BACKGROUND/AIM Active surveillance is an important component of surgical site infection (SSI) reduction strategy. The aim of this study was to analyze and compare SSI surveillance data in orthopedic patients in the Military Medical Academy (MMA), Belgrade. METHODS A 4-year prospective cohort study was performed to identify the incidence rate and risk factors for SSI in orthopedic patients in the MMA, Belgrade. We collected data regarding patients characteristics, health care and micro-organisms isolated in SSI. The National Nosocomial Infection Surveillance (NNIS) risk index was subsequently calculated for each patient. The Centers for Disease Control and Prevention criteria were used for the diagnosis of SSI. RESULTS Assessment of 3,867 patients after different orthopedic operations revealed SSI in 109 patients. The overall incidence rate of SSI was 2.8% with the decrease from 4.6% in 2007 to 1.6% in 2010. Using NNIS risk index for surgical procedures there were: 53.7% (2,077) patients with risk 0--the incidence rate of 1.4%; 38.9% (1,506) patients with risk 1--the incidence rate of 3.1%; 7.3% (281) patients with risk 2--the incidence rate of 11.7%; 0.1% (3) patients with risk 3--without infection within the risk. Multivariate logistic regression analysis identified 6 independent risk factors associated with SSI: contaninated or dirty wounds, smoking, preoperative infection, NNIS risk index, body mass index and the length of hospital stay. CONCLUSION The results of our study are valuable confirmation of relations between risk factors and SSI in orthopedic patients. A decreasing incidence rate of SSI (from 4.6% to 1.6%) during a 4-year active surveillance approved its implementation as an important component of SSI reduction strategy.

Introduction: Omphalocele and gastroschisis are developmental defects of the anterior abdominal wall, which have only recently been categorized as separate entities. In both cases, it is a herniation of abdominal organs through appropriate defects of the anterior abdominal wall. It is considered that the omphalocele are quite often developmental anomalies and are often associated with other developmental disorders, unlike gastroschisis, which usually occur isolated. Aims of the study: To determine the frequency of cases of omphalocele and gastroschisis in the Clinical Center of Banja Luka in the period from 2000 to 2013. Patients and methods: Insight into medical records, a retrospective analysis of all cases of congenital defects of the anterior abdominal wall at the Clinical Center of Banja Luka was done from the year 2000-2013. The analysis included all cases of omphalocele and gastroschisis, and prematurity, associated anomalies, the rate of mortality in the first year, exposure to environmental factors during pregnancy, maternal diabetes, maternal age, and familiar occurence of these anomalies were taken into consideration. Cases of „the prune belly“ syndrome and umbilical hernia were not included in this research. Results: During the period 2000-2013, there was a total of 19 cases of omphalocele, of which eigth live births. In the same period there was 14 cases of gastroschisis, and there was seven children born alive with this defect. In 73 percent of omphalocele cases there was associated anomalies, while this rate at gastroschisis was significantly lower and amounted to 28 percent. Among the live births, prematurity rate was 37.5 percent for the omphalocele group and 57 percent for the group of gastroschisis. The mortality rate in the first year of life was 25 percent for omphalocele and 14 percent for gastroshisis. In all these cases, the cause of death was not directly related to abdominal defect, but the associated complications (respiratory distress in the first place). Half of the mothers from both groups stated that they had used some medicines or consumed cigarettes during pregnancy. There was also a single incident of gestational diabetes in the group of omphalocele and one case of a positive family history from the gastroschisis group. Discussion: In this study, the relation of omphalocele and gastroshisis was 19/14 or 1.3:1, compared to the expected 3:2 ratio in the world literature. Other studies around the world show a higher incidence of gastroschisis and lower incidence of omphalocele. We had no reported cases of stillbirths in omphalocele group although, in the world literature, data of 11-12 percent were noticed . The reason for this discrepancy could be a different criteria for stillbirth compared to abortion, and perhaps the reporting was biased. The percentage of associated anomalies was higher in group of omphalocele, and similar results were reported in other studies. The mortality rate in thefirst year of life in a group of omphalocele was much higher when compared to gastroschisis group. For unknown reasons, stillborn children with omphalocele were not represented in this study. 56 Scripta Medica Vol. 46 • No 1 • April 2015. • www.scriptamedica.com

