Efficacy of nebulized hypertonic saline versus normal saline in the treatment of acute bronchiolitis in inpatient infants

Aim Compare the efficacy of nebulized hypertonic saline and normal saline in the treatment of infants hospitalized for bronchiolitis. Methods This retrospective study was conducted at the Department of Pulmonology, Paediatric Clinic, Clinical Centre University of Sarajevo, covering the period from January 2015 to December 2019 and comprising 380 children aged between 1 and 12 months having bronchiolitis. One group received nebulized hypertonic saline (NHS, 3% NaCl)), and another group received nebulized normal saline (NNS, 0.9% NaCl). The control group did not receive any of these treatment options. Results There was no statistically significant difference between the treatment groups regarding length of hospital stay (LOS) and Clinical Severity Score (CSS) at admission and discharge as well as in oxygen therapy duration and antibiotic use, the duration of symptoms before hospital admission, frequency of nasal discharge, elevated temperature, dyspnoea, cough and dehydration. Conclusion The results of this study are consistent with several recent studies or meta-analyses and support the evidence against the use of NHS in hospitalized infants with mild or moderate bronchiolitis.

Incidence of asthma in children in Tuzla Canton--Bosnia and Herzegovina

Asthma is one of the most common chronic diseases whose incidence shows constant growth in childhood. The objective of this work was to look into asthma incidence in children in relation to their age group and sex in a retrospective study, at Tuzla Canton area. The study comprised children of both sexes, age 0-14 who fell sick with asthma within the period from January 1st 2003 to December 31st 2007. The overall incidence and the incidence in relation to age group and sex was calculated as the number of children suffering from asthma, within the age group 0-14 years per 1000 children of the same age group in the Tuzla Canton. Asthma was diagnosed in 277 children (66.1% male and 33.9% female). The difference between asthma frequency in boys and girls was significant (chi2 = 56.16; df = 1; p < 0.0001). The average difference in proportion between the boys and girls was 32.2% (95% CI = 24.32-40.08). From this sample group the boys had a 3.8 times greater risk (OR = 3.79; %95 CI = 2.67-5.39) of contracting asthma. The average rate of incidence of asthma for both sexes in the observed period was 0.67/1000 (95% CI; 0.6-0.7; for boys 0.86/1000; for girls 0.47/1000). There was a statistically significantly higher incidence of asthma in boys in relation to girls (t = 6.3836, df = 32; p < 0.0001). The epidemiological data obtained could be useful for early detection and adequate treatment of children with asthma in the mentioned area.

Lipoprotein lipase gene polymorphism and lipid profile in patients with hypertriglyceridemia

AIM

To assess lipid profile and the genotype distribution of lipoprotein lipase gene polymorphism at Pvu II polymorphic site within the intron between exons 6 and 7 in patients with hypertriglyceridemia.

METHODS

Pvu II polymorphism was determined in 116 hypertriglyceridemic patients and 50 normolipidemic controls from Zagreb, Croatia. DNA was extracted from peripheral blood mononuclear cells. Polymerase chain reaction was used for amplification of 6th intron, which was then restricted with Pvu II-restriction endonuclease. Serum lipid and lipoprotein fractions were determined by standard enzymatic methods. Cholesterol concentrations in HDL subfractions, HDL2 and HDL3, were determined after precipitation with polyethyleneglycol. Apolipoproteins (apo) A-I and B were determined by immunonephelometry.

RESULTS

Triglycerides showed a positive correlation with total cholesterol (r=0.222, 95% CI=0.041-0.389, p=0.017) and inverse correlation with HDL-cholesterol (r= -0.278, 95% CI= -0.449 to -0.088, p=0.005), especially with HDL3-cholesterol (r= -0.333, 95% CI= -0.497 to -0.147, p=0.001). The respective frequencies for genotypes /, +/, and +/+ were 22, 58, and 36 in the patient group, and 17, 17, and 16 in the control group. Serum triglycerides in the patient group, expressed as median in mmol/L, were 3.30 (range, 2.60-10.90), 3.60 (range, 2.50-21.50), and 3.99 (range, 2.50-15.56), respectively. Serum concentration of triglycerides differed significantly between the +/+ and / genotype (p=0.043).

CONCLUSION

There is an association between genetic variation at the locus for lipoprotein lipase and high serum triglyceride levels. This might prove useful in the detection of individuals susceptible to the development of hypertriglyceridemia, as well as a marker in the analysis of this genetic defect in patient families.

