Cantonal Hospital Zenica Research Articles

Basic biochemical and hematological parameters in COVID-19 deceased: Analysis of potential mortality predictors

Introduction: As a result of research conducted globally, experts continue to extensively study the long-term consequences that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can have on patients, as well as the factors contributing to severe outcomes. The aim of this study was to investigate the values of basic biochemical and hematological parameters in patients with fatal outcomes of SARS-CoV-2 infection, as well as to determine the combination of hematological and biochemical parameters that contribute to the progression of SARS-CoV-2 infection. The examined parameters were correlated with the age and gender distribution of patients with fatal outcomes from the SARS-CoV-2 infection. Methods: The study represents a retrospective study of patients hospitalized at the Cantonal Hospital Zenica from February to April 2021, focusing on the biochemical and hematological parameters of subjects with confirmed presence of the SARS-CoV-2 virus using the reverse transcription-polymerase chain reaction methods who were hospitalized at the Cantonal Hospital Zenica. Results: Of the 250 deceased subjects in the sample, females comprised the relative majority at 53.6%. Among the examined parameters, hemoglobin, mean corpuscular hemoglobin (MCH), and MCH were significantly lower in females compared to males, while males had significantly higher values of urea, creatinine, and troponin. The average age of the patients was 74 years, and with aging, the values of erythrocytes, hemoglobin, and troponin increased. Troponin showed a statistically significant positive correlation with age, as well as with urea and creatinine. Conclusion: We can conclude that hemoglobin, urea, creatinine, and troponin are parameters that can be considered to contribute to the progression of SARS-CoV-2 infection. These parameters can be useful for assessing disease severity and prognosis in patients infected with the SARS-CoV-2 virus.

Morphometric and Ki-67 proliferative index-related characteristics of meningiomas and their correlation with demographic, clinical, histopathological, and postoperative features

<p><strong>Aim<br /></strong> To investigate the correlations between tumour characteristics, symptoms, intraoperative findings, and outcomes in patient<br />with meningioma.<br /><strong>Methods<br /></strong> A retrospective study was conducted on 86 surgically treated patients at Department of Neurosurgery of Cantonal Hospital Zenica from 2010 to 2020. Patients with intracranial meningiomas underwent neurological evaluation and MRI scans to analyse tumour characteristics, including volume (TV), peritumoral brain oedema (PTBE) and oedema index (EI). Surgical treatment was performed, followed by postoperative MRI and outcome assessment. Intraoperatively, the tumour’s relationship with cortex, pial membrane, skull bones, and sinuses was evaluated, and the extent of tumour resection was graded. Meningioma samples underwent histopathological analysis to assess the grade and regularity of borders, and Ki-67 labelling index was determined using<br />immunohistochemistry. <br /><strong>Results</strong> <br />Significant correlations were found between PTBE and Ki67 expression (p<0.001), PTBE and vomiting/nausea (p=0.002), cognitive impairment (p=0.047), venous compression (p=0.001), cortical, pial and dural invasion (p<0.05), and the postoperative presence of oedema (p=0.002). Venous compression, cortical, pial, dural and bone invasion positively correlated with Ki-67 expression (p<0.001). Grade and tumour border positively correlated with Ki-67 expression (p<0.001). Oedema persistence postoperatively showed a positive correlation with Ki-67 expression (p<0.001).<br /><strong>Conclusion</strong> <br />The study revealed significant correlations between Ki-67 expression and PTBE, with notable associations with clinical symptoms, tumour characteristics, and postoperative oedema presence.</p>

Histopathological spectrum of lumbar disc changes in obesity: analysis of intervertebral discs in lumbar hernia patients in Zenica-Doboj Canton, Bosnia and Herzegovina

