Kliničke karakteristike i dijag nostika COVID-19 kod pacijenata u COVID-ambulantama u opštoj medicini Clinical characteristics and diag nosis of the COVID-19 in patients in COVID outpatient clinics

Objective. Examine clinical manifestations, PCR test results, and visit outcomes in patients in COVID -outpatient clinics. Method . The survey was performed using the question -naire, in February 2021. in patients in four COVID -outpatient clinics in Belgrade and one in Subotica. We got the data about their jobs, gender, age, present symptoms and comorbidities, PCR-testing, and visit outcomes. The data were processed us ing the software statistical package SPSS 17. Statistical sig nificance was defined for level p<0,05. Results . We included 676 participants, of both genders, with an average age of 49. They visited the doctor 1-3 days after symptoms onset. The most common symptoms were fever and cough, followed by fatigue and muscle aches. Hy pertension and obesity were the most common comorbidities, mostly in patients over 65 (p=0,000). We tested 92% of the participants, using PCR tests, and out of 676, 60,95% tested PCR positive, mostly those over 50 (p=0,010). Due to the disease severity, 17,3% of the participants were referred to the hospitals, mostly those aged 51 to 65, but the difference wasn`t statistically significant (p=0,183). Conclusion . The most common symptoms of the COVID -19 were high temperature and cough, and the partici pants visited the doctor 1 to 3 days after symptoms onset. Hypertension and obesity were the most common comorbidi ties, more often in participants over 65. The PCR tests were positive in more than half of the participants, mostly in those over 50.


Introduction
The first cases of the disease, soon to be known as CO-VID- 19, were spotted in the Chinese city of Wuhan in December 2019. The cause was the new virus, from the coronavirus family, SARS-CoV2. The World Health Organization -WHO declared a pandemic on March 11th, 2020, and it`s still ongoing, with huge morbidity and mortality 1 . This respiratory virus is hugely transmissible. The epidemiological surveys confirmed people`s movement, economic, trade, and other social connections, and inter-personal communication led to spreading the virus all around the world 2,3 . Clinical manifestations vary from mostly mild forms of infection to severe with numerous acute complications which sometimes lead to deathly outcomes. The most common symptoms of the disease are similar to flu: fatigue, fever, dry cough 4-8 , although some researches show there could be other numerous symptoms, as well -headache, muscle pain, dyspnea, nausea, vomiting 9 , and the loss of smell is singled out as the fourth isolated symptom 1 . It`s not possible to make the diagnosis of COVID-19 based only on the symptoms and clinical presentation 10 . Fast diagnosis enables disease recognition and isolation of the diseased in order to control the spreading. The most common methods for COVID-19 diagnosis are chest Xray, ultrasound, computerized tomography of the chest, and PCR test 11 . The gold diagnostic standard for the disease is the polymerase chain reaction test -PCR test, which is easily performed and is convenient for mass testing 12,13 . These fast diagnostic tests are an important tool in the management of all infectious diseases 14 . At first, it was believed the virus affects only the respiratory tract but the research results showed it can damage other organs and systems, especially the cardiovascular system 6,[15][16][17][18] . There are numerous researches worldwide on epidemiological and clinical characteristics of the pandemic and finding solutions to prevent the virus transmission and spreading, and its presence in the community 1,4,5,9,19,20 . There were four disease waves in Serbia until now. We practice nonpharmacological preventive measures, mass vaccination but there are still new-found cases. General practitioners working in the COVID -outpatient clinics are the first to come into contact with the patients suspected of COVID-19 infection. The Scientific Board of the Section of General Medicine of the Serbian Medical Society devised the survey, and the GPs working in the COVID -outpatient clinics carried it out, so we could identify the characteristics and specificities of the pandemic in our community.

Objective
We aimed at researching clinical manifestations, PCR test results, and visit outcomes in patients visiting COVDoutpatient clinics in general practice.

Method
This multicentric research was carried out by the physicians working in four COVID -outpatient clinics in Belgrade (PHC Novi Beograd, PHC Palilula, PHC Zvezdara, PHC Lazarevac) and PHC Subotica in February 2020. The physicians participating in the research were filling out the questionnaires during five consecutive days, including all patients over 18 who came for their first medical check-up. The questionnaire included data on: gender, age, existing symptoms, comorbidities and other health issues, time from symptoms onset to doctor`s visit, PCR test results, and visit outcomes (whether the patient was sent home or to the hospital). CO-VID symptoms were divided into main symptoms: fever, dry cough, and dyspnea; other symptoms: a sense of smell and taste disorder, headache, muscle and joint aches, fatigue, sore throat, diarrhea, vomiting, and "alarm" symptoms indicating the severe form of the infection that can endanger the patient`s life: dyspnea and orthopnea, chest pain, hemoptysis, oliguria and anuria, patient`s inability to get up and stand up on his own and loss of consciousness.

Statistical processing and data analysis
The obtained data were statistically processed using the software package SPSS 20.0. We used descriptive analysis in data processing. in the form of frequencies and percentages, for showing sample and answer for each question asked. Results were presented in tables and figures, and the frequency of the observed parameters was shown in percentages. Pearson`s χ 2 -test was used for deducing statistically significant differences between individual participants` characteristics. If there were several different groups in the independent variable, we used one-factorial analysis of variance -ANOVA of different groups with additional tests to identify the statistically significant difference between the groups. Statistical significance is defined for level p<0,05.

Tabela 1. Struktura ispitivane populacije
As far as the main symptoms go, the most frequent was fever (35.21% of the participants). In more than half of the participants, the main symptoms appeared collectively, most often at the same time -fever and dry cough (29,88% of the participants). All three main symptoms were mostly present in people over 50, and in those over 65, alongside high fever, dyspnea was mostly present (p=0,000). There was no statistically significant difference concerning gender (p=0.375). Every fourteenth participant had none of the main symptoms. (Table 3). Od ostalih simptoma kod više od polovine ispitanika, najčešće je postojao umor (56,51%) i bolovi u mišićima (50,3%), (Grafikon 1).
Out of other symptoms, in more than half of the participants, the most common was fatigue (56,51%) and muscle aches (50,3%). (Figure 1).

Сукоб интереса
Изјављујем да аутори немају никакав сукоб интереса у писању овог рада. gender but persons over 60 were at a higher risk for severe clinical presentation due to the comorbidities 2 , which was confirmed in the research of Alkhathami MG et al. as well 26 .

Conclusion
The most common symptoms of COVID-19 in our participants were fever and cough, and they visited a doctor after 1 to 3 days from symptoms onset, on average. Out of the comorbidities, the most common were hypertension and obesity, more often in those over 65. In more than half of the participants, the PCR test was positive, most commonly in those over 50. In all the looked at parameters there was no statistically significant difference in relation to gender.

Conflict of interest
I hereby confirm the authors have no conflict of interest in writing this paper.