Purpose: Ventilator associated pneumonia (VAP) is one of the most common hospital-acquired infection in patients hospitalized in intensive care unit (ICU). Aim of this study was to evaluate predictive values of quantitative and qualitative culture of broncholaveolar lavage (BAL) in the diagnosis of VAP comparing with clinical pulmonary infection score (CPIS), and to determine positive and negative predictive values of the tests in patients on mechanical ventilation. Methodology: 209 samples were prospectively taken from the patients hospitalized in ICU on mechanical ventilation; along with the clinical pulmonary infection score (CPIS). After sampling, quantitative and qualitative culture of BAL was done. As the cut off value of quantitative culture 104 CFU/mL was taken, according CDC recommendations. Results: In our study, sensitivity of the quantitative culture of BAL was 91%, specificity 70%, positive predictive value 80% and negative predictive value was 85%. Sensitivity of the qualitative culture of BAL was 93%, specificity 36%, positive predictive value 70,2% and negative predictive value was 76%. Conclusion: Quantitative culture of BAL has better predictive values in VAP diagnosis in patients on mechanical ventilation, helping in the discrimination between colonization and the infection. Qualitative culture of BAL has higher sensitivity, but lower specificity than quantitative culture.

Background: Tablet splitting is commonly used in clinical practice as a way to attain a desired drug dose and/or reduce its side effects, particularly among paediatricians and psychiatrists. However, uneven tablet scoring can lead to significant fluctuations of the administered doses, where subpotency or superpotency of drugs might harm the patients. The aim of this study was to evaluate the influence of tablet splitting on dose uniformity of diazepam by the utilisation of Ph. Eur. 9.0 and FDA recommendations. Methods: Mass variation of whole and half-tablets in parallel with the determination of their content uniformity were performed according to the pharmacopoeial methods. The weight loss after tablet splitting was assessed by employing FDA guidelines. It was also investigated if tablet splitting influenced the in vitro dissolution properties of diazepam tablets. Results: Diazepam whole tablets fulfilled the pharmacopoeial requirements in regard to all the investigated properties. The weight uniformity of scored diazepam tablets ranged from 63.80% to 122.55% label claim. The losses of mass after splitting diazepam tablets were 5.71%. Despite the average content of diazepam in half-tablets was found to be 104.24% label claim, the requirements of Ph. Eur. were not fulfilled. Diazepam content in half-tablets ranged from 0.76 mg to 1.21 mg, thus, patients might receive doses that vary by as much as 45%. However, after weight adjustment, diazepam content in each of the tested half-tablets was in the range of 85-115% of the average drug content meeting the Ph. Eur. criteria. Dissolution profiles of whole and half-tablets were found to be similar, following the Hixson-Crowell kinetic model. Conclusion: According to the results, splitting of diazepam tablets greatly influenced the drug content in the obtained parts, ie the dose accuracy was fully dependent of the ability to score the tablet into exactly equal halves.

Background: Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections in patients hospitalized in intensive care unit (ICU). The aims of this study were to evaluate quantitative culture of bronchoalveolar lavage (BAL) in the diagnosis of VAP comparing with clinical pulmonary infection score (CPIS), and to determine positive and negative predictive values of the test. Methods: A total of 209 samples were taken from the patients hospitalized in ICU with clinical suspicion on VAP, along with the CPIS. As the cut-off value of test, quantity of 104 colony-forming unit (CFU)/mL was taken, according to Centers for Disease Control and Prevention (CDC) recommendations. Results: Positive culture has been found in 142 patients (68%). The most common isolates were Acinetobacter baumanii in 49 (34.5%) patients, Klebisella pneumoniae in 31 (21.8%), Pseudomonas aeruginosa in 14 (9.9%), Staphylococcus aureus in eight (5.6%), Serratia marcensens in seven (4.9%), Escherichia coli in four (2.8%), other Enterobacteriaceae in five (3.5%), Pseudomonas spp in three (2.2%), Candida albicans in two (1.4%), and mixed infection in 19 patients (13.4%). In our study, sensitivity of the quantitative culture of BAL was 91%, specificity was 70%, positive predictive value was 80% and negative predictive value was 85%. Conclusions: Quantitative culture of BAL can be useful in VAP diagnosis in patients hospitalized in the ICU, helping in the discrimination between colonization and the infection.

