Anthropometric characteristics and traffic accident circumstances of patients with isolated whiplash injury in University Clinical Hospital Mostar.

Aim To investigate anthropometric characteristics and traffic accident circumstances of subjects with isolated whiplash injury. Methods This cross sectional study involved 75 subjects from traffic accidents with isolated whiplash injury classified by Quebec Task Force (QTF). Anthropometric data were collected as well as claims about circumstances of traffic accidents. Results Distribution of 1st (28; 37.3%), 2nd (25; 33.3%) and 3rd (22; 29.3%) grade of whiplash injury was almost equal. Females had smaller anthropometric measurements than males; neck circumference was the most significant difference between males and females in the context of whiplash injury. The most frequent collision mechanism was impact to front (26; 34.7%) or to rear end (26; 34.7%) of a small passenger's car. Assertions of participants were that their car damage was significant (37; 49.2%) or total (24; 32%). A total of 38 (50.7%) participants claimed that they were not wearing safety belt and 52 (69.3%) did not find themselves responsible for accident. Conclusion Driving habits of our participants facilitate incidence of whiplash injuries, especially in vulnerable groups such as women and elderly.

Pain Intensity Scales Comparison in Patient with Abdominal Pain.

BACKGROUND: The aim of study was to explore efficiency of the pain rating scales on patients experiencing abdominal pain, determine correlation between the scales and their applicability to general population and determine the minimal clinical important difference in mm on the VAS as discriminatory for difference in pain intensity. SUBJECTS AND METHODS: The study was performed at the Emergency Department of the University Clinical Hospital of Mostar on patients with abdominal pain which started less than 24 hours before, excluding patients under 16 years old, uncooperative patients and those with altered state of consciousness. The sample data were collected from February to May 2010. Hundred patients completed the questionnaire. Two patients, admitted to the Abdominal Surgery Department, were excluded. The patients were asked to sign the informed consent form and assess the level of pain on three scales (VAS, NRS, VRS). RESULTS: The NRS showed a significant difference in assessing the pain intensity in the observed time. By lapse of time, the patients were reporting lower pain intensity (P=0.017). VAS and NRS had high correlation coefficient values, indicating strong correlation and credibility. The NRS showed strong results correlation (r=0.784; P<0.001). Inter-scale correlation was growing over time. Correlation between VAS and NRS was very strong, the strongest in the last measurement (r=0.950; P<0.001). The NRS correlation with VRS (r=0.430; P<0.001) was slightly better than with VAS (r=0.402; P<0.001). The NRS proved to be the most sensitive to changes in pain intensity (SRM=0.305), whereas the VRS showed extremely low responsiveness (SRM=0.185). CONCLUSION: Having proved as the most useful, reliable and efficient pain assessment instrument, the NRS is hereby recommended as method of pain objectification and determining changes in pain intensity.

Attitudes of Students of Medicine, University of Mostar According to Induced Abortion.

BACKGROUND: Aim of this study was to establish attitudes of medical students on induced abortion and connection of those attitudes with religiousness, length of their studies, sex and various circumstances of pregnancy. SUBJECTS AND METHODS: In total, 148 students of the first, second, fifth and sixth year of medical faculty participated in the research. The study was conducted at the Medical Faculty of the University in Mostar. While collecting the data, we used a survey taken over from literature. The data were tested with adequate statistical methods afterwards. RESULTS: 81.1% of students would perform an abortion under certain circumstances (χ2=57.189; P<0.001). Most students answered that they would perform an abortion in case that a fetus had malformations (χ2=3.892; P=0.49) or if the mother's life were endangered (χ2=47.676; P<0.001). By comparison of students' readiness to perform an abortion under various circumstances of pregnancy depending on length of medical education, statistically significant difference was proved in the following circumstances: rape (χ2=6.097; P=0.014) and if the pregnancy would endanger mother's mental health (χ2=4.488; P=0.034). Students with shorter medical education expressed more liberal attitudes in the above stated circumstances. By comparison of students' readiness to perform an abortion under various circumstances of pregnancy depending on religiousness statistically significant difference was proved in the following circumstances: in case of 'abortion on demand', no matter the reason (χ2=11.908; P=0.012), teenage pregnancy (χ2=33.308; P<0.001) and if the pregnancy would interfere with mother's career χ2=35.897; P<0.001). Unreligious students expressed more liberal attitudes. CONCLUSION: Influence of length of medical education and sex on attitudes on abortion was not proved statistically. Impact of religiousness on that attitude cannot be commented due to very small share of unreligious students in the sample.

