Azythromicin versus amoxicillin-clavulanate in the treatment of acute sinusitis in children.

In this prospective study we compared the efficiency of azithromycin and amoxicillin-clavulanate in treatment of acute sinusitis in children. Seventy patients were included in the age between 5 and 15 years. Beside ENT and pediatricians examination, nasal and throat smear on culture and antibiogram is taken from all the patients, as well as, X-ray of paranasal sinuses and laboratory findings, followed by check-up of nasal and throat smear and X-ray of paranasal sinuses. Azithromycin in single daily dose of 10 mg/kg during three days showed same efficiency as amoxicillin-clavulanate given three times per day in dose of 45 mg/kg during ten days.

Genetic examination of children suffering from cystic fibrosis.

CFTR protein (cystic fibrosis trans membrane conductance regulator) is expressed in multiple epithelial tissues, including upper and lower respiratory tracts, pancreas, sweat glands and gastrointestinal tract. More than 800 mutations and 100 polymorphic variants of DNA sequences were identified in patients with CF (Cystic fibrosis) and CFTR-diseases. In this study, genetic CFTR analysis of the children suffering from chronic lung disease (cystic fibrosis) is presented. They are treated and regularly controlled at the Pediatric hospital Sarajevo. CFTR analysis was done in 9 cases, 4 boys (44.4%) and 5 girls (55.55%). There are 3 children (33.3%) in the age group 1 to 3 years, 1 child (11.1%) in the age group 3 to 6 years, 3 children (33.3%) in the age group 6 to 9 years and 2 children (22.2%) in the age group 9 to 12 years. Genetic analysis was conducted at the Medical center for molecular biology, School of Medicine, Ljubljana. PCR method with PAGE and direct sequestration on ABI PRISM 31 was applied. The majority of children (7 children, i.e. 77.77%) had CFTR mutation Delta F 508 whilst one child had G542X mutation and one child R 1174 mutation. The purpose of this study is to emphasize the need for CFTR gene identification in the institutes of our country.

Evaluation of efficiency practical issues in the management of childhood asthma.

Asthma is the most common chronic illness in children and adolescents. The pediatric "Asthma School" has been established to improve the health and quality of life of children with asthma through education and support. The purpose of work is evaluation of efficiency education adolescents, children and parents in prevention, adequate use medications and control of asthma. It was operational investigation. The study was enrolled 70 participants from 7 cities in FBiH, which were attended "Asthma School". Evaluations of efficiency of education program have been done through questionnaires using 5-point scale. Observing variables were: attitude about quality of education and level of knowledge about asthma at the end of the educational round. "Asthma School" attended 62 parents and 8 adolescents. The age of children was 6-14 years. The most of participants were with middle school education (64.3%). Successfulness of seminar was score with highest point of scale by 79%. Access to health information was important for patients in adequate treating illness (80.6%) and in prevention of asthma (15%). There was a significant improvement for 38,4% in the basic knowledge of asthma among participants, from 2.7 before to 3.8 after education. Among 20 children that have learned proper technique breathing there was not register worsening symptoms of asthma by 83.4%. There was a significant improvement in the condition of patient, following by greater value PEF (72.3% participants). The results implicate necessity of continuity such action in order to make life of young asthma patient.

[Staphylococcus pneumonia--complications]. / Stafilokokna pneumonija--komplikacije.

The paper presents the case of a 4-year-old child who was admitted with the diagnosis Dg: Pleuropneumonia lat. sin, while in the further course as a suspicion due to progressive flow as staphylococcus pneumonia. The illness is complex in terms of treatment. The diagnosis was set based on the history of illness, its clinical course, laboratory findings, radiology tests. The boy was hospitalized in January in current year with symptoms (coughing, vomiting and fever) that have been lingering for the past two days. The boy has been treated with a ternary antibiotic therapy (cephalosporin of third generation parenterally with aminoglycosides, plus anti-staphylococcus therapy). In laboratory findings Sedimentation rate increased 88/134 WBC 75 thousands. Radiologically extended pleuropneumonia on the left side. In sputum staphylococcus aureus was isolated. In the further course of hospitalization, due to the development of progressive form of staphylococcus pneumoniae with a fever of up to 39 degrees, pale aspect and dyspnoic patient with anemia and with complications in the form of cysts, ruptures and pneumothorax, with a thoracic drainage performed. In the further course, the cysts were gradually absorbed, while the thoracic drain was grafted. Clinically, the child was looking better. We continued the anti-staphylococcus therapy (stanicide), to which the child reacted well clinically and radiologically. Auscultatory breathing on the left side was audible. The last follow-up and the last rtg pulmo et cor 6 months after the outbreak of illness with a complete regression of the foregoing changes.

