Oddzial Pediatrii

Bydgoszcz, Poland

Oddzial Pediatrii

Bydgoszcz, Poland
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Czaja-Bulsa G.,Zaklad Pielegniarstwa Pediatrycznego | Jakubik M.,Oddzial Pediatrii
Pediatria Wspolczesna | Year: 2012

Introduction: In the pathogenesis of the eosinophilic esophagitis (EoE) a crucial role is played by genetic factors, exposition to food and environmental allergens and the IgE-dependent activation of the immunological system. Aim of the study: The incidence of atopy and allergies as well as the EoE children's response to treatment. Material and methods: The study covered 14 children (3 girls, 11 boys) at the average age of 9.2 years (aged 8 months to 17 years), whose esophageal mucosa contained at least 15 eosinophils (18-80) per high power field (×400). The diagnostic procedures included the analysis of medical records and clinical manifestations, prick and patch tests as well as an open elimination and provocation test. The results of treatment by means of elimination diet as well as topical and systemic steroids were also analysed. Results: Food allergy was diagnosed in 64% of children, inhalatory allergy - in 57%. Food related EoE was diagnosed in 3 (21%) children. Clinical response was achieved in 86% of children: in three of them after food elimination, in two - after fluticasone treatment and in seven of the patients following a 3-6-month administration of prednisone (all the children suffered from asthma bronchiale). Conclusions: 1. The group at risk of the EoE are children suffering from allergies. 2. The EoE therapy includes an elimination diet as well as topical and systemic steroids. Administration of topical steroids is effective in children who do not suffer from bronchial asthma. In children with bronchial asthma therapeutic effects are achieved no sooner than after several months of treatment with systemic steroids. Copyright © 2012 Cornetis.

Introduction: One of the important factors of successful therapy of a non-specific colitis is mucosal healing. It is believed that treatment with biological drugs is exceptionally fast and effective. Aim of the study: The assessment of the impact of infliximab (IFX) treatment on mucosal healing and clinical remission in pediatric patients with severe Crohn's disease. Material and methods: The data concerning 10 children (7 boys, 3 girls) aged 6-18 (mean of 13.5) were analyzed. The PCDAI disease activity score prior to biological treatment was 51.5-90.5 pts. (mean of 60). In 6 children the disease was observed in the colon, in 4 - in the ileum and colon, while in one boy the upper digestive tract was affected. The mean time of biological treatment that started on the disease diagnosis was 13 months (3-33). IFX was administered in a dose of 5mg/kg of body mass, in a scheme of 0, 2, 6 weeks, in order to induce remission, followed by maintenance doses every 8 weeks. Corticosteroids, azathioprine and methotrexate were administered as supplementary treatment. One month after the induction therapy, the disease activity was assessed by means of the PCDAI scale as well with the simplified SES-CD endoscopic scale. In 4 patients the control endoscopic test was carried out later: in 3 of them following the 4th dose, in one - after the 6th dose. Results: After 3 doses of infliximab the clinical remission (PCDAI <10 pts.) was achieved in 5 (50%) patients, a clinical response (15 pts ≤ PCDAI ≤ 30 pts.) in 2 (20%). In 3 (30%) children disease symptoms stabilised, their general feeling and biochemical test results improved with no full clinical response criteria observed. In 4 (40%) patients colonic mucosa partially healed and the score in SES-CD scale fell by the average of 10 points. Only one girl demonstrated full endoscopic and histological remission. In a short term observation the biological treatment was safe. The complications were mild and easily treated: 2 patients developed herpes zoster infection and during infusion general symptoms were observed. One boy developed pneumonia. Conclusions: In children with severe Crohn's disease who have not responded to conventional treatment the biological 3-dose IFX therapy is an effective form of treatment leading to the stabilization of symptoms; in half of the patients it induces clinical remission. However, in the majority of the children it is not sufficient to heal the colonic mucosa. The long-term maintenance of healing by IFX therapy is necessary to achieve optimal benefit. © 2010 Almamedia Press.

