OBJECTIVE To determine the quality of life in adolescents with acne vulgaris in relation to the severity of clinical picture and sex using the Skindex-29 general questionnaire. PATIENTS AND METHODS Using a sectional study, the quality of life was analyzed in 90 adolescents of both sexes, aged 16 to 21 years, who were suffering from acne vulgaris. The study was conducted between January 1, 2008 and January 31, 2009, at Department of Dermatovenereology, Dr. Irfan Ljubijankić Cantonal Hospital in Biha6. According to the type of efflorescence, its localization and severity of clinical features, respondents were classified in three groups: group 1 consisted of adolescents with acne comedonica, group 2 with acne papulopustulosa, and group 3 with acne conglobata. The quality of life in these adolescents suffering from acne vulgaris was evaluated by using the general Skindex-29 questionnaire consisting of 30 questions grouped into three scales (scale of emotions, symptom scale, and scale of social and physical functioning) about the psychological impact of acne on the quality of life. RESULTS In the study group, there were 54 (60%) female and 36 (40%) male respondents, mean age 17.5 (range 15.6-20.6) years. Of the total number of patients with acne vulgaris, nine (4 female and 5 male; 10%) had acne comedonica (group 1), 72 (46 female and 26 male; 80%) acne papulopustulosa (group 2) and nine (4 female and 5 male; 10%) acne conglobata (group 3) (p > 0.95). Skindex-29 values expressed as mean +/- SD or median (range) in groups 1,2 and 3 were as follows: on the scale of emotions 43.1 +/- 22.2, 60.4 +/- 20.1 and 52.5 +/- 28.7 (p = 0.084); on the scale of symptoms 26.5 +/- 15.4, 49.0 +/- 20.5 and 42.95 +/- 26.1 (p = 0.039); and on the scale of functioning 23.4 +/- 24.6, 36.0 +/- 23.2 and 34.8 +/- 30.9 (p = 0.341), with cumulative score of 31.0 +/- 10.5, 47.5 +/- 12.0 and 43.44 +/- 8.8 (p = 0.069), respectively. Skindex-29 values were expressed as median (range) in women and men in all three groups, as follows: women, scale of emotions 44.0 (27.5-60), 64.0 (10-90) and 62.5 (5-83) (p = 0.25); scale of symptoms 32.7 (21.5-42.4), 54.2 (17.6-90) and 63.5 (17.8-92) (p = 0.17); scale of functioning 22.2 (2-46.5), 39.2 (0-90) and 51.6 (0-83) (p = 0.31); and men, scale of emotions 30.0 (22.5-90), 55.5 (7.5-100) and 40.2 (30-97.5) (p = 0.26); scale of symptoms 11.9 (4-50), 54.0 (0-75) and 28.5 (17.8-42.8) (p = 0.003); and scale of functioning 13.0 (5-77), 31.7 (0-84) and 14.6 (4.5-72.9) (p = 0.58). CONCLUSION Acne vulgaris affects the quality of life in adolescents involved regardless of the severity of the clinical picture, with a pronounced impact in women.

Sudden infant death syndrome (SIDS) is an idiopathic conditionthat affects seemingly healthy infants under one year ofage, whose death remains unexplained after the performanceof a complete postmortem examination, toxicological analyses,genetic testing, death scene investigation, and a reviewof the mother’s and infant’s medical history. Detailed epidemiological,pathological, and forensic information has beenreported regarding SIDS from the developed countries. However,SIDS information from developing countries is eitherwidely scattered or non-existent. This is the first publishedcase report of SIDS from the country of Bosnia and Herzegovina.A previously healthy 3 months old, white male infantwas found dead after being placed to sleep in the prone position.The features of this case report closely parallel the classicalfeatures of SIDS cited in the world literature. The infantwas healthy, male, between the ages of 2-12 months, discoveredin the prone position and had a negative postmorteminvestigation. It is important for developing countries such asBosnia and Herzegovina to conduct detailed forensic investigationsof deaths from SIDS and provide epidemiological,pathological, and circumstances of that information to theworld’s collective knowledge.

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.

