2017, Vol 13, No 3
Impedance cardiography during exercise – new technology, new possibilities
Pediatr Med Rodz 2017, 13 (3), p. 303–310
DOI: 10.15557/PiMR.2017.0031

Exercise impedance cardiography is a non-invasive method for the assessment of haemodynamic parameters of the cardiovascular system during exercise. Owing to the technology based on morphological analysis of the impedance signal and advanced artifact filtering, the method enables to perform a test at the onset of symptoms. High repeatability and accuracy of exercise impedance cardiography have been confirmed in a number of studies. Previous clinical experience indicates the utility of exercise impedance cardiography in the objectification of reported complaints, identification of haemodynamic background of the observed symptoms and subclinical cardiovascular dysfunction. Qualitative assessment of impedance cardiography waveform may be useful in the detection of left ventricular diastolic dysfunction, ventricular dyssynchrony and hypervolaemia. Evaluation of haemodynamic parameters during exercise may support the diagnosis of ischaemic heart disease, heart failure, arterial and pulmonary hypertension. Stroke volume profile or cardiac output alterations may precede clinical symptoms and abnormalities previously detected by standard methods. Therefore, exercise impedance cardiography is undoubtedly an added value to classical diagnostic methods such as the echocardiography or exercise tests. This is highlighted in the current 2016 guidelines for the implementation of ergospirometry. Exercise impedance cardiography, as a relatively simple, inexpensive and reliable test, is likely to play an increasingly important role in evaluating patients’ physical capacity, particularly as an alternative to invasive haemodynamic methods. The clinical value of exercise impedance cardiography should be evaluated in future studies.

Keywords: impedance cardiography, exercise test, heart failure, hypertension
Superficial vein thrombosis and deep vein thrombosis – a comparison
Pediatr Med Rodz 2017, 13 (3), p. 311–316
DOI: 10.15557/PiMR.2017.0032

Although superficial vein thrombosis is commonly considered a rather minor condition, a number of studies indicate that its consequences can be much more severe. Since the introduction of Doppler ultrasonography to common diagnosis of venous diseases, the approach to threats associated with superficial vein thrombosis has changed, mainly in the context of venous thromboembolism. Superficial thrombosis in varicose veins must be differentiated from that occurring in patients without varicosities. In the former case, superficial vein thrombosis is usually caused by haemodynamic disorders (slower flow), while in the latter, it is caused by thrombophilia or inflammation, but it can also be a prodromal sign of cancer. Ultrasonography enables one to distinguish deep vein thrombosis caused by superficial vein thrombosis progression (by extension through perforator veins or the great/small saphenous vein ostium into the deep venous system) from deep vein thrombosis occurring at a certain distance from the site of superficial vein thrombosis. The authors emphasise that due to the possibility of concomitant deep vein thrombosis or pulmonary embolism, our attitude to the diagnostic process, potential complications and treatment of superficial vein thrombosis should be changed.

Keywords: superficial vein thrombosis, venous thromboembolism, varicose veins
Do surgeries for varicose veins carry a risk of deep vein thrombosis? Endovenous laser ablation and conventional saphenectomy – a comparison
Pediatr Med Rodz 2017, 13 (3), p. 317–326
DOI: 10.15557/PiMR.2017.0033

Venous diseases, in particular varicose veins of the lower extremities, are one of the most common chronic diseases and a significant cause of morbidity in Europe and the USA. Varicose veins are considered a risk factor for deep vein thrombosis. Most patients with varicose veins have great saphenous vein ostial insufficiency and reflux of varying degrees. Standard treatment in these cases is high ligation and stripping of the great saphenous vein. This surgery, however, carries a risk of thrombotic complications. Minimally invasive procedures, which include endovenous laser ablation of the great saphenous vein, are the current world trends. This method is a relatively new treatment option for great saphenous vein reflux. The authors present the current state of knowledge on the risk of deep vein thrombosis after different surgical procedures for the treatment of varicose veins in the lower extremity. The literature analysis has led to a hypothesis that lower limb varicose vein surgeries that involve laser obliteration of the great or small saphenous veins carry a lower risk of deep vein thrombosis compared with conventional surgeries. Tumescent anaesthesia, short duration of the procedure and rapid return to physical activity may play a role in deep vein thrombosis prevention. The authors underline that thromboprophylaxis should be implemented irrespective of the method, using risk evaluation, e.g. based on the Caprini scale.

