The development of the Sabin–Pinkerton triad despite prenatal screening for congenital toxoplasmosis

The paper presents a case of a boy who developed the symptoms of congenital toxoplasmosis: hydrocephalus, retinitis, choroiditis and intracranial calcifications (the Sabin–Pinkerton triad). Despite prenatal screening in the first trimester of pregnancy (in accordance with the guidelines of the Ministry of Health), which indicated the diagnosis of asymptomatic primary Toxoplasma gondii infection in the pregnant mother, no antiparasitic therapy was used. The presented serological and imaging findings, as well as specialist consultations confirm the intensified effects of congenital infection in the child. Although the child was put on anti-toxoplasma therapy immediately after birth, he developed severe psychophysical development disorders. The paper discusses recommendations for maternal diagnosis and antiparasitic treatment that could have prevented the full-blown congenital toxoplasmosis in the described patient.

Multifactorial aetiology of recurrent respiratory tract infections in children

Recurrent respiratory tract infections in children are a common health problem. Exposure to harmful environmental agents and coexistence of chronic diseases affect the severity and rate of infections. Ineffective outpatient treatment is an indication for a more comprehensive diagnostic workup. The aim of the study was to determine the cause of recurrent respiratory tract infections in children. The study group included 130 children aged 3–17 years who were referred for diagnostic investigation to determine the cause of recurrent respiratory tract infections. The eligibility criterion for the study group was the occurrence of 8 or more respiratory tract infections a year in children aged up to 6 years and 5 or more infections a year in children aged 7–17 years. The study group was subdivided into the following age groups: 3–5 years (n = 60), 6–9 years (n = 35), 10–13 years (n = 11) and 14–17 years (n = 24). The presence of potential risk factors for recurrent infection was analysed on the basis of questionnaires. Tests and examinations were also performed in order to exclude allergies, ear, nose and throat disorders and gastroesophageal reflux disease. Selected laboratory values (complete blood count, vitamin D concentration, immunoglobulin levels) were compared with those obtained from 86 healthy children from the control group. The majority of children had risk factors for recurrent respiratory tract infections. Adenoid hypertrophy was diagnosed in 44.6% of children, asthma in 36.9%, vitamin D deficiency in 30.7%, gastroesophageal reflux disease in 16.2% and immunodeficiency in 9.2% of children. Multimorbidity was found in 34.6% of the subjects. In the study group, there were higher vitamin D levels [study group: 25.6 ng/mL (25th percentile = 17; 75th percentile = 33.3), control group: 22.84 ng/mL (25th percentile = 16.3; 75th percentile = 28.7); p < 0.044] and higher leukocyte levels [study group: 7.5 × 103/μL (25th percentile = 5.9; 75th percentile = 9.1), control group: 6.4 × 103/μL (25th percentile = 5.3; 75th percentile = 7.7); p < 0.02]. The results indicate that children with recurrent respiratory tract infections are a heterogeneous group of patients. The youngest children were the largest group (n = 60). In the majority of children, the onset of symptoms was associated with the beginning of nursery/preschool or school attendance. In 1 in 3 children, a combined presence of a few diseases was found which increase susceptibility to recurrent respiratory tract infections.

Epithelial gastric polyps

Gastric polyps are lesions projected above the mucosal surface, which are detected in approximately 1–6% of upper gastrointestinal endoscopies. Based to their shape, polyps are classified as pedunculate, semi-pedunculate, sessile and flat. Depending on the histopathological type, some of them have the potential to transform into adenocarcinoma. Polyps can be of epithelial and non-epithelial origin. The first group, which is discussed in greater detail in this paper, includes fundic gland polyps, hyperplastic, adenomatous and hamartomatous polyps. Non-epithelial polyps include stromal tumours, leiomyomas, fibrous inflammatory polyps, fibroids, fibromyomas, lipomas, ectopic pancreas, neuroendocrine tumours, neuromas, and some vascular lesions. Multiple polyps in patients under the age of 40 years require more extensive diagnosis for hereditary polyposis syndromes, which are associated with an increased risk of gastric cancer, as well as other gastrointestinal and extra-gastrointestinal malignancies. In recent years, there has been a clear decrease in the proportion of hyperplastic polyps and an increase in the proportion of fundic gland polyps among all gastric polyps, which is probably related to the increased use of proton pump inhibitors and a reduced incidence of Helicobacter pylori infections. About 90% of gastric polyps are detected accidentally and usually do not cause clinical symptoms, but large polyps may be responsible for anaemia, bloody stools, abdominal pain, and even pyloric obstruction, which may be manifested by vomiting, severe flatulence, lack of appetite or progressive weight loss.

