2018, Vol 14, No 3
Lactose in drugs and lactose intolerance – realities and myths
Pediatr Med Rodz 2018, 14 (3), p. 261–266
DOI: 10.15557/PiMR.2018.0027
ABSTRACT

Lactose intolerance is a set of clinical symptoms occurring after lactose intake, characterised by abdominal pain, bloating and diarrhoea. Adult-type hypolactasia is the most common cause of lactose intolerance and is associated with the physiological loss of lactase activity in adulthood. Hypolactasia occurs in 30% of the population of Polish adults. It should be noted that the presence of lactase deficiency does not mean that the patient will develop symptoms of lactose intolerance. Currently, many patients self-diagnose lactose intolerance based on the occurrence of various symptoms and begin to apply a restrictive diet, avoiding dairy products without consulting a doctor. Self-reported lactose intolerance is often not confirmed by objective tests. A restrictive diet can, however, lead to complications. Studies have shown that the occurrence of lactose intolerance symptoms depends on the dose of consumed disaccharide, and the dose of 12 g is considered to be well-tolerated in most patients. This means that, for many patients, it is not necessary to completely eliminate lactose from diet. Lactose is one of the most commonly used excipients in pharmaceutical industry. Some studies have shown that small amounts of lactose contained in medicines do not cause symptoms in patients; however, their role in inducing symptoms of lactose intolerance has not been confirmed so far. Moreover, the information on the exact content of lactose in drugs is often limited. This data could positively impact the quality of care for lactose intolerant patients and increase their medication compliance.

Keywords: lactose, lactose intolerance, excipients
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The effects of steroid therapy on the cardiovascular system
Pediatr Med Rodz 2018, 14 (3), p. 267–270
DOI: 10.15557/PiMR.2018.0028
ABSTRACT

Glucocorticoids are widely used as anti-inflammatory, antiproliferative and immunosuppressive agents in many diseases. Their use is often long-term, which is associated with the risk of adverse effects from various systems. In this paper, we pay particular attention to the effects of steroid therapy on cardiovascular diseases as long-term steroid therapy increases the risk of cardiovascular death. The risk of complications depends on the dose and therapy duration. Complications may also occur when steroids are used locally. According to literature data, glucocorticoids may contribute to the development of hypertension, myocardial ischaemia, heart failure and, according to some studies, stroke. The use of steroid therapy can lead to the development of disorders that are part of the metabolic syndrome. The pathogenesis includes the effects of glucocorticoids on the renin–angiotensin–aldosterone system, the autonomic system, stimulation of the mineralocorticoid receptor, and effects on the synthesis of factors regulating the width of blood vessels. Other disorders that may develop in the course of this therapy include osteoporosis, myopathy, electrolyte and metabolic disorders. However, it is difficult to determine to what extent the complications are caused by the therapy itself and to what extent by the treated disease. It is also worth noting about the negative impact of anabolic steroids, the use of which is usually not a part of therapy.

Keywords: glucocorticosteroids, cardiovascular diseases, Cushing’s syndrome, steroid therapy
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Guillain–Barré syndrome: the most common but difficult to diagnose acquired polyneuropathy
Pediatr Med Rodz 2018, 14 (3), p. 271–276
DOI: 10.15557/PiMR.2018.0029
ABSTRACT

Guillain–Barré syndrome, an acute autoimmune inflammatory polyneuropathy, is the most frequent cause of acute onset flaccid paresis. Various sources report its incidence of 1–4/100,000 individuals per year. A triggering factor in most cases is a previous respiratory or gastrointestinal tract infection. Apparently, via the molecular mimicry mechanism, antibodies against bacterial or viral antigens are formed and bind with similar epitopes in the peripheral nervous system. The clinical picture is highly diversified and may range from slight muscle weakness within the feet to full-blown tetraplegia with respiratory failure. The typical course of the disease consists of the progressive phase, the plateau phase and the recovery phase, lasting even 6–14 months. The diagnosis is based on the criteria published in 1978. They encompass clinical signs and symptoms as well as electrophysiological and pathomorphological parameters. A crucial sign leading to the diagnosis is progressive flaccid paresis of more than one limb with the absence or reduction of tendon reflexes. The treatment involves plasma exchange and intravenous immunoglobulin. The use of glucocorticosteroids, interferon beta, rituximab and eculizumab requires further investigation. Moreover, symptomatic treatment, kinesiotherapy, respiratory physiotherapy, thromboembolic prophylaxis, nutritional therapy and pain management are also very important. Prognosis is in most cases favourable, but mortality ranges from 4 to 15% despite appropriate treatment and intensive care. The aim of this article is to sum up current information about Guillain–Barré syndrome and to emphasise the relevance of this disease, which requires further investigation in both paediatric and adult patients.