[Treatment of Pseudomonas aeruginosa in cystic fibrosis in a child]. / Tretman pseudomonas aeruginosa kod oboljele djece sa cisticnom fibrozom.

The report deals with the case of a 10-year-old girl with chronic cystic fibrosis. She has been repeatedly treated at the hospital. She has been hospitalized due to respiratory deterioration. Cystic fibrosis is a rare disease, inherited autosomaly recessively, but is very complex in terms of diagnostic and treatment. Fibrosis is the formation of scar tissue due to injury or long term inflammation. The diagnosis is confirmed based on a clinical picture of the child, measure of Chloride in the sweat, chest X-ray, CT thorax, laboratory findings--genetic confirmation CFTR genes. The diagnosis is originally set when she was 4 years old. She is now admitted due to a deterioration of the main disease. Five days before the admission, the girl had a higher bodily temperature, cough and difficult breathing. Due to the deteriorated general condition and the respiratory insufficiency and respiratory acidosis in blood gas analysis, the girl was intubated and put on the complete mechanical ventilation (IPPV). Since the girl is a chronic patient with bronchiectasie chronic walls of bronchi changes full of the mucus, who is not responding to conservative treatment (antibiotics), therapeutic and diagnostic flexible bronchoscopy had to be performed, resulting in a gram-negative bacteri Pseudomonas aeruginosa--a typical bacteri for chronically sick C. F. patient. Pseudomonas aeruginosa is typically acquired in early childhood. This bacteria is giving progressive lung disease and often aggravates morbidity and mortality. So the main thing as a respiratory management is prevention of lung infection with this bacteria. A Pseudomonas therapy was prescribed according to the sensitive antibiogram, (Garamycin). Antibiotics are crucial to treating cystic fibrosis lung infections. Therapy with an amynoglicoside in combination with a B-lactam or a quinolone antibiotic is standard. It is a difficult to deliver a high doses at these antibiotics via the iv. route without significant systemic adverse events (otoxicity and nephrotoxicity). A reformulation of the aminoglycoside antibiotic tobramicin or garamycin therapy is solution for inhalation. To be well established infections the suppression of Pseudomonas aeruginosa has been shown to lead to decreasing same bacteria and benefits lung function from antibiotic therapy in a way that can be maintained over extended period. During bronchoscopy was given locally on changes mucous pulmozyme (to destroy a very hard mucous) and garamycin. So, after taking out a lot of mucus, it was later continued spontaneously. Control chest x ray and blood gas analysis are now very improved.

[Morbus Albers Schonberg osteopetrosis]. / Mramorna bolest kostiju.

The patient presented has bone disease, so called "mramor disease". The disease is characterized by insuffiticnty of ostcoclasts which results n persisting of primary spongiosis without normal eroding and bone rebuilding. The discase is diagnosed by X rays where the bone density is increased. The medular space is completly closed by dense bone knitting which, with soft cortical space, seems like bone in bone. This is autosomal recessive disease with serious clinical picture in infants.

[The frequency of pollen allergy at the population of Sarajevo region during the 2002 year]. / Ueestalost polenskih alergija u populaciji sarajevskog podrucja tokom 2002. godine.

The frequency of pollen alergy in the sample of population of Sarajevo region during the 2002 year has been investigated. The age and gender population has been different. For determination of allergy has been use of standard test carryed out in the respective laboratories of Clinical center of University of Sarajevo. The testing has been on the pollen of weed plant species and grass (graminejae) pollen. In the mixture of pollen weed plant species have been following plants: Plantago lanceolata L., Chenopodium album L., Solidago gigantea L., Artemisia vulgaris L. and Urtica dioica. 589 have been tested patients by mixture of pollen mentioned plant species and found 115 as a sensitive on pollen alergy; 65 male and 50 females. Even 61 are children to 14 years, or 53% of total sick patients. The origin of grass pollen is no determined by taxonimicly, but on the base of phenophase of grasses from this area it is possible determine potential allergenic species: Dactylis glomerata, Cynosusrus cristatus, Alopecurus pratensis, Phleum pratnse, vrstama rodova Bromus, Hordeum, Festuca and Poa. 116 pateints have been identified as sensitive on pollen alergy; 49 male and 65 females. The highest proportion of sick people have been in correlation with pollination of allergenic plants in this area.

