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The cholera vaccine can protect patients with inflammatory bowel disease (IBD) against both cholera and travelers’ diarrhea. However, both immunosuppressive treatment and IBD can affect its vaccine immunogenicity. The aim of this study was to assess the immunogenicity and safety of the cholera vaccine in children with IBD. Children older than 6 years with diagnosed IBD were enrolled in this multicenter study. All patients were administered two doses of the oral cholera vaccine (Dukoral®). Anti-cholera toxin B subunit IgA and IgG seroconversion rates were evaluated in a group with immunosuppressive (IS) treatment and a group without IS treatment (NIS). Immunogenicity was assessed in 70 children, 79% of whom received IS treatment. Post-vaccination seroconversion was displayed by 33% of children, for IgA, and 70% of children, for IgG. No statistically significant differences were found in the immune responses between the IS and NIS groups: 35% vs. 27% (p = .90), for IgA, and 68% vs. 80.0% (p = .16), for IgG, respectively. One case of IBD exacerbation after vaccination was reported. The oral cholera vaccine is safe. The immunogenicity of the oral cholera vaccine in children with IBD was lower than previously observed in healthy ones. The treatment type does not seem to affect the vaccine immunogenicity.

Objectives Human milk (HM) is a complex fluid that meets the nutritional needs of infants. Its composition idrfs associated with environmental, maternal, and foetal variables. It provides nutrients and bioactive substances, including cytokines, immunoglobulins, and constituents with antioxidative properties. Boys are reportedly more susceptible to oxidative stress. This study aimed to determine the relationship between infant sex and the antioxidants vitamins C and E, and the fatty acid (FA) profile of HM. Results of this investigation may infer sex differences for the composition of infant formulas. Methods Thirty days after delivery, a sample of HM was collected from 152 healthy, non-smoking mothers of full-term new-borns (77 males) born in good clinical condition. After FAs were extracted from the fat component, they were converted into methyl esters and separated using high-performance gas chromatography. Tocopherol content was determined using a method described in a previous study. Vitamin C content was determined using reversed-phase high-performance liquid chromatography with ultraviolet detection, as described in the same study. Results The study groups (male versus female offspring) did not differ in terms of vitamin and FA content in HM. The only difference found was in gondoic acid 20:1 (n-9), with a higher concentration in the HM of mothers with female offspring (mean 0.63 ± 0.18 versus 0.59 ± 0.15 g/100 g FA; p Conclusions Despite the acknowledged differences in the composition of HM associated with infant sex and the increased oxidative stress in males, antioxidant content did not appear to differ according to infant sex. These results suggest that there is no need for the antioxidant content of infant formulas to be sex specific.

Background: Prediabetes has become a worldwide health problem. Multiple clinical trials have been conducted to determine the potential benefits of vitamin D supplementation in preventing the conversion to diabetes, but the results are inconsistent. The aims of this study were to evaluate the current knowledge and to suggest recommendations for researchers on designing future trials regarding that matter. Methods: Four databases were searched for randomized control trials from the last 10 years about vitamin D and insulin resistance. The systematic electronic literature search identified 2645 studies, of which thirty-eight qualified for full-text reading and discussion. Finally, eight trials were included. Results: Final results of seven trials reported that supplementation of vitamin D does not reduce insulin resistance nor reduces the risk of diabetes mellitus type 2 development in prediabetes. Only one trial showed improvements in fasting glucose and HOMA-IR. Conclusions: Due to the great variation and biases in study designs, an unambiguous interpretation of the results is not possible. To eliminate those vulnerabilities in the future, we made certain suggestions for study design. Long-term and well-designed studies are still required.

Katarzyna Sznurkowska,1 Justyna Luty,2 Ewa Bryl,2 Jacek M Witkowski,3 Blanka Hermann-Okoniewska,4 Piotr Landowski,1 Marta Kosek,1 Agnieszka Szlagatys-Sidorkiewicz1 1Department of Pediatrics, Pediatric Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, Gdańsk, Poland; 2Department of Pathology and Experimental Rheumatology, Medical University of Gdańsk, Gdańsk, Poland; 3Department of Pathophysiology, Medical University of Gdańsk, Gdańsk, Poland; 4Department of Pathology and Neuropathology, Medical University of Gdańsk, Gdańsk, PolandCorrespondence: Katarzyna SznurkowskaDepartment of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Medical University of Gdańsk, Nowe Ogrody 1-6, Gdańsk 80-803, PolandTel +58 663625861Fax +48 58 764 04 40Email k.sznurkowska@gumed.edu.plBackground/Aims: The proportions of intestinal and peripheral regulatory T cells (Tregs) in pediatric inflammatory bowel disease (IBD) were poorly investigated, as well as different subsets of these cells. Helios and Neuropilin-1 were proposed as markers differentiating between thymic and peripheral Tregs. Therefore, the aim of current work was to investigate the proportions of Tregs and expression of Helios and Neuropilin-1 in Tregs in peripheral blood and intestinal mucosa of children with inflammatory bowel disease.Materials and methods: Fifteen patients newly diagnosed with inflammatory bowel disease: ulcerative colitis (n=7) and Crohn’s disease (n=8) were included in the study. Nine children who presented with no abnormalities in colonoscopy served as a control group. Quantification of regulatory T cells of the CD4+CD25highFOXP3+ phenotype, as well as Helios+ and Neuropilin-1+ in peripheral blood and bowel mucosa was based on multicolor flow cytometry.Results: The rates of circulating and intestinal Tregs were significantly higher in the studied group than in the control group. The rate of intestinal T regulatory lymphocytes was significantly higher than circulating Tregs in patients with IBD, but not in the control group. The median proportion of circulating FOXP3+Helios+ cells amounted to 24.83% in IBD patients and 15.93% in the controls. The median proportion of circulating FOXP3+Nrp-1+ cells was 34.23% in IBD and 21.01% in the control group. No statistically significant differences were noted for the circulating FOXP3+Helios+ cells and FOXP3+Nrp-1+ cells between the studied and the control group.Conclusion: The rates of circulating and intestinal T regulatory cells are increased in naïve pediatric patients with IBD. The rate of Tregs is higher in intestinal mucosa than in peripheral blood in patients with IBD. Flow cytometry is a valuable method assessing the composition of infiltrates in inflamed tissue. Helios and Neuropilin-1 likely cannot serve as markers to differentiate between natural and adaptive Tregs.Keywords: T regulatory cells, circulating Tregs, intestinal Tregs, Helios, Neuropilin-1, IBD, inflammatory bowel disease, children

