2015, Vol 11, No 1
Asthma according to the GINA report 2014
Pediatr Med rodz Vol 11 Numer 1, p. 10–29
DOI: 10.15557/PiMR.2015.0001

The authors of this paper decided to present three chapters of the new revised GINA report of 2014. In the first chapter, the new definition of asthma is proposed and the diagnostic processes as well as general methods of asthma treatment are presented. This definition is simpler than the one given in earlier reports. According to the GINA report 2014, a detailed history and physical examination of a patient lead to the correct diagnosis but additional tests, such as airflow parameters, bronchial obstruction reversibility test and airway hyperresponsiveness test, are helpful in the diagnosis. According to the first asthma management guidelines, the treatment of this disease depends on the severity defined by clinical symptoms and lung function parameters. However, the asthma severity level does not reflect the response to treatment. Therefore, the GINA report of 2006 recommended a change in the approach to asthma management that consists in determining the asthma control level, and distinguished between controlled, partially controlled and uncontrolled asthma. The second chapter of the GINA report 2014 confirms this approach and emphasises that obtaining an optimal disease control is the main goal of asthma treatment. Accurate assessment of asthma control improves treatment efficacy. The third chapter discusses problems associated with asthma treatment. Determining the asthma control level is the basis for selecting and modifying pharmacotherapy. The GINA report 2014 confirms the division of antiasthmatic drugs into two main groups i.e. controllers and relievers of dyspnoea. It also confirms the division into five steps of treatment.

Keywords: asthma, GINA report, definition of asthma, phenotypes of asthma, treatment of asthma
Chronic kidney disease in disadvantaged populations
Pediatr Med Rodz 2015, 11 (1), p. 31–37
DOI: 10.15557/PiMR.2015.0002

Of all of the forms of inequality, injustice in health is the most shocking and inhumane.

Dr. Martin Luther King, Jr.

Diagnosis and treatment of prostate cancer in elderly men
Pediatr Med Rodz 2015, 11 (1), p. 39–47
DOI: 10.15557/PiMR.2015.0003

Prostate cancer is the most common malignant tumour in elderly men in Europe. The prevalence rate of prostate cancer is still increasing. This is related to higher costs of treatment. The biology of prostate cancer indicates that it belongs to a group of non-homogeneous tumours, including both neoplasms of small malignancy and clinical importance as well as neoplasms of high malignancy and great impact on the quality of life and lifespan. In the past years, many studies and meta-analyses on adjustment of diagnosis and treatment of prostate cancer to age and comorbidities have been conducted. The abovementioned studies show that not everyone with diagnosed prostate cancer should undergo radical treatment. In some groups of patients, complications of treatment may be greater than potential benefits, lead to the loss of the quality of life or even shorten life expectancy due to adverse effects. An individual choice of treatment is especially important in elderly men with multiple comorbidities. Therefore, the G8 and GISR questionnaires were established and assessed. Their aim is to evaluate the patient’s condition and choose an appropriate treatment method. The purpose of this study is to present the results of the above-mentioned meta-analyses and guidelines. This paper was prepared based on the EAU Guidelines from 2014.

Keywords: prostate cancer, treatment after the age of 70, diagnosis after the age of 70, CISR-G, Geriatric 8
Thrombosis in cancer
Pediatr Med Rodz 2015, 11 (1), p. 48–67
DOI: 10.15557/PiMR.2015.0004

Malignant tumours are among the strongest risk factors for venous thromboembolism. The probability scores for deep vein thrombosis and pulmonary embolism, which we use in our everyday practice, have not yet been validated in patients with cancer, which is why they should be used with caution. Prevention of thrombosis should always be implemented in patients undergoing surgery and most patients treated conservatively, which results from the application of appropriate probability scores assessing the risk of thrombosis in these patients. The prevention method should be adjusted individually depending on the characteristics of the patient and the existence of contraindications to the use of given methods, bearing in mind their availability, cost and ability to monitor the anticoagulant effect. Treatment of venous thromboembolism in patients with cancer is different from treating it in patients with no concomitant tumour. These differences relate to both the type of treatment (anticoagulant drug selection and dosage) and its duration. Low-molecular-weight heparin is the preferred form of both initial and long-term treatment, which should last at least 6 months. Both oncologists and other health care professionals working in cancer teams should make sure at each time that the patient has at least minimal knowledge about the symptoms ensuring early detection of thrombosis. Good communication with the patient considerably facilitates effective prevention and treatment.

