Reference values of ventilatory variables for healthy adolescents aged 15-19 years.

The main goal of this investigation was the formation of the reference values of ventilatory variables for group of adolescents of both sexes at the age between 15 and 19 years, what was done for the first time for the region of Vojvodina. These values are important in evaluation of respiratory data obtained from patients in the everyday routine examinations. The investigation was carried out on 1151 healthy school children--nonsmokers having the same ethnic origin from the region of Vojvodina. There were 567 males and 584 female participants. Vitalograph dry spirometer (Vitalograph Ltd, Moreton House, Buckingham, England) was used in these examinations. The whole procedure was explained and demonstrated to the participants and best results of their consecutive attempts were taken for further statistical analysis, ie., for calculations of the mean, SD, SEM, coefficient of variation and linear regression. All tests were performed in the morning hours between 8-12 a.m. The results obtained served for calculating the reference values of forced vital capacity (FVC), volume expired in first second of FVC (FEV1.0) and forced midexpiratory flow (FMF). A positive correlation between the respiratory variables and the body height values was found in all groups of participants. The equations of the linear regression related to the ventilatory variables and the height (in 5 cm intervals) were formed separately for both genders. Analysis of the data shows significant differences of the values for all respiratory variables between males and females, which increased with the increasing height of the person. The values for the male group were always higher. In taller volunteers the difference between the sexes becomes even statistically significant, what points that it is necessary to calculate the equations for each gender separately.

[Characteristics of morbidity in school-age children in families at social risk]. / Osobitosti morbiditeta dece skolskog uzrasta iz porodica sa socijalnim rizikom.

INTRODUCTION: Social and economic circumstances have a significant influence on children's health. The health status differs from country to country and it depends on gross national product. The aim of the study was to investigate characteristics of morbidity of school children from disadvantaged families. MATERIAL AND METHODS: The study included 232 school children from disadvantaged families who were hospitalized at the Institute of Child and Adolescents Health Care in Novi Sad during a five year period. Disadvantaged families are those with the following risk factors: low income, parents who are not able to comply with parenthood, unsuitable parents, single parent. Discharge diagnoses were analyzed. Diagnoses of children from disadvantaged families were compared with diagnoses of other hospitalized children. RESULTS: School children from disadvantaged families were significantly more often hospitalized because of infectious diseases, parasitic infections, mental disorders, neurologic disorders, symptoms, signs and undefined conditions, poisonings and injuries than children from families without social risks. School children from disadvantaged families significantly more often suffered from mental retardation, emotional and behavior disorders, epilepsy, cerebral palsy and poisonings, than other hospitalized children. CONCLUSION: School children from disadvantaged families have a specific morbidity which differs from the morbidity of children from families without social risks.

[Significance of normal oropharyngeal flora in the development of streptococcal pharyngitis and outcome of penicillin therapy]. / Znacaj normalne orofaringealne flore u nastanku streptokoknog faringitisa i ishodu terapije penicilinom.

