2012, Vol 8, No 3
International consensus concerning management of asthma in children, based on International consensus on (ICON) pediatric asthma
Pediatr Med rodz Vol 8 Numer 3, p. 195-206
ABSTRACT
Throughout the world asthma is the most common chronic lower respiratory disease in childhood. There are several guidelines supporting medical decisions on paediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these, these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI, and WAO, has proposed an international consensus on (ICON) paediatric asthma. The aim was to highlight the key information common to the existing guidelines as well as review and comment gap thus providing a concise reference. Generally the principles of paediatric asthma management are being accepted. Overall, the treatment goal is a disease control. In order to achieve this, patients and their parents should be educated to optimally manage a disease, in collaboration with healthcare professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re-evaluate treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent of chronic treatment. There is a trend toward considering phenotype-specific treatment choices however this goal has not yet been achieved.
Keywords: asthma, treatment, guidelines, children, exacerbation
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Immunomodulatory properties of macrolide antibiotics – possibilities for the treatment of respiratory diseases in children
Pediatr Med rodz Vol 8 Numer 3, p. 207-213
ABSTRACT
The abnormalities in structure and respiratory function in children predispose to a higher incidence of infections in this age group. The basis mechanism of action of the macrolide antibiotics are bacteriostatic properties, resulting from blocking protein synthesis by interacting with the large ribosomal 50s and 23s subunits of ribosomal RNA. Macrolides have an additive nonantimicrobial properties. These properties include the effects on cells of the immune system, cytokine response, respiratory tract and metabolism of glucocorticosteroids. The paper presents the current knowledge of the mechanisms of action of this group of antibiotics. Macrolides reduce the number of neutrophils at the site of inflammation by inhibiting the secretion of chemotactic factors, blocking cell surface glikoproteins involved in the migration process and inducing apoptosis of inflammatory cells. Multidirectional influence of macrolide antibiotics on cytokine response is mainly based on reducing the secretion of pro-inflammatory cytokines and nitric oxide synthesis inhibition. In addition, they prevent the respiratory tract from P. aeruginosa colonization by inhibiting the production of: biofilm components, elements of quorum sensing (that enables communication between bacteria) and virulence factors. The use of macrolides also reduces production of mucus in respiratory tract and improves mucociliary clearance. In the treatment of cystic fibrosis, macrolides reduce overproduction of mucus in the airways and prevent colonization by P. aeruginosa. In addition, macrolides reduce the frequency of exacerbations and improve quality of life. However, significant improvement in spirometric parameters was not observed. Use of macrolides in the treatment of RSV infection reduces severe inflammatory response, airway hyperresponsiveness and mucus hypersecretion, which result in shorter hospitalization time and faster resolution of symptoms. These clinical effects of macrolides require additional well-documented research.
 
Keywords: macrolides, asthma, respiratory syncytial virus, cystic fibrosis, cytokines
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Henoch-Schönlein purpura – old disease, new diagnostic challenges
Pediatr Med rodz Vol 8 Numer 3, p. 214-221
ABSTRACT
Our article describes history, clinical features, systemic complications, current practice, and management of Henoch-Schönlein purpura (HSP). HSP is an acute, systemic, small-vessel vasculitis usually seen in healthy children and adults. HSP is the most common vasculitis affecting children. The classic symptoms are: nonthrombocytopenic purpuric rash, arthralgia or arthritis, glomerulonephritis and gastrointestinal involvement: abdominal pain, ulcerations in the stomach, duodenum and colon. More rarely, patients present neurological manifestations: cerebral vasculitis or peripheral nervous system dysfunctions. Although the pathogenetic mechanisms are still not fully described, the role of immunoglobulin A1 (IgA1) in the pathogenesis of the formation of the circulating immune complex was established. Antibody complexes form as a result of infections, drugs, vaccinations and immune mechanisms. There are no specific laboratory tests and markers which can confirm diagnosis. Treatment of HSP is controversial. Recognition of multiorgan manifestations, particularly glomerulonephritis needs the systemic steroids intervention. Angiotensin converting enzyme inhibitor therapy is recommended for reduction of proteinuria. The prognosis depends on severity of renal involvement. Follow-up for children should include: urine testing for proteinuria and haematuria and measurement of a blood pressure for at least 6 months. The risk of complications (proteinuria, hypertension) during pregnancy occurs more often to women with previous history of HSP. Our article describes history, clinical features, systemic complications, current practice, and management.
