POSTOPERATIVE INFECTIONS AFTER POSTERIOR SPONDYLODESIS OF THORACIC AND LUMBAL SPINE. SURGICAL SPINE INFECTIONS

Background: Postoperative infection after posterior spondylodesis of thoracic and lumbal spine is the most common complication, and a reason for revision surgery. Aim of this work is to analyze rate of postoperative spine infections at our institution, and to determine eventual risk factors. Subjects and methods: In our paper we analyze incidence of deep surgical infections after posterior spondylodesis, performed on our Spine department during last 5 years (September 1, 2008 – September 1, 2013). Including criteria were: posterior spondylodesis with transpedicular screws from Th1 to S2 due to different spine indications (injuries, degenerations, deformities, tumors), absence of local or general infection prior the index surgery, surgery performed by the same surgeon (MB). Excluding criteria were: needle procedures (kypho/vertebro-plasties, nerve root and faset blocades), anterior spine surgeries, cervical spine surgeries, and decompresive surgeries. Results: One hundred sixty five patients with 183 surgeries have been included in this study. Early surgical infection (within a month after the surgery) has appeared at five patients (2.7%). There have been no late surgical infections. Analyzing patients’ charts, we have found that Meticillin-susceptible Staphylococcus aureus (MSSA) and Methicillin-resistant Staphylococcus aureus (MRSA) have caused infections in two patients, while Clebisiela pneumoniae ESBL has caused infection in one patient. Those five patients with infections have had further risk factors: long preoperative hospitalization at four patients, polytrauma, diabetes and advanced age at one patient, each. Three patients with postoperative infection had completely non-titanium surface of implants, and other two had about 20% of non-titanium implant surface, although vast majority of surgeries have been performed by implants whose surface was completely titanium alloy. Infections have appeared between 10-30 postoperative days. In two patients where revision surgeries (debridement, drainage, antibiotic according the species) had been performed in two weeks after appearance of infection, infections have been cured. In three patients where revisions had been postponed for longer than two weeks, additional surgeries (removal of implants) were necessary for curing the infections. Conclusions: This study presented that rate of infection, microbiological species and risk factors are similar to the other orthopedics procedures and other institutions. Early revision is preferable, since it effectively avoids implant removal

Immigrant patients in brief meetings with anaesthetist nurses - experiences from perioperative meetings in the orthopaedic setting

Aim To explore the experience of anaesthetist nurses in brief meetings with immigrant patients in the perioperative setting. Methods The study was conducted through open individualised interviews using open-ended questions. Eighteen anaesthetist nurses (six men and twelve women) participated in the interviews. Their age varied between 35 and 65 and they had worked as anaesthetist nurses for a period between six and twenty eight years. The text was analysed using qualitative content analysis. Results Meetings with immigrant patients made nurses with less experience to prepare more, to study behaviour of these patients and to ask their older colleagues for advice. More experienced nurses acted on the basis of their previous experience and treated the patients in the same way as before. They also emphasised the great responsibility and wider scope of assistance needed by these patients than those born in Sweden. The majority of nurses begin the meetings with these patients by requesting an interpreter, while some nurses begin the meeting directly with the patient and, if they see it is not going well, they request an interpreter. Conclusion Nurses need better guidelines and education in how to deal with the legislation relating to immigrant patients in order to handle the situation more effectively. Training in cross-cultural care should be improved to help nurses deal with stress through co-operation with the Migration Board and others. In order to provide for good communication and patient safety professional interpreters should be used

Increased mean platelet volume is associated with acute myocardial infarction in patients with diabetes mellitus type 2

Background: The correlation between diabetes mellitus and acute myocardial infarction is greater every day. The mean platelet volume (MPV), which is the determinant of platelet function, is an independent risk factor for the cardiovascular disease. The aim of the study was to investigate the effect of each disease (hypothyroidism, hypertension, myocardial infarction) individually and combined on MPV in diabetic patients.Methods: The cross-sectional study included 102 patients who suffer from diabetes mellitus type 2 (DMT2), of both sexes (46 females, 56 males), with the average age of 58.91 (SD=12.93). All the patients were treated at the Primary Health Centre in Zenica from May to July 2017. All patients had diabetes mellitus and the disease had lasted for 10 years in both sexes.Results: Mean platelet volume was significantly higher in patients with myocardial infarction than in those without myocardial infarction. Age, sex, HbA1c, BMI, lipids and platelet count did not show any significance in either group of patients. Regression analysis showed that the prevalence of myocardial infarction had the highest predictive significance for MPV values, (predictor importance 0.49; coefficient 1.275, p<0.001).Conclusions: Mean platelet volume was significantly higher in patients with diabetes mellitus and myocardial infarction than in DM patients without myocardial infarction. Regression analysis showed correlation with acute myocardial infarction in patients with DMT2, but not with other chronic illnesses. The highest platelet volume indices were observed in patients with myocardial infarction. MPV can be used as a specific indicator in diabetic patients with myocardial infarction.  

