Non-specific inflammatory bowel disease or allergic colitis in small children - what is the final diagnosis

The reason of bleeding from alimentary tract in small children - may sometimes be a big problem and we may need a long observation before making the diagnosis. One of the most frequent reasons of bleeding is food allergy, which resembles allergic colitis. However, bleeding can be the first symptom of ulcerative colitis or Crohn's disease, but it is very rare in small children. We present three cases of small children with bleeding from alimentary tract, in which it was difficult to make the final diagnosis. In our cases, the endoscopic and histopathological examination showed changes, which suggested non-specific inflammatory bowel disease. The microabscesses in crypts and inflammatory infiltration in the mucosa indicated ulcerative colitis. Moreover, one child had also inflammatory infiltration in the oesophagus and duodenum, which is typical for Crohn's disease. We conclude that even when the clinical course suggests that the reason of presenting symptoms was food allergy, there is need for longer observation until one can make the final diagnosis.     

Sposoby oceny przez rodziców ciepłoty ciała dzieci

Introduction

There are various methods of measuring the temperature, various types of thermometers and places where the temperature can be measured. Currently electronic thermometers are the most widely used, mercury thermometers gradually becoming obsolete. A common point of measurement is the armpit, but in pediatric practice the measurement in the external auditory canal is considered to be the golden standard. Many people also assess temperature by touch, regardless of whether they have a home thermometer or not.The aim of the study was to analyze parental ways to measure body temperature, taking into account the thermometer measurements and approximate measurement.

Materials and methods

The survey was conducted on 206 people (194 mothers, 11 fathers, and 1 grandmother). The mean age of children was 24.2 months (min 2 weeks, max. 17 years, SD 37.7). The questionnaire included questions open and closed, single- and multiple-choice, and were concerning the assessment of the child's body temperature when fever was suspected. They were asked for a measurement method and the interpretation of the other symptoms of the child's fever. The results were statistically analyzed using Statistica version 6.0.

Results

The parents most often measure the temperature only using the electronic thermometer – 143 people (often in urban areas); 42 people measured fever using the mercury thermometer (more often in older children as well as in rural areas); in some cases – with several types of thermometers. Frequently temperature is measured in the armpit (in this way 90/186 people measure the temperature; more often in older children), less frequently – on the forehead (46/186 people, often younger children), rectum (40/186 people; often younger children), in the ear (31/186 people), and occasionally in other places. 115/125 people also measure children's temperature in an “orientation” way, by hand, usually on the head/forehead. For parents, other methods of assessing a child's fever are: the evaluation of the child's behavior, the change of the face expression, eyes, mouth, and a change in breathing.

Conclusions

In our study all parents use thermometers. The most commonly used are electronic thermometers, rarely – mercury thermometers. Frequently temperature is measured in the children's armpit, alternatively on the forehead, in the rectum, and the outer ear. A large number of parents additionally assess the child's body temperature by touch, and sometimes parents pay attention to other symptoms of fever.     

Wykładniki metabolizmu tlenowego u dzieci i młodzieży z refluksem żołądkowo-przełykowym

Gastroesophageal reflux disease is a consequence of backward movement of the stomach content to the esophagus. The symptoms are caused by irritation of esophageal mucosa by acidic ingestant. Various factors cause disorders of cellular defense mechanism that lead to significant increase of oxygen-derived free radicals concentration and as a consequence to pathological damage of tissues and development of inflammation.     

Analiza zależności między wywiadem rodzinnym a występowaniem nadwrażliwości na pokarmy u niemowląt karmionych wyłącznie piersią w wieku do 6. miesiąca życia

Introduction

The literature describes an association between a positive family history of allergic diseases and the incidence of allergies in children.

Selenium supply and glutathione peroxidase activity in breastfed Polish infants

Selenium (Se) concentration in human milk in Poland is below 10 ng ml^?1 and the Se intake by breastfed infants is about 6 μg day^?1. Supplementation of lactating mothers with selenium-enriched yeast increases rapidly and significantly the Se concentration and glutathione peroxidase activity in maternal blood components. Se concentration in milk is also significantly elevated. After 1 month the mean Se intakes by breastfed infants were greater than the recommended dietary allowance of 10 μg day^?1 for infants from birth to 6 months of age.     