<p><strong>Aim</strong> <br />To investigate the correlation of body mass index (BMI) with severity of intervertebral disc degeneration.<br /><strong>Methods <br /></strong>The study enrolled patients who had undergone surgical intervention for a herniated disc at the Department of Neurosurgery of the Cantonal Hospital Zenica. Patients underwent thorough preoperative evaluation, including medical history, neurological and physical assessments, and radiological analysis. The surgical intervention consisted of a posterior lumbar discectomy, and the excised disc material was preserved and subjected to histopathological analysis based on Histopathologic Degeneration Score (HDS). Patients were divided in two groups according to Body Mass Index (BMI): study group with BMI≥25 and control group with BMI<25.<br /><strong>Results</strong> <br />Among 69 patients with herniated IVD, 26 (37.7%) were with BMI≥25 (study group), and 43 (62.3%) were with BMI<25<br />(controls). The study group displayed substantial increase in height, 1.80±0.06 m compared to controls, 1.74±0.06 m (p=0.001). Weight and BMI were significantly higher in the study group of patients (weight: 91.60±10.22 vs. 67.37±9.20 kg, BMI: 28±2 vs. 22±2; p<0.001). Differences were confirmed in HDS values in the study group comparing to the control group (p<0.001). The study group exhibited significant differences in chondrocyte proliferation, tears and clefts, granular changes, and mucous degeneration (p<0.05), and positive correlations were found between BMI and<br />these alterations found in the herniated discs (p<0.05). Therefore, HDS showed positive correlations with BMI (R=0.599; p<0.001) and weight (R=0.696; p<0.001).<br /><strong>Conclusion</strong> <br />The study's findings confirmed that BMI has a significant impact on intervertebral disc degeneration, emphasizing the<br />importance of weight management in preventing disc degeneration.</p>

Breaking Barriers in Cranioplasty: 3D Printing in Low and Middle-Income Settings-Insights from Zenica, Bosnia and Herzegovina.

Background and Objectives: Cranial defects pose significant challenges in low and middle-income countries (LIMCs), necessitating innovative and cost-effective craniofacial reconstruction strategies. The purpose of this study was to present the Bosnia and Herzegovina model, showcasing the potential of a multidisciplinary team and 3D-based technologies, particularly PMMA implants, to address cranial defects in a resource-limited setting. Materials and Methods: An observational, non-experimental prospective investigation involved three cases of cranioplasty at the Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina, between 2019 and 2023. The technical process included 3D imaging and modeling with MIMICS software (version 10.01), 3D printing of the prototype, mold construction and intraoperative modification for precise implant fitting. Results: The Bosnia and Herzegovina model demonstrated successful outcomes in cranioplasty, with PMMA implants proving cost-effective and efficient in addressing cranial defects. Intraoperative modification contributed to reduced costs and potential complications, while the multidisciplinary approach and 3D-based technologies facilitated accurate reconstruction. Conclusions: The Bosnia and Herzegovina model showcases a cost-effective and efficient approach for craniofacial reconstruction in LIMICs. Collaborative efforts, 3D-based technologies, and PMMA implants contribute to successful outcomes. Further research is needed to validate sustained benefits and enhance craniofacial reconstruction strategies in resource-constrained settings.

Rijetki slučaj empijema cavum septi pellucidi i principi neurokirurškog zbrinjavanja

Aim: To present a very rare case of empyema cavuma septi pellucidi. Case report: A 5-year-old male child was admitted to the Department of Infectious Diseases Cantonal Hospital Zenica because of fever (38.30C), headache and vomiting. The patient developed intracranial hypertension as a result of a compressive purulent collection formed due to meningitis between the lamine of the septum pelucidum with consequent intracranial hypertension. Conclusion: The decision regarding the modality of treatment was not easy. We considered that empyema evacuation using the transcallosalinterhemispheric approach allows the complete removal of purulent collection and the placement of drainage, which allows additional emptying of the empyema cavity and prevents empyema recurrence. Empyema evacuation with drainage and antibiotic therapy have shown beneficial results.

Magnetic resonance morphometry of the lumbar spinal canal in Zenica - Doboj Canton in Bosnia and Herzegovina.

