2012, Vol 8, No 4
Adolescent behavioural eating disorders
PEDIATR MED RODZ Vol 8 Numer 4, p. 293-297
ABSTRACT
Eating disorders such as anorexia nervosa, atypical anorexia, bulimia nervosa belong to the behavioural and psychiatric disorders especially common in adolescents during the puberty period. The girls aged 14‑18 years old constitute the risk group for anorexia nervosa with the tendency to affect even the younger girls. Eating disorders are characterized by body dissatisfaction related to the overvaluation of the thin body ideal associated with dysfunctional patterns of cognition and weight control behaviours that results in significant medical, psychological and social complication. The important factor for initiating the onset of eating disorders is dysfunctional family background: controlling and with high expectations and demands mother and the certain personality traits of the adolescent such as low esteem, high ambition, perfectionism, perseverance, determination. The first symptoms of anorexia nervosa are often unnoticeable. They began with gradual elimination of the chosen food products e.g. sweets, bread, meat and introduction of “healthy” or “fit“ eating patterns to the daily diet routine. During the initial phase of the disease the food restriction plays the corroborant role giving the anorectic patient the feeling of full control, satisfaction and even sense of the success. Patient with bulimia nervosa are often undiagnosed because there is no spectacular and evident reduction of the body mass. The half of the patients with anorexia demonstrate the suicidal thoughts and suicidal attempts.The majority of them shows the self‑destructive behaviours. The treatment of eating disorders comprise the permanent and complex psychiatric therapy including the individual and family psychotherapy together with nutritional treatment. There is clear correlation between the duration of the disorder and the prognosis.The earlier diagnose is established, the better prognosis for the effective treatment is achieved.
Keywords: eating disorders, anorexia nervosa, bulimia nervosa, refeeding, psychotherapy
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Eating disorders in adolescents – an initial diagnose in general physician practice
PEDIATR MED RODZ Vol 8 Numer 4, p. 298-303
ABSTRACT

Nowadays the increasing prevalence of eating disorders in adolescents urges general physicians to faced this problem in their daily practice more often than it used to be before. It is well known that early identification of the risk group of eating disorders and referring such patients to the further confirmation of the initial diagnose to the specialist with subsequent early introduction of the psychological and psychiatric therapy constitutes the key point of good prognosis. That’s why the role of the general physician can not be overestimated. The confirmation of the diagnoses belongs to the psychiatrist’s competency, however the initial diagnose is purely the general practitioner’s task. This is very difficult role because the patients quite often are conceal ‑ ing symptoms of the disease and what’s more confusing, they are denying the fact of their existence. Even, if it happened that the patients report some complains, their symptoms are often non ‑ specific as well as the abnormality in the physical examination are. Therefore there is a great need for establishing the screening tools – universal, reliable, easy and time ‑ saving methods for eating disorders diagnosis in the general practitioner’s office. Such methods were elaborated and used in the USA settings with the positive outcome. The aim of this paper is to present the most popular and wide used screening methods for eating disorders in the adolescents with the suggestion to incorporate them to the Polish general physicians’ practices.

Keywords: eating disorders, diagnostic criteria, adolescents, screening methods, patient’s examination
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Diagnosis of Barrett’s oesophagus
PEDIATR MED RODZ Vol 8 Numer 4, p. 304-307
ABSTRACT
Barrett’s oesophagus (BE) is premalignant condition of oesophagus connected with long‑term oesophageal reflux disease and is defined as a process of replacing normal squamous epithelium above Z‑line in intestinal columnar epithelium. This premalignant condition is connected with higher risk of adenocarcinoma of the oesophagus. Actually, upper gastrointestinal endoscopy with oesophageal biopsy is recommended in diagnosing Barrett’s oesophagus. The frequency of endoscopic examination depends on presence of grade of dysplasia. Prague Criteria helps us to define spreading of intestinal epithelium. In this classification, the maximal length (M) (including tongues) of Barrett’s oesophagus as well as the length of the circumferential Barrett’s segment (C) are measured during endoscopy. Due to the technical progress there are many new endoscopic technics which are tested in diagnosing Barrett’s oesophagus. They should have the highest specificity and sensitivity and must be characterised by minimal invasiveness to the human body. Nowadays we use such technics as: classical and electronic chromoendoscopy, narrow band imaging, autofluorescence, high resolution endoscopy, magnification endoscopy, confocal laser endomicroscopy. In this view we will try to present the most important modern endoscopic methods which may be useful in diagnosing and monitoring of Barrett’s oesophagus.
