2018, Vol 14, No 2
An analysis of the composition of kidney stones
Pediatr Med Rodz 2018, 14 (2), p. 125–132
DOI: 10.15557/PiMR.2018.0012

The presence of stones in the patient’s urinary tract is a sign of a disease process leading to the precipitation of chemical compounds and formation of deposits. It is estimated that kidney stone formation affects up to 10% of population, and the first identified deposit is associated with 25% risk of recurrence within 10 years. Therefore, it is very important from the diagnostic point of view to analyse every spontaneously excreted or surgically removed stone. Precise determination of the structure and chemical composition of stones allows to identify the reasons of their formation, choose appropriate treatment method and modify patient’s diet, and thus prevent recurrence. A number of methods have been developed for the analysis of urinary stones, such as qualitative chemical analysis, polarised light microscopy, scanning electron microscopy, infrared spectroscopy and computed tomography. The paper discusses different analytic techniques for the evaluation of kidney stones, including their advantages and limitations. In the current state of knowledge, infrared spectroscopy seems to be the most effective, rapid and precise measuring technique. It should be noted, however, that a comprehensive approach, i.e. the use of several different techniques, is of key importance in the diagnosis, as only their simultaneous use allows to compare the obtained results and obtain full information about the patient’s condition. Innovative methods for the analysis of kidney stones, such as nanoscale flow cytometry, are currently sought to improve deposit identification and rapid implementation of appropriate treatment. Works to improve the currently used techniques as well as the search for new quicker and more effective methods give rise to hopes that a single unique method for a comprehensive assessment of stones collected from patients will be selected.

Keywords: diagnosis, kidney stones, infrared spectroscopy, computed tomography
Health-promoting properties of pineapple
Pediatr Med Rodz 2018, 14 (2), p. 133–142
DOI: 10.15557/PiMR.2018.0013

Pineapple is one of the most popular tropical fruit and an indispensable part of many people’s diet. It was brought to Europe in 1493 by Christopher Columbus. The fruit has been valued for years for its unique taste and richness in nutrients, such as micro- and macronutrients, dietary fibre and a variety of vitamins. Pineapple is low in calories, but rich in nutrients; therefore, it is often included in a weight-watcher menu. Frequent consumption of pineapple almost completely covers the recommended daily intake of vitamin C, manganese and copper. Phytochemical analysis of pineapple leaf extract revealed the presence of alkaloids, flavonoids, saponins and tannins, all of which are said to be hypoglycaemic and analgesic. Studies on bromelain, pineapple’s most complex bioactive compound, demonstrated its antioxidant, anti-inflammatory, digestion-enhancing and cardioprotective effects. The multitude of potential uses of bromelain combined with the effects of many other nutrients found in a pineapple, allow us to appreciate not only its unquestionable taste, but also other benefits of this fruit. Pineapple is no exception and throughout the years many myths about its beneficial and harmful properties have emerged. Fortunately, most of these have never been confirmed scientifically and pineapples have no known negative impact on the human body. The aim of this study was to present the nutritional value of pineapple and its role in medical treatment.

Keywords: pineapple, bromelain, nutrition, dietetics, medicine
Abnormal psychomotor development of children. Part I: The basic definition and information
Pediatr Med Rodz 2018, 14 (2), p. 143–150
DOI: 10.15557/PiMR.2018.0014

Psychomotor retardation refers to a situation when a child does not attain developmental milestones in the right time, i.e. he or she is unable to master skills that should develop at a given stage of life. Child development proceeds in strictly correlated phases. To attain a higher developmental level, one must first acquire and consolidate the lower level. The maturation of the central nervous system is quite intensive, even prenatally. Its individual structures develop in a specified order, depending on the week of gestation. Brain immaturity is a frequent cause of psychomotor retardation in children. The nervous tissue is composed of neurones (their cell membranes consist of a double lipid layer) and glial cells. Neurones form up to the 20th week of gestation, while glial cell formation starts after birth. This intensive development of the central nervous system may be accompanied by certain defects that will result in psychomotor retardation, which is also influenced by various physiological processes occurring in the child’s life. The type of damage and the grade of its severity depend on its location, area of pathological brain tissue and age at which the defect occurred. Injuries that cause psychomotor retardation in children may be divided into microinjuries, macroinjuries as well as endo- and exogenous causes. Psychomotor retardation is assessed on the Brunet–Lézine scale. It contains tasks that a child should be able to perform at a given stage of his or her development. The result is a psychomotor development quotient. Retardation may present as a complete deficit of given skills and their absence in the later stages of development. Psychomotor retardation may reveal itself at the beginning of the child’s life or in the later period. This depends on the causes of these limitations. The diagnosis of psychomotor retardation requires cooperation of various specialists.