Keywords: varicose veins in the lower extremities, laser ablation, stripping, deep vein thrombosis
The assessment of pit pattern on the polyps’ surface as the essential part of high quality colonoscopy
Pediatr Med Rodz 2017, 13 (3), p. 327–334
DOI: 10.15557/PiMR.2017.0034

The meaning of the term high-quality endoscopy is gradually widening and consists of multiple elements. The highest possible quality of colonoscopies constitutes the basis of anticancer protective action by the identification and treatment of early precancerous lesions. Data from randomised trials demonstrate that only top quality endoscopy has a protective value against colon cancer morbidity. On the other hand, data coming from medical centres which do not meet high standards confirm the lack of protective anticancer value of low-quality colonoscopies and an increased rate of interval cancers. The fundamental indicators of high standards are: caecal intubation rate, adenoma detection rate, colonoscopy withdrawal time and bowel preparation. These parameters are gradually widened to include other factors such as: proximal colon polyp detection rate, retrieval rate of removed polyps, sedation practice and many others. One of the biggest challenges we have to face is the effort to perform endoscopic visual assessment of polyps in vivo. The principal aim of this action is to reduce the number of redundant histopathological tests and in general to reduce histopathology workload for very low-risk lesions, especially polyps ≤5 mm in diameter, this being the so called “resect and discard” strategy. One of useful tools is the assessment of the pattern of colonic crypt outlets, known as the pit pattern. The combination of the pit pattern and the Paris polyp classification determine high-risk lesions well in terms of advanced histology and technical problems with safe removal. Lesions originally found as unresectable should be reassessed and resected endoscopically in experienced expert centres.

Keywords: high-quality endoscopy, pit pattern, interval cancer
Probiotics in the prophylaxis of recurrent urinary tract infections in children
Pediatr Med Rodz 2017, 13 (3), p. 335–343
DOI: 10.15557/PiMR.2017.0035

Recurrent urinary tract infections are a serious clinical problem both in adults and children. Febrile episodes of recurrent urinary tract infections may lead to the formation of renal scars and development of chronic kidney disease. Traditionally, management involved antibiotic prophylaxis introduced after a first febrile episode. Recently, however, the indications for antibiotic therapy have been narrowed down to treat cases of recurrent urinary tract infections and disorders which pose a significant risk for their development. In the current era of the ubiquitous use of antibiotics, bacterial resistance is an increasingly alarming problem, hence the recent search for alternative methods of prophylactic treatment. For many reasons, probiotics appear to be an excellent alternative. The microbiome of the human gastrointestinal tract and urogenital tract consists of a multitude of helpful probiotic bacteria, including the especially beneficial Lactobacillus strain. A significant relationship has been confirmed to exist between infections of the urinary tract and a decreased number of lactobacilli. Their antibacterial properties include their ability to secrete numerous substances inhibiting the growth of pathogenic microorganisms and to form a biofilm preventing the adhesion of uropathogens to the epithelium of the urinary tract as well as, indirectly, their immunomodulatory potential. This study is aimed at discussing the existing evidence supporting the effectiveness of probiotics in the prophylaxis of recurrent urinary tract infections, with special emphasis on the paediatric population. Probiotics make an excellent and safe alternative for the traditional prophylactic antibiotic therapy.

Keywords: recurrent urinary tract infection, prophylaxis, probiotics, children
Back pain as a lifestyle disease
Pediatr Med Rodz 2017, 13 (3), p. 344–351
DOI: 10.15557/PiMR.2017.0036

The frequency in which back pain is diagnosed and treated has markedly increased in the recent years. At present, back pain and dysfunction syndrome is becoming a lifestyle disease, along with hypertension and diabetes. It affects more and more people. Low back pain is currently one of the most common complaints with which patients report to the doctor, including a primary care physician. Depending on the affected part of the spinal motion segment, we can distinguish: discogenic pain, radicular pain, facet joint pain and muscle pain. Unambiguous determination of its aetiology is generally difficult since, usually, several overlapping pathologies are involved. The aim of this paper is to draw attention to the problems associated with back pain and the complexity of its pathomechanism as treatment is adjusted to the site of pathology. This article is based on data from international, broadly cited literature on spinal dysfunctions. Back pain is not usually a very severe condition and can be treated conservatively in most cases. Despite this, it affects a vast number of people and constitutes a considerable financial burden for the state budget. This is associated with costs of medical procedures, but most of all, with absence at work and early opinions of incapacity for work.