Keywords: Barrett’s oesophagus, chromoendoscopy, narrow‑band imaging, endocytoscopy, optical coherent tomography
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Treatment basics of Barrett’s oesophagus
PEDIATR MED RODZ Vol 8 Numer 4, p. 308-314
ABSTRACT
Barrett’s oesophagus, reflux disease complication is a raising and important clinical issue. Basic diagnostic tool facilitating intestinal metaplasia diagnosis in squamous epithelium of lower part of oesophagus is endoscopy with histopathological samples. Because of high risk of malignant transformation endoscopic surveillance is required in patients with Barrett’s oesophagus. On the basis of histopathological type of lesion, length, and its location different procedure should be implemented. In the paper we discuss current treatment paradigm of Barrett’s oesophagus. Pharmacotherapy and anti‑reflux procedures can be implemented in patients with symptoms and without dysplasia. Endoscopic procedures (mucosectomy) or surgical (lower part of oesophagus removal) should be used in patients with high grade dysplasia and adenocarcinoma. In case of neoplastic lesion findings following rules should be used. Neoplastic lesion of low grade – endoscopic resection all visible lesions. In case of high grade neoplasia lesions endoscopic resection of all neoplastic lesions and all Barrett’s epithelium ablation is required. In case of patients with Barrett’s oesophagus and high grade dysplasia or intraepithelial carcinoma when oesophagus removal is planned they should be referred to surgical centers specialized in upper part of gastrointestinal tract cancer and dysplasia treatment.
Keywords: Barrett’s oesophagus, endoscopic treatment, adenocarcinoma, oesophagus carcinoma, treatment
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Basal management of gastrointestinal diseases in pregnant women
PEDIATR MED RODZ Vol 8 Numer 4, p. 315-323
ABSTRACT
Pregnancy is a physiologic state, however pregnant women often require diagnosis and treatment of serious gastrointestinal tract disorders (GI) which are some of the most frequent complaints during pregnancy. Some women have GI disorders that are unique to pregnancy. Other pregnant patients present with chronic GI disorders that require special consideration during this period. Understanding the presentation and prevalence of various GI disorders is necessary to optimize care for these patients. Pregnancy has little effect on gastrointestinal secretion or absorption, but it has a major effect on gastrointestinal motility. Pregnancy‑related changes in motility are present throughout the gastrointestinal tract and are related to increased levels of female sex hormones. In addition, the enlarging uterus displaces bowel, which can affect the presentation of common omplaints such us constipation. Knowledge of the gastrointestinal adaptation to pregnancy is necessary for accurate interpretation of laboratory tests, as well as imaging studies in the gravid patient. Endoscopy is rarely required during pregnancy. The potential risks of endoscopy during pregnancy include foetal hypoxia due to sedative drugs and exposure to radiation. There is no evidence that endoscopy precipitates premature labour, and studies in this area have concluded that endoscopy during pregnancy is generally safe. There should be a strong indication for the procedure, which should be deferred whenever possible to the second trimester. Procedures should be performed without any sedation, or with the lowest dose of sedative medication. Radiation exposure should be kept to a minimum. Support should be obtained from specialists in obstetrics and anaesthesia. 
