2019, Vol 15, No 4
The 2019 novel coronavirus (2019-nCoV) – transmission, symptoms and treatment
Pediatr Med Rodz 2019, 15 (4), p. c1–c5
DOI: 10.15557/PiMR.2020.0001

For years, coronaviruses have been regarded as benign pathogens responsible for mild respiratory symptoms resolving spontaneously within a few days. However, the emergence of new, highly infectious species increased interest in these pathogens. In November 2002, an epidemic caused by a previously unknown, highly infectious coronavirus species (SARS) broke out in one of the Chinese provinces. Ten years later, cases of a new respiratory disease caused by MERS coronavirus were reported. Both SARS and MERS are classified as zoonotic viruses, which may cause infections in humans and animals. Bats are their natural reservoir hosts. These viruses had to cross the species border twice, i.e. first transmission from bats to other mammals (intermediate hosts), followed by transmission from these mammals to humans, to become pathogenic to humans. Human-to human transmission of SARS and MERS occurs through close contact (droplets, direct contact). High resistance to environmental factors and the ability to survive in an aerosol are important species-specific pathogenicityrelated features of coronaviruses. The aim of this paper was to present the characteristics of the new coronavirus known as 2019-nCoV, which emerged in the human population in 2019. We discussed the course of transmission and epidemic outbreak, the symptoms and immune response to infection as well as treatment options and prognosis.

Keywords: epidemic, pandemic, coronavirus, zoonosis, acute respiratory failure
Cardiac patients and COVID-19: what the general practitioner should know
Pediatr Med Rodz 2019, 15 (4), p. c6–c9
DOI: 10.15557/PiMR.2020.0002

The pandemic of COVID-19 (coronavirus disease 2019), a disease caused by the novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), presents medicine with previously unknown challenges. Primary healthcare facilities and general practitioners face a number of problems related to the current epidemiological situation. The gravity of the situation affects not only patients who are suspected of or diagnosed with COVID-19. New threats and organisational restrictions must also be taken into consideration when providing medical care to other patients, especially those with chronic diseases, requiring regular monitoring. Even though COVID-19 presents as a a mild respiratory disease in the majority of patients, it may pose a serious risk to health and life in the elderly population and individuals with underlying health concerns. The presence of previously diagnosed cardiovascular diseases is associated with an especially poor prognosis in patients with COVID-19. The aims of the paper are to present the cardiovascular symptomatology of COVID-19 and the potential effect of SARS-CoV-2 infection on the laboratory cardiac markers, discuss the impact of cardiac disorders on the course of COVID-19, and summarise the current expert statement on the controversies surrounding the treatment with angiotensin converting enzyme inhibitors and angiotensin receptor blockers during the COVID-19 pandemic. In addition, attention is drawn to the fact that cardiac patients can use telemedicine to get advice from specialists, so that continuity of care is ensured while adhering to the rules of epidemiological safety.

Keywords: 2019-nCoV, cardiovascular system, COVID-19, SARS-CoV-2, telemedicine, hypertension
The role of RAGE and its ligands, AGEs, in hypertension and cardiovascular diseases
Pediatr Med Rodz 2019, 15 (4), p. 353–357
DOI: 10.15557/PiMR.2019.0059

Dietary advanced glycation end products (AGEs) and their interactions with soluble receptors for advanced glycation end products (sRAGE) play an essential role in the pathogenesis of numerous diseases. RAGE belongs to the immunoglobulin superfamily of receptors that bind several classes of ligands, such as S100/calgranulin family, amyloid β peptides, leukocyte b2 integrin, transthyretin and AGEs. Their production and release cause further interaction with their cell-bound receptor (RAGE), resulting in generation of oxygen radicals, nuclear factor kappa-β, proinflammatory cytokines and cell adhesion molecules. The soluble isoform of receptors for advanced glycation end products acts against the adverse effects of AGE–RAGE interaction by competing with RAGE for binding with AGE. AGEs have been implicated in a number of pathological processes associated not only with micro- and macrovascular disease complications in diabetes, but also in hypertension, cardiovascular disease and atherosclerosis. Low levels of sRAGE have been proposed as biomarkers for many diseases. Evidence acquisition process was performed using PubMed and Medline databases with manually checked articles. A total of 44 articles presenting current knowledge on AGEs, sRAGE and endogenous secretory RAGE (esRAGE), with special focus on their role in the pathogenesis of coronary disease, were reviewed to understand the pathophysiological mechanisms of these receptors. In this review, we discuss structure and function of AGE–RAGE axis in the context of hypertension and cardiovascular diseases.