Katarzyna Sznurkowska,1 Justyna Luty,2 Ewa Bryl,2 Jacek M Witkowski,3 Blanka Hermann-Okoniewska,4 Piotr Landowski,1 Marta Kosek,1 Agnieszka Szlagatys-Sidorkiewicz1 1Department of Pediatrics, Pediatric Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, Gdańsk, Poland; 2Department of Pathology and Experimental Rheumatology, Medical University of Gdańsk, Gdańsk, Poland; 3Department of Pathophysiology, Medical University of Gdańsk, Gdańsk, Poland; 4Department of Pathology and Neuropathology, Medical University of Gdańsk, Gdańsk, PolandCorrespondence: Katarzyna SznurkowskaDepartment of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Medical University of Gdańsk, Nowe Ogrody 1-6, Gdańsk 80-803, PolandTel +58 663625861Fax +48 58 764 04 40Email k.sznurkowska@gumed.edu.plBackground/Aims: The proportions of intestinal and peripheral regulatory T cells (Tregs) in pediatric inflammatory bowel disease (IBD) were poorly investigated, as well as different subsets of these cells. Helios and Neuropilin-1 were proposed as markers differentiating between thymic and peripheral Tregs. Therefore, the aim of current work was to investigate the proportions of Tregs and expression of Helios and Neuropilin-1 in Tregs in peripheral blood and intestinal mucosa of children with inflammatory bowel disease.Materials and methods: Fifteen patients newly diagnosed with inflammatory bowel disease: ulcerative colitis (n=7) and Crohn’s disease (n=8) were included in the study. Nine children who presented with no abnormalities in colonoscopy served as a control group. Quantification of regulatory T cells of the CD4+CD25highFOXP3+ phenotype, as well as Helios+ and Neuropilin-1+ in peripheral blood and bowel mucosa was based on multicolor flow cytometry.Results: The rates of circulating and intestinal Tregs were significantly higher in the studied group than in the control group. The rate of intestinal T regulatory lymphocytes was significantly higher than circulating Tregs in patients with IBD, but not in the control group. The median proportion of circulating FOXP3+Helios+ cells amounted to 24.83% in IBD patients and 15.93% in the controls. The median proportion of circulating FOXP3+Nrp-1+ cells was 34.23% in IBD and 21.01% in the control group. No statistically significant differences were noted for the circulating FOXP3+Helios+ cells and FOXP3+Nrp-1+ cells between the studied and the control group.Conclusion: The rates of circulating and intestinal T regulatory cells are increased in naïve pediatric patients with IBD. The rate of Tregs is higher in intestinal mucosa than in peripheral blood in patients with IBD. Flow cytometry is a valuable method assessing the composition of infiltrates in inflamed tissue. Helios and Neuropilin-1 likely cannot serve as markers to differentiate between natural and adaptive Tregs.Keywords: T regulatory cells, circulating Tregs, intestinal Tregs, Helios, Neuropilin-1, IBD, inflammatory bowel disease, children

Children with severe central nervous system (CNS) impairment are at risk of developing various degrees of nutritional deficit that require long-term nutritional intervention. Interventions are most often implemented through enteral nutrition (EN) using commercially manufactured feeds administered via gastro/jejunostomy or nasogastric or nasojejunal tubes. The modality of feeding—continuous feeding or bolus feeding—is dependent on the function of the gastrointestinal tract, particularly the efficiency of gastric emptying. In the literature, the relationship between this type of nutrition and the occurrence of hyperglycaemia is often discussed. In addition, children with chronic neurological diseases are vulnerable to disorders of many mechanisms of neurohormonal counter-regulation related to carbohydrate management, and due to limited verbal and logical contact, it is difficult to recognise the symptoms of hypoglycaemia in such patients. We aimed to assess the carbohydrate metabolism in children with severe CNS impairment, with enteral nutrition delivered via nasogastric, nasoenteral, or percutaneous tubes, based on continuous glycaemic monitoring (CGM) and the measurement of glycated haemoglobin (HbA1c) levels. Materials and methods: This prospective, observational study included nineteen patients (median (25–75 pc) age: 12.75 (6.17–15.55) years) with permanent CNS damage (Gross Motor Function Classification System V) receiving long-term tube enteral feeding, recruited from two paediatric university nutritional treatment centres. Patients with acute conditions and diagnosed diabetes were excluded. The nutritional status and nutritional support were analysed in all the inpatients in accordance with a uniform protocol. Using the CGM system (Medtronic iPro2), glycaemic curves were analysed, and in addition, HbA1C levels were determined in fourteen patients. CGM results were analysed using GlyCulator2.0. Statistical analysis was performed using the Statistica version 11 software (StatSoft Inc. Tulsa, OK, USA). Results: More than half (11/19; 58%) of the patients were undernourished (BMI < 3 pc for age and gender), with the stature age being significantly lower than calendar age (5 (4.5–9) vs. 12.75 (6.17–15.55) years; p = 0.0010). The actual caloric intake was 50 (37.7–68.8) kcal/kg (median; 25–75 pc). In patients fed using the bolus method, the number of calories consumed per day was statistically significantly higher than in children subjected to a continuous feeding supply (56.00 (41.00–75.00) vs. 33.40 (26.70–50.00) kcal/kg BW (body weight; p = 0.0159). Decreases in blood glucose levels below the alarm level ( 140 mg/dL (TAR 140) recorded overnight in children with BMI ≥ 3 amounted to 1.6% vs. 0% in undernourished patients (TAR 140: 0.0 (0.00–1.6%) vs. 0% (0.00–0.0%; p = 0.0375); the percentage of glycaemic concentrations

