Anaemia is the most common extraintestinal complication of inflammatory bowel diseases in both hospitalised and outpatient patients. Symptoms associated directly with reduced haemoglobin levels as well as the consequences of iron, vitamin B12 or folic acid deficiency significantly impair the quality of life. Memory disorders and difficulty focusing, depression or mood swings are just some of the symptoms that can be a consequence of undiagnosed and untreated anaemia. Determination of the aetiology of anaemia in inflammatory bowel diseases, which may result not only from gastrointestinal bleeding, is important in choosing an appropriate treatment regimen. Proper diagnosis and monitoring are important in the prevention and diagnosis of anaemia. Choosing the right treatment method is the key element. Decisions regarding the use of oral or intravenous iron forms should be justified and applicable in everyday practice. The goal to be achieved is effective treatment of anaemia, which translates into improved quality of life of patients with inflammatory bowel disease. Improved comfort of life, which is so important for these patients, may be achieved regardless of the clinical activity of the underlying disease. Furthermore, proper treatment of anaemia optimises the therapy, reducing the frequency of hospitalisations and blood transfusions and, consequently, the total cost of treatment.
Aerosol therapy is the basis for the treatment of respiratory diseases. Effective treatment of asthma, infections and inflammations of the upper and lower respiratory tract, and chronic lung diseases is not possible without effective inhalation therapy. Nebulisation is the oldest way of administering medications by inhalation. The clinical effect depends on several elements, without which effective nebulisation cannot be performed. Meeting certain conditions (proper selection of the inhaler, technique of the procedure, dosage) determines the success of the therapy. The article presents the decalogue of nebulisation in a concise manner – a set of basic principles that should be followed by doctors, so that this way of treating respiratory diseases is effective.
Decalogue of nebulisation:
In their daily work, a primary care physician often meets patients with indications to issue a prescription for epinephrine for self-supply. However, they should not settle for writing a prescription, but also carry out full instructions as to the indications as well as the method of injection. The instruction should be carried out by a doctor or a nurse and be adapted to the specific medication that the patient will purchase. Attention should be paid not only to the patient, but also to all persons in the patient’s environment who may be forced to administrate epinephrine. The article discusses the mechanism of action of epinephrine, indications for its prescription and applicable contraindications. Attention was paid to the correct dosage of the drug, in particular – the need to prescribe at least two doses of the drug to the patient, so that the patient had at least two pieces of the medicine with him. Potential risks for the patient in the case of improper use are presented, for example a wrong route of administration. Differences between pre-filled syringes and auto-injectors are described. The preparations available on the Polish drug market (Adrenaline WZF and EpiPen) are presented. The work describes in detail how to use these devices, which allows a doctor or a nurse to prepare for the training of the use of a pre-filled syringe or an auto-injector. Attention is drawn to the application of training devices in order to instruct the use of the EpiPen.
Selenium is important for the proper functioning of the human body. This element is closely related to the proper functioning of the thyroid gland and normal metabolism of thyroid hormones. Moreover, it plays a role in the treatment of diseases affecting this organ. The present work was aimed at collecting recent reports on the effect of selenium supplementation on the course of Hashimoto’s disease and was an attempt to explain how this element can affect the thyroid gland. The paper presents the effect of selenium supplementation at various stages of Hashimoto’s disease and the possible molecular basis for the observed biochemical and therapeutic changes. The studies presented by the authors describe the effect of selenium on, inter alia, the level of antithyroid antibodies, proinflammatory factors and echogenicity of the thyroid in people with Hashimoto’s disease. The article also discusses interesting molecular studies describing the importance of selenium in the process of apoptosis, or in the modification of the HLA expression on thyroid cells. Selenium is probably involved in the modification of autoimmune reactions in the affected thyroid gland. What is more, thanks to its special antioxidant properties, selenium reduces chronic inflammation in the thyroid with Hashimoto’s disease. It is definitely worth paying attention to this micronutrient because it may improve the therapy of chronic autoimmune thyroiditis and, maybe in some time, after more clinical investigation, it will become an important part of the therapy in this disease entity.
