2014, Vol 10, No 2
Nanoparticles in medical applications – a direction of the future?
Pediatr Med Rodz 2014, 10 (2), p. 104–110
DOI: 10.15557/PiMR.2014.0015

Methods of producing nanoparticles, called nanotechnologies, have inspired lively interest over the recent years due to the broad possibilities for application of nanoparticles in numerous fields, including electronics, information technology, biotechnology, medicine, pharmacy, cosmetology and others. Nanoparticles are defined as particles which may occur in various shapes and which have at least one dimension smaller than 100 nm. Depending on the process of creation we can differentiate between natural nanoparticles occurring in the environment and designed nanoparticles, which are man-made. Designed nanoparticles are characterised by special physical properties which make them suitable for biomedical applications, among others. An example of such an application is the use of silver nanocomposites, which in a micronised form display a strong bacteriostatic and bactericidal effect. Graphene, the latest achievement of nanotechnology with unique mechanical and physical properties, is another material which raises much interest among researchers. The dynamic development of numerous directions in modern technologies based on nanotechnologies is an indisputable sign of progress. The discovery of the unique properties of nanomaterials opens wide possibilities for numerous applications; however, it also requires comprehensive research to ensure they are safe to use.

Keywords: nanoparticles, nanotechnologies, silver nanoparticles, graphene, nanocomposites
Tuberculosis in children – from diagnostics to chemoprophylaxis and treatment
Pediatr Med Rodz 2014, 10 (2), p. 111–127
DOI: 10.15557/PiMR.2014.0016

Tuberculosis is a disease known to the mankind for centuries, but still poses a big social problem and a challenge for the twenty-first century medicine. It is estimated that at least 30% of the global population is infected with the tubercle bacillus. The disease develops in 9 million people annually, including 1 million children aged below 15. Tuberculosis in the paediatric population requires particular attention because the incidence in this age group is a measure of the epidemiological situation of tuberculosis in a given area. Diagnosis of tuberculosis in children is particularly difficult due to its sparse and non-specific symptoms, imitating other diseases and increasing number of cases of mycobacterial infection without clinical, radiological and microbiological symptoms – so-called latent tuberculosis. If conditions are favourable, latent mycobacterial infection may develop into an active disease and therefore the authors draw attention to the need for rapid diagnosis of infection with Mycobacterium tuberculosis and describe the existing diagnostic methods (tuberculin skin test, interferon-gamma release assays) as well as indications for chemoprophylaxis and principles of conducting it in children. Moreover, the authors also emphasise the necessity for a thorough interview and physical examination, analysis of sputum-positive patient’s contacts, imaging and microbiological tests as well as a significant role of family physicians and paediatricians. Due to the growing phenomenon of resistance of mycobacteria to different drugs (according to the WHO, the general number of new cases of MDR-TB and XDR-TB diagnosed in 2012 amounts to 450 thousand), the issue of multidrug-resistant tuberculosis as well as its treatment and available medications are discussed.

Keywords: tuberculosis in children, latent tuberculosis, multidrug-resistant tuberculosis, IGRA tests, BCG vaccine
Is there a cure for bacterial infections of the upper respiratory tract with multiple locations?
Pediatr Med Rodz 2014, 10 (2), p. 128–136
DOI: 10.15557/PiMR.2014.0017

Upper respiratory tract infections (often with multiple locations) are a common problem, especially in the GP’s office. These infections account for about 50–60% of all community-acquired infections and are the most common cause of fever in infants and young children. Most are viral infections. Bacterial factors are S. pneumoniae, H. influenzae and M. catarrhalis. The basic procedure is a detailed medical anamnesis, a careful examination and determination of the likely aetiology of the infection. The decision to empirically treat the infection is generally based on the initial differential diagnosis, without the need for a microbiological examination. In case of a viral infection, a symptomatic treatment is sufficient. In the case of suspected bacterial aetiology, is bacteriological confirmation is not suitable, but empirical antibiotic therapy should be implemented. Physicians must pay attention particularly to compliance. Without compliance the treatment generally fails. Currently, physicians have antibiotics (such as amoxicillin with clavulanic acid) which in terms of efficiency and safety are almost ideal drugs. Among the features of an ideal antibiotics we may find: spectrum of effect covering the most common pathogens, efficiency, bioavailability, multiple dosage form, safety, availability and a low cost of treatment. In case of complications or failure of the therapy the exact aetiology should be determined (bacteriological, virological, mycological examination) and hospitalisation should be considered. Following and respecting such scheme of behaviour may contribute to a faster and more efficient treatment of the upper respiratory tract infections, decrease the number of complications, which is equally important, and reduce direct and indirect costs of the therapy.

