Primary congenital hypothyroidism is a common preventable cause of mental retardation. Neonatal thyroid screening is highly successful in early diagnosis and the improvement of developmental prognosis in the hypothyroid neonate. However, rarely cases could be missed, so doctors must be aware of the earl symptoms and signs of hypothyroidism. Therefore, the purpose of this study was to emphasize the presenting clinical features of primary congenital hypothyroidism at the age of diagnosis. The study population included 17 children with primary congenital hypothyroidism who attended the Department of Pediatrics, University Clinical Center Tuzla between 1986 and 1999. The diagnosis of all patients was confirmed by serum thyroid function tests (T4 and TSH). Of the 17 patients 10 (58.8%) were diagnosed in the first three months of life and 3 of them (17.6%) between fourth and sixth month of life. Four children (23.5%) were diagnosed after the age of six months. In the first three months of life hypothermia, constipation, jaundice, poor feeding, hoarse cry, macroglossia and hypoactivity were the moste common symptoms. Among the 17 patients with primary congenital hypothyroidism 5 of them (29.4 %) were diagnosed to have disgenetic thyroid tissue and 12 (70.6%) as having dyshormonogenesis. TSH and T4 levels were higher in patients in whom thyroid tissue was dysgenetic as comapared with those with dyshormonogenesis but the difference was not statistically significant (p > 0.05). Now it is expected that neonatal screening program in Bosnia and Herzegovina Federation will contribute to the detection of primary congenital hypothyroidism in early days of life. However, until an effective screening test is not yet routine in whole country, paediatricians should consider the diagnosis of hypothyroidism whenever it is clinically suggested.

The aim of my study was to investigate the consequences of early institutional rearing on the mental health of a sample of children aged 8-12 years. This study was conducted between the 15111 May and the 15111 June 2003 in two institutions in Bosnia and Herzegovina. These institutions were chosen because they share the same care model. A sample of 30 children completed structured questionnaires, which had been translated from English. These were the Child Behaviour Check List-form for parents, TRF- for teachers and YSRF for youngster. I also used my own socio-demographic questionnaire, which measured other characteristics of the sample. The control group was 60 children who attended the elementary schools in Tuzla. Our research confirmed that early deprivation in an institution has a negative effect on behaviour in every day’s life. The lack of parental authority and family protection, together with suffered personal losses among close relatives, contribute to trauma of institutionalized children and diminish their invulnerability. Institutionalized children lean towards apathy, which can be a sign of emotional stress they are submitted to and point towards significant sources of deprivation in every day’s life. Mental health problems are much more represented among children in institutions. Our research confirmed that young children from institutions are a vulnerable group of people and emphasizes the need for equalization of the Bosnian care model to the European standards.

Thyroid size was estimated by ultrasound and physical examination in 480 schoolchildren (238 boys and 242 girls), 7-14 years old, living in Tuzla Canton. By physical examination goiter was found in 13.5% (n=65) of subjects. When compared with the upper limits of the reference thyroid volumes reported by WHO and ICCIDD, goiter by ultrasonography was found in 12.9% (n=62) of all subjects. All goitrous children had a diffuse goiter. The differences in mean thyroid volumes between groups with and without goiter detected by physical examination were significant in all age groups (p<0.05). The results of ultrasound examinations correlate well with palpatory findings and show higher values for the thyroid volume in children with goiter. It generally confirms the values of the findings by palpation, even in areas with mild iodine deficiency.

The objective of the present study was to determine median age at menarche and the influence of familial instability on maturation. The sample included 7047 girls between the ages of 9 and 17 years from Tuzla Canton. The girls were divided into two groups. Group A (N=5230) comprised girls who lived in families free of strong traumatic events. Group B (N=1817) included girls whose family dysfunction exposed them to prolonged distress. Probit analysis was performed to estimate mean menarcheal age using the Probit procedure of SAS package. The mean menarcheal age calculated by probit analysis for all the girls studied was 13.07 years. In girls from dysfunctional families a very clear shift toward earlier maturation was observed. The mean age at menarche for group B was 13.0 years, which was significantly lower that that for group A, 13.11 years (t=2.92, P<0.01). The results surveyed here lead to the conclusion that girls from dysfunctional families mature not later but even earlier than girls from normal families. This supports the hypothesis that stressful childhood life events accelerate maturation of girls.

A study of the age at menarche was conducted in Tuzla Canton on a sample which included 7047 girls between the ages of 9 and 17 years. Data were collected using thc status quo method. Median age at menarche estimated by Probit analysis was 13.07±0,05 years with a standard deviation of 1,05 years. Girls in rural places had a delay in their menstruation, with a mean age at menarche of 13,19 years, compared to those who lived in urban places, with a mean age at menarche of 12,84 years (P < 0.0001). As no previous Information is available about the age at menarche in Tuzla Canton, the present results will afford a basis for future studies which should aim at analyzing the secular trend in menarche while attempting to define the differences between the various socio-economic levels.

This paper revives present knowledge on disorders induced by iodine deficiency. The Recommended Dietary Allowance of iodine is 50 /µg/day from 0 to 12 months, 90 /µg/day from 1 to 6 years, 120 /µg/day from 7 to 12 years, 150 /µg/day during adolescence and adulthood and 200 /µg/day during pregnancy and lactation. When the physiological requirements of iodine are not met in a given population, a series of functional and developmental abnormalities occur in ali ages, which are grouped under the general heading of iodine deficiency disorders among that goiter is only the visible “top of the iceberg”. Iodine deficiency is the leading cause of preventable mental retardation and neurointellectual deficits in schoolchildren. One of very important of health consequence of iodine deficiency is an elevated thyroid uptake of radioiodine that aggravates the risk of thyroid cancer in case of a nuclear accident. In addition to health problems, iodine deficiency has a negative impact on domestic animals, resulting in a reduction of productivity with negative economic consequences. As a solution for these disorders the most logical approach is the introduction of iodine prophylaxis that public health care aspects include the planning and monitoring of prophylactic campaigns, the technical aspects of production and distribution of iodised salt and the other methods of iodine prophylaxis. The last recommendation by WHO-UNICEF-ICCIDD is that, in order to provide 150 /zg/day of iodine via iodised salt and considering the average salt intake and the loss of iodine from production site to the household and cooking, the iodine concentration in salt at the site of production should range between 20 to 40 mg of iodine per kilogram of salt.

In the paper it was identified firstly the short stature, then importance of anamnesis, physical examination, anthropometric measurements and calculated parameters of growth. Then followed the classification of causes for short stature with a specific review on differentiation of normal from pathologic variants. Further in the text it was pointed out the importance of observing normal variants of short stature since between 84% and 87% children are with height under the 3rd percentile. Then followed tables showing pathologic causes of the short stature, and then diagnostic and therapeutic approach to the child with proportionately short stature and short stature associated with dysmorphic features.