Heart murmur and anaemia in the pediatric population.

Innocent heart murmurs are hearth murmurs that occur in patients with a normal heart structure. They do not represent a disease of the heart and vascular system, and should not be treated as such. Iron-deficiency anaemia often causes, along with other symptoms, systolic heart murmurs and tachycardia. It appears in children of all ages representing a most common haematological paediatric disease. To establish the influence of iron-deficiency anaemia on genesis of innocent murmurs and to compare auscultatory and phono-electrocardiographic findings in patients with anaemia and heart murmurs before and after iron therapy. The study includes 120 patients with innocent heart murmurs that have been auscultated at cardio-rheumatic outpatient department of Pediatric Clinic of the Clinical Center of the University of Sarajevo, during the period from 01/01/2004 to 31/12/2004. Further diagnostic procedure, i.e. laboratory tests, diagnosed iron-deficiency anaemia in 30/120 patients. These patients have been followed in this study. 22/30 patients had systolic murmur I/II intensity of Levin scale; 8/30 patients had II/VI systolic murmurs of intensity by Levin. The highest number of examinees had 0-1 years of age, and in this group the number of boys was higher than the number of girls (M: F = 12:4). During the auscultatory and phono-ECG examinations of murmurs, 6 patients had haemoglobin values less than 95 g/l, which corresponds to an average and severe type of anaemia. 24 patients had haemoglobin values between 95 and 110 g/l, which corresponds to benign type of anaemia. The most numerous were patients aged between 0 - 1 year (3 patients with hemoglobin value Hb < 95 g/l, 13 patients with hemoglobin value Hb 95-110 g/l). All patients were treated with iron medicaments. After three months, clinical and laboratory re-evaluation was performed and it has demonstrated that after iron therapy 24 patients had level of a haemoglobin Hb >110 g/l and 6 patients had haemoglobin levels between 95 and 110 g/l. By auscultatory and phono-ECG examinations, murmurs of a level of intensity I/II was registered in only one child, while in the other 29 patients there were not any registered heart murmurs. Diagnosis of anaemia in the paediatric population group delays definitive diagnosis of heart murmurs. Innocent murmurs in children with sideropenic anaemia occur as its consequence. After adequately conducted iron therapy, i.e. cured anaemia, heart murmurs were not auscultated.

[Modern approach to treatment of juvenile rheumatoid arthritis]. / Savremeni terapeutski tretman pacijenata sa juvenilnim reumatoidnim artritisom.

PURPOSE: Juvenile rheumatoid arthritis (JRA) is the most common form of arthritis in paediatric population. The aim of this study is to evaluate patients (pts) with JRA in correlation to age, sex, type of illness as well as treatment algorhytm and its efficacy. WORK METHOD: During period time from 1.1.2002. till 31.12.2001. patients with JRA hospitalised at Paediatric Clinic of the Clinical Centre of University of Sarajevo were retrospectively studied. The soruce of research was histories of illness, clinical examinations and clinical findings during follow-up period. WORK RESULTS: according to our data girls were more often affected with JRA-23 patients (66%) age 2 to 6 years. The most frequent type of illness was monoarticular in 48.5%, polyarticular 34.2% and systemic in 14.3%. All pts were treated with first line therapy: nonsteroid anti-inflammatory agents combined with physio therapy which had satisfactory outcome, so 80% patients entered the remission zone of illness. Patients with systemic (14.3%) and polyarticular form with complications, received steroid therapy. One patient with systemic form was treated withmethotrexat. Duration of pts stay at Clinic differ from illness, 35% were cured and 5% non-cured patients. DISSCUSION: Treatment of JRA is a combination of medications, physio therapy and psycho therapy. The goals of treatment are to relive pain and inflammation, slow down or to prevent the destruction of joints and to restore use and function of affected joints in order to promote optimal child's growth and development, physicalactivity, social and emotional development. CONCLUSION: Treatment with nonsteroid antireumatics in combination with physio therapy proved very successful in patents with JRA. Multidisciplinary approach is mandatory to achieve primary goal: to cure illness. It is necessary to start therapeutic algorhytm as early as possible in best patient's interest.