Paediatric and adult congenital cardiology education and training in Europe.

BACKGROUND: Limited data exist on training of European paediatric and adult congenital cardiologists. METHODS: A structured and approved questionnaire was circulated to national delegates of Association for European Paediatric and Congenital Cardiology in 33 European countries. RESULTS: Delegates from 30 countries (91%) responded. Paediatric cardiology was not recognised as a distinct speciality by the respective ministry of Health in seven countries (23%). Twenty countries (67%) have formally accredited paediatric cardiology training programmes, seven (23%) have substantial informal (not accredited or certified) training, and three (10%) have very limited or no programme. Twenty-two countries have a curriculum. Twelve countries have a national training director. There was one paediatric cardiology centre per 2.66 million population (range 0.87-9.64 million), one cardiac surgical centre per 4.73 million population (range 1.63-10.72 million), and one training centre per 4.29 million population (range 1.63-10.72 million population). The median number of paediatric cardiology fellows per training programme was 4 (range 1-17), and duration of training was 3 years (range 2-5 years). An exit examination in paediatric cardiology was conducted in 16 countries (53%) and certification provided by 20 countries (67%). Paediatric cardiologist number is affected by gross domestic product (R2 = 0.41). CONCLUSION: Training varies markedly across European countries. Although formal fellowship programmes exist in many countries, several countries have informal training or no training. Only a minority of countries provide both exit examination and certification. Harmonisation of training and standardisation of exit examination and certification could reduce variation in training thereby promoting high-quality care by European congenital cardiologists.

The Significance of Bronchoalveolar Lavage Fluid Cytology in Diagnosing Lung Infiltrates in Children.

AIM: The aim of this research is to show why is it important in diagnosing children with lung infiltrates. METHODS: Our study included 50 children with lung infiltrates during period 2005-2012, and was conducted on Pediatric Clinic of the University Clinical Center Sarajevo. We sent all cytological BAL analyses to the University Clinical Center Sarajevo. Cytology was performed by direct microscopy. BAL cytology was performed by the principle of sending samples for centrifuging, 12000 revolutions during a 10 min Shandon-cyto spin. Then the centrifuged sample is dried in the air during 1-2 hours, and is then dyed under the May-Grünwald-Giemsa staining, and analyzed under the Olympus BX41 microscope. RESULTS: Nosocomial pneumonia has occurred in 32% children, acquired pneumonia in 38%, and 30% children had a lung infiltrates. 6 (12%) of children were younger then 1 year old, 23 (46%) children were between 1 to 5 years, 14 (28%) of children were between 5 to 10 ages, and 7 (14%) of children were between 10-15 ages. The most of the changes in observed children took place on the right lung, 34%, while 26% occurred on the left side, 22% were normal and 18% changes have affected both lungs, right and left. Percentage of cells in cytological smear in children with BAL were: cylindrical cells 28%, lung macrophage 26%, lymphocytes 17%, detritus 17% and phlegm 12%. Erythrocyte sedimentation rate (ESR) in children with BAL was up to 10-52%, to 50-30%, while ESR after first hour was above 50-18 %. CONCLUSION: Clinical parameters and local inflammation of the affected lobe are associated with positive bronchoalveolar cytology lavage findings.

Analysis of Cystic Fibrosis in Federation of Bosnia and Herzegovina.

AIM: The aim of this study is to present the first total number of tested children in the Federation of Bosnia and Herzegovina and the number of children with positive sweat test. During the study we determined the number of ill children, the median age of children with cystic fibrosis, date of initial diagnosis, an average amount of chloride in the sweat. MATERIAL AND METHODS: The study was a retrospective, conducted at the Department of Pulmonology Pediatric Clinic of University Clinical Center of Sarajevo. RESULTS: In the period from March 2003 to December 2014, we have tested 625 children. 351 child were from Sarajevo Canton and 272 children from other cantons. Female children were more affected then male children, in the ratio of 1: 1,105. An average age of female children was 4.19±4.26 years, and the male 2.15±3.11 years. The median concentration of chloride in the sweat measured by sweat test was for male children 103.05±21.29 mmol/L, and for the female children 96.05±28.85 mmol/L. CONCLUSION: Most of children in Federation of Bosnia and Herzegovina have ∆F508 gene mutation. In the post-war period we started to use a sweat test. Male children tend to live longer than female children with CF.

Obesity and atherosclerosis in children.

