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Background/Aim: Preventing lower limb diabetic complications begins with identifying those at risk for diabetic foot ulceration (DFU). DFU development is related to abnormal pattern of plantar pressure distribution caused by alterations in foot rollover process due to loss of foot-ankle muscular strength, impaired range of motion (ROM) and nervous function, as their integrity is needed to enable proper load absorption on plantar surface. Objective of study was to determine correlation between biomechanical parameters of lower limb: ankle and foot muscle strength, ROM at ankle joint (AJ), subtalar joint (SJ) and first metatarsophalangeal joint (I MTP) and overall risk for DFU assessed by IWGDF 2019 Guidance risk stratification system. Methods: A cross-sectional study included 100 diabetic patients, both types. Patients were classified into 4 DFU risk categories applying IWGDF Guidelines 2019 stratification risk system. Function of ten foot and ankle muscles was evaluated by manual muscle testing applying Michigan Diabetic Neuropathy Score system and was expressed by muscle score (MS) on dominant leg. ROM at AJ, SJ and I MTP was measured with a goniometer on dominant leg and was expressed by degree (°). Results: Average MS in specified categories were as follows: Category 0: 9.2; Category 1: 13.9; Category 2: 13.3; Category 3: 15.2 and they were significantly different. Average ROM at AJ in specified categories were as follows: Category 0: 49.3°; Category 1: 48.8°; Category 2: 45.5°; Category 3: 44.6° and they were not significantly different. Average ROM at SJ in specified categories were as follows: Category 0: 37.8°; Category 1: 31.3°; Category 2: 35.0°; Category 3: 28.7° and they were significantly different. Average ROM at I MTP in specified categories were as follows: Category 0: 78.60 ; Category 1: 74.4°; Category 2: 65.5°; Category 3: 57.9° and they were significantly different. Conclusions: Risk for DFU ulcer significantly correlates with decreased ankle and foot muscle strength and ROM at SJ and I MTP but does not correlate with ROM at AJ.

Background/Aim: Many factors affect initial in-brace correction and treatment outcome in patients with idiopathic scoliosis. Previous studies have observed contradictory results on the role of BMI in orthotic treatment. The aim of this study was to examine whether BMI impacts in-brace correction, isolated and in relation to other predictive factors (curve magnitude, curve location and Risser sign). Methods: A retrospective study has been conducted on patients with idiopathic scoliosis treated with Cheneau-Sobernheim brace, that had no prior treatment. The collected and analysed data included patient demographics, BMI percentile and radiological parameters (curve magnitude in Cobb angle, curve location, Risser sign). The initial in-brace correction was expressed as a percentage of Cobb angle reduction in the brace as opposed to Cobb angle out of brace. Patients were categorised into groups according to their BMI, expressed in percentiles, ie: low BMI (< 5 percentiles), normal BMI (5-85 percentiles) and high BMI (> 85 percentiles). To determine the significant difference and correlation relationship between the examined variables, variance tests, t-test with unequal variance, and Pearson correlation coefficient have been used. Results: The cohort study comprised 213 patients (170 females and 43 males) with a mean age of 13.5 years at brace prescription. Low BMI has been detected in 10 % patients, normal BMI in 78 % and high BMI in 10 % patients. No significant difference in in-brace correction has been found between BMI groups, nor has there been any significant correlation between BMI and in-brace correction. Regarding other factors, significant difference within BMI groups was found between in-brace correction and curve location, as well as in-brace correction and Risser sign. Lumbar curves had significantly better in-brace correction than thoracic curves. Significant correlations between in-brace correction and curve magnitude, curve location and Risser sign were detected. Conclusion: The results of the present study show that, as an independent factor, BMI does not impact in-brace correction. Other factors, such as curve magnitude, curve location and Risser sign, play a more significant role in the orthotic treatment of patients with idiopathic scoliosis.

