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B. Tomas, Herzegovina, Darko Zelenika, Ž. Rončević

Sounds produced by acoustic activity of the heart are series (sequences) of quasi-periodic events which are repeated throughout life, one period (cycle) of these events lasts less than one second. The advancements in technology have enabled us to create various tools for audio and graphic representations of these events. Physicians, by using such tools, can more accurately determine diagnosis by interpretation of heart sound and/or by visual interpretation of graphic displays of heart sounds. This paper presents frequency parameters and graphic illustrations of heart sound signals for two groups of heart murmurs: innocent Still’s murmur and pathologic heart murmur of Ventricular Septal Defect (VSD). Also, on behalf of the frequency analysis of acoustic cardiac signals with Still’s murmur was given a medical explanation of cause and origin of Still’s murmur.

Citation: Roncevic Z (2014) New Technologies and the Future of Cardiology: Journal of Cardiology & Current Research. J Cardiol Curr Res 1(3): 00012. DOI: 10.15406/jccr.2014.01.00012 I am honored to be in Editorial Board of this brand new journal hoping that The Journal of Cardiology & Current Research has a bright future. It is important for JCCR to be open for all practicing cardiologist and researchers from all countries around the world regardless of whether they are developed or undeveloped. The main goal is to give a chance for a “Step into the World of Researchˮ to all.

V. Jegdić, Ž. Rončević, V. Škrabić

Aim/Hypothesis. To examine whether children with DMT1 are less physically fit than healthy children and to assess whether an elevated level of HbA1c was associated with decreased physical fitness among children with diabetes. Methods. The study was conducted using case-control methodology. The cases were 100 children with T1DM, 7–17,9 years. Study subjects underwent a 6MWT, where distance measured, heart rate, and oxygen saturation was recorded. Results. Results of the 6MWT for children with T1DM and controls were 601.3 ± 86.1 meters versus 672.1 ± 60.6 meters, respectively (P < 0.001). The cases were divided into two subgroups, one with HbA1c levels >8% and one with HbA1c <8%. Results for both groups were inferior to the controls (P < 0.001). The posttest pulse rate in all subjects was higher than the pretest pulse rate (P < 0.001). Pulse oxygen levels were lower than controls at the pretest measurement (P < 0.001), and for both cases and controls, pulse oxygen levels decreased after test (P = 0.004). However, the change in oxygen saturation did not differ between the groups (P = 0.332). Conclusions. Children with T1D are less fit than matched controls. The level of HbA1c did not affect the physical fitness of children with T1D.

A. Bajraktarević, M. Miković, Andrea Pahor Kurilic, S. Penava, B. Begović, Amina Selmovic, Zlatko Guzin, T. Frankic et al.

H. Begić, H. Tahirovič, Fatima Begić, Ž. Rončević, Stevan Bajić, S. Mesihović-Dinarević, Majda Smajlagić, Snežana SIMIĆ-PERIĆ

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

Nedjeljka Simunović, Ž. Rončević

The aim of this study was to investigate the parental reaction after they have been informed that their child has a heart murmur. This study also explored whether their reaction was influenced by the fact that the heart murmur is innocent, which actually means that the child is healthy. One hundred parents participated in this cross-sectional study. According to the statistical results, minor parent concern was notable after cardiologist's examination and consulting. Whereas before the cardiologist's examination 98% of parents were concerned about their child's health, later, less than half of them, or to be exact, only 38% of them, were still concerned. Before the questionnaire was filled, according to gender distribution, males were less concerned than females. Regarding the number of children, parents having three or more children were less worried before the medical examination. Before the examination, only 17% of parents were completely confident that their child had no heart complaint, and after a month 60% of parents had the same opinion. After cardiologist's examination and educational consulting, parental concern dropped significantly, which points to an obligatory need to thoroughly familiarize parents with their child's health condition.

B. Tomas, Ž. Rončević

Time and frequency review of acoustic heart signals in children is given in this paper. The following sound recordings were compared: Still’s innocent heart murmur (Still), pathologic murmur of the congenital ventricular septal defect (VSD) and the recording without the murmur (Normal). Goertzel algorithm was used, for the first time, to determine the spectral energy of the heart signals. The aim of this study is to show that this algorithm is very suitable to analyze the heart sound signals as well as suitable for heart murmurs recognition. Still’s murmur is analyzed in more detail because it is incorrectly diagnosed by many doctors. Analysis of Still’s murmur shows that it is, actually, a realistic musical tone of low frequency similar to glissando tone played on a bass guitar.

