Functional gastrointestinal disorders in children: a single centre experience.

Functional gastrointestinal disorders in childhood (FGIDs) constitute a significant time-consuming clinical problem for healthcare practitioners, and they carry an important psychosocial burden for patients and their families. The aim of this study was to characterize etiology, clinical features, and interventions in a paediatric cohort of patients with FGIDs, who were referred to a tertiary care university-affiliated centre. Methods A retrospective study of children aged 1-15 years old referred to the Clinic for Children's Diseases, University Clinical Center Tuzla, from January 2022 to December 2022, who fulfilled criteria for FGIDs (n=209), were divided in three groups: 0-3, 4-10 and 11-15 years old. Demographic characteristics, number of examinations, duration of symptoms, initial diagnosis, hospital evaluation and outcomes of each child were collected. Results During the study period, 670 patients were referred to a gastroenterologist, out of whom 209 (31.2%) fulfilled the criteria for FGIDs, with median age of 8.0 years. Females were predominant in all groups (p=0.0369). Children aged 4 to 10 years were significantly more frequent (p<0.0001). A median duration of symptoms was one year. Functional constipation was the most common diagnosis, 99 (47.4%), followed by functional abdominal pain not otherwise specified, 67 (37.2%), and functional dyspepsia, 25 (12.0%). Fifty-two percent of patients did not require further follow-up by the gastroenterologist. Conclusion Although FGDIs are frequent, they are not well accepted neither among patients nor physicians. Extensive diagnostic procedures are often unnecessary and the cessation of specialized care follow-up is possible in a significant number of cases.

Predictors of adverse short-term outcomes in late preterm infants.

BACKGROUND: Infants born between 34 weeks and 36 weeks and 6 days of gestation are defined as late preterm infants (LPIs), and they account for approximately 74% of all premature births. Preterm birth (PB) remains the leading cause of infant mortality and morbidity worldwide. AIM: To analyse short-term morbidity and mortality and identify predictors of adverse outcomes in late preterm infants. PATIENTS AND METHODS: In this retrospective study, we evaluated adverse short-term outcomes of LPIs admitted to the Intensive Care Unit (ICU), Clinic for Children's Diseases, University Clinical Center Tuzla, between 01.01.2020 and 31.12.2022. The analysed data included sex, gestational age, parity, birth weight, Apgar score (i.e., assessment of vitality at birth in the first and fifth minutes after birth), and length of hospitalization in NICU, as well as short-term outcome data. Maternal risk factors we observed were: age of mother, parity, maternal morbidity during pregnancy, complications and treatment during pregnancy. LPIs with major anatomic malformations were excluded from the study. Logistic regression analysis was used to identify risk factors for neonatal morbidity among LPIs. RESULTS: We analysed data from 154 late preterm newborns, most of whom were male (60%), delivered by caesarean Sect. (68.2%) and from nulliparous mothers (63.6%). Respiratory complications were the most common outcome among all subgroups, followed by CNS morbidity, infections and jaundice requiring phototherapy. The rate of almost all of the complications in the late-preterm group decreased as gestational age increased from 34 to 36 weeks. Birth weight (OR: 1,2; 95% CI: 0,9 - 2,3; p = 0,0313) and male sex (OR: 2,5; 95% CI: 1,1-5,4; p = 0,0204) were significantly and independently associated with an increased risk for respiratory morbidity, and gestational weeks and male sex were associated with infectious morbidity. None of the risk factors analysed herein were predictors of CNS morbidity in LPIs. CONCLUSION: A younger gestational age at birth is associated with a greater risk of short-term complications among LPIs, thus highlighting the need for increased knowledge about the epidemiology of these late preterm births. Understanding the risks of late preterm birth is critical to optimizing clinical decision-making, enhancing the cost-effectiveness of endeavours to delay delivery during the late preterm period, and reducing neonatal morbidity.

Risk factors associated with the development of secondary hyperparathyroidism in dialysis patients.

