Coronavirus disease 2019 (COVID 19) is a pandemic disease that is today a global public health problem caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) COVID-19 is a disease of middle and old age, but clinical expression may also be present in childhood Asymptomatic and mild clinical forms are most often present in persons aged 0-19, but severe clinical forms such as, among others, acute respiratory distress syndrome and multisystem inflammatory syndrome may occur In addition to presenting the epidemiology, clinical symptomatology of COVID-19, the authors consider certain specifics of COVID-19, that is, possible reasons for the lower incidence of the disease as well as unusual and rare clinical forms of the disease in children The current activities of health professionals in the supervision of COVID-19 are mainly focused on early detection, isolation and treatment of patients, isolation of contacts, the regular and thorough practice of respiratory hygiene, hand hygiene, and physical distancing Future efficient and safe vaccination will solve the biggest global medical challenge caused by the new coronavirus in the best possible manner © 2020, University of Sarajevo - Faculty of Health Studies

The rapid pace of change continues to be a hallmark in cardiovascular medicine and many see that pace accelerating in adult cardiovascular medicine as well as in paediatric cardiology medicine. Cardiovascular medicine is an area of clinical practice with a continually rapid expansion of knowledge, guidelines, best practices and new technology. Cardiovascular diseases are the leading cause of mortality in the world and cause major costs for the health sector and economy. Primary care clinicians are challenged to optimally manage a multitude of diseases including congestive heart failure, coronary artery disease, valvular diseases, arrhythmias, lipid disorders, and hypertension. Multimodality imaging techniques are being used more frequently as their utility is better appreciated. Echocardiography has been the mainstay approach, cardiac computerized tomography and magnetic resonance imaging provide a good imaging alternative for patients with multiple complex surgeries. 3D printing has seen a rapid growth in use for planning treatments for patients with congenital heart disease. Simulation using 3D models is emerging as a fundamental resource for teaching procedural techniques and a new standard of care. Artificial intelligence holds the greatest potential for revolutionizing medicine. Innovative technologies in the world of cardiovascular health are expanding every day: wearable computing technologies, bioresorbable stents, leadless pacemaker, valve-in-valve procedure, protein patch for heart muscle growth and others. As a part of lifelong learning process for all professionals in cardiovascular medicine, the imperative is to have continuity of reviewing novelties, with results data from numerous researches in order to treat patient according to best practices and evidence-based medicine.

Cardiovascular diseases (CVDs) are the major cause of disability and premature death all over the world. Annually, 17.5 million people die from CVDs, representing 30% of the total number of deaths. Despite established guidelines for the treatment of acute coronary syndrome, cardiac weakness, atrial fibrillation and CVD prevention, many patients remain inadequately treated, particularly in less developed nations. A brief overview of the development of CVDs, description of the current practice guidelines, and a cross sectional analyses of the status of CVD prevention and control in the Federation of Bosnia and Herzegovina is given. In the past 7 years, there has been a steady increase in deaths, where half of all deaths in the Federation of Bosnia and Herzegovina are attributed to CVDs. Deaths from the acute myocardial infarction had a rate of 91.0/100,000 inhabitants, a significant increase compared to 2010, when this rate was 69.2. The second leading cause of death, a stroke, with a rate of 87.1 showed a slight decrease compared to 2010, when it was 89.9. The third leading cause of death, heart failure, with a rate of 68.4, has a slight decrease compared to 2010, when the rate was 75.7. CVDs are the leading cause of mortality in Federation of Bosnia and Herzegovina, which, in addition to the large number of premature deaths, also causes major costs for the health sector and economy.

Atherosclerosis is the most frequent disease of arteries characterized by lumen reduction of blood vessel due to local thickening of internal blood vessel by plaque/atheroma [1-3]. It is now one of the leading causes of death in developed countries. Of the ten most common causes of death, diseases of the heart and blood vessels, as a result of atherosclerosis, accounts for six of them. Atherosclerosis begins in childhood, the patient goes a long time without developing symptoms, increasing with age and at about 50 years of age, atherosclerosis seriously begins to threaten health. As a cardiovascular disease, atherosclerosis is an interdisciplinary problem that is treated by: cardiologists, neurologists, epidemiologists, nutritionists etc.

Mitral valve / MV / is a functional complex that is based on the normal morphology, geometrical relations and function of all constituents. Its role is triple: 1. regulate blood flow to the LV during diastole with low pressure gradient, preventing the recurrence of systolic blood flow in LA, 2. contribute to the formation of LV outflow tract in systole and 3. its integrity is essential for maintenance of a normal size and geometry function of LV. The disease of heart valves, mitral and aortic caused by degenerative changes, is quite common in adults. In a young person, the more common causes are: inflammatory diseases, cardiomyopathy and ischemic heart disease. Using color Doppler echocardiography, the morphological valve changes and damage to its function can be diagnosed. The goal of treatment is: to reduce or eliminate symptoms of disease, to avoid damage to LV function or right ventricle, improving the quality of patient’s life, prevention of complications and mortality reduction. Treatment options for valvular heart disease are: medical therapy, balloon valvuloplasty and surgical therapy: valve replacement or valve reconstruction. In children there are predominantly acquired valvular heart diseases of rheumatic etiology. Mitral stenosis is rare, more common is mitral regurgitation /MR/. Treatment of MR involves: SBE prophylaxis, afterload reducing agents, diuretics and digoxin. Surgical correction prefers reconstruction over MV replacement. Asymptomatic patients with MV prolapse do not require treatment, and symptomatic patients need beta blocker agents. Reconstructive surgery or MV replacement is indicated in rare patients with severe MR.

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.

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.

This case report presents a four month old infant with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome including clinical presentation of severe cardiomyopathy and left-sided heart failure. Child was operated for reimplantation of ALCAPA to aortic root with satisfactory outcome.

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.

Types of acquired heart disease among children include: cardiomyopathy, endocarditis, myocarditis, pericarditis, Kawasaki disease, arrhythmia, hypertension, rheumatic fever, and obesity. These are diseases that occur after birth, as opposed to congenital heart disease, which is present at birth. Acquired heart disease in children constitutes diagnoses which do not occur in adults (eg. Kawasaki disease), or which may be similar to conditions present in adolescents and adult patients (eg. dilated cardiomyopathy). Most frequently diagnosed are rheumatic fever and Kawasaki disease. Children who are diagnosed and treated for congenital heart disease are at higher risk of developing endocarditis and cardiomyopathy. Although heart disease in childhood has a complex aetiology – and is often caused by unknown factors – a wide palette of diagnostic tests is required to determine its cause, including: genetic, echocardiography, X-ray, MRI, CT, heart catheterisation, endomyocardial biopsy, and nuclear studies. Pathological process directly affects cardiac structures, causing myocardial dysfunction. If myocardinal function is suspected, it is necessary to take a detailed history of the disease, along with a physical examination, and apply a diagnostic and therapeutic algorithm in order to stabilise a haemodynamically compromised patient with acquired heart disease.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital cardiac anomaly. ALCAPA syndrome mostly presents in the first few months of life. Left untreated, the mortality rate in the first year of life is 90% secondary to myocardial ischemia or infarction and mitral valve insufficiency leading to congestive heart failure. Sudden death may occur because of inadequate collateral circulation between the left and right coronary artery systems and/or development of arrhythmia. Currently, the prognosis for patients with ALCAPA syndrome is dramatically improved as a result of both early diagnosis and improvements in surgical techniques, including myocardial preservation. This case report presents a four month old infant with ALCAPA syndrome including clinical presentation of severe cardiomyopathy and left-sided heart failure. Child was operated for reimplantation of ALCAPA to aortic root with satisfactory outcome.

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.