Keywords: advanced glycation end products, cardiovascular diseases, hypertension, AGE receptor, soluble AGE receptor
Alopecia areata
Pediatr Med Rodz 2019, 15 (4), p. 358–361
DOI: 10.15557/PiMR.2019.0060

Alopecia areata is a disorder with an estimated lifetime risk of 1 to 2%. The prevalence is the highest in the age group of 10 to 25 years. The exact aetiopathogenesis of alopecia areata is not precisely known, however, some factors that seem to play an important role in the development of the condition include autoimmune processes, stress or genetic vulnerability. Also, alopecia areata often coexists with depressive or anxiety disorders. The clinical presentation of alopecia areata includes sharply demarcated patches of hair loss, though the skin remains otherwise unaffected by any pathological changes. The severity of the condition varies greatly, and symptoms may range from isolated areas of hair loss on the scalp to total hair loss of the scalp – or even total loss of body hair. The most important differential diagnosis to consider in patients with suspected alopecia areata is androgenetic alopecia, i.e. the most common form of hair loss. The course of alopecia areata remains difficult to predict. In the majority of cases, the hair grows back spontaneously, but relapses are common. Treatment involves a variety of drugs, mainly immunomodulatory agents – either the types generating an allergic reaction or producing immunosuppressive effects. There are, however, no established treatment regimens for alopecia areata. It is worthwhile to note that antidepressants and non-pharmacologic interventions such as psychotherapy are also frequently used for treatment. Patients with alopecia areata often experience an impaired quality of life secondary to the disease. This fact, combined with the potential contribution of stress to the development of the condition, seems important from the viewpoint of considering psychological support in this group of patients.

Keywords: alopecia areata, autoimmune thyroid disease, hirsutism, glucocorticosteroids
Transthoracic lung ultrasound – the basics
Pediatr Med Rodz 2019, 15 (4), p. 362–365
DOI: 10.15557/PiMR.2019.0061

Transthoracic lung ultrasound has been conducted for over 40 years. Initially, it was mainly performed to evaluate pleural fluid, but, with time, studies confirmed its usefulness in the diagnosis of lung diseases. By contrast with X-ray, ultrasound does not expose patients to harmful ionising radiation, owing to which it can be repeated many times without hazards to the patient. Transthoracic lung ultrasound enables evaluation of the pulmonary pleura, the parietal pleura, the pleural space and the pulmonary tissue itself. This review presents the scanning technique and basic artefacts observed in a normal ultrasound scan. The examination can be performed with any ultrasound machine equipped with convex and linear-array probes. The basic image is referred to as a “bat sign,” i.e. the image made up by shadows of two neighbouring ribs and a hyperechoic line between them, which is the pleural line. Subsequently, the sliding sign, i.e. pleural movement, must be assessed as its absence may indicate pneumothorax. Moreover, one must search for artefacts present in normal images, such as horizontal lines parallel to the pleural line, called A-lines, and vertical lines that move according to the respiratory movements, called Z-lines, I-lines and B-lines. The knowledge of the basics of transthoracic lung ultrasound is useful in the search for pathology. Performing ultrasound examinations frequently increases one’s experience, which helps to interpret this relatively simple examination.

Keywords: transthoracic lung ultrasound, B-lines, bat sign
Modern standards for pharmacological treatment of insomnia
Pediatr Med Rodz 2019, 15 (4), p. 366–369
DOI: 10.15557/PiMR.2019.0062

In clinical practice, insomnia can be classified as temporary and chronic. They differ in duration. Chronic insomnia lasts over 3 months, with symptoms occurring at least 3 times a week. Insomnia treatment standards were defined e.g. by the American Academy of Sleep Medicine in 2017. There are two treatment approaches. First, non-pharmacological methods should be applied, which are the basis of treatment and guarantee its sustained effect. These methods include abiding hygiene of sleep rules, sleep period limits, stimuli control and cognitive therapy. The second form of treatment is pharmacotherapy. It is based on benzodiazepine receptor agonists, which have replaced previous benzodiazepines. They have less side effects and lower addictive potential. This group includes zolpidem, zaleplon and zopiclone. Dosing regimen mainly depends on the form of insomnia being treated: temporary or chronic. Accidental and temporary insomnia should be treated with hypnotics without delay. It is advised to have a pill near one’s bed and take it only when the patient waits too long to fall asleep after laying down or after an arousal. Such dosing scheme significantly reduces the risk of addiction and lowers the risk of transformation of insomnia into the chronic form. In chronic insomnia, when benzodiazepines are taken daily, 2 week period cannot be exceeded. Prolonged time is only allowed when using the drugs 2–3 times a week (or up to 10 times a month). Such pharmacotherapy guidelines are easier to tolerate, when the patient simultaneously complies with behavioural therapy. Besides that, a tricyclic antidepressant drug can also be used – doxepin. The list of inadvisable medications for the treatment of insomnia is composed of: trazodone, tiagabine, diphenhydramine, melatonin, tryptophan, valerian.

Keywords: insomnia, pharmacotherapy of insomnia, insomnia treatment
Andropause – facts and myths
Pediatr Med Rodz 2019, 15 (4), p. 370–373
DOI: 10.15557/PiMR.2019.0063

According to the Polish Menopause and Andropause Society, andropause is a period of the male aging process defined by gradually declining production of androgenic hormones (testosterone and dehydroepiandrosterone), growth hormones and melatonin. The drop in hormone production usually occurs in men over 50 years of age. The symptomatology of these disorders includes gradual deterioration in the quality of life, general well-being and professional performance, libido disorders, sexual dysfunction, intellectual impairment and sleep disturbances. The aim of this paper is to present the pathophysiology of andropause, taking into account the clinical and laboratory diagnostic work-up, available treatment modalities as well as myths about the andropausal period. Since the vast majority of men (several million in Poland) experience systemic changes related to andropause, the topic should be approached holistically, with a proper degree of empathy. A variety of therapeutic modalities are available, which should be employed according to defined principles and contraindications. Unfortunately, a large group of men believe that “this is how it is supposed to be at this age and nothing can be done about it – this is just biology.” This belief, however, is a myth and not a reality. It should be fought against, primarily by raising public awareness, applying prophylactic measures and ultimately through medical interventions.

Keywords: andropause, testosterone, diagnostics, treatment
Influence of sleep bruxism on primary headaches in children: a 2013–2018 literature review
Pediatr Med Rodz 2019, 15 (4), p. 374–377
DOI: 10.15557/PiMR.2019.0064

Introduction: Headaches are a common problem in children and adolescents and are the primary cause of school absence. Primary headaches are the most common type of headaches in children (migraine, tension-type headaches, neuralgia), which may be the consequence of bruxism, a parafunction consisting in teeth clenching during sleep and when awake. The aim of this review was to determine the link between bruxism episodes and primary headaches in children. Material and methods: The material for this review were studies found independently by two authors in the PubMed, ResearchGate and Google Scholar academic research databases. In order to identify suitable papers the search was conducted using the combination of the following keywords: “bruxism,” “children,” “headache” (according to Medical Subject Headings). Two studies were included in this review. Results: Children with diagnosed episodes of bruxism had a higher risk of primary headache. Sleep bruxism was more frequently diagnosed in children who had episodes of migraine. However, according to the assessment criteria adopted in this review, the results of the analysed studies were rated as “moderate value of evidence.” Conclusions: Considering the value of evidence and the size of study groups in the analysed research projects, a link between bruxism and primary headaches in children cannot be confirmed. Further research is necessary regarding the relationship between bruxism and primary headaches in children.

