Zijo Begic

Mitral valve replacement in a patient with infective endocarditis and aneurysm of the cerebral artery: a case report.

OBJECTIVE Endocarditis can have profound and devastating neurological consequences, with the vast majority of these complications in patients with left-sided valvular disease. The approach to the acute management of stroke in children with infective endocarditis is limited by the inadequacy of published data on their clinical course and outcome. CASE REPORT This case report presents a 12 year old girl with diagnosed endocarditis, complicated with intracranial hemorrhage, due to the rupture of an aneurysm of the peripheral branch medial cerebral artery and gradient therapeutic approach, with an excellent final result. CONCLUSION Congestive heart failure resulting from valvular insufficiency required mitral valve replacement, after cerebral aneurysm clipping.

Pulmonary Hypertension – New Trends of Diagnostic and Therapy -

Pulmonary hypertension is a pathophysiological state hemodynamically defined as the increase of the mean pulmonary arterial pressure above 25, or 30 mmHg at rest, measured by catheterization of the right heart. Laboratory findings usually reveals polycythemia, the ECG right ventricle hypertrophy, and x-ray characteristic of diseased branches (echocardiography and biomarkers such as B-type natriuretic peptide (BNP) and N-terminal pro-BNP hormones are potentially helpful tools in identifying PH). Echocardiography can be found the increase of the right atrium and ventricle, right ventricular hypertrophy, abnormal contraction of the interventricular septum, left ventricular diastolic dysfunction and decreased left ventricular size, with reduced volumes of systole and end diastole. Doppler confirming tricuspid regurgitation. Pharmacological therapy would represent a use: Calcium Channel Blockers, Prostacyclin Analogues, Endothelin Receptor Antagonists and Phosphodiesterase-5 Inhibitors. Alpha adrenergic antagonists, endothelial receptor subtype A (Bosentan, Tracller) with treatment of the underlying disease or anticongestive therapy, are recommended. In case of inadequate response to treatment with a specific drug, guidelines recommend the combined use of drugs from the basic three groups, using their synergism.

Software for acid-base status disorders management

Normal acid-base status represents the value of hydrogen ions in extracellular fluid is within pH range of 7.36 (44 nmol/L) and 7.44 (36 nmol/L). Acid-base balance disorders may be a result of enhancement or reduction in amount of hydrogen ions, and include four basic disorders: metabolic and respiratory acidosis, metabolic and respiratory alkalosis. First step implies diagnosing the type of acid-base status disorder. The application input consists of blood analysis data and body weight info. Next step is determining the significance of the disorder and finally recommending future treatment. Software offers the optional functionality of entering mineral level values to improve treatment recommendations. Following the latest trends, along with the aim of increasing availability and mobility of the system, the software is developed for the Android platform using the Java programming language.

In Memoriam: Prof Smail Zubcevic, MD, PhD (1958-2017)

Th ere are moments when you get caught and surprised, and when you do not realize that something has happened. First, you do not believe it because it is not meaningful and it is not fair, but then, you become aware that there is something beyond that you’re not able to control. I guess destiny, as a warning, you should recognize. Two nights ago, the heart of our Smajo stopped knocking. Th ey say easy death has to be earned, but nevertheless it was premature. Smail Zubcevic was born on 12th April 1958 in Sarajevo, where he fi nished Primary school and “Second Gymnasium‘, with the Music High School and after that Faculty of Medicine in 1984. He then worked at the Clinical Center University of Sarajevo, on Clinic for Neurosurgery, after that in “Vogosca Health Center”, and from 1989 he started to work at the Pediatric Clinic where he was working for almost three decades. In 1996 he completed his specialization in Pediatrics, and from 1996 to 1999. he was on subspecialization in Neuropathy, Epileptology and Clinical electroencephalography. During 1997 1999 he stayed in Gent (Belgium), Charleston (South Carolina), Italy, Austria and Slovenia for education in the fi eld of Neuropediatrics. Master’s thesis “Prophylactic treatment of febrile convulsions with diazepam or phenobarbital” (1997-2001) and doctoral thesis “Incidence of epilepsy in pediatric population” (2001-2006), with papers mostly in the fi eld of Neuropediatrics (over 150 papers, fi rst author or co-author, about twenty books, author of books or chapters) ranked him into a group of leading neuropediatricians in Europe. He is the founder and president of the Society of children’s neurologist of Bosnia and Herzegovina as well as a member of the European Paediatric Neurology Society, the American Academy for Cerebral Palsy and Developmental Medicine as well as the European Academy of Childhood Disability. He was also the organizer of numerous meetings and seminars, both domestic and international, coordinator of the Tempus Phare project, projects of the Federal Ministry for Neuropediatric Treatment as well as vaccination of children. For the past two years, he was also a professor of Pediatrics at the Faculty of Medicine and Faculty of Dentistry of the University of Sarajevo. It is little known that he completed two years of English Language and Literature at the Faculty of Philosophy of the University of Sarajevo in 1982 and that in the recent war he was the commander of sanitary troops of the Army of the Republic of Bosnia and Herzegovina. All education, excellent knowledge of English language and excellent comprehension of information technology with continuous work led to a respectable knowledge and status. His modesty never emphasized all of the above mentioned abilities and achievements, and his simplicity probably did not apostrophe it as it is commonplace today. Character of non-aggression classifi ed him in the group of scientifi c workers par excellence and prominent intellectuals. Even his closest, wife Nadja, daughters Esma and Naida, mother Behija and brother Semir, and other relatives, many friends, colleagues and medical workers, did not know and are still unaware of what he did for them and for the society. We knew him as a man ready to accept new things, with an attitude, sometimes loud one, especially when patient was concerned. He was professional to the core, with a great deal of criticism and self-criticism. Th ere are two things we hardly accept. First of all as ones who were close to him, we really did not know him as much, how much we know each other, and second we are still not trying to correct generation frustration of over-indulgence and consumption, bad affi rmation, devastating war and with a lot of work without adequate satisfaction. It is hard to cope with the loss of a friend, a professor, a teacher, a humanist, an intellectual, a father, a son, a husband... It is diffi cult to handle the loss of our Smajo and make this loss at least a little bit smaller with these words...