Lyme disease, also known as Lyme borreliosis, is a systemic infectious disease caused by Borrelia burgdorferi spirochetes. It is spread by the bites of infected ticks of the genus Ixodes which inhabit forest plants in the northern hemisphere, including western Asia and Europe. In the classic course of Lyme disease, the most common early manifestations include erythema migrans, a circular red skin rash around the tick bite, and general symptoms. The most prevalent clinical manifestation of late disease is neuroborreliosis. The migration of urban residents to regions endemic to ticks of the genus Ixodes which are vectors of Borrelia burgdorferi increases the risk of neuroborreliosis in all children regardless of their place of residence, especially during the summer and early autumn. The absence of characteristic manifestations in the first stage of the disease, shortly after the tick bite, involving typical skin lesions and systemic symptoms, may result in delayed diagnosis and initiation of causal treatment. In adult patients, the disease appears typically as meningoradiculoneuritis. In children, common manifestations associated with late-stage Lyme disease are meningitis and cranial nerve palsy including peripheral facial nerve palsy. Symptoms of neuroborreliosis are uncommon in the early stage of the disease. Facial nerve palsy can be a diagnostic symptom of multiple nervous system disorders, including infectious diseases. Neuroborreliosis is a form of Lyme disease that affects the structures of the nervous system, and may present as peripheral facial nerve palsy. Consequently, children with peripheral facial nerve palsy should undergo diagnostic work-up for Borrelia burgdorferi infection also in cases without typical erythema migrans in the early stage of the disease.
Early childhood autism is a serious overall developmental disorder, the typical features of which are problems with communication with the environment and social bonds. The aetiology of autism is probably multifactorial and has not been fully understood. The characteristics of an autistic child make its caretakers seek help from various specialists, and the diagnosis of the disorder often comes very late. The prognosis for curing is bad. The treatment of childhood autism should be of a multidirectional character and consider the needs of the child and its family. First, behavioural therapy, sensory integration therapy, speech therapy and pharmacological symptomatic treatment as well as treatment of coexisting ailments, including otorhinolaryngological diseases, are introduced. Hearing impairment in children with developmental disorders may cause even greater difficulties in contact with the environment, which is of fundamental importance for the child’s development, its rehabilitation and psychiatric/psychological treatment. Autism may coexist with sensorineural hearing loss. Some authors suggest that in such cases, the most common is profound sensorineural hearing loss. The problem of hearing loss in children with autism concerns not only the sensorineural hearing loss, but also the conductive hearing loss, which is characteristic to preschool and school age. In a child with overall developmental disorders, both hearing loss and other laryngological symptoms may remain unnoticed by parents. Laryngological care for an autistic child seems insufficient. It is necessary to create a systematic laryngological control and conditions for periodic hearing tests in this group of children.
Background: Heart failure is a condition with diverse aetiology and pathogenesis. This is associated with higher rates of comorbidities, such as i.e. hypertension, atrial fibrillation chronic kidney disease, anaemia and iron deficiency. The purpose of this study was to characterise patients hospitalised due to acutely decompensated heart failure, with a particular emphasis on any comorbidities and laboratory test abnormalities. Material and methods: A total of 102 patients aged over 18 years, hospitalised due to acute decompensated heart failure. Thorough medical history (including any concomitant diseases) was obtained from all patients. They also underwent a clinical examination and biochemical tests. Results: The subjects included were mostly men (76.5%) with ischemic aetiology (63.7%). The most common comorbidity was hypertension (66.6%), while hypotension affected only 2% of patients. The most common heart failure subtype was heart failure with reduced ejection fraction (60.8%). The detected blood test abnormalities included elevated cystatin C levels in 94.7%, hyperuricaemia in 75.5%, anaemia in 55.9%, and iron deficiency in 78.3% of patients. Conclusion: Most of acute decompensated heart failure patients suffer from comorbidities with a documented impact on prognosis. Cardiovascular decompensation poses a risk of multi-organ dysfunction and estimating its actual consequences requires a detailed assessment of complex laboratory tests, including levels of creatinine, cystatin C, uric acid, red blood cell parameters and iron metabolism parameters.