Diastrophic dwarfism (author's transl)

On the basis of their own patient the authors discuss clinical and radiological features of diastrophic dwarfism. In this rare disorder the infant is dwarfed, the limbs are shortened. It is associated with marked talipes equinovarus, limited movements and contractures of other joints. Dislocation in the hip or knee and development of kyphoscoliosis leads to furhter deformity. As aetiopathogenesis the authors consider the role of infection in the mother during her early pregnancy or teratogenic aspects of some drugs (tetracyclines, septrim).     

Ocena przydatności doustnej prowokacji pokarmowej metodą podwójnie ślepą kontrolowaną placebo u dzieci leczonych eliminacyjną dietą bezmleczną

Introduction

The gold standard for the diagnosis of food allergy is a double-blind placebo-controlled food challenge (DBPCFC). Open food challenge is recommended in younger children because of the limited impact of symptoms subjectivization during its duration.

Aim

The aim of the study was the assessment of usefulness of DBPCFC in confirmation of tolerance to cow's milk proteins after a period of elimination diet in children with a positive result of the open challenge and evaluation of the clinical cow's milk allergy symptoms in children.

Material and methods

The analysis included the medical records of 80 children between 7 and 48 months of age using dairy-free diet. After a period of elimination diets and resolution of clinical signs in these patients open provocation tests were conducted, the results of which were positive. For this reason, they have been qualified for DBPCFC in order to confirm or rule out the persistence of allergy to cow's milk proteins.

Results

The application of DBPCFC method allowed to rule out allergy to cow's milk proteins in 80% of the children. The elimination diet has been used for an average of 13.18 months, it was more often based on the whey hydrolysate. The average age of patients was 18.7 months. An analysis of the clinical symptoms showed that the most common form was atopic dermatitis (76.25%).

Conclusions

DBPCFC is an effective method of showing the children's acquisition of tolerance for cow's milk proteins (which were not tolerated earlier) after a period of elimination diet; the method has a high clinical value. A strong influence of parent's emotional factors on the objective assessment of clinical reactions of the child is an argument for using blind trials.     

Helicobacter pylori infection is associated with oxidatively damaged DNA in human leukocytes and decreased level of urinary 8-oxo-7,8-dihydroguanine

Helicobacter pylori infection is responsible for inflammation, increased production of reactive oxygen species and oxidatively damaged DNA in the gastric mucosa. There is also evidence which suggests that H.pylori infection may lead to the development of several extragastroduodenal pathologies with reactive oxygen species involvement. In order to assess whether the infection may impose oxidatively damaged DNA not only in the target organ (stomach) but in other organs as well we decided, for the first time, to analyse the two kinds of oxidatively damaged DNA biomarkers: urinary excretion of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) and 8-oxo-7,8-dihydroguanine (8-oxoGua) as well as the level of oxidatively damaged DNA in leukocytes. Using high performance liquid chromatography prepurification/gas chromatography with isotope dilution mass detection methodology, we examined the amount of oxidatively damaged DNA products excreted into urine and the amount of 8-oxodG in the DNA of leukocytes' (with the the HPLC/EC technique) in three groups of children: (i) control group, (ii) H.pylori infected children and (iii) children with gastritis where H.pylori infection was excluded. The levels of 8-oxodG in DNA isolated from leukocytes of H.pylori infected patients and in the group with gastritis without H.pylori infection were significantly higher than in DNA isolated from the control group. The mean level of 8-oxoGua in urine samples of children infected with H.pylori was significantly lower than in the urine of the group with gastritis without H.pylori infection. The data suggest that inflammation itself, not just H.pylori infection, is responsible for the observed rise of 8-oxodG level in leukocytes. However, the observed decrease in the level of modified base in urine seems to be specific for H.pylori infection and possibly linked with nitric oxide mediated inhibition of a key base excision repair enzyme (human 8-oxo-7, 8-dihydroguanine glycosylase) responsible for the repair of 8-oxo-7,8-dihydroguanine.