INTRODUCTION Good knowledge of diabetic patients about their disease is often not related with good glycemic control. The aim of this study was to determine the level of application of acquired knowledge about diabetes in recognizing and resolving hypoglycemic and hyperglycemic conditions in patients who did or did not do blood glucose self-monitoring as well as the impact of self-monitoring on HbA1c during education of patients with diabetes type 2. MATERIAL AND METHODS There were 91 patients with the type 2 diabetes who completed six months education about their disease in four family medicine practices in Tuzla Canton during the period from March to September 2005. The patients who did or did not do self-monitoring with glucometer were interviewed on knowledge about recognizing and resolving hypoglycemia and hyperglycemia by family physician and HbA1c was assessed at the beginning of the education, 3 months after reading the brochure (passive education) and additional 3 months of group (intensive) education. RESULTS Out of 91 interviewed patients, there were 29 who did self-monitoring by glucometer at the beginning of the education, 30 patients during the passive education and 34 after the intensive education. At the beginning of education, regardless of doing self-monitoring, the patients were less able to recognize and resolve hypoglycemia and even less hyperglycemia. At the end of education, their knowledge was better at both recognizing and resolving hypoglycemia (P=0.01) as well as at recognizing (P=0.01) and resolving hyperglycemia (P=0.001). In the patients who did self-monitoring the average value of the HbA1c did not improve significantly (P=0.44) compared to those who did not practice self-monitoring (P=0.10) during education. CONCLUSION Only one third of patients with type 2 diabetes had done self monitoring with glucometer and although their knowledge about hypoglycemia and hyperglycemia was improved during education, these patients did not have improved significant values of the HbA1c compared to patients who had not done self-monitoring.

Monitoring the growth and development of children is the main task of preventive programs of pediatric health care. This is the best and simplest way of establishing the state of health of the child population, and at the same time, in the case of growth disorders, to make possible the timely application of possible preventive measures. For each child with short or tall stature in primary health care a detailed medical history should be taken, a physical examination undertaken using anthropological standards, assessment of bone maturation, calculation of genetic potential and basic laboratory tests. If there is a suspicion of normal variants of either short or tall stature, in order to establish a definite diagnosis the patient should be referred to a pediatric endocrinologist. Insofar as this suspicion is confirmed, the patient and his/her parents should be acquainted with the nature of the disorder and given information on attaining the definitive height of the child. The growth of these children should be monitored up to the end of growth at least once a year. In patients whose body height is below the 3rd percentile, or above the 95th percentile, after excluding normal forms of short or tall stature, attention should be turned to discovering the pathological causes of short or tall stature. The examination of these children may be long, complex and expensive, but its needs to be done in stages, mainly in a specialized institution.

This year it is five years since the first issue of the journal Paediatrics Today came out. This is a sufficiently long period for a short review of the work of the journal and to answer a frequently asked question: why publish this specialized journal in such a small country? Paediatrics Today is the first paediatric journal in Bosnia and Herzegovina. It was founded in 2005 with the aim of making new insights in paediatrics and its related fields available to doctors involved in treating children and adolescents in Bosnia and Herzegovina, but also to doctors in the wider area. This means that the idea was for the journal to be primarily scholarly with an educational emphasis, that is, the content of its articles would be useful for everyday paediatric practice.

A 2 day-old male infant was referred to the Department of Paediatrics for a large goiter. The boy was born as the third child of healthy unrelated parents at 40 weeks of gestation with birth weight 4,950 g and length 55 cm. Antiseptics containing iodine were not used in the mother, nor in the infant. Physical examination revealed myxedema of the face, protruding tongue, dry skin, hoarse cry, large goiter and hypotonia. An ultrasound examination revealed enlarged thyroid gland. Thyroid function tests at 2 days of age were as follows: total triidothyronine (T3) 3.0 nmol/1 (normal range: 1.04-2.5), total thyroxine (T4) 23.2 nmol/1 (normal: 65-160), free thyroxine (fT4) 2.6 pmol/1 (normal range: 10-25), thyroid-stimulating hormone (TSH) 165.1 mIU/1 (normal range: 0.15-3.2), and thyroglobulin 2,093 ng/ml. He was immediately started on 50 g/day of L-thyroxine. Roentgenography of the knee demonstrated dysgenesis of the distal femoral epiphysis, while the proximal tibial epiphysis were not visualized. Molecular genetic analysis of the TPO gene was done. In the examined regions of the TPO gene, all 17 exons except exon 14, no mutations were detected. His mother's serum T4 and TSH levels were normal, and thyroglobulin and thyroperoxidase antibody tests were negative. There was no family history of thyroid diseases. No maternal use of medication was reported. Weaning off the L-thyroxine was started on the 23 day of life due to elevated T4 level. At the age of 4 months he was completely weaned off L-thyroxine and has not required any since. The patient is now 3.8 years old, thyroid enlargement is still present, and physical and neurological development are normal. Iodine overload, iodine deficiency, and matemal thyroid antibodies are common causes of transient congenital hypothyroidism. The etiology of transient hypothyroidism in this newborn is unknown. More research is required in order to evaluate the frequency, causes and optimal therapy of transient neonatal hypothyroidism.

