2012, Vol 8, No 1
Urinary tract infections in children
Pediatr Med rodz Vol 8 Numer 1, p. 12-22
ABSTRACT
Urinary tract infections are one of the most common bacterial diseases among children. In the adult population urinary tract infections represent 10‑20% of community‑acquired infections and approximately 40‑50% of nosocomial infections. In the neonatal period and in the first three months of live urinary tract infections are observed more frequently among boys whereas in the following years this is more common among girls. Urine found in the urinary tract of a healthy men is sterile. The presence of microorganisms (bacteria, viruses, fungi) in the urinary tract located above the sphincter of the bladder is considered to be the urinary tract infection. Increased uropathogenic colonization around the external urethral orifice, urinary retention and weakness of local defence mechanisms are playing crucial role in developing the urinary tract infections. Evolution of urinary tract infections among children usually takes place through the ascending path. Haematogenous urinary tract infections occur mainly during neonatal period and among infants. Recurrent urinary tract infections are usually observed among children during their first year of life. Escherichia coli is responsible for approximately 33‑90% cases of urinary tract infections among children, depending on age and sex. Clinical symptoms of urinary tract infections vary depending on the child’s age, anatomic location and severity of inflammatory changes. It is not possible to take one standardized approach in the treatment of urinary tract infections. Generally, the rule is that the younger the child and the more severe form of the disease, the therapy should be more intense. Method treatment is always chosen individually. Co‑trimoxazole prophylaxis treatment, for 12 months, reduces the risk of re‑infection.
Keywords: urinary tract infection, urinary tract abnormalities, vesicoureteric reflux, children, treatment
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Obstetrical haemorrhage – the management algorithm
Pediatr Med rodz Vol 8 Numer 1, p. 23-32
ABSTRACT

Obstetrical haemorrhage still remains one of the most common causes of death among pregnant women and women in labour. Almost 88% of these women die within the first 4 hours of its onset. Knowing the mechanisms that regulate hemostasis of the woman in labour at the molecular, immunological, hormonal, neurological level and the role and function of the uteroplacental unit has a huge impact on the further therapeutic decisions in case of obstetrical haemorrhage. There are a number of various definitions concerning obstetrical haemorrhage which proves how difficult it is to recognize and diagnose this condition. Taking under consideration the haemodynamic changes, the systemic consequences and the need of making specific therapeutical decisions it seems necessary to include in the definition the dynamics of the blood loss in the specific time unit: cumulated blood loss of 150 ml/min or 1.5 ml/kg of body weight per minute and a 50% loss of circulating blood volume in 3 hours. The prognosis of the haemorrhage depends on many different elements, including: rapid diagnosis, notification and implement of the management therapeutic algorithm and interdisciplinary co‑work of various teams taking part in the diagnostic‑therapeutic process. It is crucial that there is an effective, simultaneous cooperation among the experienced anaesthesiology team, ob‑gyn team, the operating theatre team, diagnostic‑laboratory teams and the regional blood donation agencies. Coordinating work of that many people, that are often spread within the organizational structures of the hospital on different floors or buildings, is excessively challenging. On the other hand, establishing the management algorithm that takes into account the order and the way of notifying as well as implementing certain procedures in individual organizational structures has a huge, direct impact on patient’s survival and the quality of life. Most of the management procedures for the severe obstetrical haemorrhage, such as resuscitation, monitoring, bleeding control, should be performed simultaneously.

Keywords: obstetrics, haemorrhage, definition, management algorithm, interdisciplinary co‑work
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Obstetric complications after assisted reproductive technology
Pediatr Med rodz Vol 8 Numer 1, p. 33-36
ABSTRACT

