2008, Vol 4, No 4
Wheezing and asthma in early childhood – a PRACTALL consensus report
PEDIATR MED RODZ Vol 4 Numer 4, p. 227-232
ABSTRACT
Asthma is a serious global health problem, because people of all ages are affected by this illness. It was show that a one in three child has at least one episode of wheezing prior to there third birthday. That is why GINA report and other guidelines for diagnosis and treatment of wheezing in children were issued. One of them is PRACTALL consensus report as a guideline for clinical practice in Europe and in North America. In this report four different pattern of recurrent wheeze in paediatric population have been proposed: transient, nonatopic, persistent asthma and severe intermittent asthma. PRACTALL report underlying that age and triggers can be used to define different phenotypes. According to ERS TASK FORCE (2008) episodic and multiple trigger wheezes are recognized. Episodic wheeze is defined as wheeze in discrete episodes child being well between episodes. This phenotype is usually associated with viral respiratory tract infection. Among multiple triggers are different allergens, viruses, tobacco smoke. The PRACTALL report states that age is one of the strongest determinants of asthma phenotype in childhood and it is important to design diagnostic and management strategies based on age. In infants (0-2 years old) persistent symptoms is a major indicator of severity, in preschool children (3-5 years old) the asthma phenotypes are established basing the persistent wheeze during last year. If symptoms disappear between episodes of viral infections, viral asthma is the most appropriate diagnosis. In children with skin prick tests or in vitro test are positive the allergen-induced asthma should be recognized because atopy is a strong risk factor for asthma. In some children phenotype non-allergic asthma can be identified. An important risk factor for new-onset asthma in early adult life is pre-existing allergic rhinitis. Also bronchial hyperresponsiveness in non-asthmatic children at age 6 years showed increased risk asthma by 11 years.
Keywords: wheezing, asthma, viruses, phenotypes of asthma, PRACTALL report
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Allergy and respiratory tract infection in children – options for prevention and therapy
Pediatr Med rodz Vol 4 numer 4, p. 233-238
ABSTRACT
The aim of this paper is to review the relationship between the prevalence of atopic disease and exposure to respiratory infection. Mucosal inflammation in asthma is present from the beginning of the disease and is even seen in patients with allergic rhinitis predisposed to asthma. In other hand, a viral infection may be the immediate cause for an asthma exacerbation. Rhinoviruses infections are common and can be transmitted easily, leading to an asthma exacerbation. The peak of the epidemic asthma hospitalisation is synchronized with school return after the summer vacation. Children returning to school after the summer vacation are re-exposed to respiratory viral infections, most commonly rhinoviruses aetiology. The infections of the upper respiratory tract are one of the most common health problems in preschool and school children. Recurrent respiratory tract infections are demanding medical consultation and diagnosis of the causes. These infections have a lot reasons and the risk factors. Therefore it is important to administer antibiotics only in necessary cases. Specific vaccine play role in prevention of the bacterial infections. Immunostimulatory drugs presume to prevent respiratory tract infections.
Keywords: respiratory infections, atopy, allergy inflammation, immunologic process, children
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Practical aspects of prophylactic immunization in children
children, vaccinations, vaccination suitability, vaccines, adverse events following immunization
ABSTRACT
The paper discusses practical aspects of prophylactic vaccinations in Poland. Special attention was put to vaccination suitability, selection of vaccines, schedule and application methods. Active immunization in children is performed in accordance with national prophylactic immunization program, in case of epidemiological threats, additionally special vaccination actions are performed in high risk groups. Before every vaccination appropriate medical qualification should be carried out, including history, physical examination, evaluation of potential post-vaccination risks, recommendations and indications. The usage of 10-point screening pre-vaccination “Questionnaire in children and adolescents” is highly recommended. Appropriate time intervals between living vaccines applications or subsequent doses of the same vaccines should be observed. In case of repeated injections in children it is also vital to relieve pain by breast-feeing or sucrose solution during vaccine application. Local anaesthetics or painkillers can also be applied. It can be problematic for a doctor to recommend vaccinations for children suffering from allergies. It should be pointed out that only anaphylaxis to vaccine antigens or other parts of vaccine is an absolute contraindication against its usage. Children with chronic diseases should be immunized during remission periods and receive a wider than obligatory range of vaccines.
