The Impact of Maternal Hypothyroidism during Pregnancy on Minipuberty in Boys

Minipuberty is a period of increased reproductive axis activity in infancy, which seems to be implicated in the postnatal development of male genital organs. Impaired thyroid function during pregnancy is associated with an increased risk of prenatal, perinatal, and postnatal complications. The aim of this study was to investigate whether the presence of hypothyroidism during pregnancy modulates the course of male minipuberty. We compared three matched groups of male infants: sons of women with hypothyroidism uncontrolled or poorly controlled during pregnancy (group A), male offspring of women treated over the entire pregnancy with adequate doses of levothyroxine (group B), and sons born to women with no evidence of thyroid disease (group C). Salivary levels of testosterone, androstenedione, dehydroepiandrosterone sulfate, estradiol, progesterone, and 17-hydroxyprogesterone, as well as urine concentrations of FSH and LH, were assessed once a month in the first 6 months of life, and once every two months between months 6 and 12. Gonadotropin and testosterone levels during the first 6 months of life were lower in group A than in groups B and C. Differences in testosterone and gonadotropin levels were accompanied by similar differences in penile length and testicular volume. Concentrations of the remaining hormones did not differ between the study groups. The obtained results suggest that untreated or undertreated maternal thyroid hypofunction in pregnancy has an inhibitory effect on postnatal activation of the hypothalamic-pituitary-testicular axis and genital organ development in their male offspring.

Minipuberty in Sons of Women with Low Vitamin D Status during Pregnancy

Minipuberty is a transient phase of reproductive axis activation during the first several months of life, playing an important role in the development of reproductive organs in boys. Low 25-hydroxyvitamin D levels during pregnancy are associated with an increased risk of neonatal complications. An inadequate gestational vitamin D status is hypothesized to affect the postnatal activation of the hypothalamic-pituitary-gonadal axis. The purpose of our study was to assess whether a low vitamin D status during pregnancy determines the course of minipuberty in boys. The study included three groups of male infants born to women with different vitamin D statuses: sons of women with vitamin D deficiency (group 1), sons of women with vitamin D insufficiency (group 2), and male offspring of females with normal 25-hydroxyvitamin D levels (group 3 (the reference group)). Concentrations of testosterone, androstenedione, dehydroepiandrosterone sulfate, estradiol, progesterone, and 17-hydroxyprogesterone in saliva, as well as concentrations of gonadotropins in urine, were assayed monthly from postnatal months 1 to 6, and once every 2 months in the second half of the first year of life. Additionally, at each visit, penile length and testicular volume were assessed. Concentrations of testosterone, FSH, and LH, as well as penile length and testicular volume, were greater in group 1 than in groups 2 and 3. In turn, group 2 was characterized by higher FSH levels and a greater testicular volume than group 3. Peak concentrations of LH and testosterone were observed earlier in group 1 than in the remaining groups. The obtained results suggest that a low vitamin D status during pregnancy may have a stimulatory impact on reproductive axis activity and on the early postnatal development of male genital organs, correlating with the severity of hypovitaminosis D.

Lipid metabolism and renal function markers in obese adolescents

AIM OF THE STUDY

To investigate the relationship of renal function markers and lipid metabolism parameters in obese adolescents.

MATERIAL AND METHODS

The study comprised 76 children aged 11-17 years, hospitalised due to: obesity (group I - 19 children) or obesity accompanied by obesity-induced hypertension (group II - 30 children) or normosthenic children with a diagnosed tension headaches (control group - 27 children). A subgroup with metabolic syndrome (MS - 16 children) was also separated. Renal function was assessed on the basis of: serum creatinine concentration, glomerular filtration rate estimated using Schwartz eqation (eGFR), determination of plasma and urinary neutrophil gelatinase-associated lipocalin and cystatin C. On the basis of statistical analysis, it was checked whether renal function markers depend on lipid metabolism parameters.

