2009, Vol 5, No 1
Probiotics and prebiotics in gastrointestinal diseases in children
Pediatr Med rodz Vol 5 Numer 1, p. 16-22
ABSTRACT

Probiotics are viable microorganisms which being consumed in a proper dose exert beneficial effects on the host. Lactic acid bacteria Lactobacillus and Bifidobacterium and selected strains of Streptococcus, Bacillus, yeast Saccharomyces boulardii are most frequently used as probiotics. Dependently on the strain and the dose probiotic bacteria restore natural properly functioning system of intestinal flora, inhibit the development of numerous pathogenic microorganisms, alleviate the course and shorten the duration of bacterial and viral diarrhoea, prevent the occurrence or relieve antibiotic-associated diarrhoea, eliminate or diminish the symptoms of lactose intolerance as well as normalize intestinal motor activity disorders. Prebiotics are substances contained in food (or added to it) which selectively stimulate the growth and/or activity of some strains of probiotic bacteria found in the alimentary tract. Prebiotics improve the content of intestinal biocenosis, intestinal motor activity, regression of clinical symptoms of intestinal inflammatory diseases and have a beneficial effect on intestinal epithelial cells nourishment by stimulation and creation of conditions for the growth of probiotic strains. Probiotics, prebiotics as well as their combination – synbiotics improve in a natural way by multidirectional therapeutic effect of viable bacterial cultures, our health condition, contribute to pharmacological therapy and are more and more important in modern medicine. The study presents the share of probiotics and prebiotics in the formation of alimentary tract biocenosis and their application in the prophylaxis and treatment of selected gastrointestinal diseases.

Keywords: probiotics, prebiotics, intestinal microflora, digestive tract diseases, children
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When cow's milk can be introduced to the diet of the infant and young children?
Pediatr Med rodz Vol 5 Numer 1, p. 23-26
ABSTRACT

Exclusive breastfeeding in the early infancy, continued partial breastfeeding and timely transition to the only selected foods are reported in nonhuman primate infants. In humans there is growing body of evidence about short- and long-term consequences of feeding practices in the first years of life. Young child must be fed and decisions must be made about how this should be done. Cow’s milk and milk-derived products constitute a significant part of the Polish diet. The feeding of cow’s milk to infants has undesirable consequences in several areas, like iron deficiency, food allergy, high renal solute load and the risk of severe dehydration, autoimmunity, obesity, and displacement of breast-milk or formula consumption. Faced with a parent asking at what age the whole cow’s milk and milk products can be introduced to the diet, the GP or paediatrician has to integrate a reasonable schedule based on pathophysiological and epidemiological data mixed with evidence-based consensuses and expert guidelines. In this article a review of the evidence and guidelines data for the timing of the introduction of whole cow’s milk and use of skimmed milk is presented. Professionals who make decisions regarding feeding of infants and young children have to consider multiple variables. Further studies are now warranted to examine a broader range of feeding patterns to obtain the empirical information that will be needed to establish appropriate cow’s milk feeding recommendations and also to ensure decreased risk of allergy and iron deficiency development, as well as minimum displacement of breast-milk consumption. Conclusions: 1) When whole cow’s milk is introduced a sufficient iron intake should be secured. Experts from Poland and most other countries recommended introduction of cow’s milk not before the age of 12 months. 2) Cow’s milk with a reduced fat content may be an acceptable alternative for children between 12 months and 3 years with clearly recognised indications. 3) A huge intake of cow’s milk (in so called milkaholics) disturbs diversification of the diet.

Keywords: cow’s milk, infant formula, milk-derived products, reduced fat content, complementary foods, nutrition
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Risk factors of chronic obstructive pulmonary disease in hospitalised patients
Pediatr Med rodz Vol 5 Numer 1, p. 27-32
ABSTRACT