Keywords: bruxism, children, headaches
Prevention of early childhood caries – the role of paediatricians
Pediatr Med Rodz 2019, 15 (4), p. 378–386
DOI: 10.15557/PiMR.2019.0065

Early childhood caries is a serious health problem among Polish children. Dental caries is by definition a transmissive infectious disease leading to demineralisation and proteolytic breakdown of hard dental tissues. Its estimated incidence among 3-year-olds is 50% and has not changed for many years. Poor hygiene and diet as well as low parental knowledge of cariogenic factors and the consequences of untreated cries are the primary reasons for the spread of the disease. It has been indicated that paediatricians play an important role in raising social awareness in this regard. Early implementation of an individualised caries prevention plan for children may help eliminate the disease as well as improve both oral and general health at a later age. Home and professional caries prophylaxis may be distinguished. The main focus of home prophylaxis is proper oral hygiene and wellbalanced, varied diet free of cariogenic products. Professional prevention is based on procedures performed in a dental office. Diagnosis of early lesions, i.e. white spot lesions, is crucial as they may be reversed at this stage. Lack of treatment, on the other hand, leads to irreversible changes in the form of carious cavities, which require invasive treatment. In this paper, we discussed the causes of early childhood caries, its clinical picture and the key preventive recommendations based on our own observations and the available literature.

Keywords: early childhood caries, dental caries, caries prevention, fluoride prophylaxis
Analysis of nutritional status and diet in children with cow’s milk protein allergy on a milk elimination diet
Pediatr Med Rodz 2019, 15 (4), p. 387–392
DOI: 10.15557/PiMR.2019.0066

Aim: To analyse the somatic development and nutritional status of children with cow’s milk protein allergy on a milk elimination diet. Material and methods: The study enrolled 46 children aged 13–36 months with cow’s milk protein allergy diagnosis, following a milk elimination diet for 6 to 30 months. Exclusion criteria were chronic diseases. The control group included 30 healthy children of the same age. Somatic development was evaluated on the basis of anthropometric parameters, while nutritional status was based on Cole’s index. Nutrition was analysed on the basis of a 3-day food record using the Dieta 5 programme. Results: 10.87% of children with cow’s milk protein allergy and 16.67% of children in the control group were found to be underweight; 8.7% of children with cow’s milk protein allergy and 10% of children in the control group were identified as overweight, and 6.52% of children with cow’s milk protein allergy as obese. The evaluation of the examined children’s nutritional status based on body mass index indicated that there were 13% of malnourished children in the study group and 20% in the control group. An analysis of the examined children’s diets proved an excessive intake of protein, carbohydrates, sodium, phosphorus, magnesium, vitamins A and C in both of the groups, and vitamins D and E in the study group. The intake of fats, iron, vitamins C, E, D and fibre was higher in the study group than in the control group. Conclusions: The somatic development and nutritional status in the study group of children aged up to 3 years with cow’s milk protein allergy on an elimination diet did not significantly differ from the respective parameters obtained in the control group of children. A thorough evaluation of the nutritional status and nutrition should be carried out in the course of check-ups in all children.

Keywords: nutritional status, cow’s milk protein allergy, elimination diet, nutrition
Effect of regular training on lung function in adolescents
Pediatr Med Rodz 2019, 15 (4), p. 393–397
DOI: 10.15557/PiMR.2019.0067

The respiratory system of people who actively and regularly practise sport undergoes systematic changes. The development of the respiratory tract and consequently the tidal volumes depend on the type, intensity, severity, duration and frequency of physical effort. Research indicates that tidal volumes achieved by people who regularly practise sport are higher than in those who have less active lifestyles. The assessment of respiratory system functioning is possible by spirometry, which can help in establishing a correct diagnosis and in monitoring the respiratory system in both healthy people and in patients with chronic diseases. The aim of the study was to evaluate selected parameters of lung function in adolescents who actively practise sport and compare them with the general population. The study involved 180 adolescents, aged 12–17 years. These were 90 boys who actively practised sport in a sports school and 90 boys from a state school who did not train regularly. Sports school students played soccer every day. Spirometry was performed in all the boys who were enrolled in the study. The students who actively played soccer presented significantly higher values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and maximal expiratory flow (MEF25). Moreover, a positive correlation was found between the body mass index (BMI) and FEV1, FVC, PEF and MEF25 in the boys who regularly practised sport; in children who did not train regularly, a similar correlation was found only between BMI and FVC. The results indicate that regular training has a positive effect on spirometry parameters in adolescents.

