Aim Compare the efficacy of nebulized hypertonic saline and normal saline in the treatment of infants hospitalized for bronchiolitis. Methods This retrospective study was conducted at the Department of Pulmonology, Paediatric Clinic, Clinical Centre University of Sarajevo, covering the period from January 2015 to December 2019 and comprising 380 children aged between 1 and 12 months having bronchiolitis. One group received nebulized hypertonic saline (NHS, 3% NaCl)), and another group received nebulized normal saline (NNS, 0.9% NaCl). The control group did not receive any of these treatment options. Results There was no statistically significant difference between the treatment groups regarding length of hospital stay (LOS) and Clinical Severity Score (CSS) at admission and discharge as well as in oxygen therapy duration and antibiotic use, the duration of symptoms before hospital admission, frequency of nasal discharge, elevated temperature, dyspnoea, cough and dehydration. Conclusion The results of this study are consistent with several recent studies or meta-analyses and support the evidence against the use of NHS in hospitalized infants with mild or moderate bronchiolitis.

Background: This research paper is an expression of a desire to view COVID 19 from the perspective of a spontaneous hemorrhage induced on different organ systems. Introduction of a stratified approach to the problem of hemorrhage has become an imperative in medical treatment. Aim: To determine the real figure of spontaneous hemorrhage cases in severe forms of infections caused by Covid 19.Material and methods: The research included 745 patients that suffered from severe forms of infections caused by Covid 19 who were treated in a Respiratory clinic in Tuzla University Clinical Center during 2020 and 2021. The spontaneous hemorrhage was determined on the grounds of laboratory parameters of blood counts and CRP, hemodynamic monitoring of TA and pulse, and CT imagining diagnostic technique.Results: The study presents information about the medical treatment outcome in the case of 5 patients (0,67%) who experienced spontaneous hemorrhage as a part of Covid 19 infection in relation to the total number of 745 patients who were treated during that period in the Respiratory clinic as Covid patients with severe forms of infection. Out of 5 patients who acquired spontaneous hemorrhage 3 were operated. For 4 patients the outcome was lethal. One of the female patients who was in the group of those who were not operated and who had undergone a conservative treatment has survived. In our group of analyzed patients two patients suffered from the hematoma of the front abdominal wall, two had retroperitoneal hematoma and one patient acquired hemorrhage in the abdomen and thoracic with the developing DIC.Conclusion: Relatively low percentage of cases developing spontaneous hemorrhage 5 (0, 67%) but relatively high mortality rate in the cases where it did occur, 4 out of 5 monitored patients, requires certain suggestions that are being presented in this study as to how to approach the cases of spontaneous hemorrhage in the severe forms of Covid 19 infections in more consistent manner in order to improve the outcome of the medical treatment of these cases.

Objective - To assess 25(OH)D status in children with Multisystem Inflammatory Syndrome (MIS-C) associated with SARSCoV-2 infection, and the association between serum levels of 25(OH)D and inflammatory marker values.Patients and methods - This retrospective study was conducted at the Clinic for Children’s Diseases, University Clinical Center, Tuzla in the period from November 2020 to November 2021.Results - The study included 23 children with MIS-C with a median age of 6.9 years, and 22 children with acute SARS-CoV-2 infection, with a median age of 1.1 years. Both groups of children had low serum levels of 25(OH)D in the range of deficiency; median levels of 25(OH)D in MIS-C children were lower (median 44.60 nmol/L) than in children with acute SARS-CoV-2 infection - median 52.45 nmol/L. There was no statistically significant difference in 25(OH) D levels between the two groups of children included in the study (P=0.33). The same number of children in both groups had adequate serum levels of 25(OH)D. The children in both groups had elevated markers of inflammation, but we did not find a significant correlation between the values of 25(OH)D and the inflammatory marker values.Conclusion - Deficiency of 25(OH) D could be one of the precipitating factors that lead to the development of both MIS-C - related SARS-CoV-2 and more severe forms of acute infection. 25(OH)D enriched food, as well as supplementation with 25(OH)D, should be considered a long-term strategy in all high-risk children and adolescents.