Keywords: neurology, psychomotor retardation, paediatric neurology, milestones
Abnormal psychomotor development of children. Part II: Electroencephalography
Pediatr Med Rodz 2018, 14 (2), p. 151–156
DOI: 10.15557/PiMR.2018.0015

In paediatric neurology, various pathological conditions, including psychomotor retardation, are assessed in electroencephalography (EEG). This examination is inexpensive, non-invasive and can be repeated multiple times. Moreover, there are no significant contraindications to its performance. The examination consists in registration of brain bioelectrical function with electrodes placed on the surface of the patient’s head in accordance with the international 10–20 system created by Dr Herbert Jasper from the Montreal Neurological Institute. The electrodes are fixed to the patient’s head using conductive gel (applied in order to facilitate the transition of ionic current from the skin surface to the electrode), head band or a special rubber cap which additionally helps with proper location of the electrodes on the patient’s head. In the 10–20 system, even numbers in the electrode markings refer to the right hemisphere, while odd numbers refer to the left hemisphere. The cerebral function recorded during an EEG examination is a result of the motion of electrical loads present in neuronal membranes. The EEG signal recorded during the examination with the use of electrodes is transferred to an electroencephalograph (where it is enhanced) and then, in the digital form, to a computer. Several types of waves are distinguished in EEG: delta, theta, alpha, beta, gamma, mi and lambda. Children are characterised by the variability in the occurrence, range, shape and amplitude of brain waves. EEG involves the use of various activation methods, such as hyperventilation, photic stimulation and sleep deprivation. They are useful in making a proper diagnosis and can be factors that elicit abnormalities that could not be otherwise visualised. Psychomotor retardation is often strictly associated with structural and functional central nervous system abnormalities.

Keywords: diagnosis, electroencephalography, neurology, children
The early diagnosis of Alzheimer’s disease
Pediatr Med Rodz 2018, 14 (2), p. 157–166
DOI: 10.15557/PiMR.2018.0016

Early and accurate diagnosis of Alzheimer’s disease, which is the most common cause of dementia, is of great importance, as it allows pharmacological treatment of patients with dementia due to this disease. Unfortunately, it is often a long-term process, mainly because of the lack of access to specialists, limited possibilities of additional tests and, above all, the lack of knowledge about the nature of this disease. Sometimes, due to an atypical clinical manifestation, the diagnosis is delayed, preventing timely introduction of pharmacological and non-pharmacological therapy. Obtaining a diagnosis in the preclinical stage of the disease enables the implementation of methods delaying the onset of dementia, mainly by increasing cognitive and physical activity, caring for the physical and mental health and adjusting the diet. These are the only modifiable risk factors for the development of dementia caused by Alzheimer’s disease, as opposed to genetic conditions, age, the number of years of formal education, and a history of brain disorders. The article presents the clinical picture of Alzheimer’s disease in its most common form, mainly presenting with episodic memory disorders, while also providing information about rare, atypical variants of this disease, such as posterior cortical atrophy, logopenic primary progressive aphasia, and the frontal and variant with corticobasal syndrome (dominant apraxic symptoms). The latest diagnostic criteria and the detailed diagnostic workup for dementia are described, and tips facilitating correct diagnosis are given. Particular attention has been paid to the role of information provided by the patient’s caregiver, decompensation factors and the practical use of popular cognitive screening methods. The paper also discusses the most common causes of diagnostic difficulties, including the influence of the natural aging process, somatic burden, and mood disorders on the cognitive state.

Keywords: Alzheimer’s disease, dementia, episodic memory, ageing, mood disorders
Trends in the treatment of idiopathic nephrotic syndrome in children based on a single-centre experience
Pediatr Med Rodz 2018, 14 (2), p. 167–174
DOI: 10.15557/PiMR.2018.0017