Background: The population of patients on home parenteral nutrition (HPN) worldwide is growing. Since only a few counties provide data from national registries long-term observations are valuable to address this specific area of nutrition support. This study is a nationwide analysis determining the trends in the epidemiology of HPN (prevalence, age distribution, death rates), indications for HPN, causes for hospitalizations, and cost analysis of HPN reimbursement in Poland between 2010–2020. Methods: A retrospective analysis of data obtained from the national health fund (NHF) of Poland on adult patients on HPN. Results: The prevalence of adult patients on HPN in Poland in 2020 was 53.26 per million citizens with a 2.99-fold increase and a growing trend observed from 2010. Significant decrease in the percentage of patients between 18–34, 45–54 and an increase in patients between 65–74 and patients over 75 years old was observed. Trend analysis showed an increase in new patients between 65–74 and a decrease between 35–54. Malnutrition (34.28%), postprocedural disorders of the GI tract (19.61%), intestinal malabsorption/other intestinal diseases (20.41%) and GI obstruction due to cancer (17.36% as primary and 23.16% as secondary diagnosis) were mostly reported as the primary indications for HPN. Cancer patients were mostly gastric, ovarian and colon cancer (34.74%, 17.83% and 12.3%). HPN and total health cost reimbursement increase was 2.6 and 2.57—fold respectively. Costs of HPN and total health care costs in 2020 per patient were € 10,015 and € 16,038, respectively. Overall death risk rate during the first year of nutrition was 0.59 with a significant increase in the observation period p-trend &lt, 0.004. A significant increase in the death rate was observed in patients above 75 years old (estimate 1.629, p-trend &lt, 0.030). Cancer, infection, malnutrition and GI symptoms were the most common indications for hospitalizations of HPN patients. The rate of patients with a maximal length of HPN of 5 months in 2010 was 54.9% and was growing up to 78.1% in 2020. Conclusions: The prevalence of HPN in Poland is growing. Trends of age distribution show increasing numbers of patients with more advanced age and shorter survival. Costs of HPN are comparable with other European data.

Allergies are among the most common chronic diseases in Europe. The most serious complication is anaphylactic shock. Most cases occur outside the hospital, thus, knowledge of symptoms and first aid is crucial. This study aimed to evaluate the awareness of anaphylaxis and the ability to use adrenaline auto-injectors among medical students, and to determine an improvement after training based on non-formal education. The research was conducted among 364 medicine students (years 1–5) from the Medical University of Gdańsk, with year-specific curriculum-based general medical knowledge. Training consisted of pre-test, practical training and post-test. Descriptive statistics were used to reveal the characteristics of students from different grades. A Mann–Whitney U test was used for statistical analysis. The tested students did not have sufficient knowledge to provide first aid in cases of anaphylaxis before training. There was an increase in knowledge (on average, 28.6%, p = 0.005) after training. Almost all (99.4%) of the respondents believed that they would be able to use an adrenaline auto-injector in case of emergency after the training. The training based on non-formal education was effective. The use of the subject-performed task method helped students to remember the stages of action in stressful situations.

The problem of overweight and obesity is a growing phenomenon in the entire population. Obesity is associated with many different metabolic disorders and is directly associated with an increased risk of death. The aim of the study was to assess the changes in body composition and physical fitness in children participating in an integrated weight-loss programme and to analyse the possible relationship between changes in body composition and improvements in fitness. Participants of the study were recruited from the “6–10–14 for Health”-multidisciplinary intervention programme for children aged 6 to 15 years old. A total of 170 patients qualified for the study, and 152 patients were enrolled. Statistically significant changes in body composition were found after the end of the intervention program, as measured by both BIA (bioimpedance) and DXA (Dual Energy X-ray Absorptiometry). The differences in KPRT (Kasch Pulse Recovery Test) results at baseline and after intervention are positively correlated with the difference in fat mass between baseline and the after-intervention measure. Improving physical fitness is positively correlated with a decrease in FM (fat mass) and an increase in FFM (fat-free mass) measured in both absolute values and %. Both BIA and DXA methods proved to be equally useful for measuring body composition.

Nutritional status disorders are a worldwide problem. Approximately 5.9 million children under the age of five die each year, and 45% of these deaths are related to malnutrition. The aim of the study was to analyse the prevalence of underweight children aged between 6 and 7 years old, living in the Gdańsk, Poland, in the years 1994–2020. The anthropometric parameters of 67,842 children were analysed. BMI (Body Mass Index) value &lt, 5 percentile (pc) was defined as underweight. The BMI value was compared to the WHO (World Health Organization) centile charts and the OLAF (research project PL0080) national reference charts. The prevalence of underweight children in relation to the WHO charts was 1.9%, underweight status was found to be more significant in the group of boys (2.1%) than the group of girls (1.7%) (p &lt, 0.001). According to the OLAF centile charts, the underweight figure among all of the study population was 2.1% and no statistical significance between boys (2.1%) and girls (2.0%) was found (p = 0.670). The occurrence of underweight indviduals in the studied group slightly increased in the years 1994–2020. We found a statistically significant increasing linear trend in the analysis of underweight children in our group (p &lt, 0.001), in group of boys (p &lt, 0.001), but not girls (WHO p = 0.603, OLAF p = 0.787). This points to the need to conduct regular screening systems for children and adolescents.

