Rehabilitation outcome following war-related transtibial amputation in Kosovo.

BACKGROUND: Previous literature has suggested that age, level of amputation, residual limb length, comorbidities, mental disorders, and cause of amputation can affect the ability to successfully ambulate with prosthesis. OBJECTIVES: The objective of this study was to analyze the predictors that affect the rehabilitation outcome of war-related transtibial amputees and the relationship of these factors with ambulation ability after prosthetic fitting. STUDY DESIGN: Retrospective observational study. METHODS: We reviewed the records of 69 war-related transtibial amputees. The rehabilitation outcome was analyzed according to the grade of rehabilitation summarized in three grades. Multiple logistic regression analysis was used to determine the odds of achieving the first rehabilitation grade. RESULTS: The majority of patients with transtibial amputations achieved the first grade of rehabilitation (59.4%). The factors that significantly influenced the achievement of the first grade of rehabilitation were age and absence of posttraumatic stress disorder. For every 1-year increase in patient age, the odds of achieving first grade of rehabilitation decreased by a factor of 0.9. Patients without posttraumatic stress disorder had 12.9 greater odds of achieving the first rehabilitation grade compared to patients with posttraumatic stress disorder. CONCLUSION: Achievement of the first grade of rehabilitation among war-related transtibial amputees is dependent on patient age and the absence of posttraumatic stress disorder. CLINICAL RELEVANCE: Understanding the factors that may affect the rehabilitation outcome of war-related amputees could lead to a more specific organization of the rehabilitation, especially in a country that has recently been involved in war. This is the first study to focus on determinants of prosthetic rehabilitation in these patients.

Rehabilitation of patients with war-related lower limb amputations.

AIM: To investigate the influence of factors: the amputation type and the time lag between last surgery and prosthetic rehabilitation, on the rehabilitation duration and outcome, in patients with war-related lower limb amputations. METHODS AND SUBJECTS: We reviewed the records of 101 war-related lower limb amputees who had inpatient rehabilitation at the National Ortho-Prosthetic Centre (NOPC) of Kosovo in Pristina, from July 1999 to June 2001, a retrospective observational study. Assessment of rehabilitation outcome-ambulation grade with prosthesis, is made on a 3-point scale. RESULTS: The amputation type was shown as an important predictor for the rehabilitation duration and outcome. The analysis by comparative groups has confirmed the amputation type to be of biggest importance. Earlier prosthetic rehabilitation, was shown as a factor of influence on the rehabilitation duration in all cases (r=0.22, P=0.027). This predictor was not relevant for the rehabilitation outcome. The most frequent type of prosthesis manufactured for the amputees, was the patellar tendon bearing below-knee prosthesis with suspension band (36.9%). CONCLUSION: Amputation of the limb should be performed as low as possible. If there are possibilities for prosthetic rehabilitation, any delays must be avoided, particularly in war-related lower limb amputees.

Low back pain predict sickness absence among power plant workers.

BACKGROUND: Low back pain (LBP) remains the predominant occupational health problem in most industrialized countries and low-income countries. Both work characteristics and individual factors have been identified as risk factors. More knowledge about the predictors of sickness absence from LBP in the industry will be valuable in determining strategies for prevention. OBJECTIVES: The aim of this longitudinal study was to investigate whether individual, work-related physical risk factors were involved in the occurrence of LBP sickness absence. METHODS: A follow-up study was conducted among 489 workers, aged 18-65 years, at Kosovo Energetic Corporation in Kosovo. This cross-sectional study used a self-administered questionnaire to collect data on individual and work-related risk factors and the occurrence of LBP sickness absence. Logistic regression models were used to determine associations between risk factors and the occurrence of sickness absence due to LBP. RESULTS: Individual factors did not influence sickness absence, whereas work-related physical factors showed strong associations with sickness absence. The main risk factors for sickness absence due to LBP among production workers were extreme trunk flexion (OR = 1.71, 95% CI = 1.05-2.78) as well as very extreme trunk flexion (OR = 6.04, 95% CI = 1.12-32.49) and exposure to whole-body vibration (OR = 1.75, 95% CI = 1.04-2.95). CONCLUSION: Reducing sickness absence from LBP among power plant workers requires focusing on the working conditions of blue-collar workers and risk factors for LBP. Increasing social support in the work environment may have effects in reducing sickness absence from LBP.

Tuberculous meningoencephalitis.

Tuberculous meningitis is an infection of the the membranes covering the brain and spinal cord (meninges). Tuberculous meningitis is a major global health problem and is the most severe form of extrapulmonary tuberculosis, with high rate mortality. Last years in Kosovo incidence of TB was decreased in less than 1000 cases per year and 10-20 cases per year of TB meningoencephalitis. Still Kosovo has limited numbers of TB. TBM is diagnosed on the basis of clinical features, cerebrospinal fluid (CSF) studies, and radiological findings. Clinical picture, neurological status, anamnestic data, suspect (but not specific) lab tests, and imaging new methods, together can give very valuable help to clinicians for early adequate and successful treatment.

Thrombosis of the superior sagittal sinus.

Thrombosis of the sinuses is a distinct cerebrovascular disorder that, unlike arterial stroke, most often affects young adults and children. The symptoms and clinical course are highly variable. During the past decade, increased awareness of the diagnosis, improved neuro-imaging techniques, and more effective treatment have improved the prognosis. More than 80% of all patients now have a good neurologic outcome. This review summarizes recent insights into the pathogenesis of sinus thrombosis, risk factors, and clinical and radiological diagnosis and discusses the current evidence and controversies about the best treatment.