Keywords: Henoch-Schönlein purpura, diagnosis, vasculitis, nephropathy, purpura
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The influence of having a child with chronic kidney disease on the attitudes of parents towards organ transplantation
Pediatr Med rodz Vol 8 Numer 3, p. 222-228
ABSTRACT
Chronic kidney disease (CKD) is a challenge for medicine of the 21st century because is rare detection and the often concealed course. It is known that kidney transplantation is the best, though not only procedure for the final cure of this illness. The social awareness about transplanting is being shaped by a lot of factors. A chronic disease appearing at close friends and family can be one of them. Examining the influence of having a child with chronic kidney disease on the knowledge and attitudes of parents towards organ transplantation were a purpose of the study. The examination was conducted amongst 120 parents. Examined parents were divided to 3 equal-numerous groups, on account of illness of their child. Parents of children with CKD constituted the first group, second – parents of children with other nephropathies and of urinary system, lastwhereas parents of healthy children. Anonymous authorial questionnaire was applied as a method. Parents of children from CKD in spite of the lower level of education demonstrate greater knowledge about the legal possibility of being living donor of organs and the need to take immunosuppressive drugs after the transplant. Parents of children with CKD definitely accept taking organs from deceased donor. However, parents of children with other nephropathies would more often agree to be a potential donor of organs than parents of children with CKD. Parents of healthy children fundamentally more often had no opinion on taking organs from a relative after her or his death. This group more often think that people do not want their organs after death to be taken because of the distrust the medical staff. The fact that majority of examined persons confirmed the fact that Polish transplantology is not completely free from the phenomenon of the organ trade is also important. Parents of children witch CKD more often think that the greater social awareness of organ transplantation can affect the number of transplants. All groups have similar opinion about actions that can have a positive effect on increasing the number of transplants and institutions which should back the idea of transplantology up in Poland. The study indicated that parents in all examined groups stand for the idea of transplanting organs. Having a child with CKD changes the parents’ attitude. They are more determined to the idea of transplanting. Although their willing of becoming a donor is not stronger than in other groups.
Keywords: children, chronic kidney disease, organ transplant, opinion
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CO2 laser as a method of treatment scrotum lymphoblastoma in patients with haemophilia
Pediatr Med rodz Vol 8 Numer 3, p. 229-232
ABSTRACT
The paper discusses a case of 31-year-old patient with haemophilia A with the multiple vascular changes on the scrotum. Haemophilia is hereditary genetic disorder and is also the genetic plasma’s diathesis. It is the recessive sex-linked X chromosome disorder. It is more likely to occur in males than females, women are transmitters of mutant gene. In Poland, a prevalence of haemophilia A is 1:16 000, there are about 2000 of registered patients. The abovementioned vascular changes of the scrotum were a both relative cosmetic and psychological problem of the patient, therefore a resection was performed. The patient’s classification to surgery was difficult because of haemophilia A. A risk of bleeding was increased in resection of vascular changes. The gold standard of preoperative treatment in patients with haemophilia is cumulative therapy of factor VIII. To reduce a risk of bleeding, the laser CO2 CTL 1401 was used. This article presents three phases of treatment:preoperative treatment, surgery and postoperative treatment, with success. The use of laser surgery caused a shortening of surgery’s time. In the surgery there were any complications. After four days of hospitalization the patient was in good condition, there was noticed no bleeding. The authors claimed that CO2 laser surgery is very prospective way in advanced laser technology in patients with haemophilia. It provides standard general precautions and high availability of medical device.