Keywords: low back pain, back pain, discopathy, spine
The role of supplementation in the regulation of structural and functional central nervous system disorders among patients with Down syndrome
Pediatr Med Rodz 2017, 13 (3), p. 352–362
DOI: 10.15557/PiMR.2017.0037

Down syndrome is the most common genetic cause of intellectual disability in humans, which results from the presence of an extra chromosome 21. Significant progress has been made over the past years in expanding knowledge on molecular, structural and functional abnormalities in patients with Down syndrome. The obtained findings encouraged many scientists to attempt to use bioactive substances in in vivo and in vitro settings to inhibit central nervous system disorders. The use of supplements in the form of epigallocatechin gallate (EGCG) contributes to improved mitochondrial function in neurons, reduced DYRK1A overexpression and limited overproduction of reactive oxygen species. Certain doses of resveratrol improve mitochondrial function, increase hippocampal progenitor cell proliferation and, similarly to curcumin and pomegranate juice, inhibit premature ageing and prevent Alzheimer’s disease. Furthermore, it was observed that the use of choline supplements during pregnancy in healthy and trisomic experimental animals contributed to the stimulation of hippocampal neurogenesis, improved concentration, mood and cognitive functions in the offspring.

Keywords: Down syndrome, epigallocatechin gallate, resveratrol, curcumin, choline
Pregorexia – anorexia of pregnant women
Pediatr Med Rodz 2017, 13 (3), p. 363–367
DOI: 10.15557/PiMR.2017.0038

Eating disorders represent a serious and complex health and social problem which is encountered by many medical professionals in their practice, including by family doctors. An increasing number of individuals are affected by these disorders. The media, which promote slim figure as fashionable or perfect, are a contributing factor. Pregnant women are a group which is especially vulnerable to eating disorders. Their bodies are subject to dynamic changes; as a result, these are often far from the widely promoted ideal. Malnutrition in women planning to conceive a child and in pregnant women is a risk factor for abnormal course of pregnancy and poor health status of the newborn child. Therefore, it is important for women who are planning pregnancy to change their lifestyle and follow the rules of appropriate, balanced diet. The aim of the paper was to review the available publications on pregorexia, i.e. an eating disorder which involves self-starvation and/or inducing vomiting during pregnancy. The article presents the current recommendations concerning body mass of a woman during pregnancy and the consequences of pregorexia for the mother and the unborn child as well as discussing the role of medical professionals regarding this non-specific eating disorder. Based on the available sources it may be concluded that there is a need for wider education concerning diet and physical activity provided by medical professionals to higher-risk groups. Early intervention by an interdisciplinary therapeutic team contributes to better treatment results with appropriate health education being of key importance.

Keywords: pregorexia, anorexia, pregnancy, eating disorders, nutrition
Intensification of regular physical activity in patients with resistant hypertension
Pediatr Med Rodz 2017, 13 (3), p. 368–376
DOI: 10.15557/PiMR.2017.0039

Introduction: Regular physical activity is recommended in patients with arterial hypertension as part of the necessary lifestyle modifications. Aim of the study: The aim of the study was to assess the possibility of increasing the physical activity of patients with resistant hypertension. Material and methods: The study group consisted of 27 patients meeting the diagnosis criteria of resistant hypertension and 26 patients with well-controlled hypertension, as a control group. Anthropometric and bioimpedance-based body composition measurements were performed three times within the course of the 6-month-long study, at baseline and after 3 and 6 months, and a physical activity profile was determined based on the International Physical Activity Questionnaire. The study also included accelerometer measurements conducted for 72 consecutive hours. The participants were recommended to perform regular aerobic physical activity, chosen individually during meetings with the study scientist, in accordance with the guidelines of the American Heart Association. Moreover, the patients were motivated to perform physical activity with short text messages and phone calls. Results: A significant change in the resistant hypertensives was observed after 6 months, regarding the number of steps taken (17,361 ± 6,815 vs. 23,067 ± 7,741; p < 0.005), metabolic equivalent of task (1.325 ± 0.3 vs. 1.464 ± 0.3; p = 0.001), duration of rest (1,595 ± 265 vs. 1,458 ± 292 min; p < 0.05) and sleep (1,278 ± 228 vs. 1,147 ± 270 min; p = 0.02), as assessed based on 3-day accelerometer measurements. An increase in activity was also observed based on the International Physical Activity Questionnaire and positive changes in body composition were determined. Conclusions: In the case of patients with resistant hypertension, intensification of physical activity is a well-tolerated, implementable and cost-effective therapeutic intervention.