Summary Background & aims We assessed the tolerability and safety of implementing early enteral nutrition in children at 3 h after percutaneous endoscopic gastrostomy (PEG) placement to establish an optimum feeding mode in paediatric patients that reduced the fasting period, the inadequate nutritional support interval, and the hospitalisation time. Methods Children with clinical indications for PEG placement were recruited from six medical centres in Poland to participate in the study. The patients were centrally randomised to receive the first bolus feed, which comprised a polymeric diet (1 kcal/mL), via a feeding tube at 3 h (group 1) or 8 h (group 2) after PEG placement. The pre-procedural preparation, the post-operative care, and the resumption of feeding were performed on all of the patients in accordance with the study's protocol. The primary endpoint was the number of patients who consumed a full feed, which contained their total fluid and caloric requirements, within 48 h of the first bolus feed. The secondary endpoints were the number of complications and the duration of hospitalisation after PEG placement. Results Of the 97 randomised patients, 49 were assigned to group 1 and 48 were assigned to group 2. There were no differences between the groups regarding feeding tolerability (81.6% vs. 91.6%), the number of complications (25.5% vs. 37.5%), or the duration of hospitalisation after PEG placement (p > 0.05). Full feed post PEG placement was achieved within 24–48 h in most cases (74% vs. 82%). Most of the complications were mild. Two patients in group 2 due to dislocation of the PEG were qualified for laparotomy (at 6 days post-PEG placement in one case and at 14 days post-PEG placement in the other case). One patient in group 2 died at 7 days post-PEG placement; the death was unrelated to the investigation. Conclusions Introducing feeding at 3 h post-PEG placement in children appears to be well tolerated. The early initiation of post-PEG feeding was not associated with an increase in the number of complications and it had no impact on the duration of hospitalisation. Clinical trial registry www.clinicaltrials.gov (NCT02777541; registration date: 18/05/2016).

Background: Neopterin, regarded as a marker of cellular immune activation, has been used in diagnosis of infection caused by intracellular pathogens. We have aimed to evaluate the clinical usefulness of serum neopterin (NPT) in acute bacterial diarrhea caused by group C enteropathogenic Escherichia coli (EPECs) and group D Salmonella spp. Methods: Serum concentration of NPT was determined by ELISA. The study group included 47 children with diagnosis of bacterial diarrhea: 32 caused by group C enteropathogenic Escherichia coli (EPECs) and 15 by group D Salmonella spp. 105 healthy children constituted the control group. Results: Serum concentration of NPT in children infected with group D Salmonella spp. turned out to be higher than in the other groups. The fraction of Salmonella-infected patients with serum neopterin above 11 nmol/l proved higher as compared to children with diarrhea caused by group C EPECs or to the healthy controls. The prevalence of a C-reactive protein (CRP) to NPT ratio of greater than 1 did not differ significantly between children with diarrhea of various etiology. Conclusions: Neopterin can be used as a non-specific marker differentiating between bacterial diarrhea of various etiology.

Background Malignant peripheral nerve sheath tumor (MPNST) is rare, aggressive soft tissue sarcoma which may affect children. Objective We aimed to assess prognostic significance of immunohistochemical (IHC) markers, osteopontin, fibronectin, survivin, cyclin D1 and p53, in pediatric MPNST. Methods A total of 26 pediatric MPNST patients were enrolled in the current study with a median follow-up of 51 months. IHC staining using commercially available monoclonal antibodies were employed to detect analyzed antigens on tissue microarrays. Eventually, all markers were subclassified to high (H) and low (L) expression categories in all analyzed tumors. Results High IHC expressions of survivin, cyclin D1, osteopontin, fibronectin, and p53 were detected in 18 (69.2%), 13 (50%), 16 (61.5%), 16 (61.5%), and 13 (50%) tumors, respectively. A significant correlation was demonstrated between cyclin D1 and osteopontin (p= 0.004). Both markers were associated with neurofibromatosis type 1 (NF1) status (p= 0.041 and p= 0.037, respectively). H-fibronectin was more prevalent in deeply located tumors (p= 0.046). None of the markers was associated with IRS stage, age at diagnosis, and tumor size. Univariate analysis identified IRS stage, regional lymph node metastases, NF1, and cyclin D1 as variables associated with overall survival (OS), whereas tumor depth, osteopontin, and cyclin D1 - for relapse-free survival (RFS). Subsequent multivariate analysis identified cyclin D1 and p53 as independent variables predicting RFS, whereas cyclin D1 and regional lymph nodes status were independent predictors for OS.

Histamine intolerance is defined as a disequilibrium of accumulated histamine and the capacity for histamine degradation. This clinical term addresses a non-immunologically mediated pathology when histamine ingested with food is not particularly high, however its degradation is decreased. This paper aims to provide a narrative review on etiopathology, epidemiology, possible diagnostic algorithms and diagnostic challenges of histamine intolerance in children. The clinical picture of histamine intolerance in children is similar to that observed in adults apart from male predominance found in paediatric patients. Both in children and adults, a histamine-reduced diet is typically the treatment of choice. Diamine oxidase supplementation offers another treatment option. There is no symptom or test pathognomonic for histamine intolerance. Nevertheless, manifestations of chronic gastrointestinal symptoms, measurements of diamine oxidase deficits, positive results of histamine provocation tests and improvement in symptoms with histamine-reduced diet considerably increase the probability of histamine intolerance diagnosis. These factors have been included in the proposed diagnostic algorithm for histamine intolerance. In children histamine intolerance most likely co-occurs with allergies and bowel diseases, which creates an additional diagnostic challenge. As the evidence for children is poor further research is needed the determine epidemiology, validate diagnostic algorithms and establish possible treatment options regarding histamine intolerance.