Pharyngitis is one of the most frequent diseases in children. The most important of the bacterial infections is due to Streptococcus pyogenes. For many years, penicillin is considered to be the drug of choice for streptococcal pharyngitis, although failure rates of up to 20% have been reported. One of possible explanations for penicillin treatment failure is presence of other species of bacteria in the normal oropharyngeal flora that can interfere with colonization and growth of Streptococcus pyogenes and influence the development of pharyngitis. A wide variety of microorganisms, including alpha-haemolytic streptococci and anaerobic bacteria, are present within the oropharynx (table 1). The strain of alpha-haemolytic streptococci is in interference with Streptococcus pyogenes. By producing bacteriocins, they inhibit colonization and growth of Streptococcus pyogenes and assist in its eradication. Anaerobic bacteria may play a direct or indirect role in development of pharyngitis. They may be directly responsible for specific forms of pharyngitis or contribute indirectly with possibility of synergy between them and Streptococcus pyogenes. Beta-lactamase-producing aerobic and anaerobic organisms may contribute to penicillin treatment failure. By producing beta-lactamase within the tonsillar tissue, they destroy penicillin and protect streptococci from the antibacterial effect of penicillin. Pharyngeal bacterial flora may vary according to the state of the patient (Figure 1). During an acute infection and in the cases of treatment failure and recurrent pharyngitis the number of alpha-haemolytic streptococci declines, while there is an increase in the number of anaerobic and beta-lactamase-producing organisms. After successful treatment the number and type of bacteria is similar to those found within normal tissue. Knowing the distribution and changes in pharyngeal bacterial flora is important for choosing the optimal drug for treatment of streptococcal pharyngitis. Although penicillin reduces the number of interfering beta-haemolytic streptococci, because of its advantages, if remains the drug of choice for the treatment of streptococcal pharyngitis. In cases of treatment failure and recurrent infections cephalosporins and macrolides may be a useful alternative to penicillin because they possess relatively poor activity against alpha-haemolytic streptococci, resistance to beta-lactamase and because of better penetration into tonsilar tissue.

[Treatment of respiratory infections in children]. / Lecenje respiracionih infekcija kod dece.

Review of respiratory infection farmacotherapy is presented in the paper. It is emphasised that the inital therapy bacterial pneumonia is related to age of the child. The role and importance of ribavirin and specific immunoglobulin in the treatment of acute bronchiolitis caused by RSV is stressed. Also, positive influence of immunostimulators as a possibility for prevention of repeated bronchitic attacks is explained. In the treatment of chronic pulmonary disease in cystic fibrosis antibiotic therapy along with physical therapy is of a crucial importance. The use of amiloride, proteinase inhibitors and DN-ase by inhalation offer hopeful results in treating pulmonary disease in cystic fibrosis. Symptomatic therapy, physical therapy, general measures, care and nutrition have very important role in treatment of the respiratory infections.

[The hyperventilation syndrome in children]. / Hiperventilacioni sindrom u dece.

Hyperventilation syndrome is not a rare disorder present primarily in children, but in adolescents too. It points to anxiety in children with or without family problems. The clinical picture is polymorphous and often without a clear connection with hyperventilation. That is why it is necessary for the physician to be aware of this problem in practice. The diagnosis is made on the basis of clinical picture and hyperventilation provocative test, when one expects this disorder might occur. We have reported five cases of children with this syndrome, with a special review concerning clinical picture and the way which led to the confirmation of diagnosis.

[Backache in children]. / Bol u ledima kod dece.

Back ache is a rare phenomenon in children and adolescents, but it is always caused by serious pathologic changes. The aim of this study was to point to pediatricians to the importance of anamnesis and clinical examinations in making a diagnosis.

[Adolescent mortality in Vojvodina]. / Mortalitet adolescenata u Vojvodini.

The aim of the study was to determine the mortality rate of adolescents in Vojvodina and analyze the most common causes of their death. For the analysis we used the data from the Health Statistics Annual and from individual statistics reports. The observation period was between 1986 and 1988. The mean mortality rate of the adolescents in Vojvodina for that period was 6.7/100000. The leading cause of death (54.74%) was accidents (mostly traffic accidents), malignant diseases and finally cardiovascular diseases. The mortality rate was higher among older adolescents. It was 4 times higher in the outpatients compared to the inpatients and caused either by the severity of the injury and/or inadequately handled injuries. For the highest percentage of the accidents responsible were external factors among which risk behavior of the young played a significant role. The task of the society is to take appropriate measures which would reduce the role of the external factors as a cause of death.

[Modern approach to the therapy of viral croup]. / Savremeni pristup terapiji virusnog krupa.

