Childrens University Hospital Of Cracow

Kraków, Poland

Childrens University Hospital Of Cracow

Kraków, Poland

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Mizerska-Wasiak M.,Medical University of Warsaw | Maldyk J.,Medical University of Warsaw | Rybi-Szuminska A.,Medical University of Bialystok | Wasilewska A.,Medical University of Bialystok | And 13 more authors.
Pediatric Nephrology | Year: 2015

Background: The aim of this study was to evaluate the usefulness of serum immunoglobulin A/complement factor 3 (IgA/C3) ratio for predicting histological severity of kidney lesions in children with IgA nephropathy (IgAN) based on World Health Organization (WHO) and the Oxford classification (OC). Methods: We studied 89 children with IgAN with a mean age of 11.38 ± 4.1 years (range 2–18 years). Based on available medical records, we retrospectively evaluated clinical data, IgA/C3 ratio, and kidney biopsy findings using the five-grade WHO classification and the OC The mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental sclerosis (S), tubular atrophy/interstitial fibrosis (T) (MEST) score (absent = 0, present = 1) calculated as the sum of M+E+S+T ranging from 0 to 4. Results: Mean IgA/C3 ratio values were significantly higher (P < 0.05) in patients with M1, S1, and T1 compared with M0, S0, and T0, respectively (P < 0.05); there were no differences in the WHO classification. We found a significant positive correlation between the IgA/C3 ratio and proteinuria (r = 0.24) and determined optimal cutoff values of the IgA/C3 ratio, with a corresponding confidence interval for specific MEST scores. Conclusions: The IgA/C3 ratio in children with IgAN may be a useful marker of the severity of lesions found in kidney biopsy as evaluated using the OC. © 2015, IPNA.


PubMed | The University Hospital in Cracow, University of Warsaw and Childrens University Hospital of Cracow
Type: Case Reports | Journal: Journal of clinical microbiology | Year: 2015

Truncatella angustata is a coelomycetous fungus, typically associated with vascular plants as either an endophyte or a pathogen. This organism has not previously been implicated in human disease. This report describes a case of T. angustata subcutaneous infection in an immunocompetent patient. A conclusive diagnosis was achieved through partial sequencing of ribosomal DNA (rDNA) cluster. The patient was successfully treated with voriconazole followed by itraconazole.


Skoczynska A.,Polish National Medicines Institute | Wasko I.,Polish National Medicines Institute | Kuch A.,Polish National Medicines Institute | Kadlubowski M.,Polish National Medicines Institute | And 9 more authors.
PLoS ONE | Year: 2013

Background:Neisseria meningitidis is a leading etiologic agent of severe invasive disease. The objective of the study was to characterise invasive meningococcal disease (IMD) epidemiology in Poland during the last decade, based on laboratory confirmed cases.Methods:The study encompassed all invasive meningococci collected between 2002 and 2011 in the National Reference Centre for Bacterial Meningitis. The isolates were re-identified and characterised by susceptibility testing, MLST analysis, porA and fetA sequencing. A PCR technique was used for meningococcal identification directly from clinical materials.Results:In the period studied, 1936 cases of IMD were confirmed, including 75.6% identified by culture. Seven IMD outbreaks, affecting mostly adolescents, were reported; all were caused by serogroup C meningococci of ST-11. The highest incidence was observed among children under one year of age (15.71/100,000 in 2011). The general case fatality rate in the years 2010-2011 was 10.0%. Meningococci of serogroup B, C, Y and W-135 were responsible for 48.8%, 36.6%, 1.2% and 1.2% of cases, respectively. All isolates were susceptible to third generation cephalosporins, chloramphenicol, ciprofloxacin, and 84.2% were susceptible to penicillin. MLST analysis (2009-2011) revealed that among serogroup B isolates the most represented were clonal complexes (CC) ST-32CC, ST-18CC, ST-41/44CC, ST-213CC and ST-269CC, and among serogroup C: ST-103CC, ST-41/44CC and ST-11CC.Conclusions:The detection of IMD in Poland has changed over time, but observed increase in the incidence of the disease was mostly attributed to changes in the surveillance system including an expanded case definition and inclusion of data from non-culture diagnostics. © 2013 Skoczyńska et al.


