Purpose: To investigate the association between an eye injury and later academic performance as w... more Purpose: To investigate the association between an eye injury and later academic performance as well as the level of social engagement.Method: A case-crossover study was used to investigate any changes in academic success and social inclusion before and after an injury. Eligibility criteria included all severe injuries admitted during 2011-2017 period at the main regional clinic. Parents/caregivers were surveyed during 2018-2019 asking questions on academic performance, level of community or social involvement. Results. The total sample for assessing social inclusion and academic success were 36 and 25 children, respectively. In the following academic year's kappa agreements decreased from 0.88 (p-value <0.001) comparing pre-injury with one-year post to 0.5106 (p-value <.0001) in the second year and 0.4750 (p-value=0.003) in the third, suggesting the deteriorating trend of academic success with subsequent years. Comparing academic success before an injury to two years and ...
A bony fracture in the orbital floor, the most common site, can lead to tissue herniation, enopht... more A bony fracture in the orbital floor, the most common site, can lead to tissue herniation, enophthalmos, hypoglobus, or strabismic diplopia. Several surgical approaches for repair have been described in the literature. This report is a description of an illustrative case and a brief summary of the literature related to the transconjunctival approach to orbital floor fracture repair as performed by ophthalmologists. A 19-year-old female patient had fallen from a 5-meter-high fence and sustained panfacial fractures, including both orbits and the surrounding sinuses. An acute repair was performed by a maxillofacial team to stabilize the facial structure. Following neurosurgical stabilization, she was referred to ophthalmology with pronounced hypoglobus and enophthalmos, diplopia, relative afferent pupillary defect, and a slightly pale right optic nerve head. Surgery was performed under general anesthesia using the transconjunctival approach and an alloplastic implant. This approach was effective, providing excellent exposure while reducing the risks of lower eyelid retraction and surgical scars associated with the transcutaneous approach.
Purpose : To investigate state- and trait-like risk factors leading to childhood eye injuries con... more Purpose : To investigate state- and trait-like risk factors leading to childhood eye injuries controlling for the between-subject difference. This study measured socioeconomic, environmental, behavioral, and injury event characteristics to identify eye injury protective and risk factors. Methods : A retrospective case-crossover study including patients aged 0–18 years old (y.o.) with severe eye trauma treated at the Canton Hospital Zenica between 2011 and 2017 was conducted. One case time point was at the time of injury, and two control time points 1 month before the injury and a month before the survey. Results : Of 36 patients meeting the criteria, four were excluded, resulting in 32 cases and 64 controls. The mean age was 10.79 in males (77.8%) and 11 y.o. in females (22.2%). In univariate GEE logistic regression unusual activity had odds of 17.25 (95%CI = 6.97, 42.70), working/chores vs.running activity odds of 6.60 (95%CI = 1.71, 25.46), very active level vs.an intermediate chi...
Periocular skin is highly prone to malignancies, especially basal cell and squamous cell carcinom... more Periocular skin is highly prone to malignancies, especially basal cell and squamous cell carcinomas. Because of the complex anatomy and eye-protecting functions of the periocular tissues, treatment of these cancers requires special considerations. Mohs micrographic surgery is usually the treatment of choice, whenever possible, in order to enhance margin control while limiting collateral damage to nearby normal structures. Cancer excision, whether by Mohs or other techniques, will leave a complex defect that requires careful anatomical and functional reconstruction. This study presents some of the challenges of treating periocular skin cancer and associated reconstructive surgery and provides an intellectual framework for addressing these challenges. The key topics are adherence to anatomical landmarks and aesthetic units, proper distribution of tension, and matching the correct reconstructive approach, that is, type of flap or graft, to the defect at hand. This review is not meant t...
Ophthalmic Plastic & Reconstructive Surgery, 2020
Purpose: To perform a comprehensive review of dermis fat graft (DFG) in socket reconstruction and... more Purpose: To perform a comprehensive review of dermis fat graft (DFG) in socket reconstruction and illustrate the technical nuances and outcomes using a retrospective case review. Methods: A literature search of 143 texts was reviewed. A retrospective case series of 34 patients following primary or secondary DFG after enucleation at a single institution (2009-2019) was performed. Clinical outcomes were statistically analyzed. Variables investigated included age, sex, race, surgical indication, muscle reattachment, complications, motility, eyelid position, prosthesis fit, and need for additional surgery. Results: The history of DFG, use in socket reconstruction, primary and secondary indications, and surgical techniques are described. Thirty-two adults and 2 pediatric cases of DFG were reviewed; 18.75% indications were primary and 81.25% were secondary. Good eyelid position was observed in 83.3% of patients with primary DFG versus 37.5% with secondary DFG (p = 0.07). Postoperative complications occurred in 58.8% of patients, were typically mild, and resolved with minimal or no intervention. No statistically significant differences were found between occurrence of any particular complication in primary versus secondary DFG placement (p = 0.36) or between primary and secondary DFG placement and the need for additional surgery (p = 1.0). Among the 67.7% patients who had implant exposure or extrusion as an indication for DFG, 39.1% required additional surgery within 2 years. Advanced age was not associated with higher complication rates (p = 0.12). Conclusions: DFG is an excellent option for socket reconstruction, particularly in cases involving pediatric patients, complicated orbits, history of multiple previous surgeries, and inflamed, contracted, or scarred sockets.