The purpose of this study was to compare the nutritional status between deltaF508 CFTR hetero- and homozygous paediatric patients with cystic fibrosis. We assessed the percentage profiles of fatty acids measured in erythrocyte membranes and the serum levels of vitamins A, D3, E and K1 in the studied groups. We also measured the weights and heights and calculated the body mass indexes (BMIs). The studied groups consisted of 34 heterozygous and 30 homozygous patients. No statistically significant differences were found in the serum vitamins or erythrocyte membrane fatty acid profiles between the hetero- and homozygous patient groups, except for heptadecanoic acid (p = 0.038). The mean percentiles of height, weight and BMI did not differ significantly between the two groups. The homozygous and heterozygous paediatric patients with cystic fibrosis were similar in terms of their nutritional statuses.

Background: Home artificial nutrition (HAN) is a developing method of treatment that reduces the need for hospitalizations. The epidemiology of pediatric HAN in Poland has not yet been covered in detail. This study is a longitudinal nationwide analysis of incidence, prevalence, and patients’ profile for HAN in Polish children. Methods: Assessment of National Health Fund (NFZ) data covering all pediatric patients treated with HAN in Poland between 2010 and 2018. Results: HAN was received by 4426 children, 65 patients were on home enteral nutrition (HEN) or home parenteral nutrition (HPN) at different times (HEN n = 3865, HPN n = 626). HAN was most frequently started before the child was 3 years old and long-term HAN programs (5–9 years) were reported. The most common principal diagnosis in HEN was food-related symptoms and signs. In HPN, it was postoperative gastrointestinal disorders. A regionally differentiated prevalence of HAN patients and centers was demonstrated. Mortality among patients was 24.9% for HEN, and 9.6% for HPN, and the main in-hospital cause of death was cardiac arrest. Conclusions: HAN’s use is increasing and evolving in Poland. Uneven distribution of patients and centers results in difficult access to the nutritional procedure which, together with the increasing number of patients, highlights the need for data analysis and development of nutrition centers.

Histamine intolerance is defined as disequilibrium of accumulated histamine and the capacity for histamine degradation. This clinical term addresses a non-immunologically mediated pathology when histamine ingested with food is not particularly high, but its degradation is decreased. Clinical picture of histamine intolerance in children is similar to that observed in adults apart from male predominance found in paediatric patients. Both in children and adults, histamine-free diet seems to be the treatment of choice. Diamine oxidase supplementation offers another treatment option. There is no symptom and\or test pathognomonic for histamine intolerance. Nevertheless, manifestations of chronic gastrointestinal symptoms, measurement of diamine oxidase deficits, positive results of histamine provocation tests and improvement of symptoms with histamine-free diet greatly increase the probability of histamine intolerance diagnosis. These factors have been included in the proposed in this paper diagnostic algorithm for histamine intolerance. In children histamine intolerance probably co-occur with allergies and bowel diseases, which creates an additional diagnostic challenge. As the evidence for children is weak, further research is needed the establish epidemiology, validate diagnostic algorithms and establish possible treatment options regarding histamine intolerance.

The prevalence of childhood obesity is increasing worldwide. Some obese children can go on to develop metabolic syndrome (MetS), but exactly who among them remains to be determined. The aim of this study was to indicate predisposing factors for metabolic syndrome, especially those that can be modified. The study comprised 591 obese children aged 10&ndash, 12 years. They were all Caucasian residents of Gdańsk, Poland, with similar demographic backgrounds. Clinical examination, anthropometry, biometric impedance analysis, blood tests (including oral glucose tolerance tests (OGTT) and insulinemia), and dietary and physical activity evaluation were conducted. The results of our study show that the risk factors for MetS or any of its components include male sex, parental (especially paternal) obesity, low body mass at birth, as well as omitting breakfast or dinner. There are few risk factors for metabolic syndrome both in obese adults and children. Some of these predictors can be modified, especially those in relation to lifestyle. Identifying and then influencing these factors may help to reduce the development of metabolic syndrome and consequently improve health and quality of life.

BackgroundAllergies are among the most common chronic diseases in Europe. The most serious complication of allergies is anaphylactic shock. Most of cases occur outside the hospital, thus knowledge of symptoms and first aid is crucial. The aim of this study was to evaluate the level of knowledge about anaphylaxis and ability to use adrenaline auto-injectors among medical students and to determine an improvement after a training based on non-formal education.MethodsThe research was conducted among 365 medicine students from the Medical University of Gdańsk. The respondents completed a multiple-choice knowledge test, before theoretical and practical training on adrenaline auto-injector use was given, then they re-took the test. Descriptive statistics were used to reveal characteristics of students of different grades. T-test was used for statistical analysis.ResultsThere was an increase in knowledge test scores (on average, 28.6%, p=0.0168) after training. The average test score increase questions for the whole study group was 2.29, varying between 4.96 and 7.25, out of 8. Almost all (99.4%) of the respondents after training believed that they would be able to use adrenaline auto-injector in an emergency.ConclusionsTested students didn’t have sufficient knowledge to provide first aid in cases of anaphylaxis before schooling. The training based on non-formal education was effective. Using the subject-performed task method helps remembering stages of action in stressful situations. This type of training would increase self-efficacy among various social groups.

