The primary objective of the study was to examine the relationship between generic and disease-specific HRQOL scores and metabolic control in children with Type 1 Diabetes Mellitus (T1DM). This cross-sectional study included 65 consecutive children between ages 5 and 18 years with T1DM. According to their values of glycosylated hemoglobin (HbA(1C)), the children were assigned to one of two groups. In Group 1 (N = 21) were the children with HbA(1C) values < 8% (good to moderate metabolic control) and Group 2 (N = 44) were children with > 8% (poor metabolic control). To evaluate generic and disease-specific HRQOL scores in children with T1DM in relation to metabolic control, we used the PedsQL 4.0 Generic Core Scales and the PedsQL 3.0 Diabetes Module. The patients in Group 1, by pediatric patient self-report and parent proxy-report, had statistically better disease-specific HRQOL scores on the diabetes symptoms, treatment barriers, treatment adherence and worry domains in comparison with Group 2. We also found significant correlations between the total generic HRQOL scores and HbA(1C) for both parent proxy-reports' Spearman's coefficient of rank correlation rho = -0.257; p = 0.0412 and pediatric patients' Spearman's coefficient of rank correlation rho = -0.269; p = 0.0313. The current findings suggest that poor glycemic control in children with T1DM is associated with lower generic and disease-specific HRQOL scores in developing and transitional countries.

The aim of this study was to assess the quality of life children after cardiac surgery for congenital heart disease (CHD) and to compare these results with healthy children. To assess the quality of life children after surgery for CHD we performed a cross-sectional study of 114 patients who were patients at the Department of Paediatrics in Tuzla, between the ages of 2 and 18 years, of both sexes, and with one of their parents. We used the "PedsQL 4.0 Generic Core Scales", with both child self-report and parent proxy-reports. By self assessment, the PedsQL total scores for quality of life were statistically significantly different between children after cardiac surgery for ages 13 to 18 years and healthy children, while by parent report PedsQL total scores were statistically significantly different between children after cardiac surgery for ages 5 to 7 years and healthy children. By self assessment, children after cardiac surgery for ages from 5 to 7 and 13 to 18 years reported that they have a statistically significantly lower quality of life in the segment school functioning compared to the healthy children. By parental assessment, children after cardiac surgery for ages 2 to 4, 5 to 7 and 8 to 12 years have a statistically significantly lower quality of life in the segments of physical and psychosocial health, emotional, social and school functioning. The results of our study indicate that children after cardiac surgery for CHD by self and parent assessment have a lower quality of life than healthy children.

No abstract available

A 6.6-year-old girl presented for leftsided cardiac enlargement on chestradiography (Panel A). Th ree yearsearlier she had undergone a lobectomyof the lower lobe of the leftlung for extraction of an echinococcalcyst.

Objective – The research was undertaken to analyze the dietary habits and lifestyle of adolescents from Trogir, Croatia, and to determine the proportion of overweight subjects according to International Obesity Task Force (IOTF) standards.  Subjects and Methods – This pilot study was undertaken in 2009 on a sample of 497 adolescents aged 14-19 years, 322 of whom were girls (79%). The subjects filled out an anonymous questionnaire about their lifestyle and dietary habits and they were measured anthropometrically. The cut off value for overweight was defined according to IOTF standards and is equivalent to Body Mass Index (BMI) equal or higher than 25 kg/m2 in adults.  Results – We detected gender differences in terms of lifestyle and dietary habits. Breakfast is equally often skipped by both boys and girls, but girls significantly often skip also lunch (p=0.050) and dinner (p<0.001). Boys consumed low-quality diet significantly more often than girls. While half of the population consumed olive oil daily, it can be said for less than 30% of girls and 40% of boys eat fresh fruit (p=0.018). Number of boys and girls who smoke did not differ significantly but twice as much boys than girls consumed alcohol (48% vs. 24%, p<0.001). On the other hand, boys were more often involved in out-of-school sports (p<0.001). In this population, 22.8% of boys and 9% of girls had BMI ≥ 25 kg/m2 for their age and sex.  Conclusion – This study results indicate the presence unhealthy lifestyle and dietary habits of the adolescents from Trogir, especially boys. Therefore, we will focus on planning the programme to elevate awareness regarding the importance and effect of healthy adolescents` lifestyle on decreased morbidity and mortality risk in the adulthood.

Objective – The study was undertaken in order to assess on the basis of the opinions of high school teachers if the conditions exist in their schools to provide adequate assistance to pupils suffering from type 1 diabetes mellitus in a state of hypoglycaemia.  Subjects and Methods – 74 teachers from 35 different schools were surveyed by means of a cross-sectional study. According to whether the school was attended by a pupil suffering from T1DM, the teachers were divided into two groups: group 1 (schools with a pupil suffering from T1DN; n=7) and group 2 (schools without any pupils suffering from T1DM; n=47).  Results – Most of the teachers knew what hypoglycaemia is, and there was no statistically significant difference between the two groups in this regard (p=0.718). There were more negative answers in both groups (p=00.001 and p<0.001) to the question: “Does the school have written instructions on how to treat hypoglycaemia?” In the first group the question: “Can a pupil measure his/her blood sugar levels during lesson time?” received more positive replies (p=0.013), whilst in the second group the difference between the replies was not statistically significant (p=0.144). In response to the question “Does the school have drinks or food available to treat hypoglycaemia?” there were more negative answers in both groups (p<0.001 and p<0.001). To the question: “Can a child suffering from diabetes eat food or have a drink during lesson time?” there were more positive answers in both groups (p<0.001, and p<0.001). In response to the question: “Does the school have people who know how to give an injection of glucagon?” there were more negative answers in both groups (p=0.003, and p<0.001). There were no statistically significant differences between the groups in terms of the answers given. The main reasons for insufficient care for pupils suffering from T1DM whilst in school were seen by 40.5% of teachers as a lack of attention given to the problems of these pupils and the lack of education of teaching staff about T1DM.  Conclusion – The results obtained indicate that the conditions are not met in our schools to provide appropriate assistance to children suffering from T1DM in a state of hypoglycaemia.