Introduction: Eye lid reconstruction followed by severe, extensive body and facial burns represen... more Introduction: Eye lid reconstruction followed by severe, extensive body and facial burns represents a surgical challenge due to difficulties to obtain proper, healthy skin graft, tissue ischemia and necrosis. Presentation of case: We present a reconstructive lid surgery of cicatricial bilateral lower eyelid ectropion in a case of 31-year-old man who sustained thermal injuries, affecting more than 60% of total body surface area, causing severe, deep dermal burns. Reconstruction was made using the technique of skin cantus-to-cantus incision, contracture release, orbicularis liberation and lid elevation; and oversizing free full-thickness skin graft (FTSG) (Wolfe technique) from the left inguinal region, as the only healthy skin on the entire body surface. Residual lower left lid laxity was addressed by pentagonal wedge resection, not interrupting marginal arcade vessels, thus minimizing ischemia. Discussion: Method of choice of the graft type has been much debated question; however, significantly less reoccurrence rate of ectropion was observed using FTSG. Time of grafting should be balanced to avoid excess granulation and, thus scaring caused by delayed grafting time, or poor graft adherence caused by premature grafting. An interruption of the marginal arcade vessels should not be performed due to already severe ischemic process and increased risk for lid necrosis. Conclusion: Major issues when addressing cicatricial ectropion followed by severe burns are: right donor site selection, appropriate graft thickness with the least possible disturbance of the affected place vascularisation, followed by immediate grafting after debridement of scaring and unhealthy tissue, with generous preservation of the orbicularis muscle.
Background ̸Purpose. Adults as well as children may have problems with strabismus, which can sign... more Background ̸Purpose. Adults as well as children may have problems with strabismus, which can significantly affects on quality of social and professional life. Strabismus surgery in adults are not conditioned for years of a patient, and the main goal of this kind of surgery is to improve motoric-senzorial relationship of eyes, and to improve esthetic moment of a patient. Patients&Methods. A surgical review was performed on 35 adult patients with strabismus in period between January 2016 - May 2018 years. The type of strabismus, preoperative measurements, and indications for surgery were obtained from the patient notes, as were all final outcomes. Final measurements, on average, were 3 to 6 weeks postoperatively, and patients were asked to comment subjectively on their outcome. Results. In total number 35 of adult strabismic patients, were 12 (34,3%) male and 23 (65,7%) female, mean age 34,15±13 ( 20 to 67 years), 17 patiens (48,6%) were exotropic, esotropic 11 (31,4%) patiens, and h...
Background : Eye injuries can result in long-term disability, and healthcare providers need bette... more Background : Eye injuries can result in long-term disability, and healthcare providers need better tools to predict outcomes. Few prognostic models for poor visual acuity have been examined using variables usually present in very severe injuries, which creates a gap in prognosis. Therefore, a model associated with severe and less severe injuries is examined. Methods : Eye injuries hospitalized in Bosnia and Herzegovina from 2006 through 2014 were included. A total of 298 eye injuries met the inclusion criteria of being an acute mechanical, chemical or physical eye injury. Prognostic variables were grouped by patient characteristics, eye injury characteristics and eye injury diagnosis. Poor final visual acuity was the main outcome measure (vision less than 20/200). Multivariate regression analysis used stepwise selection to identify the strongest set of predictive variables. Results : Lens subluxation (95 % CI : 2.09-14.83), vitreous prolapse (95 % CI : 2.76-26.87), vitreous hemorrhage (95 % CI : 1.71-10.03), posterior segment intraocular foreign body (95 % CI : 1.19-39.09), and vitritis (95 % CI : 0.97-11.12) were significantly associated with poor final visual acuity. The predictive model identified the combination of age over 36, lens subluxation, vitreous prolapse and hemorrhage, vitritis, and macular hemorrhage as the combination most likely to have poor visual acuity. The final model resulted in a strong fit as measured by AIC, log likelihood, goodness-of-fit, and the c-statistic.