BACKGROUND Neonatal TSH screening has as its main goal the early detection and treatment of permanent sporadic congenital hypothyroidism. At the same time neonatal TSH is one of the indicators for monitoring progress towards eliminating iodine deficiency disorders (IDD). AIM To evaluate the usefulness of neonatal TSH screening data as a monitoring tool for IDD evaluation and control in Bosnia and Herzegovina. INFANTS AND METHODS The study included a total of 8,105 newborns. Neonatal TSH was measured in whole blood drawn between day 3 and day 5 of life, spotted on filter paper using a sensitive fluorometric assay (Delfia). RESULTS Levels above 5 mIU/l were found in 282 (5.5%) neonates. Median TSH values and the percentage of samples of neonatal TSH above 5 mIU/l were significantly higher in neonates who were born by Caesarean section (6.4%) compared with neonates born by vaginal delivery (1.4%). CONCLUSION Our findings suggest that neonatal TSH should not be used as a monitoring tool for IDD evaluation and control if iodinated skin disinfectant is used on a large part of the mother's skin in maternity hospitals.

AIM To evaluate the influence of topical iodine-containing antiseptics on neonatal TSH in full-term infants born by Caesarean section in an iodine sufficient area. POPULATION AND METHODS Urinary iodide excretion (UIE) was estimated in 86 mothers on the second day after delivery by Caesarean section and their 86 full-term neonates. The mothers were divided into two groups according to the use of antiseptic to prepare Cesarean sections: 42 mothers who were prepared with povidone-iodine (Isosept, Bosnalijek) comprised the study group, and 47 mothers who were prepared with alcoholic solution (Skinsept color, Ecolab) formed the control group. Neonatal TSH was measured in whole blood drawn between day 3 and 5 of life, spotted on filter paper using a sensitive fluorometric assay (Delfia). RESULTS Maternal and neonatal UIE were significantly higher (p < 0.05) in the study group compared to the control group. No significant difference was found for neonatal TSH. CONCLUSION Our data suggest that perinatal iodine exposure of full-term neonates who were born by Caesarean section in an iodine sufficient area did not influence neonatal TSH, although median UIE was higher, suggesting optimal iodine intake during pregnancy. Further research is needed to define a critical value of urinary iodine concentrations in full-term neonates in an iodine sufficient area that may lead to the impairment of thyroid function.

AIM The aim of this retrospective study was to establish clinical characteristics of first febrile convulsions in children admitted to Department of Pediatrics in Tuzla, Bosnia and Herzegovina, and diagnosed with febrile convulsions in the period from January 1, 1999 till December 31, 2004. METHODS Data were collected from medical records of the children admitted to Department of Pediatrics in Tuzla during the study period. The study included 716 medical records of children aged from one month to 7 years, analyzed for the following data: type of seizure (simple or complex), clinical manifestation of the convulsion (tonic-clonic, tonic, atonic, partial unilateral), body temperature after convulsion, and the length of convulsion. Of laboratory tests, the findings indicating possible infection and electroencephalogram (EEG) results were analyzed. Study subjects were divided into four age groups: 1-12 months (infants), 13 months to 2.9 years (young), 3 to 4.9 years (middle) and 5-7 years (older) groups. The chi2-test and Kruskal-Wallis test were used on testing statistical significance of between-group differences. The level of statistical significance was set at p < 0.05. RESULTS Simple febrile convulsions were found in 88.8% and complex febrile convulsions in 11.2% of children (p = 0.0016). Tonic-clonic seizures were recorded in 90% and atonic in 8.6% of cases (p < 0.0001). Body temperature immediately after febrile convulsions ranged between 38 degrees C and 41.5 degrees C. Kruskal-Wallis test produced no statistically significant difference between the groups tested. Febrile convulsions lasted up to 5 minutes in 73.5% of cases, with the highest recorded in younger group (76.7%); 17.3% of children had seizures lasting between 6 and 10 minutes, mostly in older group (39%). Normal EEG findings were recorded in 96.9%, specifically altered findings in 1.4% and non-specifically altered findings in 1.7% of patients. DISCUSSION The significantly higher prevalence of simple febrile convulsions as compared with complex forms and tonic-clonic seizure as the most common clinical manifestation of the attacks, recorded in the present study, were also confirmed in previous retrospective and prospective studies. It occurs with elevated body temperature above 38 degrees C. In the greatest proportion of children, it lasted for up to 15 minutes, and most children with febrile convulsions had normal EEG findings. CONCLUSION Data on the clinical characteristics of first febrile convulsions in the Tuzla Canton, Bosnia and Herzegovina, recorded in the present study, may prove useful on planning the programs of pediatric health care in the region.