Introduction: The pathogen of multivisceral echinococcosis is the same agent as for single-organ echinococcosis: Echinococcus granulosus.According to the consensus of experts under the aegis of the WHO-IWGE WHO-Informal Working Group on Echinococcosis options of treatment should be: (1) percutaneous treatment, (2) surgery, (3) anti-infective drug treatment or (4) watch and waitapproach or combinations thereof. Case report: The presented case was a sevenyear-old Caucasian boy, a permanent resident of rural region near Tuzla, Bosnia and Herzegovina, who had a history of asymptomatic giant liver and small lung hydatid cyst (multivisceral echinococcosis). We consider that the patient was in the phase of secondary hydatidosis even before undergoing the first treatment PAIR method of liver and continued with adjunctive chemotherapy. Two weeks after discharge, during the adjunctive chemotherapy he had one of possible complication where pre-existed smal lung hydatid cyst got inflamed and performed an abscess mass and potential septic risk, which required surgical and antibiotic treatment. Surgery and early postoperative course were normal and the patient was discharged with recommendation to continue with previously started adjunctive chemotherapy (Albendazol) according to treatment protocol. Conclusion: Most infected persons are asymptomatic and clinical manifestations vary according to the anatomic location of the cyst, so we want to indicate the importance of routine ultrasound screening of preschool children, and eventually X ray chest scan.This case report highlights the necessity of caution with choosing appropriate treatment, even though size of cyst can be irrelevant to take surgical treatment in first line instead of medical therapy.

Aim: Asthma and obesity represent one of the most crucial public and health problems of modern society that frequently begin in childhood and have some mutual elements of risk. Abdominal distribution of connective tissue is important determinant which brings to decrease of lungs function. Multiple influence of overweight on function of the lungs would clearly manifest over reduction of forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC). Method: Examining was conducted at Pediatric Clinic of University Clinical Hospital Tuzla during the year 2013/2014. Research included 60 children with diagnosed asthma who were in relation to BMI were divided in 3 groups. The first group was children with BMI ranging from 5 to 85 percentile, the second were children with 85 to 95 percentile and the third was 95 percentile. By prospective study, compared identical pulmonary variable for all three age group of asthma patients were analyzed, the children with normal body mass a well as the overweight and the obese. Results: At the beginning of testing, the frequency of normal spirometric findings was significantly lower in the obese group in comparison with other two observed groups (p<0,05). The only cases of mixed and restrictive disorder of ventilation were registered in the obese group of tested at the beginning of the examined (p<r0,001). Conclusion: When being compared the values of spirometric parameters before and after the research, the only significant difference was in the obese group, the values after tests were significantly higher, with the exception of relation FEV1/FVC, that had the same distribution of values before and after research. However, the group with normal body mass and overweight, had all the spirometric parameters with equal distribution before and after research (p>0,05 for all measurements).

Objective – Subglottic infantile haemangioma (SGH) is a rare but potentially life-threatening disease. We describe a case of successful treatment with propranolol of a severely respiratory compromised 2-month-old infant with an obstructing SGH. Case report – A fullterm 2-month-old male infant, weighing 4.8 kg, without cutaneous haemangioma, presented with stridor, dyspnoea, oxygen desaturation and tachycardia. Contrast enhanced neck–chest CT scan was used to diagnose a 5A—7A—7 mm subglottic elliptic lesion, referable to SGH with a free air column of 2 mm wide. Per oral propranolol was started with a therapeutic dosage of 2 mg/kg/day in 3 administrations. On the second day of treatment there was rapid clinical improvement of the infant with withdrawal of respiratory symptoms. After treatment, the control CT showed the regression of SGH. Twenty-one months later the patient is without respiratory symptoms. Conclusion – Propranolol medical treatment should be considered in all subglottic haemangioma, even in acute cases.

Asthma is one of the most common chronic diseases whose incidence shows constant growth in childhood. The objective of this work was to look into asthma incidence in children in relation to their age group and sex in a retrospective study, at Tuzla Canton area. The study comprised children of both sexes, age 0-14 who fell sick with asthma within the period from January 1st 2003 to December 31st 2007. The overall incidence and the incidence in relation to age group and sex was calculated as the number of children suffering from asthma, within the age group 0-14 years per 1000 children of the same age group in the Tuzla Canton. Asthma was diagnosed in 277 children (66.1% male and 33.9% female). The difference between asthma frequency in boys and girls was significant (chi2 = 56.16; df = 1; p < 0.0001). The average difference in proportion between the boys and girls was 32.2% (95% CI = 24.32-40.08). From this sample group the boys had a 3.8 times greater risk (OR = 3.79; %95 CI = 2.67-5.39) of contracting asthma. The average rate of incidence of asthma for both sexes in the observed period was 0.67/1000 (95% CI; 0.6-0.7; for boys 0.86/1000; for girls 0.47/1000). There was a statistically significantly higher incidence of asthma in boys in relation to girls (t = 6.3836, df = 32; p < 0.0001). The epidemiological data obtained could be useful for early detection and adequate treatment of children with asthma in the mentioned area.