Keywords: pregnancy, gastrointestinal tract diseases, liver diseases, endoscopy, treatment
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Contrast-induced nephropathy
PEDIATR MED RODZ Vol 8 Numer 4, p. 324-328
ABSTRACT
Recent clinical data suggest that contrast‑induced nephropathy (CIN), defined as a rapid deterioration 
of renal function that usually occurs 48‑72 hours after the administration of the contrast agent, is much more common than previously thought. In most cases, the clinical course of acute renal failure is mild and transient, but it has been proved that even a subtle impairment of renal function causes severe clinical consequences in the future. The difficulties in diagnosis of CIN is further aggravated by the fact that the kidney damage caused by contrast agent administration usually takes place without obvious clinical symptoms and oliguria. Current researches focus on improving the diagnostic process and try to develop effective prophylactic protocols. The increase in serum creatinine concentration is relatively late indicator of acute kidney injury thus more useful markers are being investigated. High expectations are given by clinical use of cystatin C, NGAL and interleukin 18. Many publications are focused on attempts of identifying risk factors of contrast‑induced nephropathy. It is already known that a very careful intravascular contrast administration is needed in case of patients with chronic renal disease or diabetes mellitus. Procedure dependable risk factors are as following: a type and dose of contrast agent, a method of contrast administration or repeatability of the procedure in a short period of time. The highest prophylactic value has an adequate hydration of the patient, moreover, N‑acetylcysteine has been found as the most promising pharmacological agent.
Keywords: contrast‑induced nephropathy, creatinine, contrast agents, acute kidney injury, osmolality, N‑ace‑ tylcysteine
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Varicella in children
PEDIATR MED RODZ Vol 8 Numer 4, p. 329-334
ABSTRACT
Chickenpox (varicella) is one of the most common and most infectious diseases in children. The disease 
is caused by the primary infection of Varicella zoster virus (VZV), reactivation of latent form of the virus 
is manifested as herpes zoster. This paper presents the characteristics of the virus, varicella’s clinical picture, diagnostic capabilities, and also highlights the consequences of intrauterine infection. Although the disease usually presents typically and treatment is usually symptomatic, in some patients, even previously healthy, there can be severe, life‑threatening complications. Newborns, immunocompromised patients, patients during immunosuppression therapy, with haematological disorders and malignancies, and pregnant women are the most vulnerable to severe disease’s course group of patients. In view of the real risk of complications in each patient, deliberate exposure of children to infection by their parents during the so‑called “pox parties” seems extremely irresponsible. Acyclovir is available on the market for over 20 years and is designated for the treatment of infections caused by the Varicella zoster and Herpes simplex virus. In patients with properly functioning immune system VZV infection is mild and requires usually supportive treatment. Most cases of chickenpox do not require antiviral treatment but there are proven benefits from usage of such therapy. According to available studies the use of acyclovir within the first 24 hours after the onset of rash is shortening the appearance of skin eruptions, accelerates their healing and reduces their total number. Acyclovir reduces the duration of fever and mitigates symptoms of the disease. It should be noted that such treatment does not impair long‑term resistance of immune system against VZV. The prevention is available in form of two‑doses varicella vaccination acceptable to start from 9th month of life. Specific immunoglobulin (VZIG) can be applied in selected cases discussed below.
 
Keywords: arivcella, Varicella zoster virus, children, treatment, vaccines
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Pertussis – disease which cannot be forgotten
PEDIATR MED RODZ Vol 8 Numer 4, p. 335-340
ABSTRACT
Pertussis (whooping cough) is an acute respiratory disease which may have a severe course, especially in newborns. Despite general conviction about disease eradication it is still a crucial clinical problem. Pertussis morbidity is different every year but the decreasing number of younger children and increasing number of people at the ages over 15 years falling ill could be observed. The main factors influencing the clinical course are age and immunization level. Among infants the disease mostly divides into three stages: catarrhal, paroxysmal and convalescent. Persistent cough is the most common manifestation of pertussis in adolescents and adults. The criterion standard for diagnosis of pertussis is isolation of B. pertussis in culture. Serologic antibody titre testing is available, but a comparison with results of the same test made 3‑5 weeks later is needed. The principle of prophylaxis is the obligatory vaccination carried out at the ages of 1, 2 and 6 years. For the first four doses usage of a whole cell vaccine (DTPw) is recommended. For the fifth dose at the age of 6 years an acellular pertussis vaccine (DTaP) should be used. The whole cell vaccine is contraindicated for prematurely born children and patients with cerebral palsy connected to perinatal hypoxia. Acquired immunity against whooping cough is decreasing with time. To eradicate B. pertussis from the respiratory tract macrolide antibiotics are the preferred agents or co‑trimoxazole if macrolides are contraindicated. Duration of treatment is 3‑5 days for azithromycin and 7‑14 days for the other macrolides and co‑trimoxazole. Prophylaxis for susceptible persons may be started up to 3 weeks after exposure. Such procedure is to the advantage of infants up to the age of 4 months and women in the third trimester of pregnancy.