Ophthalmic Plastic & Reconstructive Surgery, 2019
Many primary and secondary coagulopathies have been linked with NTSOH including liver disease, Sc... more Many primary and secondary coagulopathies have been linked with NTSOH including liver disease, Scurvy, thrombolysis/anticoagulation, disseminated intravascular coagulation, Christmas disease, chronic myeloid leukemia, Henoch-Schonlein purpura, Von Willebrand disease, thalassemia, and thrombocytopeni. 1 The typical location in most of these cases was in the superior orbit with frequent bilaterality. 1 The atypical location in our case may suggest that the underlying coagulopathy contributed to its development non traumatic subperiosteal hemorrhage as opposed to NTSOH seen in the setting of pansinusitis. Nontraumatic or spontaneous orbital subperiosteal hemorrhage associated with sinusitis tend to occur with frontal and ethmoid sinusitis. It has not always apparent whether the subperiosteal collection is infective or hemorrhagic, and this usually becomes clear at surgery. The acute clinical deterioration and radiologic progression as seen in MRI as well may point to the diagnosis of NTSOH rather than subperiosteal abscess in many cases. However, we cannot rule out a significant role of the bilateral sinusitis in this case as a contributing factor to the development of NTSOH. The diagnosis of NTSOH can be established by either CT or MRI of the orbit. The CT appearance of acute NTSOH is a biconvex, well-defined, nonenhancing mass of homogeneous density slightly higher than that of the brain, while MRI may reveal a biconvex, well-defined mass of varied signal intensity, depending on the age of the hematoma. 2 In this case, the first CT scan was done without contrast and the diagnosis was NTSOH could not be made with confidence since the appearance initially may resemble a subperiosteal abscess, which may exhibit a slightly lower density to that of blood. Treatment of mild, nonvision threatening, subperiosteal hemorrhage is usually observation; however, urgent surgical evacuation is indicated if there is optic nerve compression. Fine needle aspiration can also be attempted. However, in the early stages when the clots is not completely liquefied, it may be of limited value and surgical evacuation may still be needed. 10 CONCLUSION NTSOH can present in the setting of pansinusitis and can cause acute deterioration of the clinical picture and optic nerve compromise. In our case, NTSOH can be attributed to the underlying sinusitis. However, the atypical location (superolateral) suggests that the underling coagulopathy, Bernard-Soulier syndrome, may have played a role in its development.
The aim of the study was to investigate the effects of vascular endothelial growth factor (VEGF) ... more The aim of the study was to investigate the effects of vascular endothelial growth factor (VEGF) concentration in vitreous on postoperative complications after pars plana vitrectomy (PPV). Material and methods: Ninety subjects were surgically treated with PPV and followed up for 12 months at the Clinical Centre University Sarajevo, Clinic for Eye Disease. Exclusion criteria were presence of other eye diseases, systemic acute/chronic inflammatory conditions, or malignant neoplasms; previously performed PPV surgery; previously received intravitreal or systemic anti-VEGF therapy. A vitreous sample was obtained while performing the PPV procedure, using the Quantikine ELISA test to determine VEGF level, as a risk factor. Outcome measures were intraoperative and postoperative complications reported using categorical data: blunt and sharp dissection of membranes, intraoperative hemorrhage stopped by increasing infusion pressure, pressing with blunt instrument, or using diathermy. The following postoperative complications were assessed on the first day and at the 12-month follow-up visit: vitreous hemorrhage, fibrovascular proliferation (FVP), rubeosis iridis, and neovascular glaucoma (NVG). Results: Levels of vitreous VEGF at the time of PPV were significantly higher in eyes with: vitreous hemorrhage on the first day after PPV (p = 0.003); FVP on the first day and 12 months after PPV (p = 0.002 and p < 0.001, respectively); iris rubeosis on the first day and 12 months after PPV surgery (p < 0.001, and p = 0.001, respectively); NVG on the first day and 12 months after PPV surgery (p = 0.043 and p = 0.011, respectively), compared to the eyes without complications. Conclusions: Preoperative levels of VEGF in vitreous can be a useful biomarker and predictor of the postoperative outcome in terms of intraoperative and postoperative complications.
International journal of occupational safety and health, 2014
Health Professional exposures of health care workers (HCW) to potentially infective blood and bod... more Health Professional exposures of health care workers (HCW) to potentially infective blood and body fluids presents a serious health threat, including hepatitis B, hepatitis C and HIV transmission. This study was conducted to assess the risk for and reporting of needle stick injuries, sharp injuries and other occupational exposures of health care workers in a large healthcare center in Sarajevo. This cross-sectional survey was conducted in May 2013. The study target population included all hospital health care workers who had a high potential for exposure. The estimated sample size was 48 physicians, 132 nurses/technicians and 30 auxiliary personnel. During their career, 124 (63.3%) HCW reported exposures to blood and body fluids. In total, needle stick injuries (66.1%) were the most common source of exposure, followed by contact with intact skin (12.1%) and cut with sharp object (11.3%). Only 43 (35.5%) reported any of these exposures to health authorities during their career. The o...
Diabetes mellitus (DM) is a complex metabolic disorder resulting from tissue resistance to insuli... more Diabetes mellitus (DM) is a complex metabolic disorder resulting from tissue resistance to insulin or failure of the pancreas to produce insulin. Complications of DM include, amongst all, foot ulcerations, foot infections. These foot diseases are commonly referred to as a diabetic foot and are the leading causes of hospital admissions of patients with DM. Risk factors for foot ulcers include peripheral sensory neuropathy with a subsequent loss of protective sensory function as well as inadequate foot hygiene, minor cuts and injuries. 162 patients with a diagnosis of diabetic foot were admitted to the surgery department of the Canton Hospital in Zenica, Bosnia and Herzegovina between January 2010 and January 2012. All patients were treated surgically and received extensive education on foot hygiene, foot inspection and foot care. Using of appropriate footwear and basic principles of foot wound dressing were presented as well. Type, severity and rate of complications were monitored on...