Darinka Šumanović-Glamuzina, Violeta Saraga-Karacić, Ž. Rončević, A. Milanov, T. Božić, M. Boranić

OBJECTIVES To determine the prevalence of major congenital malformations in West Herzegovina, a part of Bosnia and Herzegovina, immediately and five years after 1991-1995 military activities, which allegedly included the use of weapons with depleted uranium. METHODS The study included all live-born and stillborn neonates and excluded all aborted fetuses in two one-year cohorts (1995 and 2000) of neonates in the Maternity Ward of the Mostar University Hospital. Malformations were recorded according to the recommendations of the EUROCAT protocol. RESULTS Major malformations were found in 40 (2.16%) out of 1,853 neonates in 1995 (95% confidence interval [CI], 1.49-2.82%) and in 33 (2.26%) out of 1,463 neonates five years later (95% CI, 1.50-3.01%), ie, at comparable prevalence. In both cohorts, anomalies of the musculoskeletal system were the most common, followed by anomalies of the digestive system (in 1995) and the cardiovascular system (in 2000). The prevalence of malformations and the organ systems involved were essentially comparable with those in other populations not affected by military activities. CONCLUSION Despite alleged environmental pollution in some regions of the former Yugoslavia, which was attributed to military activities and the presence of depleted uranium (the "Balkan syndrome"), there was no significant postwar increase in the prevalence of congenital malformations.

H. Tahirovič, A. Toromanović, N. Hadzibegić, D. Stimljanin, R. Konjević, Z. Budimić, H. Cengić, Ž. Rončević et al.

Abstract Assessment of the status of iodine prophylaxis was studied in 5,523 schoolchildren randomly selected in all cantons in Bosnia and Herzegovina Federation (BHF). According to the iodine content of household salt samples, all cantons of BHF were divided into two groups: Group A: 95.5% of the salt used is produced in the Tuzla plant, in which the salt is iodized at 5-15 mg Kl/kg salt, and 4.5% of the salt used is produced in the Pag plant, in which the salt is iodized at 20-30 mg Kl/kg of salt, and Group B: 19.9% of the salt used is produced in the Tuzla plant and 80.1% in the Pag plant. In Group A the amount of iodine in salt was significantly lower than in Group B (11.4 mg/kg vs 18.9 mg/kg, P <0.001). In Group A the prevalence of goiter was significantly higher than in Group B (32.6% vs 19.7%, P <0.001). The highest prevalence of goiter was in Bosnian Podrinje Canton (51.2%) and Central Bosnian Canton (42.6%) while the lowest was in West Herzegovina Canton (12.9%). Significantly higher concentrations of urinary iodine were found in Group B than in Group A (82.6 μg/1 vs 75.2 μg/1, P <0.001). In Group A the percentage of urine samples below 50 μg/1 iodine was significantly higher than in Group B (35.6% vs 26.9%, P <0.001), but there was no difference in the percentage of urine samples with iodine values less than 100 μg/1 (70.7 μg/1 vs 68.25 μg/1, P >0.05). We conclude that FBH is an iodine deficient area and that the improvement of iodine prophylaxis is urgently required, primarily by increasing salt iodine content to 20-30 mg/kg, in order to eradicate endemic goiter.

H. Tahirovič, A. Toromanović, N. Hadzibegić, D. Stimljanin, Z. Budimić, H. Cengić, Ž. Rončević, E. Denjo et al.

Iodine deficiency which causes the wide spectrum of disorders for all ages, is one of the significant public health problem worldwide. From the ancient times different iodine deficiency disorders were noticed in Bosnia and Herzegovina and in its some areas the goiter existed in endemic form. These facts confirm that its soil bas been iodine deficient and that necessity for iodine prophylaxis is obvious on its territory. The study was based on 5,523 children, of both sex boys and girls school age from 7 to 14 years, randomly selected with the equal participate subjects in relation to the age. The sample is representative and it has been assessed based on: total number of school children aged from 7 to 14 years, anticipated prevalence of goiter 5% level of probability 95%, relative punctuality 30% and the factor called "design effect" which is 3. The study was carried out in whole ten cantons in the schools with equal representation among cities and villages. In examining of prevalence of giter we used inspection and palpation. Determination of iodine concentration in urine was carried out by the method is based on Sandel-kolthof's reaction. The technique used for determination of concentration of iodine in salt was iodinemetric titration. The prevalence of goiter was 27.6% in Federation of Bosnia and Heryegovina. The highest prevalence of goiter was in Bosnia Podrinje Canton (51.20%) while the lowest was in West Herzegovina Canton (12.90%). The urinary iodine excretion in investigated children varied from 1 to 208 *mg/L with median of 77.6 *mg/L. Iodine contetn in household salt samples was from 3 to 29.8 mg/kg, range 14.4 + 5.9 mg/kg. The results of our study show the persistence of mild to moderate iodine deficiency in Bosnia and Herzegovine Federation. Therefore according to the recommendations of the World Health Organisation, UNICEF and International Council for Control of Iodine Deficiency Disorders, the salt for human, and animal consumption as well as for food industry which is consuming on its teritory, has to be iodinated on the place of its production without looking back whether or not it is produced or imported in Bosnia and Herzegovina Federation, lodination has to be performed with 20 to 30 mg KI per one kg of salt, thereby an average the iodine content has to be 25 mg per kg. In this way it will be prevented the wide spectrum of disorders, which we often are not aware for that its are caused by iodine deficiency. In addition it will be prevented many very important socioeconomical consequences of iodine deficiency.

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