Vitamin Status in Children with Cystic Fibrosis Transmembrane Conductance Regulator Gene Mutation

Background: The issue of vitamin metabolism in children with cystic fibrosis screen positive, inconclusive diagnosis (CFSPID) is not well known. The aim of this study was to determine the status of vitamins A, D, E, and C in the blood of a group of children with CFSPID. Material and Methods: A total of 89 children were enrolled in the study (Me: 3.6 years, 52.8% boys), as follows: 28 with CFSPID, 31 with CF (cystic fibrosis), and 30 HC (healthy children). Their blood concentrations of vitamins A, D, E, and C, and their dietary intake of these vitamins were analysed in the study groups on the basis of a three-day food diary. Results: The patients with CFSPID had significantly higher serum vitamin D (p = 0.01) and E (p = 0.04) concentrations, compared to the children with CF. None of the children with CFSPID revealed vitamin A or E deficiencies. Patients with CF had been consuming significantly higher vitamin D and E amounts (p = 0.01). The vitamin concentrations did not depend either on the pancreatic/liver function or on anthropometric parameters. In total, 32.14% of patients with CF did not cover the baseline recommended calorie intake, and 53.6% and 36% did not take the recommended vitamin E and vitamin A intake, respectively. Conclusion: Children with CF and CFSPID did not fully cover the dietary recommendations for vitamin supply, but vitamin deficiency was found only in CF.

The occurrence of abnormal body weight values and selected eating habits and physical activity of nurses

Aim. The aim of the research was to analyze the incidence of abnormal body weight values and to assess eating habits and physical activity of nurses.Material and Methods. The studies involved all first‑year nursing students of the second degree daily studies, working as a nurse. The women’s eating habits were analyzed based the diet. The questionnaire allowed the researchers to determine daily consumption of each particular dietary component (proteins, carbohydrates, fats, fatty acids, vitamins) as well as the women’s calorie consumption.Results. The analysis showed that the group of underweight participants was comprised of 5 students (group I), the group of participants with normal body weight — of 43 students (group II), and the group of participants with excessive body weight — of 10 students (group III). Group II students spent the longest time on (moderate and intense) physical activity (on average 378 minutes/week), whereas group III students — the shortest (on average 203 minutes/week). While analyzing the average protein intake, it was found that all groups exceeded its daily requirement. The intake of sodium and cholesterol was exceeded more than twice of the recommended amount. A very low intake of vitamin D — covering from 40 to 48% of the daily requirement — was observed in all groups.Conclusions. Despite the fact that the nurses’ diet includes all nutrients necessary for the body, it is not properly balanced which obliges to raising awareness of types of consumed food.

Minerals in the diet of adolescents aged 15

BackgroundStudies which focus on the supply of minerals in the diet of adolescents show that the diet is deficient in such macroelements as calcium and magnesium and such microelements as copper, zinc, iodine and iron. Inadequate supply of minerals may increase the risk of development of diet related diseases at a mature age.MethodsThe questionnaire on the consumption of food products consumed every day for the period of 7 days was filled in by the person conducting the survey. The needs for minerals were defined individually for every child with reference to recommended dietary allowance.ResultsThe norm of daily sodium intake among 15-year-old adolescents was exceeded in all tested groups, however, in the group of boys sodium intake was at a higher level than in the group of girls. Potassium intake in the group of both girls and boys did not reach the recommended daily value, whereas the recommended daily consumption of manganese was exceeded twice. In all tested subjects, the ratio of calcium to phosphorus was very low. In the group of girls who are underweight, daily consumption of iron did not cover 50% of the demand.ConclusionsInadequate supply of minerals recorded in all tested 15-year old subjects, regardless of their BMI, may lead to developmental disorders and diet related diseases at a mature age.