Keywords: pertussis, persistent cough, pertussis toxin, DTaP, dTap
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The management of upper respiratory tract in paediatric emergencies
PEDIATR MED RODZ Vol 8 Numer 4, p. 342-350
ABSTRACT
Introduction: Most cases of sudden cardiac arrest occurring in children is mainly due to asphyxia than primary myocardial dysfunction associated with arrhythmias. Respiratory failure leading to cardiac arrest can often be caused by airway obstruction, respiratory disease and injury. Regardless of the cause of airway obstruction (foreign body, asthmaticus status, trauma), both, resuscitation proceedings and treatment of the underlying disease may be ineffective if the patency of the airway and attempt to restore adequate ventilation and oxygenation of blood will be delayed or inadequate. Objectives: The objective of this study was to presents the most effective methods of respiratory tract management in the life‑threatening condition among children discussed in the world literature and recommended by the European Resuscitation Council. Material and methods: The testing method applied to analyse the content of airway methods in the states direct threat to the life of children included in the publications indexed in databases of medical literature and synthesize their own practical experience. Conclusions: In children with preserved conscious defensive reflexes and proper respiratory endurance airway patency is tilted head and exits the mandible forward. In children, unconscious of defensive reflexes absent best way is airway intubation. In case of encounter obstacles intubation or lack of appropriate skills, is recommended to use supraglottic airway devices.
Keywords: airway management, tracheal intubation, supraglottic airway devices, children, European Resus‑ citation Council
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Second generation antihistamines in everyday practice
PEDIATR MED RODZ Vol 8 Numer 4, p. 351-359
ABSTRACT
Second generation antihistamines have been commonly used in treatment of allergic disorders for decades, especially in allergic rhinitis, urticaria, atopic dermatitis and allergic conjunctivitis. They are frequently used in everyday clinical practice, mainly because of high efficacy and excellent safety profile. In allergic disorders we use the potency of antihistamines to bind to histamine receptors, while in other diseases we use them because of their possible anti‑inflammatory mechanisms. Antihistamines are usually administered in monotherapy, however, in some cases we combine them with other agents. Certain antihistamines drugs have similar mechanisms of action, however, we can find distinct differences between the drugs. This is the reason why in case of no significant clinical improvement it is possible to add one antihistamine drug to another in order to enhance efficacy, it is also possible to increase a single therapeutic dose even up to four times. These observations based on clinical experience are the reason why it is necessary to conduct further studies on schemes of antihistamines drugs’ administration. In the article frequently used drugs are presented, especially their clinical efficacy and safety. Results of chosen clinical trials are also reported. Some controversial topics are mentioned, especially combined use of certain drugs and the possibility of applying higher daily doses.
