Introduction: Newborn screening (NBS) is a system of organized search in the entire neonatal population for specific diseases. In Bosnia and Herzegovina, two diseases are included in NBS, congenital hypothyroidism (CH), and phenylketonuria. The screening for CH is based on determination of thyroid stimulating hormone (TSH) levels in blood obtained by heel prick method. The aim of this study is to evaluate the effectiveness of NBS program for CH based on TSH and establish the mean age of diagnosis of CH.Methods: TSH was measured by time-resolved fluoroimmunoassay (DELFIA Neonatal hTSH kit). The TSH cutoff value was 9 μU/mL. Neonates with TSH < 9 μU/mL had a negative NBS result. Neonates with TSH ≥ 9 μU/mL were recalled for a confirmation test and thyroid hormones were determined from venous blood to establish diagnosis of CH.Results: A total of 24,351 neonates were subjected to NBS in our institution. A total of 164 newborns with TSH ≥ 9 μU/ml were sent to additional testing (mean recall rate of 0.68%) at a mean age of 11.4 ± 0.5 days of life. In this group, diagnosis of CH was confirmed in 22 neonates (13.41%). The mean rate of false positive results of NBS was 0.59%. The incidence of CH in Sarajevo Canton ranged from 1/2477 in 2018 to 1/641 in 2020. The mean incidence of CH over a 5-year period was 1/1085, while the mean age at the time of diagnosis was 16.5 ± 1.2 days.Conclusion: The analysis of NBS on congenital hypothyroidism data showed the satisfactory recall and false positive rate and indicated well selected TSH cutoff value. The mean age at the time of diagnosis assures early treatment and good neurological outcome in neonates with CH.

Introduction: Bronchiolitis, a viral infection of the lower respiratory tract, is one of the most substantial health burdens for infants and young children worldwide. Despite the respiratory syncytial virus (RSV) being the most common causative agent of bronchiolitis, there is a number of established risk factors associated with development of severe bronchiolitis. The aim of this study was to investigate the prevalence of established risk factors for severe bronchiolitis among hospitalized infants during the first year of life, as well as to compare the diagnostic and treatment methods between pulmology and neonatology department. Material and methods: This epidemiological, case-controlled, retrospective-prospective study included all children aged one year or younger who were diagnosed with severe bronchiolitis and hospitalized in Pediatric Clinic of Clinical Center University of Sarajevo from 1 May 2017 to 30 April 2018 (12 months). Patient data was collected from the patients’ histories and through interviews with parents and filled in the previously designed questionnaire. Results: The research included 95 hospitalized infants diagnosed with bronchiolitis who were less than 12 months old. Sample size was homogenized by gender (p>0.05). Patients were predominantly term children younger than 6 months at the time of the hospitalization. Admission rate was highest during the first four mounts of the year (71.6%) with peak in March (23.3%). The findings show that significant risk factors are presence of viral disease in the family, smoking during pregnancy and smoking in the household. Most of the patients (87.3%) received antibiotic or corticosteroid treatment during hospitalization, with a significant difference in antibiotic and corticosteroid use between pulmology and neonatology department (p<0.05). Conclusion: Infants with comorbidities and negative gestational and socioeconomic factors more often develop severe form of bronchiolitis during the first year of life.

Introduction: Osteoporosis is a consequence of reduction in bone mass and disorders of bone structure, which makes the bones prone to fractures. Physiological variations of thyroid-stimulating hormone (TSH) may be an early indicator of the predisposing basis of the emergence of osteoporosis. Aim: To evaluate the thyroid hormone status and bone density ratio in euthyroid postmenopausal women in early and late stage of bone loss. Methods: The research is an observational, intersected, controlled study involving postmenopausal women admitted to the Clinic for Nuclear medicine and endocrinology of the Clinical Center University of Sarajevo (CCUS). The study included a total of 120 postmenopausal subjects divided into two groups. First group included 60 postmenopausal patients with osteoporosis, 30 of them were at the early stage of postmenopause, and 30 were in the late postmenopausal phase. The second group consisted of 60 postmenopausal patients with preserved bone mass, 30 of which were in the early stage of postmenopause and 30 in the late postmenopausal phase. For all patients included in the study follicle-stimulating hormone (FSH), TSH, free thyroxine (FT4), free triiodothyronine (FT3) were analyzed. Results: The mean duration of the postmenopausal period was statistically significantly higher in the group of women with osteoporosis (11.4 ± 1.1 years). The mean values of FSH were statistically significantly higher in the group of women with osteoporosis (54.0 ± 2.6 IU / L). The mean level of TSH and FT3 did not statistically significantly differ in the group of women with osteoporosis compared to the control group of women. The mean FT4 level in women with osteoporosis was statistically significantly lower (14.7 ± 0.29 pmol / L) compared to the control group of women (15.95 ± 0.3 pmol / L) (p = 0.004). Conclusion: In our examined group, the FT4 patient (mean) was significantly lower in the serum of women with osteoporosis compared to subjects with preserved bone mass. It would be most effective to recognize risk factors in order to influence them on time, and to alleviate and slow down the consequences of osteoporosis. One of these possible factors is the hormonal status of the thyroid gland, that is, TSH whose physiological variations may be an early indicator of the predisposing basis for the emergence of osteoporosis. The frequency and prevalence of these medical problems require additional research, and it is also a great challenge to understand the effects of thyroid hormone on bone tissue.