Aim: The aim of the study was to perform a retrospective analysis of treatment modalities in children with idiopathic nephrotic syndrome, types of responses to the therapies used and adverse effects induced by the drugs based on a singlecentre experience. Material and methods: Medical histories of 146 patients (82 boys and 64 girls) diagnosed with idiopathic nephrotic syndrome and hospitalised in the Clinic of Paediatric Nephrology, Medical University of Wroclaw, between 2012 and 2016 were included in the analysis. Results: Remission was achieved in 83.6% of patients treated due to the first episode of idiopathic nephrotic syndrome, whereas primary steroid resistance was diagnosed in 16.4% of cases. During the treatment of subsequent disease recurrences, 52% of children developed steroid dependence, while secondary steroid resistance occurred in 8% of patients. Cyclosporine A was the most common second-line regimen after steroids. Alkylating agents were used as second-line therapy in 1/3 of children; however, they were not used in any of the patients at the end of the follow-up period. Although mycophenolate mofetil was used as a second-line drug in only 3 patients, it was the most common therapeutic option for subsequent relapses. Adverse effects were observed in 50.5% of children receiving steroid therapy and 58.8% of patients receiving cyclosporine A. Adverse reactions were observed in less than 1% of patients receiving alkylating agents and mycophenolate mofetil. Conclusions: Cyclosporine A was the most widely used and a safe second-line drug in the treatment of paediatric idiopathic nephrotic syndrome. Mycophenolate mofetil became an important therapeutic option and an effective alternative for cyclosporine A in the therapy of steroid-dependent idiopathic nephrotic syndrome. Appropriate selection and monitoring of therapy with new generation drugs allowed to avoid irreversible complications in most cases.

Keywords: cyclosporine A, alkylating agents, mycophenolate mofetil, steroid dependence, steroid resistance
Renal cysts in children: a single centre study
Pediatr Med Rodz 2018, 14 (2), p. 175–182
DOI: 10.15557/PiMR.2018.0018

Kidney cysts may be congenital (associated or not with genetic disorders) or rarely acquired. They may be an isolated abnormality or be part of an anomaly syndrome. The aim of the study was to analyse the history of patients with suspected/diagnosed cysts of the kidney(s) admitted to the authors’ department in 2015–2016. Material and methods: In this period 1,604 patients were hospitalised, including 49 children aged 1 month – 17 years with a suspected/diagnosed cyst of the kidney(s). There were 30 first-time admissions and the remaining cases were repeat admissions. Results: There were 14 infants (mean age of 4.2 months) among the children hospitalised for the first time. The final diagnoses in this group were as follows: autosomal recessive polycystic kidney disease in 3 children, autosomal dominant polycystic kidney disease in 1 child, right multicystic dysplastic kidney in 4 children, right multicystic dysplastic kidney combined with left ectopic kidney in 1 child, bilateral multicystic dysplastic kidney in 1 child, single renal cysts in 2 children and renal cystic hypodysplasia in 2 children. Among the remaining 16 children (mean age of 10.1 years) diagnosed for the first time due to arterial hypertension or abnormalities on abdominal ultrasound imaging, autosomal dominant polycystic kidney disease was found in 11 children, right multicystic dysplastic kidney in 4 children and left multicystic dysplastic kidney in 1 child. Among 19 patients hospitalised more than once (mean age of 9.5 years) autosomal dominant polycystic kidney disease was diagnosed in 4 children, autosomal recessive disease in 6 individuals, right multicystic dysplastic kidney in 4 children, left multicystic dysplastic kidney in 3 children and other forms of cystic kidney disease in 2 children. In 23 children (47%) various stages of chronic kidney disease were found and in 3 patients a renal transplant was performed. Conclusion: Renal cysts are not a common reason for hospitalisation at a pediatric nephrology centre (3.1% of patients); however, they do require diagnosis and monitoring of patients due to the risk of development of chronic kidney disease.

Keywords: renal cysts, children, chronic kidney disease
Serum concentration of 25(OH)D in children with recurrent infections from Łódź Province
Pediatr Med Rodz 2018, 14 (2), p. 183–188
DOI: 10.15557/PiMR.2018.0019

Vitamin D plays an important role in regulation of innate and acquired immunity. The aim of the study was to assess the serum concentration of a vitamin D metabolite – 25(OH)D – in children with recurrent respiratory tract infections. Two hundred and ninety-six children with recurrent infections, aged 1–18 years, who were hospitalised in the Department of Paediatrics and Allergy for an extended diagnosis of recurrent infections were recruited. The hepatic metabolite of vitamin D, namely 25(OH)D was determined in the analysed sera in different seasons of the year. Sixty-one per cent of the children had a low concentration of 25(OH)D. The vitamin D level was shown to be inversely correlated with the age of the patient; the younger the child, the higher the serum concentration of calcidiol. There was no correlation between the concentration of 25(OH)D and gender or season of the year in which the measurements were done. The results showed that vitamin D deficiency (serum concentration below 30 ng/mL) is common in children with recurrent respiratory tract infections from the region of Łódź.