Introduction: Diabetic maculopathy is the major cause of reduced visual acuity in patients with n... more Introduction: Diabetic maculopathy is the major cause of reduced visual acuity in patients with non-proliferative diabetic retinopathy and occurs on average in 29% of patients who have diabetes for 20 or more years. Aim: The aim of this study is to re examine the correlation between the findings of optical coherence retinal tomography, stereo bio-microscopic images from fundus of an eye and values from visual acuity of diabetic macular edema. In addition, the aim is to show the importance of various ophthalmic tests for establishing diagnosis in time. Material and methods: The research sample consisted of 90 subjects-patients from Cabinet for photographic documentation, fluorescein angiography and laser photocoagulation in Department of Ophthalmology at the University Clinical Centre in Sarajevo. The study was a one-year long, prospective, clinical study. Results: Research has shown a positive correlation between the various tests that are applied for the diagnosis of diabetic macular edema. Accurate and early diagnosis is of great importance for the treatment in time of this disease by applying laser photocoagulation, intravitreal injections of Anti-VEGF drugs or surgical treatment by Pars Plana Vitrectomy.
BACKGROUND: Intestinal worm infestation is widely prevalent in developing countries and can resul... more BACKGROUND: Intestinal worm infestation is widely prevalent in developing countries and can result in impaired nutrition and development. AIMS: To estimate prevalence of and risk factors for intestinal geohelminths and other intestinal parasites in children aged 6 to 23 months. SETTINGS AND DESIGN: Cross sectional study in rural India. MATERIALS AND METHODS: Proportionate population size sampling method was used to randomly select 15 villages per block. Thereafter, house-to-house survey was done to recruit eligible children and obtain fecal sample for microbiological examination. STATISTICAL ANALYSIS: Univariate distribution of variables was assessed and comparison between categorical variables and continuous variables was done using a Chi-square test and student's t-test, respectively. Odds ratio was calculated to assess associations. RESULTS: Overall 926 children were recruited and 909 fecal samples examined. Combined prevalence of infestation with intestinal geohelminths treatable by albendazole and other intestinal parasites non-treatable by albendazole was 50.3% (457/909) and 51.6% (469/909), respectively. Exclusive use of hand pump water (OR = 1.79, CI = 1.36-2.35, P < 0.001) and use of hand pump water plus field defecation increased risk of geohelminthic infection (OR = 1.75 CI = 1.34-2.30, P < 0.001) while use of well water (OR = 0.45 CI= 0.33-0.60, P < 0.001) and exclusive use of soap and water practice for hand washing after defecation was protective (OR = 0.54, CI = 0.40-0.73, P < 0.001). CONCLUSION: Since almost half the children are infected with intestinal geohelminths treatable by albendazole, targeted deworming of population in this age group should be considered.
PURPOSE Conjunctival cicatrizing conditions are vision threatening, with poor outcomes despite ag... more PURPOSE Conjunctival cicatrizing conditions are vision threatening, with poor outcomes despite aggressive systemic therapy. This study tests the utility of serial injections of 5-fluorouracil (5-FU) into the fornices to treat conjunctival scarring in patients with ocular cicatricial pemphigoid or Stevens-Johnson syndrome/toxic epidermal necrolysis. METHODS Retrospective cohort study. Fisher exact test and multivariable logistic regression analyses were used to compare clinical outcomes of patients who were administered 5-FU injections versus patients who were not injected. Model fit was examined for multivariable regression. RESULTS One hundred twelve eyes (56 patients) met the inclusion criteria. Thirty-eight eyes (34%) had Stevens-Johnson syndrome/toxic epidermal necrolysis, and 74 eyes (66%) were diagnosed with ocular cicatricial pemphigoid. Twenty-five eyes received ≥1 injection of 5-FU. Sixteen eyes received 1-4 injections, while 9 received ≥5. Median follow-up until last encounter was 18 months. Analysis of each disease entity alone and in combination revealed that 5-FU injections were associated with improvement in final visual acuity, corneal scarring, trichiasis, need for/number of mucous membrane graft surgeries, and severity of symblephara. CONCLUSIONS Serial injection of 5-FU in the affected fornices is a promising treatment for severe vision-threatening conjunctival scarring from ocular cicatricial pemphigoid and Stevens-Johnson syndrome/toxic epidermal necrolysis. Given the excellent safety profile of 5-FU around the eye, the solid biologic foundation for using 5-FU in this setting, and the severe risk of vision loss from these disorders, the authors suggest that serial 5-FU injections be adopted as therapy for conjunctival scarring from ocular cicatricial pemphigoid or Stevens-Johnson syndrome/toxic epidermal necrolysis despite the limitations of this retrospective study.