Since the first live birth resulting from in vitro fertilization (IVF), there has been a dramatic rise in the number of infants born as a result of this technology. Assisted reproductive technologies (ART) are now widely used in the treatment of human infertility. It is likely that well over 1 million babies have been born worldwide using ART. The majority of perinatal morbidity after assisted reproductive technology is due to multiple pregnancies. In United States and Europe even 30% of twins are conceived by IVF, intracytoplasmic sperm injection (ICSI), or frozen embryo replacement (FER). ART carries a significantly increased risk of multiple pregnancies, which are associated with a higher rate of prematurity and low birth weights, and carry well‑established risks of morbidity to the child. Many recent studies have suggested also that even singleton pregnancies are at increased risk for preterm birth, low birth weight, congenital anomalies, perinatal mortality and several other pregnancy‑related complications. In addition, it has been shown that the infertility characteristics of the parents may influence the perinatal outcome. Finally, procedural factors related to fertility treatments themselves may confer health risks to ART children. These include the artificial induction of ovulation with the possibility of changes in follicle milieu and oocyte structure, exposure of sperm and embryos to in vitro environments which might change their natural function, freezing and manipulation of oocytes and embryos.

Keywords: assisted reproductive technology (ART), in vitro fertilization, obstetric complications, preterm delivery, low birth weigh
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Ultrasound diagnosis of preterm labor
Pediatr Med rodz Vol 8 Numer 1, p. 37-39
ABSTRACT

Progress in basic science as well as the dynamic development of medical equipment contributed substantially to the knowledge and understanding of the pathogenesis of preterm labour, which, together with the improvement of neonatal care, contribute to the reduction of infant mortality. Paper discusses the common causes of premature birth, and shows the possibilities of modern ultrasound in the diagnosis and its impact on further proceedings in these cases. Among the most common causes of premature birth include: obstetric infections of urogenital system, autoimmune diseases, cervical incompetence, congenital uterine abnormalities, fibroids, multiple pregnancy, polyhydramnios, oligohydramnios, fetal defects, pregnancy induced hypertension and eclampsia, abnormal location of the placenta, premature rupture of membranes. Modern ultrasound techniques are extremely important both in the emergence of high‑risk groups and the selection of appropriate treatment and monitoring its effectiveness. These studies include ultrasound of uterus, uterine cavity and cervix 2D and 3D presentation as well as elastography. Furthermore, assessment of uteroplacental‑fetal perfusion can select a high risk of developing pregnancy‑induced hypertension, fetal hypotrophy and the early detection of intrauterine hypoxia. In many cases it allows appropriate treatment as well as carefully and safely monitor the further course of pregnancy, and in due time decide to complete the pregnancy. Authors believe that the prevention of preterm birth should be a multistage, and ultrasonography together with the identification of patients at increased risk is an extremely important part of secondary prevention.

