Ljiljana Markovic-Denic

Is pre-fracture functional status better than cognitive level in predicting short-term outcome of elderly hip fracture patients?

Introduction The aim of the study was to determine to what extent severe cognitive impairment impacts short-term rehabilitation outcomes of elderly patients with proximal hip fracture. Material and methods A total of 337 community-dwelling elderly patients with acute hip fracture were observed during a 12-month period at a major teaching hospital in Serbia. Cognitive status was assessed at admission with the Short Portable Mental Status Questionnaire (SPMSQ). Outcome after 4 months was analysed with respect to presence of severe cognitive impairment, defined as an SPMSQ score of < 3. Outcome assessment included presence of postoperative complications, absolute motor Functional Independence Measure (FIM) gain, Activities of Daily Living index (ADL), Instrumental Activities of Daily Living score (IADL), and walking ability. Results An SPMSQ score of < 3 was observed in 36 patients (10.7%) with acute hip fracture. Patients with an SPMSQ score of < 3 achieved worse short-term outcomes regarding all observed variables. However, cognitive status was found to be an independent predictor only with respect to mortality at 4 months (odds ratio (OR) = 0.969, 95% confidence interval (CI) = 0.947-0.992, p = 0.009). In contrast, pre-fracture motor FIM independently predicted mortality (OR = 2.982, 95% CI = 1.271-7.000, p = 0.012), and preserved walking ability at 4 months follow-up (OR = 0.945, 95% CI = 0.912-0.980, p = 0.002). Correspondingly, pre-fracture ADL was an independent predictor of absolute motor FIM gain at 4 months follow-up (OR = 0.175, 95% CI = 0.405-11.426, p = 0.035). Conclusions Failure to consider functional status prior to fracture might overestimate the impact of cognitive status on functional outcome of hip fracture patients.

Risk factors for ventilator-associated pneumonia in patients with severe traumatic brain injury in a Serbian trauma centre

INTRODUCTION The aims of this study were (1) to assess the incidence of ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI), (2) to identify risk factors for developing VAP, and (3) to assess the prevalence of the pathogens responsible. PATIENTS AND METHODS The following data were collected prospectively from patients admitted to a 24-bed intensive care unit (ICU) during 2013/14: the mechanism of injury, trauma distribution by system, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the Abbreviated Injury Scale (AIS) score, the Injury Severity Score (ISS), underlying diseases, Glasgow Coma Scale (GCS) score, use of vasopressors, need for intubation or cardiopulmonary resuscitation upon admission, and presence of pulmonary contusions. All patients were managed with a standardized protocol if VAP was suspected. The Sequential Organ Failure Assessment (SOFA) score and the Clinical Pulmonary Infection Score (CPIS) were measured on the day of VAP diagnosis. RESULTS Of the 144 patients with TBI who underwent mechanical ventilation for >48h, 49.3% did not develop VAP, 24.3% developed early-onset VAP, and 26.4% developed late-onset VAP. Factors independently associated with early-onset VAP included thoracic injury (odds ratio (OR) 8.56, 95% confidence interval (CI) 2.05-35.70; p=0.003), ISS (OR 1.09, 95% CI 1.03-1.15; p=0.002), and coma upon admission (OR 13.40, 95% CI 3.12-57.66; p<0.001). Age (OR 1.04, 95% CI 1.02-1.07; p=0.002), ISS (OR 1.09, 95% CI 1.04-1.13; p<0.001), and coma upon admission (OR 3.84, 95% CI 1.44-10.28; p=0.007) were independently associated with late-onset VAP (Nagelkerke r(2)=0.371, area under the curve (AUC) 0.815, 95% CI 0.733-0.897; p<0.001). The 28-day survival rate was 69% in the non-VAP group, 45.7% in the early-onset VAP group, and 31.6% in the late-onset VAP group. Acinetobacter spp was the most common pathogen in patients with early- and late-onset VAP. CONCLUSIONS These results suggest that the extent of TBI and trauma of other organs influences the development of early VAP, while the extent of TBI and age influences the development of late VAP. Patients with early- and late-onset VAP harboured the same pathogens.

Estimating the effect of incident delirium on short‐term outcomes in aged hip fracture patients through propensity score analysis

We aimed to evaluate the factors contributing to delirium after hip fracture and assess the effect of incident delirium on short‐term clinical outcomes.

