2020, Vol 16, No 1
Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim guidance
Pediatr Med Rodz 2020, 16 (1), p. 9–26
DOI: 10.15557/PiMR.2020.0003
Operational considerations for case management of COVID-19 in health facility and community. Interim guidance
Pediatr Med Rodz 2020, 16 (1), p. 27–32
DOI: 10.15557/PiMR.2020.0004
Contact tracing in the context of COVID-19. Interim guidance
Pediatr Med Rodz 2020, 16 (1), p. 33–39
DOI: 10.15557/PiMR.2020.0005
Surveillance strategies for COVID-19 human infection. Interim guidance
Pediatr Med Rodz 2020, 16 (1), p. 40–44
DOI: 10.15557/PiMR.2020.0006
Sudden cardiac arrest in children in the general practitioner’s practice
Pediatr Med Rodz 2020, 16 (1), p. 45–48
DOI: 10.15557/PiMR.2020.0007

Sudden cardiac arrest in children is a very rare occurrence in the general practitioner’s office. There is no doubt that prompt initiation of cardiopulmonary resuscitation and good quality of cardiopulmonary resuscitation provided by healthcare professionals are crucial for increasing the chance of survival. Consequently, it is vital for primary care physicians and other staff working in primary care to be able to recognise sudden cardiac arrest. The legal system in Poland neither imposes an obligation on physicians to take Basic Life Support (BLS) training, nor does it specify how often medical professionals should refresh their skills. Certificates confirming the completion of European Resuscitation Council (ERC) courses in BLS are valid for 3 years. After that time, the course must be repeated, which increases the frequency of staff training in this field. It is also important to note that guidelines for the management of sudden cardiac arrest are updated by the European Resuscitation Council every 5 years. In the event of loss of consciousness, and impairment or complete absence of breathing occurring in a patient in the general practitioner’s office, cardiac arrest should be suspected, and cardiopulmonary resuscitation should be initiated as soon as possible. Checking for a pulse is not currently recommended, and should be avoided both by medically untrained and professionally qualified medical staff. Since palpation of a pulse is not reliable as a determinant of the need for cardiopulmonary resuscitation, the decision to initiate resuscitation should be made based on the patient’s complete picture. The paper presents the methodology of administering cardiopulmonary resuscitation to children over 1 year of age, and illustrates it with suitable photographs.

Keywords: cardiopulmonary resuscitation, sudden cardiac arrest, child
Side effects of gadolinium MRI contrast agents
Pediatr Med Rodz 2020, 16 (1), p. 49–52
DOI: 10.15557/PiMR.2020.0008

Magnetic resonance imaging is widely used as a diagnostic tool in the clinic. Magnetic resonance imaging contrast agents such as gadolinium are very often used to improve the quality of images acquired by magnetic resonance imaging. Until recently, it was believed that gadolinium is effectively cleared within 24 hours after intravenous injection, and that it does not have any harmful effects on the human body. However, recent studies on animals and analyses of clinical data have indicated that gadolinium is retained in the body for many years post-administration, and may cause various diseases. This is especially concerning for paediatric patients because of the anticipated longer time of exposure and its effects on children’s continuing development, and patients who receive repeated magnetic resonance imaging scans and hence repeated doses of gadolinium. Here, we give a short review of the most recent findings on the accumulation and side effects of gadolinium.