Grazyna C.-B.,Zaklad Pielegniarstwa Pediatrycznego | Anna K.-B.,Oddzial Pediatrii | Aneta G.,Samodzielna Pracownia Propedeutyki Chorob Dzieci
Pediatria Wspolczesna | Year: 2010

Introduction: Eosinophilic colitis (EC) ia a rare disease chararcterised by an increased number of eosinophils in an infiltration. Such a growth in eosinophils number in an inflammatory infiltration can also be observed in some patients with Crohn's disease (CD). Aim of the study: The analysis of the clinical, edoscopic, histological pictures and of the efficiency of treatment of children with the eosinophilic infiltration of colonic mucosa. Material and method: Retrospective assessment of the disease course in 6 children with eosinophilic infiltration >50/hpf: 3 boys with EC (5.5-13 years old, mean of 9.2) and 3 children with CD (a boy and two girls: 1.5 to 13 years old, mean of 6.8). Results: Each of the 3 patients earlier had been treated due to another intestinal disease: mucoviscidosis, non-classified colitis or salmonellosis. In 3 children a colonoscopy was conducted as the first examination (abdominal pain, long-lasting diarrhoea or sigmoid distention), while in others as the second control one (infliksimab and MTX treated CD and mesalazine treated non-classified colitis). In children with CD the endoscopic picture was typical of the disease exacerbation. In the remaining ones - it was different in each case: healthy mucus or swollen mucus with contact bleeding and lymph follicle hypertrophy or whitened mucus covered with calcified masses. In all the children the infiltration was observed in the colon, while in 3 of them - in the ileum as well. In all the biopsy specimens the number of eosinophils was in the range of 50-181/hpf, the infiltration volume was changeable in 5 and stable in 1 child. The peripheral blood eosinophilia was not observed. In 2 children lambliasis was early diagnosed, in 5 - atopy (4 were allergic to foods, 1 to pollen), one demonstrated food allergy, 2 of them suffered from other allergies. In 2 children prednisone (1 mg/kg/day for 3 months) were administered, resulting in the decrease of eosinophils in the infiltration (from 63-179 to 15-85), then they were successfully treated with budesonid for 3 months. One child was successfully treated with mesalazine. The treatment of children with CD remained unaltered. One of them returned to steroids. Conclusions: Children with the eosinophilic infiltration of colonic mucosa do not demonstrate any co-relation among the clinical, endoscopic and histological pictures. The sole common feature is the incidence of diseases that activate eosinophil incidence, such as allergy, atopy or helminthises. © 2010 Almamedia Press.

Sawilska-Tanska M.,Oddzial Pediatrii | Pawlowska M.,Klinika Chorob Zakaznych i Hepatologii Wieku Rozwojowego | Wietlicka-Piszcz M.,Katedra Podstaw Teoretycznych Nauk Biomedycznych i Informatyki Medycznej CM UMK
Pediatria Polska | Year: 2016

The aim of the study was to estimate the changes in the clinical course and treatment of meningitis in children hospitalized at the Hospital of Infectious Diseases in Bydgoszcz during the years 1989-2010. Material and methods 184 treated children (96 boys and 88 girls) aged from 2 weeks to 18 years, underwent epidemiology, clinical course and treatment of meningitis. Results The etiology detection was 57.1%. Most common pathogens were Neisseria meningitidis (25.00%), Haemophilus influenzae (19.02%) and Streptococcus pneumoniae (8.69%). In the youngest group of patients, the most common causes of meningitis were group B Streptococcus and Salmonella. There were high inflammatory markers in the blood and high pleocytosis in the cerebrospinal fluid. Top rates of these indexes, as well as a serious course of the disease, were observed in meningitis due to Streptococcus pneumoniae. Conclusions Throughout the analyzed time a significant decrease in meningitis incidence was observed.The etiological changes of meningitis through the years reflect the introduction of active immunoprophylaxis and suggest a possibility of the occurrence of meningitis due to non-vaccination strains.An increase in the incidence of meningitis due to Streptococcus pneumoniae and Neisseria meningitidis C as well as its serious clinical course signalizes the need of vaccination recommendation.Inflammation markers indicate a correlation with the patient's clinical condition and the dynamism of the illness process.Higher antibiotic therapy efficacy results in shorter meningitis treatment duration. © 2015 Polish Pediatric Society.