Well Water Characteristics and the Balkan Nephropathy

A total of 366 inhabitants of a village affected by Balkan nephropathy (BN) have been followed over 12 years. It was shown that depth of the well to the water level, height of the water column, electroconductivity, and NO3 content of the water were not associated with BN. The risk of developing the disease was significantly higher if a well was at a lower altitude and contained a higher concentration of SiO2. Low altitude might have been expected to correlate with the BN frequency; as for silica, however, there are sound indications that it could just be a correlate of a cause rather than a direct determinant of BN.

Occupational Exposure to Blood and Body Fluids among Health-Care Workers in Serbia

Objectives: The aim of this study was to examine the epidemiology of occupational accidents and self-reported attitude of health-care workers (HCWs) in Serbia. Subjects and Methods: A cross-sectional study was conducted among HCWs in selected departments of five tertiary care hospitals and in one secondary care hospital in February 2012. A previously developed self-administered questionnaire was provided to HCWs who had direct daily contact with patients. χ2 test and Students t test were used for statistical analysis of the data. Results: Of the 1,441 potential participants, 983 (68.2%) completed the questionnaire: 655 (66.7%) were nurses/medical technicians, 243 (24.7%) were physicians and 85 (8.6%) were other personnel. Of the 983 participants, 291 (29.6%) HCWs had had at least one accident during the previous year and 106 (40.2%) of them reported it to the responsible person. The highest prevalence (68.6%) of accidents was among nurses/technicians (p = 0.001). Accidents occurred more often in large clinical centers (81.1%; p < 0.001) and in the clinical ward, intensive care unit and operating theater (p = 0.003) than in other departments. Seventy-six (13.1%) nurses/medical technicians had an accident during needle recapping (p < 0.001). Of all the HCWs, 550 (55.9%) were fully vaccinated, including significantly more doctors (154, 63.4%) than participants from other job categories (p < 0.001). Conclusion: There was a relatively high rate of accidents among HCWs in our hospitals, most commonly amongst nurses and staff working in clinical wards, intensive care units and operating theaters. The most common types of accidents were needlestick injuries and accidents due to improper handling of contaminated sharp devices or occuring while cleaning instruments or by coming into contact with blood through damaged skin or through the conjunctiva/mucous membranes.

Health care–acquired infections in neonatal intensive care units: Risk factors and etiology

A 1-year prospective cohort study of health care-acquired infections was conducted at the neonatal intensive care unit of the University Clinical Centre Kragujevac, Serbia. The incidence rate of neonates with health care-acquired infections was 18.6%, and the incidence rate of the infections themselves was 19.4%. The incidence density of the health care-acquired infections was 9.1 per 1,000 patient days. The independent risk factors for health care-acquired infections were birth weight, length of hospitalization, duration of mechanical ventilation, and Apgar score. More than half of all isolated microorganisms were Klebsiella-Enterobacter (39.3%) and Escherichia coli (25.0%).

Is anemia at admission related to short-term outcomes of elderly hip fracture patients?

Hip fracture in elderly people is associated with high morbidity and mortality. Therefore, it is important to identify risk factors that potentially influence outcomes after hip surgery. The main purpose of this study was to evaluate the relationship of anemia at admission and short-term outcomes after hip fracture. We studied 343 community-dwelling patients who underwent surgery for hip fracture from March 2009 to March 2010. Functional mobility at discharge, postoperative complications, hospital length of stay and in-hospital mortality were analyzed in respect to presence and severity of anemia at admission. Anemia (defined as hemoglobin levels < 13.0 g/dl for men and < 12.0g/dl for women) was present in 185 (53.9%) patients, of whom 54 (29.2%) were severely anemic (defined as hemoglobin level 10.0g/dl or below). In multivariate analysis anemia was associated with age, gender (female), type of fracture (intertrochanteric) and American Society of Anesthesiologists (ASA) classification (3 or 4), while severity of anemia was associated with recovery of ambulatory ability at discharge. There was no difference in the incidence of postoperative complication, in-hospital mortality and length of hospital stay between the groups at discharge. Overall anemia at admission is an indicator of poor general health status. Ambulatory recovery in hip fracture patients is independently related to severity of anemia at admission.

Seroprevalence and risk factors for hepatitis C virus infection among blood donors in Serbia: A multicentre study.