Keywords: vitamin D, children, recurrent infections
Child vaccination programme in family doctor practices in 1997–2015: a cross-sectional study in Białystok, Poland
Pediatr Med Rodz 2018, 14 (2), p. 189–200
DOI: 10.15557/PiMR.2018.0020

Introduction: Vaccination is the most effective method of infectious disease prevention. Contemporary technologies have created the possibility of producing vaccines against many diseases. Their use has been facilitated due to the development of combined vaccines aimed at multiple microorganisms. Vaccine regimens differ between countries depending on their epidemiological and population needs. Aim of the study: Assessment of vaccination programme implementation among young patients, including with the use of combined and recommended vaccines in family doctor practices in Białystok, Poland, in 1997–2015. Material and methods: The research material constituted medical records of children aged 0–19 years who were under the care of three family doctor practices in the city of Białystok, Poland. Vaccination cards of 2,804 children born in 1997–2015 have been analysed. Results: Under the official vaccination programme 98.43% of children have been immunised; 42.0% of them received combined pentavalent or hexavalent vaccines (financed by parents) in place of free-of-charge, state-reimbursed vaccines. Recommended vaccines were received by 45.7% of children and adolescents. Recommended vaccinations were rarely used in children aged over 10 years. Among non-mandatory vaccines the most commonly used ones included acellular pertussis component vaccine, which was used to immunise 1,178 (42.0%) children, Streptococcus pneumoniae vaccine (18.1%) and rotavirus vaccine (13.0%). Due to a lack of parental consent or contraindications (temporary or permanent) 81 (2.9%) children have not received a full set of vaccinations. Conclusions: 1) The vaccination rate among children receiving mandatory vaccines is high in family doctor practices. 2) Recommended vaccines are more frequently administered to children up to 3 years of age, less frequently to preschool children and even less frequently to schoolchildren. 3) There is a need for parent education on the available effective methods of protecting children against infectious diseases.

Keywords: vaccinations, vaccinology, combined vaccines
Parental knowledge about development and care of a child aged 0–12 months
Pediatr Med Rodz 2018, 14 (2), p. 201–212
DOI: 10.15557/PiMR.2018.0021

Aim: The aim of the study was to assess parental knowledge about the development and care of a child aged 0–12 months as well as to verify whether this knowledge is sufficient to detect potential abnormalities and thus allow for early intervention. Another aim of the study was to determine the effects of selected sociodemographic characteristics of respondents on their knowledge about the development and care of a child aged up to 1 year. Material and methods: A total of 99 parents (82 women and 17 men) with children aged 0–12 months were included in the study. The study was conducted using an author’s online questionnaire. Two scales were the main dependent variables. One scale allowed for an assessment of respondents’ knowledge about child development, while the other scale verified the knowledge about childcare. The obtained data were analysed statistically using the IBM SPSS Statistics version 20. The analysis of contingency tables used percentage profiles and the Pearson Chi-square independence test as well as Cramér’s V association. The results were considered statistically significant at α = 0.05. Results: Statistical analysis of data points to an insufficient level of parental knowledge about the development and care of a small child. Factors such as education, place of residence and attending childbirth classes have a significant impact on this knowledge. Conclusions: Parental education on normal child development and childcare is necessary. This will help prevent many abnormalities by proper care as well as earlier detection of disorders and, consequently, early intervention.

Keywords: newborn, infant, childbirth, motor activity, care
Tetany as the cause underlying the loss of consciousness
Pediatr Med Rodz 2018, 14 (2), p. 213–221
DOI: 10.15557/PiMR.2018.0022

Tetany is a group of symptoms associated with increased neuromuscular excitability. Manifest and latent tetany may be distinguished. Manifest (hypocalcaemic) tetany presents with numbness and paresthesia in the areas of the mouth, tongue, hands and feet as well as paroxysmal contractions of the muscles of the face, hands and feet, which may be accompanied by presyncope and syncope. Latent (normocalcaemic) tetany, which is associated with hypomagnesemia or alkalosis, manifests in malaise, depressed mood, pain and irritability. This form of tetany is diagnosed based on typical neurological symptoms such as Chvostek sign, Trousseau sign and Lust sign. Electrolyte disorders that lead to tetany may be caused by imbalanced diet, gastrointestinal, endocrine, nephrological and genetic disorders as well as iatrogenic factors. Manifest tetany seizure requires differentiation from epilepsy. The differential diagnosis should also include angina, migraine and bronchial asthma in the case of manifest tetany as well as other causes of syncope, anxiety and depressive disorders in the case of latent tetany. Tetany is diagnosed based on typical clinical symptoms, laboratory findings and electromyography. If latent form is suspected, special diagnostic tests for tetany are performed. The choice of therapeutic modality depends on the cause of the disease. The treatment of latent tetany involves magnesium and vitamin B6 supplementation. Calcium and magnesium solutions are used in the causative treatment of manifest tetany. It is also worth combining calcium and vitamin D supplementation. The paper discusses three clinical cases: a 15-year-old girl with episodes of syncope, a 17-yer-old girl with fainting, upper limb numbness and impaired vision, and a 16-year-old girl with hand tremor, numbness in the fingers, involuntary muscle contractions in the limbs and palpitations.