Wilczynska D.,Nicolaus Copernicus University | Lezyk-Ciemniak E.,Nicolaus Copernicus University | Kobusinska K.,Oddzial Pediatrii | Grzesk E.,Nicolaus Copernicus University | And 4 more authors.
Pediatria Polska | Year: 2016

Introduction Fever is one of the most common reasons why parents and a child go to the pediatrician. Fever of unknown origin (FUO) is a very difficult diagnostic problem. Objective The study aims were retrospective analysis of causes of FUO and periodic fevers in children and trying to prepare a diagnostic algorithm. Material and methods The study involved 77 children, aged 1-19 years who were hospitalized in the Department of Pediatrics, Oncology and Hematology and the Department of Pediatrics, Cardiology and Rheumatology in the years 2005-2011. Since the work is retrospective, qualifications for the study took place on the basis of medical records such as a medical history. The study group included children who had a temperature over 38 °C lasting more than 3 weeks or appearing on a regular basis every 3-4 weeks without an obvious cause. Results The most common cause of FUO was neoplastic diseases (48%), especially acute lymphoblastic leukemia. Other diagnoses were made in 41.6%. Among them, in 15.6% patients autoimmune diseases and other immunological syndromes, in 7.8% periodic fever syndromes and in 18.2% infectious diseases were diagnosed. 10.4% patients were without final diagnosis. Very important in diagnostic process was analysis of concomitant signs and symptoms. Conclusions Infectious, autoimmune and noeplastic diseases should be concerned in a differential diagnosis of FUO. Appropriate questions, physical examinations and basic laboratory tests often allow to make the correct diagnosis. The proposed diagnostic algorithm might be helpful to a successful diagnostic process. © 2016 Polish Pediatric Society.

Czaja-Bulsa G.,University Of Szczecin | Gebala A.,Oddzial Pediatrii | Jakubik M.,Oddzial Pediatrii
Przeglad Gastroenterologiczny | Year: 2012

Introduction: In recent years the increased incidence of diagnosed primary eosinophilic oesophagitis (EoE) has been observed in West Pomerania. Aim: The analysis of clinical and endoscopic pictures of EoE in children. Material and methods: The study covered 14 children (3 fe male, 11 men) at the average age of 9.2 years (aged 8 months - 17 years) whose oesophageal mucosa contained at least 15 eosinophils (18-80) per high-power field (400x). The group of younger children (aged 0-10 years, n = 8) was compared to the group of older children (aged 11-1 years, n = 6). Retrospective medical records of clinical manifestations and endoscopy examinations were analysed. Results: The most common EoE symptoms were abdominal pain, food aversion and regurgitation (83-100%). Older children also displayed dysphagia, odynophagia and feeling of food impaction (50-66%). In 2/3 of younger patients no changes were observed in the endoscopic picture. The lesions were observed in all the older children. They included concentric rings (83%), longitudinal furrows (50%), granulated mucosa and oesophageal stenosis (17% each). Conclusions: It is its clinical, endoscopic and histological picture that makes EoE different from gastroesophageal reflux disease. The clinical picture of EoE changes with age. In younger children the clinical picture is non-specific, while older children suffer from dysphagia, odynophagia and the sensation of food impaction. Since EoE often occurs in younger children with healthy mucosa, there is a high risk of overlooking the disease during a routine endoscopy of the upper part of the alimentary tract.

Krzywy I.,Oddzial Pediatrii
Annales Academiae Medicae Stetinensis | Year: 2010

Lead (PB, latin name plumbum) is a heavy metal commonly found in nature. In the environment it is not biodegradable nor does it undergo dissociation. It can accumulate in the tissues of living organisms. Throughout the years the attitude towards lead has changed. Once widely used, currently considered a big threat to the health ofa human. The development of civilization and associated with it an increase of lead emission contributes to a major contamination of the natural Pb environment. The authors have focused attention on the causes and effects on the environmental contamination of lead on human health. Environmental and occupational dangers of lead exposition have been discussed. Strict interdependence between the dose and time of exposition, its concentration in tissues and the appearance of clinical symptoms among humans have been stressed. Additionally, rules of controlling lead concentration in natural environments and places of work with the aim of avoiding lead poisoning have been discussed.

Gebala A.,Samodzielna Pracownia Propedeutyki Chorob Dzieci Pomorskiego | Czaja-Bulsa G.,Zaklad Pielegniarstwa Pediatrycznego Pomorskiego | Czaja-Bulsa G.,CNRS Laboratory for Oceanography and Climate, Experimentation and Digital Approaches] | Korlatowicz-Bilar A.,Oddzial Pediatrii
Gastroenterologia Polska | Year: 2012