Purpose: To investigate the association between an eye injury and later academic performance as w... more Purpose: To investigate the association between an eye injury and later academic performance as well as the level of social engagement.Method: A case-crossover study was used to investigate any changes in academic success and social inclusion before and after an injury. Eligibility criteria included all severe injuries admitted during 2011-2017 period at the main regional clinic. Parents/caregivers were surveyed during 2018-2019 asking questions on academic performance, level of community or social involvement. Results. The total sample for assessing social inclusion and academic success were 36 and 25 children, respectively. In the following academic year's kappa agreements decreased from 0.88 (p-value <0.001) comparing pre-injury with one-year post to 0.5106 (p-value <.0001) in the second year and 0.4750 (p-value=0.003) in the third, suggesting the deteriorating trend of academic success with subsequent years. Comparing academic success before an injury to two years and ...
A bony fracture in the orbital floor, the most common site, can lead to tissue herniation, enopht... more A bony fracture in the orbital floor, the most common site, can lead to tissue herniation, enophthalmos, hypoglobus, or strabismic diplopia. Several surgical approaches for repair have been described in the literature. This report is a description of an illustrative case and a brief summary of the literature related to the transconjunctival approach to orbital floor fracture repair as performed by ophthalmologists. A 19-year-old female patient had fallen from a 5-meter-high fence and sustained panfacial fractures, including both orbits and the surrounding sinuses. An acute repair was performed by a maxillofacial team to stabilize the facial structure. Following neurosurgical stabilization, she was referred to ophthalmology with pronounced hypoglobus and enophthalmos, diplopia, relative afferent pupillary defect, and a slightly pale right optic nerve head. Surgery was performed under general anesthesia using the transconjunctival approach and an alloplastic implant. This approach was effective, providing excellent exposure while reducing the risks of lower eyelid retraction and surgical scars associated with the transcutaneous approach.
Purpose : To investigate state- and trait-like risk factors leading to childhood eye injuries con... more Purpose : To investigate state- and trait-like risk factors leading to childhood eye injuries controlling for the between-subject difference. This study measured socioeconomic, environmental, behavioral, and injury event characteristics to identify eye injury protective and risk factors. Methods : A retrospective case-crossover study including patients aged 0–18 years old (y.o.) with severe eye trauma treated at the Canton Hospital Zenica between 2011 and 2017 was conducted. One case time point was at the time of injury, and two control time points 1 month before the injury and a month before the survey. Results : Of 36 patients meeting the criteria, four were excluded, resulting in 32 cases and 64 controls. The mean age was 10.79 in males (77.8%) and 11 y.o. in females (22.2%). In univariate GEE logistic regression unusual activity had odds of 17.25 (95%CI = 6.97, 42.70), working/chores vs.running activity odds of 6.60 (95%CI = 1.71, 25.46), very active level vs.an intermediate chi...
Periocular skin is highly prone to malignancies, especially basal cell and squamous cell carcinom... more Periocular skin is highly prone to malignancies, especially basal cell and squamous cell carcinomas. Because of the complex anatomy and eye-protecting functions of the periocular tissues, treatment of these cancers requires special considerations. Mohs micrographic surgery is usually the treatment of choice, whenever possible, in order to enhance margin control while limiting collateral damage to nearby normal structures. Cancer excision, whether by Mohs or other techniques, will leave a complex defect that requires careful anatomical and functional reconstruction. This study presents some of the challenges of treating periocular skin cancer and associated reconstructive surgery and provides an intellectual framework for addressing these challenges. The key topics are adherence to anatomical landmarks and aesthetic units, proper distribution of tension, and matching the correct reconstructive approach, that is, type of flap or graft, to the defect at hand. This review is not meant t...
Ophthalmic Plastic & Reconstructive Surgery, 2020
Purpose: To perform a comprehensive review of dermis fat graft (DFG) in socket reconstruction and... more Purpose: To perform a comprehensive review of dermis fat graft (DFG) in socket reconstruction and illustrate the technical nuances and outcomes using a retrospective case review. Methods: A literature search of 143 texts was reviewed. A retrospective case series of 34 patients following primary or secondary DFG after enucleation at a single institution (2009-2019) was performed. Clinical outcomes were statistically analyzed. Variables investigated included age, sex, race, surgical indication, muscle reattachment, complications, motility, eyelid position, prosthesis fit, and need for additional surgery. Results: The history of DFG, use in socket reconstruction, primary and secondary indications, and surgical techniques are described. Thirty-two adults and 2 pediatric cases of DFG were reviewed; 18.75% indications were primary and 81.25% were secondary. Good eyelid position was observed in 83.3% of patients with primary DFG versus 37.5% with secondary DFG (p = 0.07). Postoperative complications occurred in 58.8% of patients, were typically mild, and resolved with minimal or no intervention. No statistically significant differences were found between occurrence of any particular complication in primary versus secondary DFG placement (p = 0.36) or between primary and secondary DFG placement and the need for additional surgery (p = 1.0). Among the 67.7% patients who had implant exposure or extrusion as an indication for DFG, 39.1% required additional surgery within 2 years. Advanced age was not associated with higher complication rates (p = 0.12). Conclusions: DFG is an excellent option for socket reconstruction, particularly in cases involving pediatric patients, complicated orbits, history of multiple previous surgeries, and inflamed, contracted, or scarred sockets.