Keywords: gadolinium, MRI, contrast, paediatric patients
SIBO – what the general practitioner should know
Pediatr Med Rodz 2020, 16 (1), p. 53–56
DOI: 10.15557/PiMR.2020.0009

Healthy gut microbiota performs many important functions and is necessary for maintaining the body in a state of metabolic equilibrium. Unfavourable conditions may lead to the development of small intestinal bacterial overgrowth (SIBO), a condition defined as an excessive bacterial colonisation of the small intestine. The prevalence of SIBO in the general population is still unknown. Some risk factors which have been implicated in the pathogenesis of SIBO include disorders of gastrointestinal motility, history of intestinal resection, chronic comorbidities, and elderly age. SIBO may present with a range of non-specific symptoms, the most common of which are bloating and abdominal distension, nausea, abdominal pain, bowel movement disorders, lack of appetite or unintentional weight loss. SIBO is diagnosed by invasive tests and the increasingly popular non-invasive breath tests. Supplementary diagnostic examinations include microscopic evaluation of stool for the presence of fat, complete blood count, and measurement of vitamin B12 or albumin levels. First-line treatment is based on eubiotics, one of which is rifaximin-α. The drug is characterised by a broad spectrum of activity against a variety of Gram-negative and Grampositive bacteria, both aerobic and anaerobic. A major component of SIBO therapy is appropriate diet combined with lifestyle modifications (regular physical activity, avoidance of stress, and restoration of normal sleep pattern). In rare cases, for example in patients with anatomical anomalies, surgical management should be considered. The paper presents basic information about SIBO, which is useful in the everyday practice of primary care physicians.

Keywords: SIBO, bacterial overgrowth, gut microbiota, rifaximin-α
Role of the microbiome and probiotics in the prevention of allergic diseases
Pediatr Med Rodz 2020, 16 (1), p. 57–61
DOI: 10.15557/PiMR.2020.0010

Microbes are present in many places in our body (the intestines, skin, reproductive organs), but the majority of them, which play the most important role, are those which reside in the gastrointestinal tract. It is known that the digestive tract of a foetus is sterile; however, after birth, the number of microorganisms in the neonate’s intestines grows rapidly. The colonisation of the gastrointestinal tract by bacteria is of fundamental importance to one’s future life. Particular attention is paid to the so-called health programming. It is believed that during the first 1,000 days of a child’s life (including foetal life, infancy and early childhood), it is possible to programme human metabolism through appropriate nutrition. Adequate nutrition during pregnancy, lactation and the first few years of a child’s life not only ensures appropriate weight gain and optimal nutritional status, but is also part of long-term health programming. Presumably, health programming also plays a role in the development of allergic diseases. Recent evidence indicates that the risk of atopy may be associated with intestinal dysbiosis; as a result, there has been a growing interest in the role of probiotics in the prevention of allergic diseases. The best documented practice is the preventative administration of probiotics to pregnant and nursing women, and to children in their first 6 months of life in order to reduce the rate of atopic dermatitis. Certain data also point to the role of probiotics in the acquisition of food tolerance. In addition, it is important that the probiotic administered be effective, since not every formulation present on the market guarantees the desired effect. The bacterial strains must be examined for their genome, catalogued in banks and marked with an appropriate identification number. It is only from such catalogued and well-studied strains that colonies for the most effective formulations can be grown. It is not quantity, but quality of the bacteria that ensures their effectiveness.

Keywords: microbiome, probiotics, allergic diseases, children
A review of practical issues related to the diseases of the nail unit useful for doctors (including non-dermatologists)
Pediatr Med Rodz 2020, 16 (1), p. 62–69
DOI: 10.15557/PiMR.2020.0011

The human nail unit is a highly specialised, keratinised structure belonging to the group of skin appendages. It performs many important functions necessary to maintain homeostasis, such as protection of the distal phalanx against damages or stabilisation of the fingertips. Human nail unit is formed by the nail plate and the proximal nail fold, lateral nail folds, nail matrix, nail bed and hyponychium. Human nail unit diseases are often diagnosed with delay, mainly due to anatomical conditions, but also due to understating the problem not only by the patients themselves, but also by doctors. Changes within the human nail unit are a frequent component of many dermatoses or separate disease entities. The main disturbances associated with pathologies within the nail matrix include the Beau lines (transverse pits indicating temporary disruption of the nail plate growth), onychomadesis (nail shedding), onychorrhexis, nail pitting, koilonychia (spoon nails) or trachonychia (sandpapered nails). The group of diseases associated with disorders of the nail bed includes onycholysis (loss of communication between the nail plate and the nail bed), subungual hyperkeratosis, apparent leukonychia (associated with the swelling of the nail bed) and subungual petechiae. The article also presents selected nail diseases associated with the deposition of dye (including melanonychia), some congenital disorders of the nail unit (such as, for example, malalignment of the great toenail or nail-patella syndrome) and selected manifestations of systemic diseases within the human nail unit. Getting familiar with the correct onychological nomenclature and presented issues will certainly facilitate establishing a dialogue between specialists in skin diseases and general practitioners.

Keywords: human nail unit, nail matrix diseases, disorders within the nail bed, congenital nail disorders
Epidemiology and the consequences of fear of missing out (FOMO). The role of general practitioners in early diagnosis, treatment and prevention of FOMO in teenagers and young adults
Pediatr Med Rodz 2020, 16 (1), p. 70–76
DOI: 10.15557/PiMR.2020.0012

Published reports, mainly concerning education and psychology, imply that FOMO may be a consequence of excessive and incorrect use of the Internet, social media and mobile devices. FOMO may be explained as a fear of missing out on important information. It disappears when people with FOMO check notifications on their telephone or sit down at a computer, and this leads to the development of a vicious circle. FOMO may lead to the development of e-addictions. A survey study conducted in a group of 1,060 randomly selected Poles aged 15 and older showed that one in five Internet users from the younger group of subjects had a high FOMO index. One fifth of respondents with FOMO suffer from somatic symptoms: nausea, dizziness, abdominal pain or increased sweating, when not using social media. The results of these studies prove that the FOMO problem is clearly noticeable among digital media users. Further studies on the incidence of FOMO are needed, particularly in the case of teenagers and young adults, to evaluate the health consequences of FOMO. Prevention of FOMO and the associated e-addictions should be implemented not only at schools, for example, as a part of the school syllabus, but also in the form of therapeutic treatments offered to people using digital tools in a risky way. General practitioners can be an important link in the chain of FOMO prevention, diagnosis, and treatment. The advantageous solutions may include, for example, the implementation of a pilot programme for the prevention of FOMO and e-addictions addressed to teenagers, that will be financed from the National Health Fund resources and included in general practitioners’ practices.

Keywords: FOMO, addiction, prevention, teenagers
Epidemiology and clinical course of acute gastroenteritis in the Department of Paediatrics, Paediatric Nephrology and Allergology in 2018
Pediatr Med Rodz 2020, 16 (1), p. 77–82
DOI: 10.15557/PiMR.2020.0013

Introduction: Rotavirus infection is the most common cause of acute diarrhoea in all European countries. In contrast, norovirus aetiology is becoming more common in countries where rotavirus vaccination has become a standard practice. Aim: The aim of the paper was to assess the aetiology and the clinical course of acute gastroenteritis in children hospitalised in the Department of Paediatrics, Paediatric Nephrology and Allergology of the Military Institute of Medicine. Materials and methods: Medical records of children hospitalised in the Department of Paediatrics, Paediatric Nephrology and Allergology of the Military Institute of Medicine in Warsaw between January and December 2018 due to gastroenteritis were analysed retrospectively. The study group included children diagnosed with acute gastroenteritis who had microbiological stool analysis performed. Results: Gastroenteritis of unknown aetiology was diagnosed in 93/155 children, rotaviral aetiology in 37, adenoviral aetiology in 7, and noroviral aetiology in 5 children. Stool culture was positive for Salmonella spp. in 5 children. Furthermore, mixed aetiology was found in 8 children (rotavirus/adenovirus in 5, and rotavirus/norovirus in 3 children). Rotaviruses were the most common aetiology of gastroenteritis among children aged ≤2 years. Vomiting and diarrhoea were the only symptoms in 48 and 40 children, respectively. The symptoms co-occurred in 67 children. Increased C-reactive protein (CRP) was found in patients with adenoviral aetiology and Salmonella spp. infection. We observed statistically more common low CRP levels and increased aminotransferase levels in patient with rotavirus infection. Conclusions: Rotaviruses were the most common aetiology of acute gastroenteritis in the study group. The clinical picture of rotavirus infection is dominated by vomiting and diarrhoea, which are relatively often accompanied by transient hypertransaminasemia.

Keywords: acute gastroenteritis, children, rotavirus, adenovirus, norovirus, hypertransaminasemia
Serum levels of zinc in children with recurrent infections from Lodz Province
Pediatr Med Rodz 2020, 16 (1), p. 83–86
DOI: 10.15557/PiMR.2020.0014

Infections, especially those of the respiratory system, are very common in children from areas with high air pollution, and the incidence of infections is even greater in the case of immature immune system. Zinc plays an important role in the regulation of innate and acquired immune response. This element is involved in the production of proteins, wound healing, DNA synthesis and cell division, and is essential in the development and activation of T cells. Zinc deficiency disrupts phagocytosis, intracellular killing and cytokine production by macrophages. The aim of the study was to assess serum zinc levels in children with recurrent respiratory infections from the Łódź region, diagnosed at the Department of Paediatrics and Allergy in Korczak Paediatric Centre. Materials and methods: The study included 60 children with recurrent infections (≥6 respiratory infections over 6 months) and 60 healthy children aged 1–18 years. Flame spectrometry was used to measure serum zinc levels in all patients. Results: Nearly 40% of children with recurrent infections had low serum zinc levels (<70 μg/dL). There were no statistically significant differences in zinc levels depending on sex. Multivariate analysis showed significant differences in serum zinc levels between the control group and the group with recurrent respiratory infections (p = 0.044). Conclusions: The obtained results indicate that zinc deficiency is frequent in children with recurrent respiratory infections from the region of Łódź.

Keywords: zinc, children, infection
Transthoracic lung ultrasound in children with signs of acute lower respiratory infection
Pediatr Med Rodz 2020, 16 (1), p. 87–92
DOI: 10.15557/PiMR.2020.0015

Pneumonia, which may be accompanied by the full spectrum of various clinical symptoms, with the most common including fever, chills, cough, chest pain, dyspnoea, tachypnoea, hypoxia, and auscultatory changes (crepitations, rales), is one of the most common lower respiratory infections. Chest radiography is a standard method used to confirm pneumonia. Transthoracic lung ultrasound has recently emerged as an alternative to radiology. The aim of this paper was to assess the utility of transthoracic lung ultrasound as an alternative to chest radiography in children with clinical manifestations of acute lower respiratory infection. A total of 63 patients aged between 1 month and 18 years, hospitalised in the Department of Paediatrics, Paediatric Nephrology and Allergology were qualified for the study. The study group included 44 children (mean age 4.3 ± 4.4 years), and the control group included 19 children (mean age 6.5 ± 3.8 years). Cough (42/44, 95%), dyspnoea (31/44, 70%), and fever (28/44, 64%) were the most common clinical symptoms in the study group. Auscultatory manifestations typical of pneumonia, i.e. crepitations, rales, reduced vesicular murmur, were observed in 30/44 (68%) patients; uncertain clinical symptoms of lower respiratory infection were observed in 14/44 (32%) patients. Lung ultrasound was performed within 48 hours of chest radiology. Both ultrasonographic and radiological lesions typical of pneumonia were found in 25/30 children presenting with clinical symptoms of pneumonia; no lesions in either of the modalities used were detected in 1/30 patients. Both ultrasonographic and radiological lesions typical of pneumonia were identified in 8/14 children with clinically uncertain pneumonia; no lesions were detected in diagnostic imaging in 1/14 children. Conclusions: Lung ultrasound is a useful tool for the assessment of lower respiratory inflammation in children. Ultrasonographic findings are comparable with those in radiology, which is considered a standard modality.

Keywords: lung ultrasound, paediatrics, pneumonia
Measles virus infection as an element of differential diagnosis with other viral diseases – case reports
Pediatr Med Rodz 2020, 16 (1), p. 93–99
DOI: 10.15557/PiMR.2020.0016

Introduction: Measles is an infectious disease caused by an RNA virus of the genus Morbillivirus of the Paramyxoviridae family. It is most common in children up to the age of 15 years; however, the disease can occur at any age. The virus is transmitted through respiratory droplets. Measles presents with macular or maculopapular rash. It first appears on the head, and then spreads to the trunk and the limbs (descending nature). The rash fades in the same order it appeared, leaving skin discolourations. Measles complications occur in about 20–30% of patients, with most of them reported in children ≤5 years of age and adults >20 years of age. Diagnosis is based on the clinical picture confirmed by serology. According to the guidelines of the World Health Organization, each suspected case should be confirmed with laboratory testing (serological or molecular diagnosis). Active immunisation is the only effective method for preventing the spread of the measles virus. In Poland, measles vaccination is one of the free mandatory vaccinations. Complete clearance of the virus is seen in the majority of immunocompetent patients. There is no specific antiviral treatment for measles. Supportive care in the form of maintaining hydration and antipyretics is used. Antimicrobial treatment should be implemented only in the case of complications. Aim: The aim of this paper is to present cases of children who developed a macular rash suggestive of measles during respiratory infection. Conclusions: Measles is an infectious disease associated with high complication rates, especially in the youngest children. Detailed differential diagnosis is needed due to its similar clinical picture to those seen in other viral rash diseases.

Keywords: measles, MMR vaccine, infectious mononucleosis, macular rash, vitamin A
Periodic fever in everyday paediatric practice – case report of 6-year-old girl and a literature review
Pediatr Med Rodz 2020, 16 (1), p. 100–103
DOI: 10.15557/PiMR.2020.0017

PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, cervical adenopathy) is the most common periodic fever syndrome occurring in children. Exacerbation period is characterised by episodes of high fever with pharyngitis, cervical lymphadenopathy and increased inflammatory markers. It is believed that the PFAPA syndrome does not increase sepsis markers. In the paper, we present a clinical case of a 6-year-old girl who was presented with recurrent fever episodes. After exclusion of other causes, PFAPA syndrome was diagnosed. Recurrences of fever were accompanied by an elevated level of procalcitonin and C-reactive protein. Corticosteroid treatment caused a permanent remission of the disease symptoms. Discussion is focused on increased inflammatory markers and the differentiation of the syndrome with generalised bacterial processes. Widening the knowledge of the syndrome among general practitioners and paediatrics is crucial for early diagnosis and implementation of proper treatment.

Keywords: fever, autoinflammation, procalcitonin, children
A 16-year-old boy with severe lumbar pain
Pediatr Med Rodz 2020, 16 (1), p. 104–106
DOI: 10.15557/PiMR.2020.0018

A 16-year-old boy presented with acute lumbar pain and headache, and was hospitalised at a paediatric hospital. The symptoms appeared three days before his admission, the lumbar pain was strong and movement exacerbated it. On admission the patient had nuchal rigidity, bilaterally positive Kernig’s sign and pain of the L4–S1 spinous processes. Blood tests revealed leukocytosis and positive IgM and negative IgG antibodies against Borrelia spp. Cerebrospinal fluid was xanthochromic with a high cell count. Culture of cerebrospinal fluid was negative. Magnetic resonance imaging of the lumbar spine revealed an oval tumour at the level of the L3 vertebra. The tumour was excised completely. Histopathological examination revealed myxopapillary ependymoma of the filum terminale. Conclusion: A sudden and unexplained pain of the lumbar spine appearing in children is an indication for in-depth diagnostic investigation, involving in particular magnetic resonance imaging, which allows one to visualise many pathologies, including spinal canal tumours.