Keywords: Pediatr Med rodz Vol 4 Numer 4, p. 240-244
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Changes in the range of prophylactic immunization in children
Pediatr Med rodz Vol 4 Numer 4, p. 245-252
ABSTRACT
Vaccinations belong to the basic and most important prophylactic activities. The paper presents the latest changes in vaccination recommendations for healthy neonates and high risk groups (premature infants) as well as infant population. Considerable changes in tuberculosis immunization for developmental age population have been noted recently in Poland. According to the latest recommendations BCG vaccination should be applied once, as soon as possible after a child’s birth, yet not necessarily during the first 24 hours of life, but on a chosen day of stay in a neonate clinic. The obligation of scare after vaccination evaluation has been abolished, too. However, the duty of medical documentation control in the first year of life in order to check if BCG vaccination has been performed is obligatory. In premature neonates with the risk of serious bacterial infections, compulsory vaccinations should not be delayed, and in children without clinical problems, they should be performed in accordance with chronological age. The children from this group should also be covered by the extended program of active immunization available today in Poland. The constant threat of infectious diseases is noted in WHO reports. The latest report published in 2008 presents the groups of the most dangerous diseases which require priority preventive activities. The group includes pneumococcal and meningococcal infections, influenza and varicella. Compulsory refunded vaccinations against pneumococci for children up to the age of 5 and against varicella for children up to the age of 12 were introduced in October 2008 in Poland. One should hope that thanks to the progress in vaccinology and new vaccines implementation it will be possible to effectively protect the developmental age population against numerous diseases.
Keywords: prophylactic vaccination, neonates, premature infants, infants, children from high risk groups
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Controversy in the obesity dietary treatment
Pediatr Med rodz Vol 4 Numer 4, p. 253-256
ABSTRACT
Obesity rates are increasing in most countries throughout the world. It is estimated that more than 50% of adults population in industrial countries is overweight and the percentage of the obesity reaches up to 30% in some countries (USA, United Kingdom). This alarming tendency in also observed among children and adolescents. The obesity epidemic – the sudden and rapid increase in obesity rates has started in 1980s and continues unabated today. It became a serious public health problem. The reasons for the increase are complex and involve biological, behavioural and environmental factors, especially unsatisfied level of daily physical activity and bad food habits. So far success in long-term obesity treatment is poor and appears to require promotion of life style modification and proper eating strategies for the whole population. Popular weight-loss plans often have conflicting recommendations, which makes it difficult to determine the most healthful approach to weight loss. The outcomes of many dietary strategies in obesity are often short time lasting and weight loss is soon followed by rapid body mass gain as yo-yo effect. Therefore there is need for further researches on differences in the composition of the energy-restricted diets and on their influence on body mass reduction in long-term perspective. The authors in this paper are presenting some of the most popular dietary approaches for weight loss, pointing out the efficacy and the overall adherence rates of them, dietary quality and medical grounds for their application in the obesity therapy.
Keywords: obesity dietary treatment, energy-restricted diet, low-carbohydrate diet, author’s diet, diet guidelines in obesity
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Controversy in the obesity dietary treatment
Pediatr Med rodz Vol 4 Numer 4, p. 253-256
ABSTRACT
Obesity rates are increasing in most countries throughout the world. It is estimated that more than 50% of adults population in industrial countries is overweight and the percentage of the obesity reaches up to 30% in some countries (USA, United Kingdom). This alarming tendency in also observed among children and adolescents. The obesity epidemic – the sudden and rapid increase in obesity rates has started in 1980s and continues unabated today. It became a serious public health problem. The reasons for the increase are complex and involve biological, behavioural and environmental factors, especially unsatisfied level of daily physical activity and bad food habits. So far success in long-term obesity treatment is poor and appears to require promotion of life style modification and proper eating strategies for the whole population. Popular weight-loss plans often have conflicting recommendations, which makes it difficult to determine the most healthful approach to weight loss. The outcomes of many dietary strategies in obesity are often short time lasting and weight loss is soon followed by rapid body mass gain as yo-yo effect. Therefore there is need for further researches on differences in the composition of the energy-restricted diets and on their influence on body mass reduction in long-term perspective. The authors in this paper are presenting some of the most popular dietary approaches for weight loss, pointing out the efficacy and the overall adherence rates of them, dietary quality and medical grounds for their application in the obesity therapy.
Keywords: obesity dietary treatment, energy-restricted diet, low-carbohydrate diet, author’s diet, diet guidelines in obesity
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