Background/Aim. Drug utilisation monitoring could identify drug-related problems and hence improve the awareness of irrational drug use. The objective of this study was to analyse the drug utilisation patterns in a rehabilitation hospital over the period 2011–2016. Methods. The Anatomic Therapeutic Chemical classification/Defined Daily Dose (ATC/DDD) methodology was used to monitor the drug utilisation expressed as a number of DDD per 100 patient-days (HPD). The values of DDDs were obtained from the World Health Organisation (WHO) Collaborating Centre for Drug Statistics Methodology. Utilisation trends were analysed by means of the Compound Aggregate Growth Rate (CAGR), which is defined as an average annual change rate of some value during the period of interest. Results. The number of patient-days increased during the six years period; the CAGR being1.8% annually. At the same time, the total number of dispensed DDDs as well as the number of DDD/HPD decreased with the CAGR of -2.0% and -3.7% respectively. The average drug cost per patient-day varied from BAM 1.38 in 2013 to 0.95 in 2016; the CAGR being -1.8%. The most utilised drugs belonged to the ATC groups C, A, B, M and N and they contributed to an average of 77% of all drugs used each year. On the top of the list of most utilised drugs were: hydroxocobalamin, thioctic acid, enalapril, diclofenac, amlodipine, acetylsalicylic acid, pantoprazole, paracetamol and bromazepam. Conclusions. The overall drug utilisation in the hospital was modest and almost equal in 2016 compared to 2011. Besides the leading consumption of vitamin B12 and thioctic acid, this study points out some interesting prescribing patterns, such as predominant use of diclofenac over ibuprofen, and overuse of proton pump inhibitors. There is a need for educative interventions among physicians in order to improve their prescribing practice.

Introduction: Non-enzymatic protein glycosylation in diabetic patients leads to stiffening of collagen-containing tissues affecting joint mobility. Motor dysfunction in diabetic patients can be detected as muscle weakness or atrophy. Objective: To determine the presence of muscles weakness and limited joint mobility at ankle (AJ), subtalar (SJ) and frst metatarsophalangeal joint (I MTP) in diabetic patients and to determine impact of diabetes duration on those changes. Patients and Methods: A cross-sectional study was conducted among 100 diabetic patients in 'Primary Health Care Centre Banjaluka' in 2014. Function of ten foot and ankle muscles has been evaluated by manual muscle testing. Muscle strength was scored by semiquantitative grading system used in the Michigan Diabetic Neuropathy Score. Range of motion (ROM) at the AJ, SJ and I MTP was measured with goniometer. Results: The average patients age was 61.91±10.74 and diabetes duration 12.25±8.60 years. The average strength of foot and ankle muscles expressed by muscle score was 11.56±5.08. The average ROM at AJ (47.85°) was significantly decreased compared to the reference value that is 65° (t =-15.378, P=000). The average ROM at SJ (35.10°) was significantly decreased compared to the reference value that is 50° (t =-15.378, P=000). The average ROM at the I MTP (72.70°) was significantly decreased compared to the reference value that is 120° (t =-15.378, P = ,000). Conclusion: Patients with diabetes have decreased foot and ankle muscle strength, and the average values of the range of motion at AJ, SJ and I MTP, but the duration of the diabetes does not correlate significantly with those changes.

Introduction: Cervical syndrome is a set of symptoms that are manifested by pain in the neck segment and shoulder blade region, with the feeling of tightness and tension, and limited movement of the neck segment of the spine. Because of the long-term duration of symptoms, we often find psychopathological manifestations in the form of anxiety and depression in these patients. Objective: The goal was to detect the presence of anxiety and depressive manifestations of personality in patients with cervical syndrome at the beginning of rehabilitation treatment, to determine to what extent the presence of anxiety and depressive symptomatology affects the functional recovery of patients after a physical rehabilitation treatment. Patients and Methods: The study was conducted as a prospective study involving 100 patients. Criteria for inclusion were the diagnosis of cervical syndrome and the age of patients between 20 and 60 years of age. Exclusion criteria were diagnosis of cervical radiculopathy, vertebrobasilar syndrome, diagnosis of anxiety and depressionconfrmed by psychiatrist, as well as use of psychotropic substances. On admission, each patient filled in Beck's questionnaire for anxiety and depression (BAI and BDI)and accordingly patients were divided into 3 groups. Results: Out of total of 100 patients, 74% were female and 26% were male. In 77% of patients psychopathological manifestations of personality were found. A statistically significant association of gender and group placement was found (p=0,003). The women had a far greater percentage of anxiety and anxietydepressive manifestations of the personality than men. In terms of BAI and BDI, there was a statistically significant difference between genders. All of the parameters ( VAS, Schober, CSS) monitored during rehabilitation treatment were improved at the end of treatment (p=0,0001). There was a positive correlation of BAI and BDI with CSS on admission and at discharge (p=0,05) in a group of anxiety-depressed patients. Conclusion: The presence of anxiety and depressive manifestations of personality did not have a negative impact on the functional recovery of patients. Physical therapy has led to reduction of pain, increased mobility and better functional status of cervical spine for patients with cervical spine syndrome.