Atherosclerosis, one of the leading causes of death in developed countries is characterized by lumen reduction of blood vessels due to local thickening of internal blood vessels caused by plaque/atheroma. It begins in childhood, goes for a long time without manifesting symptoms, increasing with age it begins to seriously threaten health. The most important risk factors for the development of atherosclerotic disease are: hyperlipidemia, hypertension, smoking, diabetes, high fibrinogen, excessive weight, increased level of homocysteine, physical inactivity, heredity and immune response in some diseases. The primary intention of prevention is to preclude the occurrence of risk factors for atherosclerosis, and the secondary is to prevent the development or aggravation of the illness along with the reduction or control of existing risks. There is an increasing number of studies that show that children are overweight, which in adolescence is certainly a risk factor for the onset of many chronic diseases, namely: cardiovascular, type 2 diabetes, orthopedic, and psychological diseases. The obesity epidemic is one of the most serious health problems of today affecting individuals of all ages. Atherosclerosis demands action with the aim of early detection and treatment as well as the reduction of development of risk factors for coronary artery diseases. Finding the most effective preventive measures for obesity in each country requires precise epidemiological data on the number of obese children and youth, as well as on their eating and activity habits.

Public Health Dimensions of CVD Prevention and Control - Global Perspectives and Current Situation in the Federation of BiH.

Background: CVD remains a leading cause of death in Europe and worldwide accounting for 3.9 million deaths each year in Europe alone. Even with well-known risk factors and the current standards of health care, improvement of health and quality of life of CVD patients are still remains one of the biggest public health challenges we must overcome. Objective: The aim of this narrative review is to provide a brief overview of the recent and relevant documents of good practice in prevention, diagnostic and therapeutic approaches of Cardiovascular diseases that should be consider as milestones for the health authorities in the Federation of BiH. Cardiovascular diseases stil represent a worldwide public health problem, with some new dimensions caused by challenges caused through pandemic of COVID-19. The wellknown cardiovascular risk factors require new and more efficient public health approaches to the prevention and control. Conclusion: Due to the recently developed cardiovascular guidelines that were made by the European Society of Cardiology and World Heart Federation, key priority for health authorities should be is to update the existing CVD guidelines in the Federation of BiH in accordance with the international good practice.

COVID-19 Seroprevalence in Children during Pandemic Waves in Sarajevo, a Single Center Experience.

OBJECTIVE: The aim of this study was to present data on the prevalence of seropositive children tested in the laboratory of the Eurofarm polyclinic in Sarajevo, from September 2020 to May 2021. MATERIALS AND METHODS: Peripheral blood samples were collected and anti-SARS-CoV-2 antibodies were detected using an electrochemiluminescence immunoassay. RESULTS: In the total of 762 tested children, 187 were positive (24.5%), based on cut-off value. Of all the positive cases 42.8% were female while 57.2% were male. There were 10.1% of positive children in the first age group (0-5 years), 44.4% in the second group (6-13 years), and 45.5% in the third group (14-18 years). There was no statistically significant difference in seroprevalence between age groups and gender. The lowest seroprevalence (3.6%) was observed in October 2020 after the first pandemic wave, and the highest seroprevalence (60.3%) was observed in April 2021, corresponding to the third pandemic wave. CONCLUSION: The results of our study showed that the seroprevalence in children was low, especially during the first year of the pandemic. In the second year of the pandemic, there was an evident statistically significant increase in the number of seropositive children. Similar data have been shown in studies for adults.

Frequency of sweet and salty snack consumption among children in relation to their mothers' education level.

Aim To investigate the frequency of consumption of sweet and salty snacks among children aged 2-18 years in relation to their mothers' education level. Methods A descriptive epidemiological study was conducted in five dental practices at the School of Medicine of the University of Mostar from May to October 2022. The data were collected from medical records. Results: Out of a total of 477 children, 172 (36.1%) had mothers with a high school education, while 305 (63.9%) had mothers with a university degree. In the group of preschool children (aged 2-6 years), there were 42 mothers with high school education and 105 with university degree. In the group of school children (age 7-18 years) there were 130 mothers with high school education and 200 with university degree. The difference in the consumption of sweetened beverages among children of mothers with high school and university was not statistically significant. Similar results were found for the consumption of salty snacks, lollipops, caramels and candies. The frequency of the consumption of biscuits, chocolate and cakes (several times a day) was statistically significantly higher among the children of mothers with high school education (p=0.04), especially among school children. Eating habits of children, regardless of the level of education of their mothers, differed significantly only in the consumption of lollipops, caramels, and candies (p=0.03), which were consumed once a day by 79 (63.7%) schoolchildren and 45 (36.3%) of pre-schoolers. Conclusion A higher level of education among mothers does not necessarily equate to proper nutritional knowledge.