Wojcik M.,Jagiellonian University | Wojcik M.,Childrens University Hospital Of Cracow | Sudacka M.,Jagiellonian University | Wasyl B.,Jagiellonian University | And 6 more authors.
European Journal of Pediatrics | Year: 2015

The prevalence of type 1 diabetes (T1D) varies greatly between countries. However, over the past several decades, a global rise in the incidence of T1D in the pediatric population has been noted. The aim of our study was to investigate the incidence of T1D in children living in the Lesser Poland during the period of time from January 1, 1987, to December 31, 2012, and to analyze the demographic characteristics and occurrence of diabetic ketoacidosis (DKA) in patients with newly diagnosed T1D in the second part of the study (2006–2012). During 26 years, 636 children (331 boys, 305 girls) aged 0–14 years were newly diagnosed with T1D (0–4 years old, n = 131; 5–9 years old, n = 253, 10–14 years old, n = 252). The standardized incidence ratio (SIR) ranged significantly (p < 0.001) from 5.2/100,000/year in 1987 to 21.9/100,000/year in 2012. The highest SIR was observed in age group 5–9 years old (21.2) and the lowest in 0–4 years old (8.8). There was no association with sex or living in urban or rural area. On admission, DKA was diagnosed in 22.4 % of patients. There were no significant differences relating to the presence of DKA (p = 0.912) in subsequent years. Conclusions: The incidence of T1D among children is increasing rapidly with the highest SIR in the 5–9 years old age group. DKA is still an important problem in the pediatric population. © 2015, Springer-Verlag Berlin Heidelberg.


Zachwieja K.,Jagiellonian University | Korohoda P.,AGH University of Science and Technology | Kwinta-Rybicka J.,Childrens University Hospital of Cracow | Miklaszewska M.,Jagiellonian University | And 5 more authors.
Advances in Medical Sciences | Year: 2015

Purpose: We assessed the reliability of calculating eGFR in children as compared to the iohexol disappearance test (GFR-I), which was performed 417 times in 353 children aged 2 and more. Material/methods eGFR was estimated with equations based on serum creatinine: Schwartz (1: eGFR-Scr), Cockroft-Gault (2: eGFR-CG) and MDRD (3: eGFR-MDRD), and on creatinine clearance (4: eGFR-U), or relying on serum cystatin C: Hoeck (5: eGFR-H), Bokenkamp (6: eGFR-B) and Filler (7: eGFR-F), and on the three Schwartz markers (8: eGFR-S3M). Mean relative error (RE), correlation (R), Bland-Altman analysis and accuracy of GFR-I were studied in all patients and in subgroups: at GFR < 60 ml/min/1.73 m2; in children aged ≤12 and >12. Results: The results by eGFR-Scr, eGFR-S3M demonstrated no statistical difference to GFR-I at GFR < 60 ml/min/1.73 m2, but underestimated eGFR at higher filtration values by 11.6 ± 15.1% and 19.1 ± 16.4, respectively (p < 0.0000). The eGFR-B, eGFR-F and eGFR-MDRD equations illustrated important overestimation of reference GFR results (RE: 84 ± 44.2%; 29.5 ± 27.9%, 35.6 ± 62%; p < 0.0000 for all). The MDRD and C-G formulas showed statistically better consistency in children aged >12. A good agreement was achieved by the eGFR-H equation (5.1 ± 21.9%; p < 0.0000; R = 0.78). Conclusions (1) Schwartz equations show a good conformity at GFR < 60 ml/min/1.73 m2, but underestimate the results at higher GFR values. (2) The Bokenkamp equation with original coefficient should not be employed in children. (3) The use of the Hoeck formula in all children and C-G and MDRD formula in children aged >12 is possible. (4) The error of eGFR calculations increases at higher GFR values. © 2014 Medical University of Bialystok.


Jagielski T.,University of Warsaw | Zak I.,Childrens University Hospital of Cracow | Tyrak J.,University Hospital in Cracow | Bryk A.,University Hospital in Cracow
Journal of Clinical Microbiology | Year: 2015

Truncatella angustata is a coelomycetous fungus, typically associated with vascular plants as either an endophyte or a pathogen. This organism has not previously been implicated in human disease. This report describes a case of T. angustata subcutaneous infection in an immunocompetent patient. A conclusive diagnosis was achieved through partial sequencing of ribosomal DNA (rDNA) cluster. The patient was successfully treated with voriconazole followed by itraconazole. Copyright © 2015, American Society for Microbiology. All Rights Reserved.


Zak I.,Childrens University Hospital of Cracow | Jagielski T.,University of Warsaw | Kwiatkowski S.,Childrens University Hospital of Cracow | Bielecki J.,University of Warsaw
Diagnostic Microbiology and Infectious Disease | Year: 2012

This report describes a rare case of neuroinfection due to Prototheca wickerhamii in a child with severe, congenital hydrocephalus. The infection resolved completely after the patient was treated with oral ketoconazole, followed by intravenous fluconazole and amphotericin B. A probable source of infection was contamination during ventriculoperitoneal drain care procedures. © 2012 Elsevier Inc.