Isometric muscle fatigue of the paravertebral and upper extremity muscles after whiplash injury.

BACKGROUND: Whiplash-associated disorders (WAD) result from injury of neck structures that most often occur during traffic accidents as a result of rapid acceleration-deceleration. The dominant symptoms manifest in the musculoskeletal system and include increased fatigue. Because of the frequency of whiplash injuries, a simple, cheap and useful diagnostic tool is needed to differentiate whiplash injury from healthy patients or those faking symptoms. OBJECTIVES: To determine muscle fatigue in patients with whiplash injury in six body positions. DESIGN: Analytical cross-sectional study. SETTING: Emergency center, university hospital. PATIENTS AND METHODS: We studied patients with whiplash injury from vehicular traffic accidents who presented to the emergency center within 6 hours of sustaining the injury. We determined whiplash injury grade according to the Quebec Task Force (QTF) classification and measured isometric muscle endurance in six different body positions. Control subjects for each patient were matched by age, gender and anthropomorphic characteristics. Cut-off values were determined to distinguish patients with whiplash injury from controls and for determination of injury grade . MAIN OUTCOME MEASURE(S): QTF grade, time to muscle fatigue in seconds. RESULTS: From September 2013 to September 2016, we enrolled 75 patients with whiplash injury and 75 matching control subjects. In all six positions, the patients with whiplash injury felt muscle fatigue faster than equivalent controls (P < .05) and the time to onset of muscle fatigue decreased with increasing injury grades in all six positions. Assignment to the patient or control group and to injury grade could be predicted with more than 90% accuracy on the basis of time to muscle fatigue. The most efficient position was the highest injury grade, by which 99.9% of the patients were accurately categorized. Isometric muscle endurance correlated with whiplash injury grade in all six positions (P < .01). CONCLUSION: Under clinical conditions, muscle endurance and the appearance of isometric muscle fatigue during testing can be a useful indicator of whiplash injury and grade. LIMITATIONS: The size of the sample was small. An objective parameter such as electromyography is needed to confirm isometric muscle fatigue.

Accuracy of Modified Alvarado Score, Eskelinen Score and Ohmann Score in Diagnosing Acute Appendicitis.

INTRODUCTION: By processing the data of a large number of patients with abdominal pain, diagnostic scores whose implementation attempts to facilitate acute appendicitis diagnostics were developed. Modified Alvarado score, Ohmann score and Eskelinen score are used as assistance when setting the diagnosis and making a decision to undertake surgery. AIM: To assess accuracy of Alvarado score, Ohmann score and Eskelinen score in diagnosing acute appendicitis and to establish connection of total score of these scoring systems with histopathological degree of appendicitis. SUBJECTS AND METHODS: A cross-sectional study was conducted at the Department of Surgery of University Clinical Hospital Mostar. The study included 70 patients who underwent appendectomy and were scored before surgery. All tested persons were examined by experienced surgeon who took anamnesis, physical status and ordered laboratory diagnostic tests. Appendicitis was excluded or confirmed by means of histopathological diagnostics, and the degree of appendicitis was determined. RESULTS: According to accuracy parameters (sensitivity, specificity, negative and positive predictive value), the score which was of highest value was Ohmann score, followed by Eskelinen score, while the lowest value was the one of modified Alvarado score. Total score in all three scoring systems follows the degree of appendicitis, but statistical significance was proven only for Ohmann and Eskelinen scores. CONCLUSION: Ohmann and Eskelinen scores can be useful in diagnosing acute appendicitis, predicting the degree of appendicitis, as well as assistance when making decision to undertake an operative procedure. Modified Alvarado score in our subjects did not prove sufficient value. Diagnostics of acute appendicitis still must be led by contemporary algorithms in which diagnostic scoring is implemented.

Restless Legs Syndrome in Patients with Hypertension and Diabetes Mellitus.