COPD is currently one of the most important health problems all over the world. The most frequent factor responsible for COPD development is smoking of cigarettes, both active and passive. Other reasons influencing COPD development are occupational exposure to dust, chemical substances, irritant gases. The risk factor is congenital deficiency of α1-antitrypsin (genetic factor). The aim of the paper was to analyse any risk factors influencing development of COPD. The study was performed in 200 people with diagnosed COPD treated between 2005 and 2007. A patient medical history based on a questionnaire prepared for the study was performed in all patients. The study results then underwent statistical analysis. Of the subjects 124 (62%) were males and 76 (38%) were females. Mean age of the males – 66.1 years and of the females – 66.4 years. The main risk factor of the disease in the group studied was cigarette smoking – found in 170 patients (85%), from them 37.5% were current smokers, 47.5% were former smokers. Smoking history of current and former smokers averaged 42 pack-years (range 1-160). COPD was also found in 30 lifelong non-smokers (15%). Exposure to passive smoking at work and/or at home was observed in 175 people (87.5%). The inhalation of hazardous substances in the work environment was reported in 150 of the people studied (75%). Due to the fact that the smoking habit is very frequently found among COPD patients, it seems necessary to intensify actions taken to spread knowledge regarding COPD’s causes and effects, increase anti-smoking education and implement cheap and effective test screening methods.

Keywords: COPD, risk factors, cigarette smoking, occupational exposure, anti-smoking education
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Dependence between environmental factors and Helicobacter pylori infection in children
Pediatr Med rodz Vol 5 Numer 1, p. 33-36
ABSTRACT

Introduction: Helicobacter pylori (H. pylori) infection is a world problem. It occurs in children and adults and concerns half population of the whole world and the number of the infected increases on the average by 0.5-1.0% a year. Epidemiologic data related to H. pylori infection in children differ dependently on the country they come from. In literature there is a consensus of opinions as regards the increase of the prevalence of the infection with age. The influence of socioeconomic and hygienic conditions on the prevalence of H. pylori infection has been emphasized. Aim of this study was evaluation of environmental conditions and hygienic habits of children with H. pylori infection. Clinical material: Three hundred and two children, aged 1-18 years (mean 10.1) from Piotrków Trybunalski. Methods: Serum level of anti-H. pylori antibodies IgG class was assessed with ELISA. A questionnaire concerning the socioeconomic conditions of the child’s family, hygienic habits. Results: H. pylori infection was diagnosed in 37% children. Living and sanitary conditions were similar in both groups, but in the H. pylori-negative group the metric area per person was significantly larger. In H. pylori-seropositive children a greater number of adult household members was observed and more families lacking money for covering the cost of living. Infected children significantly less frequently washed their hands before meals, after returning home, using toilet, contact with animals and more frequently ate unwashed fruit, and in this group children used someone else’s toothbrushes. Conclusions: In the families of children with H. pylori infection worse socioeconomic conditions were observed and these children had bad hygienic habits.

Keywords: Helicobacter pylori, children, environmental conditions, socioeconomic condition, hygienic habits
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Nocturia and daytime urinary incontinence in children with detrusor pseudohyperactivity syndrome and constipations
Pediatr Med rodz Vol 5 Numer 1, p. 37-42
ABSTRACT

The aim of study was the evaluation of dependencies occurring urinary incontinence in children with chronic constipations. Material and methods: Examinations were conducted on 45 children aged between 6 and 13, including 20 girls and 25 boys, staying in the Clinic because of nocturia and daytime urinary incontinence coexisting with chronic constipations. In all children a complex diagnostic of lower alimentary tract segment and urinary system with evaluation of space behind the bladder in ultrasonography (USG) examination were performed. Also, 3 day evaluation of frequency and volume of each portion of urine, as well as urodynamic examination were performed. Results: The examinations of urinary system in all examined children did not reveal marks of infection nor coexisting urinary system anomalies and the performed USG examination revealed the pressure of overflown rectal ampulla on the rear wall of the urinary bladder of various degree. Urodynamical examinations revealed decrease of the tenesmus feel threshold during the filling of the urinary bladder. This phenomenon had a firm connection with the release of small portions of urine by children. Emptying of bowel from retenting faeces masses, diet correction and faeces loosening medications, as well as applied prokinetical medications, caused regression of constipations and nocturia and daytime urinary incontinence, which influenced the gradual increase of volume of passed urine portions. Conclusions: In the analysis of urine passing disorders in children the chronic habitual stool constipation should be taken into account. In the therapeutical management of some types of nocturia and daytime urinary incontinence (detrusor pseudohyperactivity syndrome) in children, a treatment of chronic constipation should be applied first of all.