Keywords: lymphoblastoma, scrotum, therapy, CO2 laser, haemophilia A
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Sick sinus syndrome in siblings
Pediatr Med rodz Vol 8 Numer 3, p. 233-238
ABSTRACT
Sick sinus syndrome (SSS) describes an arrhythmia phenotype attributed to dysfunction of sinus node. It is frequently associated with heart disease and occurs in the elderly, much rarer in children, and it also may occur in the foetus. The typical arrhythmias for sinus node disease in standard or Holter electrocardiogram (ECG) is the basis of diagnosis. Paediatric patients may be asymptomatic, may have impaired exercise tolerance, syncope, or fainting. Sinus node dysfunction in a young person without associated heart disease is suspected to be congenital and needs a deepening of family history. In the article is presented siblings with sinus node disease. In both of the children with normal heart, on ECG sinus bradycardia with supraventricular wandering pacemaker dominates. Up to now, none of them had presented any symptom. They do not require a permanent cardiac pacing. Because of the potential progression of the disease they need to be under the cardiologic observation. The children’s father suffered from bradycardia, in their grandfather a peacemaker was implanted when he was young. The mother and brother of those children have normal cardiac rhythm. The occurrence of sinus node dysfunction in children, their father and their grandfather suggests a familial sick sinus syndrome.
Keywords: familial sick sinus syndrome, bradycardia, children, congenital arrhythmia, dysfunction of sinus node
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Different clinical manifestations of cow’s milk allergy
Pediatr Med rodz Vol 8 Numer 3, p. 239-245
ABSTRACT
Food hypersensitivity is a syndrome of clinical disorders, which are caused by the intake of various, specific kinds of food or different chemical substances present in the food. It can either activate immunological mechanisms (food allergy) or not. The frequency of allergic disorders has been steadily increasing recently. The symptoms usually show up in early infants (allergy to cow’s milk). In the following years apart from food allergy, inhalator pathogens start playing more and more important role. The clinical picture of food allergy changes into “the allergic march”. The most common kind of allergy in infants and small children is the cow’s milk allergy. In the clinical manifestation of food hypersensitivity to cow’s milk protein the skin manifestation can be observed most frequently, the next characteristics being motoric disorders in the lower and upper part of the digestive system, ileitis and colitis, which are caused by food and eosinophilic inflammation in the mucosa of the digestive system. Food allergy to cow’s milk protein can also be manifested with respiratory symptoms or general bodily disorders. The treatment is based on eliminating the badly tolerated food product from the diet and replacing it with a well-tolerated food product with the same nutric value. The aim of thework is to present the two clinical cases of food allergy to cow’s milk in infants: the boy with the severe kind of atopic dermatitis and the girl with eosinophilic enteritis. The patients were firstly treated with hypoallergenic kinds of milk – getting no good clinical results. However, after administering the basic preparations as well as applying pharmacological treatment the condition of the patients improved.
Keywords: food allergy, children, food hypersensitivity, atopic dermatitis, eosinophilic enteritis
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Giardiasis in children – proper diagnosis can be difficult
Pediatr Med rodz Vol 8 Numer 3, p. 247-251
ABSTRACT
Giardiasis is a parasite illness of alimentary canal, caused by invasion of primeval – flagellum from species of Giardia intestinalis. Infection appears all over the world, in some areas it affects up to 30% of population. It affects mostly children of 2-5 years old. The infection passes from the infected persons. Life cycle of Giardia takes place in one individual and embraces two stages of development: trofozoit and cyst. Alimentary canal is a way of infection which can be caused by drinking water or eating food containing lamblia’s cysts. In most cases it affects children gathered in kindergartens or day nurseries where the infection is spread by direct contacts. Clinical outcome of giardiasis is varied, it can present either no symptoms or a typical but not very specific symptoms, e.g., diarrhoea, stomachache or fever. The disease can cause chronic diarrhoeas, the lost of weight, and give rise to the symptoms of allergy. Finding the cysts in stool is diagnostic but plenty of examines are usually necessary. The immunoflourescent examination and immunoenzimatic technique (ELISA) become commonly used in detection of antigen Giardia lamblia. These testes display high sensitivity and specificity. Such drug substances as metronidazole or other nitroimidazoles has been used for years and they are still the first choice in treatment of G. intestinalis infection. In this paper two cases with different clinical outcome are presented. Both cases turned out to be a diagnostic challenge. The difficulties delayed the application of proper treatment and recovery.