Keywords: lung function, BMI, sport, adolescents
Analysis of selected malignant tumours in Bielsko-Biala in the year 2015
Pediatr Med Rodz 2019, 15 (4), p. 398–402
DOI: 10.15557/PiMR.2019.0068

Introduction: In 2015, 163,281 new cases of malignant tumours were registered in Poland, with 81,649 cases in men and 81,632 cases in women. In the province of Silesia, there were 19,180 new cases: 9,567 in men and 9,613 in women (absolute numbers). In the Beskid Oncology Centre – John Paul II Municipal Hospital, there were 430 cases of malignant tumours in men and 403 in women. Aim of the study: This study presents the incidence of selected malignant neoplasms among the residents of the city of Bielsko-Biala, who were hospitalised in the above mentioned hospital in 2015. Material and methods: Statistical data in the form of the annual report for 2015 were received from the Beskid Oncology Centre – John Paul II Municipal Hospital in Bielsko-Biala, Poland. The statistical analysis concerned breast cancer, testicular cancer and prostate cancer. Results and discussion: In the Beskid Oncology Centre – John Paul II Municipal Hospital in Bielsko-Biala, there were 7 cases of malignant testicular cancer and 80 cases of prostate gland carcinoma in 2015. In women, there were 90 malignant breast cancer cases, and it was the most frequent cancer in the discussed hospital. The vast majority of the reported cancers of various types occurred in the group of people, both men and women, over 60 years of age. Conclusions: Cancer is a serious health problem in both Poland and worldwide. In Poland, cancer is the second cause of death in general and the first cause of death among patients at the age below 65 years. The analysis of the data showed that, in the city of Bielsko-Biala, cancers of the breast and prostate gland belong to the group of the most common malignant tumours.

Keywords: epidemiology of cancer, neoplasm, prostate cancer
Hypercalciuria caused by CYP24A1 mutation as the cause of recurrent urinary tract infections – a case report
Pediatr Med Rodz 2019, 15 (4), p. 403–406
DOI: 10.15557/PiMR.2019.0069

Idiopathic hypercalciuria is the most common metabolic disorder leading to urolithiasis. The following factors are involved in its pathogenesis: environmental and dietary factors, kidney defects leading to excess loss of calcium in urine, conditions characterised by increased bone calcium resorption, and genetic mutations impairing vitamin D metabolism. The severity of hypercalciuria may vary, from vitamin D intoxication, through nephrocalcinosis, urolithiasis, hypercalciuria, to milder forms, which occur during vitamin D supplementation. Hypercalciuria may produce non-specific symptoms, such as erythrocyturia, haematuria, sterile leukocyturia, and urinary tract infections. We present a case of a 10-year-old girl with recurrent urinary tract infections. Following the exclusion of urinary tract defect and urinary bladder dysfunction, the patient was diagnosed with renal hypercalciuria. Genetic testing confirmed CYP24A1 mutation. Treatment with thiazides resulted in calciuria normalisation and resolution of recurrent urinary tract infections. Conclusions: Genetic hypercalciuria should be suspected in patients with recurrent urinary tract infections.

Keywords: CYP24A1 mutations, hypercalciuria, urinary tract infections
Vesicular rash in a 5-year-old boy with dyspnoea
Pediatr Med Rodz 2019, 15 (4), p. 407–411
DOI: 10.15557/PiMR.2019.0070

Mucocutaneous complications, including erythema multiforme, Stevens–Johnson syndrome or toxic epidermal necrolysis, may develop in up to one third of patients infected with Mycoplasma pneumoniae. This paper reports the case of a 5-year-old boy presenting with atypically severe pneumonia caused by M. pneumoniae. Cutaneous and mucosal manifestations associated with the condition were helpful in the establishment of correct diagnosis. Target (bull’s-eye) lesions with possible bullae formation, as well as prominent mucosal lesions in a child accompanying features of respiratory tract infection should raise the suspicion of atypical infection.

Keywords: community-acquired pneumonia (CAP), respiratory tract infections, atypical respiratory pathogen, vasculitis, mucositis, diagnosis
Moderately-differentiated neuroendocrine carcinoma of the larynx: a case report and literature review
Pediatr Med Rodz 2019, 15 (4), p. 412–415
DOI: 10.15557/PiMR.2019.0071

Laryngeal neuroendocrine carcinoma is a rare tumour of the larynx, accounting for only about 1% of all primary laryngeal tumours. Laryngeal neuroendocrine carcinomas are classified as well-, moderate- and poorly-differentiated neuroendocrine carcinoma. The differentiating features of each category include nuclear atypia, mitotic rate and presence or absence of necrosis. Immunochemistry stains also help in diagnosing laryngeal neuroendocrine carcinoma. In this article, we present a case report of moderately-differentiated neuroendocrine carcinoma of the larynx in a 57-year-old man who presented with neck pain and dysphagia persisting for one month. There is no standard treatment regimen for laryngeal neuroendocrine carcinoma. However, due to the poor prognosis for moderately-differentiated laryngeal neuroendocrine carcinomas, we advocate aggressive and prompt treatment and surveillance PET-CT scan 6 months postoperatively.