Clinical Course and Treatment of Dilated Cardiomyopathy During Twenty Years of Follow-up

Objective Demonstration of idiopathic dilated cardiomyopathy with unusual flow, unpredictable clinical picture and complex therapy. Case report Patient A.P., female, 38 years old, had symptoms of dilated cardiomyopathy (with possible infectious myocarditis in the background) at age 17. After hospitalization for ten months and ten days, while waiting for heart transplantation (with threatening death outcome), without a clearly pronounced threatening arrhythmia, but with a low ejection fraction and a poor general condition, remission occurred. The therapy focused primarily on the treatment of heart failure, prevention of arrhythmia and thromboembolism. Normalization of the disease by improving the function of the left ventricle (expected in 16% of patients) occurred and lasted for 4 years, followed by an exacerbation of the disease that lasted for two years. In the next few years the patient was stable, had a first child with normal pregnancy. During the second trimester of the second pregnancy, there was an exacerbation (postpartum dilatation cardiomyopathy) lasting for couple of months. At the time of case report (May 2017), the patient is stable on therapy (ACE inhibitor, beta blocker, diuretics, If channel blocker), without limitation of physical capacity, mother of two children, unemployed. Conclusion The clinical course of dilated cardiomyopathy is extremely unpredictable and therapy is very complex and demanding.

Tetralogy of Fallot - Clinical Course and Treatment as a Mirror of Contemporary Cardiology/Cardiac Surgery Development in Correction of Congenital Heart Disease in the Adults

Aim: The aim of this paper was to present a 65 year old female patient with chronic heart disease, surgically treated for congenital heart defect type Tetralogy of Fallot. Case report: In the sixth year of life the patient underwent palliative Potts anastomosis surgery which created an anastomosis between the left pulmonary artery and the descending aorta. Total correction was made in 34 years of life, six months after catheterization, which indicated malignant pulmonary hypertension. She is regularly followed up by the cardiologists and receives daily therapy. The present state of the patient is satisfactory with cardiomegaly, light left ventricular dysfunction, moderate mitral and tricuspid regurgitation, pulmonary arterial hypertension, and aneurysmatic dilatation of left pulmonary artery as well as atrial fibrillation. Conclusion: The intense development of cardiology and cardiac surgery in the USA in children and adults over the last fifty years has led to the extension and improvement of the quality of life.