Adult congenital heart disease training in Europe: current status, disparities and potential solutions.

OBJECTIVES: This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe. METHODS: A questionnaire was sent to ACHD cardiologists from 34 European countries. RESULTS: Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors 'on the job'. The median number of ACHD centres per country was 4 (range 0-28), median number of ACHD surgical centres was 3 (0-26) and the median number of ACHD training centres was 2 (range 0-28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p<0.001). CONCLUSION: Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to 'train people on the job'. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care.

Therapeutic Modalities in the Treatment of Persistent Ductus Arteriosus in Premature Babies: Report of Two Cases.

BACKGROUND: Persistent Ductus Arteriosus (PDA) is a vascular structure that connects the pulmonary artery and the descending aorta. It plays an important role in the fetal blood flow pattern. OBJECTIVE: The aim of this paper is to present two cases from Neonatology of Cantonal hospital in Bihac, with hemodynamically significant ductus, different "timing" of treatment and different therapeutic options. RESULTS AND DISCUSSION: The ductus closes functionally within the first 72 to 96 hours after the birth. Its anatomical closure follows in the next 14 days. If it remains open after the third month of life, it is treated as a congenital heart anomaly with a left-right shunt. Approximately 10% of all congenital heart defects are PDA with an incidence of 2-4 per 1000 live births. It has been clinically proven that PDA is present in 45% of premature babies with a birth weight of less than 1750 g and in about 80% of premature babies with a birth weight below 1200 g. As criteria for the application of drug therapy (in this case we use Paracetamol) for ductal closure, we took into account clinical parameters and echo parameters that indicated that it was a hemodynamically significant ductal shunt. Prerequisites for treatment were normal liver function confirmed by laboratory tests, normal platelet count, no intracranial hemorrhage, normal gastrointestinal function, normal coagulation parameters, normal renal function, calm parameters of inflammation. CONCLUSION: The diagnosis of PDA in the early, asymptomatic phase, in premature babies, is made by early echocardiographic examination. The decision on treatment should be based on clinical and echocardiographic criteria. Paracetamol is an alternative in the treatment of this cardiac problem of premature infants and could be more effective if used in early, presymptomatic phase.

The Use of Continuous Electrocardiographic Holter Monitoring in Pediatric Cardiology.

OBJECTIVE: To show the place and role of continuous electrocardiographic twenty-four-hour ECG monitoring in daily clinical practice of pediatric cardiologists. METHODS: According to protocol, 2753 patients underwent dynamic continuous ECG Holter monitoring (data collected from the "Register of ECG Holter monitoring" of Pediatric Clinic, UCC Sarajevo in period April 2003- April 2015). RESULTS: There were 50,5% boys and 49,5% girls, aged from birth to 19 years (1,63% - neonates and infants, 2,6% - toddlers, 9,95% - preschool children, 35,5% - gradeschoolers and 50,3% children in puberty and adolescence). In 68,1% of patients Holter was performed for the first time. Indications for conducting Holter were: arrhythmias in 42,2% cases, precordial pain in 23,5%, suspicion of pre-excitation and/or pre-excitation in 10%, crisis of consciousness in 8%, uncorrected congenital/acquired heart defects in 4,2%, operated heart defects in 3,7%, hypertension in 3,1% cases, control of the pacemaker in 1,63% and other causes in 3,5% cases. Discharge diagnosis after ECG Holter monitoring were: insignificant arrhythmias in 47,1% cases, wandering pacemaker in 21,3%, pre-excitation in 16,2%, benign ventricular premature beats in 6,3%, atrioventricular block in 3%, sinus pause in 2.2% cases and other arrhythmias in 3,5%. In mentioned period 57 cases of Wolf Parkinson White syndrome were registered, in 4,5% of patients antiarrhythmic therapy was administered. Radiofrequent ablation was performed in 23 cases. CONCLUSION: The development of pediatric cardiac surgery has initiated development of pediatric arrhythmology as imperative segment of pediatric cardiology. Continuous ECG Holter monitoring has become irreplaceable method in everyday diagnostics and therapy of arrhythmias in children.

Diagnostics of common microdeletion syndromes using fluorescence in situ hybridization: single center experience in a developing country.