Viral croup as the most frequent of laryngeal obstructions in childhood appears in the form of spasmodic croup and acute laryngotracheitis. The evaluation of the severity of laryngeal obstruction can be made by using score systems. In more severe forms of viral croup the inhalation of 0.25 ml/kg 2.25% epinehrine and a single dose dexamethasone 0.6 mg/kg i.m. is recommended.

[Drug poisoning in children in Vojvodina]. / Trovanje dece lekovima u Vojvodini.

Epidemiological characteristics of acute drug poisoning in children were investigated over a period of two years (1988-1989). The total number of poisonings was 450. Among causes of poisoning psychopharmaca, especially benzodiazepine, came first (33.3%). They were followed by drugs affecting the nervous system (9.1%), usually by analgoantipyretics, and by drugs affecting the cardiovascular system (7.8%). In 10.6% of the cases poisoning was due to two or more drugs. In 12.3% of the poisonings drug was unknown. Sodium fluoride was the most frequent single cause of acute poisoning. The average age of the poisoned children was 5.1 years. Poisoning with drugs was more frequent among girls than among boys (55:45%). In more than half poisoning accidents there was no one present when poisoning occurred. A major number of poisonings were an attention-getting gesture or a suicidal attempt. There were 11 cases of repeated poisoning with the same drug.

[Acute poisoning in children in Vojvodina]. / Akutna trovanja dece u Vojvodini.

The paper deals with acute poisoning among children in Voivodina from the point of view of frequency, characteristics and regional differences. The histories of the poisoned children aged 0-16 years, who were hospitalized in all eleven in-patient clinics in Voivodina during 1985, 1986, 1988 and 1989, were analysed. Acute poisoning in children accounted for 2.4% of hospital morbidity. The most frequent causes of poisoning were medicaments (60.6%), pesticides (8.7%), ethanol (6.34%), organic solvents (5.7%) and all other substances (18.35%). Poisoning occurred more often among boys than among girls (53.47%). The average age of the poisoned was 4.7 years. The average age of the poisoned girls was significantly higher than that of the poisoned boys. Poisoning usually took place during a "game", but a major number of poisonings was suicidal. There were great regional differences as regards the course of poisoning, sex and average age of the poisoned, circumstances of poisoning and period in which it happened. The children's age and circumstances of poisoning point to the absence of preventive measures or their failure.

[Acute poisoning in children in the region of Vojvodina]. / Akutna trovanja u dece na teritoriji AP Vojvodine.

The aim of this study was to examine the frequency, characteristics and regional differences of acute poisoning in children on the territory of AP Vojvodina. The medical histories of children aged from 0 to 15 years which were hospitalized in all hospitals throughout Vojvodina in the course of 1985 and 1986, were retrospectively analyzed. Acute poisoning in children on the territory of AP Vojvodina is represented by 2.5% in hospital morbidity. The most frequent causes of poisoning are drugs (62.8%), and after that follow pesticides (7.4%), alcohol (6.5%) and dissolvents (6.3%). The average age of those poisoned is 4 years and 2 months. Boys are more frequently poisoned than girls (54.5%: 45.5%). In the largest number of cases the circumstances of the poisoning remained unknown. Regional differences were observed in relation to the type of substance which was taken, as well as in relation to the age and sex of the poisoned, therefore the circumstances under which the poisoning occurred. The number of poisonings, the age of those poisoned and circumstances of poisoning indicate that preventive measures were absent and that they were suppressed.

[Morbidity and mortality in adolescents in Vojvodina]. / Morbiditet i mortalitet adolescenata U SAP Vojvodini.