Keywords: nocturia, daytime urinary incontinence, encopresis, constipations, pseudohyperactivity detrusor syndrome
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Congenital familial long QT syndrome - diagnostic problems
Pediatr Med rodz Vol 5 Numer 1, p. 43-49
ABSTRACT

Congenital long QT syndrome (LQTS) is characterized by prolongation of the QT interval and T wave abnormalities on electrocardiogram (ECG). The prolongation of QT interval (manifestation of prolongation of ventricular repolarization) predisposes to syncope, seizure and sudden cardiac death due to typical polymorphic ventricular tachycardia torsade de pointes or ventricular fibrillation. Long QT syndrome may associate with deafness as Jervell and Lange-Nielsen syndrome, described in 1957, which is very rare and later described Romano-Ward syndrome without deafness affecting 1 in 2500-5000 persons. LQTS is hereditary disorder, genetically heterogeneous, caused by mutations in specific cardiac ion channel genes. The most prevalent form of LQTS is LQT1 with mutation on KCNQ1 gene encoding cardiac potassium IKs channel protein. The result of the mutation is incorrect function of the channel. Genetic tests are important for identification of a mutation. Diagnosis of long QT syndrome may be difficult and sometimes we need several recorded electrocardiograms to find QT interval prolongation. The Schwartz and Moss clinical criteria may be steel useful for LQTS diagnosis. Beta-blockers are effective in patients with long QT syndrome and should be administered at diagnosis. Patients should avoid as physical and emotional stresses, as drugs prolonged corrected QT interval. It is necessary to examine the family members. We present a patient with genetically documented familiar LQT1 syndrome. Diagnostic problems, symptoms and therapy are discussed.

Keywords: LQT1 syndrome, electrocardiographic diagnosis, molecular tests, familiar mutation, treatment
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Various clinical manifestations of Mycoplasma pneumoniae infections
Pediatr Med rodz Vol 5 Numer 1, p. 50-55
ABSTRACT

Mycoplasma pneumoniae was first isolated over 100 years ago. There are intensive researches on this atypical pathogen causing various diseases at humans, lasting for over 50 years. Progress of serological diagnostic possibilities, increasing sensitivity and specificity, influences various results of epidemiological researches. It allows recognition of MP infections in course of diseases previously not connected with atypical bacteria and it allows also to prove influence MP infections on classical pulmonary diseases. MP infections affect both children and adults. Mycoplasmatic infections do not respond to classical antibacterial treatment, intracellular drugs like macrolides bring treatment effect. Contact with MP bacteria is quite common, mostly non-symptomatic. Diseases caused by MP classically give respiratory tract symptoms and are easy to recognize, but there always is a possibility of appearance of extrarespiratory signs of Mycoplasma pneumoniae infections. Mostly they are mild, but they can appear as skin symptoms, motor system symptoms, such as erythema nodosum, erythema multiforme, infectious arthritis and others like examples described in the article. Nervous system and hematopoietic system signs are less common. There where also diagnosed acute pancreatitis, hepatitis, pericarditis and peritonitis. The last one can be caused by MP in patients with immunological deficiency.

Keywords: atypical pneumonia, infectious arthritis, erythema nodosum, erythema multiforme, mycoplasmatic infection
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Visceral larva migrans syndrome in a 3-year-old boy
Pediatr Med rodz Vol 5 Numer 1, p. 56-59
ABSTRACT