Keywords: preterm labour, ultrasonography, Doppler ultrasound, cervical incompetence
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Serological remarks of Borrelia burgdorferi s.l. infection in Upper Silesia inhabitants
Pediatr Med rodz Vol 8 Numer 1, p. 40-45
ABSTRACT
Introduction: Borrelia burgdorferi s.l. is a tick‑transmitted spirochaete, which can cause acute or chronic infection, either symptomatic or occult. The result depends on spirochaete species’ interaction with individual human immunity. Material and methods: The survey was conducted in the group of 1104 Silesia inhabitants (age 3‑96 years; mean 44.9±19.2) who remembered tick‑bite episode in the past and had not had recognized chronic borreliosis. The anamnestic data were focused on erythema episode and confirmation of erythema migrans by physician. The analysis of anti‑Borrelia IgM and IgG antibodies in serum with ELISA method, and verification of positive or uncertain results with Western blot analysis were conducted. Results: Erythema after tick‑bite exposition was noticed in 22.5%; 70% of them realized medical consultation and erythema migrans was confirmed in ¾ of cases. Twenty‑five percent of those without erythema asked for medical help and early borreliosis was diagnosed in 4.2% of them. In the group of patients with erythema migrans confirmed in the past 55% had positive ELISA tests results while in the group with exclusion – over 40%. Coincidence of results obtained with ELISA and Western blot methods expressed by Kendall’s τ coefficient was low: 0.256. Conclusions: In persons with tick‑bites in anamnesis and none of chronic borreliosis diagnosed the serological tests positive results seems to be not enough for disease confirmation. Because of low ELISA and Western blot tests results compatibility, the final diagnosis should be based on perceptive analysis of individual clinical picture.
Keywords: Borrelia burgdorferi s.l., erythema migrans, anti‑B.b. antibodies, ELISA method, Western blot test
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The adherence in patients with atopic diseases treated with loratadine
Pediatr Med rodz Vol 8 Numer 1, p. 46-55
ABSTRACT
Introduction: Atopic diseases are mainly chronic disorders developing at the base of hypersensitivity reactions. Loratadine is an anti‑histamine drug with potential of inflammation and allergy symptoms minimizing. Reaching the best treatment results needs patient’s cooperation. The study was focused on loratadine treated patients’ adherence. Material and methods: In adult patients taking loratadine according to doctor’s recommendations minimum one month before enrolment the questionnaire survey was realized during two consecutive routine control visits in an outpatient clinic. The data of clinical indication for loratadine, other chronic diseases and prescribed medications, regularity of loratadine taking and the possible causes of doses omission as well as patient’s and doctor’s estimation of clinical course of atopic disease were collected. Results: In 36 960 adult patients (41.38±15.05 years old; 53.3% of women) treated by general practitioners (58.76% of doctors) and specialists, loratadine was recommended because of seasonal allergic rhinitis (44.82%), allergic conjunctivitis (25.25%), perennial allergic rhinitis (16.37%) and urticaria (13.56%). The majority of participants stated that loratadine treatment should not be ceased, but regular intake was realized only in about 40%. The irregular treatment was most frequent in patients beneath 30 years old (25.85% of study group) and in patients with concomitant diseases (37.71% of all participants). Predominant cause of irregular loratadine taking were organizational fails, symptoms relief and belief, that the disease is cured, and apprehension of drug side effects. In the end of the first visit 97% of patients were given additional information about atopic diseases and during the next one the percentage of organizational fails in treatment was significantly lower. Conclusions: Adherence of loratadine treated patients appeared far unsatisfied. Patients with atopic diseases should be offered more information about them and the rules of treatment.
Keywords: seasonal allergic rhinitis, perennial allergic rhinitis, allergic conjunctivitis, urticaria, adherence
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Food allergy and skin diseases in infants and small children
Pediatr Med rodz Vol 8 Numer 1, p. 56-61
ABSTRACT

The role of food allergy in etiopathogenesis of skin diseases is a controversial problem. The incidence of food allergy in general paediatric population is 3‑8%. The most common sensitising allergens are cow’s milk proteins as well as eggs’ and nuts’ allergens. Higher incidence of food allergy has been detected in children with atopic diseases. It seems that food allergy may be the earliest sign and symptom of atopy in the atopic march. Many parents are convinced about the problem of food allergy in their children because skin lesions do exacerbate after ingestion of certain alimentary allergen. Often doctors themselves are responsible for the over‑diagnosing of food allergy and administration of restricted elimination diet without obtaining a detailed anamnesis and without performing appropriate diagnostic procedures. It is known that in the early childhood gastrointestinal and immunological systems as well as skin are not properly matured. Therefore, certain non‑immunological and/or non‑allergic reactions in relation to the food ingestion may develop. Different mechanisms of these reactions result obviously in distinct characteristics of skin lesions, different course of the disease and an appropriate spectrum of diagnostic as well as therapeutical procedures should be selected. In case of suspected food allergy, detailed diagnostics should be performed and what should be stressed results need to be evaluated in terms of their clinical importance. It seems that unjustified introduction of unnecessary elimination diets may be reduced in this particular way.

