Pediatric arrhythmology deals with studying of frequency and regularity of heart rhythm disorders in childhood. Rhythm disturbances (dysrhythmias, arrhythmias) occur as a result of disturbances in the creation or conduction of stimuli in the specific or working musculature of the heart. Simplifying the knowledge of everyday work on pediatric arrhythmias, they can originate from the atria of the heart when we speak about supraventricular arrhythmias or from the heart chambers when we talk about ventricular arrhythmias. There are currently three major problems that burden pediatric cardiologists and pediatric arrhythmologists, and which are the focus of interest in pediatrics as a whole. These are primarily sudden cardiac death in children (SCD), fetal arrhythmias (FA) and postoperative-incisional arrhythmias (IA). The development of pediatric arrhythmology is imperative in the development of pediatrics and pediatric cardiology.

Cardiomyopathies (CMP) are very rare disease in newborn with a very poor uotcome. Only isolated case reports and small case series have been reported. CMP is a disease that affects the myocardium and causes mechanical or electrical cardiac dysfunction. Even cumulatively, these conditions account for only approximately 1% of childhood cardiac disease. CMP presents a therapeutic challenge for the clinician, as evidenced by the fact that 10% of all pediatric cardiac deaths can be attributed to this condition. The estimated incidence of pediatric CMP was determined to be 1,13 cases per 100.000 children. Incidence varied according to sex, region and racial origin.We concluded that the best approach for evaluating a neonate who has a potential CMP is to identify the possible type of CMP and subsequently determine the potential cause wich leads terapeutic issue. Aetiology and clinical course are especially heterogeneous in infants. The most commonly identified aetiologies are genetic syndromes and metabolic diseases. A multidisciplinary approach is recommended for defining the aetiology and developing individual treatment strategies.

Objective - The purpose of this investigation was to determine the frequencies and types of associated congenital heart disease and other cardiac lesions in children with congenital anomalies of the kidneys and urinary tract (CAKUT). Participants and method - This was a prospective cardiac evaluation of children with diagnosed CAKUT, conducted between January 2013 and December 2015 at the Department of Pediatrics of the University Clinical Hospital, Tuzla. All cases were reviewed for age, gender, consanguinity, occurrence of congenital heart disease (CHD) and CAKUT in family history. Cardiac examination included: physical examination, noninvasive blood pressure measurement, a twelve lead electrocardiogram and echocardiogram. Results - Complete cardiac examination was performed in 144 children with congenital anomalies of the kidneys and urinary tract. Clinically insignificant morphological or hemodynamical changes were noted in 13% or 9.0% children. Congenital heart disease was found in 32 (22.2%), hypertrophic cardiomyopathy in 2 and pulmonary hypertension in 1 of the 144 children. In 4 children congenital heart disease was part of other known genetic syndromes, and all of these cases had severe CHD. In twenty-six or 76.5% of the total of 32 patients it was already known, and in 6 (23.5%) CHD was discovered during this research. Ventricular septal defect was the most common malformation (13% or 40.6% of patients). Vesicoureteral reflux was the most frequent CAKUT associated with CHD. Conclusions - The results of this study showed a significant association between CAKUT and CHD. Therefore we suggest performing cardiac assessment of all children with CAKUT.

Background: Palivizumab is indicated for respiratory syncytial virus (RSV) prophylaxis in high-risk children. Methods: Observational study, based on 4 sites in Bosnia and Herzegovina (BH 365 (61.9%) infants in total were born before 33 weeks. Average gestational age of preterm infants enrolled for prematurity only was 30.2 ± 3.2 weeks; for preterm infants with BPD/CLD it was 28.3 ± 3.7 weeks. Overall average of palivizumab injections was 4.1 ± 1.0. Hospitalization rate related to severe lower respiratory infections (LRI) during the period of protection by palivizumab was 1.2%. Respiratory infections which deserved medical attention were observed in 3.7% infants included in palivizumab prophylaxis.Conclusion: RSV prophylaxis in B&H is provided systematically and successfully, following the national guidance established in 2009, with the aim of achieving a good cost-benefit ratio, with very low hospitalization rate for severe LRI in prophylaxed infants. New randomized controlled trials (RCTs) and American Academy of Pediatrics (AAP) guidance revised in 2014 will be taken into account in establishing a new national recommendation.

A 6.6-year-old girl presented for leftsided cardiac enlargement on chestradiography (Panel A). Th ree yearsearlier she had undergone a lobectomyof the lower lobe of the leftlung for extraction of an echinococcalcyst.

