Helicobacter pylori infection as a cause of sideropenic anaemia resistant to treatment - own observation

A relationship is described between H. pylori infection and diseases localized beyond the gastrointestinal tract, for example: atherosclerosis, stenocardia, cerebral stroke, chronic urticaria, rosacea, hemicrania and in, children with height deficit or anaemia, caused by iron deficiency. Two cases of sideropenic anaemia in children resistant to oral iron are presented. Gastrointestinal tract symptoms were not observed and most probably the reason for anaemia was H. pylori infection. The first 14 years old patient with normal menstrual periods had been treated for four months by oral iron, without any effect (Hgb 10.2 g%, Fe 36.8%, ferritin < 10.8 mg%). On endoscopy of upper gastrointestinal tract there were macroscopic typical changes of H. pylori infection in antrum part of the stomach. On histological examination of biopsy segments inflammation of stomach mucosa in average intensification and H. pylori infection was confirmed. Recovery caused normalization of iron in the organism and of erythrocyte morphology. There was no recurrence of anaemia in long-term observation of the girl. A 14 years old boy treated without success for severe sideropenic anaemia (Hgb 7.1 g%), with positive family history (father has gastric ulcer). In spite of lack of gastrointestinal tract symptoms, on endoscopy there were features of chronic active hemorrhagic inflammation of stomach mucosa with H. pylori infection. Oral iron and effective eradication (proton pump inhibitor, amoxycillin, clarithromycin), achieved normalization of morphological changes. Recurrence of anaemia has not been observed.     

Profilaktyka alergii pokarmowej już od narodzin

Children of allergic parents or siblings are special risk group for allergy development. The most important method of primary prevention of allergic diseases is mode of feeding. Exclusive breastfeeding in the period of first 4–6 months of life is recommended in allergy prevention. If it is impossible, feeding with partially hydrolyzed formula allows to avoid allergy development in many cases. Many formulas contain additional components with biological activity. Some of them, for example probiotics and prebiotics, long-chain polyunsaturated fatty acids and nucleotides can be effective in prevention of allergic diseases. It is postulated to introduce of new products into infant diet gradually and singly, not before 4^th month and not later then the end of 6^th month of life.     

Saccharomyces boulardii w profilaktyce biegunki związanej z antybiotykoterapią – doświadczenia własne

IntroductionSaccharomyces boulardii has documented clinical activity in the prevention and treatment of diarrhea associated with antibiotic therapy in children and adults.AimThe aim of the study was to evaluate the incidence of loose stools and/or increased their number in patients who received S. boulardii during antibiotic therapy and comparison with results of other published studies on this topic.Patients and methodsObservational data were evaluated from 130 patients aged 3 mth.–17.5 years who received S. boulardii (250–500 mg per day) during antibiotic therapy. The occurrence of loose stools and/or increased their numbers per day, which occurred de novo in the course of antibiotic therapy was analyzed. Antibiotic therapy was used in patients with upper and lower respiratory tract inflammation – the group I (n=83) and during Helicobacter pylori eradication – the group II (n=47). In group I, there were 18 infants and 65 children over 12 months. The most commonly used antibiotics for patients with respiratory tract infection (group I) were: amoxicillin with clavulanic acid (n=39) and cefuroxime (n=21). In the eradication of Helicobacter pylori amoxicillin and metronidazole were used – group II.ResultsLoose stools and/or increased their number on any day of observation occurred in 18 patients of group I (21.68%) and 6 patients in group II (12.76%), but only in 11.5% of the whole analyzed group symptoms occurred 48 hours or longer, 14.46% in group I and 6.38% in group II. The total number of days with problems in each group was: group I – 43 of 757 (5.68%), group II – 10 of 470 (2.12%). Only in 4 (3.07%) patients symptoms occurred for longer than three days. Average number of days with symptoms was: 2.38 days in the group I, 1.8 days – in group II. More often, symptoms lasting 48 hours or more was observed in treated with cefuroxime – 19.05% (n=7), than in patients treated with amoxicillin with clavulanic acid – 7.69% (n=3). In the group I loose stools and/or increased their number occurring for 48 hours or longer were more frequent in infants (27.78%) compared to children aged above 12 months of life (10.77%). There was no patient in whom antibiotic therapy was discontinued because of occurrence of loose stools and/or increase their numbers.ConclusionSaccharomyces boulardii is effective in preventing diarrhea associated with antibiotic therapy.     