Aim To investigate morphometric determinants of lumbar canal in patients treated in Cantonal Hospital Zenica, and their variation according to gender. Methods Morphometry of lumbar spinal canal was assessed in 52 patients treated at the Department of Neurosurgery of Cantonal Hospital Zenica in the period between September 2022 and November 2022. Data were collected retrospectively: anteroposterior and transverse diameter of lumbar vertebrae and intervertebral discs, as well as anteroposterior diameter of the spinal canal. Results Gender appeared to be an important morphometric determinant, since it significantly differed when it comes to lumbar vertebral anteroposterior and transverse diameter, being mostly larger in males. Conclusion This study increases anatomical knowledge of the vertebras and spinal canal of the lumbar region. Therefore, the measured dimensions of the lumbar vertebrae and spinal canal could be used as a baseline point for evaluation of patients presenting with low back pain and potential spinal canal stenosis.

Cardiac findings in multisystem inflammatory syndrome in children (MIS-C) – single institution experience

Abstract Background Multisystem inflammatory syndrome in children (MIS-C), associated with coronavirus disease 2019 (COVID-19) is a rare but serious condition, affecting children mostly after acute SARS CoV2 infection. MIS-C presents with fever, laboratory evidence of inflammation, and multiorgan dysfunction, including heart. Purpose We analized the degree of cardiac involvement and clinical outcomes of MIS-C patients hospitalized in Pediatric department of Cantonal hospital Zenica, to compare with previously reported findings. Methods Cardiac testing results in pediatric patients hospitalized with MIS-C from November 2020. until March 2022. were retrospectively analized. For this study, MIS-C patients with positive cardiac testing were defined as having an abnormality of one or more of the following on admission: cardiac biomarkers, electrocardiogram, and/or echocardiogram. Results Cardiac abnormal findings were present in almost all of our ten patients with MIS-C, but the extent of cardial injury was lower than we expected it to be. Abnormal EKG was found in 80% patients with the most common electrocardiography findings: low voltage (50%) and T wave abnormality (70%). Echocardiography abnormalities were present in 80% patients mostly including valvular regurgitation (mitral, pulmonal), and rarely pericardial effusion or left ventricular diastolic disfunction (20%). Elevated cardiac biomarkers were seen in 70% patients. By the time of hospital discharge or short time follow-up all cardiological findings were diminished. Six months follow-up found no cardiac sequellae and 24h electrocardiogram with heart rate variability parametres found no disturbancies outside physiological or underlying chronic disease. Conclusion While most patients in our study had evidence of abnormal cardiac testing on hospital admission, all cardiac findings were normal by hospital discharge. Cardiologic findings were representative for subacute myocardial injury with good clinical outcome and no sequellae. The degree of cardiac involvement was mild compared with previous reports. Funding Acknowledgement Type of funding sources: None.

Pregnancy outcomes of COVID-19 positive pregnant women at the Cantonal Hospital Zenica, Bosnia and Herzegovina.

Aim To investigate clinical presentation of COVID-19 infection in pregnancy, its course during pregnancy, effects on pregnancy outcomes for both mothers and newborns as well as the potential for vertical transmission. Methods This retrospective observational study included all identifi ed COVID-19-positive pregnant women admitted to the Cantonal Hospital in Zenica at any stage of pregnancy or labour from 30 April 2020 to April 30 2021. Maternity and newborns were followed until discharge from the hospital. Results Twenty-four pregnant women were positive for COVID-19. There were 79.2% asymptomatic cases, 12.5% had mild symptoms, while 8.3% had more severe forms of the disease. The main follow-up morbidities were high BMI 33.3%, anaemia 16.7%, thrombocytopenia 12.5%, hypertensive disorders 4.2% and diabetes 4.2%. The rate of premature births was 33.3%, while 8.3% pregnant women had premature rupture of the amniotic sac. Caesarean section was done for 75% women while 25% delivered vaginally. Previous caesarean section (54.2%) was the most common indication for operative completion of labour. Twentythree (92%) live babies were born, of which 8 (33.3%) were admitted to the neonatal intensive care unit. Two (8%) intrauterine foetal deaths were recorded that occurred before admission to our hospital. Two infants (8.7%) had a positive PCR test for COVID-19. Conclusion COVID-19 viral disease in pregnancy is usually presented as an asymptomatic or mild disease. It is associated with high rates of preterm birth, admission of newborns to the intensive care unit and intrauterine foetal death. Vertical transmission is possible but the newborns were asymptomatic.