Background COVID-19 pandemic impacts many communities worldwide. In this study the Poles’ knowledge about COVID-19 as well as people’s behaviours, attitudes and fears during the pandemic were assessed. Changes in these between the outset of the pandemic and the imposition of the strictest lockdown measures in Poland were investigated. Methods Physicians, nurses, students of medicine-oriented faculties, non-medical professionals, students of non-medicine-oriented faculties and secondary school students were surveyed by an anonymous online questionnaire two times: at the onset of the pandemic and in the second week of the strictest lockdown. Statistical analyses were performed using non-parametric tests – Pearson Chi Square, Kruskal-Wallis tests. Results In total 2618 responses were collected. At the beginning people knew that the respiratory system was attacked (97.9%); correctly identified the major symptoms of COVID-19 (95.0%) and ways to prevent infection: hand washing (99.8%), covering mouth (85.9%) and the need to call sanitary-epidemiological services if one experienced COVID-19-like symptoms (92.1%). The biggest changes between the first and second phase of the study concerned behaviours: more people wearing facial masks (+ 37.5%) and staying at home (+ 66.1%). Respondents in the second wave of the survey were also more scared of the pandemic (+ 19.6%), economic crisis (+ 64.1%), and worried about their families (+ 26.5%). However, they were less afraid of the quarantine (lockdown) (− 18.2%). Nurses and physicians were the most worried groups. Conclusions The study showed that even at the outset of the pandemic Polish population had a good initial knowledge about symptoms, transmission, and preventive behaviours regarding COVID-19. People revealed more short-term concerns, such as the worries about coping with quarantine and isolation. After a month, the knowledge and the concerns among the respondents changed. A shift towards long-term pandemic management issues was observed. Respondents reported to experience more fears concerning the pandemic in general, as well as economic and healthcare crises. Medical professionals reported higher level of fear of the pandemic than other groups included in this study. This study uses before-and-after approach which highlights the changes in people’s knowledge and perception of the COVID-19 pandemic during the pandemic’s progression.

Objectives The aim of the study was to assess the complication rate and identify whether age, nutritional status, and history of respiratory aspiration prior to percutaneous endoscopic gastrostomy (PEG) are risk factors for post-PEG placement complications in Polish children. In addition, the safety of two enteral feeding methods (3 h vs. 8 h) after PEG insertion in children was compared. Methods Children with clinical indications for PEG placement were recruited from six medical centers in Poland to participate in the study. The patients were centrally randomized to receive the first bolus feed via a feeding tube at 3 h (group 1) or 8 h (group 2) after PEG placement. The preprocedural preparation, postoperative care, and resumption of feeding were performed on all of patients in accordance with the study protocol. Patients were followed for 12 mo. Results Of the 97 randomized patients, 49 were assigned to group 1 and 48 to group 2. Full feed after PEG placement was achieved within 24 to 48 h in most cases (74% vs. 82%). There were no differences between the groups regarding the number of early mild (31.3% vs. 31.3%) and serious (2.1% vs 8.3%) complications or the duration of hospitalization after PEG placement (P > 0.05). The most common serious complication after PEG placement was accidental displacement of PEG. Most reported late complications were mild. The results of the regression analysis indicate no statistically significant effect of age, body mass index standard deviation score, white blood cell count, serum albumin level, and respiratory aspiration in the medical history on the occurrence of mild and severe complications. Conclusions The early initiation of post-PEG feeding was not associated with an increase in the number of complications. Most complications after the PEG procedure were mild. Age, serum albumin level, white blood cells, body mass index standard deviation score, and a history of aspiration to the respiratory tract were not confirmed as a risk factor for post-PEG complications in children.

Lactose intolerance and constipation are common in children and impact everyday life, not only for patients but also their families. Both conditions can be comorbid with other diseases or form a part of their clinical presentation, but constipation is not usually associated with lactose intolerance. The typical symptoms of lactose intolerance include abdominal pain, bloating, flatus, diarrhoea, borborygmi, and less frequently nausea and vomiting. In approximately 30% of cases, constipation can be a symptom of lactose intolerance. Constipation is characterized by infrequent bowel movements, hard and/or large stools, painful defecation, and faecal incontinence, and is often accompanied by abdominal pain. This paper provides a narrative review on lactose intolerance, its epidemiology, pathogenesis, the correlation between lactose intolerance and constipation in children, and potential mechanisms of such association.

Background: Prevalence of childhood obesity increases worldwide. Some of the obese children develop metabolic syndrome (MetS) , who of them - remains to be determined. The aim of this study was indicate predisposing factors for metabolic syndrome,, especially those which can be modified.Methods: The study comprised 591 obese children aged 10-12 years. Clinical examination, anthropometry, biometric impedance analysis, blood works (incl. OGGT and insulinemia) as well as dietary evaluation and physical activity were estimated. Results: The risk factors of MetS or feature of this are: male, parent’s especially father’s obesity, low body mass at birth as well as omitting breakfast or dinner.Conclusions: There are few risk factors of metabolic syndrome in obese subjects, also in obese children. Some of these predictors can me modified, especially those referring to lifestyle. Indicating and then influencing these factors can be one way to diminish metabolic syndrome development, such improving health and quality of life. Besides certain socioeconomic effects could be gain too.