Microdeletion syndromes are caused by chromosomal deletions of less than 5 megabases which can be detected by fluorescence in situ hybridization (FISH). We evaluated the most commonly detected microdeletions for the period from June 01, 2008 to June 01, 2015 in the Federation of Bosnia and Herzegovina, including DiGeorge, Prader-Willi/Angelman, Wolf-Hirschhorn, and Williams syndromes. We report 4 patients with DiGeorge syndromes, 4 patients with Prader-Willi/Angelman, 4 patients with Wolf-Hirschhorn syndrome, and 3 patients with Williams syndrome in the analyzed 7 year period. Based on the positive FISH results for each syndrome, the incidence was calculated for the Federation of Bosnia and Herzegovina. These are the first reported frequencies of the microdeletion syndromes in the Federation of Bosnia and Herzegovina.

Heart murmur and anaemia in the pediatric population.

Innocent heart murmurs are hearth murmurs that occur in patients with a normal heart structure. They do not represent a disease of the heart and vascular system, and should not be treated as such. Iron-deficiency anaemia often causes, along with other symptoms, systolic heart murmurs and tachycardia. It appears in children of all ages representing a most common haematological paediatric disease. To establish the influence of iron-deficiency anaemia on genesis of innocent murmurs and to compare auscultatory and phono-electrocardiographic findings in patients with anaemia and heart murmurs before and after iron therapy. The study includes 120 patients with innocent heart murmurs that have been auscultated at cardio-rheumatic outpatient department of Pediatric Clinic of the Clinical Center of the University of Sarajevo, during the period from 01/01/2004 to 31/12/2004. Further diagnostic procedure, i.e. laboratory tests, diagnosed iron-deficiency anaemia in 30/120 patients. These patients have been followed in this study. 22/30 patients had systolic murmur I/II intensity of Levin scale; 8/30 patients had II/VI systolic murmurs of intensity by Levin. The highest number of examinees had 0-1 years of age, and in this group the number of boys was higher than the number of girls (M: F = 12:4). During the auscultatory and phono-ECG examinations of murmurs, 6 patients had haemoglobin values less than 95 g/l, which corresponds to an average and severe type of anaemia. 24 patients had haemoglobin values between 95 and 110 g/l, which corresponds to benign type of anaemia. The most numerous were patients aged between 0 - 1 year (3 patients with hemoglobin value Hb < 95 g/l, 13 patients with hemoglobin value Hb 95-110 g/l). All patients were treated with iron medicaments. After three months, clinical and laboratory re-evaluation was performed and it has demonstrated that after iron therapy 24 patients had level of a haemoglobin Hb >110 g/l and 6 patients had haemoglobin levels between 95 and 110 g/l. By auscultatory and phono-ECG examinations, murmurs of a level of intensity I/II was registered in only one child, while in the other 29 patients there were not any registered heart murmurs. Diagnosis of anaemia in the paediatric population group delays definitive diagnosis of heart murmurs. Innocent murmurs in children with sideropenic anaemia occur as its consequence. After adequately conducted iron therapy, i.e. cured anaemia, heart murmurs were not auscultated.

Mitral valve replacement in a patient with infective endocarditis and aneurysm of the cerebral artery: a case report.

OBJECTIVE: Endocarditis can have profound and devastating neurological consequences, with the vast majority of these complications in patients with left-sided valvular disease. The approach to the acute management of stroke in children with infective endocarditis is limited by the inadequacy of published data on their clinical course and outcome. CASE REPORT: This case report presents a 12 year old girl with diagnosed endocarditis, complicated with intracranial hemorrhage, due to the rupture of an aneurysm of the peripheral branch medial cerebral artery and gradient therapeutic approach, with an excellent final result. CONCLUSION: Congestive heart failure resulting from valvular insufficiency required mitral valve replacement, after cerebral aneurysm clipping.

The reliability of transthoracic and transesophageal echocardiography in predicting the size of atrial septal defect.