[Evidence law in health care, development of a health care information system and use of automatic processing of information]

The aim of work is to analyse the state of health-statistic and information system within the Federation of Bosnia and Herzegovina, analyse the Program on health statistic research important for the entire country, analyse the Law on records in the field of health and present how deficient it is, as well as to propose the set of other data, based on our own research, that could fill noticed defects in the practice, provide the use of computer technology in data tracking from the Law on issued records in the field of health within the activity as an example for others--health statistic sheet, form 3-21-61/A, and to present further possibilities and recommendations for development of health information system. The used method of work is descriptive analysis of methodological approach to the health statistic information system of Bosnia and Herzegovina (taken from the former Yugoslavia). We have also applied the data from the statistic records (retrospective analysis) of the registered cases from the neurological ward of the Neurological Clinic Tuzla for December 1997. In such a way we formed the data base and presented the statistic data processing ideological project including modern computer technologies.

[Experience in the development of information systems at the canton level]

In the aim of need and necessity of stronger orientation and more efficient aim realization 35 Strategy SZO (health information system) country members should have the health information system able to provide information support to their National strategy "Health for All until 2005". Such a health information system should provide the information support for the planning process, monitoring and health evaluation, health care and work in public-health services sector. The experiences in the work of information system organization in Tuzla Canton Public Health Institute should be seen from two aspects: Aspect of the information system significance in the framework of the social-medical, epidemiological, hygiene-ecological and other activities of the Institute; Aspect of the information system development within the Public Health facilities of Canton in relation to the automatic data processing important for registration, tracking and recognition of success and population health care needs. From the aspect of establishing the information system in the area of Tuzla Canton and the Public Health Institute role, there is a need for adequate high technology technical equipment, with the task to enable practical realization of defined projects and in such a way, varied acceleration of work giving as a result usable information. The canton Public Health Institute needs as follows: necessary resources for free information system work; to provide free computer access to all; to ensure connection with other PHI through communications. In this way the canton Public Health Institute information system would be connected with other information systems in the field of health. In would be a base for development of integrated health information system. The information system is desirable aim for the work of Public Health Institute, method of selection and leading content of modernization. Analysing the Bill of Law on Health Care, a defectiveness has been noticed, since the information system is not regulated. Therefore, the need to be issued by Lay is of great importance. A statement that all projects on local information systems, started before war or during the war have been stooped, joins to the aforesaid, and also a series of independent information system in different health segments, which are not connected into one, unique information system. In any case, this disparaged the quality of medical decision making and therefore, providing of high-quality services at all levels of health work.

[TORCH infections in mothers as a cause of neonatal morbidity]

When possible, diseases by expectant mothers and newborns, like long-term disabilities also, should be prevented by establishing early diagnoses, evaluation and implementation adequate therapy. The major goal of medical care is prevention of disorders with provision of adequate prenatal care for the expectant mother and precautions regarding the exposure to teratogenic infections. The range of pathological conditions produced by infections agents is wide, and the difference between maternal and fetal effects caused by any one agent is also important. Some maternal infections, especially during the early gestation, can result in fetal loss or malformation because the ability of the fetus to resist infectious organisms is limited and the fetal immunologic system is unable to prevent the disemination of infectious organisms to the various tissues. These infections are responsible for significant congenital neonatal morbidity as for as compromises a child's quality of life and infertility and sterility. One group of microbial agents--generally known as TORCH infections can cause remarkably similar manifestations, and is uncommon to test all when a prenatal infection is suspected. We analysed the practice of TORCH analyses with our patients and their mothers during last year (1999th) at the Pediatric Clinic and Clinic of Gynecology and Obstetrition-UCC Tuzla. At this time there were 5.028 deliveries. Out of short figure 544 or 10.8% newborns were early born and 245 or 4.8% were hypotrophic and 62 were still-born or 12.3 from 1000 deliveries. TORCH infection was analysed only in few cases. In the same period there were 3.457 children treated at the Pediatric Clinic in Tuzla. Only in 20 cases or 0.58% TORCH was made. Three or 15% were with remarkable sequeles like microcephaly, cerebrospinal liquid abnormality, seizures, hepatomegaly, cirrosis etc. TORCH analysis was made with all mothers. Only one was serologic CMV positive and we started with the therapy. History of four mothers or 20% have data about spontaneous abortions, and in other four or 20% we found data about early deliveries. The prevention of conatal infections was not made by any one. In our small group we made TORCH because of evident problems that were suspected of conatal infections. We concluded that there is a big risk of untreated maternal infections with women in fertile age in Bosnia and Herzegovina. This problem is not enough present in our medical practice.

Contact allergy and psoriasis

The study was conducted over a two-year period and included 48 psoriatic patients with palmar and plantar lesions and 61 psoriatic patients without palmar and plantar lesions who served as controls. The objective was to establish the incidence of contact sensitization and its importance as the causative factor in palmar and plantar psoriasis. The most frequent contact allergens were: nickel sulphate, mercapto mix, balsam of Peru, potassium dichromate, mercury mix and fragrance mix. Patch tests were positive in 41.7% psoriatics with palmar-plantar psoriasis and in only 6.6% of psoriatics without palmar-plantar involvement. The study showed an increased incidence of contact allergy in patients with palmar-plantar psoriasis.