Enteric viruses are commonly found obligate parasites in the gastrointestinal (GI) tract. These viruses usually follow a fecal-oral route of transmission and are characterized by their extraordinary stability as well as resistance in high-stress environments. Most of them cause similar symptoms including vomiting, diarrhea, and abdominal pain. In order to come in contract with mucosal surfaces, these viruses need to pass the three main lines of defense: mucus layer, innate immune defenses, and adaptive immune defenses. The following atypical gastrointestinal infections are discussed: SARS-CoV2, hantavirus, herpes simplex virus I, cytomegalovirus, and calicivirus. Dysbiosis represents any modification to the makeup of resident commensal communities from those found in healthy individuals and can cause a patient to become more susceptible to bacterial and viral infections. The interaction between bacteria, viruses, and host physiology is still not completely understood. However, with growing research on viral infections, dysbiosis, and new methods of detection, we are getting closer to understanding the nature of these viruses, their typical and atypical characteristics, long-term effects, and mechanisms of action in different organ systems.

In recent years, it has been shown that gastrointestinal microflora has a substantial impact on the development of a large number of chronic diseases. The imbalance in the number or type of microbes in the gastrointestinal tract can lead to diseases and conditions, including autism spectrum disorder, celiac disease, Crohn’s disease, diabetes, and small bowel cancers. This can occur as a result of genetics, alcohol, tobacco, chemotherapeutics, cytostatics, as well as antibiotic overuse. Due to this, essential taxa can be lost, and the host’s metabolism can be severely affected. A less known condition called small intestine bacterial overgrowth (SIBO) can be seen in patients who suffer from hypochlorhydria and small intestine cancers. It is characterized as a state in which the bacterial population in the small intestine exceeds 105–106 organisms/mL. The latest examination methods such as double-balloon enteroscopy and wireless capsule endoscopy have the potential to increase the accuracy and precision of diagnosis and provide better patient care. This review paper aims to summarize the effect of the gastrointestinal environment on chronic disease severity and the development of cancers.

Orthopedic surgical judgment and a decision-making process in peace is a topic that has been discussed and written about for decades, but the wartime surgical judgment is something that cannot be predicted or prepared for. There is no wartime surgery class in any medical school worldwide that can prepare a surgeon for his/her work under a wartime environment applying all of their knowledge, skill and effort to achieve the best possible result for a patient. With this short note, authors would like to raise awareness on all surgical and medical staff worldwide working under wartime conditions and giving their super-human efforts to save patients.

Background/Aim. Despite bunion surgery having been performed for more than 100 years, there has yet to be a technique considered as the ?Gold Standard?. The aim of the study was to compare postoperative results of Mitchell vs. Golden methods of treating moderate hallux valgus deformity. Methods.This observational case control study included 49 patients (81 feet) who had the Mitchell distal metatarsal osteotomy performed, and 49 patients (77 feet) that had the Golden proximal metatarsal osteotomy performed. The results of treatment were evaluated using Hellal?s modification of the Bonney and McNab classification and the Hallux Metatarsophalangeal Interphalangeal Score (HMIS). The statistical analysis of the results was done, thus the values p < 0.05 were considered statistically significant. Results. Both operative procedures showed successful and statistically significant postoperative results compared to the preoperative status (p < 0.001). Comparative analysis of the results from the Mitchell and Golden procedures, according to the Hellal?s modification of Bonney and McNab classification, proved that there was a high statistically significant difference in favor of the Mitchell method (p < 0.001), whereas the comparison based on the HMIS showed no statistically significant difference (p = 0.123) between the two methods. The estimated results analysis of both procedures, based on the values of hallux valgus angle, intermetatarsal angle, sesamoid position, length of immobilization, treatment duration and complications demonstrated that there was a highly significant difference in favor of the Mitchell method (p < 0.001), whereas the value of the shortening of the first metatarsal bone indicated that the shortening was greater in the Mitchell method (p < 0.001), which goes in favor of the Golden method. Regarding the flexion of the thumb of the feet operated on, there was no statistically significant difference (p = 0.723). Conclusion. The examinations performed indicated that both methods showed good postoperative results, but applying the Mitchell method they were better.

Blood vessel branching of the proximal femur by its scheme differs from all other major joints. This scheme changes during the individual's development, dynamically depend ing on age. Namely, the caliber, blood flow rate, and dominance of certain arteries from the entire network of blood vessels that participate in the vascular supply of the hip are not equally expressed in all stages of development. In each successive stage, blood supply is dominated by a different artery that, after a certain period of time, shifts its major role to another artery. Anastomoses between individual arteries are not constant in all stages of development, and they represent a great importance for compensatory mechanisms. The disturbance of local arterial blood vessels, at a time when they domi - nate the blood supply and affect the quality of hip development and maturation, leads to reduced perfusion, and consequently, to the lack of development, ossification, and possible osteonecrosis.

Every long bone fracture in orthopedic surgery represents a possible scenario for devel- opment of embolism complication, especially the fat embolism. There is no scientific explanation why fat embolism occurs and what are the hypotheses for development of fat embolism or the proper way of prevention, but just speculations and possible theories in the evolution of the clinical picture of fat embolism syndrome. Throughout this chap- ter, the authors will explain the possible theories of development of fat embolism, risk factors, pathology, and pathophysiology during progress of the clinical picture and signs of the fat embolism syndrome and therapy.