Pediatric Cardiac Anamnesis: Prevention of Additional Diagnostic Tests

Pediatrics is defined as the science of a healthy and sick child from birth to end of adolescence. Diseases of the cardiovascular system are the leading causes of mortality in adults, with frequent onset in childhood. The cardiologic examination starts with anamnesis in a pleasant atmosphere, refined space, enough time and patience, detailed measurements, and preferably a noncrying child. Anamnesis, regardless of the development of diagnostic procedures, still constitutes the basis of every clinical examination. The basic characteristics of pediatric cardiac anamnesis are comprehensiveness, that is, details, clarity, concurrency, and chronology. Proper and conscientiously taken anamnesis with a thorough clinical examination of a sick child is a solid protection against dehumanizing the relationship between a physician and patient. Pediatric cardiac anamnesis can be variable, completely negative, but very rich. Anamnesis should, first of all, clarify whether only a child is sick or it is perceived like that be his or her environment. Preschool and school-age children are normally attending anamnesis. High-quality, comprehensive medical history can keep the patient at one level of health care, with a strict focus primarily on the diagnostic processes, reduce crowds in specialist and subspecialist institutions, and make economic savings. A large number of patients in specialist and subspecialist clinics can be reduced by proper screening and by developing primary health-care system (from the local health-care center). Taking patients medical history with thoroughness has a strong educative character for young doctors at the beginning of their careers.

Antihypertensive therapy dosage calculator

Hypertension is defined as values ≥140mmHg systolic blood pressure and/or ≥90 mmHg diastolic blood pressure. Pharmacological and non-pharmacological therapy is used in treatment of hypertension. Non-pharmacological therapy (lifestyle changes) is extremely important and represents the foundation for the treatment of hypertension. Pharmacological therapy refers to the administration of antihypertensive drugs, which, however, includes a large group of drugs. In internist everyday practice, in revisions of patients therapy, and in the work of physicians, family medicine specialist, on a daily basis a need for modification of therapy occurs (primarily due to unregulated pressure, then due to side effects that can happen in use of certain treatment, or because of drug interactions, which can lead to poor quality of treatment). In this modification of therapy or switching one drug to another there is a need for knowledge of equivalence doses of certain drugs. Individualization of therapy for the patient is a trend that will certainly in future even more come to the fore. Number of mobile clinical decision support systems is on the rise due to availability and ease of use. The antihypertensive therapy dosage calculator would be modeled as a cross platform mobile application targeting the two predominant mobile platforms, iOS and Android.

Accidental Heart Murmurs

Introduction: Accidental murmurs occur in anatomically and physiologically normal heart. Accidental (innocent) murmurs have their own clearly defined clinical characteristics (asymptomatic, they require minimal follow-up care). Aim: To point out the significance of auscultation of the heart in the differentiation of heart murmurs and show clinical characteristics of accidental heart murmurs. Material and methods: Article presents review of literature which deals with the issue of accidental heart murmurs in the pediatric cardiology. Results: In the group of accidental murmurs we include classic vibratory parasternal-precordial Stills murmur, pulmonary ejection murmur, the systolic murmur of pulmonary flow in neonates, venous hum, carotid bruit, Potaine murmur, benign cephalic murmur and mammary souffle. Conclusion: Accidental heart murmurs are revealed by auscultation in over 50% of children and youth, with a peak occurrence between 3-6 years or 8-12 years of life. Reducing the frequency of murmurs in the later period can be related to poor conduction of the murmur, although the disappearance of murmur in principle is not expected. It is the most common reason of cardiac treatment of the child, and is a common cause of unreasonable concern of parents.

Productive Cough in Children and Adolescents - View from Primary Health Care System

Cough is one of the most common symptoms that doctor faces in working with pediatric population, and according to some characteristics of cough, doctors can often conclude localization, and sometimes even the nature of the disease that causes it. Cough is not only the physiological defense reaction, but a symptom of a disease. According to duration it can be acute, chronic and recidivist, recurrent and persistent, strong or discreet, caused by changes in body position and changes in outside temperature. Pathoanatomically it is divided into lobar, lobular, alveolar and interstitial, pathogenetically to bronchogenic and hematogenous, as well as in immuno competent and immunocompromised, and clinically on the local and inpatient (72 hours after hospital admission). Considering the contents, cough can be productive–with secretion from the respiratory tract, and unproductive-dry, without secretion. By auscultation bronchial breathing, rattle and crepitus can be heard. The primary diagnostics is radiological, posterior to anterior (P-A) and lateral footage of the chest. Laboratory findings in typical pneumonia, are characterized by leukocytosis, neutrophilia and shift of blood image to the left. Sedimentation is accelerated and C-reactive protein is elevated. The basic bacteriological diagnosis is sputum Gram’s stain and culture of sputum. In atypical pneumonia, leukocytes are usually in the normal range, and it is necessary to do serological tests (IgM and IgG antibodies). The role of doctors in primary health care is auscultation differentiation of murmurs with confirmation of doubt if there is pathological findings by laboratory tests and treatment, depending on the type of cough. Treatment is essentially pharmacological, with irrefutable importance of non-pharmacological measures.