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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 Crohns 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.

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. (Inflamm Bowel Dis 2010;)

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.

Inflammatory Myofibroblastic Tumor of the Heart in the Infant: Review of the Literature.

Primary heart tumors are extremely rare, constituting approximately 0.02% of all malignancies. Inflammatory myofibroblastic tumor (IMT) constitutes <5% of primary heart tumors. Until now, IMT of the heart has been described in 21 infants below 1 year of age. Its etiology remains unknown. IMT usually develops within the right atrial and ventricular endocardium. The main clinical symptoms reported in the affected infants involved increasing respiratory failure, cyanosis, and heart murmurs. Histopathologically, IMT is characterized by the myofibroblast proliferation with inflammatory infiltrates composed of plasmocytes, lymphocytes, and histiocytes. Tumor resection is the treatment of choice in IMT. Such tumor location is associated with the high risk of perioperative failure. Steroid therapy and chemotherapy is reported in the literature as a nonsurgical treatment alternative. Here, we present a review of clinical symptoms, diagnostic and treatment options, based on published case reports of IMT in infants, including our 11-month-old patient with IMT located within the pericardium.

Opinie rodziców na temat szczepień ochronnych u dzieci

Introduction. Vaccination is the most effective method of preventing infectious diseases in children, implemented according to the annually updated immunization programme. The degree of implementation of the vaccination in children depends of parents’ awareness. Aim of the study. The aim of this study was to investigate the opinions of parents about vaccination, of their security and sources of obtaining information for parents about vaccinations. Material and methods. The study was conducted from January to May 2012 in the Paediatrics Hospital in Bielsko – Biała, in a group of 123 parents who completed an anonymous survey. Results. Analysis of the collected data showed that the degree of compulsory vaccinations among children is high. The recommended vaccinations are performed in a small group of children. Most respondents believe vaccinations are safe for children. The main source of information on vaccination for parents is a doctor. Conclusions. 1. Parents vaccinate their children despite doubts about the efficacy and safety of vaccines used in children. 2. There is a need for greater activation of the media, journals, radio and television, in order to disseminate information on immunization and vaccines. 3. There is a need to promote health education among parents and to shape proper attitudes towards immunization. This is a major task for health staff.

Psychologiczne aspekty operacyjnego leczenia skolioz u młodzieży

Wstep Przebywając na oddzialach urazowo-ortopedycznych pacjenci oczekujący na zabieg operacyjny korekcji skoliozy rzadko mają mozliwośc rozmowy z psychologiem, a zatem uzyskania wsparcia w tej trudnej sytuacji. Jak wiadomo, nie wszystkie dzieci potrafią poradzic sobie z bolem, a powstalą w wyniku stresu zlośc rozladowac w konstruktywny sposob. Cel Celem badania byla ocena sily indywidualnych przekonan dotyczących kontrolowania bolu osobiście (wewnetrznie), poprzez wplyw lekarzy (sila innych) oraz przypadkowe zdarzenia, ocena nasilenia gniewu zewnetrznego i wewnetrznego, jak rowniez nastroju przed operacją i po zabiegu. Metoda Zbadano 20 dzieci w wieku 15–18 lat (19 dziewcząt i 1 chlopiec) za pomocą Kwestionariusza Przekonan na Temat Kontroli Bolu (BPCQ) autorstwa Suzanne Skevington oraz Zygfryda Juczynskiego oraz Skali Ekspresji Gniewu (SEG) Niny Oginskiej-Bulik i Zygfryda Juczynskiego. Nastroj oceniali pacjenci wedlug skali 0–10 (0 – najnizszy nastroj, 10 – najwyzszy). W taki sam sposob oceniali odczuwane przez nich nasilenia bolu (0 – najnizszy, 10 – najwyzszy) [1] . Wyniki Uzyskane wyniki surowe przeliczano na skale stenową wedlug tabel autora [1] , a nastepnie porownywano ich średnie wielkości. Dzieci oceniające bol jako przypadkowe zdarzenie najnizej ocenialy nastroj przed oraz po operacji skoliozy. Ich ocena bolu po zabiegu, w porownaniu z badanymi potrafiącymi kontrolowac wlasne doznania bolowe samemu bądź dzieki pomocy lekarzy byla najwyzsza. Badani chorzy (z wyjątkiem jednej osoby) wykazali znacznie wyzszy gniew wewnetrzny od gniewu zewnetrznego, co mogloby sugerowac, iz nie potrafią oni rozladowac zlości powstającej w nich na skutek trudnej sytuacji. Wnioski Wskazane jest przeprowadzenie badan na wiekszej grupie dzieci oraz wlączenie opieki psychologicznej jako standardu postepowania z osobami przed operacją i po operacji kregoslupa, w celu obnizenia leku oraz konstruktywnego rozladowania powstalej zlości.