Flail chest, often defined as the fracture of three or more ribs in two or more places, represents the most severe form of rib fractures. Conservative treatment, consisting of respiratory assistance with endotracheal intubation and mechanical ventilation (internal pneumatic stabilization) and pain control, are the current treatments of choice in the majority of patients with multiple rib fractures. However, the use of mechanical ventilation may create complications. In selected patients, operative fixation of fractured ribs within 72 h post injury may lead to better outcomes. We conducted a retrospective analysis of a series of nine cases of patients who developed flail chest after blunt trauma, and were treated with surgical osteofixation of the chest wall and postoperative epidural analgesia at the University Clinical Center of the Republic of Srpska during the period from January 2015. to December 2016. Two patients had trauma to the chest only, and the other patients had associated injuries to the head, abdomen, spine, and fractures of the pelvis and long bones. In the majority of patients (77.7%), surgical stabilization of the chest was performed on the second day following the injury, (mean, 2.33 days) and no later than 5 days after the injury. All patients received epidural analgesia with 0, 25% bupivacaine and 0, 01% morphine and intravenous multimodal analgesia, beginning 6 h after thoracotomy. The average length of ICU stay was 14.7 days (range 2–36), while the average number of days of mechanical ventilation was 8.1. The average duration of hospitalization was 25.4 days. Tracheotomy was performed in 33.3% of study patients. Mortality in the observed group was 44.4%. This study shows that surgical stabilization and epidural analgesia reduced ventilator support, shortened trauma intensive care unit stay, and reduced medical costs vs internal pneumatic stabilization.

Aneurysm of the visceral arteries is a rare condition and it represents around 1% of all arterial aneurisms. Aneurysm of the inferior pancreaticoduodenal artery represents around 2% of all visceral aneurysms. Aneurysm associated with occlusion of the coeliac trunk is very rare condition and there are only about 40 cases presented in the literature. In our study, we presented 56 year-old female admitted to hospital with obstructive jaundice. CT scan diagnosed tumor of the head of pancreas and CT angiography confirmed aneurysm of the inferior pancreaticoduodenal artery which was successfully operated at our clinic.

ABSTRACT Introduction: Central Venous Catheters (CVC) are essential in everyday medical practice, especially in treating patients in intensive care units (ICU). The application of these catheters is accompanied with the risk of complications, such as the complications caused during the CVC insertion, infections at the location of the insertion, and complications during the use of the catheter, sepsis and other metastatic infections. Patients and methods: This study is a retrospective-prospective and it was implemented in the period 1st January 2011- 31st December 2012. It included 108 examinees with CVC placed for more than 7 days. Results: The most common complications occurring in more than 2 attempts of CVC applications are: hearth arrhythmias in both groups in 12 cases, 7 in multi-lumen (12.72%) and 5 in mono-lumen ones (9.43%). Artery puncture occurs in both groups in 7 cases, 5 in multi-lumen (9.09%) and 2 in mono-lumen ones (3.77%). Hematoma occurred in both groups in 4 cases, 3 in multi-lumen CVCs (5.45%) and 1 in mono-lumen ones (1.88%). The most common complication in multi-lumen catheters was heart arrhythmia, in 20 cases (36.37%). The most common complications in mono-lumen CVCs was hearth arrhythmias, in 20 cases as extrasystoles and they were registered in 16 catheter insertions (30.18%). Out of total number of catheters of both groups, out of 108 catheters the complications during insertion occurred in 49 catheters (45.40%). The most common complications in both groups were heart arrhythmias, artery punctures and hematomas at the place of catheter insertion.

Aim: The aim of this study was to investigate a relationship between seasonal variation and incidence of type A acute aortic dissection (AAD) and spontaneous abdominal aneurysm rupture (rAAA) in Canton Tuzla, Bosnia and Herzegovina. Patients and methods: A total of 81 cases, 41 AAD and 40 of ruptured AAA were identified from one center over a 6-year, from 2008 till 2013. In 2012 were admitted (45.6% or 36 patients). Results: Seasonal analysis showed that 19(23.4%) patients were admitted in spring, 15(18.5) in summer, 26(32%) in autumn and 21(25.9) in winter. The most frequent period was autumn/winter with 47 or 58% patients. A causal link between atmospheric pressure (AP) and incidence of rAAA and AAD on seasonal and monthly basis was found.

AIM The aim of this study was to investigate a relationship between seasonal variation and incidence of type A acute aortic dissection (AAD) and spontaneous abdominal aneurysm rupture (rAAA) in Canton Tuzla, Bosnia and Herzegovina. PATIENTS AND METHODS A total of 81 cases, 41 AAD and 40 of ruptured AAA were identified from one center over a 6-year, from 2008 till 2013. In 2012 were admitted (45.6% or 36 patients). RESULTS Seasonal analysis showed that 19(23.4%) patients were admitted in spring, 15(18.5) in summer, 26(32%) in autumn and 21 (25.9) in winter. The most frequent period was autumn/winter with 47 or 58% patients. A causal link between atmospheric pressure (AP) and incidence of rAAA and AAD on seasonal and monthly basis was found.