Does the mutation of the SERPINA1 gene contribute to liver damage and cholestasis in patients with diagnosed cystic fibrosis? preliminary study

Mutation of the SERPINA1 gene is present in about 2% of patients with cystic fibrosis but is more common and accounts for about 5% in patients with cystic fibrosis and co-existing liver lesions. The SERPINA1 gene is responsible for the synthesis of a serine protease inhibitor. The protein related with this gene is accumulated within the endoplasmic reticulum of hepatocytes causing their damage, inflammation and cirrhosis. The aim was to assess the presumable effect of the SERPINA1 mutation gene in patients with diagnosed cystic fibrosis on damage to the liver and/or cholestasis.

MATERIAL AND METHOD

The analysis included 30 children, 13 girls (43.3%) and 17 boys (56.6%), aged from 6 months to 18 years (the average age was 5.5 years) with diagnosed cystic fibrosis. All the patients have undergone a genetic test of the mutation of the SERPINA1 gene. The analysis included age, sex, clinical symptoms, type of mutation of the CFTR protein, abnormalities in laboratory tests (the activity of aminotransferases, GGTP, alkaline phosphatase , protein, the indicator of acid steatocrit, the rate of APRI) and abdominal ultrasonography.

RESULTS

Symptoms of damaged liver were concluded in 9/30 patients (30%) with diagnosed cystic fibrosis. Most commonly observed were increased activities of aminotransferases in 9/30 patients (30%) and of gamma glutamyl transferase in 6/30 (20%) of the assessed patients. In 4/30 patients the abdominal ultrasonography revealed an enlarged liver and increased echogenicity. Mutation within the SERPINA1 gene was observed only in 1/30 patients (3.3%) with diagnosed cystic fibrosis. As far as the patient is concerned, currently the activities of aminotransferases, GGTP and AF are normal, but there has been a considerable increase in the intensity of symptoms from the respiratory system. No corelation between the mutation of the SERPINA1 gene and clinical symptoms, type of mutation of the CFTR protein, laboratory results of the functions and damage to the liver and the abdominal ultrasonography was observed.

CONCLUSIONS

We did not find a more frequent occurrence of the SERPINA1 gene mutation in children with cystic fibrosis and coexisting features of damaged liver and cholestasis. The obtained results suggest the contribution of other than SERPINA1 gene mutation factors responsible for the development of changes in the liver in patients diagnosed with cystic fibrosis. The studies on the subject should be extended and performed on a larger group of patients. .

Diagnostic problems in cystic fibrosis - specific characteristics of a group of infants and young children diagnosed positive through neonatal screening, in whom cystic fibrosis had not been diagnosed

INTRODUCTION

Neonatal cystic fibrosis screening contributes to an early diagnosis of cystic fibrosis and to implementing appropriate therapeutic management. Long-standing screening tests have made it possible to identify a group of newborns in whom the diagnosis was ambiguous and required further specialised tests.

AIM

The aim is to present cases of patients with a positive result of newborn screening for cystic fibrosis who were found to be carriers of the mutation in both alleles, however the lack of clinical symptoms and correct sweat testing values did not lead doctors to diagnosing cystic fibrosis and by the same token implementing the treatment.

MATERIAL AND METHODS

The analysis encompassed a group of 22 infants and children 3 months to 3 years of age, in whom, in spite of a positive result of newborn screening for cystic fibrosis and the presence of 2 mutations in the CFTR gene, the diagnosis of cystic fibrosis was not made, and appropriate treatment was not administered because of diagnostic doubts (due to correct concentration of chlorides in sweat, correct IRT level and lack of clinical signs of cystic fibrosis). The control group consisted of 55 children treated in our centre, in whom neonatal screening for cystic fibrosis was positive and the diagnosis was confirmed by genetic testing, sweat chloride testing and IRT concentration.

RESULTS

There were no differences in birth body weight between the groups. The differences in chlorideion levels in sweat secretion tests and mean IRT values were statistically significant and were: 97.5 for the control group and 26.4 for the test group. At the present time there are no clinical symptoms to give a diagnosis of cystic fibrosis and start treatment in the test group.

CONCLUSIONS

Newborn screening contributes not only to an early diagnosis of cystic fibrosis but also to CFTR-related metabolic syndromes (CRMS), which is a phenomenon requiring further observation. This fact constitutes a definite psychological problem for the parents of these patients. .