OBJECTIVE: To determine the reliability of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in predicting the size of an atrial septal defect (ASD). MATERIAL AND METHODS: The study included 16 patients who underwent the catheter-based procedures to close an atrial septal defect between February 2008 and December 2011 at the Paediatrics Clinic, CCU Sarajevo, after clinical and TTE and TEE evaluation. In order to determine the assumed diameter of the balloon (A-SBD), we used the formula of quantification A-SBD=TTE defect diameter×1:09 + 3.9 mm and A-SBD=1.1× transesophageal diameter of ASD+2.0 mm. The ASD was examined using the long-axis view, the basal short-axis view, the apical four-chamber view and the subcostal view to observe its position, diameter and relation to neighbouring structures. The largest diameter was selected as the reference diameter. RESULTS: Of the total number of treated patients, 11 were female. Treatment was conducted by a foreign and local team of invasive cardiologists. The average age of the patients was 8.43 years (2 -17 years). Apart from a transient disturbance of rhythm in the youngest patients, there were no other intra and postprocedural complications. The obtained formulas represent "our" default size of the SBD, based on measurements of TTE and TEE: A-SBD (TTE)=6.02+0.86×TTE and A-SBD (TEE)=3.93+0.86×TEE. CONCLUSION: ASD diameter determined by TTE and TEE can reliably determine the appropriate size needed Amplatzer Septal Occluder device.

Cardiovascular screening in young athletes in Sarajevo Canton.

Potential risk of sudden death during sports participation makes screening of competitive athletes of vital importance. Congenital cardiac anomalies and non-atherosclerotic, acquired myocardial conditions are primary causes underlying exercise-induced cardiac death in young patients. Since cardiovascular conditions are the leading causes of non-traumatic, exercise-induced cardiac events, cardiovascular screening preceding sports participation in mandatory. The objectives of this study were to determine prevalence of cardiac conditions through cardiovascular screening of young athletes and to establish preventive strategy. The study was conducted at the Sports Medicine Center of Sarajevo Canton and at the Pediatric Clinic of University of Sarajevo Clinics Centre in the period 2007-2009. The study was supported by Canton Sarajevo Ministry of Health and Ministry of sports, science and culture. The study targeted a group of 214 athletes, 8-18 years of age with average age being 15.26. The group was subdivided into five groups according to the age. After taking the anamnesis (family, personal and cardiological) patients were subjected to the measuring of body mass and height, blood pressure and heart rate and oxygen saturation, recording of 12-lead ECG, specialist examination (pediatrician, sports medicine specialist and cardiologist) and complete heart echocardiography. No examined athletes expressed subjective discomfort. Congenital cardiac anomalies were not diagnosed in any athlete. Also, cardiovascular abnormalities requiring additional evaluation, positive cardiac anamnesis, abnormal auscultatory findings, hypertension or abnormal ECG findings were not recognized in any patient. Moderate correlation was found among the left ventricle mass and heart rate (p<0.05). In order to minimalize or even possibly prevent the risk of sudden cardiac death it is necessary to establish an adequate strategy of cardiovascular screening of young athletes.

Epidemiology and etiology of obesity in children and youth of Sarajevo Canton.

The aims of the study were to estimate the prevalence of excessive weight in infants and school-age children in Sarajevo Canton, to isolate the main causative agents and to propose a strategy for its efficient prevention. The methods included anthropometry and originally designed questionnaire. Calculated body mass index was classified according to the criteria proposed by Centre for Disease Control and Prevention (CDC). The research included 3608 students from elementary and secondary schools from Sarajevo Canton. Nearly 1/5 of subjects had excessive body weight while 12.49% of students were malnourished. Elementary school lower graders had the highest grade of excessive weight, while the secondary school students exhibited the lowest grade of excessive weight. During school hours, about 42.47% of students were fed on bakery produces and snacks. Non-sparkling, thickened juices are frequently consumed beverages (20.65%), second only to water (51.82%). 58.15% of children consume sweets on daily basis. This is even more prominent among secondary school students (80.85%). Only 1/3 of students practice sports on daily basis, while 8.51% of them rarely engage in sports. Elementary school lower grade students had the lowest level of activity while the secondary school students were the most active. As many as 27.56% students spend two hours or more sitting by the computer or TV set. The most significant mediators of excessive weight gain are sedentary life-style, frequent consumption of sweets and thickened juices and unsuitable nutrition during school hours. Continuous preventive and therapeutically activities must be undertaken among as wide population as possible.

[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.

[Sarcoma Ewing left hemithorax]. / Sarcoma Ewing lijeve strane grudnog kosa.