Keywords: tetany, syncope, hypocalcaemia, hypomagnesaemia, alkalosis
Aortic coarctation in an infant with RSV infection
Pediatr Med Rodz 2018, 14 (2), p. 222–230
DOI: 10.15557/PiMR.2018.0023

The paper presents a case of an infant with aortic coarctation, which was accidentally detected during respiratory infection. The child, who showed no symptoms either during the neonatal period or during the first six months of life, suddenly developed severe heart failure initially manifesting as a respiratory infection. Preliminary diagnosis was based on a chest radiograph. Chest radiography has been underestimated and even avoided in the diagnosis of respiratory conditions in recent years, particularly in the youngest children.

Keywords: aortic coarctation, congenital heart defect, chest radiography
Enterogenous cyst in the Douglas’ pouch – a case report
Pediatr Med Rodz 2018, 14 (2), p. 231–236
DOI: 10.15557/PiMR.2018.0024

Enterogenous cysts are rare congenital lesions, diagnosed mainly prenatally and during infancy. These anomalies may occur anywhere along the gastrointestinal tract – from the mouth to the anus. They are difficult to diagnose because there are no characteristic symptoms. Coexistence of enterogenous cysts with other developmental defects is common. They are primarily diagnosed using ultrasound or magnetic resonance scans. Most cases of enterogenous cysts are treated surgically. We report the case of an enterogenous cyst in the Douglas’ pouch of a 3-month-old girl who was referred to the Department of Child Endocrinology with suspected ovarian cysts.

Keywords: Douglas’ pouch, enterogenous cyst, enteric duplication, children
Diarrhoea in a 2-year-old boy – thinking beyond the gut
Pediatr Med Rodz 2018, 14 (2), p. 237–240
DOI: 10.15557/PiMR.2018.0025

We report a male child with an unusual, very rare cause of chronic diarrhoea – WDHA (watery diarrhoea, hypokalaemia, achlorhydria) syndrome. A 2-year-old boy presented with long-term diarrhoea, failure to thrive and a presumed diagnosis of coeliac disease. The failure of a gluten-free diet, permanent hypokalaemia and the progressive worsening of the patient’s condition led to the finding of an adrenal tumour (mature ganglioneuroma) with elevation of vasoactive intestinal polypeptide (VIP) – criteria for the diagnosis of WDHA syndrome. Complete symptoms resolution occurred after tumour excision.

Keywords: WDHA, VIP, celiac disease, hypokalaemia
Paraplegia as a rare presentation of nasopharyngeal carcinoma
Pediatr Med Rodz 2018, 14 (2), p. 241–244
DOI: 10.15557/PiMR.2018.0026

Nasopharyngeal carcinoma is a common encounter in otorhinolaryngology. It is a non-lymphomatous squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx and shows varying degrees of differentiation. The aetiology is multifactorial. The disease is more common in the Chinese, those exposed to Epstein–Barr virus and in individuals with environmental factors, such as cigarette smoking, consumption of salted fish or preserved vegetables containing volatile nitrosamine, and exposure to industrial fumes or household smoke. Signs and symptoms include neck swelling, hearing loss, nasal blockage, epistaxis, cranial nerve palsy, headache, neck pain, earache or discomfort, weight loss and central nervous system manifestation when distant metastasis is present. Amongst these manifestations, 60% of patients will present with cervical lymphadenopathy followed by epistaxis which occurs in 40% of cases. However, distant site involvement uncommonly becomes the sole presenting symptom. We report a 58-year-old Chinese patient with nasopharyngeal carcinoma who presented with bilateral lower limb weakness. The patient was initially seen by an orthopaedic surgeon, with various radiological investigations conducted, including magnetic resonance imaging. Metastatic lesions were detected at the lumbar vertebra, sacrum and iliac bone. After positron emission tomography, a suspicious primary malignant lesion was detected in the nasopharynx and its biopsy confirmed the diagnosis of nasopharyngeal carcinoma. The patient was referred to the oncology team for definitive treatment, but refused further therapy.

Keywords: nasopharyngeal carcinoma, metastasis, PET scan