AIM: The aim of this study was to analyze frequency of restless legs syndrome (RLS) in patients with hypertension and diabetes mellitus. PATIENTS AND METHODS: It was analyzed 120 subjects (from Health Center Zivinice/Family Medicine Department) through a survey conducted in the period from March to June 2015, of which 30 (8 men/22 women). Subjects were 30 patients with longtime hypertension (HT)(18 men/12 women), 30 patients with diabetes mellitus (DM) type I or II (9 men/21 women), 30 patients with long standing DM type I or II and HT (12 men /18 women), and 30 control subjects (12 men/18 women). RLS were evaluated by questionnaire - International RLS Study Group Criteria. The average age of patients in the group with HT was 58.70 ± 9.07, in the group with DM 48.43 ± 15.37, and in the group of patients with HT and DM 63.90 ± 7.49 years. In the control group mean age was 52.76 ± 14.83 years. Statistical data were analyzed in Excel and SSPS statistical program. RESULTS: RLS was identified in 10 (30%) of those with HT; 7 (21%) in patients with DM, and 10 (30%) in patients with HT+DM. In the control group RLS was verified in 4 (12%) patients. Comparing the results, it was observed significant difference between the HT and the control group (p=0.0012) and HT+ DM and control group (p=0.0012). The frequency of RLS between DM and the control group was not significantly significant (p=0.107). CONCLUSION: RLS is frequent in patients with hypertension (30%), hypertension+ diabetes mellitus (30%), and patients with DM (21%).

The Influence of Palliative Care on Quality of Life in Patients with Lung Cancer.

OBJECTIVE: Objective of this work is to determine influence of palliative care on the quality of life in patients with lung cancer. SUBJECTS AND METHODS: Our study group included 40 patients, consecutively selected, which is determined by symptomatic treatment and hospitalized at the Department of Palliative Care of University Clinical Center Tuzla. The control group consisted of 40 patients who had a diagnosis of lung cancer treated at home by an authorized ambulance Health Center Tuzla. Tests in both groups were carried out using the test SF-36 scale for assessing quality of life in period of two weeks. Two-stage test was performed, initially, immediately after disease was diagnosed, and two weeks later. RESULTS: All life quality parameters (general, physical and emotional) were better in second test, in patients who were situated in the department of palliative care (study group) (p<0.0001). In the area of physical health (physical function, physical limitations, pain, general health), in patients who have resided in the department of palliative care (study group), showed a statistically significant improvement in all the aspects (p<0.0001). In the study patients all aspects of mental health were statistically significantly improved after two weeks being in department (p<0.0001). CONCLUSION: Two weeks treatment of patients with lung cancer in the Department of Palliative Care significantly improve all general aspects of quality of life.

The etiological relation between serum iron level and infection incidence in hemodialysis uremic patients.

Through the treatment of anaemia in dialysis patients part of the iron ions remain free in the serum which is at the bacterias disposal for growth and the strengthening of their virulence. The linear relation of the increased serum iron level and tissue iron stores in the body and the infection incidence in dialysed patients has become more emphasised. The need of a clearly defined upper threshold of the serum iron concentration limit has been mentioned in scientific journals intensely, and consequently the demand for more precise professional instructions for anaemia treatment. For the purpose of participating in these professional and scientific discussions, we have observed the relation between the iron overload of the organism and complication incidence in 120 of our haemodialysis uremic patients, with special emphasis on infections. It has been established that the sepses incidence is much higher in patients with a serum ferritin concentration above 500 microg/L, than in those patients with a ferritin level lower than the mentioned value ( 2 = 7.857, p = 0.005). The incidence of vascular access infection is significantly higher in those patients with a serum ferritin level above 500 microg/L than in those patients with a ferritin level lower than the mentioned value (Chi2 = 23.186, p = 0.001). Furthermore, it has been determined that the incidence of total infection in patients is 3.8 episodes per 100 patients months, which is in accordance to the referral values of other authors. CONCLUSION--In the analysis of the achieved results, it has been determined that the infection incidence is significantly higher in dialysed patients with a serum iron level higher than 500 g/L, than in those patients with lower values.

A randomised two-way comparison of mastectomy performed using harmonic scalpel or monopolar diathermy.