International publications of authors from Bosnia and Herzegovina in Current Contents indexed publications in 2008

Since its foundation in 1992, the Croatian Medical Journal (CMJ) has followed the strict standards of quality in the scientific publishing. However, the Journal has been aware that its specific position demands more than just following the already established rules. From the very beginning, the Journal declared an “author-helpful policy,” stating that “journal editors should have a major role in training authors in science communication, especially in smaller and developing scientific communities. Journal authors usually send scientifically acceptable but poorly prepared articles and it is a pity to lose valid data because of their poor presentation.” (1,2). In brief, the editors and editorial staff of the CMJ have been well aware that the skills of scientific reporting and publishing in our academic community are not developed and that valuable research results and valid data are being lost because of poor presentation. To be perfectly honest, ten years ago this statement looked like a nice promise, one of the many we in academic medicine learnt not to take too seriously.

OBJECTIVE To investigate the effect of the method of feeding on respiratory and gastrointestinal illnesses during the first six months of life. METHODS Observational study of infants feeding practice and respiratory and gastrointestinal illnesses in first six months who were born in Gynecology-Obstetric department in period from May-September 2004, who weighed 2500 gm or more and at least 37 gestation weeks. In that period was born 1838 babies. Dates were collected by means of answered questionnaires. RESULTS We sent 612 questionnaires and 518 (85%) were answered. From 493 eligible questionnaires 395 (80.1%) infants were breastfed, and 98 (20%) formula fed. A total of 279 episodes of illnesses were observed in 493 infants. These infants had on average 1.76 episodes of illnesses. The crude incidence density ratio (IDR) revealed a protective effect of breastfeeding on respiratory illnesses (IDR = 059; 95% confidence interval (CI), 0.44-0.79), for gastrointestinal illnesses (IDR = 0.50; CI, 0.24-0.86) and on all illnesses (IDR = 0.58; CI 0.45-0.86). The IDR adjusted in turn for infant's age, mother's age, socioeconomic status and cigarette consumption in family were similar to the crude IDR. CONCLUSION the results of this study suggest a protective effect of breastfeeding against respiratory and gastrointestinal illnesses.

AIM The aim of the study is to estimate how far physical education teachers from elementary school understand diabetes and are trained in its management and in the treatment of diabetes emergencies according to their understanding. METHODS In the study a descriptive research method has been used and a closed type survey for data gathering has been employed. The study included 83 physical education teachers from 83 primary schools. They have been divided into 2 groups: the first consisting of 28 physical education teachers whose schools are attended by at least one child with diabetes type 1, the second consisting of 55 physical education teachers whose schools do not have children with diabetes type 1. RESULTS In answer to the question about whether the physical education teachers are able to recognize the symptoms of hypoglycemia a larger number of school staff in the first group answered ''yes'' compared to the second group, while interest in education in comparison to lack of interest was significantly present in both groups. As for the question: ''Is glucose or meal allowed in the classroom?'', in the first group there were more positive answers, while in the second group there was no difference in terms of positive and negative answers. As for the question ''Is blood glucose testing allowed in the classroom?'' there was a difference between the groups: the first group's answers were significantly positive while the second group's negative. CONCLUSIONS The results of our survey show that children with diabetes do not have appropriate diabetes care in school and that school staff want to solve this problem.