Aim To determine risk factors associated with the development and severity of secondary hyperparathyroidism in dialysis patients. Methods A cross-sectional study at the Clinical Centre of the University of Tuzla (March 2022) included 104 adult patients (males 51.9%, females 48.1%) with chronic kidney diseases under dialysis treatment. Based on parathyroid hormone (PTH) values, patients were divided into two groups: study group (45/104, PTH >792pg/mL) and control group (59/104, PTH 176-792 pg/ mL). The analysis aimed to resolve whether there was a connection between the duration of dialysis, the type of therapy treatment administered, the underlying kidney disease, and the presence of comorbidities with the values of PTH, and a wide spectrum of monitored laboratory parameters. Results The most common causes of chronic renal failure were undefined kidney diseases (32.7%), followed by diabetic nephropathy (18.3%) and chronic glomerulonephritis (16.3%). In the examined biochemical parameters, a significant difference was found in mean values of alkaline phosphatase (p<0.001). The correlation was proved between the duration of dialysis (p=0.028), the values of phosphorus (p=0.031), and alkaline phosphatase (p<0.001) with absolute values of PTH. The most common present comorbidity was hypertension (78.8%), followed by cardiovascular diseases (40.4%) and diabetes (22.1%). Conclusion A number of factors contribute to the development and severity of SHPT. Modulation of therapy and better control of risk parameters can prolong and reduce the frequency of SHPT in dialysis patients, as well as the occurrence of comorbidities.

Frequency of Urinary Tract Infection When Diagnosing Vesico Uretheral Reflux in Children in Tuzla Canton.

Background: Vesicoureteral reflux (VUR) represents the return of urine from the bladder into the ureter and the renal canal system. Reflux can occur only on one or both kidneys. VUR most often occurs due to an incompetent ureterovesical junction, which consequently leads to hydronephrosis and dysfunction of the lower parts of the urinary system. Objective: The aim of the study was to determine the frequency of urinary infection when diagnosing vesicouretheral reflux in children in the Tuzla Canton, in the five-year period from 01.01.2016 to 01.01.2021. Methods: Through a retrospective study, we analyzed data from 256 children with vesiocouretheral reflux (VUR), examined in the Nephrology Outpatient Clinic, Clinic for Children's Diseases, University Clinical Center Tuzla, in the period from 01.01.2016 to 01.01.2021, from early neonatal to 15 years of age. The age and gender of children, the most common symptoms of urinary tract infections during the detection of VUR, and the degree of VUR were analyzed. Results: From 256 children with VUR, 54% were male and 46% female. The highest prevalence of VUR was in the age group 0-2 years, and the lowest in the age of children > 15 years. There was no statistically significant difference between the groups of our respondents in relation to age groups, nor in relation to the gender of the children. Statistically significantly more children were without nonspecific symptoms and with asymptomatic bacteriuria in the group without UTI symptoms in children with VUR compared to the group with UTI symptoms in children with VUR. Pathological urine culture between the groups was without a statistically significant difference. Conclusion: Although urinary tract infection in children is common, the possibility of permanent consequences should always be kept in mind if VUR is not diagnosed and treated in time.

Uveitis Associated with Juvenile Idiopathic Arthritis, our Observations.