Ethnic differences in the perception of pain: a systematic review of qualitative and quantitative research

Aim To investigate existence of scientific support for linking differences in the experience of pain to ethnicity. Methods The study was designed as a systematic literature review of qualitative and quantitative studies. The inclusion criteria were scientific studies published in scientific journals and written in English. Studies that described children’s experiences and animals were excluded. There were 10 studies, one qualitative and nine quantitative. Results The result was divided into two main sections. The first section presents the results of investigated material regarding different ethnic groups, the groups’ different experiences with regard to pain and its treatment focusing entirely on the patients’ perspective. Several studies have revealed major differences in the way individuals perceive their pain, using various pain evaluation tools. The second section explained different coping strategies depending on ethnicity and showed that different ethnic groups handle their pain in different ways. Conclusion Healthcare professionals have a duty to pay attention to and understand the patients’ experience of their disease and suffering and, as far as possible, mitigate this using appropriate measures. For this purpose, ethnic, cultural and religious differences between different patients need to be understood. It is necessary to continue to study ethnic differences in reporting and predicting pain and its consequences, including the assessment of variables associated with pain, as well as examining the use of prayer as a form of dealing with pain, with an evaluation of various effects of such different influences

The Radiological Estimation of Vertebral Body Volumes on the Thoracic and Lumbal Spine: Radiological Estimation of Vertebral Body Volumes

The aim of this work is to radiologicaly estimate the width, height and depth of bodies of thoracic and lumbal vertebras. Charts of one hundred and seventeen patients with implanted internal fixateur on the thoracic and lumbal spine, between 01.01.2008. and 31.3.2010. at the Department of Orthopedics and Traumatology - Clinical centre Sarajevo, were retrieved, and only 14 patients, with totally 46 vetrtebras have meet including criteria (clearly visible measured structures on X-ray and CT scans, and data about implants dimensions). Digitalized anteroposterior and laterolateral X ray, and transversal and sagital CT scans were basic inputs for measurement of height, width and depth of the vertebral body - CH, CW, CD. The correction of enlargement on X-ray pictures was performed according to known dimensions of implants and the length scale on CT scans. Enlargement of those parameters, from T1 to L5 spine level was from 60 to 100%, except the stagnation in the mid-thoracic region, and decreasing of corporal depth on the L5 vertebra (CD/L5), in comparison to the fourth vertebra (CD/L4). The clinical importance of this work is in estimation and comparison of dimensions of vertebral bodies measured on X ray and CT scans, as the basic inputs during surgical procedures of vertebroplasty and anterior spondilodesis

The effect of changing one’s country of residence on the decision to become an organ donor: the experience of religious immigrant women living in Sweden

Aim To explore and elucidate women’s knowledge of and willingness to take part in organ donation, and to explore if their opinions were changed by coming to Sweden. Methods The study was designed as a qualitative study using data from interviews with women from Bosnia and Herzegovina, Macedonia, Croatia and Kosovo. The inclusion criteria were women who were immigrants in Sweden and have lived in Sweden for more than 10 years. Five groups including forty-five women were invited to participate in the study and 39 agreed. The women were aged 29 to 73 years (mean 52.5 years). Results Regarding knowledge and information about organ donation, most women found it very important to be able to talk about such things. However, the knowledge and information about organ donation of almost all the women was at a very low level. None of the women changed their opinion on the organ donation and attitudes from their countries of origin. All women firmly emphasized and explained that by coming to another state they do not become a different person and retain all values they had and with which were born in home country. Conclusion It is important to study how to find new ways to communicate and work with minorities and vulnerable groups in order to discuss organ donation with all those who could be potential donors in the Swedish health care system

The predictive value of the clinical sign of limited hip abduction for developmental dysplasia of the hip (DDH)

Aim To assess the relationship between the clinical sign of limited hip abduction and developmental dysplasia of the hip (DDH). Methods A research was conducted on 450 newborns at the Neonatal Unit at the Clinic of Gynaecology and Obstetrics and the Orthopaedics and Traumatology Clinic of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns’ hips were performed using the Graf method on their first day of life. Results Clinical sign of limited hip abduction showed significant predictive value for DDH. There were 67 (14.7%) newborns with the clinical sign of limited hip abduction, of which 26 (5.7%) were on the left hip, 11 (2.4%) on the right hip and 30 (6.6%) on both hips. Limited hip abduction had a positive predictive value (PPV) of 40.3% and a negative predictive value (NPV) of 80.4% for DDH. Conclusion Limited hip abduction, especially unilateral, is a useful and important clinical sign of DDH. Doctors, who perform the first examination of the child after birth, would have to pay attention to this clinical sign. Newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis