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.

www.pedijatrijadanas.com Objective The research was undertaken with the aim of establishing the range and frequency of congenital heart disease (CHD) in children with Down syndrome (DS), who are monitored at paediatric cardiology centres in Bosnia and Herzegovina, its association with other anomalies, the time of diagnosis of DS and CHD, and to analyse their surgical care. Patients and methods By a cross-sectional study, data was collected on children aged from 0 to 18 years with DS and CHD who were monitored at paediatric cardiology centres of primary, secondary and tertiary health care (Banja Luka, Bihać, Bijeljina, Mostar, Sarajevo, Tuzla and Zenica) in Bosnia and Herzegovina. Results Data for 100 children (51 boys and 49 girls) of an average age of 6.1 (from 0 to 17.1) were collected and analysed. The most frequently diagnosed CHD was atrioventricular septal defect, which was found in 36% of children followed by ventricular septal defect in 33%. In 79% children the CHD was isolated and 21% had multiple heart anomalies. Associated anomalies of other systems were found in 26% of children. In only one case was an intrauterine suspicion of DS established. A statistically significant reduction in the age of post-natal diagnosis of DS and CNHD was registered. In 73% patients cardiosurgical treatment was indicated, 43% underwent surgery, 19% are waiting for surgery and in 11% pulmonary hypertension developed. Conclusion The range of CHD found in children with DS in Bosnia and Herzegovina does not differ from most similar research. The results obtained show that in the period in question there was insufficient prenatal diagnostics of DS and CHD. Postnatal diagnostics, although also insufficient at the beginning of the period in question, significantly improved over time, which resulted in a reduction of the age at which the diagnosis of DS and CHD was established. Moreover there was a clear reduction in the time difference between the diagnosis of DS and the diagnosis of CHD. However, the possibilities of early cardio-surgical treatment are still limited. The results should serve Hidajeta BEGIĆ1, Husref TAHIROVIĆ2, Fatima BEGIĆ3, Željko RONČEVIĆ4, Stevan BAJIĆ5, Senka MESIHOVIĆ-DINAREVIĆ6, Majda SMAJLAGIĆ7, Snežana SIMIĆ-PERIĆ8 CONGENITAL HEART DISEASE IN CHILDREN wITH DOwN SYNDROME wHO ARE MONITORED AT PAEDIATRIC CARDIOLOGY CENTERS IN BOSNIA AND HERZEGOVINA

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.

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.

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.

Congestive heart failure occurs when the heart can no longer meet the metabolic demands of the body under normal physiologic venous pressures. The evolution and progression of congestive heart failure is a result of the mutual interaction of complex haemodinamic neurohormonal, cells and genetic factors. Decreased cardiac output is a consequence of complex interaction factors. Systolic dysfunction, which occurs in congestive heart failure, is characterized by diminished ventricular contractility, resulting in decreased ability to increase the stroke volume to meet systemic demands. Diastolic dysfunction results from decreased ventricular compliance, necessitating an increase in venous pressure to maintain adequate ventricular filling. The most frequent causes of cardiac insufficiency in children are congenital structural heart anomalies and genetic, metabolic defects of heat muscles. The signs of congestive heart failure vary with the child’s age, they include apart from tachycardia: a high level of cathemolamins, venous congestion and insufficient cardiac output. Diagnosis is made upon history taking, physical examination, laboratory tests, x ray diagnostics, electrocardiography and echocardiography. The management of CHF is difficult and sometimes dangerous without knowledge of the underlying cause. Consequently, the first priority is acquiring a good understanding of the aetiology. The goals of medical therapy are reducing the preload, enhancing cardiac contractility, reducing afterload, improving oxygen delivery and enhancing nutrition. Up to date medicament therapy includes: inotropc drugs, inhibitors fosfodiesteraze, diuretics, ACE inhibitors, digitalis, beta blockers and vasodilatators. The treatment of CHF due to the various kinds of causes should be created individually to each patient’s demands and be monitored.

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.

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.

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.