Introduction: Eye lid reconstruction followed by severe, extensive body and facial burns represen... more Introduction: Eye lid reconstruction followed by severe, extensive body and facial burns represents a surgical challenge due to difficulties to obtain proper, healthy skin graft, tissue ischemia and necrosis. Presentation of case: We present a reconstructive lid surgery of cicatricial bilateral lower eyelid ectropion in a case of 31-year-old man who sustained thermal injuries, affecting more than 60% of total body surface area, causing severe, deep dermal burns. Reconstruction was made using the technique of skin cantus-to-cantus incision, contracture release, orbicularis liberation and lid elevation; and oversizing free full-thickness skin graft (FTSG) (Wolfe technique) from the left inguinal region, as the only healthy skin on the entire body surface. Residual lower left lid laxity was addressed by pentagonal wedge resection, not interrupting marginal arcade vessels, thus minimizing ischemia. Discussion: Method of choice of the graft type has been much debated question; however, significantly less reoccurrence rate of ectropion was observed using FTSG. Time of grafting should be balanced to avoid excess granulation and, thus scaring caused by delayed grafting time, or poor graft adherence caused by premature grafting. An interruption of the marginal arcade vessels should not be performed due to already severe ischemic process and increased risk for lid necrosis. Conclusion: Major issues when addressing cicatricial ectropion followed by severe burns are: right donor site selection, appropriate graft thickness with the least possible disturbance of the affected place vascularisation, followed by immediate grafting after debridement of scaring and unhealthy tissue, with generous preservation of the orbicularis muscle.
Background ̸Purpose. Adults as well as children may have problems with strabismus, which can sign... more Background ̸Purpose. Adults as well as children may have problems with strabismus, which can significantly affects on quality of social and professional life. Strabismus surgery in adults are not conditioned for years of a patient, and the main goal of this kind of surgery is to improve motoric-senzorial relationship of eyes, and to improve esthetic moment of a patient. Patients&Methods. A surgical review was performed on 35 adult patients with strabismus in period between January 2016 - May 2018 years. The type of strabismus, preoperative measurements, and indications for surgery were obtained from the patient notes, as were all final outcomes. Final measurements, on average, were 3 to 6 weeks postoperatively, and patients were asked to comment subjectively on their outcome. Results. In total number 35 of adult strabismic patients, were 12 (34,3%) male and 23 (65,7%) female, mean age 34,15±13 ( 20 to 67 years), 17 patiens (48,6%) were exotropic, esotropic 11 (31,4%) patiens, and h...
Background : Eye injuries can result in long-term disability, and healthcare providers need bette... more Background : Eye injuries can result in long-term disability, and healthcare providers need better tools to predict outcomes. Few prognostic models for poor visual acuity have been examined using variables usually present in very severe injuries, which creates a gap in prognosis. Therefore, a model associated with severe and less severe injuries is examined. Methods : Eye injuries hospitalized in Bosnia and Herzegovina from 2006 through 2014 were included. A total of 298 eye injuries met the inclusion criteria of being an acute mechanical, chemical or physical eye injury. Prognostic variables were grouped by patient characteristics, eye injury characteristics and eye injury diagnosis. Poor final visual acuity was the main outcome measure (vision less than 20/200). Multivariate regression analysis used stepwise selection to identify the strongest set of predictive variables. Results : Lens subluxation (95 % CI : 2.09-14.83), vitreous prolapse (95 % CI : 2.76-26.87), vitreous hemorrhage (95 % CI : 1.71-10.03), posterior segment intraocular foreign body (95 % CI : 1.19-39.09), and vitritis (95 % CI : 0.97-11.12) were significantly associated with poor final visual acuity. The predictive model identified the combination of age over 36, lens subluxation, vitreous prolapse and hemorrhage, vitritis, and macular hemorrhage as the combination most likely to have poor visual acuity. The final model resulted in a strong fit as measured by AIC, log likelihood, goodness-of-fit, and the c-statistic.
