Necrotizing pneumonia in children is a rare and severe complication of bacterial community-acquired pneumonia. Main characteristics are a loss of normal lung parenchyma and formations of multiple thin-walled cavities filled with air or fluid. Treatment with antibiotics broad spectrum and pleural drainage is often enough, and children get fully recovered in 5-6 months after diagnosis. The child was admitted to our clinic with 38.5 C and irritating cough, misdiagnosed and treated before as pneumonia. On the x-ray of the chest was left homogenous shade. Abdominal ultrasound showed locally pleural effusion. CT scan showed multilocular denser fluid encapsulated in left hemithorax and acted compressively to the mediastinum and suppresses it to the right. Laboratory findings indicate elevated erythrocyte sedation, leukocytopenia, thrombocytopenia, elevated serum amylase, lipase, amylase in thoracic drainage content, amylase in urine, also reduced values of haemoglobin, MCV, MCHC, urea, creatinine. We gave to patient meropenem and vancomycin. And patient after 24 hours became afebrile with 90 ml haemorrhagic content in a pleural drain. CRP was declining. The radiograph of the chest shows a re-expansion of the lungs with an elevated left diaphragm. Necrotizing pneumonia can be successfully treated with antibiotics and pleural drainage without major surgical procedures.

Introduction Insulin therapy of pediatric patients with type 1 diabetes mellitus (T1DM) is highly demanding due to their dynamic growth, development and different daily life activities. Goal To determine the optimal insulin delivery method for the prevention of hypoglycemia recorded by continuous monitoring of glucose in patients with insulin pump and PEN. Material and Methods The study included patients up to 18 years of age with diagnosed T1DM and treated with insulin pump and by insulin therapy with PEN at the Pediatric Clinic of the Clinical Center in Sarajevo. The study involved 149 patients, and lasted for 3 years. Patients were divided into two groups: group of patients on insulin pump therapy and group on insulin PEN. Results There were 73 patients (49.6%) on insulin pump therapy and 79 patients (52.4%) on the insulin PEN therapy. There was no significant difference in the age between genders nor groups with different insulin application methods. There were no significant differences in the number of anamnestic hypoglycemia in patients with a different mode of insulin application (83.56% vs. 81.58%, p=0.114, F=2.533 < Fk=3.919). The number of hypoglycemia episodes in history is higher with the PEN therapy than in the insulin pump group. Conclusion The number of anamnesis hypoglycemia as well as hypoglycemia from CGM records did not differ significantly in patients with IP and PEN therapy. The CGM record was significantly more valuable in the presentation of hypoglycemia compared to the history of hypoglycemia in all patients studied. Continuous monitoring of glycemia due to the ability to show glycemia variability and unrecognized hypoglycemia as well as predictive options for long-term metabolic control should be performed for all T1DM patients at least once a year.

Introduction: Epilepsy is one of the most common neurological diseases in childhood and adolescence. Carbamazepine (CBZ) and valproate (VPA) have been widely used as the first generation of antiepileptic drugs (AED). Aim: The aim of the study has been to evaluate and compare the effect of CBZ and VPA monotherapy on aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) serum levels in children. Material and methods: The study has included 100 patients (boys 57/girls 43, age range 1 to 18 years), who have been treated with CBZ or VPA, as initial monotherapy, for at least 12 months. Patients with liver lesions or patients who have been treated with other drugs have been excluded from the study. The initial serum enzyme levels (AST, ALT and GGT) and after 12 months of treatment have been compared. Results: 53/100 (53%) patients have been treated with CBZ and 47/100 (47%) patients have been treated with VPA.The initial level of enzymes were within the referece range. After one year-long treatment AST was elevated at 4/53 (7.5%) CBZ patients and 9/47 (19.15%) VPA patients (x2 test =3.965, p<0.05). ALT was elevated at 5/53 (9.4%) CBZ patients and 9/47 (19.15%) VPA patients (x2 test =6.953, p<0.05). GGT was elevated at 18/53 (34%) CBZ patients and 7/47 (14.9%) VPA patients (x2 test =4.831, p<0.05). Conclusion: The levels of enzymes AST and ALT have been elevated statistically significant in VPA group and GGT in CBZ group.

Introduction: In spite of measures to avoid invasive mechanical ventilation, many preterm infants are still artificially ventilated. The need for intubation and positive pressure ventilation is associated with so-called ventilator-induced lung injury (VILI) and bronchopulmonary dysplasia (BPD). A lot of strategies are made in order to minimise VILI. One of these strategies is the use of permissive hypercapnia, in which clinicians use more gentle ventilatory strategies and accept higher than “normal” alveolar partial pressure of carbon dioxide (PaCO2) values. Although there are promising studies about the use of permissive hypercapnia in preterm infants, we are still not sure if and when this mode of treatment is safe.Aim: The aim of this study is to investigate conditions in which permissive hypercapnia is safe to prematurely born infants regarding their survival.Methods: The present study was conducted in a tertiary research and educational hospital, NICU, Pediatric Clinic, Clinical Center University of Sarajevo (Sarajevo, Bosnia and Herzegovina). All infants had chest X-ray at admission, and were treated for respiratory distress syndrome (RDS) with nasal continuous positive airway pressure (nCPAP), conventional mechanical ventilation (CMV), or high frequency oscillatory ventilation (HFOV). At admission we registered data regarding birth weight (BW), gestational age in weeks (GW), Apgar score and prenatally given steroids. Inclusion criteria were fulfilled by 200 infants. According to their mean PaCO2, patients were divided into hypercapnia and normocapnia groups. We analyzed the outcome (survival) of these two groups.Results: The two groups didn’t differ regarding GW, prenatally given steroids, RDS severity, surfactant use, 1- and 5-minute Apgar score, nor according to their CRIB score. Groups had also similar survival. After performing ROC analysis we have found that infants born ≤ 27 GW and ≤ 1,000 g treated with permissive hypercapnia, and infants with normocapnia born ≤ 26 GW and ≤ 980 g, have a prediction of negative outcome regarding survival, with a high level of accuracy.Conclusions: This study shows that ventilation with permissive hypercapnia of preterm infants with RDS is not safe, considering survival in children with GW ≤ 27 and BW ≤ 1,000 g.