RESULTS

In the study groups mean creatinine concentrations were significantly higher and eGFR values significantly lower than in the control group, but they remained within norm. Differences in plasma and urinary neutrophil gelatinase-associated lipocalin concentrations were not significant. Mean cystatin C concentrations were significantly higher in the group of obese children. Multiple linear regression analysis showed that the most important predictor was: LDL-C for urinary neutrophil gelatinase-associated lipocalin (R2 = 0.42) and TG for eGFR (R2 = 0.44) concentrations in group I; cholesterol for creatinine concentrations in MS group (R2 = 0.44).

CONCLUSIONS

Renal function of the obese adolescents included in the study was normal and the associations with lipid metabolism were poorly expressed.

Abundance of domestic mites in dwellings of children and adolescents with asthma in relation to environmental factors and allergy symptoms

Exposure to house dust allergens, mainly from domestic mites, is an important cause of allergic reactions in sensitized asthmatic patients. A total of 63 dust samples were collected from 16 flats in Bytom (south Poland); in each flat a person (age 4-17 years) suffering from bronchial asthma lived with his/her family. Mite density was calculated as the number of specimens per g of dust. The results were compared with household features and the data were statistically analyzed. In total 566 mite specimens were isolated, including 526 members of the family Pyroglyphidae (93%). The dominant species were Dermatophagoides pteronyssinus (60% of the total count) and Dermatophagoides farinae (32%). Pyroglyphids were found in all mite positive samples (68%) of which 35% also contained non-pyroglyphids, including glycyphagids, cheyletids and gamasids. The results suggest associations between the density of some mite taxa (per g of dust) and the following indoor environmental factors: presence of pets, number of inhabitants, coal-stoves as a type of heating, cleaning frequency, higher relative humidity, presence of flowers and PVC windows. The severity of asthma seems to be associated with the numbers of D. farinae, total domestic mites and live mites per g of dust.

Sialadenitis as chickenpox complication in a 6-year-old girl

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In the 6.year old girl with chickenpox we diagnosed an typical complication in the shape of sialadenitis (especially submaxillitis).

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Within the last twenty years, only in one child the relationship between sialadenitis and varicella-zoster virus infection has been suggested.

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Our observation has important clinical significance.

Chickenpox is considered as a mild disease, but sometimes it is associated with complications. Among them sialadenitis is mentioned sporadically. We describe a case of the 6-year-old girl suffering from complicated chickenpox. On the basis of clinical data and ultrasound image we diagnosed in her inflammation of both submandibular glands. Moreover, the ultrasound image suggested possibility of an inflammation developing in the left parotid gland.

A Patient with Berardinelli-Seip Syndrome, Novel AGPAT2 Splicesite Mutation and Concomitant Development of Non-diabetic Polyneuropathy

Primary polyneuropathy in the context of Seip-Berardinelli type 1 seipinopathy, or congenital generalized lipodystrophy type 1 (CGL1) has not been previously reported. We report the case history of a 27 year old female CGL1 patient presenting with an unusual additional development of non-diabetic peripheral neuropathy and learning disabilities in early adolescence. Whole exome sequencing (WES) of the patient genome identified a novel variant, homozygous for a 52 bp intronic deletion in the AGPAT2 locus, coding for 1-acylglycerol-3-phosphate O-acyltransferase 2, which is uniquely associated with CGL1 seipinopathies, with no molecular evidence for dual diagnosis. Functional studies using RNA isolated from patient peripheral blood leucocytes showed abnormal RNA splicing resulting in the loss of 25 amino acids from the patient AGPAT2 protein coding sequence. Stability and transcription levels for the misspliced AGPAT2 mRNA in our patient nonetheless remained normal. Any AGPAT2 protein produced in our patient is therefore likely to be dysfunctional. However, formal linkage of this deletion to the neuropathy observed remains to be shown. The classical clinical presentation of a patient with AGPAT2-associated lipodystrophy shows normal cognition and no development of polyneuropathy. Cognitive disabilities and polyneuropathy are features associated exclusively with clinical CGL type 2 arising from seipin (BSCL2) gene mutations. This case study suggests that in some genetic contexts, AGPAT2 mutations can also produce phenotypes with primary polyneuropathy.