INTRODUCTION: Uveitis as extra-articular manifestation of juvenile idiopathic arthritis (JIA) is present in 20% of children with the persistent form, in 30% with the extended oligoarticular form, while it is present in psoriatic and polyarticular rheumatoid factor (RF) negative arthritis in 10% and 14%, respectively. AIM: The aim of the study was to evaluate the frequency of uveitis and its complications in children with JIA. MATERIAL AND METHODS: A retrospective study was conducted with an analysis of the medical records of children with JIA who were treated for the last 5 years. The analysis included the following: the child's age and sex, age at onset of arthritis, of uveitis, complications, RF values and antinuclear antibodies (ANA). RESULTS: The study included 97 children with JIA: in 14 (14.4%) uveitis was observed; the most common form of JIA was the oligoarticular extended form (6/14), oligoarticular persistent form was observed in 5 children, while 3 children with uveitis had polyarticular RF negative JIA. The age of arthritis onset was lower in children with uveitis (4.7 vs 8.2 years); ANA positivity was more common in children with JIA and uveitis (64% vs 41%). Uveitis was the first manifestation of the disease for 2 children; 28.6% of children had clinically asymptomatic uveitis, while 42.4% of children developed uveitis within 4 years from the JIA onset. 8/14 children developed uveitis complications: 3 cases of synechia, 2 band keratopathy, 2 cataracta, 1 glaucoma. CONCLUSION: Uveitis as significantly present manifestation of JIA requires to timely recognize, treat, monitor children in order to prevent complications.

Development of Respiratory Allergies, Asthma and Allergic Rhinits in Children with Atopic Dermatitis.

Children with atopic dermatitis (AD) usually develop symptoms when they reach the age of 6-7 years, but the risk of developing respiratory allergies, asthma and allergic rhinitis (AR) remains high. In most children with AD, the development of asthma and AR is associated with sensitization to food allergens and/or aeroallergens, while only a small percentage missed atopic diathesis. In about 35% of children with AD, food allergy is the provoking cause, and 60% of infants who had AD in the first 3 months of life were sensitized against aeroallergens by the age of 5. The aim of the study was to follow development of asthma and AR and to assess the most significant risk factors for developing respiratory allergy. A total of 114 children with AD were followed up for five years. At annual visits, the severity of disease, total immunoglobulin E (IgE) antibody values, skin prick tests, specific IgE antibodies to food allergens and aeroallergens, and absolute eosinophil count were assessed. Information on the family history of atopy and AD, feeding patterns during infancy, data on sensitivity to food allergens and/or aeroallergens, and on the occurrence of bronchial obstruction and nose symptoms were obtained. Asthma developed in 36 children, median age 7.7 years; 33 children had symptoms of AR, and 13 children with AD had both diseases associated; 38 children had sensitivity to food, of which 24 developed asthma and 13 AR; asthma developed in 18/23 children with sensitivity to aeroallergens, and almost an equal number of children developed AR. The increased absolute eosinophil count and specific IgE to aeroallergens and food allergens were the best asthma predictors, while AR predictors were family history and early onset of AD. In conclusion, children with AD are at a significant risk of developing respiratory allergies, and those with the increased absolute eosinophil count, positive specific IgE to aeroallergens and food allergens, heredity of AD, and early onset of AD are at the highest risk. Identification of risk factors will enable us to improve the treatments of AD in order to reduce the severity of disease and prevent manifestation of respiratory allergy.

The predictive score for early-onset neonatal sepsis.

The aim of the present study was to analyze complete blood count (CBC) and C-reactive protein (CRP) levels to create the predictive score for diagnosis of early-onset neonatal sepsis (EONS). All neonates treated for suspected EONS between January 2004 and December 2006 were evaluated from their case record. A diagnosis of EONS was made if either clinical findings consistent with sepsis developed within 72 hours of life, or if positive cultures were obtained. Evaluations for EONS were preformed in 341 neonates, and 199/341 (58.4%) developed EONS. Total white blood count, immature/total ratio, immature/ mature ratio, and CRP levels were found to be independent predictors of EONS, and the predictive score for EONS was created. An increase in the predictive score for EONS was directly correlated with possibility of EONS. Receiver operating characteristic (ROC) curve analysis determined a cut-off value of a predictive score for EONS > 0.503, with sensitivity of 73% and specificity of 89%. Correct prediction of EONS was found in 78% of all neonates, 80% for positive and 75% for negative outcome (p < 0.0001). In conclusion, for its high sensitivity and prediction rates, the predictive score for EONS is useful in diagnostic evaluation of neonates suspected for EONS.

Association of Low Birth Weight Infants and Maternal Sociodemographic Status in Tuzla Canton during 1992-1995 War Period in Bosnia and Herzegovina.