The evaluation of function and the ultrasonographic picture of thyroid in children treated for medulloblastoma

PURPOSE

Medulloblastoma (MB) is one of the most frequent and sensitive to radiation aggressive brain tumor in children. Abnormalities of the thyroid function are common complications of head and neck irradiation for childhood cancer. The aim of this study was to assess thyroid function in children treated for medulloblastoma according to the treatment protocol phase.

PATIENTS AND METHODS

Twenty-three children with MB were enrolled to this study. All patients underwent chemotherapy and radiotherapy to the whole craniospinal axis and boost with the conformal therapy restricted to the tumor bed to a total dose of 54 Gy. Thyroid function was evaluated based on thyroid-stimulating hormone (TSH), free thyroxine (fT4) levels controlled before MB treatment, directly after irradiation and at the end of the treatment protocol. Ultrasonography has been used to detect parenchymal abnormalities.

RESULTS

All patients presented normal thyroid hormone range before chemotherapy. Hypothyroidism was found in 12 patients in the course of treatment, in 2 patients hormone deficits diagnosed directly after irradiation, in 10 patients such condition was observed at the end of the whole therapy. All of these patients needed thyroid hormone substitution. None of them presented clinical symptoms of hypothyroidism. Ultrasound-detected abnormalities have been found in 20 patients.

CONCLUSIONS

It is crucial to monitor the functions of the thyroid gland in children treated for medulloblastoma because of the high risk of hypothyroidism resulting from the treatment. The change in the echogenicity of the thyroid gland may be an early marker for a dysfunction of this organ in children treated for medulloblastoma.

Feeding problems in children with neurological disorders

INTRODUCTION

The aim of this study was to evaluate the prevalence of selected risk factors of weight deficiency in children with chronic metabolic diseases.

MATERIAL AND METHODS

The study group involved 160 children, from 2 months to 15 years (mean age 3.14 years), with diseases of the nervous system and body weight deficiency. According to the type of neurological disease the following groups of patients were separated: static encephalopathies, progressive encephalopathies, disorders of mental development of undetermined etiology, genetically determined diseases. As the exponent of malnutrition, z-score of weight-for-age standards was used. An inclusion criterion for the study group was z-score of weight-for-age < - 2SD. The analysed risk factors of body weight deficiency were: mode of feeding children, neurological disorders, oral motor dysfunction, diseases of other organs, gastrointestinal motility disorders (oral cavity, esophagus, intestines) and type of nutritional therapy.

RESULTS

The most advanced malnutrition was in children with progressive encephalopathies and genetically determined diseases. Seizures and muscular hypotonia were most common neurological disorders. Oral motor dysfunctions were observed in 40% of patients.

CONCLUSIONS

Malnutrition in children with neurological disorders is associated mainly with neurological deficits. In this group of children monitoring of somatic development and early nutritional intervention are necessary.

Immunogenecity of hepatitis A vaccine in pediatric patients with inflammatory bowel disease

BACKGROUND

There are only a few studies on immune response to routine vaccinations in children with inflammatory bowel disease (IBD), despite a strong need for this kind of study. The aim of the study was to evaluate the immunogenicity of an inactivated hepatitis A vaccine (HAV) in IBD pediatric patients compared with healthy controls.

METHODS

This was an open, prospective, and controlled study on anti-HAV-negative children and adolescents age 2-18 years with IBD. HAV using 720 enzyme-linked immunosorbent assay (ELISA) units were administered at 0 months and at 6-12 months. Seroconversion and geometric mean titers were measured after each vaccine dose. The evidence of local and systemic adverse effects for 3 days after the first and second dose of vaccine was registered.

RESULTS

A total of 134 subjects (66 patients and 68 controls) completed the whole study course consisting of two doses of vaccine and six serum samples. There was no significant difference in the rate of seroconversion between IBD patients and controls when measured after the second dose of vaccine (97% versus 100%, P = 0.2407), but the rate was significantly lower in the IBD group when measured after the first dose (39% versus 64%, P = 0.00001). The mean geometric titers were statistically significantly lower in the IBD group than in the control group at all of the measured timepoints. There were no serious adverse events related to HAV during the study.

CONCLUSIONS

HAV is both immunogenic and safe in pediatric patients with IBD.

Platelet and intestinal 5-HT2A receptor mRNA in autistic spectrum disorders - results of a pilot study

The etiology and pathogenesis of autistic spectrum disorders (ASD) are still unknown. Platelet hyperserotonemia has been detected in 25-60% of autistic children. Higher incidence of gastrointestinal problems in people with autism is observed. The aim was compare the expression of platelet 5-HT(2A)r mRNA in autistic and non autistic groups. In a subgroup of patients with gastrointestinal problems an upper gastrointestinal tract endoscopy was performed and additionally the expression of 5-HT(2A) receptor mRNA in the duodenum was assessed. The examination was conducted in 79 children - 51 with ASD and 28 without autistic traits. Statistically significant differences between the study and control groups were proven in gastrointestinal problems. The analyses reveal a significantly higher level of 5-HT(2A)r mRNA in platelets of the study group patients, which could suggest serotonin system dysregulation.

Serologic investigations in children with inflammatory bowel disease and food allergy

The aim of the study was the evaluation of frequency and titre of IgA ASCA and IgG ASCA and p-ANCA, c-ANCA in children with IBD and occurrence of ASCA antibodies in relation to coexistence of FA. Patients and methods. The study comprised 95 children at the ages of 2 to 18 years. The diagnosis of IBD was established on the basis of Porto criteria. Tests of blood serum were performed in all children: IgA and IgG ASCA, p-ANCA, c-ANCA using ELISA method. Results. IgE-dependent FA was found in 32.5% children with UC and in 21% with CD. We did not observe any relation between the occurrence of FA and the frequency and ASCA titre. p-ANCA were significantly more frequent in the group of children with UC. The occurrence of ASCA antibodies was observed in 73.7% of children with CD, 17.5% with UC and almost 30% with allergic colitis. Conclusions. Patients with CD and the presence of ASCA revealed a significantly more frequent localization of lesions within the small bowel and a tendency towards older age. We observed a connection between the occurrence of antibodies and the examined mutations of gene NOD2/CARD15.

[Parenteral symptoms and intestinal complications in children with inflammatory bowel diseases in relation to card15 mutation]

THE AIM OF THE STUDY

Was evaluation of the incidence of parenteral symptoms and complications in children with inflammatory bowel disease and their analysis in relation to the examined mutations of CARD15 gene.

PATIENTS AND METHODS

The study involved 38 children with Crohn's disease, aged from 5 to18 years (median14) and 40 children with ulcerative colitis, aged from 6 to18 years (median14). The control group included 23 children, aged from 4 to 18 years (median15), with functional disorders of the alimentary tract resulting from lactose intolerance. In all the examined patients as well as in the control group, mutations R702W, G908R and L1007fs of the CARD15 gene were determined, according to the protocol described by Tukel et al.

RESULTS

Parenteral symptoms, in the group of children with Crohn's disease, manifested as arthritis and erythema nodosum, were observed in 7 patients (18.4%), whereas in the group with ulcerative colitis they presented - in 4 children (10%). Intestinal complications in the form of stenosis, fistula, abscess and gastrointestinal bleeding were the most frequently observed changes in children with Crohn's disease (n=15; 39,5%). Parenteral symptoms were statistically significantly more frequent in children with Crohn's disease and with at least one mutation of CARD15 gene. Intestinal complications statistically appeared more often in children with Crohn's disease and mutation L1007fs.

CONCLUSIONS

1. Parenteral symptoms and intestinal complications occurred more frequently in the group of children with Crohn's disease, in comparison with the children with ulcerative colitis. 2. We observed a relation between parenteral symptoms and at least one mutation of CARD15 gene and a relation between intestinal complications and L1007fs mutation.