The role of hepcidin in regulating iron homeostasis in selected diseases

Iron is an element whose content in the human organism remains under strict control not only due to its involvement in many life processes but also because of its potential toxicity. The latest studies in iron metabolism, especially the involvement of hepcidin, which is the main regulator of iron homeostasis, broadened our knowledge in many medical fields (immunology, nephrology, hematology, gastrology). The present paper is a review of the literature devoted to the importance of hepcidin under selected conditions.

Evidence of a significant vitamin D deficiency among 9-13-year-old Polish children: results of a multicentre study

PURPOSE

To evaluate the extent to which the population of Polish preadolescents is vitamin D deficient and to assess seasonal variations in vitamin D status.

PARTICIPANTS AND METHODS

A total of 720 healthy children aged 9-13 years (409 girls, 311 boys) residing in 6 representative geographical locations in Poland were studied. A parental-assisted questionnaire provided data on nutritional habits, vitamin D supplements and sun exposure. Serum concentration of 25-hydroxyvitamin was determined twice, after the winter in March and after the summer in October.

RESULTS

In March, vitamin D deficiency (25-50 nmol/L) was found in 64%, and severe deficiency (< 25 nmol/L) in 20.2% of children. In October, the deficiency and severe deficiency were still noticed in 25.9 and 0.1% of children, respectively. The mean serum concentration of 25-OHD was 52% higher in October (55.4 ± 14.0 nmol/L) than in March (36.4 ± 13.5 nmol/L), (p < 0.01). In children with 25-OHD < 50 nmol/L in March, their 25-OHD concentration increased by 64% through March to October (32.5 ± 8.2 vs. 53.2 ± 7.9 nmol/L, p < 0.01). An association was found between 25-OHD concentration and regular consumption of vitamin D supplements, cod-liver oil and fish.

CONCLUSIONS

The majority of preadolescent Polish boys and girls show vitamin D deficiency after the winter period, although a distinct amelioration over summertime is found in this age group. There is a need to implement effective prevention and intervention strategies in the management of vitamin D deficiency among schoolchildren in Poland, with the supplementation throughout the entire year.

Meckel's diverticulum - a congenital defect of the gastrointestinal tract underestimated in differential diagnostics. Own experience

Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct. It is the most frequent defect of the gastrointestinal tract and is present in approx. 2% of the population: more often in boys than in girls, at a 3:1 ratio. Meckel's diverticulum causes clinical symptoms only in 4-6% of individuals. It is situated approximately 60-100 cm away from the Bauhin's valve. The wall of Meckel's diverticulum consists of all layers typical of the small intestine. It is usually approx. 2-3 cm long, but it can reach lengths of over 10 centimetres. It is usually set on a narrow base. Related symptoms usually occur by the 2nd-3rd year of life and have an acute character. They may occur in older children, which must be remembered in differential diagnosis. An example can be the case of an 8.5-year-old boy with symptoms indicating obstruction of the gastrointestinal tract in which a large, atypically accreted and partly twisted Meckel's diverticulum was found with strangulation of the small intestine between the diverticulum and the mesentery.

[Variable magnetic fields in the treatment of tics disorders - preliminary results]

INTRODUCTION

Tics disorders is frequent pathological syndrome, particularly typical for children's age. The symptoms of this disease are differential, and their intensification individualized, which makes difficult unique recognition. Tics disorders concern the most often the muscles of face, head, upper limbs and trunk.

MATERIAL AND METHODS

The study group consisted of 16 patients (11 boys and 5 girls) with tics complex disorders about unknown etiology particularly relating of face and upper limbs muscles. In the treatment were the interventions with use a magnetotherapy and magnetostimulation applied. The procedures were ones daily by 3 weeks in two series executed. It author's pool was the frequency of occurrence tics disorders as well as the proportional opinion of effectiveness conducted treatment estimated.

RESULTS

After 10 weeks in 14 patients was the decrease of occurrence frequency involuntary movements observed, in proportional scale about 75%. The results of subjective opinion of mood showed, that decrease the frequency tics disorders had in all children the direct shift on improvement their mood, and also satisfaction in their parents.

CONCLUSIONS

The use of variable magnetic fields influenced on decrease the occurrence frequency tics disorders, and also on improvement quality of life the treated patients.

