Sanamed

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Authors: Zulic Evlijana, Hadzic Devleta

Introduction: Reasons for acute renal failure in hospitalized infants were sepsis, hypovolemia, asphyxia, respiratory distress syndrome, surgical interventions and congenital heart defects. The aim of this study was to determine the frequency and main etiologies, and early outcome of neonatal acute renal failure. Materials and Methods: At Intensive Care Unit, Clinical Center Tuzla, from 15. 01. 2013 to 15. 01. 2015 in 21 newborn was diagnosed renal failure, based on the amount of excreted urine and serum creatinine. Results: The prevalence of renal failure was 6.84%, with a higher incidence of female. 33.3% of infants were term neonates. Oliguria was diagnosed in 71.4% of newborns. Sepsis was the most common predisposing factor for the development of renal failure, associated with high mortality. Other causes of renal failure were perinatal hypoxia, RDS, surgical interventions and congenital heart defects. There was a positive correlation between the gestational age of the newborn and serum creatinine. Discussion: Early prevention of risk factors with rapid diagnosis and effective treatment, can affect further outcome of acute renal failure in infants.

5

Authors: Ljaljevic Agima, Scepanovic Lidija, Mugosa Boban, Catic Sabina

Introduction: The aim of this study was to determine perceptions of service providers in the healthcare on their awareness and knowledge about HIV/AIDS, as well as the relationship of the above parameters and the existence of stigma and discrimination against people with HIV/AIDS. Method: The type of the study was a behavioral cross sectional study. The survey was conducted in 2012, on a representative sample of health workers in Montenegro. The main survey instrument was specifically designed questionnaire that consisted of six parts, out of which one was related to knowledge about HIV and AIDS. Data were analyzed by methods of inferential statistics. Results: More than four out of ten respondents have never attended educational workshops on HIV/AIDS. Research has shown that there is a highly significant statistical correlation between estimates of their own knowledge about HIV / AIDS and previous educations. Almost two-thirds of respondents, who attended some type of education in the field of HIV/AIDS, believe to have a satisfactory level of knowledge in the area. Conclusion: Health care service providers evaluate their knowledge of HIV/AIDS as insufficient.

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Authors: Zenev Ivan , Sapundzhiev Nikolay

Background: Definitive enlargement of the glottis with preservation of adequate voicing in patients with bilateral recurrent nerve paralysis remains a surgical challenge especially in patients with previous unsuccessful surgery. Study design: Report of a novel surgical technique for glottis enlargement and presentation of midterm results. Methods: Four adult patients with bilateral recurrent nerve paralysis were subjected to submucosal arytenoidcordectomy through a thyreofissure approach with ventricular folds transposition and long-term translaryngeal stenting. Two of them had had previous surgeries at the glottic level. Preoperative data as well as postoperative functional results are reviewed. Follow-up ranged from 8 to 28 months. Results: In all patients tracheostomy closure was achieved. Midterm follow-up revealed stable airway, adequate for the patients' routine physical activities. Postoperatively patients phonated with the ventricular folds and the resulting voice quality was good. Conclusions: We describe a novel approach formanagement of impaired airway because of bilateral recurrent nerve paralysis and/or stenosis. It comprises intralaryngeal soft tissue resection, enlargement of the cartilaginous framework of the larynx and long-term translaryngeal stenting. The surgical approach described here proved to be successful both in patientswith simple bilateral vocal fold motion impairment and in those, who have been already unsuccessfully treated with other surgery. Nevertheless the technique should be regarded as an option only in complicated revision cases, rather than a primary intervention in bilateral vocal fold paralysis.

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Authors: Skokic Fahrija , Hotic Nesad, Muratovic Selma, Skokic Maida, Hadzic Devleta, Cosickic Almira, Selimovic Amela, Zulic Evlijana, Meric Alma, Halilbasic Amir

Introduction: Despite growing progress of perinatal medicine and perinatal care, between 9-19% of preterm infants are born each year. Improvement in survival of infants and the reduction in infant mortality rates is a key role of perinatal quality healthcare. The Aim: To evaluate the perinatal outcome of preterm infants in maternity wards of the Federation of Bosnia and Herzegovina for a period of one year. Material and methods: Of 22 897 live newborns, the research criteria matched 669 (2.9%) preterm infants with complete medical records in ten cantons of the Federation Bosnia and Herzegovina. We analyzed data from maternity wards documentation and discharge letters from tertiary health care centers. Results: Most deliveries were in the Tuzla and Sarajevo Canton with 42.5% of preterm infants. The mean gestational age of preterm infants was 31.4 weeks, with SD ± 5.34, and the mean birth weight 1295 grams, SD ± 234.2. The mean Apgar score was 4.6 ± 2.1, and in the fifth minute 6.6 ± 1.9.Of 669 examinees, there were 345 (51.56%) males and 324 (48.44%) females (51.56 vs 48.44; χ 2 = 1.19; P = 0.27). By analyzing the frequency of preterm infant birth rate according to weight categories, we found a significant difference in some levels of perinatal health institution, between the 1st and 2nd institutions levels (1.76% vs 3.01%; P< 0.0001), also between 2nd and 3rd institutions levels (3.01% vs 3.03%; P < 0.0002), and between 1st and 3rd institutions levels (1.76% vs 3.03%; P < 0.0001). A significant statistical difference in survival of tested newborns was found in institutions of 3rd level χ 2 = 49.25; P < 0.0001 with a low risk for unfavorable outcome [OR = 0.436; 95%CI (0.346-0.550)]. Conclusion: Perinatal outcome of preterm infants in the Federation Bosnia and Herzegovina significantly depends on the level of perinatal health care. Survival rate of infants born in the institutions of the 3rd level was statistically much higher than the survival rate of infants who were born in the 1st and the 2nd level institutions.

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Authors: Jovanovic Dusan, Loncar Zlatibor, Doklestic Krstina, Karamarkovic Aleksandar

Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic - treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. 'Source control' is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections.