2015, Vol 11, No 3
Transfusion-related acute lung injury – a frequently undiagnosed reaction following transfusion of blood components
Pediatr Med Rodz 2015, 11 (3), p. 250–258
DOI: 10.15557/PiMR.2015.0023

Transfusion-related acute lung injury is the leading cause of mortality following transfusion of blood components. Its characteristic feature is acute hypoxaemia during or 6 hours after transfusion. The syndrome should be differentiated from cardiogenic respiratory failure and transfusion-associated circulatory overload. This article presents: 1) The aetiology and pathomechanism of transfusion-related acute lung injury, which are still not fully understood despite numerous studies. The model currently accepted is the multi-event one which involves both factors related to the patient and to the transfused blood components. Transfusion-related acute lung injury may be either immunological, with anti-HLA/HNA antibodies in blood components, or non-immunological, with no antibodies. 2) The diagnosis of transfusion-related acute lung injury which is based on clinical signs, evidence of the relationship with blood component transfusion and detection of antibodies. 3) The treatment and prevention of transfusion-related acute lung injury. The most important element in the prevention of transfusion-related acute lung injury is a reduction in blood component transfusion, particularly of plasma and platelet concentrate. Yet, further studies on larger groups of patients are necessary to specify the limitations of blood component transfusion.

Keywords: transfusion-related acute lung injury (TRALI), anti-HLA antibodies, anti-HNA antibodies, blood components, DAMPs
Electrocardiographic manifestations of inherited heart diseases – a sports cardiologist’s point of view. Part 1. Cardiomyopathies
Pediatr Med Rodz 2015, 11 (3), p. 259–267
DOI: 10.15557/PiMR.2015.0024

Sudden death during physical activity is sometimes the first manifestation of an underlying cardiovascular disease. Medical evaluations, including a resting 12-lead electrocardiogram, before and during physical training, enable the identification of still asymptomatic athletes with life-threatening heart diseases and help to protect them from sudden cardiac death. The incidence of sudden cardiac death is estimated at two cases for 100,000 young athletes per year, and it is 2–4 times higher when compared with non-athletes. The most common causes of sudden cardiac death in athletes younger than 35 are cardiomyopathies (e.g. familial hypertrophic cardiomyopathy in the U.S. and arrhythmogenic right ventricular cardiomyopathy in Italy, especially in the Veneto region). Hypertrophic cardiomyopathy is the most common genetic cardiovascular disease (1:500) caused by mutations in multiple genes, most of which encode sarcomeric proteins (especially beta-myosin heavy chain, cardiac myosin binding protein C and cardiac troponin T), and characterized by left ventricular hypertrophy (mainly interventricular septum). In contrast, arrhythmogenic right ventricular cardiomyopathy is a heart muscle disorder characterized by progressive replacement of the right ventricular myocardium with fatty and connective tissue. These two cardiomyopathies may lead to sudden death (predominantly during or after strenuous physical exercise) as a result of malignant dysrhythmias. The main aim of this article was to provide some information helpful in the recognition of electrocardiographic changes of inherited heart diseases that can cause sudden cardiac death in young physically active people, especially athletes.

Keywords: electrocardiogram, cardiomyopathies, athletes, sudden death
Electrocardiographic manifestations of inherited heart diseases – a sports cardiologist’s point of view. Part 2. Ion channel diseases
Pediatr Med Rodz 2015, 11 (3), p. 268–277
DOI: 10.15557/PiMR.2015.0025

Physical activity is associated with an increased risk of sudden death for individuals with an undiagnosed cardiovascular disease. Medical evaluations, including a resting electrocardiogram, conducted before and during physical training, enable the identification of still asymptomatic athletes with life-threatening heart diseases and help to protect them from sudden cardiac death. The incidence of sudden cardiac death is estimated at two cases for each 100,000 young athletes per year and it is 2–4 times higher when compared with non-athletes. The most common causes of sudden cardiac death in athletes younger than 35 are cardiomyopathies: hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Three to four per cent of young athletes who die suddenly have no evidence of a structural heart disease, and the cause of their cardiac arrest is primarily electrical heart diseases, such as inherited cardiac ion channel defects (channelopathies), including long and short QT syndromes, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia. The clinical courses of all these channelopathies are highly varied. They can be asymptomatic. In certain cases, episodic syncope or aborted cardiac arrest can occur. Sudden cardiac death, especially during physical exercise, can be the first sign. The aim of this article was to provide some information helpful in the recognition of electrocardiographic changes in genetic ion channel diseases, especially in the context of the prevention of sudden cardiac events in young athletes.