Keywords: Guillain–Barré syndrome, diagnosis, work-up, treatment
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Visual analogue scale. A simple tool for daily treatment monitoring in allergic rhinitis
Pediatr Med Rodz 2018, 14 (3), p. 277–281
DOI: 10.15557/PiMR.2018.0030
ABSTRACT

In patients with allergic rhinitis, continuous assessment and monitoring of symptom severity, their nature and changes depending on the place, time and situation in which they occur are essential. Symptoms of allergic rhinitis are often subjective, and difficult to assess and verify. Individualised therapy and continuous monitoring of the disease create the need for a simple and effective tool. Visual analogue scale (VAS) is an instrument that can be used in daily practice. VAS is usually a horizontal 100 mm long scale with two opposing descriptors at its end points. Patients with allergic rhinitis specify a point on the scale that best corresponds to the severity of their symptoms. Symptoms of allergic rhinitis can be assessed globally or separately on different scales (nasal obstruction, rhinorrhoea, itching, sneezing). Advantages of VAS include: possibility to distinguish minimal differences in symptom severity, simplicity and easy interpretation, which translate into reproducibility, uniform evaluation system and high patient acceptance. VAS is well correlated with the Allergic Rhinitis and its Impact on Asthma classification, and a score of 50 (in a 100 mm scale) indicates moderate and severe allergic rhinitis. It has been shown that, irrespective of a baseline VAS score, a 23 mm improvement indicates that treatment has been effective, while a 30 mm improvement is associated with an improvement of the quality of life parameters. The scale is particularly useful for the purposes of documentation of allergic rhinitis severity and disease control in everyday practice due to its simplicity, timeeffectiveness and low susceptibility to errors, especially when combined with modern communication technologies, such as smartphone applications.

Keywords: visual analogue scale, allergic rhinitis, monitoring, work-up
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The impact of body posture on self-image and psychosocial functioning during adolescence
Pediatr Med Rodz 2018, 14 (3), p. 282–285
DOI: 10.15557/PiMR.2018.0031
ABSTRACT

Adolescence is the time when not only the self-image and self-esteem, but also the physiological body posture is intensely formed. A self-image may be described as a mental construct used by an individual to perceive, describe, understand and present oneself. It is subject to changes throughout life; however, developmental changes (such as maturation, pregnancy, aging) and difficult situations (such as health conditions, psychological crises, accidents) have a particular impact on its development. Disturbances in the above-mentioned areas are of great importance for child’s development and entering into adulthood. The aim of this paper is to present the relationship between abnormal body posture, self-image, self-esteem and social functioning of adolescents. We used the available literature to describe the specifics of puberty and factors influencing physical and mental development of adolescents as well as to characterise the most common bone deformity in this group, i.e. idiopathic scoliosis. We also presented the results of scientific research confirming that the discussed spinal deformity and the method of treatment may have a great impact on the quality of life, body perception, mental state and self-esteem of patients. Therefore, we believe that rehabilitation of children with postural defects or deformities, such as scoliosis, should be comprehensive, including the presence of a psychologist in the therapeutic team. At the same time, it seems worth implementing correction and shaping of correct body posture among children with low self-esteem or lack of self-acceptance.

Keywords: body posture, idiopathic scoliosis, postural defect, body image, self-esteem, adolescence
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Laboratory diagnosis of influenza
Pediatr Med Rodz 2018, 14 (3), p. 286–292
DOI: 10.15557/PiMR.2018.0032
ABSTRACT