Influence of atherosclerotic diseases on hospital mortality in Bosnia and Herzegovina – one center experience

Background and Aims: To analyze impact of atherosclerotic diseases on mortality in Department for Internal Diseases in Cantonal Hospital Zenica, Bosnia and Herzegovina.

Fasting state requirements for blood sampling: a survey of patients in Cantonal Hospital Zenica, Bosnia and Herzegovina.

Aim To explore patient's awareness and appliance of the fasting state requirements for blood sampling. Methods This observational survey was performed at the Department of Medical Biochemistry and Immunology Diagnostics, Cantonal Hospital Zenica, from June to July 2019. An anonymous questionnaire was conducted on 200 consecutive outpatients older than 18, who were admitted to the laboratory for routine blood testing. Results A total of 134 (67%) patients were informed that they needed to be at fasting to perform laboratory tests. Patients were mostly informed by a requesting physician or a nurse, 68 (50.8%), and by other patients, members of the family and friends, 58 (43.3%); only seven (5.2%) patients were informed in the laboratory. A total of 75 (37.5%) patients arrived to the laboratory properly prepared. Conclusion Most patients were not well informed about fasting state requirements for blood sampling and consequently they were not adequately prepared for laboratory tests. Laboratory should establish updated fasting recommendations available to patients and healthcare professionals, and conduct continuing education of patients and health care staff.

First encounter of extrapulmonary-gastrointestinal manifestation of SARS-CoV- 2 in a CoV+ patient in Cantonal Hospital Zenica

First encounter of extrapulmonary-gastrointestinal manifestation of SARS-CoV- 2 in a CoV+ patient in Cantonal Hospital Zenica

Challenges in diabetic foot treatment during pandemic of COVID-19.

Objectives:To avoid hospital spread of Coronavirus-2019 (COVID-19) and to analyze out of hospital outcomes after amputation.Methods:Prospective analysis of data obtained from 60 diabetic patients in 2020 was performed at Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina. Personal protection equipment included double surgical mask, glasses, disposable surgical coats, and surgical masks for patients. Swabs were used to take samples from wounds. We randomly divided patients in 2 groups of 30 patients each. In pre-operative treatment, we used local anesthesia lidocaine hydrochloride 2% (Belupo, Koprivnica, Croatia) in group A and systemic analgesia intravenous tramadol chloride 100 mg intravenous (Krka, Novo Mesto, Slovenia) in group B. Wounds were surgically treated each day and heal spontaneously. Periodical control exams were performed.Results:Wound healing did not present any statistically significant differences between groups (group A: 69±21.97 and B: 61±22.13 days, t=−1.22; p=0.11). No statistically significant differences (p<0.05) between groups A and B in wound healing regarding to gender or cigarette use was noted.Conclusion:No significant differences in amputation treatment between the 2 comparative groups were noted. No confirmed COVID-19 infections in medical staff who performed surgical interventions or in treated patients were detected.

A one-year review of macrosomic births at the Cantonal Hospital Zenica, Bosnia and Herzegovina.

Aim To identify a rate of macrosomic births in a one-year review, associated maternal characteristics and pregnancy outcome. Methods This one-year retrospective review included all macrosomic deliveries at the Department of Obstetrics and Gynaecology at the Cantonal Hospital Zenica between 1 January 2018 and 31 December 2018. The data were collected from maternal and newborn medical records. A total of 361 singleton normal birth weight term newborns (birth weight <4000 g, but not small for gestational age) who were delivered in the same period, represented the control group. Results Among the total of 2758 women who gave birth, 360 (13.05%) macrosomic infants (birth weight more than 4000 g) were delivered. Mean birth weight was 4258.90 g (maximum 5460g); nine (0.33%) were >5000g. Male macrosomic infants were more frequently represented, 245 (68,1%) comparing to the control group (p<0.01); in the control group female infants were more frequently represented (p<0.01). The overall Cesarean section rate, including elective Cesarean delivery was 23.2%, and 76.1% underwent an attempt of labour delivered vaginally. Conclusion Macrosomia represents a risk for adverse outcome for the mother and neonate, with a higher risk for the operative mode of delivery.