Keywords: electrocardiogram, ion channel diseases, athletes, sudden cardiac death
Arterial hypertension in children and adolescents – optimisation of the diagnostic and therapeutic process
Pediatr Med Rodz 2015, 11 (3), p. 278–288
DOI: 10.15557/PiMR.2015.0026

Arterial hypertension constitutes a significant clinical problem in everyday medical practice. It mainly concerns adult patients, but can also develop in childhood and adolescence. The diagnosis of hypertension in children and adolescents is possible by the systematic measurement of blood pressure levels during routine visits (observing the principles concerning the adequacy of measurements) and by referring the values to biological norms (blood pressure percentile tables) and applying proper definitions. Arterial hypertension in children and adolescents can be essential (primary), but much more frequently (compared with adults), it is secondary to a disease of other organs and systems. The predominant secondary causes of hypertension in children and adolescents are renal parenchymal and vascular pathologies, which must be considered in the diagnostic process. Additional examinations conducted in a patient with arterial hypertension depend on the child’s age, severity of hypertension, history and physical findings. Examinations to evaluate the advancement of target organ complications should be conducted simultaneously with the diagnostic process conducted to determine the aetiology of hypertension. A diagnosis of arterial hypertension in the developmental age makes it possible to implement an adequate therapy by treating the underlying condition, modifying patient’s lifestyle or prescribing pharmaceutical agents. The goal of an effective therapy is to prevent early and late complications of hypertension and reduce the risk of hypertensive emergencies.

Keywords: arterial hypertension, children, adolescents
Substances of plant origin and their potential application in treating Alzheimer’s disease
Pediatr Med Rodz 2015, 11 (3), p. 289–294
DOI: 10.15557/PiMR.2015.0027

Alzheimer’s disease is the most common neurodegenerative condition in elderly people which is characterised by progressing dementia. Patients present weaker episodic memory, attention and orientation disorders as well as cognitive and language dysfunctions. General atrophy of the brain, primarily the hippocampus and frontal cortex, is observed. Microscopically, senile/neuritic plaques composed of, inter alia, β-amyloid concretions, are found. The degeneration of the basal forebrain causes decreased activity of acetylcholine and choline acetyltransferase. Alzheimer’s disease is treated mostly by symptomatic measures since there are no drugs able to slow down or reverse the changes. The main medications include: donepezil, rivastigmine, galantamine and memantine. The prevalence increases from 3% at the age of 65 to 47% at the age of 85. The prognosis is poor; the disease progresses and causes death in a few years, mostly due to complications. Various tests on the effects and potential application of substances of plant origin in treating Alzheimer’s disease have been conducted. Quercetin found in apples, resveratrol in grapes and red wine as well as rosmarinic acid and tanshinones in salvia exhibit a protective action against the toxicity of β-amyloid concretions. Water extract from peach seeds might be a valuable inhibitor of acetylcholinesterase while vegetables possess only anti-butyrylcholinesterase activity. The purpose of this paper is the analysis whether the substances found in plants might be potentially useful in treating Alzheimer’s disease.