Influenza has always been and still is the cause of considerable morbidity and, consequently, frequent multiorgan complications, often irreversible and even fatal. It is an acute infectious disease caused by type A, B and C viruses, members of the family Orthomyxoviridae. Infections caused by the influenza virus are reported in every epidemic season. Influenza infections should be considered not only in the aspect of health, but also in the quantifiable, measurable economic aspect. For many years, influenza has been one of the basic priorities of public health. Virological and epidemiological surveillance of influenza, which is implemented in each epidemiological season, is one of the key elements of public health. Virological surveillance involves laboratory confirmation of infection, while epidemiological surveillance involves monitoring of actual and suspected cases of influenza. Laboratory diagnosis is performed to confirm influenza virus antigen in the material collected from the patient, isolate the virus and confirm viral infection based on increased serum antibody levels. Isolating influenza viruses that circulate in a given epidemiological season is necessary to prepare a vaccine against influenza. An early and correct virological diagnosis of respiratory infection, with particular reference to influenza, is currently of great importance in terms of both medical and economic aspects. The paper discusses influenza diagnostic methods currently used in Poland to help physicians in deciding whether laboratory confirmation of diagnosis is justified in the aspect of possible treatment to avoid influenza-induced multiple organ complications.

Keywords: influenza, diagnostic test, molecular biology methods, serological methods
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Nutritional status and selected atherosclerotic risk factors in young adults in relation to their birth weight
Pediatr Med Rodz 2018, 14 (3), p. 293–300
DOI: 10.15557/PiMR.2018.0033
ABSTRACT

Barker’s thrifty phenotype hypothesis suggests a relationship between low birth weight and obesity, type 2 diabetes mellitus and atherosclerosis in later life. Aim: The aim of the study was to assess the nutritional status and the incidence of selected atherosclerotic risk factors among people in their third decade of life in relation to their birth weight and term of delivery. Material and methods: A total of 119 subjects aged between 19 and 29 years were classified into the following groups: born prematurely (group I – 38 subjects), born at term, but with low birth weight (group II – 39 subjects), and born at term with normal birth weight (group C – 42 subjects) as well as into groups with birth weight <10th percentile and ≥10th percentile for gestational age. We analysed sociodemographic data on health behaviours and the health status of both participants and their parents. Body weight and height, waist and hip circumferences as well as blood pressure were measured. Additionally, body composition was estimated by bioelectrical impedance analysis. Glucose, cholesterol and triglyceride levels were determined using strip tests. Results: Significantly higher mean levels of cholesterol, a significantly higher prevalence of increased cholesterol and a non-significant increase in the prevalence of obesity, including abdominal obesity, were found in group I compared to other groups. A non-significant increase in the prevalence of abdominal obesity and a higher proportion of adipose tissue compared to controls as well as significantly the lowest prevalence of hypercholesterolaemia were observed on group II. A positive correlation was observed between the body mass index in those born prematurely and the body mass index of their mothers. Among the independent variables affecting the number of atherosclerotic risk factors, the importance of premature birth, age and excessive parental nutritional status was confirmed. Conclusions: 1) Premature birth increases the risk of elevated serum cholesterol levels in the third decade of life. 2) Premature birth and intrauterine growth restriction do not increase the risk of obesity in the third decade of life. 3) Premature birth, increasing age and excessive parental nutritional status have an impact on the number of atherosclerotic risk factors in the third decade of life.

Keywords: birth weight, term of delivery, atherosclerotic risk factors, young adults
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Comparison between bioelectrical impedance analysis and anthropometric indices in hypertensive patients
Pediatr Med Rodz 2018, 14 (3), p. 301–305
DOI: 10.15557/PiMR.2018.0034
ABSTRACT

Aim: Obesity is one of the most crucial challenges of contemporary medicine. Bioelectrical impedance analysis is a useful tool to identify individuals with increased fat mass. However, the equipment is relatively expensive, especially compared to basic anthropometric methods. The aim of this study was to evaluate the relations between anthropometric indices and bioelectrical impedance analysis in patients with uncomplicated arterial hypertension. Material and methods: In 137 hypertensives the correlations between fat mass (absolute, FM; relative, %FM) and anthropometric parameters (body mass index, BMI; waist circumference, WC; waist-to-hip ratio, WHR; waist-to-height ratio, WHtR; body adiposity index, BAI; visceral adiposity index, VAI) were analysed. Results: Classic anthropometrics correlated well with bioimpedance indices of adipose tissue content: %FM vs. BAI (R = 0.77), WHtR (R = −0.54), BMI (R = 0.52), WC (R = 0.29); FM vs. BMI (R = 0.82), WC (R = 0.66), BAI (R = 0.58), VAI (R = 0.26), WHtR (R = 0.23), WHR (R = 0.19). In females BMI, WC and BAI showed the strongest correlations with adiposity. In males they were WHtR and WC. Conclusions: Some anthropometric measurements show good agreement with bioelectrical impedance analysis and can be considered a valid surrogate for body composition assessment in the case of its inaccessibility. In hypertensive women WC and BMI seem to be the most precise in the assessment of %FM, while in men WHtR and WC are more useful