Introduction/Objective. Idiopathic scoliosis (IS) is an orthopedic condition of multifactorial origin. The aim of our study was to evaluate the factors that are associated with IS in female population and factors associated with varicose veins in females with IS. Methods. This retrospective-prospective cross-section study included 89 patients (the study group) and 87 controls. The following parameters were analyzed: body weight, body height, presence and the degree of varicose veins (the first, second, and third degree), and age (group in the range of 17–26 years, in the range of 27–36 years, and in the range of 37–46 years). Results. The study group has significantly lower body weight (p = 0.046), significantly higher proportion of varicose veins (p < 0.001) compared to controls, significantly lower proportion of patients aged 27–36 years (p = 0.014), and significantly higher proportion of patients aged 37–46 years (p = 0.025) compared to controls. There is significantly higher proportion of patients in the study group with the first degree of varicose veins (p = 0.007). There is weak positive correlation between body weight and body height in the group of patients without varicose veins (R = 0.456) and in the group with the second degree of varicose veins (R = 0.291), while for the group with the first degree of varicose veins there is moderate positive correlation (R = 0.543). Conclusion. Our preliminary findings point out that lower body weight and presence of varicose veins are significantly associated with IS. The group of patients with IS above 37 years of age tends to have significantly higher proportion of varicose veins.

Introduction: An ankle joint is a modified hinged joint consisted of three bones and ligaments. Muscles that result in plantar, that is, dorsal flexion, work through this functional unit. Aim of the Study: The aim of the paper is to analyze injuries of supra-syndesmotic fractures of the fibula, which were treated operatively with or without syndesmotic screw as well as to evaluate clinical results of the treatment after 3, 6 and 12 months. Patients and Methods: A retrospective-prospective study consisted of 102 respondents treated at the Clinic for Orthopedics and Traumatology UCC Sarajevo. Patients were divided into two groups. The first group (G1) consisted of 48 (47%) respondents who had met the required criteria - placement of a syndesmotic screw during the operation, and the second group (G2) consisted of 52 (53%) respondents who did not have a syndesmotic screw inserted during the operation. Results: The average value of the AOFAS score after 12 months in the group G1 was 91.15 points. The average value of the AOFAS score in the group G2 was 89.15 points. The value of the T-test was 1.688, p = 0.095 (p> 0.05). There was no significant difference in the average AOFAS score between the G1 and G2 respondents. Conclusion: The results obtained in the study confirm that there is no significant difference in the final outcome of the treatment between the G1 and G2 respondents. There is no significant difference in duration of treatment and hospitalization between groups G1 and G2. Significantly better average values regarding mobility for patients in the group G2 during the check-ups 3 and 6 months after the surgical procedure were transient.

Introduction: In the available literature there are sporadic data about the relationship between the impaired collagen synthesis and poor posture on one side, and the occurrence of varicose veins and uterine prolapse on the other side. However, there are no studies which specifically target this issue. Aim of the Study: To determine the prevalence of varicose veins and/or uterine prolapse occurrence in women previously treated for idiopathic scoliosis in comparison to the control group - women who have never been treated for idiopathic scoliosis. Patients and Methods: The study was designed as a cross-sectional study. The frequency of occurrence of varicose veins and/or uterine prolapse in a group of women previously treated for scoliosis was compared with a control group. The results were obtained through descriptive analysis and through conclusive results of statistical tests, where p < 0.05 was set as a statistically significant value. Results: In comparison to the control group, the frequency of varicose veins occurrence was higher, with a statistically significant difference in the group of women treated for idiopathic scoliosis. There was not a single case of uterine prolapse. Conclusion: Modern approach to scoliosis treatment requires the involvement of multidisciplinary teams for scoliosis in specialized health care facilities which have developed the expertise in this field. These teams should work on prevention, early detection and diagnosis, promoting the adequate treatment approaches anchored in evidence based medicine, but also get involved in the continuous research striving to improve the quality of life of their patients.

Introduction. Scoliosis is a three-dimensional deformity of the spine that requires a three-dimensional correction. The aim of the paper. The aim was to evaluate the effectiveness of the Cheneau brace in the treatment of idiopathic scoliosis. Patients and Methods. The retrospective study included 20 girls treated by the Cheneau brace. The criteria for inclusion were: double idiopathic thoracolumbar scoliosis over 20 degrees as measured by Cobb at the beginning of the treatment, continuous treatment with a brace and exercises controlled by an expert team until the end of growth and upon reaching skeletal maturity (Risser 5). The data were collected from medical records: age, the value of Cobb's angle and degree of bone maturity at the beginning and end of treatment. We analyzed changes in scoliosis at the end of treatment compared to the initial curve by examining the two radiographs made at the beginning and end of treatment. The change of scoliosis is described as: reduced, stabilized or worsened curvature. The success of the treatment is considered to be the reduction and stabilization of scoliosis. Statistical analysis tool SPSS was used for result presentation and statistical inference. Values p