This is a review article on congenital primary hypothyroidism. In addition to the defi nition of the disease and its transient and permanent forms, the signifi cance of neonatal screening is underlined. The procedure for the analysis of the test results, for establishing the defi nitive diagnosis and its etiology are delineated. The importance of starting early treatment is emphasized.

The history, the present and the future of the Laboratory for the detection of congenital metabolic diseases at the Department of Pediatrics, University Hospital Tuzla are reviewed. The importance of implementation of neonatal screening of primary congenital hypothyroidism and fenilketonuria, cooperation with similar laboratories in the world and starting within a short time a screening programme for congenital adrenal hyperplasia is emphasized. In addition, a brief account of the running research programmes and of the published papers is given.

Thyroid size was estimated by ultrasound and physical examination in 480 schoolchildren (238 boys and 242 girls), 7-14 years old, living in Tuzla Canton. By physical examination goiter was found in 13.5% (n=65) of subjects. When compared with the upper limits of the reference thyroid volumes reported by WHO and ICCIDD, goiter by ultrasonography was found in 12.9% (n=62) of all subjects. All goitrous children had a diffuse goiter. The differences in mean thyroid volumes between groups with and without goiter detected by physical examination were significant in all age groups (p<0.05). The results of ultrasound examinations correlate well with palpatory findings and show higher values for the thyroid volume in children with goiter. It generally confirms the values of the findings by palpation, even in areas with mild iodine deficiency.

Family home and institutions for children without parental care represent the rearing-environments where, from the early years, whole human development goes on. It's known today that despite the recognized importance of inborn traits, the influence of child-rearing environments dominates current models of development. The aim of the study was to investigate the satisfaction with the rearing-environment of school-aged institutionalized children, their dominating feeling and if institutionalization affects life optimism for now and for the future. The study was conducted in two institutions in Bosnia and Herzegovina who share the same care model imitating the traditional Bosnian families where the older children care for the younger siblings. We took as a sample 30 institutionalized children aged 8-12, and for the control group 60 children matched by age and sex. Parents, children and teachers who gave their informed consent answered the questionnaires. It was confirmed that children without parental care are vulnerable group and in a great risk who need urgent help of professional multidisciplinary team of their close and broad environment. Lack of social support cause the withdrawing and suffering and can lead soon or later to problematic behaviour.

The objective of the present study was to determine median age at menarche and the influence of familial instability on maturation. The sample included 7047 girls between the ages of 9 and 17 years from Tuzla Canton. The girls were divided into two groups. Group A (N=5230) comprised girls who lived in families free of strong traumatic events. Group B (N=1817) included girls whose family dysfunction exposed them to prolonged distress. Probit analysis was performed to estimate mean menarcheal age using the Probit procedure of SAS package. The mean menarcheal age calculated by probit analysis for all the girls studied was 13.07 years. In girls from dysfunctional families a very clear shift toward earlier maturation was observed. The mean age at menarche for group B was 13.0 years, which was significantly lower that that for group A, 13.11 years (t=2.92, P<0.01). The results surveyed here lead to the conclusion that girls from dysfunctional families mature not later but even earlier than girls from normal families. This supports the hypothesis that stressful childhood life events accelerate maturation of girls.

The organized health care in Tuzla region begins by the establishment of hastahana in Tuzla 1874 year, when thanks the first graduated physician Dr. Mehmed Serbic Sami was opened the Vakuf's hospital in Tuzla, which he success fully lead to his death 1918 year. The great role in the treatment of the become ill inhabitants played the general hosptals, established during Australia-Hungarian period (Tuzla - 1886, Brcko - 1886...) whose capacities later were enlarged, and their health staff enabled at the universitets in the surrounding countries, later also in B&H, during the past period. The significant role in this played also the series of the health educators from which some will become the names in the segment of the health-care in this region and wider. About them and the institutions in this region, which merited not to be overlet to for fulness, the authors write in this paper.

In the paper it was identified firstly the short stature, then importance of anamnesis, physical examination, anthropometric measurements and calculated parameters of growth. Then followed the classification of causes for short stature with a specific review on differentiation of normal from pathologic variants. Further in the text it was pointed out the importance of observing normal variants of short stature since between 84% and 87% children are with height under the 3rd percentile. Then followed tables showing pathologic causes of the short stature, and then diagnostic and therapeutic approach to the child with proportionately short stature and short stature associated with dysmorphic features.

The purpose of the study was an estimation of the immunoglobulin serum and the way of nutrition of a new-born child at the beginning of bacterial infections during the first month of life. 120 new-born children (infantiles) of both sexes was prospectively studied, who were born in the Gynecology-obstetrician clinic in Tuzla, in the period from March-May 2000 year. On the base of mothers SES during the pregnancy, new-born children were separated in two groups. Group A was formed of 60 new-born children (32 female and 28 male), mothers had good SES during the pregnancy, and concentration of serum immunoglobulin G (IgG) examined from cords blood, from 10.02 to 17.58 g/L (X 14.48 g/L +/- 1.87). Group B was formed of 60 new-born children (27 female and 33 male), with bad mothers SES and with concentration of IgG from 6.80 to 13.01 g/L (X 10.62 g/L +/- 1.49). Immunoglobulins M and immunoglobulins A were negative in both groups of children. During the first month of life it was studied the way of nutrition and health condition of each new-born child. New-born children with bad mothers SES during the pregnancy, with low values of IgG and who were on the artificial food (nutrition), were showing with the significant difference (p < 0.001) in bacterial infections, comparing with the group who had good IgG. The new-born children with natural nutrition, despite the lower concentration of IgG, were protected from severe bacterial infections.