Keywords: laminectomy, spinal tumour, neuroborreliosis, radiotherapy, paediatric neuro-oncology
Rare manifestation of Pott’s spine
Pediatr Med Rodz 2020, 16 (1), p. 107–109
DOI: 10.15557/PiMR.2020.0019

Retropharyngeal abscess with cervical spine tuberculosis is a rare presentation of extra-pulmonary tuberculosis, which can lead to severe life-threatening complications. We report a case of a young man who presented with odynophagia and neck pain. Intraoral examination revealed cystic mass over the posterior pharyngeal wall, which turned out to be a retropharyngeal abscess secondary to tuberculosis of spine. The patient recovered with anti-tubercular treatment. We would like to highlight the diagnostic challenge faced and the management of this entity.

Keywords: retropharyngeal abscess, Pott’s spine, tuberculous retropharyngeal abscess
A rare case of cervical schwannoma: a never-ending conundrum
Pediatr Med Rodz 2020, 16 (1), p. 110–112
DOI: 10.15557/PiMR.2020.0020

Aim of the study: To emphasise the importance of meticulous history-taking and examination, and to raise the awareness of various possibilities in patient diagnosis and management. Schwannoma is a rare benign, slow-growing tumour of the nerve sheath originating from Schwann cells. Non-specific presentation of this type of mass remains a quandary mainly to the consulting physicians. At present, surgery is the main modality of treatment for this disease entity. However, surgical resection of extracranial schwannoma is often associated with major morbidity. Case report: We discuss a case of cervical schwannoma in a young man, presenting as a lateral neck mass initially thought to be a sebaceous cyst. Surprisingly, however, histopathological examination of the excised mass revealed it to be a schwannoma. Conclusion: We want to highlight the need for clinical suspicion among attending physicians in all cases involving a lateral neck mass.

Keywords: schwannoma, neurilemmoma, Schwann cells, nerve sheath tumours
Congenital nasal pyriform aperture stenosis: a rare condition treated successfully by expectant management
Pediatr Med Rodz 2020, 16 (1), p. 113–117
DOI: 10.15557/PiMR.2020.0021

Aim: Our aim is to highlight the successful treatment of congenital nasal pyriform aperture stenosis by expectant management and the importance to understand other disorders that may occur alongside it. Discussion: Congenital nasal pyriform aperture stenosis may occur in isolation, or as a part of the holoprosencephaly spectrum. This case report demonstrates the role of diagnostic imaging to confirm its diagnosis and to look for other concurrently occurring pathologies. Case history: We report a newborn developing respiratory embarrassment shortly after birth, requiring intubation to sustain breathing. A diagnosis of congenital nasal pyriform aperture stenosis was clinched as evidenced by the radioimaging features. The patient also had a solitary median maxillary central incisor. Conclusion: Expectant management has proved to be beneficial as exemplified in this case report. Although this rare disease may present as an isolated entity, it is paramount to be mindful of other anomalies that may coexist.

Keywords: incisor, neonate, holoprosencephaly, stenosis
The use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with COVID-19. Scientific Brief
Pediatr Med Rodz 2020, 16 (1), p. 118–119
DOI: 10.15557/PiMR.2020.0022
COVID-19 and the use of angiotensin-converting enzyme inhibitors and receptor blockers. Scientific Brief
Pediatr Med Rodz 2020, 16 (1), p. 120–121
DOI: 10.15557/PiMR.2020.0023
“Immunity passports” in the context of COVID-19. Scientific Brief
Pediatr Med Rodz 2020, 16 (1), p. 122–123
DOI: 10.15557/PiMR.2020.0024
Bacille Calmette–Guérin (BCG) vaccination and COVID-19. Scientific Brief
Pediatr Med Rodz 2020, 16 (1), p. 124–124
DOI: 10.15557/PiMR.2020.0025