Adolescents. The aim of this study was to analyze the morbidity and mortality of adolescents in SAP Vojvodina. For the analysis, data was used from the statistical yearbooks on the health protection of the population and data from individual statistical reports. The period from 1980 to 1986 was observed. In order to more easily follow the morbidity and mortality, and for a better insight into the pathology, the adolescents were divided into 2 age groups; the younger one from 10 to 14 years of age, and the older one from 15 to 19. Adolescents in Vojvodina mostly ail from respiratory diseases, illnesses of the digestive tract, and infective diseases, but a significant role in the morbidity is also taken by injuries and poisoning. Adolescents of the age group from 10 to 14 years, get sick more often. In SAP Vojvodina 156 adolescents die annually. The highest mortality is due to injuries and poisoning (16.36/1,000,000), and after that comes the mortality due to neoplasms (5.84/1,000,000), and the diseases of the respiratory and circulatory system (3.5/1,000,000). Mortality is higher in the adolescent group from 15 to 19 years of age. With this study only a partial insight was achieved into the pathology of the adolescent age group. In order to attain a full insight, it is absolutely necessary to actively and prospectively follow the health state of adolescents and the conditions of environment.

[Acute alcoholic intoxication in children in Vojvodina]. / Akutna trovanja etanolom u dece u SAP Vojvodini.

The aim of this work was to investigate the frequency and characteristics of acute ethanol poisoning in children in the territory of the Socialist Autonomous Province of Voivodina. In a retrospective study histories of poisoned children aged 0-15 years, who were hospitalized in all eleven stationary centres in Voivodina during 1985/86, were analysed. From 795 children, 52 were poisoned with ethanol (6.54%). With the exception of Novi Knezevac, where only eight cases of poisoning were recorded during the two-year period, the frequency of ethanol poisoning showed major regional differences varying from 3.03% in Zrenjanin to 11.45% in Subotica. Poisoning among boys was significantly more frequent than among girls, especially with ethanol. The average age of children poisoned with ethanol was 8.4 years i.e. almost twice that of children poisoned with other substances. The children's age and circumstances of ethanol poisoning point to the absence and failure of preventive measures.

[Increase in body weight and levels of organochlorine insecticide and polychlorinated biphenyl residues in the blood during pregnancy]. / Prirast telesne mase i koncentracije rezidua organohlornih insekticida i polihlorovanih bifenila u serumu trudnica.

Concentrations of organochlorine residues, viz., p,p'DDE, p,p'DDT, total DDT, gamma-HCH and polychlorinated biphenyl (PHB) were determined in the serum of both pregnant and unpregnant women. It appeared that concentrations of these residues were statistically significantly lower in the pregnant women. Besides, some variations in these concentrations, observed at three stages of pregnancy (the third month, the sixth month and at the delivery), were not statistically significant. With the body weight increase during the pregnancy, an increase, instead of the expected decrease, in concentration of organochlorine residues was observed. The increase in organochlorine residue content which is statistically significant may be of clinical significance. Those pregnant women that had a greater body mass increase had also higher concentrations of organochlorine contaminants in the serum. This means that the fetus was exposed more strongly to their action. An explanation of this phenomenon should be sought in the numerous physiological changes occurring in the pregnancy. In is necessary to continue the study of the correlation between the body mass increase and the concentration of organochlorine residues in the serum of pregnant women and their milk after the delivery.

Epidemiological evaluation of anti-infective drug prescribing for children in outpatient practice.

In comparison with other regions in Yugoslavia, in the District of Novi Sad a high prescribing rate for antimicrobial drug were previously found. The aim of this study was to determine whether this high rate applies also to pediatric patients up to the age of 7 years, to define the prescribing pattern of physicians, and ultimately, to direct educational and other measures toward improving the therapeutic practices. The sample consisted of all prescriptions for 1 month for 26,652 children, comprising 8.9% of the total population. The method was based on a drug dose statistics concept, where the most frequently prescribed amount of the active substance, determined by convention as the defined daily dose (DDD), was used as a unit of measurement. The number of such statistical or average doses were expressed per 1,000 children per day. It was found that the prescribing rate in the District exceeds all other regions for which comparable data exist. In the prescribing pattern, the high usage of tetracyclines contributed to final removal of tetracyclines in syrup formulation from the market in Yugoslavia.