[Acute coronary syndrome after hornet bite, type II Kounis syndrome - a case report]. / Akutni koronarni sindrom poslije uboda strsljena, Kounisov sindrom tipa II - prikaz bolesnika.

Kounis syndrome is an accidental occurrence of acute coronary syndrome associated with anaphylaxis, where acute inflammatory mediators cause the spasm of coronary arteries with the erosion and rupture of atheromatous plaque. We present a 53-year-old male who during the treatment of anaphylaxis after a hornet bite developed acute anteroseptal myocardial infarction. The diagnosis of type II Kounis syndrome was proven by electrocardiographic abnormalities and biochemical markers with clinical manifestation of acute coronary syndrome, and was associated with anaphylaxis which demanded prehospital treatment of the patient after the hornet bite. Anaphylaxis after a hornet bite requires consideration of acute coronary syndrome if patients have chest pain and hemodynamic impairment, as these conditions occur infrequently but demand additional diagnostics and adequate treatment.

Childhood and Coress model of carcinogenesis.

INTRODUCTION: In the last fifty years the incidence of gastric cancer in developed countries is a constant trend, but mortality in all countries remains at the same level and ranks second behind lung cancer. In the case of gastric cancer has a far more important the role the early diagnosis compared to prevention. MATERIAL AND METHODS: The sample included 200 subjects aged 7-18 years treated at the Pediatric Clinic, University Clinic Tuzla and Pediatric Clinic and the Clinic for Child Surgery of Clinical Center of Sarajevo University who had endoscopic and histologically verified gastritis. The method of processing the tissue preparations of histologic sections of paraffin-fixed and paraffin tissue by hematoxylin-eosin method and Helicobacter pylori, using Giemsa. RESULTS AND DISCUSSION: Pathological analysis of the sample of patients with gastritis found that in 91% of patients had chronic superficial gastritis, while in 9% of patients were found atrophic changes, with or without intestinal metaplasia. Atrophic changes with or without intestinal metaplasia was found in 10.2% of H. pylori-positive patients with gastritis. The same analysis in a significant percentage of 5.7% of H. pylori-negative patients was atrophic changes, with or without intestinal metaplasia. Analysis of activity of the inflammatory process, we have found that the symptoms matched a statistically significant percentage (86.5%) with the active phase of the disease, which speaks against thinking that H. pylori infection is asymptomatic condition, which is often cited in the literature. CONCLUSION: Gastric mucosal lesion caused H. pylori infection is a reversible process and the eradication of this infection not only stops the activity of the inflammatory process, but also restores the mucous membranes. Eradication leads to a significant drop in the incidence of recurrence of gastritis and peptic ulcer disease, and can lead to prevention of malignant disease in 70-80% of cases, even, and perhaps more.

Early and correct diagnosis of celiac disease in the prevention of growth disorders and child development.

Coeliac, in ordinary people known as "flour allergy" and in medicine world known as gluten enteropathy which means enteric damage caused by gluten. Data about incidence of gluten enteropathy is different in different countries around the World and depend on is it or is it not the right diagnosis for enteric disorder. Sometimes, this disease is unrecognized because of unspecific clinical signs. This disease is happening in every moment of a lifetime, most common during the childhood when the children try to eat any food which contains gluten. Anyway, if children had no symptoms it doesn't¢t mean that disease not exists, and that¢is because we have to do diagnostic tests to confirm gluten enteropathy. Gluten intolerance is chronic disease and demand use of the specific non gluten food during the lifetime. Early diagnosis is right way to prevent unregularly growth. Aim of this study was to show the influence of early diagnostic about growth. For each patient we had a permission of parents and we showed our original results for three month we investigated.

Etiological and clinical characteristics of lymphadenopathy at child age in Tuzla Canton.

UNLABELLED: Lymphadenopathy is defined as an abnormality in the size or character of lymph nodes, is caused by the invasion or propagation of either inflammatory cells or neoplastic cells into the node. Numerous factors, such as age, localization, size and consistency, present and previous pathological conditions are very important in order to define the future diagnostic and therapeutic course. OBJECTIVE: The aim of this study was to determine the etiological and clinical characteristics oflymphadenopathy in children in the area of the Tuzla Canton. PATIENTS AND METHODS: This retrospective-prospective study analyzed the medical records of the Department of Pediatrics in Tuzla of 334 patients in age from 0 to 14 years, in which the clinical signs of palpable lymph nodes of one or more regions was diagnosed in the period from January 1st 1998 to June 30th 2003. The anamnesis data, clinical findings, diagnostic procedures results, therapeutic approach and disease outcome etiology defined lymphadenopathy were analyzed. RESULTS: Out of 334 children, localized lymphadenopathy have been verified in 230, and generalized in 104. Male/female ratio was 1:1.8. Final results of our study have shown the etiologies as following: Infectious etiologies, 79.34%, neoplastic 11.34%, and non-neoplastic 9.28%. In neoplastic etiologies, lymphoblastic leukemia has been the most often verified neoplastic disease (68.4%), not related to the age or sex of patient, and equally presented as localized and generalized lymphadenopathy. In this study lymphomas were presented by generalized lymphadenopathy. CONCLUSION: The regional and generalized lymphadenopathy in children depends on their etiology and has significant prognostic value for the disease.