Keywords: Alzheimer’s disease, quercetin, resveratrol, rosmarinic acid, tanshinones
The abuse of alcohol by children and young people in Poland and in the world
Pediatr Med Rodz 2015, 11 (3), p. 295–301
DOI: 10.15557/PiMR.2015.0028

Alcohol is an indispensable element of contemporary culture, which emphasises the role it plays in interpersonal contacts. These days it appears at most social and business meetings. It is one of the most commonly used psychoactive substances. The amount of alcohol drunk and the way in which it is consumed are regulated by cultural and moral norms. One has to bear in mind, however, that this substance is legally prohibited for minors. The problem of alcohol abuse by young people has been rising both in Poland and in the world. Almost all general-education secondary school students (Polish liceum with students aged 16–18 years) have tried alcohol and a significant number of them declared having consumed it within 12 months before the study. Models of drinking presented by adults from the children’s environment also have some influence on the problem, since children perceive alcohol as a token of adulthood and an element of “good fun.” The ease of access to alcoholic beverages for minors is a puzzling phenomenon: although selling alcohol to individuals aged below 18 years is legally prohibited, there is no problem with obtaining alcohol in “trusted” establishments. What is worrying is not only the rising number of adolescents drinking alcohol, but also the fact that ever younger children start drinking. Beer is still the most commonly chosen alcoholic drink. The reasons for and circumstances of drinking alcohol are determined to a large extent by communal, cultural and religious factors. The analysis of reports from other regions of the world provides evidence for the fact that alcohol abuse by adolescents is a global phenomenon. It is not a mere “isolated problem,” but a multifaceted phenomenon which must be effectively countered. One can hope that effective work with adolescents, appropriate education and social and cultural models will contribute to the reduction of alcohol consumption among young people.

Keywords: alcoholism, adolescents, minors, inebriation, alcoholic intoxication
Level of nutrition and nutrition disorders as well as characteristics of dietary habits and physical activity among 6–13-year-old school children in the city of Piekary Śląskie in Poland
Pediatr Med Rodz 2015, 11 (3), p. 302–314
DOI: 10.15557/PiMR.2015.0029

Aim: The aim of the paper was to analyse nutrition disturbances, determine dietary habits and characterise physical activity among school children at the age of 6–13 in the Polish city of Piekary Śląskie. Material and methods: The study involved children aged 6–13 attending primary schools in Piekary Śląskie. There were 508 participants: 252 boys (49.61%) and 256 girls (50.39%). On the basis of the data collected, BMI was established and the level of nutrition was analysed. Additionally, dietary habits and the amount of physical activity were analysed statistically. Results: Obesity and overweight is present in nearly 38% of children. Simultaneously, every fifth child is malnourished. Slightly more than 45% of children have a proper number of meals per day. Approximately 67% of respondents have first and second breakfast every day. Only about 5% of pupils eat five or more portions of fruit or vegetables a day. Merely 53% of children consume milk and milk products regularly. Over 82% of pupils declare that they eat meat a few times a week. Nearly every third child eats sweets or salty snacks every day. About 60% of children prefer outdoor physical activity, and more than 21% systematically practise sport. Conclusions: The children examined – pupils attending primary schools – have improper dietary habits. They consume excess amounts of certain foods (mostly sweets), but too few vegetables and fruit, fish, milk and high-fibre grain products. Moreover, it was observed that physical activity in adolescence is inappropriate.

Keywords: overweight, obesity, malnutrition, school children
Buried bumper syndrome – complication of enteral nutrition
Pediatr Med Rodz 2015, 11 (3), p. 315–320
DOI: 10.15557/PiMR.2015.0030
Good nutritional status of the patient is very often key to successful medical intervention. For patients capable of safe and efficient swallowing, the modification of diet or introduction of oral nutritional supplements is sufficient. In patients with swallowing disorders, regardless of their aetiology, artificial nutrition access is required. In the case of long-term nutritional therapy, percutaneous endoscopic gastrostomy (PEG) insertion is considered the gold standard. The procedure of inserting a PEG feeding tube is not difficult to perform and is widely used. As any invasive medical procedure, PEG tube insertion involves the risk of complications. Typical complications that may follow this common procedure include dislodgement, dysfunction, skin infection in the area of PEG catheter placement and aspiration of gastric contents. A rare or rather rarely diagnosed complication that may result from PEG tube placement is the migration of the internal bumper under the gastric mucosa, or even deeper. This can result in the covering of the internal bumper with granulation tissue and gradual loss of its functionality. Correct prevention and treatment allows to keep the catheter functionality and protect against other serious, often life-threatening, complications such as extensive phlegmon infection of the anterior abdominal wall. The best prophylaxis is the education of caregivers providing long-term care of the PEG outside of hospital. Early recognition of the complication allows for preservative treatment and maintenance of a fully functional nutrition access. In the case of extensive and deep migration and the site being fully covered with mucosa, PEG removal and insertion of a new one is often necessary. In some cases, it is possible to use the existing, mature PEG canal with well-defined edges; however, in the case of severe infection a new PEG tube is inserted at another site.
Keywords: enteral nutrition, buried bumper syndrome, complication, gastroscopy, prevention
Mycoplasma pneumoniae as an aetiological agent of acute interstitial nephritis – a case report
Pediatr Med Rodz 2015, 11 (3), p. 321–327
DOI: 10.15557/PiMR.2015.0031