Keywords: accelerometry, physical activity, IPAQ, resistant hypertension
Incidence and risk factors for Helicobacter pylori infection among the relatives of infected patients
Pediatr Med Rodz 2017, 13 (3), p. 377–383
DOI: 10.15557/PiMR.2017.0040

Introduction: According to the World Health Organization, Helicobacter pylori infection affects 70–90% of adults in developing countries and 25–50% of adults from developed countries. Objectives: An assessment of the incidence of Helicobacter pylori infection among the household members of patients with positive urease test as well as determination of risk factors, symptoms and coexisting diseases. Material and methods: Study included 62 relatives of 32 patients with Helicobacter pylori infection, who were occupying the same household. Control group included 40 relatives of patients with negative urease test. All participants were subjected to Diago-HP serological testing and completed a questionnaire including 30 questions. Results: It was found that Helicobacter pylori infection is significantly more common among the household members of infected patients compared to the control group (37.1% vs. 18.4%, p < 0.001). The incidence of infections was 58.5% in the study population (patients and their relatives). Infected patients were older than the uninfected ones (51.1 ± 15.0 vs. 36.5 ± 18.6 years, p < 0.001), they more often reported difficulties in defecation (72.7% vs. 50.8%, p = 0.04) and a feeling of fullness in the upper abdomen (75.9% vs. 50.8%, p = 0.02). Type 2 diabetes significantly increased the risk of Helicobacter pylori infection (100% vs. 53.6%, p = 0.004). No relationship was found between accommodation, hygienic habits, drug use, diet or keeping pets. Conclusions: The incidence of Helicobacter pylori infection is significantly higher among the household members of infected patients. The infection is more common among elderly and diabetic patients.

Keywords: Helicobacter pylori, epidemiology, risk factors
The status of mixed dentition in early schoolchildren reporting to dental offices
Pediatr Med Rodz 2017, 13 (3), p. 384–389
DOI: 10.15557/PiMR.2017.0041

Introduction: Negligence of the healthy behaviour associated with oral health, dental prevention and treatment in primary school children can be a source of serious health problems, both dental and systemic. Aim: The aim of this study was to evaluate the effects of selected demographic factors and reasons for visiting a dental office on the dental health of primary school children. Material and methods: The study included 210 patients aged 7–11 years, who in 2015 visited one of the dental offices in Lublin, where dental services are provided both under the contract with the National Health Fund or after payment. Dental condition was assessed by calculating dmf/DMF (decayed, missing, filled) index for deciduous/permanent teeth. Results: More than three-quarters of children (77.14%) visited a dentist for check-up, 20.0% – due to a toothache and 2.86% – due to the loss of filling. The average DMF number was 4.24 ± 3.47, and the average DMF index value was 1.74 ± 2.06. The highest intensity of caries in the primary teeth was found in children visiting the dentist due to toothache, lower – in those reporting for check-up visits and the lowest – due to the loss of filling. In the case of permanent dentition, the highest number of fillings was observed in children attending a check-up visit. Conclusions: High incidence of caries in primary school children confirms the insufficient health knowledge of parents/guardians on the oral health and insufficient dental prevention and treatment in both preschool and early-school children.

Keywords: oral health, mixed dentition, schoolchildren, Poland
Analysis of body composition and selected lipid parameters in healthy children – a preliminary report
Pediatr Med Rodz 2017, 13 (3), p. 390–397
DOI: 10.15557/PiMR.2017.0042

Aim: The aim of the study was to perform an analytical evaluation of body composition and selected lipid parameters in a population of healthy children. Material and methods: The study included a group of 81 children (44 boys and 37 girls, mean age 11.56 ± 2.84 years) participating in a research project in the Centre for Medical and Natural Sciences Research and Innovation in Rzeszow. Body composition measurement (TANITA BC-420 S MA) and lipid profile assessment (Cholestech LDX) were performed in all patients. Statistical analysis of the collected material was conducted with Statistica 10.0 (StatSoft). Parametric and nonparametric tests were used for statistical analysis of variables. The level of statistical significance was adopted at p < 0.05. Results: A statistically significant difference in fat mass (p < 0.001), fat-free mass (p = 0.003), muscle mass (p = 0.003) and total body water (p < 0.001) was observed between children with normal body weight and overweight or obese children. A significant positive impact of FM (R = 0.09; p = 0.416) and a negative impact of total body water (R = −0.40; p < 0.001) on triglyceride parameters was demonstrated. Additionally, reduced fat mass correlated with a significant increase in high-density lipoprotein (R = −0.29; p = 0.009). Conclusions: The study demonstrated differences in the selected components of body composition in a population of healthy children, which allowed to precisely monitor the nutritional status when correlated with the results of lipid profile.