Toxocariasis is an infection with a larva of dog or cat ascaris (Toxocara canis, T. cati), which, unable to turn into fully matured form, circulates in the system and reaches various human organs and tissues. Risk factors of Toxocara canis/cati infection consist of age 3-10 years old, male sex, living in the country, possession of dogs, especially puppies and young dogs up to 3 years old and pica (eating inedible things) and onychophagia (biting one’s nails). Among clinical forms of toxocariasis usually characterized are visceral larva migrans syndrome, ocular migrans syndrome and covert. In this paper, a case of a 3-yearold boy from a rural environment, admitted because of suspicion of eosinophilic leukemia is presented. In the boy with a high eosinophilia of peripheral blood, after excluding the initial diagnosis and numerous parasitic diseases, a generalized form of visceral larva migrans syndrome was recognized. Due to multiple recurrence of symptoms in the boy and repeating hospitalisations on account of that a more detailed family interview was taken, from which it followed that the boy eats a lot of contaminated, by the present there puppies, sand, from the garden adjacent to the house. The observed by the parents pica, meaning eating inedible things, in this case sand, and presence in the vicinity of the house of neglected, not disinfestated puppies was the cause of severe form of infection in the child and of recurrence of symptoms. Considering the persistence of Toxocara canis infection in dogs in Poland and of the possibility of becoming infected with toxocariasis, prophylactic actions are essential, e.g. properly managed dog disinfestation, especially puppies. It is also important to change the sand in sandpits often, limit the number of homeless animals, take dogs for walks away from places where children play etc., but also to shape proper hygienic behaviour in children. An opportunity to resolve this epidemiological issue is a targeted cooperation of medical, veterinary, sanitary and public services.

Keywords: toxocariasis, visceral larva migrans syndrome, children, parasitosis, pica
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The familial occurrence of Treacher Collins syndrome - 6 families report
Pediatr Med rodz Vol 5 Numer 1, p. 60-65
ABSTRACT

Treacher Collins syndrome (TCS), the most common type of mandibulofacial dysostosis, is an autosomal dominant disorder of craniofacial development. The estimated incidence in the general population is 1 in 50,000 live births. This syndrome arise from the first and second branchial arches during early embryogenesis. While in 40% of TCS cases previous family history can be demonstrated, the remaining 60% possibly arise from de novo mutations of TCOF1 gene, at chromosome 5q32-q33.1. The TCOF1 gene contains 26 exons and encodes a 1411 aminoacid protein named treacle. About 116 different mutations were described in literature. Most of these mutations are deletions. Clinical features of TCS included: antimongoloid palpebral fissures, coloboma of lower eyelids, lower eye lashes, atypical hair growth in form of tongue-shaped processes of the hair outline extending toward the cheeks, high of cleft palate, macrostomia, hypoplasia of the malar bones or mandible, malformation of external era, otitis media, rare internal ear. The patients need multiple operations, conducted ordinarily in the following order: reconstruction craniofacial, auricular reconstruction, surgical correction of antimongoloid palpebral fissures, cleft palate repair, repair of eyelid. Apart from a surgical treatment, the patients require a combined multidisciplinary approach with participation of paediatricians, laryngologists, speech therapists and orthodontists. Since, the spectrum and degree of deformations related to TCS are extensive, a plan of management treatment needs to be tailored to the patients specific problems. In this report, we described 6 families with TSC. The authors analyse gender, degree of kinship patients and change a developmental disorders extensive in the following generations.

Keywords: Treacher Collins syndrome, mandibulofacial dysostosis, familial occurrence, congenital malformations, craniofacial
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Penile fracture with complete urethral rupture - case report
Pediatr Med rodz Vol 5 Numer 1, p. 66-68
ABSTRACT

Penile fracture is an effect of impetuous penis flexure during erection. In 20-30% of cases trauma is combined with urethra damage. Penile fracture occurs most often during sexual intercourse, but it can be also result of injury and masturbation. Case report is about 33 years old man, who suffered from penile fracture with complete urethral rupture. Patient was admitted to Urology Department about 3 hours after sexual intercourse during which he felt penile sudden, severe pain. During hospital admission blood in the urethral orifice and penile swelling was present as well pathological penile curvature. On USG tunica albuginea rupture was diagnosed. Patient was qualified for emergency surgery. Before procedure urethrography was performed, which showed complete proximal urethral rupture. Intraoperatively this observation was confirmed as well corpora cavernosa fissure. After haematoma evacuation, corpora cavernosa were repaired and urethral stumps were connected end to end using Foley’s catheter. Suture skin ended procedure. No complications were observed just after surgery and during follow-up after one year. Patient has no micturition and erection problems. Diagnostic tools restricted in time but chosen properly and early surgery have provided good functional effect.

Keywords: penis, fracture, urethral lesion, diagnosis, treatment
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