Keywords: immunohistochemistry (IHC), larynx, neuroendocrine carcinoma (NEC), laryngectomy
Migratory foreign body in the neck
Pediatr Med Rodz 2019, 15 (4), p. 416–418
DOI: 10.15557/PiMR.2019.0072

Ingestion of foreign body is a very common reason for referral in otolaryngology practice. In most cases, it is removed in the clinic setting or under general anaesthesia. However, migratory foreign body in the throat is rare and can cause serious complications depending on the route of migration. We present a case of a migratory fish bone, which was found embedded in the right scalene muscle and was successfully removed through an external approach. The aim of this case report is to highlight the importance of a thorough history and physical examination in a patient with a foreign body in the throat, especially if the patient is still symptomatic and laryngo-oesophagoscopy findings are unremarkable. Imaging is vital to aid in the diagnosis and precisely locating the migrated foreign body eventually to avoid fatal complications.

Keywords: migratory foreign body, neck, fish bone
Clinical heterogeneity of an autoimmune disease: a case of concomitant autoimmune anaemia, autoimmune hepatitis and autoimmune bone marrow aplasia
Pediatr Med Rodz 2019, 15 (4), p. 419–423
DOI: 10.15557/PiMR.2019.0073

In autoimmune diseases, the host’s immune system produces antibodies against antigens naturally occurring in its body. The immune response can be triggered by both own and foreign antigens. An important role in controlling an autoimmune process is played by genetic and environmental factors, including infections which may cause autoantibody production. The pathogenesis of autoimmune haemolytic anaemia, autoimmune hepatitis and aplastic anaemia involves autoaggressive processes. The case described in the present paper involves the coexistence of those three diseases in one patient. It is worth noting that they occur one after the other: once one of them goes into remission, another one starts manifesting itself. This study aims to draw attention to the possibility of coexistence of different autoaggressive diseases, the presence of significant correlations between them and the need to maintain vigilance with respect to patients in remission of an autoimmune disease.

Keywords: autoimmune haemolytic anaemia (AIHA), autoimmune hepatitis (AIH), aplastic anaemia (AA)
Peculiar presentation of extraparotid Warthin’s tumour
Pediatr Med Rodz 2019, 15 (4), p. 424–426
DOI: 10.15557/PiMR.2019.0074

Aim of the study: To emphasize the importance of meticulous history and examination as well as the awareness of various possibilities of diagnosis and management. Case study: Warthin’s tumour is a benign tumour which mostly arises from the parotid gland and rarely involves minor salivary glands. Extraparotid or ectopic Warthin’s tumour most commonly involves the submandibular gland. We report a rare case of nasopharyngeal Warthin’s tumour with an unusual presentation. A 59-year-old man presented with left submandibular swelling with right-sided nasopharyngeal fullness. Biopsy of the nasopharyngeal mass along with imaging was suggestive of Warthin’s tumour. Conclusion: We would like to highlight the challenge in diagnosing this entity and discuss its management.

Keywords: Warthin’s tumour, salivary gland tumours, nasopharynx
Chronic perianal lesions in a normally developing 17-year-old boy
Pediatr Med Rodz 2019, 15 (4), p. 427–429
DOI: 10.15557/PiMR.2019.0075

We present a case of a 17-year-old so far healthy and normally developing boy, who was admitted to our Department due to perianal fistulas persisting for three years. Previous diagnostic procedures, including colonoscopy, failed to provide the diagnosis. No improvement was observed after repeated surgical interventions and oral antibiotic therapy. A suspicion of Crohn’s disease was raised. Full diagnosis was performed: gastroscopy and colonoscopy with biopsy, magnetic resonance enterography, and pelvic magnetic resonance. Crohn’s disease was diagnosed based on the overall clinical picture and laboratory findings. The aim of this paper was to emphasise the importance of early targeted diagnosis to avoid diagnostic delay and thus reduce the risk of complications. A general practitioner, who provides primary care and refers his patients for additional tests and consultations, plays a very important role in this process. Therefore, by describing the case of this young patient, we aimed to draw attention to some typical symptoms that may be the very first manifestations of chronic inflammatory bowel disease. The chronic or recurrent perianal lesions in an otherwise normally developing adolescent showing no other gastrointestinal symptoms should be a motivation for performing full diagnosis for Crohn’s disease.