Aim: Assessment of the correlation between high body mass and metabolic causes of urolithiasis in patients treated over a 2-year period in the Department of Paediatrics, Paediatric Nephrology and Allergology at the Military Institute of Medicine in Warsaw. Material and methods: A total of 109 children with urolithiasis, aged 9–18 years (mean: 13 years), were enrolled in the study. The patients were divided into two groups: Group I – children with normal body mass (body mass index <85th percentile), and Group II – children with high body mass (body mass index ≥85th percentile). Group I consisted of 74 children (33 girls and 41 boys). Group II comprised 35 children (23 girls and 12 boys). Blood serum and urine samples were collected and tested in the laboratory to determine the causes of urolithiasis. In addition, anthropometric parameters were evaluated, including body mass index, waist circumference, waist-to-hip ratio, body mass, and body height. Also, the lipid profile was examined, and arterial blood pressure was measured in the study subjects. Results: Children with high body mass were found to have statistically significantly higher serum uric acid levels [5.4 mg/dL (5.0–6.2) vs. 4.7 mg/dL (4.1–5.4); p < 0.05] and statistically significantly higher urinary uric acid excretion (determined on the basis of the uric acid/creatinine ratio in second morning urine) compared to children with normal body mass [0.3 (0.2–0.3) vs. 0.2 (0.2–0.3); p = 0.01]. There were no statistically significant differences in the excretion of other crystalloids. In addition, children with high body mass were shown to have significantly higher values of total cholesterol [167.5 (142.0–183.0) vs. 152.0 (136.0–163.0); p < 0.05], LDL [103.5 (83.0–117.5) vs. 88.5 (69.0–102.0); p < 0.05], and triglycerides [104.0 (89.0–111.0) vs. 64.0 (52.0–106.0); p < 0.05] as well as lower mean vitamin D levels (26.6 mg/dL ± 9.25 vs. 22.6 mg/dL ± 6.75; p = 0.04), and higher systolic blood pressure (110.2 mm Hg ± 11.0 vs. 115.7 mm Hg ± 11.96; p = 0.02) compared to non-overweight children. Conclusions: There is a possible correlation between overweight and urolithiasis associated with excessive uric acid excretion. Overweight patients with urolithiasis present disorders in the lipid profile which may have an impact on the formation of calculi. Lower serum vitamin D concentrations in overweight patients do not affect the level of calciuria.
Cystic fibrosis patients are characterised by disorders of fat-soluble vitamin absorption and bone metabolism. The aim of this study was to compare the effect of 3-month supplementation with calcitriol and cholecalciferol on calcium–phosphate balance in patients with cystic fibrosis. The study included 23 cystic fibrosis patients aged from 6 to 19 years. It was a crossover, placebo-controlled trial. There were 3 visits during which blood and urine were collected for analysis. The patients were treated with cholecalciferol (1,000 IU/day) or calcitriol (0.5 μg 1,25OHD) and placebo, and then received medications according to the cross-over regimen. The second visit took place after 3 months. The concentration of calcium, phosphate, parathyroid hormone and 25OHD were determined in blood serum; calcium/creatinine index was determined in urine. It was shown that after 3-month supplementation with calcitriol, the phosphate concentration decreased significantly, from 1.48 mmol/L (±SD 0.27 mmol/L) to 1.35 mmol/L (±SD 0.20 mmol/L) (p = 0.021). The calcium concentration increased significantly after 3 months of calcitriol treatment, from 3.50 mg/dL (±SD 2.60 mg/dL) to 4.35 mg/dL (±SD 3.35 mg/dL) (p = 0.001). The level of parathyroid hormone decreased significantly after 3 months of treatment with calcitriol, from 36.54 pg/mL (±SD 17.61 pg/mL) to 29.36 pg/mL (±SD 13.08 pg/mL) (p = 0.019). In the cholecalciferol supplementation group, there were no changes in phosphate, calcium or parathyroid hormone concentrations. Supplementation with either cholecalciferol or calcitriol did not affect serum 25OHD levels. In patients with cystic fibrosis, calcitriol supplementation at a dose of 0.5 μg is safe and has a more beneficial effect on the calcium–phosphate metabolism and bone metabolism than that of cholecalciferol at a daily dose of 1,000 IU.
Carbon monoxide (CO) poisoning is an important clinical problem. The symptoms of poisoning are non-specific, particularly in the paediatric population. Currently, the use of hyperbaric oxygen (HBO) is considered to be more justified with increasing severity of the patient’s clinical status and with shorter time elapsed from CO exposure. Aim of the study: The aim of this study was to assess the efficacy of hyperbaric oxygen therapy in children with symptoms of carbon monoxide poisoning. Material and methods: The study was a retrospective analysis of medical records of children hospitalised for carbon monoxide poisoning at the Department of Paediatrics, Paediatric Nephrology and Allergology of the Military Institute of Medicine, Poland, between January and December 2018. The following data were analysed: laboratory test results, CO poisoning circumstances, the manner of reporting to the Department, the number of hyperbaric chamber sessions needed to relieve the symptoms completely, the occurrence of complications and the duration of stay at the Department after treatment completion. Results: The analysis of the results did not demonstrate any relationship between carboxyhaemoglobin level and poisoning manifestations and CO poisoning severity. However, a statistically significant positive correlation was demonstrated between carboxyhaemoglobin level and HCO3− level and a statistically significant negative correlation was found between carboxyhaemoglobin level and capillary pH. No statistically significant differences were found between children with mild poisoning and those with severe poisoning in terms of potassium level, capillary pH, and HCO3− and glucose levels. At the same time, it was demonstrated that hyperbaric therapy is a highly effective and safe method. Conclusion: Regardless of the causes of CO poisoning in the paediatric population, hyperbaric therapy is a highly effective and safe method. One session in a hyperbaric chamber is sufficient to relieve the symptoms completely and prevent delayed sequelae of poisoning and CO side effects.