PB2234 MUTATIONAL SIGNATURES AFFECT THE PHENOTYPIC PRESENTATION OF DISEASE SUBTYPES IN MPN PATIENTS FROM BOSNIA AND HERZEGOVINA

Background: Philadelphia‐negative myeloproliferative neoplasms (MPNs), including PV, ET, PMF, and MPN‐U are a group of clonal myeloid disorders characterized by myeloproliferation without dysplasia. WHO 2016 revision lists the presence of driver mutations as one of several major criteria in the diagnosis of MPN patients. MPN subtypes have overlapping clinical symptoms and a common molecular basis.Aims:The aim of this study was to evaluate disease phenotypes and evolution in regards to the detected JAK2, CALR and MPL mutations in the population of MPN patients in Bosnia and Herzegovina. Also, we compared hematologic and clinical features of ET patients carrying either JAK2 or CALR mutations with JAK2 positive PV patients in order to determine the correlation of clinical features and disease evolution.Methods:A cohort of 138 patients diagnosed with MPN and treated at Clinical Center of the University of Sarajevo and Cantonal Hospital Zenica, in the period from January 2000 to June 2018 were included in this retrospective study. Analyzed patients were subcategorized according to BCR‐ABL negative MPN subtypes: ET (n = 41), PV (n = 56), PMF (n = 10), and MPN‐U (n = 31). Patients characteristics included full blood count, bone marrow characteristics, hepato/splenomegaly, overall survival as well as mutational status of JAK2, CALR, and MPL genes. Comparisons of quantitative variables between groups of patients were carried out by one‐way ANOVA. Correlation between numerical variables was tested by the Spearman's coefficient. Survival probabilities were estimated with the Kaplan‐Meier method and compared using the log‐rank test. Data were analyzed using IBM SPSS v.21.Results:In the present work, we compared hematologic and clinical features of patients with JAK2‐mutated ET with those of patients with CALR‐mutated ET and related the findings to features observed in patients with PV. Median follow‐up was 33 months (50, 45.5, 69 and 20 months for PV, ET, PMF and MPN‐U subtypes, respectively). We found that JAK2 V617F+ patients had higher values for RBC, Hb and Hct compared to CALR+ patients (p&lt;0.05). MPL+ patients had higher values for Plt compared to JAK2 V617F+ patients (p&lt;0.05). The mutant allele burden in JAK2 V617F+ PV and ET patients was directly correlated with hematological parameters (ρ = 0.36, ρ = 0.14, and ρ = 0.21 for Hb, RBC, and Hct, respectively) and inversely correlated with Plt count (ρ = −0.12). JAK2 V617F+ patients had worse survival compared to CALR+ and MPL+ patients, eventhough significant differences were not found (p &gt; 0.05).Summary/Conclusion:Mutant allele burden is a determinant of the clinical phenotypic features in JAK2 V617F MPN patients. Mutational profile define clinical course and outcomes in MPN subtypes.

Does an early discharge of a newborn influence the success of the newborn hearing screening in developing countries? A hospital based study.