Keywords: body composition, lipids, child, nutritional status
Streptococcus pyogenes as the aetiological agent of Henoch–Schönlein purpura
Pediatr Med Rodz 2017, 13 (3), p. 398–405
DOI: 10.15557/PiMR.2017.0043

Henoch–Schönlein purpura is a systemic disease mainly affecting school age children. It is characterised by leukocytoclastic small-vessel vasculitis with the deposition of IgA-containing immune complexes in cutaneous, gastrointestinal, articular and renal vessels. Although the cause is still unknown, potential aetiological factors include infectious agents, drugs, exposure to physical factors, allergens or tumour antigens. Streptococcus pyogenes responsible for bacterial pharyngitis is one of the infectious agents that can cause Henoch–Schönlein purpura. The disease is generally mild and self-limiting. Usually, only symptomatic treatment is used. However, renal, gastrointestinal and articular involvement may occur in some cases, which may require intensified treatment. Glucocorticoids are usually used in the case of nephropathy, severe pain and limited mobility of the joints as well as gastrointestinal symptoms. There are also attempts with cyclosporine A, azathioprine, methotrexate, cyclophosphamide, and plasmapheresis. ACE inhibitors are also used to reduce proteinuria and control blood pressure. The paper presents two paediatric cases of Henoch–Schönlein purpura developing within a few weeks following upper respiratory infection. Diagnosis in search of the aetiological factor showed elevated ASO titres and confirmed Streptococcus pyogenes infection in both cases. Regression of symptoms was observed after causal treatment with antibiotic.

Keywords: Henoch–Schönlein purpura, Streptococcus pyogenes, vasculitis, upper respiratory infection, diagnosis
Atrial septal defect as a cause of chronic cough and recurrent infections in a 4-year-old boy
Pediatr Med Rodz 2017, 13 (3), p. 406–411
DOI: 10.15557/PiMR.2017.0044

Recurrent infections of the respiratory system among children are the most common reason for ambulatory treatment and one of the main causes of hospitalisation. Out of many factors that can be potentially responsible for the recurrent infections in children it is necessary to consider the ones that are connected with the immaturity of the immune system of a child and ones that can disturb the proper functioning of this system. It seems that the most important observations are those pointing at links between recurrent infections of the respiratory tract and the allergic process. The present article describes a case of a boy with recurrent respiratory infections, who was diagnosed towards immune system malfunction and allergies. An echocardiographic examination revealed a major defect of the interatrial septum. This heart condition was treated with cardiac surgery as a result of which infections occur less frequently and do not require the hospitalisation of the patient.

Keywords: recurrent infections, allergy, atopy, congenital heart defects, atrial septal defect
Benign acute childhood myositis – a case report
Pediatr Med Rodz 2017, 13 (3), p. 412–418
DOI: 10.15557/PiMR.2017.0045

Numerous disease entities may present with myalgia, involving just one muscle group or many muscles (polymyalgia, polymyositis). Apart from trauma, myalgia may be caused by infectious agents, including viruses, Gram-positive, Gramnegative, anaerobic or atypical bacteria, fungi or parasites. Individual history and laboratory findings are crucial for the diagnosis. Once diagnosed, myalgia is treated with proper medication, rehabilitation and/or other methods. We report a case of a 4-year-old female patient hospitalised due to lower extremity pain and impaired gait, with a prodrome of sore throat, rhinitis, cough and pustular rash. Laboratory findings facilitated the diagnosis of a mixed, viral-bacterial aetiology, with tailored treatment promptly initiated, resulting with the patient’s quick recovery. This study highlights the need for a comprehensive diagnostic workup in cases of childhood myalgia to identify the aetiologic agent, allowing to introduce targeted therapy, and thus facilitate speedy recovery.

Keywords: myositis, myalgia, pathogen, Mycoplasma pneumoniae (MP)
Bilateral tonsillar lymphangiomatous polyps in a snoring child
Pediatr Med Rodz 2017, 13 (3), p. 419–422
DOI: 10.15557/PiMR.2017.0046

Lymphangiomatous polyps of the palatine tonsil are a rare clinical entity with only about 30 odd cases ever reported. All the cases in the literature were described as unilateral tonsillar diseases, except for one paediatric case which had bilateral tonsillar involvement. Due to its unilateral presentation and suspicious appearance similar to tonsillar malignancy, lymphangiomatous polyps may cause heightened anxiety to both patients and doctors alike on a routine oropharyngeal examination. Owing to its rarity and a variety of complex nomenclatures, this condition may also be confusing to the treating otolaryngologist as well as junior pathologist. We report an extremely rare case of bilateral tonsillar lymphangiomatous polyps in a snoring child that was successfully treated surgically via tonsillectomy.

Keywords: tonsil, tonsillectomy, polyp, hamartoma, tumour