Knowledge of pathophysiological basis of laparoscopic procedures, that is, the influence of CO2 pneumoperitoneum (PNP) on the body in particular, can prevent the complications during laparoscopy to occur. Standard intra-abdominal pressure (IAP), which is used during laparoscopic surgery, is 12-15 mm / Hg. The direct effect of CO2 pneumoperitoneum is a result of mechanical action of the gas and increasement of intra-abdominal pressure (IAP). The indirect effect of CO2 pneumoperitoneum is caused by the absorption of gas inserted into the abdomen. Analysis of published articles that assess the effects of CO2 pneumoperitoneum on the body and abdominal organs contributes to a better usage of the laparoscopic method. Different techniques in laparoscopy, created as an alternative to standard CO2-pneumoperitoneum, have the task to reduce the risks for patients with comorbidity and simultaneously raise the abdominal wall and allow the surgeon to perform smooth operation, which is especially important for ASA III and ASA IV patients. Alternative techniques can be divided into three groups: laparoscopy using pneumoperitoneum with low intra-abdominal pressure (up to 8 mm / Hg), laparoscopy using retractors abdominal wall and limited pneumoperitoneum, and laparoscopy without the use of gas (gasless laparoscopy; raising the abdominal wall retractor only ). Low insufflation pressure in the abdomen (up to 8 mm / Hg) is beneficial for patients with laparoscopic procedures and its routine usage in elderly patients and patients with severe cardiorespiratory diseases, should be common practice. Gasless laparoscopy was created because of the need to prevent the negative effects of increased intra-abdominal pressure on the body during laparoscopy, primarily in patients with high comorbidity (ASA III and ASA IV). When compared to other techniques, numerous studies prefer laparoscopy with low insufflation pressure, but in practice this is not done routinely, yet each technique is applied selectively, according to the needs and condition of the patient, which is the most appropriate. To avoid the side effects of CO2 pneumoperitoneum, which is important in high-risk patients, it is more likely to operate on low IAP (6-8 mm / Hg) or use gasless laparoscopy. This is especially important for long – duration operations. DOI: 10.7251/SMDEN1501066H (Scr Med 2015:46:66-72)

Introduction: The cases of poisoning or intoxication are pathological conditions occurring as consequences of effects of poisonous substances when taken into body regardless of the way in which they have been taken, the dosage or effects of substances that are not potentially poison ous, but if they are taken in large (enormous) dosage, they become poisonous. The reasons leading to poisoning at children's age are various, and among the most important ones are poor general and health -related education of adults as well as insufficient work on the application of preventive measures. Acute poisoning at children's age is always an emergency condition regardless of the manifestation of symptoms and signs (possible latent period with subsequent symptoms of poisoning). Aim: To present the data on the frequency of acute poisoning considering age and gender in relation to the overall number of received patients at the Paediatric Clinic in Sarajevo, to present the data on the frequency of individual poisonous substances in acute poisoning and to present the data on parents' being informed on the possibilities of their underage children's poisoning, as well as the way of prevention based on responses obtained in a questionnaire. Material and methods of work: In this work, all cases of acute poisoning at children's age were analysed in children hospitalized at the Paediatric Clinic of the Clinical Centre of Kosevo in Sarajevo in the period of four years, i.e. from 15/07/2010 to 15/07/2013, of whom there were 80 in total. The medical documentation of the Paediatric Clinic in Sarajevo was used for this work. Annual protocols of walk -in centre was used, as well as histories of diseases of children who were treated for acute poisoning at the Paediatric Clinic in Sarajevo in the period from 15/07/2010 to 15/07/2013. The research in this work is retrospective. We used Word and Excel graphical and tabular data presentation. General data were considered (age, gender, place of residence, parents' occupation), agents by which children were poisoned, the most frequent places where children got poisoned. The data obtained through a questionnaire filled in by parents were analysed; the parents were selected for the survey by the method of random selection. Results: The results indicate that during the analysed period there was no great frequency of acute poisoning at children's age in relation to reception of children into hospital for some other reasons, which was on average 0.50%. The most frequent poisoning in our country, as well as worldwide, is in the period 1-5 years of age (75%). There were more female children in acute poisoning in this research (63.5%). Most often the children got poisoned by medication. The children of averagely educated parents got poisoned most frequently. Poisoning occurred most frequently at home. It is obvious from the questionnaire that the parents of underage children were well instructed in acute poisoning prevention. Conclusion: We can conclude that it is necessary to go on working on education first of all of parents, then close relatives, a guardian living with a child and of children themselves in order to reduce further incidence of poisoning at children's age.