The purpose of this study was to perform an overall evaluation and comparison of the success rate of modified radical mastectomy by harmonic scalpel and monopolar electrocauter The prospective study included all of the patients that were planned for and mastectiomized because of breast carcinoma during July 1st 2008 until December 21st 2008 at the Department of Surgery and Urology, University Hospital Mostar. Duration of the surgical procedure, intraoperative blood loss and operational drain secretion was measured and registered. Leukocyte number (Le), interleukin 6 (IL-6), C-reactive protein (CRP) and erythrocyte sedimentation rate was tested and registered out of peripheral venous blood before the operation, 4 hrs after it, as well as on the first, second and third day after the operation. Every patient was tested for postoperative pain intensity, amount of administered analgesics during hospital stay, number and types of postoperative complications; also the time needed for return to everyday activities was registered. 61 patients were included in the study. 31 patients were operated with the harmonic scalpel, and 30 of them with the monopolar electrocauter. There is no statistically significant difference between the operation time in the two groups: 78.50 +/- 17.50 minutes by harmonic scalpel and 82.50 +/- 18.50 minutes by electrocauter (p = 0.796). The smaller amount of intraoperative blood loss is statistically significant in the group of patients mastectomized by harmonic scalpel 78 +/- 31 ml compared to 256 +/- 112 ml in the group mastectomized by electrocauter (p < 0.001); as is the total operational drain secretion: patients mastectomized by harmonic scalpel 540 +/- 390 mL compared to 960 +/- 710 mL in patients mastectomized by electrocauter (p < 0.001). There is no statistical difference in the number of leukocytes in blood after modified radical mastectomy using the harmonic scalpel or electrocauter (p = 0.957), or in erythrocyte sedimentation rate (p = 0.114), CRP (p = 0.071) and IL-6 (p = 0.082). The duration of postoperative hospital stay does not differ statistically between the two groups, nor does the postoperative pain intensity, amount of administered analgesics, number or types of postoperative complications, as well as the time needed for return to everyday activities. Therefore using the ultrasound harmonic scalpel in comparison to monopolar electrocauter brings certain advantages, which however do not contribute significantly to the total success rate of the operation.

The relation between the serum calcium level and the complication incidence in haemodialysis uremic patients.

The mineral metabolism disorder is the most influential factor of the morbidity and mortality incidence of haemodialysis uremic patients. The second most influential factor is the infection, which is the most frequent complication with an undesirable outcome. In recent times, the relation of the increased serum calcium and phosphorus level on the one hand, and the morbidity and mortality of that population in case on the other, has been observed. However, insufficient professional and scientific thought has been given to the relation of the lower serum levels of the aforementioned minerals and the morbidity and mortality incidence. We have researched the relation between lower serum calcium level (hypocalcaemia) and the complication incidence, especially infection. Throughout the time period of 18 months, 120 haemodialysis uremic patients were observed and 76 (63.3%) of them had serum calcium level below the lower threshold of referent values (9.0-9.5 mg/dL). In the patients with a lower serum calcium level (hypocalcaemia) a significant infection incidence (chi2 = 3.99; p = 0.0468), a significant sepses incidence (chi2 = 8.016; p = 0.04), a significant total complication incidence (p < 0.05) were determined, as well as a higher vascular access local infection incidence, but without statistically significant research results of this relation (chi2 = 0.098; p = 0.7598). We are of the belief that the incidence of the vascular access local infection should be examined on a greater number of patients; therefore, the significance of the examined relation in such an instance would be expected. The total infection incidence in all 120 observed patients is 3.8 for 100 months. It is to be concluded that the research findings indicate the association regarding the appearance of low serum calcium concentration (hypocalcaemia) and an increased complication incidence, especially the inflammation that leads to the requirement of further research in order to decrease morbidity, and consequently also the mortality of the observed population of patients by means of programmed therapy approach.

Hypoalbuminemia and complication incidence in hemodialysed uremic patients.