[Rotavirus infections in children]

Rotaviruses are the most common cause of acute diarrhoea in children. The disease often leads to hospitalization; it is also a source of intrahospital infections. In the last 10 years in Poland the incidence of rotavirus infections increased more than twofold In this study we analyse the etiopathogenesis, epidemiology, clinical course, diagnostic methods, treatment and prevention of rotavirus infections.

[Angiogenesis in the chronic inflammatory diseases and malignancies]

Angiogenesis is a process of creating new vessels which is necessary in pathogenesis of many diseases and disorders like inflammatory or malignancies. A lot of markers, both stimulating and inhibiting can influence on this process. Knowledge about angiogenesis and its markers, e.g. Vascular Endothelial Growth Factor (VEGF), basic Fibroblast Growth Factor (bFGF) can be used in diagnosis and treatment of diseases like malignancies. For these reasons summary of these processes seems to be very important and valid.

[Proangiogenic factors: vascular-endothelial growth factor (VEGF) and basic fibroblast growth factor--the characteristics and function]

The new blood vessels formation in the body is through vasculogenesis, angiogenesis, lymphangiogenesis and arteriogenesis processes. A process of creating new blood vessels is necessary for normal organism function, and is necessary too in pathogenesis of many diseases and disorders like inflammatory or malignancies. Vascular-Endothelial Growth Factor (VEGF) and basic Fibroblast Growth Factor (bFGF) are the main stimulators blood vessels formation. Knowledge about properties and function these markers can be used in diagnosis and treatment of diseases like malignancies. These article is summary knowledge about structure and function VEGF and bFGF.

Fecal pyruvate kinase: a potential new marker for intestinal inflammation in children with inflammatory bowel disease

OBJECTIVE

Inflammatory bowel disease (IBD) in children creates diagnostic and clinical challenges. Clinical data, endoscopic appearance and the histopathological assessment of biopsies are essential for diagnosis. However, new methods are required for non-invasive follow-up. Recently, we demonstrated that the dimeric isoform of pyruvate kinase (PK) detected in stool might serve as a potential non-invasive screening tool in inflamed pouch mucosa. The aim of this study was to investigate whether this test could be used to detect intestinal inflammation in pediatric IBD patients.

MATERIAL AND METHODS

Fecal PK immunoreactivity was assessed in 75 patients with proven ulcerative colitis (UC) and 32 with Crohn's disease (CD). Pediatric Crohn Disease Activity Index (PCDAI) and Truelove-Witts scores were determined in CD and UC patients, respectively. Thirty-five healthy subjects (HS) served as a control group.

RESULTS

Increased PK levels were documented in 94.1% and 100% active CD patients with a cut-off level of 5 U/g and a cut-off level of 4 U/g, respectively, and in 94.3% of active UC patients regardless of cut-off level. Enzyme immunoreactivity was significantly higher in all IBD patients than in HS. Abnormal PK results were documented in 71.7% of all IBD patients (65.3% and 84.4 for UC and CD patients, respectively). Enzyme levels in UC remission were significantly lower than in the active phase. Enzyme immunoreactivity significantly correlated to both scoring systems.

CONCLUSIONS

The measurement of stool PK could be a potentially useful marker of IBD activity in children. However, its clinical value demands further studies for comparison with other tests.

Children's allergic diseases and microbial contamination of indoor air--a case report

The assessment of exposure to bioaerosols in damp houses of two children who suffered from perennial rhinitis and asthma was performed. The paper presents an approach to the complex (i.e., medical and environmental) treatment of allergic diseases.