Objective – The study was conducted in order to evaluate the value of the modified nitrite test in the diagnosis of urinary tract infection (UTI) in children.  Patients and methods – The study included 300 children of both sexes, aged 1 month to 14 years who were examined due to suspicion of UTI at the Department of Paediatrics, University Clinical Center Tuzla in the period from August 1, 2006 to August 1, 2007. In relation to the age, the patients were divided into two age groups: from 1 month to 2.0 years and from 2.1 years to 14 years. These groups will further be referred to as the younger and older groups. A cross-sectional study was used to analyze the biochemical examination of urine using test strips (nitrite and modified nitrite test) and the urine culture results.  Results – The described modification of the nitrite test significantly improved its sensitivity (88%) (p=0.001), NPV (96%) (p<0.0001), LR (-) (0.1) and it is more reliable than the nitrite test to exclude the existence of a UTI. The harmony between nitrite and modified nitrite (k=0.66, 95% CI: 0.56, 0.76, p<0.001) and between the modified nitrite test and the urine culture is good (k=0.79, 95% CI: 0.72, 0.87, p <0.001). Through reliability analysis of the modified nitrite test according to the age groups, we found that in the younger age group, after the modification of the nitrite test, its sensitivity was improved (83%), although not significantly (p=0.153), the NPV (94%) (p<0.0001) and LR (-) (0.2) was also improved. The harmony between the nitrite and modified nitrite test was moderate (k=0.59, 95% CI: 0.43, 0.75; p<0.001), and between the modified nitrite test and urine culture it was good (k=0.79, 95% CI: 0.61, 0.87; p<0.001). In the older age group, after the modification its sensitivity was significantly improved (93%) (p=0.001), NPV (98%) (p<0.0001); LR (-) (0.1). The harmony between the nitrite and the modified nitrite test was good (k=0.72, 95% CI: 0.60, 0.85; p<0.001), and between the modified nitrite test and the urine culture it was very good (k=0.84, 95% CI: 0.75, 0.94; p<0.001).  Conclusion – The value of the modified nitrite test is characterized by the improved reliability of the nitrite test to exclude the existence of a UTI, especially in older children, which is important for clinical practice.

An otherwise healthy, 12.5-year-old malepresented with sudden onset chest pain, wasadmitted to hospital for elevated blood pres-Panel 1Panel 2Acta Medica Academica 2011;40(1):83DOI 10.5644/ama2006-124.12sure. Physical examination showed systolicheart murmur grade 2/6 in the aortic areawith abdominal vascular murmur and normalperipheral pulses. Blood pressure waselevated: (left arm) 170/110 mmHg, (left leg)185/115 mmHg. The plasma renin activity(6.5 nmol/l/h) was elevated. Renal functionwas normal. Doppler blood flow fromboth renal arteries showed a suspected mildobstruction.

Objective – The research was undertaken with the aim of establishing the range and frequency of congenital heart disease (CHD) in children with Down syndrome (DS), who are monitored at paediatric cardiology centres in Bosnia and Herzegovina, its association with other anomalies, the time of diagnosis of DS and CHD, and to analyse their surgical care.  Patients and methods – By a cross-sectional study, data was collected on children aged from 0 to 18 years with DS and CHD who were monitored at paediatric cardiology centres of primary, secondary and tertiary health care (Banja Luka, BihaA‡, Bijeljina, Mostar, Sarajevo, Tuzla and Zenica) in Bosnia and Herzegovina.  Results – Data for 100 children (51 boys and 49 girls) of an average age of 6.1 (from 0 to 17.1) were collected and analysed. The most frequently diagnosed CHD was atrioventricular septal defect, which was found in 36% of children followed by ventricular septal defect in 33%. In 79% children the CHD was isolated and 21% had multiple heart anomalies. Associated anomalies of other systems were found in 26% of children. In only one case was an intrauterine suspicion of DS established. A statistically significant reduction in the age of post-natal diagnosis of DS and CNHD was registered. In 73% patients cardiosurgical treatment was indicated, 43% underwent surgery, 19% are waiting for surgery and in 11% pulmonary hypertension developed.  Conclusion – The range of CHD found in children with DS in Bosnia and Herzegovina does not differ from most similar research. The results obtained show that in the period in question there was insufficient prenatal diagnostics of DS and CHD. Postnatal diagnostics, although also insufficient at the beginning of the period in question, significantly improved over time, which resulted in a reduction of the age at which the diagnosis of DS and CHD was established. Moreover there was a clear reduction in the time difference between the diagnosis of DS and the diagnosis of CHD. However, the possibilities of early cardio-surgical treatment are still limited. The results should serve in drawing up a plan of prospective monitoring of these patients in Bosnia and Herzegovina in order to define better their specific health needs.