Keywords: Crohn’s disease, children, perianal lesions
Splenic abscess in a child as a cause of fever of unknown origin
Pediatr Med Rodz 2019, 15 (4), p. 430–433
DOI: 10.15557/PiMR.2019.0076

Splenic abscess is a rare condition, with peak incidence in the third and sixth decade of life. It is significantly less common in children than in adults. The main causes of abscess include multiorgan infections, immune deficiency, and trauma. Coexisting diabetes, infective endocarditis and immune deficiency are adverse prognostic factors. Aetiological factors of splenic abscess include aerobic and anaerobic bacteria and fungi. The symptoms of splenic abscess are non-specific and include abdominal pain in the upper-left-quadrant, fever, splenomegaly, and increased inflammatory markers. The diagnosis is confirmed by abdominal sonographic and computed tomography findings. Conservative (antibiotic therapy) and surgical (drainage and splenectomy) treatment is used. Splenic abscess is an exceptionally dangerous condition in which early, correct diagnosis and treatment can reduce mortality from several dozen to less than 10%. The presented case illustrates the course of disease in a 6-year-old boy, emphasising the need to include splenic abscess in the differential diagnosis of fever of unknown origin.

Keywords: paediatrics, splenic diseases, abscess, fever of unknown origin, inflammatory markers
A rare cause of recurrent massive post-tonsillectomy bleed: facial artery pseudoaneurysm
Pediatr Med Rodz 2019, 15 (4), p. 434–436
DOI: 10.15557/PiMR.2019.0077

Post-tonsillectomy haemorrhage is a potentially serious and sometimes fatal complication. It is commonly caused by infection or premature separation of membrane granulation tissue. Conventional haemostatic measures, such as ice water gargles, electrocautery or surgical ligation, usually will control the bleeding. We report a case of a delayed recurrent massive post-tonsillectomy bleeding resistant to usual measures, which required external carotid ligation. Computed tomography angiogram performed later revealed a pseudoaneurysm of the facial artery, which was successfully controlled with endovascular embolisation of the left facial artery.

Keywords: recurrent post-tonsillectomy bleeding, pseudoaneurysm, facial artery
Model of a good paediatrician in judgements of medical courts
Pediatr Med Rodz 2019, 15 (4), p. 437–442
DOI: 10.15557/PiMR.2019.0078

The paper presents the responsibilities of paediatricians with regard to the diagnosis and treatment they should provide in compliance with the principle of due diligence. This principle – fundamental for the medical profession – stems not only from the regulations of law but also from deontological standards. For this reason, in addition to criminal and civil liability, physicians also bear professional liability, which is addressed in this paper. In the Polish legal doctrine, the professional liability of physicians is often considered to be quasi-criminal, adapted to the needs of specific institutions. Consequently, it is included in the framework of criminal law in the broad sense. Nevertheless, proceedings concerning the professional liability of physicians are held independently of criminal or other disciplinary proceedings pertaining to the same act. This paper addresses aspects related to the operation of medical courts. The issue is particularly important in view of the fact that judges sitting in medical courts of the first and second instance independently decide on factual and legal issues. With respect to the adjudication process, members of medical courts are subject to the provisions of the generally applicable law. A key element in court proceedings is the testimony of expert medical witnesses. Medical experts called by the court as expert medical witnesses show the medical context of a legal dispute based on their theoretical knowledge and practical expertise. The paper highlights the form and the elements that should be included in the expert opinion. Crucially, the preparation of expert opinions requires access to appropriate materials related to the case. Expert medical witnesses serving as court-appointed experts in disciplinary cases acquire such materials based on their personal examination of the injured party and comprehensive review of available documentation – or solely on the basis of medical records. The paper presents examples of such expert opinions.

Keywords: paediatrician, medical court, due diligence