Objective – The study was conducted in order to evaluate the value of the modified nitrite test in the diagnosis of urinary tract infection (UTI) in children.  Patients and methods – The study included 300 children of both sexes, aged 1 month to 14 years who were examined due to suspicion of UTI at the Department of Paediatrics, University Clinical Center Tuzla in the period from August 1, 2006 to August 1, 2007. In relation to the age, the patients were divided into two age groups: from 1 month to 2.0 years and from 2.1 years to 14 years. These groups will further be referred to as the younger and older groups. A cross-sectional study was used to analyze the biochemical examination of urine using test strips (nitrite and modified nitrite test) and the urine culture results.  Results – The described modification of the nitrite test significantly improved its sensitivity (88%) (p=0.001), NPV (96%) (p<0.0001), LR (-) (0.1) and it is more reliable than the nitrite test to exclude the existence of a UTI. The harmony between nitrite and modified nitrite (k=0.66, 95% CI: 0.56, 0.76, p<0.001) and between the modified nitrite test and the urine culture is good (k=0.79, 95% CI: 0.72, 0.87, p <0.001). Through reliability analysis of the modified nitrite test according to the age groups, we found that in the younger age group, after the modification of the nitrite test, its sensitivity was improved (83%), although not significantly (p=0.153), the NPV (94%) (p<0.0001) and LR (-) (0.2) was also improved. The harmony between the nitrite and modified nitrite test was moderate (k=0.59, 95% CI: 0.43, 0.75; p<0.001), and between the modified nitrite test and urine culture it was good (k=0.79, 95% CI: 0.61, 0.87; p<0.001). In the older age group, after the modification its sensitivity was significantly improved (93%) (p=0.001), NPV (98%) (p<0.0001); LR (-) (0.1). The harmony between the nitrite and the modified nitrite test was good (k=0.72, 95% CI: 0.60, 0.85; p<0.001), and between the modified nitrite test and the urine culture it was very good (k=0.84, 95% CI: 0.75, 0.94; p<0.001).  Conclusion – The value of the modified nitrite test is characterized by the improved reliability of the nitrite test to exclude the existence of a UTI, especially in older children, which is important for clinical practice.

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.

An otherwise healthy, 12.5-year-old malepresented with sudden onset chest pain, wasadmitted to hospital for elevated blood pres-Panel 1Panel 2Acta Medica Academica 2011;40(1):83DOI 10.5644/ama2006-124.12sure. Physical examination showed systolicheart murmur grade 2/6 in the aortic areawith abdominal vascular murmur and normalperipheral pulses. Blood pressure waselevated: (left arm) 170/110 mmHg, (left leg)185/115 mmHg. The plasma renin activity(6.5 nmol/l/h) was elevated. Renal functionwas normal. Doppler blood flow fromboth renal arteries showed a suspected mildobstruction.

Severe pain control is an indispensable and important part of the treatment of children with malignant diseases. The specificity of treatment is connected to the opiate’s metabolism, but it is more difficult to estimate pain and there is fear of side effects, which leads to sub-dosing and poor analgesia. The aim of this study is to show that rational use of opiates secures efficient pain suppression in children in the terminal phase of malignant diseases. Oral morphine with fast impact is the gold standard in the initial phase of severe cancer pain therapy and for the treatment of shooting pain in children. Slow release opiates are suitable for long-term use, as they combine efficiency and compatibility. Rotation of fentanyl transdermal allows simpler usage, decreases side-effects and provides good analgesia for children who cannot take opiates orally. Along with an individual estimate of the child’s condition, it is important to take care of equianalgetic doses of opiates and support therapy.

This study was undertaken to determine epidemiological characteristics of acute lymphoblastic leukemia (ALL) in children aged 0-14 years from Tuzla Canton, during a 13-year period (1995-2007). This retrospective study analyzed patient medical records from University Department of Pediatrics, Tuzla University Clinical Center, as well as documentation of other medical facilities providing additional diagnostic and therapeutic treatment to these patients. Records on the population of children during the study period were obtained from Federal Department of Statistics. ALL was diagnosed in 41 children, 27 (66.0%) male and 14 (34.1%) female. The mean incidence rate for both sexes was 3.3/100,000 (2.3-4.4). It was higher in boys (4.2/100,000) than in girls (2.3/100,000). The highest incidence rate was recorded in 2002 (7.6/100,000). Study results provided reliable insight into the epidemiological characteristics of ALL in children from Tuzla Canton and proved useful for planning a pediatric health care program in the area.

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

In this issue of the journal Acta Medica Academia, for the first time in a medicaljournal in Bosnia and Herzegovina, two papersare published on the subject of suddeninfant death syndrome (SIDS). A detailedsearch in Pub Med, an index of citations ofbiomedical literature, using the key words SIDS and Bosnia and Herzegovina, we didnot find a single publication on SIDS, whichwas in any way related to our country.

Academician Grujica Žarkovic was the corresponding member of ANUBiH from 1967, andhe received the status of academician in 1972, thus being, for a long time, a doyen-academicianwith the longest service in the current compositionof the Academy. With his human, intellectual, scientific, pedagogical, research and other qualities ,as well as with his world view, academician Žarkovic was a unique personality in our region.