Bezoar żołądka jako przyczyna guza jamy brzusznej u 16-letniej dziewczynki ☆

Przedstawiamy przypadek 16-letniej dziewczynki, ktora zostala przyjeta do Kliniki z podejrzeniem guza jamy brzusznej. Na podstawie obrazu klinicznego oraz wynikow badan specjalistycznych (TK jamy brzusznej, endoskopia gornego odcinka przewodu pokarmowego) u dziewczynki rozpoznano trichobezoar zolądka. Dziewczynke zakwalifikowano do leczenia operacyjnego. W przedstawionej pracy chcemy zwrocic uwage na mozliwośc wspolwystepowania kilku przyczyn doprowadzających do powstania bezoara zolądka. Podlozem choroby u naszej pacjentki mogly byc zarowno zaburzenia psychiczne, jak i nieprawidlowości motoryki gornego odcinka przewodu pokarmowego.

Serum Level of D-Lactate in Patients with Cystic Fibrosis: Preliminary Data

D-Lactate is produced by the intestinal biota and later absorbed into circulation. Some patients with cystic fibrosis (CF) develop exocrine pancreatic insufficiency that may disturb the gut microbiome and enhance the production of D-lactate. However, this concept has not been studied yet. The aim of the study was to assess D-lactate concentration in relation to the occurrence of clinical features, activity of CF, and diet composition in paediatric patients. Patients and Method. Serum concentrations of D-lactate were measured in 38 CF patients (19 girls and 19 boys) from 6 months to 18 years of age. The analysis included age, sex, clinical symptoms, diet (the variety and calorie needs), the laboratory tests for pancreatic efficiency (serum levels of albumin and glucose, faecal elastase activity, and faecal fat index) and faecal calprotectin (the marker of intestinal inflammation), and parameters of liver damage and of cholestasis (the activity of aminotransferases, γ-glutamyltransferase, level of bilirubin, and international normalized ratio). Results. The median level of D-lactate was 0.86 μg/ml (1Q–3Q: 0.48–2.03) and correlated with the CF severity in the Schwachman-Kulczycki score, parameters of pancreatic insufficiency, and the presence of intestinal inflammation. An increased level of D-lactate was observed in the subgroup with pancreas insufficiency (1.05 versus 0.73; p < 0.05), parallel with an elevated level of calprotectin (0.948 versus 0.755; p = 0.08). There was no relationship between energy consumption and diet composition and serum D-lactates. Conclusion. Serum D-lactate concentration in CF patients is a promising new marker of exocrine pancreatic insufficiency probably related to intestinal flora dysbiosis/overgrowth.

Acute pancreatitis in children

Introduction The acute pancreatitis is a rare disease, but it has started to be diagnosed more often in children. Aim The aim of the study was single-centre, retrospective analysis of the incidence, aetiology, and clinical course of acute pancreatitis in children. Material and methods We analysed the medical records of patients with acute pancreatitis hospitalised in the Gastroenterology Unit of the Paediatrics Department, Medical University of Silesia from Jan 2004 to Dec 2013. Results There were 76 cases of acute pancreatitis among 51 children (average age: 12.07 years) hospitalised in the Gastroenterology Unit between January 2004 and December 2013. The diagnosis of acute pancreatitis was performed on the basis of INSPIRE criteria and modified Atlanta classification. Patients were divided into groups: I – 1–12 years old, which included 20 (39.21%) children and II – 13–18 years old, with 31 (60.78%) children. The idiopathic aetiology was the most common cause of acute pancreatitis, occurring in 22 (43.1%) children, and in 15 cases the aetiology of the disease was biliary (29.4%). Genetically determined causes were diagnosed in 8 (15.7%) patients, the PRSS1 mutation in four patients, mutation in SPINK1 in 1 child, and CFTR gene mutation in 1 child. Two children simultaneously had two genes mutations (CFTR, SPINK1), and during the considered period had more than one episode of acute pancreatitis. Conclusions Acute pancreatitis of idiopathic aetiology was most common among the examined children, and this should encourage the continued search for the causes of disease, especially genetic, and with particular emphasis on younger age group.

The concentration of calprotectin in the stools of children with diagnosed cystic fibrosis

Introduction Calprotectin is a protein that plays a regulatory role in inflammatory reactions as an antibacterial and antiproliferative factor. Aim To assess the concentration of calprotectin in the stools of patients with diagnosed cystic fibrosis. Material and methods Forty-one patients were included in the study, 24 boys and 17 girls, aged from 7 weeks to 18 years. The concentration of calprotectin in stools was assessed with the ELISA method. The analysis included clinical symptoms and the results of laboratory tests and the type of mutation. Results An elevated level of calprotectin in the stool was observed in 4/41 (9.7%) patients, mainly in older children, and mainly delta F508/deltaF508 mutation. The correlation between the concentration of calprotectin and clinical symptoms, age, increased indicators of an inflammatory process, levels of protein and aminotransferases in blood serum and the values of acid steatocrit of the stool was not proven. Conclusions High concentrations of calprotectin in the stools of children with diagnosed cystic fibrosis do not correlate with the level of advancement of lesions within the gastrointestinal tract. Elevated concentrations of calprotectin in the stools of patients with cystic fibrosis may indicate inflammation of intestine and should be further scrutinised.