[Variable magnetic fields in the treatment of tics disorders - preliminary results]

INTRODUCTION

Tics disorders is frequent pathological syndrome, particularly typical for children's age. The symptoms of this disease are differential, and their intensification individualized, which makes difficult unique recognition. Tics disorders concern the most often the muscles of face, head, upper limbs and trunk.

MATERIAL AND METHODS

The study group consisted of 16 patients (11 boys and 5 girls) with tics complex disorders about unknown etiology particularly relating of face and upper limbs muscles. In the treatment were the interventions with use a magnetotherapy and magnetostimulation applied. The procedures were ones daily by 3 weeks in two series executed. It author's pool was the frequency of occurrence tics disorders as well as the proportional opinion of effectiveness conducted treatment estimated.

RESULTS

After 10 weeks in 14 patients was the decrease of occurrence frequency involuntary movements observed, in proportional scale about 75%. The results of subjective opinion of mood showed, that decrease the frequency tics disorders had in all children the direct shift on improvement their mood, and also satisfaction in their parents.

CONCLUSIONS

The use of variable magnetic fields influenced on decrease the occurrence frequency tics disorders, and also on improvement quality of life the treated patients.

[Multiloculated mesenteric and retroperitoneal tumour - lymphatic malformation - in a 4-year-old girl]

Mesenteric cysts are rare and mostly benign abdominal tumours in children. Majority of them are lymphangiomas (lymphatic malformations). We diagnosed a broad, multiloculated mesenteric and retroperitoneal cyst, associated with intensive inflammation, in a 4-year-old girl. Surgical therapy was fully successful.

Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension

INTRODUCTION

Obesity and hypertension are recognised risk factors for the development of atherosclerosis. It has not been proven whether their co-existence increases the synthesis of pro-inflammatory TNF-α and what the levels of soluble receptors of this cytokine (sTNF-R) are. This study is aimed to investigate whether there exists a relationship between TNF-α and sTNF-R concentrations in blood serum with the occurrence of obesity or obesity combined with primary hypertension in teenagers.

MATERIAL AND METHOD

68 persons, aged 9-17, including 32 persons with primary obesity (Group I) and 36 with primary obesity combined with primary hypertension (Group II). TNF-α (pg/mL) and sTNF-R (ng/mL) concentrations were determined in serum samples using the ELISA method with sets of reagents manufactured by Bender Med Systems GmbH.

RESULTS

No significant differences in TNF-α, sTNF-R, glucose or insulin concentrations were found between Group I and Group II. These concentrations were not correlated with the age and the nutritional status of the patients or with each other in either of the groups.

CONCLUSION

Both obese teenagers and teenagers exhibiting obesity combined with hypertension (as two atherosclerosis risk factors) are characterised by comparable concentrations of TNF-α and its soluble receptors.

Neopterin Concentration in Serum and Chosen Markers of Inflammatory Process in Children with Acute Diarrhea Caused by Rotavirus or Salmonella

Neopterin concentrations reflect the activation of the cellular immune system. Neopterin is released by macrophages stimulated by interferon-γ (IFN-γ), which is produced by activated T lymphocytes. Raised neopterin concentrations in body fluids are found in various disorders, e.g. viral infections (AIDS, cytomegalovirus, hepatitis), intracellular bacteria infections (Mycobacteruim tuberculosis, Mycobacterium leprae), autoimmune disorders and malignancy. Neopterin concentrations are low or not significantly increased in bacterial infections, with exception of infections with intracellular bacteria. The aim of this study was to evaluate the usefulness of neopterin in the differential diagnosis of viral (Rotavirus) and bacterial (Salmonella) origin of diarrhoea.

129 children, aged 1 month -14 years, who were hospitalized for rotavirus gastroenteritis or salmonellosis were included into the study. Rotavirus was identified by latex test and Salmonella by stool cultures and the children were divided into 2 groups: with rotavirus infection (group I (R) - 71 children) and with salmonellosis (group II (S) - 58 children). In this study it was analyzed: disease duration before hospitalization, the general condition of a child on admission, body temperature, the number of loose and bloody stools and the number of vomits. On their admission to hospital, erythrocyte sedimentation rate (ESR), leukocyte count, and in the sera of all children C-reactive protein (CRP) and neopterin concentrations were determined. The serum neopterin concentrations were analyzed by ELISA.