[Pulmonary abscess]. / Apscesi pluca.

A case of lung abscessi has been reported in 10 years old child, boy. This lung disease is uncommon, but treatment is complex. A lung abscess is a suppurative process resulting in destruction of the pulmonary parenchyma and formation of a cavity containing purulent material. The child was already treated in the hospital in Bihac since 19.07.2004. to 04.08.2004. Lung abscess was secondary caused by staphylococcus, started as panaritium second finger. The diagnosis is generally made by roentgenographic examination when a cavity with a fluid level surrounded by alveolar infiltration is demonstrated. After a few consultations with thoracal surgeon conservative treatment was continued Vankomicin 40 days and Funzol, later Stanicid 10 days. Brronchosacopy to faciliate drainage or to obtain culture is controversial so the same wasn't done. Surgical drainage of a lung abscess is almost never indicated and resection should be considered only in a children with recurrent hemoptysis, repeated episodis of infection. Serial chest roentgenograms show gradual diminution of the abscessus over a period of several weeks during hospitalization. Last one chest X ray shows as sequely air cyst on the left side. X ray of the second finger shows osteitis of the second phalange. After 40 days the child was discharged with recommendation for follow up by thoracal surgeon next 6 months.

[Congenital lobar emphysema]. / Kongenitalni lobarni emfizem.

BACKGROUND: Congenital lobar emphysema is characterized by overinflation of pulmonary lobe and is caused by localised bronchial obstruction. The disease may result in severe respiratory distress in early infancy. METHODS: Records of children, with congenital lobar emphysema, who were treated at our department between 1997-2003, were reviewed. RESULTS: Three males, aged 16 days till 1 year, were diagnosticed as congenital lobar emphysema. Presenting symptoms were dyspnea in 2 patients, cyanosis in 2 patients, wheesing in 2 patients, recurrent respiratory tract infection in 2 patients. Chest x rays and computerized tomography scans showed hyperinflation of the affected lobe in all patients. The affected sites were left upper lobe in 2 patients and right upper lobe in 1 patient. All patients underwent lobectomy. CONCLUSION: It is necessary to suspect on this uncommon anomaly in early infancy. The diagnosis was established by chest x rays and CT scans. Intensive therapy and urgent lobectomy, in severe respiratory distress, are condition for successfully treatment.

[Unusual therapeutic approach in treatment of pulmonary tuberculosis in six year old girl]. / Nuobicajen terapljski pristup lijecenja plucne forme tuberkuloze kod sestogodisnje djevojcice.

We report about interesting case of treatment of pulmonary tuberculosis in 6-year old girl. Antituberculotic therapy induced toxic hepatitis (rise of transaminases, indirect hiperbilirubinemia). She was treated with streptomycin, etambutol, ciprofloxacyn and systemic corticosteroides. Two gallbladder stones and high-density sediment were diagnosed after ultrasound examination which could be a side effect of the therapy or previous findings.

[Allergy tests in children with seasonal allergic rhinitis]. / Alergoloski test kod djece sa sezonskim alergijskim rinitisom.

The aim of this study is to show positive allergy test od tree pollen, grass pollen and weed pollen in children with season allergic rhinitis. In the study is comprised 335 children, which are tested in Pulmoallergologic out-patient department of Paediatric clinic in Sarajevo in last three years from march 1999 to march 2002 year. In testing was used prick-test with Bencard firm allergen. Criterion for positive reaction was urtica, which appear 20 minutes after testing, with diameter equal or bigger than 3 mm, and erythema was 10 mm. Positive results on tree pollen was in 98 children (29.2%), on grass pollen in 210 children (62.6%), and on weed pollen in 27 children (8.0%). In group of tree pollens Coryllus avellana pollen (Hazel pollen) has the biggest number of positive results in 74 children (75.5%), in group of grass pollens Poa pratensis pollen (Mcadow grass pollen) has biggest number of positive results in 169 children (80.4%) and in group of weed pollens main allergen is Ambrosia clator (Rag weed) in 25 children (92.0%). In therapy of our children we preferred nasal topical corticosteroide Fluticason propionate Flixonase (GlaxoSmithkline) in one daily dose 50 mcg and we had fast and prolonged result in amelioration of symptoms.