[The lunar cycle and seizures in children]. / Lunarni ciklus i cerebralni napadi u djece.

AIM: To analyze the annual trend of hospitalization and potential influence of the lunar cycle of children treated for seizures METHODS: The data of the patients treated for seizures (convulsions, epileptic seizures, disturbance of consciousness and epileptic seizures in children with neurodevelopmental disability) in the Pediatrics Clinic of the University Clinical Center of Tuzla were retrospectively analyzed during 2008 in relation to seasonal distribution, admission time (month, week, admission moment, day in a week, time of the day) and the lunar cycle. RESULTS: Out f the total of 234 treated children, 55 (23,5%) were infants, 101 (43,1%) were under six years of age and 78 (33,3%) were of school age. The most common type of seizures were convulsions, 123 (42,6%). The seizures were numerous in the midst of the week, as opposed to weekends. The highest number of children was treated in January, February, July and August, that it, in the fourth, seventh, twenty-seventh and thirty-first week of the year. Seizures occured during the day in 149 patients (63,7%) and during the night in 84 (35,9%) patients (p < 0,0034). The number of treated patients was significantly larger in the third and fourth lunar phases (p < 0,018). CONCLUSIONS: The results suggested seasonal and weekly trends of hospitalization of patients with seizures and their relation with circadian and lunar cycles. There is a need for further prospective studies in order to get better understanding of the influence of the lunar cycle on health.

[Humoral immunity in children with immunodeficiency and immunosuppression]. / Humoralna imunost u djece sa imunodeficijencijama i imunosupresijom.

The objective of the study was to determine the immunological characteristics of immunodeficiency and immunosuppression in children and to estimate the type of disorder within the immunological system. In the prospective study with 90 patients included, all were separated into three groups (30 patients per group) of which the first group was formed of patients with immunodeficiency; the second group of patients who were receiving the immunosuppressive therapy for autoimmune diseases for more than 6 months; and the third group being the control group formed of patients with uncomplicated bacterial infections. The follow-up parameters were gathered using questionnaire on personal and family anamnesis of patients with immunological parameters: humoral unspecific immunities (CRP, C3, C4, IL1 and IL2), humoral specific immunities (IgG, IgM, IgA and IgE) and cellular specific immunity. Concentrations of medium values of CRP in patients with immunodeficiency and on immunosuppressive therapy, statistically are significantly lower than in patients from the control group (p < 0.05). Individually increased concentrations of CRP within the groups are the indicator of acute inflammatory process and of relapse of basic disease in patients with autoimmune diseases. The concentrations of IL1 are lower than standard values in the test. in 28 patients (93%) with immunodeficiency and in 26 (87%) patients with immunosuppression. Increased concentrations in 2 (7%) patients with immunodeficiency are sign of acute inflammatory process, and 4 (14%) patients with immunosuppression and increased concentrations have shown signs of inflammation and relapse of basic disease. Concentration of IL2 in 1 (3%) patient from immunosuppressed group was increased (iatrogenic immunosuppressant). There is no statistically significant difference in concentrations of medium values of C3 and C4 complements among the studied groups of patients (p > 0.05). Concentrations of IgG in group of patients with immunodeficiency are statistically and significantly lower at medium and individual values (p < 0.001), as well as the concentrations of IgM and IgA (p < 0.05) comparing to other studied groups. Concentrations of IgE above 4.500 IU/ml were found in 3 (10%) patients with Hyper IgE syndrome. Results of our study have shown the possibility of evaluation of the level and the scale of disorder of the immunological system in children.

[Air pollution and hospital admission trends of children with bronchial obstruction in Tuzla Canton]. / Aerozagadenje i trend hospitalizacije djece zbog bronhoopstrukcije na podrucju Tuzlanskog kantona.