Mycoplasma pneumoniae is an atypical bacterium, widely recognised as the aetiological agent of respiratory tract infections. These infections may cause a number of complications affecting various organs. Nephrological complications of Mycoplasma pneumoniae infection include interstitial nephritis and glomerulonephritis with the deterioration of renal function and acute renal injury. In some cases, renal impairment due to Mycoplasma pneumoniae infection requires renal replacement therapy or steroid therapy, but these are usually transient disturbances which disappear after treatment. In such cases, the prognosis is good. The paper presents a case of acute interstitial nephritis in the course of Mycoplasma pneumoniae infection in a 17-year-old girl. The patient complained about pain in the lumbar region, loss of appetite, polydipsia, polyuria, fever and vomiting. She also had a cough lasting for 3 months. The girl admitted that she had consumed 5 tablets of ketoprofen 100 mg and 2 tablets of seahorse extract imported from Ukraine. During the hospitalisation an increase in inflammatory parameters, increase levels of creatinine to 3.2 mg/dl and urea to 73 mg/dl as well as hypokalaemia to 2.9 mmol/l. Urinalysis revealed a trace of protein, and the urine collection showed albuminuria and increased albumin-to-creatinine ratio. Chest X-ray demonstrated inflammatory changes, and a serological examination confirmed the infection with Mycoplasma pneumoniae. After the causal (clarithromycin) and symptomatic treatment, the symptoms resolved and renal inflammatory parameters normalised. It is being suspected that the aetiology of pneumonia was mycoplasmatic, and the development of acute renal injury was caused by two factors: Mycoplasma pneumoniaeassociated tubulointerstitial nephritis and the ingestion of considerable doses of non-steroidal anti-inflammatory drugs.

Keywords: Mycoplasma pneumoniae, clinical manifestation, acute interstitial nephritis, tubulointerstitial nephritis, acute renal injury
Facebook-based medicine, or the doctor’s professional image on the Internet
Pediatr Med Rodz 2015, 11 (3), p. 328–338
DOI: 10.15557/PiMR.2015.0032

In times of universal access to the Internet virtual reality is no longer a reflection of the real world, but is beginning to influence people’s behaviour in the real world and their views. The definition of medical professionalism therefore is also changing and doctors, who may be judged on the basis of their Internet image and whose knowledge can be verified more easily these days, face new challenges. This represents both a risk and opportunity; therefore, it is worth investigating the status of research into this issue conducted to date. In this work we present world data demonstrating an increase in social media activity of doctors and patients, including on Facebook, which is the second most frequently visited website. We also point to risks involved in sharing personal data on the Internet (real name, surname, date of birth, photograph). By sharing their private information online, the doctor allows for confronting their professional image with their private life. A patient who can see private photographs of their doctor may begin to doubt the doctor’s professionalism and competences and thus lose confidence in them, which will inevitably compromise the therapeutic process. We also provide a number of rules laid down by medical associations from many countries, which one should bear in mind when posting content on the Internet (the main rule is: “We should not post anything on the Internet that we would not say in a crowded lift”). We also describe the benefits for the doctor that can be derived from sensible use of Facebook and we summarise studies on creating a professional, coherent Internet image of the doctor.

Keywords: social media, Facebook, Internet, doctor, professionalism