Keywords: obesity, hypertension, adipose tissue, bioelectrical impedance
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The usefulness of a hospital nutrition support team, as a separate unit, in diagnosing and treating malnutrition
Pediatr Med Rodz 2018, 14 (3), p. 306–309
DOI: 10.15557/PiMR.2018.0035
ABSTRACT

Introduction: Malnutrition is still a serious clinical problem, which has negative consequences. It not only prolongs hospitalisation, but also delays recovery. The diagnosis of malnutrition is as important as any other medical diagnosis. Aim of the study: To assess the usefulness of a hospital nutrition support team, as a separate unit, to diagnose and treat malnutrition. Material and methods: Data from 5 years were retrospectively collected. We analysed the number of patients each year and the number of days of artificial nutrition (enteral and parenteral) covered by the National Health Fund. During the first 2.5 years, the nutrition support team functioned as a part of surgical department, and for the next 2.5 years it was a separate unit. Results: The activity of the hospital nutrition support team, as a separate unit, has significantly increased the number of nutritional procedures, enteral in particular. In the first half of the year 2014, the number of parenteral nutrition days was 64, and the number of enteral nutrition days was 215. However, in the next 6 months, when the team functioned as a separate unit, the number of days was 185 and 1,511, respectively, despite a similar number of hospitalised patients. The activity of a separate nutrition support unit resulted in a significant, more than 7-fold increase in the number of days of the enteral nutrition (1,032 vs. 7,479; p < 0.001). The increase in the number of days of parenteral nutrition was also significant (999 vs. 1,412; p < 0.001). Conclusion: Establishing a hospital nutrition support team significantly increased the number of days of both enteral and parenteral nutrition in malnourished patients. The activity of the team is cost-effective and profitable for the hospital.

Keywords: nutrition team, enteral nutrition, parenteral nutrition, malnutrition
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Anti-Anisakis antibodies in human umbilical cord blood
Pediatr Med Rodz 2018, 14 (3), p. 310–313
DOI: 10.15557/PiMR.2018.0036
ABSTRACT

Introduction: Little is known about the influence of seroreactivity to fish nematode antigens on the unborn child. Aim: The objective of this study was to ascertain whether infants born to women with Anisakis spp. seroreactivity had problems with growth at birth, or during neonatal care. Methods: We conducted a retrospective database search of puerperal women interviewed at two perinatal facilities in Niterói, Brazil. Neonates were selected by the presence of anti-Anisakis IgG antibodies in cord blood and categorised, by analysis of maternal blood results, as reactive or nonreactive. The Mann–Whitney U test was used for hypothesis testing in continuous variables. A generalised linear model was used for binary logistic regression. Results: Of the 147 neonates studied, 121 were labelled as nonreactive and 26, as reactive. There were no significant betweengroup differences in maternal age (p = 0.193), number of prenatal visits (p = 0.362), presence of prenatal conditions (p = 0.980), mode of delivery (p = 0.193), gestational age (p = 0.266), birth weight (p = 0.294), need for resuscitation (p = 0.675), development of conditions during hospital stay (p = 0.201), or length of hospital stay (p = 0.528). There was also no significant association between IgG positivity in cord blood in raw fish intake (p = 1.000) or intake >2 times/week (p = 0.729). Conclusions: The presence of anti-Anisakis IgG in cord blood of infants born to women seroreactive to Anisakis did not pose a hazard to this neonatal population and did not influence growth, conditions at birth, or development of any clinical conditions before hospital discharge.