Aim To investigate outcomes of newborn hearing screening (NHS) with transient evoked otoacoustic emissions (TEOAE) depending on the time from the birth to hearing screening. Methods A prospective study was performed in the Cantonal Hospital Zenica, Bosnia and Herzegovina. The NHS with TEOAE was done before hospital discharge for all infants. The total of 1217 newborns were tested during a six-month period, from 1st February to 31st July 2016. The data of 1167 were available for analysis. Those data were divided in four groups depending on the time passed from the birth to hearing screening: Group A (n= 133 newborns, NHS performed in the first 24 hours after birth); group B (n = 294 newborns, NHS performed between 24-36h after birth); group C (n = 184 newborns, NHS performed between 36-48h after birth) and group D (n= 556 newborns, NHS performed later than 48h after birth). Results Total referral rate was 19.1% (n = 223): for group A 30.1% (n=40), for group B 25.2% (n=74), for group C 19.0% (n=35) and for group D 13.3% (n=74). There was statistically significant difference between groups A and C (p=0.03), between groups A and D (p<0.001) and between groups B and D (p<0.001) in total and in well baby nursery (WBN). Conclusion The total referral rates in NHS were high because of early post birth discharge of newborns. The NHS should be performed in infants older than 36 hours according to the results in this study.

Influence of C-reactive protein on the occurrence and assessing of albuminuria severity in diabetics.

Aim To asses relation of serum high sensitive C-reactive protein (hsCRP) level with albumin concentration in daily urine in patients with diabetes mellitus type 2 (T2DM). Methods The prospective study included 69 patients with T2DM, both sexes (24 males, 45 females), aged 30-82 years. They were divided into two groups: patients with T2DM and normoalbuminuria(T2DM-NA; n=40) and patients with T2DM and microalbuminuria (T2DM-MA; n=29). Patients were hospitalized at the Department of Internal Medicine, Cantonal Hospital Zenica, in the period January-April 2014. Immunonephelometry measurement of hsCRP was performed on the Nephelometer Analyzer BN II (Siemens, Germany). Results Frequency of patients in T2DM-NA and T2DM-MA groups was not significantly different in relation to sex and age. There was significant difference in relation to duration of diabetes ( p=0.001). Average glucose and HbA1c levels were significantly higher in T2DM-NA group comparing to T2DM-MA group (p=0.008 and p=0.047, respectively). Serum creatinine (p=0.011),urea (p=0.009) and hsCRP (p=0.005) were significantly higher in T2DM-MA group compared to T2DM-NA group. Urinary albumin showed significantly positive correlation with the hsCRP (rho=0.286; p=0.017), urea (rho=0.503) and creatinine (rho=0.438) (p < 0.0005). A one unit (mg/L) increase in hsCRP concentration was associated with 11.5% increase of odds of microalbuminuria OR=1.115; 95% CI 1.014-1.225; p=0.025). Conclusion Significantly higher values of serum hsCRP in patients with type 2 diabetes mellitus and microalbuminuria in comparison to those with normoalbuminuria as well as the correlation of values of inflammatory marker with urinary albumin implicate a low grade inflammation in the progression of diabetic nephropathy.

Identification of risk factors for hearing impairment in newborns: a hospital based study.

Aim To identify risk factors for hearing impairment presented in neonates born in Cantonal Hospital Zenica (CHZ) and to estimate their influence on outcome of hearing tests in Newborn Hearing Screening (NHS). Methods Retrospective-prospective study was done at the Department of Gynaecology and Maternity. The NHS was performed with transitory evoked otoacoustic emissions (TEOAE) during a six-month period using "Titan" device (Interacoustics, Denmark). The questionnaire was written for the purpose of getting more structured basic information about every newborn and to identify risk factors for hearing impairment. Chi-square test was used to investigate the difference between experimental and control group refer incidence. Results A total of 1217 newborns was screened for hearing impairment of which 259 (21.28%) with one or more known risk factors for hearing impairment. The following risk factors for hearing impairment were identified during the study period: family history of permanent childhood hearing impairment in 42 (3.45%) newborns, prematurity in 39 (3.21%), low APGAR scores in 29 (2.40%), asphyxia in 31 (2.55%), hyperbilirubinemia in 41 (3.37%), admission of ototoxic medication (aminoglycosides) after birth in 155 (12.74%). Conclusion There were many serious risk factors for hearing loss identified in this study. Identification of risk factors for hearing impairment in neonates is necessary because a follow up of the children with risk factors is very important.

Significance of parathyroid scintigraphy and correlation of findings with parathyroid hormone values in patients undergoing hemodialysis.