Surgical treatment of hydronephrosis in children: a single-centre study

Introduction: Hydronephrosis is one of the most commonly diagnosed urinary tract defects in children. It is characterised by various degrees of dilation of the renal pelvis and calyces with concomitant thinning of the renal parenchyma. The dilation is caused by a ureteropelvic junction defect obstructing the outflow of urine from the kidney. Extreme hydronephrosis can lead to a complete lack of function of the affected kidney. The treatment of hydronephrosis involves restoring normal urine outflow from the kidney and depends on the cause of the condition. The decision to perform surgery depends on the rate of progression of abnormalities observed in the renal parenchyma, among other aspects. Aim of the study: The paper presents the experiences of a single centre in the surgical treatment of hydronephrosis in children aged up to 18 years. Materials and methods: In 2016–2020, 77 children underwent surgery for hydronephrosis at the present authors’ department. In 40% of cases, hydronephrosis was diagnosed on antenatal screening, in 31% it was observed on abdominal ultrasound performed due to abdominal pain, in 17% the condition was detected incidentally when the causes of other diseases were being investigated, in 9% urinary tract infection led to the discovery of hydronephrosis and in 3% of cases abdominal trauma was the reason the patient was examined in the first place. In 58% of the subjects, the cause of hydronephrosis was intramural stenosis of the ureteropelvic junction, in 22% it was the presence of accessory vessels and in 20% various other causes were found. In all patients, Anderson–Hynes ureteropyeloplasty was performed. Results: Surgical outcomes were assessed 12 months after the procedure, and in 97.4% of cases they were considered good. A repeat operation was performed in only 2 cases due to a lack of improvement after the original hydronephrosis surgery. Conclusions: Surgical treatment of hydronephrosis caused by ureteropelvic obstruction is an effective and safe method with a low risk of early and late complications.

Cardiovascular risk in patients with Cushing’s disease – an interdisciplinary problem

Cushing’s disease is a chronic endogenous hypercortisolaemia associated with overproduction of adrenocorticotropic hormone by a pituitary adenoma, leading to multiple systemic complications that significantly increase morbidity and mortality, as well as reduce the quality of life as a result of prolonged tissue exposure to excess cortisol. Hypercortisolaemia in Cushing’s disease is associated with significant functional and constitutional disorders of the entire body. The consequences of chronic hypercortisolaemia include haemodynamic disorders associated with excessive vascular contraction and increased blood pressure, obesity, carbohydrate metabolism disorders, dyslipidaemia, and coagulopathies, which may contribute to significant cardiovascular remodelling. Cardiovascular disorders have a particular impact on long-term prognosis and quality of life in Cushing’s disease. If left untreated, Cushing’s disease significantly increases the cardiovascular risk and limits the treatment options for secondary organ complications. Cardiovascular mortality (myocardial infarction, heart failure, stroke) is several times higher in patients with Cushing’s disease than in the general population. Early diagnosis of the corticotropic pituitary tumour, as well as a thorough morphological and functional cardiovascular assessment seem essential in risk stratification. Normalisation of cortisol levels after combined neurosurgical and/or pharmacological treatment reduces mortality and the risk of cardiovascular and respiratory complications. The aim of this study is to present the complexity of clinical problems in patients with Cushing’s disease, who are in a particular need of interdisciplinary care.

Impact of alcohol consumption on the health of pregnant women and their children – a review of studies

Introduction: Alcohol is one of the strongest teratogens. Since the 1960s, information campaigns have been conducted to address its harmful effect and promote quitting drinking, especially by pregnant women. The aim of this paper includes a review of literature concerning research on alcohol use by pregnant women and learning about their knowledge of the detrimental effects of ethanol on the health of themselves and their unborn children. This paper shall also assess social campaigns devoted to informing this group of women about the harmful effects of alcohol consumption. Description of state of knowledge: The review explicitly confirmed data on the harmful effect of alcohol on the formation of morphological and behavioural changes stigmatising children, which are not always visible from birth, and often take the form characteristic of foetal alcohol syndrome only in schoolchildren. The results of molecular and psychological tests have raised the question as to whether the acceptable limits for blood alcohol content in pregnant women should be established. The toxic effects of alcohol and its metabolites depend not only on the amount consumed, but also on the body condition, style of drinking, and age. Summary: Studies covering 11 European countries have shown that drinking alcohol during pregnancy is more and more common, especially in better-educated women with higher earnings and from larger cities. Therefore, information campaigns that stress the harmfulness of the so-called risky drinking by pregnant women should be targeted primarily at this group.