Keywords: venous thromboembolic disease, cancer, deep vein thrombosis, pulmonary embolism
Helicobacter pylori infection. Diagnosis and treatment
Pediatr Med Rodz 2015, 11 (1), p. 68–74
DOI: 10.15557/PiMR.2015.0005

Helicobacter pylori infection is common. The World Health Organization estimates that about 70% of people in developing countries and 30% in developed countries are infected with this bacterium. The infection spreads through personal contacts via an oral-oral, gastro-oral and faecal-oral route of transmission. Helicobacter pylori infection is asymptomatic in 80–90% of cases. Both invasive and non-invasive methods are used in the diagnosis of this infection. The choice of the method depends on the current clinical condition and the necessity to perform endoscopy of the upper gastrointestinal tract. Since the incidence and prevalence of Helicobacter pylori infection are high, H. pylori detection tests should be performed only when eradication therapy is planned. According to the guidelines of the Working Group of the Polish Society of Gastroenterology, eradication treatment involves a multidrug therapy with proton pump inhibitors, antibiotics and bismuth citrate. All of these drugs should be used for a period of 10–14 days. Clarithromycin should not be used as the first choice treatment because of increasing resistance in Poland. A breath test is an optimal way to evaluate the effectiveness of the antibacterial therapy but is rarely performed due to high price and low availability. Serology tests are available and cheap, but are not suitable to assess the efficacy of eradication. Helicobacter pylori antigen detection in stool is therefore important in the diagnosis. The test is not very expensive, available and characterised by very high sensitivity and specificity of up to 90%.

Keywords: Helicobacter pylori, infection, diagnosis, eradication, efficacy of treatment
Human babesiosis – a little-known tick-borne disease
Pediatr Med Rodz 2015, 11 (1), p. 75–82
DOI: 10.15557/PiMR.2015.0006

Babesiosis is an infectious, tick-borne disease caused by the parasitic species of Babesia. Transmission via blood transfusion or transplacental infections are much rarer. Most cases of human babesiosis occur in the United States, whereas only single cases have been reported in Europe, including Poland. Anaemia due to erythrocyte haemolysis, which in more severe cases may result in multiple organ dysfunction syndrome and death, particularly in immunocompromised patients, is a typical sign of babesiosis. Immunocompetent patients are asymptomatic or develop mild infection accompanied by fever, osteoarticular pain and erythrocyturia. The diagnostics of babesiosis should be considered in patients with flu-like symptoms who live or are temporarily residing in endemic areas as well as in patients diagnosed with other tick-borne diseases. Final diagnosis should be based on microscopic examination of thin blood smears (Wright or Giemsa staining followed by examination under oil immersion) or PCR-based amplification of the babesial genetic material. Treatment with atovaquone and azithromycin or clindamycin and quinine usually allows for a complete recovery and prevents complications. Severe cases of babesiosis require exchange transfusion. The infection is frequently combated by the immune system without the use of antibiotics in patients with mild or asymptomatic babesiosis. The prevention of babesiosis primarily involves protective measures that minimize the exposure to ticks, which are the only source of infection.

Keywords: human babesiosis, tick-borne diseases, haemolytic anaemia, erythrocyturia, multiple organ dysfunction syndrome
Therapy of anxiety disorders – the problem of choosing a drug in the primary health care physician’s practice
Pediatr Med Rodz 2015, 11 (1), p. 85–94
DOI: 10.15557/PiMR.2015.0007

Anxiety disorders are the most prevalent mental disorders. A vast majority of patients with such problems are treated by the primary health care physicians. In practice, the most available form of treatment at this level of health care is pharmacotherapy. The most frequently chosen drugs belong to the group of benzodiazepines. Benzodiazepine anxiolytics exhibit the commonly known advantages: they are effective in the short run and very well tolerated. A bit less attention is paid to their severe disadvantages. These disadvantages comprise first of all: inclination to induce dependence which is often connected with the need to increase the dose of the drug to obtain a comparable effect, adverse impact on cognitive functions, and the risk of a significant increase in the dose of the drug after discontinuation of benzodiazepine (rebound phenomena). The article presents disadvantages and advantages of benzodiazepines and benefits connected with the use of the underestimated though effective anxiolytic – hydroxyzine. The results of controlled studies point to the efficacy of this drug in therapy of generalized anxiety disorder. Hydroxyzine may be also effectively used during discontinuation of benzodiazepines. This drug does not exhibit any addictive properties and its administration does not cause disturbances in cognitive functions. Psychotherapy continues to be the basic form of treatment of anxiety disorders, but its use in everyday medical practice conditions is often very difficult. In pharmacotherapy of anxiety the use of hydroxyzine is safer than the use of benzodiazepines, and it is often equally effective. Also other drugs, which are not discussed extensively in this article, such as antidepressants in the group of selective serotonin reuptake inhibitors, buspirone and pregabalin, exhibit significant anti-anxiety effects.