PubMed | AGH University of Science and Technology, Jagiellonian University and Childrens University Hospital of Cracow
Type: Journal Article | Journal: Renal failure | Year: 2016

Estimation of eGFR in children with normal kidney function using the Schwartz equations results in underestimating real GFR.We propose modification of three Schwartz equations - two based on creatinine concentration (eGFRScrBS bedside) and (eGFRScr) and one 3-marker based on creatinine, urea and cystatin C concentrations (eGFRS3M). The iohexol test (reference method) was performed 417 times in 353 children >2 years with mean GFR: 9831.6ml/min/1.73m(2). The assessment included also the Filler and Zappitelli equations. The modification was performed using methods: (1) based on equation, eGFRcor=a [eGFR - T] + T, where T=50, if eGFR>T, and a equals for: eGFRScrBS 1.4043, for eGFRScr 2.0048, for eGFRS3M 1.2951, and (2) based on correction of all coefficients of the original equation.For comparison of all the results and for children with GFR<60, 60-90, 90-135 and >135ml/min/1.73m(2) the correlation coefficient, relative error (RE) and root mean square relative error (RMSRE) was employed and revealed improvement of RE from 25.9 to 6.8 and 3.9% (depending on the correction method) for eGFRScr; from 19 to 8.1 and 3.9% for eGFRScrBS and: from 11.6% to 2.0 and 2.3% for eGFRS3M (respectively). The RMSRE values changed from 30 to 21.3 and 19.8% for eGFRScr, from 25.1 to 21.6 and 19.8% for eGFRScrBS and from 19.1 to 15.8 and 15.3 % for eGFRS3M.Modifications of Schwartz equations at GFR>60ml/min/1.73m(2) significantly improves the accuracy of calculating eGFR. The 3-markers equation is more accurate and should be employed frequently.


PubMed | AGH University of Science and Technology, Jagiellonian University and Childrens University Hospital of Cracow
Type: Journal Article | Journal: Advances in medical sciences | Year: 2015

We assessed the reliability of calculating eGFR in children as compared to the iohexol disappearance test (GFR-I), which was performed 417 times in 353 children aged 2 and more.eGFR was estimated with equations based on serum creatinine: Schwartz (1: eGFR-Scr), Cockroft-Gault (2: eGFR-CG) and MDRD (3: eGFR-MDRD), and on creatinine clearance (4: eGFR-U), or relying on serum cystatin C: Hoeck (5: eGFR-H), Bokenkamp (6: eGFR-B) and Filler (7: eGFR-F), and on the three Schwartz markers (8: eGFR-S3M). Mean relative error (RE), correlation (R), Bland-Altman analysis and accuracy of GFR-I were studied in all patients and in subgroups: at GFR<60ml/min/1.73m(2); in children aged 12 and >12.The results by eGFR-Scr, eGFR-S3M demonstrated no statistical difference to GFR-I at GFR<60ml/min/1.73m(2), but underestimated eGFR at higher filtration values by 11.615.1% and 19.116.4, respectively (p<0.0000). The eGFR-B, eGFR-F and eGFR-MDRD equations illustrated important overestimation of reference GFR results (RE: 8444.2%; 29.527.9%, 35.662%; p<0.0000 for all). The MDRD and C-G formulas showed statistically better consistency in children aged >12. A good agreement was achieved by the eGFR-H equation (5.121.9%; p<0.0000; R=0.78).(1) Schwartz equations show a good conformity at GFR<60ml/min/1.73m(2), but underestimate the results at higher GFR values. (2) The Bokenkamp equation with original coefficient should not be employed in children. (3) The use of the Hoeck formula in all children and C-G and MDRD formula in children aged >12 is possible. (4) The error of eGFR calculations increases at higher GFR values.


PubMed | Jagiellonian University and Childrens University Hospital of Cracow
Type: Journal Article | Journal: European journal of pediatrics | Year: 2015

The prevalence of type 1 diabetes (T1D) varies greatly between countries. However, over the past several decades, a global rise in the incidence of T1D in the pediatric population has been noted. The aim of our study was to investigate the incidence of T1D in children living in the Lesser Poland during the period of time from January 1, 1987, to December 31, 2012, and to analyze the demographic characteristics and occurrence of diabetic ketoacidosis (DKA) in patients with newly diagnosed T1D in the second part of the study (2006-2012). During 26 years, 636 children (331 boys, 305 girls) aged 0-14 years were newly diagnosed with T1D (0-4 years old, n=131; 5-9 years old, n=253, 10-14 years old, n=252). The standardized incidence ratio (SIR) ranged significantly (p<0.001) from 5.2/100,000/year in 1987 to 21.9/100,000/year in 2012. The highest SIR was observed in age group 5-9 years old (21.2) and the lowest in 0-4 years old (8.8). There was no association with sex or living in urban or rural area. On admission, DKA was diagnosed in 22.4 % of patients. There were no significant differences relating to the presence of DKA (p=0.912) in subsequent years.The incidence of T1D among children is increasing rapidly with the highest SIR in the 5-9 years old age group. DKA is still an important problem in the pediatric population. The incidence of pediatric type 1 diabetes mellitus in Europe is increasing. The initial manifestation of the type 1 diabetes mellitus is diabetic ketoacidosis. What is New: This is the longest (26 years) continuous analysis of the incidence of type 1 diabetes in Poland and the first analysis focused on the incidence rate and also on presence of diabetic ketoacidosis.

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