Ophthalmic Plastic & Reconstructive Surgery, 2019
Many primary and secondary coagulopathies have been linked with NTSOH including liver disease, Sc... more Many primary and secondary coagulopathies have been linked with NTSOH including liver disease, Scurvy, thrombolysis/anticoagulation, disseminated intravascular coagulation, Christmas disease, chronic myeloid leukemia, Henoch-Schonlein purpura, Von Willebrand disease, thalassemia, and thrombocytopeni. 1 The typical location in most of these cases was in the superior orbit with frequent bilaterality. 1 The atypical location in our case may suggest that the underlying coagulopathy contributed to its development non traumatic subperiosteal hemorrhage as opposed to NTSOH seen in the setting of pansinusitis. Nontraumatic or spontaneous orbital subperiosteal hemorrhage associated with sinusitis tend to occur with frontal and ethmoid sinusitis. It has not always apparent whether the subperiosteal collection is infective or hemorrhagic, and this usually becomes clear at surgery. The acute clinical deterioration and radiologic progression as seen in MRI as well may point to the diagnosis of NTSOH rather than subperiosteal abscess in many cases. However, we cannot rule out a significant role of the bilateral sinusitis in this case as a contributing factor to the development of NTSOH. The diagnosis of NTSOH can be established by either CT or MRI of the orbit. The CT appearance of acute NTSOH is a biconvex, well-defined, nonenhancing mass of homogeneous density slightly higher than that of the brain, while MRI may reveal a biconvex, well-defined mass of varied signal intensity, depending on the age of the hematoma. 2 In this case, the first CT scan was done without contrast and the diagnosis was NTSOH could not be made with confidence since the appearance initially may resemble a subperiosteal abscess, which may exhibit a slightly lower density to that of blood. Treatment of mild, nonvision threatening, subperiosteal hemorrhage is usually observation; however, urgent surgical evacuation is indicated if there is optic nerve compression. Fine needle aspiration can also be attempted. However, in the early stages when the clots is not completely liquefied, it may be of limited value and surgical evacuation may still be needed. 10 CONCLUSION NTSOH can present in the setting of pansinusitis and can cause acute deterioration of the clinical picture and optic nerve compromise. In our case, NTSOH can be attributed to the underlying sinusitis. However, the atypical location (superolateral) suggests that the underling coagulopathy, Bernard-Soulier syndrome, may have played a role in its development.
The aim of the study was to investigate the effects of vascular endothelial growth factor (VEGF) ... more The aim of the study was to investigate the effects of vascular endothelial growth factor (VEGF) concentration in vitreous on postoperative complications after pars plana vitrectomy (PPV). Material and methods: Ninety subjects were surgically treated with PPV and followed up for 12 months at the Clinical Centre University Sarajevo, Clinic for Eye Disease. Exclusion criteria were presence of other eye diseases, systemic acute/chronic inflammatory conditions, or malignant neoplasms; previously performed PPV surgery; previously received intravitreal or systemic anti-VEGF therapy. A vitreous sample was obtained while performing the PPV procedure, using the Quantikine ELISA test to determine VEGF level, as a risk factor. Outcome measures were intraoperative and postoperative complications reported using categorical data: blunt and sharp dissection of membranes, intraoperative hemorrhage stopped by increasing infusion pressure, pressing with blunt instrument, or using diathermy. The following postoperative complications were assessed on the first day and at the 12-month follow-up visit: vitreous hemorrhage, fibrovascular proliferation (FVP), rubeosis iridis, and neovascular glaucoma (NVG). Results: Levels of vitreous VEGF at the time of PPV were significantly higher in eyes with: vitreous hemorrhage on the first day after PPV (p = 0.003); FVP on the first day and 12 months after PPV (p = 0.002 and p < 0.001, respectively); iris rubeosis on the first day and 12 months after PPV surgery (p < 0.001, and p = 0.001, respectively); NVG on the first day and 12 months after PPV surgery (p = 0.043 and p = 0.011, respectively), compared to the eyes without complications. Conclusions: Preoperative levels of VEGF in vitreous can be a useful biomarker and predictor of the postoperative outcome in terms of intraoperative and postoperative complications.
International journal of occupational safety and health, 2014
Health Professional exposures of health care workers (HCW) to potentially infective blood and bod... more Health Professional exposures of health care workers (HCW) to potentially infective blood and body fluids presents a serious health threat, including hepatitis B, hepatitis C and HIV transmission. This study was conducted to assess the risk for and reporting of needle stick injuries, sharp injuries and other occupational exposures of health care workers in a large healthcare center in Sarajevo. This cross-sectional survey was conducted in May 2013. The study target population included all hospital health care workers who had a high potential for exposure. The estimated sample size was 48 physicians, 132 nurses/technicians and 30 auxiliary personnel. During their career, 124 (63.3%) HCW reported exposures to blood and body fluids. In total, needle stick injuries (66.1%) were the most common source of exposure, followed by contact with intact skin (12.1%) and cut with sharp object (11.3%). Only 43 (35.5%) reported any of these exposures to health authorities during their career. The o...
Diabetes mellitus (DM) is a complex metabolic disorder resulting from tissue resistance to insuli... more Diabetes mellitus (DM) is a complex metabolic disorder resulting from tissue resistance to insulin or failure of the pancreas to produce insulin. Complications of DM include, amongst all, foot ulcerations, foot infections. These foot diseases are commonly referred to as a diabetic foot and are the leading causes of hospital admissions of patients with DM. Risk factors for foot ulcers include peripheral sensory neuropathy with a subsequent loss of protective sensory function as well as inadequate foot hygiene, minor cuts and injuries. 162 patients with a diagnosis of diabetic foot were admitted to the surgery department of the Canton Hospital in Zenica, Bosnia and Herzegovina between January 2010 and January 2012. All patients were treated surgically and received extensive education on foot hygiene, foot inspection and foot care. Using of appropriate footwear and basic principles of foot wound dressing were presented as well. Type, severity and rate of complications were monitored on...