Introduction: Pregnant women should take special care to maintain proper nutrition. During pregnancy, there is an increased need for energy and various nutrients. Diet exerts a fundamental influence on foetal development and the child’s extrauterine health. Research shows that women’s knowledge about nutrition during pregnancy is still unsatisfactory. This phenomenon is particularly pronounced among women living in rural areas. Aims: The study aimed to specify the dietary habits of pregnant women living in rural areas as well as to analyse the respondents’ most frequent nutritional mistakes. The study assessed respondents’ knowledge and awareness of nutrition during pregnancy. Material and methods: The study was conducted from 1 February to 1 May 2018 and used authors’ own questionnaire. It included 57 pregnant women from rural areas. More than half of the study participants (57%) were not in gainful employment and did not continue their education. Results: Although most of respondents believed that they had proper dietary habits, the study found that their knowledge and awareness of diet during pregnancy were at a low level. Most women (54%) paid no attention to the nutritional information on food labels. During pregnancy, the respondents chose products posing a potential threat to the developing foetus. Conclusions: Due to the unsatisfactory results, it was concluded that there is a need to disseminate knowledge on nutrition. A method that would provide long-term effects is needed to increase its efficiency. Telemedicine could be a solution.
Introduction: The number of people refusing to vaccinate their children is growing in Poland every year. Anti-vaccine organisations lead very fierce disinformation campaigns. The incidence of vaccine preventable diseases is on the rise. Monitoring of parents’ attitudes towards preventive vaccinations and gauging the level of their understanding of the issue may enable more effective actions of organisations responsible for public health. Aim: The objectives of the study included finding out about parents’ opinions and views as well as evaluating their knowledge about vaccinations in Poland. The study was also to define a parents’ assessment of the range of campaigns promoting vaccination and actions of anti-vaccine movements. Material and method: The studies were carried out with a survey conducted among 233 parents or legal guardians of the children being under the obligation of vaccinations. Results: Nearly 90% of respondents are proponents of vaccinations, one-third of them consider some vaccinations unnecessary, and almost 7% of the surveyed describe themselves as opponents of vaccinations. 78% among the parents surveyed encountered campaigns promoting the Childhood Immunisation Programme, and most of them regard such campaigns as useful. Anti-vaccine movements were heard of by 62.4% of all the surveyed parents or legal guardians. 60% of respondents regard their own knowledge of the issue of vaccinations as sufficient. However, only 35% of respondents provided correct answers to the control questions about preventive vaccinations. People with higher education have better knowledge on vaccinations, whereas those with primary education have the best opinion on their own knowledge. Conclusions: Parents’ knowledge in terms of preventive vaccinations seems inadequate. The number of opponents of preventive vaccinations is systematically growing. The paediatrician being the main source of information on the issue of vaccinations for the parents. Monitoring of parents’ attitudes and opinions about the issue of preventive vaccination will be useful in better directing promoting campaigns in social media, and in adjusting healthcare workers’ activities to specific social groups.
Varicella is a common, usually self-limiting, contagious childhood disease. Its clinical presentation in generally healthy children is characteristic enough to allow one to make a diagnosis; however, in immunosuppressed patients the diagnosis may be difficult due to atypical course of the disease. This article presents a diagnostically challenging case of a 5-year-old boy with newly diagnosed acute lymphoblastic leukaemia who developed varicella-zoster infection during induction steroid therapy, with an atypical, mild course without fever or pruritus, with eruptions of changed morphology. The presented case shows that in children with leukaemia who have been in contact with individuals with varicella, the occurrence of any rash should raise suspicion of the disease. In this group of patients the diagnostic method of choice is PCR test of skin eruption material. Intravenous acyclovir therapy should be started already before the PCR result comes back.
