In patients with diabetes type 2, good knowledge about disease often doesn't follow appropriate behavior in their life. Therefore, we wanted to find out basic level of disease knowledge and glycemic control among type 2 diabetic patients, and after that impact of passive and intensive education on knowledge and glycemic control. Starting with 130 participants, 91 patients with type 2 diabetes, from four family medicine services in Tuzla Canton, completed six months education about their disease. Disease Knowledge Test of Michigan Diabetes Training and Research Center was used to evaluate knowledge about diabetes and glycaemic control was assessed by HbA1c. Participants were tested at the beginning of survey, after 3 months of passive education and additional 3 months of intensive one. Basic test showed good knowledge of participants (score 8,3 out of 15), improved knowledge after passive education (score 9,23) and intensive one (11,19) (P<0,0001). Demographic characteristics of patients (age, sex, living area, level of education, duration of disease and type of treatment) had no influence on disease knowledge and glycaemic control during education. Generally, patient education improved significantly glycaemic control by HbA1c reduction 0,45% (P=0,011) without significant differences between passive and intensive one. Education of patients improves both disease knowledge and glycaemic control among type 2 diabetic patients.

Today’s biomedical medical periodicalswith scholarly content in Bosnia and Herzegovinanumber only 10 journals indexed innot very relevant world index bases (apartfrom the Medical Archives and the BosnianJournal of Basic Medical Sciences, whichare indexed in the Index Medicus/Medline),and they are issued two or four times a year,printed sometimes as double issues, or evenquadruple.

OBJECTIVE Thyroid dyshormonogenesis is a genetically heterogeneous group of inherited disorders in the enzymatic cascade of thyroid hormone synthesis that result in congenital hypothyroidism (CH). Thyroid peroxidase gene (TPO) mutations are one of the most common causes of thyroid dyshormonogenesis. The aim of this study was to identify TPO gene defects in a cohort of patients with thyroid dyshormonogenesis from Slovenia, Bosnia, and Slovakia. DESIGN AND METHODS Forty-three patients with permanent CH and orthoptic thyroid glands from 39 unrelated families participated in the study. Mutational analysis of the TPO gene and part of its promoter consisted of single-stranded conformation polymorphism analysis, sequencing, and restriction fragment length polymorphism (RFLP) analysis. RESULTS TPO gene mutations were identified in 46% of participants. Seven different mutations were identified, four mutations of these being novel, namely 613C > T (R175X), 1519_1539del (A477_N483del), 2089G > A (G667S), and 2669G > A (G860R). Only a single allele mutation was identified in 65% of the TPO mutation carriers. CONCLUSIONS The results showed a higher prevalence of TPO gene mutations in thyroid dyshormonogenesis when compared with published studies. The high percentage of single allele mutations implied possible intronic or regulatory TPO gene mutations or monoallelic expression.

The aim was to describe the clinical and laboratory characteristics of diabetes mellitus type 1 at its onset. The hospital records at Tuzla pediatric hospital were analysed of 109 children aged 0-14 who presented with diabetes between 1990 and 2005. The data base was divided into three age groups: 0-4.9, 5-9.9 and 10-14 years - referred to hereafter as the younger, middle and older age groups. We found the duration of symptoms prior to diagnosis to be significantly shortest in the younger age group. Polyuria, polydipsia and weight loss were the main presenting symptoms in all age groups. The median blood glucose value was 26.0 mmol/L and the pH value was 7.30. The incidence of diabetic ketoacidosis of 48.0% and the median HbA 1c value of 10.7% at diagnosis indicate that disease was not recognised long before diagnosis. Since our desire is to avoid the development of ketoacidosis, it is necessary to educate people who are in permanent contact with children about the symptoms of diabetes type 1. This could to a certain degree prevent the presentation of the life-threatening condition of diabetic ketoacidosis, if the occurrence of diabetes cannot be prevented.

AIM to determine impact of passive and intensive education on values of HbA1c, blood pressure, total cholesterol, triglycerides, mass body index as well as on practicing of recommended physical activity and habit of smoking among patients with type 2 diabetes. METHOD From 130 patients with type 2 diabetes questioned, 91 completed cycles of 3 months of passive and 3 months of intensive education. It took place in 4 family practices on Tuzla Canton from December of 2004 to December of 2005. For this purpose the Michigan Diabetes Knowledge Test was used for assessment about disease knowledge. Disease control was also assessed at the same time of diabetes knowledge testing, at the beginning, after 3 months and after 6 months of education. RESULTS After a passive and intensive education there has been a significant improvement (P < 0.05) on the following parameters of disease control: HbA1c, systolic and diastolic blood pressure and total cholesterol, however the difference in triglycerides, body mass index, smoking habits and practicing of regular recommended physical exercise statistically was not significant after passive and intensive education. CONCLUSION The total effect of passive and intensive education of patients with type 2 diabetes in our research resulted in improved metabolic control of the disease.