A case of sarcoma Ewing hemithorax lst sin has been reported in an 8-year-old girl. The girl was admitted in our hospital with referral diagnosis Pleuropneumonia exudativa left side. The girl was sent from Nova Bila with the foregoing diagnosis. The difficulties started in early April this year with high body temperature, pains in the left side of the chest. After a detailed anamnesis, clinical picture of the girl and radiological examinations/ chest x ray, CT scan of the chest and operative findings/ sarcoma Ewing diagnosis was confirmed. The disease is very rare, while diagnostics and course are complex. The girl was admitted at the Pulmology Department of the Pediatric Clinic on 16.03.2005. At the Department, the girl was medically treated with three antibiotics: cephalosporins of third generation, ceftriaxon (Longacef), aminoglycoside Amikacin and antistaphyloccoc therapy (Orbenin). Due to a dull sound on percussion and weaker auscultatory breathing on the left, and radiological shading of the left chest, a CT of the thorax was performed. It showed expansive changes of the left chest. Also performed was a pleural punction of the left chest, after which around 500 ml sero-hemorrhagic content was taken out and sent for patohistology analysis. After a pre-operative preparation, the operation was performed on 28.03.2005, which is when a fat-like tumorous mass was found completely filling up the pleural cavum and by its weight exerting pressure on the lungs. In the projection of VI and VII rib, the described mass infiltrates the thoracic wall. The tumor extirpation "in toto" was performed and sent for patohistology analysis, ex tempore. Also performed was a pleuropectomy in the projection of the wall infiltration, as well as a partial resection of the VII rib. Also performed was a decortication of the visceral pleurae. The post-operative course has been passing normally and with good pleuropulmonary findings, with the wound healing per primum. Patohistology results: sarcoma Ewing hemithorax lat. sin. The girl continued her cytostatic therapy in Zagreb following the operation.

[Modern approach to treatment of juvenile rheumatoid arthritis]. / Savremeni terapeutski tretman pacijenata sa juvenilnim reumatoidnim artritisom.

PURPOSE: Juvenile rheumatoid arthritis (JRA) is the most common form of arthritis in paediatric population. The aim of this study is to evaluate patients (pts) with JRA in correlation to age, sex, type of illness as well as treatment algorhytm and its efficacy. WORK METHOD: During period time from 1.1.2002. till 31.12.2001. patients with JRA hospitalised at Paediatric Clinic of the Clinical Centre of University of Sarajevo were retrospectively studied. The soruce of research was histories of illness, clinical examinations and clinical findings during follow-up period. WORK RESULTS: according to our data girls were more often affected with JRA-23 patients (66%) age 2 to 6 years. The most frequent type of illness was monoarticular in 48.5%, polyarticular 34.2% and systemic in 14.3%. All pts were treated with first line therapy: nonsteroid anti-inflammatory agents combined with physio therapy which had satisfactory outcome, so 80% patients entered the remission zone of illness. Patients with systemic (14.3%) and polyarticular form with complications, received steroid therapy. One patient with systemic form was treated withmethotrexat. Duration of pts stay at Clinic differ from illness, 35% were cured and 5% non-cured patients. DISSCUSION: Treatment of JRA is a combination of medications, physio therapy and psycho therapy. The goals of treatment are to relive pain and inflammation, slow down or to prevent the destruction of joints and to restore use and function of affected joints in order to promote optimal child's growth and development, physicalactivity, social and emotional development. CONCLUSION: Treatment with nonsteroid antireumatics in combination with physio therapy proved very successful in patents with JRA. Multidisciplinary approach is mandatory to achieve primary goal: to cure illness. It is necessary to start therapeutic algorhytm as early as possible in best patient's interest.

Epidemiological and clinical aspects of congenital heart disease in children in Tuzla Canton, Bosnia-Herzegovina.

UNLABELLED: Congenital heart disease (CHD) is among the most frequent of all congenital anomalies. The purpose of this study was to present the results of an initial registration of children with CHD from January 1994 to December 1999 in Tuzla Canton, Bosnia-Herzegovina. The population studied consisted of all 39,699 live-born children in this area. Diagnosis of CHD was made by clinical findings, electrocardiography, chest X-ray, echocardiography, catheterisation or autopsy. In the 6-year period, 243 children were found to have CHD, i.e. a prevalence of 6.12 per 1000 live-born. Critical CHD was present in 58 of them, or 1.46 children per 1000 live-born. The average age at diagnosis was 1.47 years. There were 132 boys (54.3%) and 111 girls. The most frequent anomaly was ventricular septum defect with a prevalence of 2.49 per 1000 live-born, representing 40.7 % of the total anomalies. Of the total group, 46 (18.9%) had extracardiac anomalies related to syndromes. Cardiac surgery was indicated in 98 patients (40.3%) but could only be carried out in 42 (17.3%). A total of 63 (25.9%) patients died, 54 of whom within the 1st month of life. CONCLUSION: congenital heart disease is a very significant health problem in Tuzla Canton. It requires urgent measures in terms of organisation of early diagnosis and proper management.