[Echocardiographic assessment of cor pulmonale in patients with cystic fibrosis]

Cystic fibrosis (CF) is an inherited multisystem disorder, characterized mainly by obstruction and infection of airways and by maldigestion and its consequences. An increasing interest concerning patients suffering from CF has been observed. Aim of this study was echocardiographic study of morphological structure, functional index and the grade of pulmonary hypertension in patients with CF. In 45 patients aged 3 to 24 years (mean 15.1 years) echocardiography was performed. Right ventricular end-diastolic dimension (RVDd) was increased in 67% of patients, right ventricular anterior wall thickness (RVAWd) was increased in 71% of patients. Pulmonary artery pressure was abnormally high in 84% of CF patients. Significant correlations between RVDd, RVAWd, PAP and Shwachman-Kulczycki clinical score was found. The dimensions of the left ventricular cavity were abnormal in 22% of patients. Insufficiency of pulmonary valve was observed in 47% of CF patients and tricuspid insufficiency in 53%. This study demonstrates that: 1) changes occurs mainly in right ventricle and appear to worsen as the disease progresses, 2) all patients with CF should remain under cardiological control, 3) echocardiography could be a useful method of long-term monitoring patients with CF.

[Hereditary angioedema in a 16-year-old girl]

The angioedema may be connected with immunological or allergic reactions, rarely appears as a genetically determined hereditary disorder. The cause of hereditary genetically determined angioedema is the defect of complement due to lack or decreased activity of Cl esterase inhibitor with the low serum C4 complement. The acquired angioedema is the most frequently the effect of lymphoproliferative and autoimmunological diseases. Hereditary angioedema was clinically characterized by subcutaneous oedema of extremities, face, neck, throat, gastrointestinal tract and brain. Tranexamic acid, sigma-aminocaproic acid and anabolic steroids- Danazol and Stanazol are administered for short- and long-term prophylaxis. Life-threatening recurrent episodes of angioedema were treated with replacement therapy. We present a case of hereditary angioedema in a 16-year-old girl admitted to hospital with massive facial oedema. The recurrence of symptoms without any effect of typical treatment was the indication for additional diagnostic tests. Diagnostic and therapeutic problems and a variable clinical course of disease were described.

[Orbital pseudotumour imitating a proliferative process]

INTRODUCTION

Orbital pseudotumour is a non-specific inflammatory process of the orbit of unknown origin. It is a rarely diagnosed disease particularly in children, which imitates a neoplastic process. Typical clinical picture is a tumour localized in the orbit, causing various degree of exophtalmus and a decrease of globe mobility and vision. The extent of intraorbital changes are revealed by imaging studies (USG, TK, MR). Diagnosis is based on histopathology of tumour sample. In treatment steroid therapy, radiotherapy or chemotherapy in resistant cases are used. Relapse and malignant transformation are observed.

CASE REPORT

We present a case of a 5-years old girl with orbital pseudotumour. In the histopathological examination there a small lymphoid cells, immunohistochemically there is mixed lymphocytic T and B infiltration (CD 3 (+), CD 20 (+), bcl (+), CD 43 (-)). She was treated with steroid therapy, and achieved complete regression of the tumour. At present she is regularly oncologically examined because of the possibility of malignant transformation.

CONCLUSIONS

1. Orbital pseudotumour should be included in the differential diagnosis of children with an orbital tumour 2. Corticosteroids seem to be the treatment of choice in orbital pseudotumour 3. Children with orbital pseudotumour should be regularly oncologically examined because of the possibility of malignant transformation.

[Mediastinal involvement in the course of proliferative diseases in children in the materials of one institution]

The mediastinum region may be the primary or secondary localization of neoplasms. The aim of our study was the assessment of clinical symptoms, histopathology and outcome of mediastinal tumours in children.

MATERIALS AND METHODS

A group of 27 children, chosen from the group of 128 patients with malignancies, which were treated in the years 2000-2004 in the Oncology and Haematology Unit of the Paediatric Department in Katowice, has been studied. In this group there were 14 boys and 13 girls at the age between 2 and 12 years. We analysed the clinical symptoms prior to the diagnosis and the duration of these symptoms, histologic type of tumours and results of treatment.