BACKGROUND The epidemiological characteristics of hepatitis C virus (HCV) infection have not yet been described in Serbia. AIMS To determine the prevalence of anti-HCV-positive individuals among first-time blood donors and the risk factors for hepatitis C transmission. METHODS A multicentre case-control study nested within a prospective cohort study was conducted at 10 main transfusion centres in Serbia in 2013 and 27,160 blood donors who gave blood for the first time were included. Blood donors with confirmed anti-HCV positivity and seronegative controls were enrolled to determine the risk factors. RESULTS Of 27,160 blood donors 52 were anti-HCV-positive; seroprevalence was 0.19%. By univariate analysis, marital status, educational level, drug use, previous transfusion, tattooing, non-use of condoms and number of sexual partners, were risk factors for hepatitis C. In the final multivariate analysis, three factors remained independently predictive: drug use, tattooing and previous blood transfusion. In total, 87.5% of cases had at least one of the risk factors for HCV transmission; 20.9% presumed that they knew when the infection occurred. CONCLUSION HCV seroprevalence in Serbia is higher than in developed European countries. Preventive measures need to be directed towards drug use and tattooing facilities. The admission questionnaire for blood donors should be improved.

Severe road traffic injuries and youth: a 4-year analysis for the city of Belgrade

The objective of this study is to describe severe road traffic injuries (RTIs) in the population under 18 years in Belgrade, the capital of Serbia. We analysed both severe non-fatal and fatal RTIs in children and adolescents under 18 years old in the Belgrade area, during the period 2008–2011. Data sources were the official statistics of the Public Health Institute in Belgrade and forensic-medical records from two paediatric university hospitals and five university hospitals for adults. Using descriptive statistical methods, demographic characteristics, mechanism, type and time of injuries, surgical treatment procedures, injury severity scores (ISS), length of stay and outcome were evaluated. The admission and mortality rates were calculated. Among the total of 379 injured, 256 (67.5%) were male; the average age was 13.0 ± 4.7 (range: 0–18 years). The annual hospital admission rate of RTIs for both sexes decreased in average by 12.6% (95% CI = 9.3%–15.9%). The mean percentage of annual changes of mortality rates was 2.0 %; 95% CI = 1.3%–5.3% (5.7 per 100,000 in 2008, 5.6 in 2009, 4.7 in 2010 and 5.9 in 2011). The highest admission rates and mortality rates were for pedestrians, followed by passengers and cyclists. Accidents occurred most commonly on Monday (18.7%). Among children hospitalised for traffic injuries, 57.8% had head and neck trauma, 30.6% extremity fractures, 5% abdominal injuries, 4.2% chest and 2.4% multiple injuries. The average ISS was 22.4 (SD = 20.4), ranging from 1 to 75. Alcohol in blood was confirmed in 7.4% males and 3.3% females (p > 0.05). The average time of hospital stay was 8.8 days (SD = 16.7), ranging from 1 to 14. The increased rates require implementation of a well-defined national strategy in our country.

Risk factors for vancomycin-resistant Enterococcus colonization in hematologic patients.

BACKGROUND/AIM Vancomycin-resistant Enterococci (VRE) is one of the most important hospital pathogens. The aim of the study was to evaluate VRE colonization in patients hospitalized at the Hematology Intensive Care Unit, as well as the associated risk factors. METHODS A prospective cohort study involved 70 patients hospitalized at the Intensive Care Unit (ICU), Clinic for Hematology, Clinical Center of Serbia, Belgrade, during 3 months. Baseline demographic data, data about antibiotic usage and other risk factors for VRE colonization during the present and previous hospitalizations (within 6 months) were recorded for each patient using the questionnaire. Feces or rectal swab was collected for culture from patients on admission and at discharge in case when VRE was not isolated on admission. Enterococci were isolated by standard microbiological methods. Isolate sensitivity was tested by disk-diffusion test using 30 microg/mL (BBL) Vancomycin plates according to the Clinical and Laboratory Standards Institute (CLSI) standard. RESULTS Analysing results showed that 7% of the patients had been already colonized with VRE upon ICU admission. The rate of VRE colonization during present hospitalization was 41.5%. Univariate logistic regression demonstrated the statistically significant differences in diagnosis, length of present stay, use of aminoglycosides and piperacillin/tazobactam in present hospitalization, duration of use of carbapenem and piperacillin/tazobactam in present hospitalization between the VRE-colonized and non-colonized patients. Acute myeloid leukemia (AML), use of carbapenem in previous hospitalization and duration of use of piperacillin/tazobactam in present hospitalization were independent risk factors for VRE-colonized patients according to multivariate logistic regression. CONCLUSION VRE colonization rate was high among the patients admitted to hematology ICU. Rational use of antibiotics and active surveillance may be helpful preventive measures against the development of bacterial resistance to antimicrobial agents.