Keywords: Anisakis spp., cord blood, ELISA, fish, newborn
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Morphological changes of the mucous membrane in children with chronic gastroduodenal pathology and infection with cytotoxic strains of Helicobacter pylori
Pediatr Med Rodz 2018, 14 (3), p. 314–318
DOI: 10.15557/PiMR.2018.0037
ABSTRACT

Introduction: Helicobacter pylori plays the main role in the development of chronic pathology of the gastroduodenal area. Helicobacter pylori infects 25% of the population in developed countries and up to 90% in developing countries. The most virulent are CagA positive (+) strains of Helicobacter pylori, which cause an intense cellular response, i.e. inflammation of the stomach mucous membrane, cell proliferation and cell death. Material and methods: We examined 75 children, aged 10 to 18 years, with chronic gastroduodenal pathology associated with Helicobacter pylori. A morphological and morphometric study of the stomach mucous membrane was performed depending on the presence of cytotoxic strains of Helicobacter pylori. Results: In children infected with CagA (+) strains of Helicobacter pylori, active and deep chronic gastritis and gastroduodenitis [21 (28.00%), 20 (26.67%), respectively] were more common than in children with CagA (−) strains [10 (13.33%), 13 (17.33%), respectively]. Discussion: Morphological studies provide an opportunity to determine quantitative and qualitative changes in the mucous membrane of the stomach in gastroduodenal pathology associated with Helicobacter infection. This increases the quality of diagnosis and predicts the course of the disease. Conclusion: A morphological study has shown that the presence of cytotoxic strains of Helicobacter pylori contributes to more significant changes in the gastric mucosa in children with chronic gastroduodenal pathology.

Keywords: children, Helicobacter pylori, chronic gastritis, gastroduodenitis, mucous membrane of the stomach
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Xanthogranulomatous pyelonephritis in a child – a case report
Pediatr Med Rodz 2018, 14 (3), p. 319–323
DOI: 10.15557/PiMR.2018.0038
ABSTRACT

Xanthogranulomatous pyelonephritis is a chronic inflammatory condition that involves the kidney and occurs mainly in middle-aged women, but rarely in children. Its aetiology has not been elucidated completely. It is believed that the following factors may play a role in its development: an obstruction for urine flow, urolithiasis, inadequately treated urinary tract infection as well as venous and lymphatic drainage disorders. Poorly specific signs and symptoms delay the correct diagnosis by even several months. Kidney enlargement with nonspecific cysts and calcifications, and concomitant adjacent tissue reaction may be suggestive of a cancerous lesion. Computed tomography plays a vital role in imaging. It helps establish an initial diagnosis to be verified intraoperatively. The final diagnosis is made in a histopathological examination of the removed organ. The case presented herein illustrates the need to consider xanthogranulomatous pyelonephritis in the differential diagnosis of abdominal masses.

Keywords: xanthogranulomatous pyelonephritis, renal pseudotumour, kidney US, nephrectomy, children
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Blastocystis infection in a 5-year-old boy – a case report
Pediatr Med Rodz 2018, 14 (3), p. 324–326
DOI: 10.15557/PiMR.2018.0039
ABSTRACT

Blastocystis hominis is one of the most common parasites present in the human gastrointestinal tract. Transmission usually occurs via food and water contaminated with cystic forms or via the faecal-oral route. The prevalence of infection is approximately 30–50% in developing countries and about 1.5–10% in developed ones. Blastocystis hominis was long considered as a large intestine commensal due to asymptomatic infestation, possibly characterised by temporary or permanent gastrointestinal carrier state, in some cases. Currently, this protozoan is considered pathogenic as symptoms develop in the course of infestation, especially in infected immunocompromised individuals. The importance of Blastocystis hominis as a factor responsible for enteral and parenteral symptoms is underestimated in clinical practice, and the infestation with this parasite is underdiagnosed. We present a case of a 5-year-old boy infected with Blastocystis hominis, who developed gastrointestinal symptoms and urticaria.

Keywords: Blastocystis infection, symptoms, treatment, children
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Pott’s puffy tumour secondary to frontal sinusitis
Pediatr Med Rodz 2018, 14 (3), p. 327–330
DOI: 10.15557/PiMR.2018.0040
ABSTRACT

Frontal sinusitis is a common encounter in otorhinolaryngology practice. Most patients will present with frontal headache which worsens on bending forward, reduced sense of smell and sometimes cacosmia. Pott’s puffy tumour is an osteomyelitis of the frontal bone, which was originally described as a result of trauma, but it can also develop as a result of frontal sinusitis. We present a rare case of a rapidly progressing Pott’s puffy tumour involving the frontal sinus. The oedema subsided after antibiotic treatment and the patient underwent functional endoscopic sinus surgery.