In the paper it was identified firstly the short stature, then importance of anamnesis, physical examination, anthropometric measurements and calculated parameters of growth. Then followed the classification of causes for short stature with a specific review on differentiation of normal from pathologic variants. Further in the text it was pointed out the importance of observing normal variants of short stature since between 84% and 87% children are with height under the 3rd percentile. Then followed tables showing pathologic causes of the short stature, and then diagnostic and therapeutic approach to the child with proportionately short stature and short stature associated with dysmorphic features.

Goiter frequency and urinary iodine excretion levels were assessed in schoolchildren, aged 7-15 years, living in Tuzla Canton. Goiter frequency was evaluated by clinical examination and ultrasound of the thyroid gland. Goiter by inspection and palpation was found in 19.1% of all subjects, in 19.8% of girls and 18.4% of boys. With regard to updated reference values for thyroid volume reported by WHO and ICCIDD, goiter by ultrasonography was found in 12.9% (n = 62) of all subjects (n = 480). Median urinary iodine was 71.0 micrograms/L. Mild iodine deficiency is observed in Tuzla Canton, based on goiter frequency and urinary iodine excretion. Neonatal TSH results, obtained in the programme of the neonatal thyroid screening, were also analyzed. The frequency of neonatal TSH above 5 mU/L was 12.0% indicating, as two other indicators, mild degree of iodine deficiency in this region. The results underline the inefficacy of iodine prophylaxis with 10 mg K1 per kg of salt in correcting iodine deficiency. On the basis of the study, carried out in the rest of the Federation of Bosnia and Herzegovina, the new regulation was proclaimed in 2001 requiring 20-30 mg of iodine per kg of salt.

Serum concentration of immunoglobulin G (IgG) of new-born child, at the birth, which reach the concentration of an adult persons, are the origin of mother and transferred by active and passive transport, by placenta. Immunoglobulin M (IgM) and Immunoglobulin A (IgA), do not pass the placenta because of their structure. Main condition for passing of IgG are normal period of pregnancy and regular function of placenta. Social-economic status (SES), and also immunologic status of a pregnant woman, an affect on the immunological status of new-born child. 120 pregnant woman and 120 of their new-born children were studied. Pregnant woman were at age of 18-34 years, and during the pregnancy they were healthy. Gestational age of new-born children was from 38 to 40 weeks, and birth weight was from 3000 grams to 4000 grams. The new-born children were from monofertile pregnancies, without visible anomalies and signs of intrauterine suffer. They were divided into 2 groups, 60 patients in every group, in comparison of SES families of a mother, in which she lived during the pregnancy. From every new-born child at the birth, from the blood of a navel it was determined the concentration of serum IgG, IgM and IgA. The values of IgG from the group with bad SES, were significantly lower (p < 0.001), in compare with a group with good SES. There was not statistically important difference between middle values of mentioned parameters among the different sex in the studied groups. Concentrations of IgM in new-born children were below the level of determination or just above it, so they could not be analysed anymore. Immunoglobulins A were not found in both groups, A and B groups.

Congenital heart diseases (CHD) are taking high position on the list of neonatal and infant mortality, and they are significantly involved in mortality of children and adults. During cardiogenesis various genetic and non-genetic ethiological factors are starting pathogenetic mechanism what results in developing of CHD. Purpose of research is evaluation of participation of some risk-factors in developing of CHD in children on Tuzla Canton area. This research included 352 children up to 15 years old, in which was discovered CHD during period from 1.1.1994 to 31.12.1999. Using method of anamnestic questionnaire we analyzed data related to occurence of CHD in relatives, reproductive age of mother, mother's illness and taking medications in first trimester of pregnancy, and professional exposure to harmful chemicals. In 24 or 6.81% of cases CHD was registered in one of first-degree relatives, and in only one case in second-degree of relatives. It was noticeable that CHD in highest number of cases (291 or 83.14%) were present in children whose mothers were 20-35 years old, while only 18 or 5.11% of mothers aged 35 and more what is considered as high risk age for development of anomalies in general. In 70 or 20% cases CHD was associated with other systems anomalies, including syndromes and chromosomopathies. Risk-factors related to earlier pregnancies of mothers were found in 40 (11.36%) of children. Data about acute and chronic diseases of mother during pregnancy were found in 36 children. analysis of exposure to harmful chemicals during first trimester of pregnancy is showing that 39 or 11.08% mothers were exposed to nicotine, while 17 or 4.83% were taking medications. Exposure to professional poisoning were found in 5 or 1.42% of cases. Results of research are pointing on need for continued observation genetic and wide range of other potential risk-factors from environment related to development of CHD in our area. This way we could explain some specific characteristic occurrences of CHD in some areas.