Keywords: giardiasis, children, clinical manifestations, diagnosis, treatment
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Ectopic pancreas – a case report, the etiopathogenesis and basic of diagnostic‑therapeutic proceedings
Pediatr Med rodz Vol 8 Numer 3, p. 252-257
ABSTRACT
Ectopic pancreas is a developmental anomaly which marks the presence of pancreas tissue in various localizations beyond the pancreas, without both anatomic and vascular connection to a properly situated organ. Thanks to development of vivid technology it is found more often. As far as etiopathological factors causing ectopic pancreas are concerned, they are as follows: intrafetal pancreas development disorder, multipotential cells metaplasia, and, basing on models of animals, also mutation of specific genes. The abundance of possible localizations and disparate histopathological types may result in the anomaly having diverse clinical course, ranging from mute to more intensified subjective and object symptoms. To diversify one should take malignant changes into consideration. A reliable diagnosis may be stated after the presence of pancreas tissue has been confirmed in histopathological examination. Yet, in peculiar circumstances it is possible to push a reliable diagnosis forward basing only on endoscopic and vivid examination. During diagnostics there maybe a problem concerning, on the one hand, diagnosis when patients suffer from intrafetally irrelevant developmental anomaly and the doctor’s job is to save them from invasive conduct. On the other hand, however, malignant changes wrongly recognized as ectopic pancreas cannot be overlooked. Treatment is undertaken only if there are clinical symptoms or tumour in ectopia has been recognized, whereas the method of treatment depends on the size and localization of the change. The prognosis is auspicious even if distant results have been observed. This work presents a case report of a patient suffering from ectopic pancreas as well as the issue of clinical meaning and difficulties in recognizing and treating this developmental defect.
Keywords: ectopic pancreas, pancreas heterotopy, submucosal tumour, endoscop
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The acute pancreatitis in 15‑year‑old girl
Pediatr Med rodz Vol 8 Numer 3, p. 258-262
ABSTRACT
The acute pancreatitis occurs in children much less often than in adults. Though, it usually has a sudden onset and, at the beginning, it proceeds with intensified pain in the area of the abdomen, thanks to the proper diagnostics and treatment, it seldom leads to permanent damage of the pancreas. The most common causes of pancreatitis, apart from calculosis of the gallbladder and other pathological conditions of bile ducts, are the injuries of the abdomen as well as various infectious factors. Acute biliary pancreatitis in children occurs rather seldom, since calculosis of the biliary ducts is not often observed at this age group. Cholesterolic calculosis of the biliary ducts in children most often concerns obese, adolescent girls. Gall stones, usually, consist of a mixture of cholesterol, bile pigments, calcium as well as inorganic substances. A case of a 15.5‑year‑old girl who was hospitalised in our Clinic is presented below. The girl suffered from the pain in the abdomen. On admission, she was initially diagnosed the acute pancreatitis. The results of the laboratory tests (higher activity of amylase in serum and urine, higher activity of lipase, and increased concentration of transaminase) and the ultrasonography of the abdomen let the doctors definitively diagnose the acute biliary pancreatitis. A strict diet, intravenous irrigation, proton‑pomp inhibitors, administration of painkillers and antibiotics led to the improvement of the general state of the patient and normalization of the laboratory tests results. In the tenth day of hospitalization the planned endoscopic regressive cholangiopancreatography (ERCP) with papillotomy was performed. No deposits in bile ducts were revealed. The girl was recommended the procedure of cholecystectomy, which was carried out in due course without any complications.