Urological complications associated with inflammatory bowel disease occur in almost 25% of patients, but renal parenchymatitis is rare. IgA nephropathy is the most common form of the primary glomerulonephritis. It can be also observed, however, as a secondary disease in association with such digestive system conditions as liver diseases, celiac disease, the Crohn's disease (CD) or colitis ulcerosa. The joint pathomechanism of these disorders is still a subject of studies. We present the case of a 15-year-old boy with severe CD who developed the extra-intestinal symptoms in a form of an erythema nodosum as well as of erythrocyturia and proteinuria during the first aggravation of the disease. The CD had been diagnosed when the boy was 13 years old, inflammatory lesions covered the upper and lower parts of the digestive system. The disease activity was assessed on the PCDAI (pediatric Crohn's disease activity index) scale at 52.5 points (severe disease). The child was treated with steroids and azathioprine, then, due to no response, the boy was treated biologically with infliximab. Consequently, full clinical remission and partial healing of the intestinal mucosa was obtained. Withdrawal of the biological treatment resulted in the primary disease aggravation accompanied by the full manifestation in the digestive system, massive changes in the form of the erythema nodosum on both shanks as well as by erythrocyturia and proteinuria. In the course of differential diagnosis based on the renal biopsy the IgA nephropathy was diagnosed. The biological treatment and the administration of angiotensin converting enzyme inhibitors were resumed which resulted in the abating of the CD intestinal and extra-intestinal symptoms. Copyright © 2012 Cornetis.

Chumiecki M.,Oddzial Pediatrii | Prokopowicz Z.,Oddzial Pediatrii | Deja R.,Oddzial Pediatrii | Jarosz-Chobot P.,Oddzial Pediatrii
Pediatric Endocrinology, Diabetes and Metabolism | Year: 2015

Introduction: Diabetic ketoacidosis (DKA) is still the most dangerous acute complication of type 1 diabetes mellitus (T1DM). It is a life-threatening condition requiring intensive treatment. DKA may be the first symptom of previously undiagnosed diabetes, especially in children. Aim of the study: Assessment of the incidence and clinical manifestation of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes. Material and methods: We analyzed 535 medical files of children (aged 9 months to 17 years, mean age 4.41±9.96, 261 girls (48%)) hospitalized from 2006 to 2009 because of the newly diagnosed type 1 diabetes mellitus. DKA was diagnosed (according to ISPAD) in children with pH <7.3, blood glucose level >11 mmol/L (>200 mg/dL) and/or blood concentration of bicarbonate <15 mmol/L with ketonuria. Severe DKA was diagnosed in children with pH <7.2. Results: DKA was diagnosed in 123 patients (23%) (63 girls (51%)). The mean age of children with DKA was significantly lower than the age of the children without DKA (9.05±4.45 vs 9.48±4.39 years; p<0.001). Mean pH was 7.21±1.03 (min. 6,82; max. 7,30). In 32.5% of children with DKA severe ketoacidosis (pH ≤7.2) was observed. The prevalence of acidosis was higher in the 0-4 age group compared to children over 4 years (28 vs. 22%, p<0.001). Neither sex, nor symptoms duration were associated with the development of DKA. Polyuria (95%), polydipsia (95%), weight loss (85%) and abdominal pain (50%) were the most common symptoms reported by patients. Conclusions: Despite the typical symptomatology of type 1 diabetes mellitus, about 1/4 of newly diagnosed diabetes in children is accompanied by ketoacidosis. The risk of acidosis is greater in younger children. © 2013, Cornetis. All rights reserved.

Mazur-Zielinska H.,laski University Medyczny towicach | Zielinski M.,laski University Medyczny towicach | Pilarz L.,laski University Medyczny towicach | Karbowska D.,Oddzial Pediatrii | Birkner E.,laski University Medyczny towicach
Pediatria Polska | Year: 2015

The imbalance of oxidative and antioxidative processes occurs in the course of various diseases. Objectives The aim of the study was the assessment of TAC and TOS value in children with juvenile idiopathic arthritis (JIA). Methods The studied parameters were measured in blood serum taken from 30 patients with JIA. Patients' age ranged from 2 to 18 years. They were hospitalized in the Rheumatology Division of the Department of Pediatrics or followed up in Rheumatology Outpatient Clinic, Silesian Medical University. The control group consisted of 18 healthy children aged from 2 to18 years. Results There were a significant difference of TOS levels in children with JIA (mean value: healthy children 14.45 ± 48.48 μmol/l, children with JIA 64.42 ± 44.81 μmol/l, p < 0.05). TAC levels were similar in both groups (mean value: healthy children 0.82 ± 0.08 mmol/l, children with JIA 0.83 ± 0.12 mmol/l, p > 0.05). Conclusion Oxidative/antioxidative processes are affected in the course of JIA. TOS can be used as an inflammation marker in JIA. © 2015 Polish Pediatric Society. Published by Elsevier Sp. z o.o. All rights reserved.

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