A frequently confused symptom that leads to mismanagement is referred pain. It can be of a great diagnostic value if one knows the potential origin of it. There are possibilities for physicians to miss an underlying oral or oropharyngeal pathology if they overlook the presentation and findings that are not familiar or directly organ-related. We present a case of a 75-year-old male diagnosed with a mandibular cyst when he presented with a sudden onset of extreme left-sided neck pain radiating to the left side of face and the post auricular region. Orthopantomography revealed a large cystic lesion extending from the left lower border of the mandible to the ramus. The most common cystic lesions affecting the maxillofacial region are odontogenic cysts.
Pulmonary artery sling is a rare congenital vascular anomaly in which the left pulmonary artery originates from the right pulmonary artery. The report presents a boy with recurrent respiratory tract infections who was continuously followed-up at a pulmonology centre since he was 2 years old. When he was 7 years old, echocardiography examination finally showed left pulmonary artery sling. Next, chest computed tomography confirmed the diagnosis and also detected bronchomalacia. Left pulmonary artery sling is a rare genetic defect that is diagnosed by echocardiography. Surgical treatment of left pulmonary artery sling at an early age prevents the development of lesions of the bronchial tree that later require long-term pulmonology treatment and rehabilitation. In case of a late diagnosis and intensified sling consequences manifest as bronchomalacia and bronchiectasis these factors will play a decisive role in the future clinical picture and the patient may need tracheoplasty treatment.
Vallecular cysts are ductal cysts that form when a mucous gland or a lingual tonsillar crypt becomes dilated due to the obstruction from inflammation, irritation or trauma. The peak incidences of vallecular cysts are bimodal; they are more frequent in children compared to the adult group. We report a case of a 22-year-old lady who presented with globus sensation for more than a year. Flexible nasopharyngolaryngoscopy revealed a huge cystic mass at the vallecula obscuring the visualisation of the laryngeal inlet. Patient successfully underwent endoscopic excision of the vallecular cyst with no intra- and postoperative complications.
Tuberculous lymphadenitis constitutes up to 40% of extrapulmonary tuberculosis. Chronic cervical lymphadenopathy may be the only manifestation of extrapulmonary tuberculosis in the head and neck region. Symptoms, clinical findings and prognosis differ greatly depending on the host’s immune system, existing comorbidities, site and extension of infection as well as early diagnosis and commencement of treatment. We report a case of miliary tuberculosis with both pulmonary and extrapulmonary involvement in a healthy male who was successfully treated with surgical drainage of neck abscess followed by 9 months of an anti-tuberculosis drugs treatment.
Chronic urticaria is a rare disease in the paediatric population. It is characterised by the presence of blebs, angioedema or the coexistence of these changes for a period of more than 6 weeks. It is assumed that the aetiology of the disease is multifactorial, but in many cases it remains undetermined. The development of urticaria depends on the activation of mast cells. High significance in the development of chronic urticaria is attributed to autoimmune mechanisms. The patients with urticaria reveal the presence of infection foci usually located in the head, including the upper respiratory tract. Pathogenic microorganisms can lead to the development of systemic reactions. Limited data on the causes of chronic urticaria among children triggers diagnostic and therapeutic concerns. Patients with chronic urticaria often require complex diagnostics and long-term treatment. Chronic urticaria significantly reduces the quality of life of patients and the pharmacotherapy used is fraught with the risk of side effects. This paper presents a case report of a 12-year-old boy with a 5-year history of chronic urticaria with a complete remission of skin lesions after adenotonsillectomy.
Capillary haemangioma of the nose is a rare entity and presents as a benign vascular tumour. Aetiology and risk factors remain uncertain and most certainly, it is a challenging condition to treat. We report a young adult male who presented with a 2-months duration of nasal obstruction and epistaxis and later confirmed to have had nasal septal capillary haemangioma. Transnasal endoscopic excision was done without preoperative embolization as the tumour was radiologically well delineated.
Incorrect organisation of the areas receiving sensory stimuli in the nervous system is the cause of many problems occurring in children, such as difficulties with learning, reading, writing, drawing and attention. Anna Jean Ayres, the precursor of sensory integration therapy, believed that children are born with an internal urge for development and thanks to natural activity they provide themselves with an appropriate amount of adequate stimuli. The endpoint of normal psychomotor development is to achieve a certain level of motor performance – closely related to the psyche. Children with sensory integration disorders learn new skills more slowly, have problems with establishing friendships and low self-esteem, they also deal with adversities worse than other children. This paper describes a case of a girl experiencing educational problems at school. The article shows examples of exercises focused on the normalisation of sensory integration processes which are performed by a child not only in the office, but also at home. The aim of the paper is to draw the attention of parents, teachers and doctors to the fact that problems with schooling may be the result of disorders in sensory integration processes.