Mean neopterin concentration was 35.0 nmol/L in patients with salmonellosis, and it was significantly higher than in patients with rotavirus infection (22.0 nmol/L; p <0,001). The neopterin level that reliably discriminated between rotavirus diarrhoea and salmonellosis was 22 nmol/L: neopterin concentration higher than 22 nmol/L suggested diarrhoea caused by Salmonella, and neopterin concentrations equal or lower than 22 nmol/L suggested a rotavirus diarrhoea The combination of the results of two (neopterin >10 nmol/L and CRP >10mg/L) or three (neopterin >10nmol/L, ESR >10mm/h, CRP >10mg/L) serum markers helps to achieve better results. The best specificity (100%) was obtained for CRP concentration >15mg/L and neopterin concentration >37 nmol/L.

We conclude that serum neopterin concentrations in children with acute diarrhea are not a laboratory indicator diversifying salmonellosis and rotavirus infection, because it increases in both infections. However higher concentrations indicate salmonellosis.

[Evaluation of infants and younger children passive smoking at home and prevalence of their lower respiratory tract infectious]

The nicotine's metabolites were determined in urine of 92 children--59 children of smoking parents (SP) and 33 of non-smoking parents (NSP). The level of metabolites of nicotine and the ratio of the nicotine's metabolites to creatinine concentration were analyzed in infants (older than 5 months) and children 2-4 years old. Moreover the frequency of bronchitis and pneumonia in children was estimated on the basis of the interview with their parents. The nicotine's metabolites concentration was significantly higher in urine of children of SP than in urine of NSP children, as well in the group of infants as in children aged 2 to 4 years. Respiratory tract infections were frequent in 69.4% of SP children and in 21.1% of NSP children. In addition, the mean and the highest level of metabolites of nicotine in urine of SP children were multiple higher in comparison to the levels found in the group of NSP children suffering from the respiratory tract infections with equal frequency.

[Assessment of association of birth weight and existence of hypertension in children and adolescents normostenic, obese or with metabolic syndrome]

It has been proved that Low Birth Weight (LBW) is a predisposing factor of elevated blood pressure in children. The aim of our study was to analyze birth weight of patients with diagnosed hypertension (HT). There has been 114 children, 6 to 17 years old, included into our study. We decided to divide them into 3 following groups: Group I--normal body mass and HT (51 children); Group II--metabolic syndrome (MS) with HT (32 children); Group III--overweight and obese children with HT (31 children). At 85% of all patients HT was diagnosed after performing ABPM. Statistically significant difference of birth weight was observed between patients with normal body mass (I) and those with overweight or obesity (III) (p<0,01). The most number of children with LBW (<2500 g) was observed in Group I (15.7%) and Group II (12.5%). It was observed that obese children with HT had had normal or high birth weigh (96.8%).

CONCLUSION

1. The frequency of low birth weight is similar in normostenic children with hipertension and children with metabolic syndrome. 2. The birth weight higher than 4000 g is more frequent in obesy hipertensive children and children with metabolic syndrome than in normo-stenic patients with hipertension.

[The assessment of urinary nicotine metabolites concentration in children and teenagers with oesophagitis]

Tobacco smoke is important pathogenetic agent of stomach digestive and duodenum ulcers, oesophagitis as well as gastro-oesophageal reflux disease. The aim of work was the assessment of urinary nicotine metabolites concentration in children and teenagers diagnosed and treated in Paediatrics Chair of Medical University of Silesia by chronic stomach pains, or oesophagitis and gastrooesophageal reflux disease symptoms. Urine was sampled from 54 persons before gastrofiberoscopy, in which the main nicotine metabolites concentration was determined by ELISA method and given per creatinine concentration. It was shown, that 30% of examined population was intensively exposed to tobacco smoke (actively or passively smoking), but 37% passively exposed to nicotine. Significant higher nicotine metabolites concentration was stated in the currently H. pylori infected sick, however without differences of these biomarkers concentrations between group with oesophagis in endoscopy as well as histopathologic examination and group without these features.