The prevalence of bronchial obstruction in children is continuously increasing at any age. Many studies have found associations between increase of respiratory diseases and air pollution. The aim of this paper was to establish possible connection between children hospital admission trends for bronchial obstruction and levels of measured concentration of air pollution agents in Tuzla Canton area. The results of investigation demonstrated that the distribution of hospital admissions of children with bronchial obstruction was different regarding place of inhabitants and season. Spatial distribution demonstrated that the highest number of children treated for bronchial obstruction was from Tuzla, Lukavac and Zivinice. The incidence of patients from these municipalities was significantly above the participation of these municipalities in total population. Seasonal distribution of hospital admissions of children with bronchial obstruction was different for single municipalities of Tuzla Canton and for different seasons. Air pollutants, sulfur oxide and dust deposition were significantly higher for heating season compared to season without heating. There is a link between frequency of hospital admission for bronchial obstruction and level of measured air pollutants.

[Brucellosis spondilitis in a ten year boy]. / Brucelozni spondilitis u desetogodisnjeg djecaka.

INTRODUCTION: Brucellosis is acute infectious disease classified as zoonosis, which can leave humans with chronic damages and disability. It can appear as sporadic cases or a smaller epidemic anywhere in the world but it is more common in some areas and there it presents significant public health issue. Clinical picture is very variegated. A long period of latency is possible, unnoticed asymptomatic start or forms with mild clinical picture up to the forms with per acute septic-toxic shock and possible lethal outcome. Symptoms of general infectious syndrome, wave like (undulating) temperature, profuse night sweat, muscle, bone and joint pain can be considered to be characteristic. Diagnosis is made based on epidemiological data, clinical findings, microbiological and serological tests. Differentially diagnostic all long-lasting febrile diseases may be considered and disease with neuralgic and arthralgic syndromes. Therapy includes antibiotics and prevention implies sanitary veterinary control, food control and measures of professional protection. METHODS: This paper descriptively describes clinical course of the disease in ten year old boy with brucellosis spondylitis. CASE REPORT: Ten year old boy was hospitalized for febrile condition and acute pain in back and abdomen of unknown etiology. We did diagnostic and therapeutic treatment with multidisciplinary approach and due to information on previous cases of brucellosis in family we also added tests to brucellosis. Diagnosis of brucellosis spondylitis is made based on MRI of lumbosacral spine and is confirmed with positive serological tests and positive blood cultures to Brucella melitensis. The boy had no other localized foci of the disease in other organs or systems. Etiological treatment was done in accordance to recommended antimicrobic scheme. A complete recovery was achieved with further need for observation of condition and Elisa titer to this agent. CONCLUSION: Osteoarticular form of brucellosis is relatively common focal form of the disease in adult patients but not so common in children. Syndrome of acute lumbosacral pain in children is of unknown etiology and diagnostic procedures must include infectious diseases with possible osteo-articular symptoms including brucellosis.

[Characteristics of broncho-obstruction in childhood]. / Karakteristike bronhoopstrukcije u djecijoj dobi.

INTRODUCTION: The prevalence of broncho-obstruction in children is in permanent increase at any age and in global. According to many studies, about 50% of children have at least one episode of broncho-obstruction in the first six years of life. Risk factors for broncho-obstruction in children include not only intrinsic, but a lot of extrinsic factors which could accelerate beginning of early symptoms. Globally, there is increase in first hospitalization with broncho-obstruction and many authors described decrease in rehospitalizations, thanks to therapy improvements. There is evidence of seasonal distribution of children treated for broncho-obstruction. Depending on country and author, different periods of year are related to increased number of patients, which could be explained by seasonal agents. Many studies described geographic variation in incidence and prevalence of respiratory diseases, which could also be explained by seasonal agents. PURPOSE: The aim of this paper is to establish frequency of broncho-obstructive syndrome, comparing the age, gender, place of inhabitance and seasonal agents in children treated at the Department of Intensive care at the Pediatrics Clinic in Tuzla trough analysis of their personal histories, clinical, radiography and laboratory findings. METHODS: Analysis was based on population of patients treated at the Department for Intensive care of Pediatrics Clinic in Tuzla with broncho-obstructive syndrome, from January 1st to 31st December 2006. All selected patients were from Tuzla Canton. Source of the data for research were Admission protocol for Pediatric Clinics, Intensive care unit protocol and personal histories of children treated. Method of work was retrospective study which analyzed anamnesis' data, clinical, radiography and laboratory findings, therapeutic procedures and length of hospitalization at the Intensive care unit and outcome of the treatment. RESULTS AND DISCUSSION: Total number of 767 children were treated during the investigated period at the Intensive care unit. Out of this number 332 children (43,3%) were treated for syndrome of broncho-obstruction. The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was most common at nursing age (40,0%) and 76,5% patients were under age of five. Boys dominated at all age groups except for repeated admissions of school age where this relation was equal. Spatial distribution demonstrated that the highest number of children treated for broncho-obstruction was from Tuzla, Lukavac and Zivinice. The incidence of patients from these municipalities was significantly above the participation of these municipalities in total population. Season distribution demonstrated that the highest numbers of children were treated in December, and lowest in July and August. Number of treated children was statistically significant higher during winter months. Broncho-obstructive syndrome in 67,5% patients was with radiography confirmed pneumonia and in 13,8% with lung athelectasis. The most common isolated agents were Staphylococcus, Klebsiella and Pseudomonas. CONCLUSION: The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was found in 67,5% patients with radiography confirmed pneumonia.

