of Education and Research (BMBF); Inventor remuneration for patent licenses - 3 patent applications licensed from the University of Münster to Bruker.; Consulting fees for Expert role in the quality assurance procedure for the diagnosis, treatment, and follow-up care of sepsis from Institute for Quality Assurance and Transparency in Health Care (IQTIG); Honorarium for the educational lecture “Acceleration of microbiological diagnostics of sepsis” at the 8th paediatric workshop from MSD; Chair of the symposiums at ECCMID 2022 organised by Bruker (support for congress travel). Djillali Annane has nothing to disclose. Antonio Artigas discloses a BIOVAP-2 PSP study grant from Abionic; a Septibell study grant from Loop-Dx; Consulting fees from Grifols for Evaluation Albus awards, Fabentech for Scientific advisor of EPIC-CROWN-2 project, Lilly Foundation for Scientific Advisor committee, Aerogen for Spanish Advisory meeting; Board participation ImmuneSep (DSMB Committee), Apeptico (DSMB Committee), Exvastat (Scientific Advisor Board). Abdullah Tarik Aslan has nothing to disclose. Ruslan Baltaga has nothing to disclose. Gabriella Bottari discloses Coordination for spreading the survey to pediatric hospital and PICUs across Europe as deputy chair of the infection systemic inflammation and sepsis section of the European Society of Pediatric and Neonatal Intensive Care without any payment. Hjalmar R. Bouma...

Background and Objectives: Coagulation disorders during COVID-19 infection are associated with a poorer prognosis and higher disease severity because thrombosis and inflammation are two processes that interfere with each other. A very important issue for clinicians is timely and adequate hemostasis and inflammation monitoring to prevent and treat potentially lethal consequences. The aim of this study was to identify specific hemostatic parameters that are associated with a higher risk of intrahospital mortality. Materials and Methods: This study was approved by the Ethics Committee of the Clinical Center Nis in Serbia. One hundred and forty-two patients presented with COVID-19 ARDS and were admitted to the ICU in the Clinic for Anesthesiology at the Clinical Center Nis from 14 April 2020 to 25 May 2020. Upon admission, blood was collected for biochemical and coagulation testing. The data obtained were analyzed using the Statistical Package for Social Sciences (SPSS v. 25, Chicago, IL, USA). Results: Among all the parameters assessed, older age; increased levels of fibrinogen, INR, D-dimer, and presepsin; and higher results in the platelet aggregation tests (aggregation induced by adenosine diphosphate based on the ADP test (AU/min), aggregation induced by arachidonic acid based on the ASPI test (AU/min), and aggregation induced by thrombin based on the TRAP test (AU/min)) and some assays of the viscoelastic test (clot amplitude after 5 min in the extrinsic coagulation pathway based on the A5 EX-test (mm), clot amplitude after 10 min in the extrinsic coagulation pathway based on the A10 EX-test (mm), clot amplitude after 5 min regarding functional fibrinogen based on the A5 FIB-test (mm), clot amplitude after 10 min regarding functional fibrinogen based on the A10 FIB-test (mm), and maximum clot firmness based on the MCF FIB-test (mm)); and lower values of viscoelastic clotting time in the extrinsic coagulation pathway based on the CT EX-test (s) were significantly correlated with mortality. In the multivariate analysis, D-dimer levels above 860 ng/mL, higher TRAP test value bins, and values above the normal reference range of the A10 FIB test were found to be independent predictors of mortality. Conclusions: Sophisticated hemostasis parameters can contribute to early risk assessment, which has initially been performed only on the basis of patients’ clinical status. Hypercoagulability is the main coagulation disorder in COVID-19 infection.

Background and Objectives: Coagulation disorders during COVID-19 infection are associated with poor prognosis and disease severity, because two processes that interfere each other are thrombosis and inflammation. Very important issue for clinicians is timely and adequate hemostasis and inflammation monitoring in order to prevent and treat potentially lethal consequences. Materials and Methods: The study was approved by the Ethics Committee of the Clinical center Nis, Serbia. One hundered fourty two patients presented with COVID-19 ARDS were admitted to the ICU in Clinic for anesthesiology Clinical Center Nis, from 14th April 2020 to 25 th May 2020. On admission blood was collected for biochemical and coagulation testing. The data obtained was analyzed using Statistical Package for Social Sciences (SPSS v. 25, Chicago, IL, USA). Results: Among all parameters assessed, mortality was associated with higher age (p<0.05), higher factor I (p<0.05), INR (p<0.001), D-Dimer (p<0.001), ADP (p<0.001), ASPI (p<0.001), TRAP (p<0.001), PSEP (p<0.001), A5 extest (p<0.01), A10 ex test (p<0.01), A5 fib (p<0.001), A10fib (p<0.001) and MCF fib (p<0.001) values, but lower CT extest values (p<0.05). Mortality was associated with extreme values of D-Dimer above 1000 (p<0.001), ADP above 590 (p<0.001), ASPI above 800 (p<0.001), TRAP above 1500 (p<0.001) and PSEP above 1000 (p<0.05). Conclusions: The key to success in the treatment of COVID 19 infection is timely and adequate therapy and patient monitoring, which is impossible without early risk stratification and mortality prediction. Sophisticated hemostasis parameters can contribute to early risk assessment, which was initially performed only on the basis of the patient's clinical status.

Perioperative anaphylaxis caused by muscle relaxants represents a relatively rare, albeit a serious complication during anesthesia. It can result in serious morbidity or even mortality. This reaction usually happens before or after intubation of a patient, that is, a few minutes after muscle relaxant administration. The beginning of the reaction can be missed, even by the most experienced anesthesiologist, since its recognition depends on the severity of the symptoms. There are no guidelines specific to the therapy of muscle relaxant anaphylaxis and therefore therapy is based simply on the general guidelines. Also, in many countries, there are no registries of the incidence of anaphylaxis caused by muscle relaxants. Therefore, this is an extremely important subject for anesthesiology practice, and it requires more attention.