Type 1 diabetes mellitus (DM1) is diagnosed in children worldwide in between 15% and 67% of cases at the stage of diabetic ketoacidosis (DKA). This complication of new onset DM1 is characterized by hyperglycemia (blood glucose >11 mmol/1), acidosis (venous pH <7.30 and/or bicarbonate <15 mmol/1) and glycosuria, ketonuria and ketonemia. In Bosnia and Herzegovina, data on DKA at DM1 onset are not yet available. The aims of the present study were to describe the frequency and patterns of the clinical and laboratory characteristics of DKA at onset of DM1 in children who were hospitalized at the Department of Pediatrics in Tuzla, Bosnia and Herzegovina, during the past 16 years.

Down Syndrome (DS) or trisomy 21 (T21) is the most frequent and the best known malformation syndrome associated with mental deficiency that appears in human,. Average incidence of this syndrome is about 1:700 newborns. Numerous researchers noted thyroid disorders in people with Down Syndrome but, clinical symptoms of thyroid dysfunction are difficult to separate from DS phenotype. The aim of this study was to examine the thyroid function in the patients with DS. Our results confirmed higher frequency of thyroid dysfunction in DS patients. Higher values of TSH were found in 60,34% of the examined DS patients, which is significantly higher value comparing with the control group (p<0,01). Compensated hypothyroidism was established in 27,92% of the examined DS patients, and most of those (63,23%) were younger than 6 years. The conclusions emphasize the necessity of implementation of thyroid function screening program in persons with DS, and the need for adequate treatment of its dysfunction. Thus, the symptoms of the disease would be alleviated and better physical and mental fitness ensured.

The aim of the study was to determine the epidemiology of type 1 diabetes mellitus in the 0 to 14 years age group on the territory of the Tuzla Canton. Primary case identification was based on the data from the local register of Type 1 diabetes, which is held at Department of pediatrics, University Clinical Center in Tuzla. Secondary independent sources were data from 13 public health centers in the Tuzla Canton. The ascertainment was based on the capture-recapture method and was estimated to be 100%. Medical records of the children with diabetes were retrospectively reviewed. In the Tuzla Canton the prevalence of the disease on December 31st of 2005 was 0.56 per 1000. The prevalence was the highest in AŒeliA‡ (1.43) and Tuzla (1.01), and the lowest (0.13) in Srebrenik. A prevalence higher than average (0.56) was found in AŒeliA‡ (1.43), Tuzla (1.01), Kalesija (0.84) and Lukavac (0.66). The highest number of patients was diagnosed in January, March, October and December and the lowest in May and June. According to age the highest incidence was found at ages 10 and 12. The mean yearly incidence in the period 2001 – 2005 was 10.5 per 100 000. In conclusion, the results of our research provide means for adequate consideration of epidemiological indicators of type 1 diabetes in children in the Tuzla Canton, which may be useful for planning preventive, organizational, and therapeutic programs in pediatric health care in the Tuzla Canton.

Early diagnoses of poisoning by organothiophosphate insecticide enables us to offer the appropriate treatment, which is in most cases crucial for the outcome of the poisoning. Our case was the serious accidental poisoning of a five year-old child, at home with organothiophosphate insecticide, which was packed in an attractively wrapped juice bottle, and within reach of the child. The history, general condition of the patient and the level of pseudoholinesterasis of 0.62 U/ml (reference limits are 7-10 U/nml) showed the severe nature of the poisoning. After emergency measures and several administrations of atropine with a total dosage of 1mg, we attained hyperatropinisation (or full atropinisation), and after two doses of the specific antagonist pralidoxim (whose "use by" date had expired three years earlier) every four hours, there was an increase in the level of pseudoholinesterasis to 1.66 Ulml. On the eighth day of hospitalization our patient was discharged in good health and his level of pseudoholinesterasis was 6.60 U/ml. Examination of the antidote pralidoxim (Neopam), was performed later and showed that its activityin relation to the standard substance was 90 9, which is good for safe treatment and adequate treatment efficacy. In conclusion, it should be emphasized that through measures of prevention, poisoning of children can be stopped, and in the case of poisoning, what is most important is prompt diagnosis and the appropriate administration of two extremely effective antidotes: atropine sulfates and pralidoxim. There should be no legal barriers to purchasing these antidotes, because the possibility of poisoning with very toxic substances such as organothiophosphate insecticides cannot be excluded.

