The impact of delayed cardiac surgery on the postnatal growth of children with congenital heart disease in Bosnia and Herzegovina.

The aim of this study was to evaluate preoperative and postoperative growth in children with congenital heart disease (CHD) when cardio-surgical treatment is delayed. Growth data were analysed on 116 children with various types of CHD (cyanotic lesions (Group 1), left to right shunt (Group 2) and obstructive lesions (Group 3)), who underwent cardiac surgery after a certain period of waiting. Preoperatively, during the time (median 1.13 (0.55-2.39)) years of waiting for surgery, their mean weight z-score decreased from -1.38 (+/- 1.19) to -1.41 (+/- 1.28), and their mean height z-score from -0.65 (+/- 1.41) to -0.81 (+/- 1.36). Children in Group 1 developed a significant linear growth deficit, in Group 2 weight was more affected than height, while in Group 3 both growth parameters were gradually slowly, but not significantly reduced. Postoperatively weight and height z scores, although they showed a linear trend of improvement for all three groups, remained significantly reduced for two years after surgery. At the time of the last examination at the age 9.11 (5.66-13.10) years, the mean height z score -0.16 (+/- 1.28), was significantly reduced p < 0.0001, than predicted height 0.23 (+/- 0.82). Growth catch-up was related to age at surgery and preoperative growth deficit. Delayed cardiac surgery in children with CHD aggravated growth deficit and caused slow and incomplete postoperative growth catch-up.

Health-related quality of life and metabolic control in children with type 1 diabetes mellitus in Bosnia and Herzegovina.

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.

Quality of life in children after cardiac surgery for congenital heart disease.

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.

[Impact of the family socioeconomic status on health related quality of life in children operated on for congenital heart defects]. / Povezanost socijalnoekonomskog stanja obitelji i kvaliteta zivota djece nakon operacije urodene anomalije srca.

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.

Does the severity of congenital heart defects affect disease-specific health-related quality of life in children in Bosnia and Herzegovina?

UNLABELLED: The aim of this study was to assess whether the severity of congenital heart defects (CHD) affects disease-specific health-related quality of life (HRQOL) in children after open heart surgery. One hundred and fourteen children with CHD and one of their parents participated in the study. HRQOL was evaluated by the PedsQL 3.0 Cardiac Module. The children were assigned to one of three groups according to severity of CHD. Children with cyanotic CHD (Group 3) reported that their HRQOL on several domains was lower than that of children with anomalies with the left-right shunt and children with obstructive anomalies. Also, by parent proxy-report, patients with anomalies with the left-right shunt had statistically significant, better HRQOL scores for the heart problems and treatment scales, perceived physical appearance, treatment anxiety, cognitive problems, and communication scales in comparison to the children with cyanotic CHD. By self-report, children of Group 1 reported that they had statistically significant, better HRQOL in the heart problems and treatment scales compared with Group 2. CONCLUSIONS: The results of the assessment by the PedsQL 3.0 Cardiac Module, a cardiac disease-specific instrument for children with CHD, indicate that HRQOL is poorest in children with complex CHD. Therefore, it is necessary to take the appropriate preventive measures for these patients, which include early (timely) cardiosurgical intervention and active psychological support to limit the negative impact of serious forms of CHD on the quality of life of these children.

Papillary fibroelastoma of the mitral valve in an 8-month-old infant.

Papillary fibroelastomas, the third most common primary cardiac tumor in adults, are extremely rare in children. These tumors grow slowly and are histologically benign but with high potential for life-threatening complications. We report an 8-month-old asymptomatic female infant with papillary fibroelastoma of the mitral valve, discovered by echocardiograph examination.

[Critical congenital heart diseases in Tuzla Canton area]. / Kriticne urodene anomalije srca na podrucju Tuzlanskog kantona.

Critical congenital heart diseases (CHD) represent extensive and complex possibilities changes of morphology and homodynamic on the heart, which vital jeopardize child at the time of birth so as at the first weeks of its life or at the first months of its life too. The purpose of this study is to determine frequency, structure and the mode of medical treatment critical UAS in the Tuzla Canton area to harmonies with experiences and results we have reached in order to treat children who have congenital heart disease. There was discovered CHD in the 493 (8,15 per 1000 live-born) from 60.493 live-born children in Tuzla Canton area during the 10-year period start at 01.01.1995. Critical congenital heart disease was discovered in 142 children what represent total prevalence of 2,35 per 1000 live-born children. Yearly prevalence was pretty consistent in observed period of the time and it was from 1,36 to 3,24 per 1000 live born children. The most frequent UAS was complete atrio ventricular canal, which has proved in the 22,4% critical UAS. The more then one-third (36,6 %) children with critical UAS have had extra cardiac anomalies and syndromes. The balloon septostomy was performed in only two of our patients, in 41 (28,8 %) cardiac surgery was performed. Only one of the children underwent surgery in the neonatal period. In 8 patients who were no surgery treated developed pulmonary hypertension, one of them had bacterial endocarditic. Of the total 142 children with critical CHD 99 (69,7%) died. The 92 of them died before surgery, 7 of them died after the surgery; 3 of the 7 in the early after surgery period; 4 of the 7 died because of complications in a later period. Timely discovering critical UAS in Tuzla Canton area is failure in the area prenatal diagnosis. The treatment of patients is inappropriate and without possibilities of emergency invasive cardiac treatment and surgical treatment.

Epidemiological and clinical aspects of congenital heart disease in children in Tuzla Canton, Bosnia-Herzegovina.

UNLABELLED: Congenital heart disease (CHD) is among the most frequent of all congenital anomalies. The purpose of this study was to present the results of an initial registration of children with CHD from January 1994 to December 1999 in Tuzla Canton, Bosnia-Herzegovina. The population studied consisted of all 39,699 live-born children in this area. Diagnosis of CHD was made by clinical findings, electrocardiography, chest X-ray, echocardiography, catheterisation or autopsy. In the 6-year period, 243 children were found to have CHD, i.e. a prevalence of 6.12 per 1000 live-born. Critical CHD was present in 58 of them, or 1.46 children per 1000 live-born. The average age at diagnosis was 1.47 years. There were 132 boys (54.3%) and 111 girls. The most frequent anomaly was ventricular septum defect with a prevalence of 2.49 per 1000 live-born, representing 40.7 % of the total anomalies. Of the total group, 46 (18.9%) had extracardiac anomalies related to syndromes. Cardiac surgery was indicated in 98 patients (40.3%) but could only be carried out in 42 (17.3%). A total of 63 (25.9%) patients died, 54 of whom within the 1st month of life. CONCLUSION: congenital heart disease is a very significant health problem in Tuzla Canton. It requires urgent measures in terms of organisation of early diagnosis and proper management.

[Risk factors for the development of congenital heart defects in children born in the Tuzla Canton]. / Ucesce riziko-faktora u nastanku urodenih anomalija srca u djece na podrucju Tuzlanskog kantona.

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.