[Selenium plasma concentrations in children with celiac disease in different stages of diagnosis]

Selenium is an important nutritional factor of human diet. Epidemiological and experimental data indicate that low selenium level can be associated with increased risk of cancer. On the other hand there are some evidence that patients with celiac disease can present selenium deficiency and increased risk of certain malignancies. Therefore the aim of study was to evaluate plasma selenium levels in children with celiac disease. The level of selenium was estimated by flame atomic absorptiometry method according to Whiteside. Celiac disease was diagnosed according to ESPGHAN criteria. Obtained results indicate that in celiac disease low plasma selenium levels are especially marked at preliminary stage of diagnosis and following low compliance to the gluten free diet. Children with this sickness may need supplementation of their diet with selenium.

[Selenium plasma concentration level in children with food allergy]

Selenium (Se) is an essential component of many mammalian enzymes and therefore plays an important role in different metabolic processes. Se deficiency occurs in inadequate diet consumption as well as in some digestive tract and allergic diseases. In this research we showed that Se plasma concentration levels in healthy children was 71.8 mg/l, whereas in those with food allergy 54.1 mg/l (with smaller intestinal villus atrophy) or 50.4 mg/l (with greater intestinal villus atrophy). Obtained results indicate that children with food allergy display higher risk of Se deficiency. Antioxidative and immunomodulatory action of Se, connecting with promising literature data of Se supplementation, promote us to state, that this trace element could be used for accessory food allergies treatment.

[Systemic sclerosis with renal involvement in a 15-year old girl diagnosed with lichen sclerosus]

In 15-year-old girl with lichen sclerosus diagnosed 4 years ago described nephritis development in systemic sclerosis without skin manifestations of scleroderma (sclerodermia sine sclerodermia). Raynaud's phenomenon, typical microcirculatory abnormalities in capilaroscopy and positive antinuclear antibodies were observed.

[Urine culture analysis in children with urinary tract infections treated at Pediatric Clinical Department in Bytom in the years 1998-1999]

Sensitivity of bacterial strains causing urinary tract infections was analysed. High sensitivity of bacteria to nitrofurantoin, guinolones and cephalosporines--mainly of the III generation, as well as minute sensitivity to penicillins were demonstrated.

Plasma beta-endorphin and insulin concentrations in relation to body fat and nutritional parameters in overweight and obese prepubertal children

OBJECTIVE

To investigate the relationship between plasma beta-endorphin (beta-end) and insulin concentrations and 1) body fat, and 2) nutritional parameters in overweight or obese prepubertal children.

DESIGN

Cross-sectional study on plasma beta-end and insulin concentrations, body fat, indirect parameters of appetite namely daily energy and macronutrient intake.

SUBJECTS

143 (67 boys and 76 girls) overweight or obese children (group I) and 48 (27 boys and 21 girls) healthy children with normal parameters of somatic development (group II). Age: 5.8-9.6 y.

MEASUREMENTS

Weight, height and subcutaneous skinfold thicknesses, plasma beta-end and insulin concentrations, diet history for energy and macronutrient intake.

RESULTS

Group I was characterised by significantly higher average concentrations of beta-end and insulin in comparison to the control group. The analysis of these concentrations in the subgroups in relation to the percentage of body fat indicates that beta-end concentrations increased more than insulin concentrations with increasing fatness. A significantly positive correlation between beta-end and insulin levels was only noted in group I. Also, only in this group was there a significant positive correlation between beta-end levels and energy and macronutrient intake. In both groups the percentage of energy intake which was fat, correlated positively with beta-end concentrations. Furthermore energy and fat intakes showed a significant positive correlation with insulin levels in both groups.

CONCLUSIONS

beta-endorphin and insulin concentrations in overweight and obese prepubertal children are not only higher than in non-obese children but also are positively correlated with each other and with the percentage of body fat. The relationship between plasma beta-end levels and food intake shows that the beta-end level may be able to be used as an indicator of appetite in overweight and obese prepubertal children whose food intake is not restricted.

[Crohn's disease with a severe course in a 12-year old girl]

A case is described of severe course of Crohn's disease in a 12-year-old girl. Discussing the period of three years of clinical observation, diagnostic and therapeutic difficulties are presented.