Discussions whether hypoalbuminemia is just a marker for the malnutrition-inflammation syndrome as well as for the increased morbidity and mortality of those patients or is it an etiological factor, are becoming more and more intense. In this research of the relation between hypoalbuminemia and the complications that threaten the vascular access with special reference to infection, and consequently to the life of the patients treated with chronic haemodialysis, we have chosen 120 patients with terminal renal insufficiency (ESRD) treated at the Clinical Hospital Mostar by chronic haemodialysis. The chosen patients for this study were observed throughout a time period of 18 months. Only the patients who, at the moment of starting the research did not exhibit either a local or a systemic infection, as well as no signs of any other complication that might have endangered the vascular access and consequently the life of the patient, were selected. From the 120 (100.0%) patients, 86.8% of them had a serum albumin level below 40.0 g/L. By analysing the research results of the clinical material, it has been established that in patients with serum albumin level below 40.0 g/L, the infection incidence was significantly higher than in those patients with the albumin level above 40.0 g/L (chi2 = 7.215 P = 0.0077). The complication incidence is significantly higher (chi2 = 9.92 P = 0.0022) among the patients with serum albumin level below 40.0 g/L, than in those patients with higher serum level. Among the patients with a serum albumin level lower than 40.0 g/L, the sepses incidence was significantly higher (chi2 = 4.77 P = 0.03), than among those patients with a serum albumin level above this value. However, the difference in incidence of local infection of the vascular access between the group of patients with a serum albumin level below 40.0 g/L and those patients with albumin level above this value is not significant (chi2 = 0.65 P = 0.69). The total infection incidence in the 120 observed patients was 3.8 episodes per 100 patient months, and within the parameters mentioned by other authors.

Abdominal pain patient referrals to emergency surgical service: appropriateness of diagnosis and attitudes of general practitioners.

This study evaluate the need for general practitioners referrals and self referrals of acute abdominal pain patients to emergency surgical service, the appropriateness of GP referral diagnosis and their attitudes dealing with abdominal pain. In three months period all acute abdominal pain patient referrals to our hospital emergency surgical service were audited. Data on final diagnosis, surgical treatment, admission to hospital and surgery performance were recorded. Self referral or GP referral, referring GP diagnosis, referral letters indicating presenting complaint or history, axillar and rectal temperature measurement, laboratory checking and abdominal radiography checking by GP were recorded as well. Also, GPs examination details as palpation, auscultation and digit-rectal checking were recorded. We calculated sensitivity, specificity, positive and negative predictive value (PV) for referring diagnosis. Self referrals and GP referrals differences were evaluated. During the study 318 patients were admitted. A total of 163 (51.25%) referrals were deemed inappropriate; 102 (52.6% of GP referrals) and 61 (49.2% of self referred) (p < 0.05). There were no differences in general treatment, hospital admission and operative treatment in self referred and GP referred groups (p < 0.05 for all three categories). Sensitivity, specificity, positive and negative predictive values for most frequent GP referral diagnoses were: abdominal colic/abdomen in observation 0.78; 0.66; 0.74; 0.70; acute appendicitis 0.37; 0.92; 0.44; 0.90; acute abdomen/peritonitis 0.30; 0.97; 0.54; 0.92; constipation 0.95; 0.98; 0.85; 0.99; and ileus 0.83; 0.97; 0.50; 0.99. Data on GP including clinical examination, patient history and running basic diagnostics were poor. Our results suggest that a general agreement within the profession about what constitutes a necessary hospital referral is necessary. GP consultation quality must be improved by booking more time per patient and by giving more medical/technical attention to patients.

The advantages of end-to-side arteriovenous anastomosis over the other two types of arteriovenous anastomosis in dialysis patients.

The functional duration of vascular access in dialysis patients depends on the emergence of threatening complications. Discussions are constantly being held in an attempt to discover their causality and decrease their emergence. In 260 patients undergoing haemodialysis, we have studied the potential existence of a cause-and-effect relation between the emergence of complications in the vascular access and the applied type of arteriovenous (av.) anastomosis in the arteriovenous (AV) fistula. We have observed the incidence of all complications, both that of the thrombosis incidence as well as the primary and secondary fistula patency (survival). The complications--The examinees with the end-to-end anastomosis showed the incidence of 8.08%, 6.15% of the patients with the end-to-side anastomosis and 7.31% of the patients with the side-to-side anastomosis. The differences regarding incidences are statistically significant (chi2-test = 29.25; P = 0.0001). Thrombosis--it has been found that thrombosis was the most frequent complication developing in 30.00% patients with the end-to-end av. anastomosis, in 2.31% patients with end-to-side av. anastomosis and in 5.56% patients with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 27.69%, and it is statistically relevant (chi2-test = 33.920; P = 0.0001). The primary patency (primary survival): within a 6-month interval following the establishment of vascular access, the first complications arose in 62.50% of patients with end-to-end av. anastomosis, 10.76% in those with end-to-side av. anastomosis and 18.88% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 51.74%, which is statistically significant (chi2-test = 49.009; P = 0.0001). The secondary patency: 24 months subsequent to the establishment of vascular access, the AV-fistula was still functional in 52.50% of the patients with end-to-end av. anastomosis, 89.23% in those with end-to-side av. anastomosis and 81.11% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 36.73%, which is also statistically significant (chi2-test = 26.579; P = 0.0001). According to our research, the end--to-side type of av. anastomosis in vascular access provides better results both in relation to the duration as well as the maintenance of the functionality of the Av-fistula and in the lower incidence of the complications than the other types, and hence it shows a definite advantage.