RESULTS

The primary localization in the mediastinum was diagnosed in 23 patients (85,2%) among them 15 (55,5%) of these children have been diagnosed as having Hodgkin's disease, and in 8 (29,6%) non Hodgkin's lymphoproliferative disease. Four of the children (14,8%) had mediastinal secondary localization of solid tumours (2 - neuroblastoma, 1 - carcinoma suprarenalis, 1 - carcinoma epitheliale of unknown origin). The most frequent symptoms were: fever (70,3%), weakness (66,6%), cough (55,5%), madiastinalpain (33,3%). The duration of these symptoms prior to the diagnosis was between 5 days and 182 clays.

CONCLUSIONS

1. In the group of neoplasms localized in the mediastinum, lymphoproliferative diseases are the most frequently diagnosed disorders. 2. In case of fever of unclear etiology and persistent cough, it is necessary to exclude mediastinal malignancy. 3. There is a need to improve the system of oncological education for medical students and doctors.

[Clinical picture of celiac disease in children]

During the last few years we have been observing the decreasing incidence of the symptomatic celiac disease and increasing incidence of mono- and asymptomatic disease. Various atypical symptoms and extraintestinal manifestations were observed in older children (above 7 years) and in adults. Clinical symptoms of celiac disease may appear at any age, in each of the following forms: clinical celiac disease (symptomatic), silent (oligosymptomatic) or latent, with late manifestation, being the effect of stress, pregnancy, infections or excessive dietary gluten provocation.

THE AIM OF THE STUDY

The presentation the variety of clinical pictures of celiac disease in children.

MATERIALS AND METHODS

We have evaluated the clinical course of celiac disease in 16 children (13 girls and 3 boys), aged between 12 months to 17 years (mean-7,5 years). The celiac disease was diagnosed on the grounds of clinical symptoms, histopathological examination of the small intestinal endoscopic biopsy and immunological examinations: serum antitransglutaminase antibodies and anti-endomysium antibodies.

RESULTS

Most commonly diagnosed form was the silent, monosymptomatic celiac disease. Four children manifested with growth retardation, one with osteoporosis, and one with iron deficiency anemia resistant to treatment. Two girls (aged 16 and 17 years) presented with symptomatic celiac disease. In 3 patients despite the gastrointestinal symptoms and histopathological changes present (villous atrophy, Marsh's index > 40) we did not find any immunological markers of celiac disease (with normal IgA levels).

CONCLUSIONS

School-aged children with celiac disease, in many cases have no evident clinical and functional disorders caused by gluten intake, despite to presence of considerable abnormalities in the histopathological examination.

[Infections of Salmonella in children aged 0-36 months--clinical and epidemiological aspects]

In this work we presented a retrospective analysis of Salmonella infections in 163 children aged between 0-36 months. The children were treated in IV Department of Pediatrics at Medical University of Silesia (Poland) in years 1987-1998. We analyzed: clinical course, dependence between age of the patients and the type of Salmonella, number of infections and their seasonal incidence during 12 years of observation. These relations were compared with the group of 17 children with Salmonella infections treated in the Department of Pediatrics GCZDzM in Katowice in 2001.

[Basal concentration of Substance P (SP) and Vasoactive Intestinal Peptide (VIP) in the blood serum of children with allergic dermatitis]

Substance P (SP) and Vasoactive Intestinal Peptide (VIP) neuropeptides play a role in the immediate and late type of hypersensitivity as well as in neurogenic inflammation. This suggests their participation in the etiology of allergic dermatitis. In the changed skin of patients with allergic dermatitis considerable increase of nervous endings was found containing SP and VIP. The aim of the study was the evaluation of SP and VIP concentration in blood serum of children with allergic dermatitis in the course of food allergy.

PATIENTS AND METHOD

We determined by radioimmunological method on empty stomach concentration of SP and VIP in the blood serum in 19 children, aged between 6 and 24 months with allergic dermatitis of various intensity. In the 6 children with alimentary tract symptoms and deficiency of body mass we have done biopsy of the small intestine mucosa.

RESULTS

Obtained medium values of SP and VIP were higher in the examined group in the comparison to the control group, but we did not find any statistical significance. However, in the group of children with co-existent malabsorption syndrome we found higher concentration of both neurohormones and we found statistical significance in the concentration of SP in comparison to children from the control group.