Objective – The study was performed to determine the frequency of positive findings from allergy skin tests of aeroallergens in children with asthma in the Tuzla Canton and to determine the frequency of positive findings in relation to the age of the patients.  Patients and methods – The study included 252 children with asthma, both sexes, aged 0-14 years who were admitted to the Department of Children’s Diseases, Tuzla in the period from January 1, 2003 to December 31, 2007. With respect to age the subjects were divided into the following age groups: from 0 to 4.9, 5 to 9.9 and from 10 to 14 years, later cited as the younger, middle and older groups. Allergic skin tests to aeroallergens were performed by prick test with six aeroallergens: one individual and five group allergen.  Results – showed that patients with asthma often have a positive allergy skin test reaction to Dermatophygoideus pteronyssinus (63.5%) and grass pollen (37.3%). In relation to the age groups, the trend of positive findings for Dermatophagoideus pteronyssinus was statistically significant (p = 0.0063), while the statistical significance of the trend of positive findings for tree pollen was borderline (p = 0.0458). For other aeroallergens there were no statistically significant differences.  Conclusion – The most common aeroallergens to which children with asthma showed a sensitivity in our community was Dermatophagoideus pteronyssinus . It was also found that the frequency of positive skin tests for Dermatophagoideus pteronyssinus and pollen of trees increases with age.

Pedijatrija danas 2010;6(2):189-196 Cilj Istraživanje je poduzeto s ciljem da se utvrdi ucestalost pozitivnog nalaza alergijskih kožnih testova na aeroalergene u djece oboljele od astme na podrucju Tuzlanskog kantona i da se ispita ucestalost njihovog pozitivnog nalaza u odnosu na dob ispitanika. Ispitanici i metode Ispitivanjem je obuhvaceno 252 djece oboljele od astme, oba spola, uzrasta od 0 do 14 godina, koja su primljena na Kliniku za djecije bolesti u Tuzli u periodu od 1.1.2003. do 31.12.2007. U odnosu na dob ispitanici su bili podijeljeni u sljedece dobne grupe: od 0 do 4,9, od 5 do 9,9 i od 10 do 14 godina, kasnije spominjani kao mlađa, srednja i starija grupa. Alergijski kožni testovi na aeroalergene rađeni su Prick metodom sa 6 aeroalergena: jednim pojedinacnim, te pet grupnih alergena. Rezultati Utvrđeno je da su pacijenti oboljeli od astme najcesce imali pozitivan alergijski kožni test na Dermatophagoideus pteronyssinus (63,5%), te peludi trava (37,3%). U odnosu na dobne grupe trend pozitivnih nalaza za Dermatophagoideus pteronyssinus bio je statisticki znacajan (p = 0,0063), dok je statisticka znacajnost trenda pozitivnih nalaza za pelud stabla bila granicna (p = 0,0458). Za ostale aeroalergene nije bilo statisticki znacajne razlike. Zakljucak Najcesci aeroalergen na koji su djeca oboljela od astme pokazala osjetljivost u nasoj sredini bio je Dermatophagoideus pteronyssinus. Također je utvrđeno da se ucestalost pozitivnog kožnog testa na Dermatophagoideus pteronyssinus i pelud stabla povecava sa uzrastom.

Objective – The research was undertaken with the goal of examining the frequency of genetic predisposition, exposure to tobacco smoke, respiratory infections, obesity, poor accommodation conditions, number of family members and antibiotic usage in children who fell sick with asthma at the time of diagnosis.  Material and methods – By retrospective analysis of the medical documentation were analyzed of 277 patients at the Paediatric Clinic and patients from 13 Community Health Centres in the Tuzla Canton Region. The diagnosis of asthma was made on the basis of the Global initiative for asthma. In relation to age when the diagnosis was made the respondents were divided into the following groups: age 0-4.9, 5-9,9 and 10-14 years. The control group was made up of 150 respondents of both sexes, chosen at random. They fulfilled the following criteria: to be closely the same age and sex as the respondents who suffered from asthma, did not have asthma or other allergic diseases, and that they are residents of the Tuzla Canton Region. For testing the statistical significance of the differences among the questioned variables in the questioned group and control group the I‡2 test was used.  Results – A statistically significantly higher frequency of genetic predisposition (I‡2 = 20.81; p < 0,0001) and exposure to tobacco smoke (I‡2 = 12.2; p = 0.0005) was found in respondents with asthma in relation to respondents from the control group. There was a statistically significantly smaller number of families with four and more members (I‡2 = 71.2; p < 0.0001) in the respondents with asthma in relation to respondents from the control group. No statistically significantly difference was determined in antibiotic usage, frequency of respiratory infections, increased body mass index and living conditions among children with asthma and the control group.  Conclusion – Our results confirm more frequent cases of asthma with children having a genetic predisposition. The other most prominent factors were exposure to tobacco smoke and children with fewer family members.