Keywords: food allergy, food intolerance, allergens, elimination diet, skin symptoms
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Stroke at 15‑year‑old girl – case report
Pediatr Med rodz Vol 8 Numer 1, p. 62-66
ABSTRACT
Strokes are one of the most common diseases among adults, but they can also occur among children. There are ischaemic strokes resulting from the occlusion of the vessel and haemorrhagic strokes when it comes to rupture of the vessel wall. Causes and risk factors of strokes are different for adults, but up to half of them remain unexplained. The most common cause in this age group are congenital defects of the heart and circulatory system. Other important risk factors include coagulation disorders, acquired heart disease, vascular dysplasia, autoimmune vasculitis and infections, trauma and metabolic disorders. Symptoms of the disease in a paediatric group are often nonspecific, poorly expressed and therefore they can cause a diagnostic problems. In the thesis one has discussed modern diagnostic methods: both laboratory and imaging, and also recommendations for the treatment, which currently are based on guidelines adopted from the adult population. The paper also presents a case of the 15‑year‑old girl with impaired consciousness, in whom MRI of the head revealed the ischaemic focus in the right frontotemporal region. In the course of medical tests a heart defects: atrial septal defect type II (ASD II), patent foramen ovale (PFO) and atrial septal aneurysm has been recognized. Psychological studies conducted after the incident showed impaired concentration, impaired quality of writing, comprehension, memory and impaired general psychomotor skills.
Keywords: stroke, children, risk factors, treatment, persistent foramen ovale
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The use of virtual bronchoscopy in the diagnosis of suspected foreign body aspiration in children
Pediatr Med rodz Vol 8 Numer 1, p. 67-72
ABSTRACT
The foreign body aspiration (FBA) is a common cause of parents arriving with their children at the Paediatric Emergency Department. In the majority of cases, the problem affects children between 1‑3 years of age and it is less common in newborn babies and school children. The most important factor for diagnosis is the positive history of aspiration. Clinical symptoms, such as sudden onset of cough, wheezing and unilateral diminished breath sounds, occur uncommonly that is why imaging studies should be always taken. However, 30% of chest radiographs show normal findings. Virtual bronchoscopy (VB) may help to determine the presence and exact localization of the foreign body and may reduce the number of unnecessary rigid bronchoscopies. Rapid diagnosis can minimize dangerous respiratory complications. The authors present 3 cases. The first case is a 6‑year‑old girl with suspected FBA because of persistent inflammatory changes of the pulmonary parenchyma and with no improvement in the clinical and radiological symptoms despite intensive treatment. The second case is a 6‑month‑old infant with pneumonia and present history of aspiration. The physical examination revealed decreased breath sounds unilaterally, wheezing and abnormalities typical for FBA in the chest X‑ray. The third case is an 11‑year‑old boy with asthma exacerbation unresponsive to intensive treatment and positive medical history of FBA. In all patients CT lung images with vascular contrast were performed. No foreign body was found with VB in 2 patients (case first and second), in 1 patient there was no suspicion of foreign body (case third).
Keywords: foreign body, aspiration, virtual bronchoscopy, chronic cough, children
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Allantoin – healing and anti‑inflammatory properties
Pediatr Med rodz Vol 8 Numer 1, p. 73-77
ABSTRACT

Allantoin is a derivative of urea exhibits keratolytic action by affecting desmosomy, which are connections between corneocytes. Allantoin by doing so you get rid of excess keratinized epidermis. At the same time by stimulating cell division and epithelization, accelerates the regeneration process of damaged skin inflammation. Allantoin also has strong moisturizing properties and a high safety of the therapy – is not allergenic, does not cause skin irritation. Because of these properties, allantoin is widely used in cosmetics and pharmacy. It is an ingredient of many preparations intended for dry skin, acne or allergy. He is also a frequent component of after‑sun preparations, deodorants, shampoos, bubble baths, and above all the local dermatological drugs. Allantoin contained in an ointment or cream accelerates the exfoliation of dead skin cells, making the skin smoother. Thanks to the allantoin accelerating the proliferation of epithelial cells also occurs to quicker recovery of the skin, making skin more easily retain more water and to rebuild the protective hydro‑lipid coat. Resolve a troublesome subjective symptoms associated with dry skin, especially the feeling of tension and burning. Preparations containing allantoin is also recommended as an adjunct in the treatment of chronic skin diseases with impaired keratosis or skin damage, such as atopic dermatitis, contact dermatitis, psoriasis, ichthyosis, ulcers or burns. Complementary therapy, external preparations containing allantoin, significantly reduces symptoms and improves the quality of life of the patient.

Keywords: allantoin, epidermis, dyskeratosis, dry skin, hydrolipidic film
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