Keywords: upper respiratory tract infections, rational antibiotic therapy, amoxicillin with clavulanic acid, treatment, children
Aspirin: yesterday, today, and tomorrow
Pediatr Med Rodz 2014, 10 (2), p. 137–151
DOI: 10.15557/PiMR.2014.0018

Clinical utility of aspirin (acetylsalicylic acid, ASA) is one of the more important issues in the primary and secondary prevention of cardiovascular disease. The present paper provides analysis of aspirin history, mechanisms of its antiplatelet activity, and expediency of the use of low- and high-dose aspirin in the groups including patients after myocardial revascularization, and requiring secondary prevention of stroke. Also gender-specific aspirin properties were mentioned, highlighting the especially important role of aspirin in women at the age of >65 years, and its utility in all women, irrespectively of age, and those who are at high risk of cardiovascular disease, including atherosclerosis-related cardiovascular disease. Moreover, the mechanisms of aspirin resistance, characterized by inability of aspirin to prevent thromboembolic complications or inadequate platelet inhibition showed in laboratory results, were mentioned. Prevalence of resistance in aspirin-treated patients is estimated to be between 1 and 68%. Stress was also put on the aspirin safety, associated with prophylaxis of peptic ulcer disease, which can be achieved i.e. by the use of the enteric-coated aspirin. This form of aspirin is associated with lower risk of gastrointestinal mucosae damage and bleeding from the gastrointestinal tract. At the end of the article, the importance of the adherence to therapeutic guidelines of aspirin use, including assessment of variation in aspirin bioavailability associated with improper dosing and altered absorption in the gastrointestinal tract, was stressed.

Keywords: aspirin, aspirin resistance, gastroprotection
The issue of treatment-resistant hypertension in clinical practice
Pediatr Med Rodz 2014, 10 (2), p. 152–162
DOI: 10.15557/PiMR.2014.0019

Resistant hypertension is defined as a clinical situation characterised by a failure to achieve lower systolic and diastolic blood pressure levels below 140 mm Hg and 90 mm Hg, respectively, despite the use of the principles of lifestyle modification as well as pharmacological treatment, including a diuretic as well as two other antihypertensives belonging to different groups, administered at adequate doses (mineralocorticoid receptor may not be included in the regimen). Previous studies suggest that the prevalence of resistant hypertension in the population of patients receiving antihypertensive treatment is 13%. According to a Polish nationwide survey NATPOL 2011, 13% of patients treated due to hypertension suffer from resistant hypertension. It was noted that factors predisposing and/or related to the development of resistant hypertension primarily include: advanced age, high/increased baseline blood pressure (systolic pressure in particular), obesity, excessive salt intake, chronic renal disease and diabetes. There is a consistent view that apart from non-compliance with lifestyle modification, an inadequate antihypertensive regimen and/or non-compliance with therapeutic indications are among the most common causes of treatment-resistant hypertension. Current recommendations for the management of patients with resistant hypertension also stress the importance of identifying the causes of secondary hypertension. This represents a very important element in the management of resistant hypertension and may facilitate pharmacological treatment. In the case of failure to achieve blood pressure target values, it is recommended to include a drug belonging to aldosterone receptor antagonists. If both, non-pharmacological and pharmacological therapies prove inefficient, surgical treatment of resistant hypertension may be considered in selected cases.

Keywords: resistant hypertension, occurrence, causes, diagnostics, pharmacological treatment, surgical treatment
Lyme disease – principles of diagnosis and treatment
Pediatr Med Rodz 2014, 10 (2), p. 163–173
DOI: 10.15557/PiMR.2014.0020

The paper discusses epidemiological and clinical data as well as therapeutic and diagnostic methods with regard to Lyme disease. Main manifestations of early (erythema migrans, borrelial lymphoma, Lyme carditis, neuroborreliosis and Lyme arthritis) and late (neuroborreliosis, Lyme arthritis, acrodermatitis chronica atrophicans) Lyme borreliosis are described and their treatment is discussed. The most useful antibiotics are doxycycline and ceftriaxone. It was noted that in most cases of Lyme disease the prognosis is good, and antibiotic treatment is very effective regardless of the stage of infection. Detection of specific anti-Borrelia burgdorferi antibodies in a patient with a history of a tick bite and clinical symptoms suggesting Lyme disease is necessary for diagnosis. The results of serological tests must be interpreted carefully and always in connection with the clinical picture. A seropositivity without clinical symptoms of the disease does not necessarily prove an active infection. Antibody serum titres should not be used to assess therapeutic efficacy or be regarded as an indication for a re-treatment. Current recommendations stress that detection of chemokine CXCL13, searching for B. burgdorferi antigens in the cerebrospinal fluid and urine, searching for B. Burgdorferi spheroplasts or L-forms as well as CD57+/CD3 subpopulation assessment as well as lymphocyte transformation test have no confirmed diagnostic significance in Lyme disease diagnostics.