Keywords: pancreatitis, children, amylase, cholecystitis, endoscopic regressive cholangiopancreatography (ERCP)
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Melkersson‑Rosenthal syndrome as a cause of recurrent facial nerve palsy in 10‑year‑old girl
Pediatr Med rodz Vol 8 Numer 3, p. 263-267
ABSTRACT

The facial nerve is the seventh, paired cranial nerve. The pathogenesis of the facial nerve disorders is strictly connected with the way it is placed. The peripheral or central paralysis of the nerve may occur at any age. The most common causes of the palsy are: idiopathic, post‑traumatic, post‑viral infectious paralysis, the transition of the inflammation from the middle ear to the VII nerve stem as well as neoplastic changes and vascular changes on the nerve. Melkersson‑Rosenthal syndrome is a rare cause of the recurrent facial nerve palsy. Though Melkersson‑Rosenthal syndrome develops most commonly between the age of 20 and 30, the early manifestation of the syndrome can start at any age. Melkersson‑Rosenthal syndrome is reported to occur also in young children. The main causes of this syndrome still have not been clearly established, however, the infectious, allergic, immunological and genetic factors are taken into consideration as the ones implicated in its aetiology. The syndrome is characterized by a triad of symptoms: recurrent facial nerve palsy, facial oedema and a fissured tongue. The full triad of symptoms occurs very rarely and thus is very uncommon. Most often the symptoms are oligosymptomatic. The paper presents a 10‑year‑old girl with the recurrent facial nervepalsy, fissured tongue and lip oedema. On the basis of the examination the girl was diagnosed to suffer from the Melkersson‑Rosenthal syndrome. The aggravation of the pathological symptoms was accompanied by the recurrent, caused by Herpes simplex virus infections.

Keywords: facial nerve palsy, Melkersson‑Rosenthal syndrome, fissured tongue, facial oedema, Herpes simplex infection
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Psychological stress and its causes for caregivers of children hospitalized for short time
Pediatr Med rodz Vol 8 Numer 3, p. 268-271
ABSTRACT
Introduction: A lot of research has been done on reactions of caregivers of children hospitalized for a long
time and suffering from chronic diseases. There are not so much articles about the impact of short term hospitalization on family. Parent’s psychological well-being, level of stress, social support can affect children while even short hospitalization. Material: The examined group consisted of 64 caregivers of children hospitalized in Szpital Dziecięcy Polanki in Gdansk. Caregivers stayed with child during hospitalization and agreed to take part in the research. Children were average hospitalized for 7 days. Method: To gather data we used demographic and clinical survey. Caregivers were asked to estimate their level of stress. To measure way of coping with stress CISS was used, GSES to measure the level of control, CECS (showing or hiding emotions), and LOT-R (optimism). Results: There is a correlation between the caregiver’s level of stress and his/hers subjective estimation of children medical condition. There is correlation between the caregiver’s level of stress andseeking for social companionship, avoidance, and ways of coping focused on emotions. There was a correlation between level of stress and suppressing depression, and self-efficacy. Conclusions: 1) Caregiver’s high self-efficacy can decrease the level of stress – explaining to parents what they can do in their situation is very important. 2) Parents of younger children, suppressing their emotions, and very stressed should be given additional psychological help (psychoterapeutic and counseling).
 
Keywords: psychological stress, caregivers, child hospitalized, self-efficacy, age of onset
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Children’s diaper dermatitis
Pediatr Med rodz Vol 8 Numer 3, p. 272-274
ABSTRACT
Diaper dermatitis (DD) is a skin inflammation located in the areas where the diaper contacts the skin. DD is one of the most common skin diseases of infancy and early childhood. It is a common infection in patients with immunodeficiency. Causes of DD are complex and multifactorial. The main predisposing factor for DD is long skin contact with wet environment. Irritated skin is sensitive to Candida albicans infection. The course of the disease is usually mild and the rush is its main symptom. More severe types of the diaper dermatitis include major rush with other symptoms (i.e. swelling, erosions, blisters) in the areas where the diaper contacts the skin. There are lumps of pale pink to pale red on the skin, scaly often peripherally. DD occurs in both sexes with the equal frequency. The mild forms of the diaper dermatitis are easily to treat with emollients. In case of an increased form of the diaper dermatitis or further complications it is necessary to use appropriate medicine; it is recommended to provide a topical antimyotic treatment. The core of the treatment is to comply with the rules of hygiene in the areas of the diaper: avoid moisture, frequent change diapers, airing infected perineal skin and avoiding the use of perineal alcohol-based preparations. The diet should be avoided corn starch, since it’s a breeding ground for Candida. The objective of this study was to systematize the news on the epidemiology, aetiology, clinical and prevention DD.
Keywords: diaper dermatitis, care, child, Candida, eruptions
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