Background COVID-19 pandemic impacts many communities worldwide. In this study the Poles' knowledge about COVID-19 as well as people’s behaviours, attitudes and fears during the pandemic were assessed. Changes in these between the outset of the pandemic and the imposition of the strictest lockdown measures in Poland were investigated.Methods Physicians, nurses, students of medicine-oriented faculties, non-medical professionals, students of non-medicine-oriented faculties and secondary school students were surveyed by an anonymous online questionnaire two times: at the onset of the pandemic and in the second week of the strictest lockdown. Statistical analyses were performed using non-parametric tests - Chi square Persons, Kruskal-Wallis tests.Results In total 2618 responses were collected. At the beginning people knew that the respiratory system was attacked (97.9%); correctly identified the major symptoms of COVID-19 (95.0%) and ways to prevent infection: hand washing (99.8%), covering mouth (85.9%) and the need to call sanitary-epidemiological services if one experienced COVID-19-like symptoms (92.1%). The biggest changes between the first and second phase of the study concerned behaviours: more people wearing facial masks (+37.5%) and staying at home (+66.1%). Respondents in the second wave of the survey were also more scared of the pandemic (+19.6%), economic crisis (+64.1%), and worried about their families (+26.5%). However, they were less afraid of the quarantine (lockdown) (-18.2%). Nurses and physicians were the most worried groups.Conclusions The study showed that even at the outset of the pandemic Polish population had a good initial knowledge about symptoms, transmission, and preventive behaviours regarding COVID-19. People revealed more short-term concerns, such as the worries about coping with quarantine and isolation. After a month, the knowledge and the concerns among the respondents changed. A shift towards long-term pandemic management issues was observed. Respondents reported to experience more fears concerning the pandemic in general, as well as economic and healthcare crises. Medical professionals reported higher level of fear of the pandemic than other groups included in this study. This study uses before-and-after approach which highlights the changes in people’s knowledge and perception of the COVID-19 pandemic during the pandemic’s progression.

Excess body weight is a serious public health problem, which affects both adults and children. Unfortunately, the prevalence of excess body weight in children in Poland is not subject to any regular screening. The aim of this study was to analyze the prevalence of overweight and obesity in 6&ndash, 7-year-old children in the municipality of Gdańsk in the years 2008&ndash, 2016. The anthropometric parameters of 12,330 children (49.55% girls and 50.45% boys) with a mean age of 6.53 &plusmn, 0.38 years were analyzed. The prevalence of overweight was 7.49% (7.91% girls and 7.07% boys) and obesity 4.24% (4.47% girls and 3.99% of boys). There was no difference in the prevalence of neither overweight nor obesity between boys and girls (p = 0.076). However, the prevalence of overweight and obesity combined is higher in girls (12.38% vs. 11.06%, p = 0.023). There were no statistically significant differences in the prevalence of overweight and obesity neither in the group of girls nor in the group of boys in children aged 6&ndash, 7 years in yearly cohorts examined between 2008 and 2016. The prevalence of excess body weight in this population is at a stable level.

Background Short bowel syndrome (SBS) is defined as the a malabsorptive condition most often caused by massive resection of the small intestine. In children most cases of SBS originate in the newborn period and result from congenital anomalies or necrotizing enterocolitis. Loss of gut mucosa during resection does not only mean loss of absorption surface, but also deprives organism of many immunocompetent cells concentrated in gut associated lymphoid tissue, which is regarded the largest immune organ in humans. Aim of the study: We have aimed to access the influence of bowel resection on adaptive immunity in children, basing on peripheral lymphocyte populations and serum immunoglobulins. Patients and methods: 18 children, who underwent bowel resection in the first month of life and required further home parenteral nutrition were enrolled into the study. 12 healthy children, constituted control group. Based on flow cytometry the following subpopulations of lymphocytes were evaluated: T, B, NK, CD4+, C8 + and activated T cells. Serum immunoglobulins were determined with the use of immunoturbidimetric method. Results The percentage of B lymphocytes was reduced, while the rates of lymphocytes T and CD8 + lymphocytes were higher compared to healthy children. We documented significantly lower absolute count and proportion of NK cells in SBS group than in the control group. Absolute counts of lymphocytes, lymphocytes B, T, CD4 + and percentages of lymphocytes CD4+, and activated T cells inversely correlated with the time after resection. No statistically significant differences were found between the levels of IgA, IgM and IgG in the studied and the control group Conclusions Children with SBS do not present with clinical signs of immunodeficiency as well as deficits in peripheral lymphocyte populations and serum immunoglobulins. Lower number of NK cells in SBS patients compared to healthy children needs to be verified in larger cohort. The tendency of the lymphocyte subpopulations to decrease over time after resection points out the necessity for longer follow- up.

Background: Vitamin D was studied in regards to its possible impact on body mass reduction and metabolic changes in adults and children with obesity yet there were no studies assessing the impact of vitamin D supplementation during a weight management programme in children and adolescence. The aim of our study was to assess the influence of 26 weeks of vitamin D supplementation in overweight and obese children undergoing an integrated 12-months’ long weight loss programme on body mass reduction, body composition and bone mineral density. Methods: A double-blind randomized placebo-controlled trial. Vitamin D deficient patients (

Background: Vitamin D was studied in regards to its possible impact on body mass reduction and metabolic changes in adults and children with obesity yet there were no studies assessing the impact of vitamin D supplementation during a weight management program in children and adolescence. The aim of our study was to assess the influence of 26 weeks of vitamin D supplementation in overweight and obese children undergoing an integrated 12&ndash, months&rsquo, long weight loss program on body mass reduction, body composition and bone mineral density. Methods: A double&ndash, blind randomized placebo&ndash, controlled trial. Vitamin D deficient patients (&lt, 30 ng/ml level of vitamin D) aged 6&ndash, 14, participating in multidisciplinary weight management program were randomly allocated to receiving vitamin D (1200 IU) or placebo for the first 26 weeks of the intervention. Results: Out of the 152 qualified patients, 109 (72%) completed a full cycle of four visits scheduled in the program. There were no difference in the level of BMI (body mass index) change &ndash, both raw BMI and BMI centiles. Although the reduction of BMI centiles was greater in the vitamin D vs. placebo group (&minus, 4.28 &plusmn, 8.43 vs. &minus, 2.53 &plusmn, 6.10) the difference was not statistically significant (p = 0.319). Similarly the reduction in fat mass&mdash, assessed both using bioimpedance and DEXa was achieved, yet the differences between the groups were not statistically significant. Conclusions: Our study ads substantial results to support the thesis on no effect of vitamin D supplementation on body weight reduction in children and adolescents with vitamin D insufficiency undergoing a weight management program.