The quality of life during the treatment of long bone fractures in children and adolescents.

This paper evaluates and compares basic emotional reactions towards the illness, as well as the quality of life in relation to the various types of treatment of isolated long tubular bone fractures of extremities in children and adolescents. This prospective clinical research comprehends 135 patients (94 males and 41 females), aged 10 to 18, treated for the mentioned bone fractures in the period from October 2003 till March 2005 at The Departments for Pediatric Surgery of three hospitals: the Clinical Hospital Centre in Rijeka (88.8% of the patients), the Clinical Children's Hospital in Zagreb (9.7% of the patients) both in Croatia, and 1.5% of the patients in the Clinical Hospital in Mostar (Bosnia and Herzegovina). 53.3% of the patients were treated conservatively, 29.6% of them underwent the elastic stable intramedullary nailing (ESIN), while the remaining 17.1% of the patients were treated with other surgical techniques (AO-plates or Kirschner-wire ostheosyntheses). The basic methods were self-reported questionnaires: the Spielberg State Trait Anxiety Inventory (STAIl) to establish momentary anxiety and the Short Form-36 Health Survey (SF-36) to evaluate quality of life, i.e. the perception of the illness during treatment. The STAI1 was administered twice to the patients: within 1 week of the experienced trauma (at baseline) and 6 months after the trauma, whereas the SF-36 was administered only once, i.e. a month after the experienced trauma. Our results point at an increased anxiety indicators in all the patients immediately after the experienced trauma, mostly in patients treated surgically, especially those who underwent the ESIN method; whereas after 6 months from the experienced trauma the anxiety indicators were greatly reduced. The quality of life was better in patients who underwent a conservative treatment, both physically and mentally, than in those surgically treated. This points to the fact that the surgical method itself despite its type, is an additional stressor which causes additional anxiety and depressive reaction. Our results suggest (from psychological point of view) that the conservative method of treating long bone fractures in children and adolescents should be used since it causes less emotional reactions on the illness ascertaining a better health experience during the treatment than the active surgical treatment (regardless of the type), which should be practised with criticism and according to strict surgical indications. If the surgical treatment should be necessarily adopted, we should take into consideration the possibility of psychologically preparing the patients in order to diminish the psychological reaction on the surgical treatment.

Burkitt's lymphoma in the boy: infiltration in the stomach, colon and the retroperitoneum--ileocecal invagination.

A 4-year-old boy was hospitalised because showing signs of weakness, slight pain in the abdomen and while urinating. The symptoms occurred 7 days before hospitalisation. The boy did not vomit, nor did he have the urge to vomit, the defecation was regular showing no traces of blood. The physical visit a soft and painless tumefaction was confirmed ileocecally. The echography tests and the computed tomography suggested invagination, not excluding the second substrate. Barium enema showed irreductible invagination. The operative test showed that it was about the ileocolic invagination with extreme thickening of the cecum, the ascedental colon, the intestine and the retroperitoneum walls. A resection of the small intestine and a ileocolic anastomosis was performed. The pathohistological test shows the primar abdominal Burkitt's lymphoma. In spite of the subsequent therapy the boy dies three weeks after the first symptoms' manifestation. We, herewith, suggest at the importance of the echography analysis when diagnosing the Burkitt's tumor and give advantage to this analysis against the computerized tomography. We also point at the huge level of malignancy of the Burkitt's tumor in this boy.