Introduction: The concept of quality of life (QoL) is becoming an increasingly important criterion in the assessment of treatment outcomes, health outcomes and in the assessment of the benefit-to-load ratio of drugs or therapies that have equivalent mechanisms of action. Aim: The aim of the study was to evaluate the improvement of quality of life, tolerability of therapy and patient compliance in patients with depression and/or anxiety disorder treated with antidepressants. Methods: The study was designed as a clinical, multicenter, prospective, cohort study involving 682 patients of both sexes diagnosed with depression and/or anxiety disorder observed over the 9 months period. The study was conducted from January to December 2017 in six research centers of the PI Health Center of the Canton of Sarajevo. The patients were divided into three groups: depressive, anxious and mixed anxiety-depressive disorder, and the therapy administered was, paroxetine or escitalopram. MOS (Medical Outcomes Study) sleep scale and Q-LES-Q-SF (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form) scale were used for quality of life evaluation. Patients were observed six times over the course of the study. Results: The results of the MOS questionnaire showed that more than 90 percent of patients with depression and/or anxiety disorder who had taken fluoxetine, paroxetine or escitalopram for 36 weeks experienced an improvement in the sleep problem index. Sleep duration was greatly improved in all patients regardless of the antidepressants used. The results of the Q-LES-Q-SF questionnaire showed a significant improvement in quality of life as well as overall pleasure and satisfaction with life due to the use of antidepressants. Conclusion: Therapy with fluoxetine, paroxetine and escitalopram leads to a significant improvement of all recorded parameters, along with the overall quality of life, which makes them very effective in the treatment of depression and/or anxiety disorders.

Aim To examine the efficiency of paroxetine treatment of anxiety disorders in adult patients over the period of 12 months and the improvement of symptoms of anxiety disorder during this period, as well as to examine the tolerability of the administered treatment and patient compliance during the study. Methods This observational, multicenter, cohort, clinical study included 171 patients with diagnosed anxiety disorder who were administrated paroxetine film-coated tablets 20 mg and followed up during the next 12 months. Patients were observed at 6 points, baseline and five additional assessments. The Beck Anxiety Inventory was used to determine the baseline severity of anxiety and Patients Health Questionnaire module GAD-7 was used to determine the severity of anxious symptoms and to follow up patients during the additional observations. Tolerability and patient compliance were followed throughout the study. Results Statistically significant decline in severity of anxiety disorder over the observation period (p=0.001) was found. At the beginning of the study, 64 (45.7%) patients had severe anxiety symptoms, 43 (30.7%) moderate, 25 (17.9%) mild and eight (5.7%) had none to minimal symptoms. At the end of the study, there were no more patients with severe anxiety, while four (3.4%) had moderate symptoms. On the other hand, 26 (22.2%) had mild symptoms and 87 (74.4%) had none to minimal symptoms of anxiety disorder. Conclusion The results of this study provide further evidence for paroxetine's efficacy and tolerability in the treatment of anxiety disorders with good patient compliance.

Objectives: The aim of this study was to investigate the effects of carvedilol treatment through improvement of New York Heart Association (NYHA) class, ejection fraction (EF) and blood pressure (BP) values in patients with chronic heart failure (CHF). Methods: This multicenter, observational, non-interventional was conducted in 25 medical centers in Bosnia and Herzegovina, from April 2015 until December 2015 (nine months). It included 167 patients of both genders, older than 50 years, who were diagnosed with CHF according to the NYHA classification and had EF <50%. The patients were administered carvedilol tablets and were followed during six visits: baseline and five follow-ups, over the period of 24 weeks. Results: At the beginning of the study, CHF NYHA class I was present in 5 (3.0%) patients, NYHA class II in 76 (45.5%) and NYHA class III in 66 (39.5%) patients. After 24 weeks, CHF NYHA class I was present in 43 (25.7%) patients, NYHA class II in 75 (44.9%) and NYHA class III in 21 (12.6%) patients. There is a statistically significant change of NYHA class before and after 24 weeks of treatment with carvedilol (rho=0.272; p=0.002). At the baseline observation, mean value of EF was 43.06±9.6%. after 24 weeks of treatment, the mean value of EF increased to 48.15±10.51% (p=0.0001). Average increase of EF after the treatment was 5%, or ranging from 1.5-7.5%. Systolic and diastolic blood pressure significantly decreased from baseline to final observation (-15.4 mmHg and -9.18 mmHg; p=0.0001). Conclusion: Carvedilol is effective in improvement of NYHA class and ejection fraction as well as in reduction of high blood pressure in patients with congestive heart failure. Keywords: chronic heart failure, NYHA classification, carvedilol, treatment efficacy

Aim To investigate the effects of carbocisteine treatment in the reduction of frequency of productive cough episodes, preventing disease progression and improving the quality of life as well as the tolerability of the administered treatment and patient compliance during the study. Methods This observational, non-interventional, multicenter, cohort study included 501 patients with chronic obstructive pulmonary disease (COPD) who were administrated carbocisteine capsules 375 mg and followed up during the next 15 days. The patients were observed at 3 points, baseline and two additional assessments. General clinical condition of patients, along with the spirometry testing at all three points were examined. Thr quality of life was assessed on the 1st and 3rd observation with Leicester Cough Questionnaire. Tolerability and patient compliance were measured throughout the study. Results There was a significant change of forced expiratory volume in 1 second (FEV1) status between the second and third observation (p=0.002). Examination of general symptoms showed a statistically significant reduction in cough by 74.9%, in sputum production by 48.5%, in dyspnea by 29% and in fatigue by 50%. After the administration of carbocisteine the median value of overall quality of life was 3.79 (3.63 - 3.89). Conclusion 375mg carbocisteine capsules were found to be effective and well-tolerated in the treatment of COPD, with a small percentage of reported mild adverse reactions and with a significant improvement of quality of life.