Introduction: Diabetic maculopathy is the major cause of reduced visual acuity in patients with n... more Introduction: Diabetic maculopathy is the major cause of reduced visual acuity in patients with non-proliferative diabetic retinopathy and occurs on average in 29% of patients who have diabetes for 20 or more years. Aim: The aim of this study is to re examine the correlation between the findings of optical coherence retinal tomography, stereo bio-microscopic images from fundus of an eye and values from visual acuity of diabetic macular edema. In addition, the aim is to show the importance of various ophthalmic tests for establishing diagnosis in time. Material and methods: The research sample consisted of 90 subjects-patients from Cabinet for photographic documentation, fluorescein angiography and laser photocoagulation in Department of Ophthalmology at the University Clinical Centre in Sarajevo. The study was a one-year long, prospective, clinical study. Results: Research has shown a positive correlation between the various tests that are applied for the diagnosis of diabetic macular edema. Accurate and early diagnosis is of great importance for the treatment in time of this disease by applying laser photocoagulation, intravitreal injections of Anti-VEGF drugs or surgical treatment by Pars Plana Vitrectomy.
BACKGROUND: Intestinal worm infestation is widely prevalent in developing countries and can resul... more BACKGROUND: Intestinal worm infestation is widely prevalent in developing countries and can result in impaired nutrition and development. AIMS: To estimate prevalence of and risk factors for intestinal geohelminths and other intestinal parasites in children aged 6 to 23 months. SETTINGS AND DESIGN: Cross sectional study in rural India. MATERIALS AND METHODS: Proportionate population size sampling method was used to randomly select 15 villages per block. Thereafter, house-to-house survey was done to recruit eligible children and obtain fecal sample for microbiological examination. STATISTICAL ANALYSIS: Univariate distribution of variables was assessed and comparison between categorical variables and continuous variables was done using a Chi-square test and student's t-test, respectively. Odds ratio was calculated to assess associations. RESULTS: Overall 926 children were recruited and 909 fecal samples examined. Combined prevalence of infestation with intestinal geohelminths treatable by albendazole and other intestinal parasites non-treatable by albendazole was 50.3% (457/909) and 51.6% (469/909), respectively. Exclusive use of hand pump water (OR = 1.79, CI = 1.36-2.35, P < 0.001) and use of hand pump water plus field defecation increased risk of geohelminthic infection (OR = 1.75 CI = 1.34-2.30, P < 0.001) while use of well water (OR = 0.45 CI= 0.33-0.60, P < 0.001) and exclusive use of soap and water practice for hand washing after defecation was protective (OR = 0.54, CI = 0.40-0.73, P < 0.001). CONCLUSION: Since almost half the children are infected with intestinal geohelminths treatable by albendazole, targeted deworming of population in this age group should be considered.
PURPOSE Conjunctival cicatrizing conditions are vision threatening, with poor outcomes despite ag... more PURPOSE Conjunctival cicatrizing conditions are vision threatening, with poor outcomes despite aggressive systemic therapy. This study tests the utility of serial injections of 5-fluorouracil (5-FU) into the fornices to treat conjunctival scarring in patients with ocular cicatricial pemphigoid or Stevens-Johnson syndrome/toxic epidermal necrolysis. METHODS Retrospective cohort study. Fisher exact test and multivariable logistic regression analyses were used to compare clinical outcomes of patients who were administered 5-FU injections versus patients who were not injected. Model fit was examined for multivariable regression. RESULTS One hundred twelve eyes (56 patients) met the inclusion criteria. Thirty-eight eyes (34%) had Stevens-Johnson syndrome/toxic epidermal necrolysis, and 74 eyes (66%) were diagnosed with ocular cicatricial pemphigoid. Twenty-five eyes received ≥1 injection of 5-FU. Sixteen eyes received 1-4 injections, while 9 received ≥5. Median follow-up until last encounter was 18 months. Analysis of each disease entity alone and in combination revealed that 5-FU injections were associated with improvement in final visual acuity, corneal scarring, trichiasis, need for/number of mucous membrane graft surgeries, and severity of symblephara. CONCLUSIONS Serial injection of 5-FU in the affected fornices is a promising treatment for severe vision-threatening conjunctival scarring from ocular cicatricial pemphigoid and Stevens-Johnson syndrome/toxic epidermal necrolysis. Given the excellent safety profile of 5-FU around the eye, the solid biologic foundation for using 5-FU in this setting, and the severe risk of vision loss from these disorders, the authors suggest that serial 5-FU injections be adopted as therapy for conjunctival scarring from ocular cicatricial pemphigoid or Stevens-Johnson syndrome/toxic epidermal necrolysis despite the limitations of this retrospective study.
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Papers by Nina Jovanovic