CONCLUSIONS

Although SP and VIP are mainly secreted to the surrounding tissues and in a smaller degree endocrinally to the blood, increased level of these neurohormones in the blood serum in children with allergic dermatitis may confirm their contribution to the pathomechanism of this form of allergy.

[Concentrations of cadmium in blood and urine and their contents in the hair of children from Katowice Murcki]

One of the leading positions on the world's list of harmful substances is taken by cadmium, which is a heavy metal. Cadmium (Cd) gets into the human body through either respiratory tract (cigarette smoke) or alimentary canal. The aim of the study was to 1) determine whether the concentrations of cadmium in blood and urine of children from Katowice Murcki--one of the cleanest districts of the town - as well as its contents in the hair of the children exceeds acceptable values and 2) to analyse the effect of chosen environmental factors (exposition to smoke, parents' education) on the amount of cadmium in these materials. The study comprised 48 children at the age from 9-11 years from Katowice Murcki, attending the same primary school. The findings were statistically analysed using Shapiro-Wilk and Wilcoxon test. Concentration of cadmium in the blood was 0.479 microg/l, in urine 0.840 microg/g creatinine and the average concentration in the hair constituted 0.23 microg/g drymass. Concentration of cadmium in the blood of 13 children (30.95%) exceeded acceptable 0.5 microg/l value, while in 10 children (23.25%) value in the urine was exceeded. It was lug/g creatinine. It has been shown that children who lived nearby motorway presented higher content of cadmium in the hair. Environmental factors such as: location of the road and intensity of traffic influence the content of cadmium in the human body.

[The evaluation of the psychosomatic development in children after infectious and idiopathic cholestatic jaundice in neonatal and infantile period]

We carried out the analysis of psychomotoric and somatic development of 38 children after the period of 6--12 months since suffering from neonatal and infantile jaundice (infectious and idiopathic). We did not confirm retardation of the psychomotoric development in the examined group, however we confirmed deficiency of body mass in 45% of patients. Cholestatic jaundice in this group did not influence the children's. psychomotoric development significantly in the following years. It seems, that deficiency of the body mass of examined children after cholestatic jaundice is mostly dependent on the gestational and labour risk factors or small birth weight rather than on clinical course of disease and etiological factors of jaundice.

[Specific IgE against inhaled allergens in dystreptic children with food allergy]

Immunoglobulin E specific for the selected inhalator allergens have been determined in 42 children with food allergy and failure to thrive, using tests and equipment 3M (Bio Whittaker). Co-existence of food allergy with hypersensitivity to inhaled allergens have been confirmed in 41 children (41%). An equivalent expression grade of IgE antibodies against food and inhaled antigens has usually been noted. Specific IgE produced in response to house dust and mixed feathers have been seen most frequently, and the first have been found in 37% of the tested children in the concentration exceeding 1.0 Ul/ml (2nd, 3rd and 4th class). The obtained results confirmed that specific IgE antibodies against inhaled allergens are being present in children who fail to grow and suffer from the food allergy. These findings should advocate further investigations in specific IgE antibodies to other groups of allergens.

[On carnitine requirements in full term and low birth weight neonates]

The concentration of total carnitine in the blood serum of 15 newborns between days 5-21 of life was determined. The concentration of carnitine in low-birth-weight newborns is decreased in comparison with normal weight newborns; this deficiency may increase as a consequence of lack of carnitine provided with food or concomitant infection. The authors suggest that supplementation with carnitine be provided to this group of patients so as to prevent possible metabolic and clinical consequences.

[Total carnitine level in infants with cystic fibrosis and deficit supplementation by means of pharmacologic preparations and diet. Introductory remarks]

Carnitine deficiency in the serum was found in 5 infants with cystic fibrosis, impaired liver function and neurological symptoms. Clinical improvement and progressive normalization of the carnitine level in the serum, as well of the biochemical parameters of liver function were obtained after enteral pharmacotherapy and a carnitine-rich diet.