Febrile convulsions are the most frequent neurological disorder of early childhood. One third of children with febrile convulsions will have a recurrence, and only a small number will develop afebrile convulsions with epilepsy variation. The aim of the work was to establish the frequency of convulsion recurrence through the retrospective study with regard to age, type of recurrence, and applied prophylaxis in children in Tuzla Canton in a two-year period after the first febrile convulsion. Amongst 716 patients, 21.9% had a recurrence. Recurrence of simple febrile convulsions occurred in 124 (78.9%), complex in 18 (11.5%), and 14 (9.8%) patients had afebrile convulsions. There was no statistically significant difference in recurrence appearance between patients who received continuous and intermittent prophylaxis or different type of continuous prophylaxis. Knowledge of recurrence frequency according to age groups opens the possibility of recurrence prevention with adequate therapeutic measures, especially in home care conditions. Good parent education would represent the first step in recurrence prevention.

Objective – The aim of this study was to determine the epidemiological characteristics of celiac disease in children in the Tuzla Canton.  Patients and Methods – This retrospective study analyzed the medical records of the Department of Paediatrics in Tuzla of 68 patients in age from 0 to 14.9 years in whom celiac disease was diagnosed in the period from January, 1, 1995 to December, 31, 2007. Patients were divided into three groups in relation to the type of the disease. The first group consisted of patients with typical, the second group of patients with atypical and the third group with asymptomatic celiac disease.  Results – Of the 68 patients 44 (64.7%) children had the typical form of celiac disease, 16 or 23.5% had an atypical form and 8 (11.8%) patients had an asymptomatic form of celiac disease. The largest number of affected children (14 or 20.6%) was in the municipality of Tuzla. The overall average incidence rate of celiac disease in the observed period for both sexes aged from 0 to 14.9 years was 0.05/1000, while the prevalence of celiac disease for 2007 was 0.73/1000 from the end of 2001. Since 2001, when there were seven patients with celiac disease, the number of newly discovered cases gradually increased to 12 in 2007.  Conclusion – The typical form of celiac disease had the highest number of affected children aged from 0 to 1.9 years, whereas atypical and asymptomatic forms of the disease were significantly less frequent. The average incidence rate of celiac disease in the period for both sexes aged from 0 to 14.9 years was 0.05/1000. The number of newly diagnosed cases of celiac disease in the observed period increased significantly, whicht may be explained by the frequent use of specific serological tests in celiac disease, as well as the use of serological screening for celiac disease in children with typ 1 diabetes mellitus and Hashimoto thyroiditis.

Objective. To determine anxiety and depression levels inadolescents with acne vulgaris in relation to clinical severityand gender. Patients and methods. Using a sectional study,the anxiety and depression level was analyzed of 90 adolescentsof both sexes, aged 16 to 21 years, who were sufferingfrom acne vulgaris. The study was conducted between February1st 2008 and January 31st 2009 at the Dermatovenerologydepartment of the Cantonal Hospital “Dr. Irfan Ljubijankic”,Bihac. According to the type of efflorescence, its localizationand severity of clinical features, respondents were classifiedin three groups: the first group consisted of adolescents withmild forms of acne, the second group had moderate formsof acne and the third had severe forms of acne. Evaluationof anxiety levels in patients with acne vulgaris was made usingSTAI questionnaire (Spielberger’s state and trait AnxietyInventory) that consists of 20 questions about the essentialcharacteristics of anxiety as the condition, and the level ofdepression was determined using the BDS-scale (Back DepressionInventory) which consists of 18 items that were usedby the respondents to perform self-evaluation of depressionlevel. Results. In the study group there were 54 (60%) femalerespondents and 36 (40%) male, mean age 17.5 years (range15.6-20.6). Of the total number of patients with acne vulgaris,nine of them or 10% (4 female and 5 male) had a mild form ofacne (first group), 72 of them or 80% (46 female and 26 male)a moderate form of acne (second group) and 9 of them or 10% (4 female and 5 male) a severe form of acne (third group)(p > 0.95). 1.1% of the respondents had an exceptionally lowanxiety level, 13.3% had low level, moderate 76.8% and 8.8%had a high level. 37.8% had distinct signs of depression, therisk group consisted of 44.4%, and a normal value was foundin 17.7%. The values of the STAI questionnaire expressed asmedian (range) in the first, second and third groups were 58.7(39-70), 57.7 (20-70) and 60.2 (40-70) (p = 0.36), while thevalues of the BDS scale within the same groups were 13.4 (8-16), 15.1 (3-29) and 14.4 (7-24) (p = 0.367). Conclusion. Thelevel of depression and anxiety in patients with acne vulgarisis not related to severity and patient sex.