Keywords: frontal sinusitis, Pott’s puffy tumour, functional endoscopic sinus surgery
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Paranasal sinusitis complicated by Pott’s puffy tumour
Pediatr Med Rodz 2018, 14 (3), p. 331–336
DOI: 10.15557/PiMR.2018.0041
ABSTRACT

Pott’s puffy tumour is defined as inflammation of the frontal bone marrow with an accompanying subperiosteal abscess manifested by swelling of the frontal region and is most often a complication of paranasal sinusitis or trauma. Early diagnosis and implementation of proper treatment are important due to the frequent co-occurrence of intracranial complications, such as epidural empyema, cerebral abscesses or meningitis. Due to the low prevalence of Pott’s puffy tumour, the knowledge on this severe complication relies on descriptions or series of cases, especially among children. We present a case of an 8-year-old girl who was admitted to the hospital due to headache and swelling in the frontal area. We also present a summary of the available publications on Pott’s puffy tumour. Diagnostic procedures revealed massive inflammatory changes in the paranasal sinuses, with the destruction of the frontal sinus walls, and showed a connection between the inflammatory lesions and the anterior cranial fossa. The girl was qualified for urgent neurosurgical and laryngological surgery.

Keywords: frontal swelling, complication of rhinosinusitis, Pott’s puffy tumour
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A rare foreign body in the nasal cavity
Pediatr Med Rodz 2018, 14 (3), p. 337–339
DOI: 10.15557/PiMR.2018.0042
ABSTRACT

Nasal foreign bodies are a common occurrence in children and are relatively easy to be removed in an outpatient setting. Depending on the type and location, special precaution needs to be taken especially in cases involving a battery or an impacted foreign body in the nostril. Although the removal procedure usually can be safely conducted in a clinic, general anaesthesia is sometimes required, especially if the foreign body is corrosive or the child is uncooperative to prevent further complications either from the procedure or the foreign body itself. We present a case of a 2-year-old boy, who presented with persistent nasal discharge of 2 week-duration. A rare type of foreign body which is a metal spring, was found in the right nostril. The spring was successfully removed under general anaesthesia without any local complications.

Keywords: nasal foreign body, nasal discharge, metal spring
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Convalescence of auditory brainstem response following idiopathic sudden onset sensorineural hearing loss
Pediatr Med Rodz 2018, 14 (3), p. 340–345
DOI: 10.15557/PiMR.2018.0043
ABSTRACT

Sudden onset sensorineural hearing loss is an emergency condition in otorhinolaryngology. Despite its common occurrence, the investigation and treatment of this condition are still controversial. Auditory brainstem response is one of hearing assessment tools used in sudden onset sensorineural hearing loss. However, its findings may be false positive at early stages of the disorder, leading to unnecessary investigations and treatments. We report two cases of idiopathic sudden onset sensorineural hearing loss, which manifested in abnormal auditory brainstem response during the acute phase of illness. However, a complete recovery of auditory brainstem response was observed after treatment completion. Therefore, we suggest that auditory brainstem response should be performed reasonably, especially during the acute phase of sudden onset sensorineural hearing loss.

Keywords: sudden hearing loss, sensorineural, auditory brainstem response
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Chicken bone in the bronchus masquerading as bronchopneumonia in an asthmatic boy
Pediatr Med Rodz 2018, 14 (3), p. 346–349
DOI: 10.15557/PiMR.2018.0044
ABSTRACT

Aim of the study: To emphasise the importance of a thorough history to exclude foreign body inhalation in children presenting with respiratory symptoms. Case study: We report a case of a 2-year-old boy with underlying bronchial asthma, who presented with cough and difficulty breathing of two-day duration, with no stridor. He was treated for acute exacerbation of bronchial asthma and bronchopneumonia. However, the symptoms persisted despite treatment. A detailed history revealed a choking episode while eating chicken curry prior admission. Bronchoscopy confirmed the presence of a piece of chicken bone in the left main bronchus, which was removed. The child was in good overall condition after the operation. Chest radiograph showed resolved lung collapse. Conclusion: A thorough history to exclude foreign body ingestion is necessary to avoid delayed complications of foreign body aspiration.

Keywords: bronchopneumonia, foreign body inhalation, bronchus
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