PURPOSE The aim of the study was to estimate, according to parents and their children with diabetes, how far school personnel have an understanding of diabetes and is trained to provide appropriate treatment of diabetes emergencies. WORK METHOD The study included 37 children and adolescents with diabetes type 1 (17 girls and 20 boys) from 31 schools in the Canton of Tuzla, aged 7-18 years. A descriptive research method was used in the study and for data gathering a closed type survey was used. RESULTS Only 13 or 35.3 % of the 37 surveyed parents were satisfied with the care of their child with diabetes at school, while 24 or 64.7 % parents expressed dissatisfaction with it. According to the parents' statements, class teachers are 100 % informed about the existence of students with diabetes type 1 at their schools, while PE teachers (97.9 %) and the headmasters of the schools (81.1 %) are less well-informed. Regarding the question about whether the school personnel is trained for diabetes-related tasks, the parents answered YES in 25.7 % cases; 54.3 % of them answered NO, and 20 % of them answered DON'T KNOW. However, only 35.2 % of parents found that some of the employees at the school are trained to recognize the symptoms of hypoglycemia while the number of positive answers concerning treatment of hypoglycemia (18.9 %) or glucagon administration (13.5 %) was much lower. The answer to the question: "Is blood glucose testing allowed in the classroom?" in 91.5 % cases was YES, 5.7 % NO and in 2.8 % of cases was DON'T KNOW. CONCLUSION The results of our survey show that children with diabetes do not have appropriate diabetes care in school.

OBJECTIVE To investigate the infants feeding practice in first six months in Tuzla canton. METHODS Observations of feeding practices in first six months of infants life, born in Obstetrics and Gynecology Department in Tuzla in period May-September 2004 who weighted more than 2500 gm and over 37 weeks gestation age. Dates were collected by standardized questionnaire mailed to 493 mothers from 13 regions in Tuzla canton. With questionnaire we mailed the explanatory letter with investigations detail. RESULTS Exclusive breast feeding at first 3 month was very high reaching from 74.4% in 1 month, 62.3% in 2 month and 50.9% in 3 month of life. After third month exclusive breast feeding was decreasing and reached 12% at sixth month. Predominant breast feeding was reaching from 13.2% at first month, 27.6% at fourth month and 20.7% at sixth month. Breast feeding and complementary feeding before six month was very low, 1% in first month reaching 47.7% in sixth month. Bottle feeding rate was 11.4% in first month and 20% in sixth month of infant life. CONCLUSION Infants feeding practice in first 6 months was inadequate according to WHO recommendation, exclusive breast feeding for first six months. Breast feeding initiation rate was high but lack of mothers support after discharge and many barriers discourage exclusive breast feeding of infants in first six months in Tuzla canton.

Primary congenital hypothyroidism is a common preventable cause of mental retardation. Neonatal thyroid screening is highly successful in early diagnosis and the improvement of developmental prognosis in the hypothyroid neonate. However, rarely cases could be missed, so doctors must be aware of the earl symptoms and signs of hypothyroidism. Therefore, the purpose of this study was to emphasize the presenting clinical features of primary congenital hypothyroidism at the age of diagnosis. The study population included 17 children with primary congenital hypothyroidism who attended the Department of Pediatrics, University Clinical Center Tuzla between 1986 and 1999. The diagnosis of all patients was confirmed by serum thyroid function tests (T4 and TSH). Of the 17 patients 10 (58.8%) were diagnosed in the first three months of life and 3 of them (17.6%) between fourth and sixth month of life. Four children (23.5%) were diagnosed after the age of six months. In the first three months of life hypothermia, constipation, jaundice, poor feeding, hoarse cry, macroglossia and hypoactivity were the moste common symptoms. Among the 17 patients with primary congenital hypothyroidism 5 of them (29.4 %) were diagnosed to have disgenetic thyroid tissue and 12 (70.6%) as having dyshormonogenesis. TSH and T4 levels were higher in patients in whom thyroid tissue was dysgenetic as comapared with those with dyshormonogenesis but the difference was not statistically significant (p > 0.05). Now it is expected that neonatal screening program in Bosnia and Herzegovina Federation will contribute to the detection of primary congenital hypothyroidism in early days of life. However, until an effective screening test is not yet routine in whole country, paediatricians should consider the diagnosis of hypothyroidism whenever it is clinically suggested.

This paper is giving detailed instructions for the correct technique of filter-paper blood spot sampling in the course of newborn screening programme for metabolic diseases. The importance of education of future parents is emphasized, and the best time, place and procedures for blood sampling are given. In addition, the necessity for providing correct data on the fi lter paper cards and their immediate transfer to the screening laboratory at the Department of Pediatrics, University Hospital Tuzla are underlined.