Keywords: antihistamines, safety, efficacy, allergic rhinitis, urticaria, atopic dermatitis
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Real life study on the effectiveness of montelukast in the treatment of outpatients suffering from bronchial asthma over 15 years old
PEDIATR MED RODZ Vol 8 Numer 4, p. 360-369
ABSTRACT

Bronchial asthma is an inflammatory disease, therefore the anti‑inflammatory agents are crucial in its management. Antileukotriene modifiers reveal such activity. They are recommended by GINA experts for usage in the monotherapy alternatively to low doses of inhaled glucocorticosteroids (ICS) on the 2nd step of asthma treatment or as the add‑on therapy to ICS on higher levels. The goal of this study was the evaluation of montelukast efficacy in outpatients aged 15 years and over suffering from persistent asthma in Poland. 11 250 patients were included to the observational program. The main inclusion criterion was previously treatment with montelukast no longer then one month. The physicians’ decision on the beginning of montelukast therapy had to be made independently of the patients’ participation in the study. The data was collected using uniform self‑prepared questionnaires during two routine visits in outpatient clinic performed in 8 week interval. The mean age of subjects was 36.79±15.62 years (range from 15 to 90). More than a half of participants (52.09%) were women. The asthma duration was usually between 2 and 5 years. Eighty three percent of subjects had atopic asthma. The main reason for beginning of montelukast therapy was insufficient asthma control (58.74%), the next was exercise induced symptoms (47.99%), in 40.85% of cases physicians indicated on allergic rhinitis coexistence. Montelukast was recommended as monotherapy in 11.35% of cases, and in 87.6% as add‑on therapy to ICS. During 8 weeks of observation the number of patients with currently completely controlled asthma increased form 8.22% (695) at visit 1 up to 44.48% (3808), the number of patients with partly controlled asthma decreased form 60.33% (5104) to 46.77% (4004), and the number of patients with uncontrolled asthma markedly decreased form 31.45% (2661) to 8.75% (749). In patients’ opinion the their overall health status markedly improved and the symptoms decreased. This observational study conducted in large group of asthmatics confirmed very good effectiveness of montelukast in achieving asthma control both in monotherapy and as add‑on therapy to the previous treatment.

Keywords: montelukast, antileukotriene agents, asthma control, outpatient therapy, observational study
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Maternal advantages of breastfeeding
PEDIATR MED RODZ Vol 8 Numer 4, p. 370-374
ABSTRACT
Breastfeeding neonates and infants has been shown to improve baby health and intellectual development. World Health Organization (WHO) strongly recommends exclusive breastfeeding for the first six months of life starting within an hour of birth. At six months, other foods should complement breastfeeding, which appears to be the best additional nutrition, for up to two years or more. Recently many researches underline breastfeeding’s protective effect against many maternal pathologies, and that skipping the lactation phase would be problematic for mothers’health. Advantages of breastfeeding for mothers include early (during postpartum period) and late beneficial effects. Right after birth breastfeeding helps mothers to recover by accelerating uterine involution, preventing from massive bleeding and iron deficient anaemia. Early breastfeeding also protects mothers from postpartum depression, enhances maternal‑infant bonding and empathic behaviour, and improves quality of disrupted at that time sleep. Late advantages include lowering the risk of: some types of cancer (breast cancer, endometrial cancer, ovarian cancer), cardiovascular disorders (coronary artery disease, hypertension), metabolic disorders (diabetes, glucose
intolerance, obesity, hyperlipidaemia, hyperinsulinemia), rheumatoid arthritis, and osteoporosis. Long lasting lactation and breastfeeding are also related with economic benefits and free natural contraception. This paper summarizes the published studies related to breastfeeding and mother health outcomes.
Keywords: breastfeeding, lactation, breastfeeding mothers, early health benefits, late health benefits
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Skin – the most important organ of our body. Let’s take care of it!
PEDIATR MED RODZ Vol 8 Numer 4, p. 375-379
ABSTRACT
The skin is the largest and the most important organ of our body, meets a number of key functions: passive (protection) and active (secretory, sensory). We have to take care of it even, when it is healthy and to prevent the disease. Primary care is the proper cleaning and moisturizing. It should also protect against abrasions. It should not be overexposed to the UV radiation, low or high temperatures, wind and high humidity. Adverse effects on the skin are also irritants. The specific structure of the skin of newborns and infants necessitates constant, very careful and thorough skin care and rapid response in the event of even a minor irritation and damage. The safest cosmetic products for infants are mild, pH‑neutral cleaner with no added colours or fragrances.Do not forget about protection from sunlight and use sunscreen regularly. In teenage skin we have problems with tattoos, piercings, excessive flaming in solariums. These situations have a very negative effect on the skin and require special care. The daily skin care of adults is necessary. We must use a systematic and continuous creams tailored to the age, health of the skin and the conditions in which we live. Skin care should be a daily habit. Choosing skin care products should be guided by three principles: it should be tailored to the age and needs of your skin, do not contain preservatives and fragrances, should be affordable, so we can use it every day.
Keywords: skin, skin care, emollients, care products, protection
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