Since developmental dysplasia of the hip (DDH) represents one of the most common con‐ genital deformations of the musculoskeletal system and the most common deformation of the hip joint, the aim is to emphasize the importance of early recognition and diagnosis of DDH as well as comprehensive screening among newborns. DDH represents a dynamic process that results in the action of a number of exogenous and endogenous factors, physiological and mechanical, exerted to the mother and to the child during pregnancy and after delivery. Summary of all current knowledge about the origin of this deformity suggests that the most important factors in the development are hard abdominal muscles and uterine muscles, as limiting factors for fetal movement, which prevents its physio‐ logical turn, and reinforces the pelvic presentation of the fetus in uterus. Considering the fact that developmental dysplasia of the hip demands multidisciplinary approach and cooperation among gynecologists, neonatologists, pediatricians, radiologists, and ortho‐ pedic surgeons, the goal of this chapter is to make a consensus about early conservative treatment among clinicians, time of commencement, and its efficacy.

Introduction. We report a case of a sixty-year-old man diagnosed with gluteal compartment syndrome caused by traumatic rupture of the superior gluteal artery associated with fracture of the inferior pubic ramus and blunt trauma. Case report. A patient was injured falling from a height of four meters. Signs of compartment syndrome and sciatic nerve compression developed three hours after the injury. The patient went through a computerized tomography (CT) scan procedure with contrast, which showed a hematoma in the gluteal region, but without signs of active bleeding. However, after observation and monitoring of the patient, CT angiography was performed which revealed a rupture of the superior gluteal artery. Fasciotomy and debridement were performed and the patient was diagnosed with gluteal compartment syndrome and rupture of the superior gluteal artery. Surgery resulted in a significant improvement of the patient’s condition. Conclusion. Traumatic gluteal compartment syndrome is a rare condition. Gluteal compartment syndrome should be taken into consideration in each patient with pelvic trauma and hematoma in the gluteal region whose neurological status is affected. Prompt diagnosis and fasciotomy are crucial in the treatment and fasciotomy presents the gold standard in the treatment.

Introduction: Degenerative disc disease is one of the most common reason for low back pain in a physical active population. The shape of the spine, especially reduction of lordosis, may have an important role in ethiology of lumbar disc degeneration. The aim of this study is to assess is there any differences within genders when evaluate lumbar spine and pelvic parameters in patients with a DDD. Materials and Methods: A prospective survey has been conducted in the Spine surgery department of Civil Hospital in Strasbourg (Service du Rachise, L'Hopital Civil, Strasbourg, France) during the period between January 1th, 2005 and December 31st, 2008. We have analyzed x rays and spino-pelvic parameters of 63 patients among of 80 patients with degenerative disc disease (DDD) of lumbar spine in which total disc arthroplasty (TDA) have been performed at one level. Standing lateral full spine x rays has been done before surgery and at final follow-up 3 years later. Following parameters were analyzed: lumbar lordosis (L1-S1), intervertebral angle, anterior and posterior disc height, sacral slope, pelvic tilt and pelvic incidence. Results : Mean follow-up time was 44 months. 45 females and 18 males patients with a mean age of 41,38 year were evaluated. The preoperative values of lumbar lordosis and sacral slope was significantly higher in a females with a DDD at L4-L5 segment. The same result has been seen and after the surgery. There have not been statistical differences these values between genders with DDD at L5-S1 segment, nor preoperatively, nor postoperatively. Conclusion : Although reduction of lordosis is pointed out as an important role for DDD we have not found that in our study that may suggest that DDD has complex etiology.

Introduction: Progressive pseudorheumatoid dysplasia (PPD) is an autosomal recessive genetic disorder reported to be caused by gene alterations of the Wnt1-inducible signaling pathway protein 3 corresponding gene (WISP3) located on chromosome position 6q22.  Up to date, there is only a handful of WISP3 mutations identified in Europe, whereas most mutations are identified in Asia and Middle East.  According to our knowledge, this is the first report of genetic dissection of WISP3 associated with spondyloepiphyseal dysplasia tarda from Bosnia and Herzegovina. Based on clinical examination findings (general manifestations, physical examination, characteristics of their bones on X-ray and laboratory results), an index patient was directed to WISP3 genotyping for confirmation of suspected diagnosis of PPD.Methods: DNA was extracted from peripheral blood leukocytes. All 5 exons and their exon-intron boundaries of the WISP3 gene were amplified by polymerase chain reaction (PCR) and sequenced by Sanger method. Segregation analysis was done to confirm the familial carrier status.Results: A missense mutation (C223G) - homozygous T to G transition at c.667 in exon 4 was identified in index patient. This mutation changed codon CAG to TAG and resulted in a subsequent change of the cysteine to glycine codon. Same mutation was observed in both parents in heterozygous form confirming the familial segregation.Conclusion: Due to its nature, the identified mutation C223G in exon 4 in WISP3 gene is the most probably causative for PPD in described patient. Here we describe the PCR based method for genotyping of specific mutation in WISP3 gene. The identification of this mutation might be a valuable addition to a regional databases on rare genetic variant although a functional analysis should be performed to explain its pathological effect.