Aim To compare finding of thyroid gland scintigraphy with serum concentration of parathyroid hormone in patients undergoing hemodialysis. Methods This retrospective-prospective study included 50 patients undergoing hemodialysis with established hyperparathyroidism who were treated at Cantonal Hospital Zenica in the period 2009 - 2014. Besides anthropological data, concentration of parathyroid hormone in serum of patients was monitored too. Scintigraphy was performed at the Department of Nuclear Medicine using two-headed gamma camera Prism 2000xp. Results Of the total number of 50 patients, 24 (48%) were males and 26 (52%) were females. The average age was 49.34±11.82 years. A total of 17 (34%) patients had normal findings of scintigraphy, 11 (22%) had mildly pronounced uptake of radiopharmaceuticals (score of 1), 14 (28%) had moderately pronounced uptake (score of 2), and eight (16%) had intensive uptake of radiopharmaceuticals (score of 3). A statistically significant difference was established in the length of hemodialysis treatment and scintigraphy finding (p=0.041). Conclusion Scintigraphy of parathyroid glands in patients undergoing hemodialysis allows us to select them for parathyroidectomy. Scintigraphy of parathyroid glands and a value of parathormone in serum should be incorporated into the test algorithm for patients with secondary hyperparathyroidism caused by chronic kidney disease.

Impact of timing on surgical outcome in patients with cauda equina syndrome caused by lumbar disc herniation.

Aim To analyze the relationship between timing of surgery and outcome in patients with cauda equina syndrome caused by lumbar disc herniation. Methods A retrospective, non-randomized clinical study included 25 consecutive patients with cauda equina syndrome (CES) caused by lumbar disc herniation. All patients were operated within 24 hours after hospitalization at the Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina, between January 2000 and December 2010. All patients were evaluated before surgery on the basis of complete history, neurological examination and neuroimaging evaluations using CT (computed tomography)and MRI (magnetic resonance imaging). Results Statistically significant difference between preoperative and postoperative bladder (p=0.05) and bowel (p=0.05) function was found. A significant number of patients had bladder and bowel recovery after surgery, nine (36%) and 11 (44%), respectively. Significant recovery of muscle strength was noted with complete recovery(5/5) in 12 (48%) and partial recovery in 13 (52%) patients. Complete sensory recovery was noted in 16 (64%), incomplete in four (16%), and in five (20%) patients there were no changes. Most commonly, patients with complete sensory recovery were operated within 48 hours of symptom onset. In most patients early surgery was associated with better outcome. Conclusion This research showed that early decompression correlated with better outcome. Patients with cauda equina syndrome must be cleared for surgery in optimal conditions and, if it possible within optimal timing for recovery (within 48 hours).

Antibiotic Resistance in Urinary Isolates of Escherichia coli.

Objectives:The aim of this study was to examine the presence of antimicrobial resistance / susceptibility strains of Escherichia coli in inpatients and outpatients.Materials and methods:It is a retrospective study carried out at the Department of Microbiology, Parasitology and Virology Faculty of Medicine, University of Sarajevo. In cooperation with the Microbiological laboratory of the Cantonal Hospital Zenica and the Microbiological laboratory of the General Hospital Tesanj, 3863 urine samples were processed in the period from March 1st to March 31st 2016.Results:Our study showed that E. coli had the highest antimicrobial resistance to trimethoprim / sulfamethoxazole (38.61%), followed by amoxicillin / clavulanic acid (19.62%), ciprofloxacin (9.49%), gentamicin (8.86%), cephalexin (8.23%), nitrofurantoin (8.23%), cefuroxime (7.52%), ceftazidime (6.33%), cefuroxime (89.87%), amikacin (4.43%).Conclusions:The isolated strains of E. coli showed the highest resistance to trimethoprim / sulfamethoxazole and amoxicillin / clavulanic acid. The isolated strains of E. coli showed the greatest susceptibility to amikacin and ceftazidime. Gender distribution of positive E. coli isolates showed statistically significant differences in favor of females.