Objective. To determine anxiety and depression levels inadolescents with acne vulgaris in relation to clinical severityand gender. Patients and methods. Using a sectional study,the anxiety and depression level was analyzed of 90 adolescentsof both sexes, aged 16 to 21 years, who were sufferingfrom acne vulgaris. The study was conducted between February1st 2008 and January 31st 2009 at the Dermatovenerologydepartment of the Cantonal Hospital “Dr. Irfan Ljubijankic”,Bihac. According to the type of efflorescence, its localizationand severity of clinical features, respondents were classifiedin three groups: the first group consisted of adolescents withmild forms of acne, the second group had moderate formsof acne and the third had severe forms of acne. Evaluationof anxiety levels in patients with acne vulgaris was made usingSTAI questionnaire (Spielberger’s state and trait AnxietyInventory) that consists of 20 questions about the essentialcharacteristics of anxiety as the condition, and the level ofdepression was determined using the BDS-scale (Back DepressionInventory) which consists of 18 items that were usedby the respondents to perform self-evaluation of depressionlevel. Results. In the study group there were 54 (60%) femalerespondents and 36 (40%) male, mean age 17.5 years (range15.6-20.6). Of the total number of patients with acne vulgaris,nine of them or 10% (4 female and 5 male) had a mild form ofacne (first group), 72 of them or 80% (46 female and 26 male)a moderate form of acne (second group) and 9 of them or 10% (4 female and 5 male) a severe form of acne (third group)(p > 0.95). 1.1% of the respondents had an exceptionally lowanxiety level, 13.3% had low level, moderate 76.8% and 8.8%had a high level. 37.8% had distinct signs of depression, therisk group consisted of 44.4%, and a normal value was foundin 17.7%. The values of the STAI questionnaire expressed asmedian (range) in the first, second and third groups were 58.7(39-70), 57.7 (20-70) and 60.2 (40-70) (p = 0.36), while thevalues of the BDS scale within the same groups were 13.4 (8-16), 15.1 (3-29) and 14.4 (7-24) (p = 0.367). Conclusion. Thelevel of depression and anxiety in patients with acne vulgarisis not related to severity and patient sex.

Objective. To determine the outcome of rehabilitationtreatment after orthopedic-surgical treatment of the lowerextremities in relation to motor function and degree of disabilityin children with cerebral palsy. Subjects and methods.An historical-prospective study included 44 treated childrenwith CP from May 2000 until June 2009 at the Departmentof Physical Medicine and Rehabilitation University ClinicalCentre Tuzla. The main criteria for entering the study werediagnosed CP and performed orthopedic-surgery of the lowerextremities during rehabilitation treatment. Assessmentof the motor function score was performed according to theGross Motor Function Measure 88 (GMFM-88), and classificationof the degree of disability was developed based on thescale of the Gross Motor Function Classification System (GMFCS).Results. In our study, motor functions were improved,so that the median value and interquartil range (IQR) of thetotal GMFM score before surgery was 35.7 (IQR from 22.9 to57.2), and after postoperative rehabilitation 58.6 (IQR from31.2 to 85.2) with a high statistical significance (p<0.0001).Median value GMFCS scores before surgery ranged around5 (IQR from 4 to 5), and after postoperative rehabilitationranged around 3 (IQR from 2 to 5), which shows a highlystatistically significant reduction in the degree of disability(p<0.001). Conclusion. Surgical intervention performed onthe lower extremities in children with cerebral palsy may improvemotor function in all developmental stages and reducethe degree of disability with intensive rehabilitation.

OBJECTIVE The aim of the study was to assess the impact of the family socioeconomic status (SES) on health related quality of life (HRQoL) in children operated on for congenital heart defects. PATIENTS AND METHODS The study included 114 children aged 1.6-18 (mean = 10.2 +/- 4.2) years (46.5% male and 53.5% female), followed up at University Department of Pediatrics in Tuzla after cardiac surgery, and one of their parents or caretakers. Of 114 children with congenital heart defects, 54.4% had anomalies with left-right shunt, 18.4% obstructive type anomalies and 27.2% complex anomalies. Control group consisted of 127 healthy age-matched subjects (age range 1.5-18, mean = 11.2 +/- 4.2 years; 49.6% male and 50.4% female). In this prospective study, we used PedsQL 4.0 Generic Core Scale to assess HRQoL of children operated on for congenital heart defects. This measurement includes both the parent proxy and child reports. The family SES was assessed by use of Hollingshead two factor index of social position. Statistical significance of differences between respondents and control group was determined by use of t-test and ANOVA with Bonferroni test. RESULTS The reports of children operated on for congenital heart defects yielded no statistically significant difference in their HRQoL according to family SES. Parental proxy reports showed medium scores for physical health and activity to be significantly lower in children from low SES families as compared with those from medium SES families. Scores on school activities also differed significantly between patients with low and higher family SES. Parental reports revealed statistically significantly poorer HRQoL in children from low SES families in terms of physical health and activity, psychosocial and emotional health and social activities scores, as compared with the control group with low SES. Children operated on for congenital heart defects from medium and high SES families also had statistically lower school activities in comparison to control group of children from medium or high SES families. CONCLUSION The results of HRQoL according to parental proxy report indicated low SES to influence various aspects of HRQoL in children operated on for congenital heart defects. This could be explained by the fact that the risk factors associated with low SES may directly or indirectly affect not only family HRQoL but also HRQoL of children operated on for congenital heart defects. Therefore, it appears necessary for the low SES families with a child suffering from chronic disease to receive help from wider community to solve the above mentioned problem.