Objectives. We examined association between incidence rate of low birth weight in liveborn infants and maternal sociodemographic status in Tuzla Canton during 1992-1995 war in Bosnia and Herzegovina. Methods. The present study covers a 22-year period (1988-2009), including the war period (1992-1995), and we retrospectively collected data on a total of 108 316 liveborn infants and their mothers from three different socioeconomic periods: before (1988-1991), during (1992-1995), and after the war (1996-2009). Association between incidence rate of low birth weight in liveborn infants and maternal sociodemographic status were determined for each study period. Results. There were 23 194 live births in the prewar, 18 302 during the war, and 66 820 in the postwar period. Among the liveborn infants born during the war, 1373 (7.5%) had birth weight of <2500 g, which is significantly more in comparison with 851 (3.6%) liveborn infants in this birth weight group born before and 1864 (2.8%) after the war. We found the number of examinations during pregnancy was 1.8 per pregnant woman in the war period, which was low in comparison with the number of examinations before (4.6 per pregnant woman) and after (7.1 per pregnant woman) the war (P<.001 for both). Prewar perinatal mortality LBW infants of 6.2 per 1000 live births increased to 10.8 per 1000 live births during the war (P<.001), but after the war, perinatal mortality LBW infants (5.2‰) and early neonatal mortality (2.4‰) decreased. Conclusions. We found statistically significant association between low-birth-weight and maternal sociodemographic status in Tuzla Canton during 1992-1995 war in Bosnia and Herzegovina.

[The predictive values of total white blood count and differential count in the diagnosis of early-onset neonatal sepsis]. / Prediktivne vrijednosti ukupnog broja leukocita i diferencijalne krvne slike u dijagnozi rane neonatalne sepse.

UNLABELLED: Early-onset neonatal sepsis (EONS) is one of the most common diagnostic challenges in neonatal population. Aims of this study was to analyse values of total white blood count (WBC) and differential count in neonates with EONS and to determine cut-off values with the highest accuracy in diagnosis of infection. PATIENTS AND METHODS: In the retrospective-prospective research we include 341 neonates born from 37th to 42nd week of gestational age, with one or more obstetric risk factors for EONS, in single pregnancy, both genders and without visible anomalies. Capillary blood samples for analysed parameters levels were obtained in the first 72 hours of life. A diagnosis of EONS was based on microbiological findings, clinical signs and radiography of chest. RESULTS: Obstetric risk for EONS at delivery had 341/12 298 (2.8%) neonates, and EONS occurred in 199/341 (58.4%) neonates. The mean total WBC count was 22.5 +/- 9.5 x 109/L, the mean absolute mature neutrophil count was 13.9 +/- 6.8 x 109/, while the mean total neutrophil count was 15.6 +/- 7.8 x 109/L. Neonates with EONS had medial of total immature neutrophil count of 1.2 x 109/L, immature to total neutrophil ratio (I:T ratio) of 0.09 and medial of immature to mature neutrophil ratio (I:M ratio) was 0.10. ROC curve analysis cut-off values of I:T (> 0.08) and I:M (> 0.09) ratio had acceptable accuracy in the diagnosis of EONS. The value of total WBC > 26.4 x 109/L, with accuracy of 88% predict EONS. High predictive value (82.9%) in EONS had total neutrophil count value of more than 17.6, and total immature neutrophil count value of more than 1.1 x l09/L predict presence of EONS with accuracy of 65.3%. Cut-off values of I:T (66.8%) and I:M (67.3%) ratio almost in the same percent predict EONS. In univariable predictive model, only cut-off value of mature neutrophil count was not significant in the detection of EONS, while cut-off values of other analysed parameters had significant predictive value (p < 0.05). CONCLUSION: Total white blood count and differential count are changed in neonates with early-onset neonatal sepsis. The predictive value of analysed parameters cut-off values is important in everyday work of neonatology's to make difference among infected and non-infected neonates.