Lamivudine therapy for children with chronic hepatitis B

AIM: To assess the effectiveness and side-effects of lamivudine therapy for children with chronic hepatitis B (CHB) who fail to respond to or have contraindications to interferon-α(IFN-α) therapy. METHODS: Fifty-nine children with CHB were treated with 100 mg lamivudine tablets given orally once daily for 12 mo. Alanine aminotransferase (ALT) activity was evaluated monthly during the therapy and every 3 months after its discontinuation. HBe antigen, anti-HBe antibodies, HBV DNA level in serum were evaluated at baseline and every six months during and after the lamivudine therapy. Sustained viral response (SVR) to lamivudine therapy was defined as permanent (not shorter than 6 mo after the end of the therapy), namely ALT activity normalization, seroconversion of HBeAg to anti-HBe antibodies, and undetectable viral HBV-DNA in serum (lower than 200 copies per mL). The analysis of the side-effects of the lamivudine treatment was based upon interviews with the patients and their parents using a questionnaire concerning subjective and objective symptoms, clinical examinations, and laboratory tests performed during clinical visits monthly during the therapy, and every 3 mo after the therapy. RESULTS: ALT normalisation occurred in 47 (79.7%) patients between the first and 11th mo of treatment (mean 4.4±2.95 mo, median 4.0 mo), and in 18 (30.5%) of them after 2 mo of the therapy. There was no correlation between the time of ALT normalization and the children's age, the age of HBV infection, the duration of HBV infection, inflammation activity score (grading), staging, ALT activity before treatment, serum HBV DNA level, and lamivudnie dose per kg of body weight. HBeAg/anti HBe seroconversion was achieved in 27.1% of cases. The higher rate of seroconversion was connected with lower serum HBV DNA level and longer duration of HBV infection. There was no connection between HBeAg/ anti HBeAb seroconversion and the children's age, age of HBV infection, grading, staging, ALT activity before treatment, and lamivudnie dose per kg of body weight. No complaints or clinical symptoms were observed during lamivudine therapy. Impairment of renal function or myelotoxic effect was noted in none of the patients. CONCLUSION: One year lamivudine therapy for children with chronic hepatitis B is effective and well tolerated. Seroconversion of HBeAg/HBeAb and SVR are connected with lower pre-treatment serum HBV DNA level.     

Ulewanie u niemowląt

Regurgitation (spiting up) in healthy infants is a frequent cause of parental anxiety. Uncomplicated regurgitation without symptoms such failure to threve, oesopgagitis or chronic or recurrent respiratory infections is only functional immaturity of digestive tract symptom but no pathology. Regurgitations usually is self-limited process and resolves by 12 months of age. The role of psychician is parental reassurance and recommend appropriate conservative management involves thickened formulas, positional treatment or probiotics.     

Zmienna tolerancja żywienia drogą przewodu pokarmowego u dziecka z zespołem Arnolda i Chiariego – opis przypadku

Feeding disorders are diagnosed in up to 90% of patients with chronic neurological diseases. We present a case of infant with Arnold-Chiari syndrome who was hospitalized several times in the clinic because of feeding difficulties. The patient had variable tolerance of nutrition through the digestive tract (oral, gastric and enteric feeding), periodically requiring the use of the parenteral nutrition. In our patient, despite performed diagnostic tests, the cause of disorders remains unknown. Adapting the methods of nutrition to the patient, however, resulted in remaining good nutritional status, helped to conduct rehabilitation and eventually enabled exclusive oral feeding.In patients with chronic neurological diseases, constant dietetic care is needed with assessment of nutritional status and feeding methods. In the case of feeding disorders, especially manifesting with dysphagia, chronic enteral feeding should be considered. Periodic parenteral nutrition is indicated in the case of intolerance of enteral feeding.     

Carcinoembryonic antigen, alphafetoprotein and alpha and beta subunits of human chorionic gonadotropin in plasma of children with acute leukaemia

The plasma carcinoembryonic antigen, alpha-fetoprotein and the alpha and beta subunits of human chorionic gonadotropin levels were measured by radioimmunoassay in 44 children with acute leukaemia. These markers were determined repeatedly every 3 months at different stages of the disease (at onset, in complete remission, during bone marrow and extramedullary relapse). Elevated CEA levels were present in 64% of children at the onset of acute leukaemia and during bone marrow relapse. Elevated CEA levels decreased during induction treatment and they became normal with attainment of complete remission. In 7/12 patients who developed bone marrow relapse elevated CEA levels and in 4 of them raised levels appeared 3-4 months before there had been any other evidence of relapse. In 6/13 patients with extramedullary relapse, elevated CEA levels were found. AFP, alpha and beta hCG values in different stages of the disease were elevated sporadically; they did not reflect the activity of leukaemia.