The role of parents in shaping good nutrition habits in children

Introduction and aim of the study: Creating and strengthening correct eating habits in preschool and school age is a basic element of developing healthy lifestyle in children. The greatest role in this significant period for developing specific eating behaviours is played by parents who are not only responsible for providing healthy food, but also the right example to follow. The aim of the study was to analyse children’s eating habits and physical activity depending on body mass index, level of education, and type of their parents’ activities. Materials and methods: The study was conducted in a randomly selected educational institution after obtaining the consent of the school’s headmaster. The participants of the study were children and their parents (N = 80; 52 girls and 28 boys) aged 6 to 13, residents of the Podkarpackie Voivodeship. Results: This study shows that mothers with a higher level of education are more likely than mothers with a lower level of education to have children with normal body weight or overweight (p = 0.026). More often, physical education classes were attended by children whose parents regularly take up physical activity, and the time spent by parents on physical activity during the week was a factor affecting their children’s participation in additional sports activities. The children of parents regularly taking up physical activity participated in them more often. Conclusions: Parents, through various processes and behaviours, instil in their children certain mechanisms which are important from the health perspective and can be helpful and contribute to the proper development of nutritional practices.

Infantile parotid haemangioma: a report of three cases

Aim of this case: To highlight the presentation of rapidly enlarging parotid haemangioma in three children who were all successfully managed with oral propranolol. Case report: Parotid haemangioma in infancy, albeit rare, has been vastly reported due to it being the most common tumour of the salivary gland in infants. Despite that, the presence of a rapidly enlarging tumour in “the little ones” may be daunting, leading to countless unwarranted procedures by attending physicians. Herein, we present three cases of infantile rapidly tumefying parotid lesions which were diagnosed clinically with the support of imaging, and successfully managed by promptly initiating oral propranolol. Conclusion: Although several recent reports have been reviewed, the challenges in diagnosis and management of the condition need to be individualised.

Analysis of clinical manifestations, risk factors and diagnostic procedures in children with urolithiasis

The incidence of urolithiasis in the paediatric population has grown in recent years. Aim: The aim of this study was to analyse clinical symptoms, risk factors and diagnostic procedures in children with urolithiasis. Materials and methods: We conducted a questionnaire study (supplemented with an analysis of medical records) in a group of 49 children diagnosed with urolithiasis, including 17 patients from the department of paediatrics at the time of the first metabolic evaluation, and 32 patients hospitalised in a one-day department of paediatric urology prior to extracorporeal shock wave lithotripsy. Results: Urolithiasis occurred in children in the study group at the age of 9.3 ± 4.9 years and manifested with abdominal pain (69.4%), vomiting (18.4%) and haematuria (10.2%); urolithiasis was diagnosed accidentally in 14.3% of patients. All patients developed renal stones (bilateral in 20.4%); 28.6% of patients additionally presented with ureteral stones, and 6.1% with bladder stones. Urolithiasis was accompanied by urinary tract infection in 44.9% of patients. The most common risk factors for urolithiasis included positive family history (75.5%), low fluid intake (51%), urinary tract infection (42.9%) and overweight/obesity (28.6%). Among patients admitted for extracorporeal shock wave lithotripsy, only 65.6% of children underwent nephrological consultation. Slightly more than a half of these patients underwent metabolic diagnosis, with exhausted evaluation in 7 cases and incomplete metabolic assessment in 5 cases. The chemical composition of stones was analysed in 22.4% of patients. Conclusions: Abdominal pain and vomiting are the most common clinical symptoms in children with urolithiasis. The paper presents modifiable risk factors and shows the need for improvement in metabolic evaluation of urolithiasis.

The role of monacolin in the treatment of dyslipidaemia

Dyslipidaemia is one of the major modifiable risk factors for cardiovascular diseases. According to the current epidemiological data, excessively high serum cholesterol levels are found in 64% of women and 70% of men aged ≥20 years in Poland. Statins are the treatment of choice in patients with high-to-very high cardiovascular risk and high low-density lipoprotein (LDL) cholesterol levels. At the other end of the spectrum, there is a group of patients with low-to-moderate cardiovascular risk and low or moderate LDL cholesterol levels, who should be put on well-planned and appropriately adjusted therapy involving lifestyle modification and, if needed, pharmacotherapy. In such cases, the current guidelines of the European Society of Cardiology make it possible to use monacolin, a nutraceutical which is a natural statin (chemically identical to lovastatin). Monacolin is found in red yeast rice and its action is based on the known mechanism of inhibition of HMG-CoA reductase, a key enzyme in endogenous cholesterol synthesis. Data on the efficacy and safety of monacolin come from many clinical trials showing a significant decrease in triglycerides, total and LDL cholesterol, resulting in a reduced number of cardiovascular events in the absence of significant adverse effects. Monacolin is likely to become an effective pharmaceutical to combat dyslipidaemia in the growing group of (relatively young) patients with low-to-moderate baseline cardiovascular risk and lowto- moderate LDL cholesterol levels, without concomitant indications for statins. This paper summarises the current knowledge on the efficacy, safety and potential indications for the use of monacolin in the treatment of dyslipidaemia.