[Influence of perinatal complications on serum levels of alpha 1-antitrypsin in preterm newborns]. / Uticaj perinatalnih komplikacija na serumske vrijednosti alfa 1-antitripsina u preterminske novorodencadi.

Influence of perinatal complications on serum levels of alpha 1-antitrypsin was investigated in preterms newborns. Investigation was performed on two groups of newborns: first group consisted of 40 preterm newborns (gestation below 37 weeks) with perinatal complications, and second group consisted of 40 newborns without perinatal complications (gestation 37-42 weeks). Values of al-AT in serum preterm newbornswere 1,76+/-0,48 g/l, and in health newborns 1,88+/-0,31 g/l. Statistically significant difference was noted between two investigated serum values (p<0,0008). There was not a statistically significant influence of sex of investigated newborns in serum levels of alpha1-AT. From all investigated perinatal complications (RDS, brain damage, infection, deviation of intrauterine growth, ruptura vela filamentorum, vitium cordis congenita and more complications) variable "infection" has had only statistically significant influence on serum levels alpha1-AT (p< 0,02). T he opinion o f authors of th is investigation is that serum levels of this protein could be usefull in a diagnostic purposes, even if antibiotic treatment was started, and it will be a usefull as an early marker of pure treatment some of diseases.

[The Stevens-Johnson syndrome--personal experience]. / Sindrom Stevens-Johnson--nasa iskustva.

Stevens-Johnson syndrome is a disorder of the skin and mucous membranes and a severe bullous forms include systemic toxic effects. In this study, we have analyzed our experiences according to ages, sex, incidence, ethological irritable factors, differential diagnosis, clinical treatment, in children with Stevens-Johnson syndrome at the Pediatric Clinic in Tuzla. In the period January 1997-May 2002, we treated 14 patients with this syndrome. All patients were male, ages from 11 months to 11.6 years (average 4.5 years). As irritable factors were detected antiepileptics (Phenobarbitol and Tegretol) in 10 children (71.44%), antibiotics (Procain Penicillin and Cephalexin) in 3 children (21.42%), and reason was stayed unknown in 1 child (7.14%). The problem in differential diagnosis usually was toxic epidermal necrolisis (TEN) and graft versus host disease (GvHD). All patients demanded treatment in the pediatric intensive care unit supporting with specialists immunologists, ophthalmologists, dermatologists, infectologists. Treatment included, besides vital volume support, systemic administration of corticosteroids, antibiotics and intensive local therapy lesions of skin and mucous membranes, specially eyes in special sterile conditions. Outcome and results of our medical treatment of all patients were good.

[Monitoring fluid balance in pediatric intensive care]. / Monitoring bilansa tecnosti u pedijatriskoj intenzivnoj njezi.

The dynamic metabolism as far as bigger amount of water versus solid tissues in child demand much better skilfulness in calculating liquid input and excretion in intensive care. It is very important fact in prevention of life threatening conditions in children and adults, especially in conditions with multiorganic disorders, because their treatment is reciprocally opposite. Considering experiences of ICU UZ Gent-Belgium we made in Paediatric intensive care unit at Paediatric clinic in Tuzla unique method of monitoring liquid balance in children within specific conditions in which standard method of monitoring just the amount of planed liquid, body weight and diuresis is not reliable enough. With this new monitoring we prescribe dynamics of parenteral input of crystalloid and colloids as well as peroral income much more precise and much more confidence in positive result and prevention of harder disorders as well. In this paper we present our own method of observation as well as results in period July 1999. Till September 2002. We did the intensive volume control in 88 or 45 of total number of 2255 patients treated in PICU in this period. We followed the liquid balance 399 days or 9576 hours. Primary nephrologic diseases were indication for balance in 17 or 19.3% children, while in other 71 or 80.6% children, were other diseases like cardiac failure, diabetic ketoacidosis, chronic systemic diseases, the Toxic shock syndrome, the conditions of intracranial hypertension. We notice the signs of threatening renal failure in 7 or 7.9% of children and signs of manifesting renal failure in 10 or 11.3%. Our experiences tell that the model we made is applicable in working conditions of ICU. Evidence of organism responds the planned input is much better and safer than in standard way of observation. The possibility of in time intervention against threatening renal failure as well as other organic disorders is much greater. We recommended this model for all life threatening conditions in Paediatric intensive care units.