Cough is one of the most common symptoms that doctor faces in working with pediatric population, and according to some characteristics of cough, doctors can often conclude localization, and sometimes even the nature of the disease that causes it. Cough is not only the physiological defense reaction, but a symptom of a disease. According to duration it can be acute, chronic and recidivist, recurrent and persistent, strong or discreet, caused by changes in body position and changes in outside temperature. Pathoanatomically it is divided into lobar, lobular, alveolar and interstitial, pathogenetically to bronchogenic and hematogenous, as well as in immuno competent and immunocompromised, and clinically on the local and inpatient (72 hours after hospital admission). Considering the contents, cough can be productive–with secretion from the respiratory tract, and unproductive-dry, without secretion. By auscultation bronchial breathing, rattle and crepitus can be heard. The primary diagnostics is radiological, posterior to anterior (P-A) and lateral footage of the chest. Laboratory findings in typical pneumonia, are characterized by leukocytosis, neutrophilia and shift of blood image to the left. Sedimentation is accelerated and C-reactive protein is elevated. The basic bacteriological diagnosis is sputum Gram’s stain and culture of sputum. In atypical pneumonia, leukocytes are usually in the normal range, and it is necessary to do serological tests (IgM and IgG antibodies). The role of doctors in primary health care is auscultation differentiation of murmurs with confirmation of doubt if there is pathological findings by laboratory tests and treatment, depending on the type of cough. Treatment is essentially pharmacological, with irrefutable importance of non-pharmacological measures.

Aim The aim was to show rare cases of congenital cystic adenomatoid malformation (CCAM) and the manner of its surgical treatment with video-assisted thoracoscopic surgery (VATS). Methods Two male and one female child, 7, 4 and 3 years of age were treated for symptoms of cough and high temperature in district hospitals. In all three children laboratory blood tests and chest radiography were done. Auscultatory findings showed the presence of pneumonia. Children were treated with appropriate doses of antibiotics. After the rehabilitation of inflammation, they were sent to the University Clinical Center Sarajevo, where video-assisted thoracoscopic lobectomy (VATS) was indicated after computerized tomography (CT). Results Chest CT scan pointed to the CCAM and pulmonary sequestration (PS) changes to the lungs. This has required surgery lobectomy of an affected part of the lungs. In two children with PS, the aberrant systemic artery came from the most proximal part of aorta abdominals, the third patient did not have an anomalous artery. Conclusion VATS lobectomy is an alternative to the traditional thoracotomy for the treatment of CCAM and PS, however, it should be investigated in the future for its safety and effectiveness.

Introduction: Thyroid gland diseases in children are in second place by frequency among all endocrine disorders. When interpreting the results of the thyroid function assessment it should be taken into account the significant differences in the concentrations of TSH, thyroid hormones, thyroid binding proteins and calcitonin among children of different ages. Goal: To present the age and sex structure of the patients diagnosed with hypothyroidism, evaluate diagnostic methods for making diagnosis, evaluation of etiology of hypothyroidism, with special review of the therapeutic modality. Patients and methods: The study have retrospective character and includes all patients who have the diagnosis of hypothyroidism, but at the moment of data collection were aged 0-18 years. Results: Distribution of patients on the basis of gender, revealed more significant representation of female (65.93%), and without significant difference in the presence of the disease in relation to age (p>0.05). Physical examination of the struma was not verified in the majority of cases (74; 81.32%, p<0.05) suffering from hypothyroidism. Ultrasound review in 22 (50%) cases confirmed the struma. Ultrasound findings in most cases 14 (31.81%) demonstrated diffuse struma and Hashimoto thyroiditis together. In relation to the etiology of hypothyroidism most patients belong to a group where hypothyroidism is associated with other diseases and conditions (27; 29.67%), but the least with congenital hypothyroidism with 18 (19.78%) cases. The average dose of L-thyroxine in the age of 0-1 months was 50 mg, 1 month–10 years 37.5 mcg, and the group of patients over 10 years 65 mcg. Conclusion: Congenital hypothyroidism has about one-fifth of patients. Physical examination revealed in about one fifth of patients the struma of the thyroid gland; TSH levels is critical for the diagnosis and correction of therapy in pediatric patients with hypothyroidism. Congenital hypothyroidism is diagnosed on average at the age of 12 days, which is optimal for period for therapeutic response; Substitution treatment is carried out with L-thyroxine which is relatively reduced in doses from neonatal age onwards.

Introduction: Thyroid gland diseases in children are in second place by frequency among all endocrine disorders. When interpreting the results of the thyroid function assessment it should be taken into account the significant differences in the concentrations of TSH, thyroid hormones, thyroid binding proteins and calcitonin among children of different ages. Goal: To present the age and sex structure of the patients diagnosed with hypothyroidism, evaluate diagnostic methods for making diagnosis, evaluation of etiology of hypothyroidism, with special review of the therapeutic modality. Patients and methods: The study have retrospective character and includes all patients who have the diagnosis of hypothyroidism, but at the moment of data collection were aged 0-18 years. Results: Distribution of patients on the basis of gender, revealed more significant representation of female (65.93%), and without significant difference in the presence of the disease in relation to age (p>0.05). Physical examination of the struma was not verified in the majority of cases (74; 81.32%, p