Keywords: pharmacotherapy of anxiety, benzodiazepines, hydroxyzine
Do children who snore have a higher blood pressure than their peers?
Pediatr Med Rodz 2015, 11 (1), p. 95–103
DOI: 10.15557/PiMR.2015.0008

Introduction: Breathing disorders during sleep in adults have an adverse influence on the circulatory system and promote the development of hypertension, among other disorders. A large number of literature data confirm the view that sleep-disordered breathing can increase the risk of the development of hypertension in childhood as well. The aim of the study was to evaluate blood pressure values in children with adenoid or tonsillar hypertrophy and sleep-related breathing disorders such as snoring or apnoea. Material and methods: Fifty-one children participated in the study (17 girls and 34 boys). Anthropometric measurements (body height and weight, body mass index, waist and hip circumference) and blood pressure values were analysed. The intensity of sleep-related breathing disorders was evaluated using a questionnaire administered to the children’s parents. The results obtained were compared to normative values established by a Polish population study (OLAF). Results: Children from the study group have body dimensions comparable with those of the whole children population. Blood pressure in the children from the study group is also within normal range, but in boys we found it to be slightly higher than in girls by comparing the Z-score values. Conclusions: We did not confirm the hypothesis that children who snore due to adenoid/tonsillar hypertrophy who were qualified to surgery had hypertension in comparison to the whole population of Polish children. However, it was observed that snoring had a greater impact on boys’ blood pressure.

Keywords: children, snoring, breathing disorders, hypertension
Antiarrhythmic therapeutic effect of polyunsaturated omega-3 fatty acids used in treatment of ventricular arrhythmia in 15-year-old female swimmer – case report
Pediatr Med Rodz 2015, 11 (1), p. 105–111
DOI: 10.15557/PiMR.2015.0009

Premature ventricular contractions are common, both in the general population and among athletes. These arrhythmias are characterized by a heterogeneous aetiology and different clinical significance. They may develop not only as a sign of structural heart disease (e.g. myocarditis, cardiomyopathy, myocardial ischaemia, heart defects), genetically determined ion channel dysfunctions, but also as a result of electrolyte imbalances and adverse effects of pharmacotherapy. However, it is not possible to determine their causes in some of the patients. Premature ventricular contractions in patients with heart disease may be a trigger for life-threatening arrhythmias, especially during physical exercise. Antiarrhythmic agents having various mechanisms of action, particularly β-adrenergic blocking agents and, in some cases, invasive procedures such as ablation of an arrhythmogenic focus, are used for the treatment of ventricular arrhythmias. Some of the dietary supplements, polyunsaturated omega-3 fatty acids in particular, may also be effective. Epidemiological and experimental studies as well as randomized clinical trials indicate that n-3 polyunsaturated fatty acids show antiarrhythmic properties by direct effects on electrophysical processes in cardiomyocytes – both atrial and ventricular. Omega-3 polyunsaturated fatty acids were observed to have, among other things, the following effects: inhibiting some of the ionic currents (sodium, L-type calcium, potassium), increasing parasympathetic tone and decreasing the sensitivity of β-adrenergic receptors. This paper presents a case of idiopathic ventricular arrhythmia in a 15-year-old female swimmer successfully treated with n-3 polyunsaturated fatty acids.

Keywords: premature ventricular contractions, antiarrhythmic therapy, n-3 polyunsaturated fatty acids, athletes
Amyotrophic lateral sclerosis – a motor neuron disease. Case report
Pediatr Med Rodz 2015, 11 (1), p. 112–118
DOI: 10.15557/PiMR.2015.0010

Amyotrophic lateral sclerosis, also known as Charcot’s disease and motor neuron disease, is a progressive neurodegenerative disease that causes muscle weakness, paralysis, and ultimately, respiratory failure. The aetiology and the pathogenesis of the syndrome remain unknown. Most people live 2–5 years after their first signs of the disease. There is no cure or effective treatment. We present a case of a female patient affected by progressing Charcot’s disease. On the Amyotrophic Lateral Sclerosis Functional Rating Scale – Revised (ALSFRS-R), the patient obtained 21 points. Atrophy and muscle spasm were very extended. Electromyography revealed features of coexisting denervation and reinnervation in the examined muscles. A growing number of Charcot’s disease cases require multidirectional actions to meet patient’s physical, emotional, and nutritional needs. Amyotrophic lateral sclerosis is an incurable disease. However, it is possible to relieve its symptoms by applying systematic physical rehabilitation.

Keywords: ALS, amyotrophic lateral sclerosis, fasciculation, motor neuron disease