Objective – The research was carried out in order to establish by retrospective research the incidence of febrile convulsions (FC) in the area of the Tuzla Canton.  Methods  – Using a retrospective cohort study, children were included from the age of one month to 7 years of life, who lived in the Tuzla Canton and who were hospitalized for their first FC at the Department of paeditrics in Tuzla in the period from 1.1.1999 to 31.12.2004. From this documentation data was analyzed related to the age and sex of the children, the type of FC attack and the seasonal frequency.  Results – The total annual incidence of FC in children of both sexes was 3.0/1000 (95%CI 2.8-3.3), 3.2/1000 for boys, and 2.9/1000 for girls.  Conclusion – The results are the first epidemiological indicators of FC in Bosnia and Herzegovina and are a good foundation for future monitoring, since they may be useful in planning preventive, organizational and therapy programs for paediatric health care in this region.

Objective – The purpose of this study was to determine median age at menarche in the Federation of Bosnia and Herzegovina (FB&H) and to estimate the distribution of age at menarche for FB&H girls.  Subjects and methods – A cross-sectional study was conducted from September 2002 to May 2003 in all Cantons of the FB&H. The random stratified sample included 19,803 girls aged 9.0 to 17.5 years. Data were collected using the status quo method. Probit analysis was used to estimate median age at menarche and 95% confidence intervals.  Results – The median age at menarche for all FBiH girls is 13.02 years (12.99-13.05, 95% CI). Three percent of all girls start to menstruate before 11.04 years of age (10.98-11.09, 95% CI), and 97% of all girls are menstruating by 15.37 years of age (15.29-15.44, 95% CI). This distribution of ages indicated that ~95% of FB&H girls start to menstruate between 11.04 and 15.37 years of age. The median age at menarche throughout FB&H varied in a range of only six months, from 12.85 in Canton Sarajevo to 13.34 in Canton West Herzegovina. Girls from three Cantons - Canton Sarajevo, Posavina and Una Sana reached menarche significantly earlier than those from other Cantons.  Conclusion – This study enabled the FB&H and each Canton to have standards of age at menarche expressed in percentiles. As no previous information was available about the age at menarche in FB&H, the present results will afford a basis for future studies which should aim at analysing the trend and tempo of secular changes in age at menarche. Â

Background Iodine is necessary for the synthesis of thyroid hormones, which play a decisive role in the development of the brain during fetal and early postnatal life. Objective To evaluate whether prophylaxis with 20 to 30 mg of iodine per kilogram of salt is enough to ensure optimal iodine nutrition during pregnancy in an iodinesufficient area. Methods A cross-sectional study of pregnant women was conducted in 2007. The urinary iodine concentration (UIC) was measured in 300 randomly selected women in Tuzla, Bosnia, and Herzegovina, in all three trimesters of pregnancy. Results The median UIC of the pregnant women was 142 μg/L, ranging from 27 to 1,080 μg/L. The median UIC of the pregnant women in each trimester of pregnancy who were not restricting their salt intake was consistent with adequate iodine nutrition, as defined by the World Health Organization Technical Consultation, whereas the median UIC of women who were restricting their salt intake was insufficient. Conclusions Pregnant women in the urban area of Tuzla had adequate iodine status except for those with restricted salt intake, which presents an increased risk to the mother as well to as the unborn child. Women in the rural area of Tuzla were found to be iodine-deficient, regardless of whether they had restricted their salt intake or not. However, for those pregnant women who have been advised to restrict their salt intake and who thus face the risk of iodine deficiency, the use of salt with higher concentrations of iodine could be advised.