Keywords: Lyme disease, diagnostic methods, ELISA, Western blot, PCR, treatment
Depressive disorders at general practitioner’s office – diagnostics and pharmacotherapy
Pediatr Med Rodz 2014, 10 (2), p. 174–189
DOI: 10.15557/PiMR.2014.0021

Depression is one of the most common mental disorders. Epidemiological studies indicate a growing risk of depression as a complication of chronic or severe somatic diseases. Depression itself has also a significant influence on the course and efficacy of therapy of many somatic diseases, thus the relationship between depression and physical illness is bidirectional. There is convincing evidence of comorbidity of depression and diseases such as diabetes, stroke, cardiovascular diseases, cancer, dementia, chronic pain or infectious diseases. Given the prevalence of these diseases and a high population risk of depression, primary care physicians should be prepared to carry out diagnosis and implement proper treatment. Due to the nature of general practitioners’ work, diagnosis of depressive disorders should be limited to the essential minimum. Both current diagnostic criteria as well as simple lists of symptoms may occur helpful. Pharmacotherapy is an effective and widely available treatment of depressive disorders. It is emphasised to individualise the selection of the right antidepressant in a group of patients with somatic burden. When choosing the drug, it is vital to take into account not only depressive symptoms. Potential side effects of antidepressants and their interaction with other drugs are equally important. In the following study, in addition to the characteristics of co-occurrence of depression and somatic diseases as well as guidelines for the diagnosis of depressive disorders, the choice of drugs with proven antidepressant efficacy is presented. Their safety profiles enable their use in outpatient settings.

Keywords: depression, psychiatry, antidepressants, comorbidity, general practitioner
Surgical treatment of pancreatic pseudocysts – clinical experience
Pediatr Med Rodz 2014, 10 (2), p. 190–199
DOI: 10.15557/PiMR.2014.0022

Introduction: Pancreatic pseudocysts are frequent complications after acute and chronic pancreatitis. They are diagnosed in 6–18% of patients with the history of acute pancreatitis and in 20–40% cases with chronic pancreatitis. The aim of the study was to analyse early results of surgical treatment of pancreatic acute and chronic pseudocysts based on our experience. Material and methods: The retrospective analysis was based on early results of surgical treatment of 46 patients aged between 20 and 78 (33 males and 13 females) who underwent treatment of acute (n = 26) and chronic (n = 20) pancreatic pseudocysts from November 2005 to July 2011 at the Second Department of General and Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract in Lublin. Results: The choice of a surgical method of treatment depended on the size, localisation, thickness of pseudocystic wall and changes in the main pancreatic duct. We used the following surgical methods: cystogastrostomy (Jurasz procedure) was conducted in 22 patients (47.8%), Roux-en-Y cystojejunostomy was performed in 19 cases (41.3%), complete excision of the pseudocyst was possible in two patients (4.3%) and cystoduodenostomy – in one case (2.1%). Also, in single cases external drainage (2.1%) and cystopancreaticojejunostomy of Puestow (2.1%) were applied. Forty-four patients (95.6%) were cured. Early postoperative complications were observed in 2 patients (4.4%). Two reoperations (4.4%) were required. Early postoperative mortality was 0%. Conclusions: Classic internal drainage procedures, known since the 19th century, are still effective methods of treatment in acute and chronic pancreatic pseudocysts.

Keywords: pancreatic pseudocyst, internal drainage, cystogastrostomy, cystojejunostomy, surgical treatment
Role of sonography in the diagnosis of the most common peripheral neuropathies
Pediatr Med Rodz 2014, 10 (2), p. 200–206
DOI: 10.15557/PiMR.2014.0023

In the practice of a general practitioner, the most common peripheral neuropathy reported by patients is carpal tunnel syndrome followed by cubital tunnel syndrome. Carpal tunnel syndrome results from entrapment of the median nerve at the level of the transverse carpal ligament, and cubital tunnel syndrome is a consequence of a compression on the ulnar nerve at the level of the groove of the humerus. The diagnosis of these syndromes is based on a specific interview, clinical examination and additional examinations. The aim of a clinical examination is to assess sensory disorders and muscle atrophy. Until today, standard additional examinations have been electrophysiological tests. At present, however, they are more and more frequently replaced by high-frequency sonography. As in other types of ultrasound examinations, the assessment of peripheral nerves, including the median and ulnar nerves, is non-invasive, well-tolerated by patients, relatively inexpensive and readily available. The examiner must possess knowledge on nerve topographic anatomy and criteria for ultrasound assessment of peripheral neuropathies. During an ultrasound examination, the following are assessed: shape, cross-sectional area of the nerve trunk, its echogenicity, vascularity and relation to adjacent tissues. Motor and sensorimotor nerves may also be assessed indirectly by analysing ultrasound images of the skeletal muscle innervated by these nerves. Furthermore, an important element of an ultrasound examination is dynamic assessment of the nerves. Carpal and cubital tunnel syndromes belong to so-called entrapment neuropathies whose common sonographic features are nerve oedema and hyperaemia proximally to the compression site.

Keywords: sonography, diagnosis, compression neuropathies, carpal tunnel syndrome, cubital tunnel syndrome