Background While in the general paediatric population the presence of abnormal lipid values is estimated at 8–20%, depending on the population, accepted norms and age, it was shown that in the population of lean children the prevalence of dyslipidemia is lower than in obese children, in whom it ranges from 20 to over 40%. Until now, however, no results of similar studies on a large sample of children form a Central or Eastern European country have been published. The aim of this study was to evaluate the prevalence of lipid disorders in overweight and obese children and adolescents participating in an integrated weight reduction programme. Methods According to the “6-10-14 for Health” programme implementation schedule, the programme accepted patients living in Gdańsk, aged 6, 9–11 and 14 years old, with BMI above the 85th percentile for age and sex, according to the Polish percentile charts. During the first visit, each of the participants underwent basic anthropometric examinations - body weight, body height, waist and hip circumference, blood pressure and body composition by bioelectrical impedance were measured. Blood samples were taken to assess lipid, glucose and insulin levels as well as alanine transaminase (ALT) and thyroid stimulating hormone (TSH) activity. Results 1948 patients underwent full anthropomethric and blood work measurements. At least one of the lipid disorders occurred in 38.23% of girls and 40.51% of boys with overweight and obesity. The most common lipid disorderswere decreased high-density lipoprotein cholesterol (HDL-C) levels (present in 20.55% of the girls and 23.79% of the boys) and elevated low-density lipoprotein cholesterol (LDL-C) (present in 15.31% of the girls and 14.25% of the boys). There was no strong association between lipid disorders and age, sex, birth weight, gestational age at birth or body composition. Conclusions Such a frequent occurrence of lipid disorders in the population of children and adolescents should be an important warning signal both at the individual and population level. Not only effective screening methods for overweight and obese children should be implemented from an early age but also therapeutic measures are required. Trial registration The trial is registered under the Local Ethics Committee at Medical University of Gdańsk, decision No. NKBBN/228/2012 from 25 June 2012.

Additional file 1.

Until 2021, the ZNF699 gene was not associated with any human genetic disease. There were only two studies exploring the associations between variants in ZNF699 and alcohol dependence. In 2021 Bertoli-Avella et al. reported 13 patients with a ZNF699 gene mutation. All patients presented global developmental delay and with systemic manifestations. A new phenotype was proposed and called DEGCAGS syndrome (OMIM 619488) (developmental delay with gastrointestinal, cardiovascular, genitourinary, and skeletal abnormalities). The DEGCAGS syndrome is inherited in the autosomal recessive mode. Here, we report a new case (14th up to date) of a patient with ZNF699 gene mutation, whose symptoms and dysmorphic features were similar to those presented by Bertoli-Avella et al. In addition, we have analyzed the frequency of occurrence of particular symptoms in the patients described so far.

Background Nitric oxide (NO) is an important mediator involved in vascular homeostasis. Changes in NO level are considered to be associated with obesity and its clinical consequences. Previous studies on NO levels in obese children provided inconclusive results, so this issue requires clarification. Objectives One of the main goals of this study was to assess whether childhood excessive body weight (EBW) is associated with changes in serum NO level and whether features like age and gender are linked to NO levels in selected groups. Material and methods In the present study, the serum NO levels were compared in 43 children with EBW and 37 ageand gender-matched children with normal weight. Moreover, in both groups, body measurements and various clinical parameters, including the serum concentrations of arginine (Arg), a precursor of NO, were determined. Results The mean serum NO level in EBW group (8.7 ±3.1 μmol/L) was significantly lower than in normal weight group (22.2 ±11.5 μmol/L). However, the serum Arg concentrations were higher in EBW children than in controls. Serum asymmetric dimethylarginine (ADMA) levels were higher in EBW group and inversely correlated with serum NO. The EBW female subgroup was characterized by slightly lower level of NO than the EBW male subgroup. There were no significant changes in serum NO level among different age subgroups in both groups. Conclusions Our results revealed that EBW in children is associated with significantly decreased level of serum NO. The decreased serum NO level in EBW children is not a result of depleted Arg in the blood. Asymmetric dimethylarginine may at least partially contribute to decreased NO levels in children with EBW. A decreased level of NO could be a potential early marker of the risk of cardiovascular disorders developing in children with EBW.

Background: Cystic fibrosis (CF) is characterized by malnutrition and chronic inflammation predominantly occurring in lungs. Evidence suggests a relation between inflammatory activity and nutritional status. Proinflammatory cytokines, playing crucial role in pulmonary destruction in CF, are regarded as a component of the pathogenesis of illness-related malnutrition. Chemerin - a novel marker of a crosstalk between nutrition and inflammation, has not been investigated in children with cystic fibrosis. The aim of this study was to determine serum level of chemerin, interleukin-1b (IL-1b), interleukin-6 (IL-6), tumor necrosing factor α (TNF-α) and interleukin-10 (IL-10) and to verify if they correlate with the nutritional status in children with CF. Methods: The study included 72 pediatric patients with cystic fibrosis. The control group was comprised of 30 healthy children. Nutritional status parameters: Body Mass Index (BMI), fat mass percentage (FM %) and fat free mass percentage (FFM%) have been assessed in all the subjects basing on bioimpedance and anthropometry according to Slaughter. Serum concentrations of chemerin and cytokines were estimated with ELISA. Results: No statistically significant difference in serum chemerin was found between the studied and the control group. We have documented a significantly higher level of IL-1b, IL-6, TNF-α and IL-10 in CF patients when compared to healthy controls. Neither the chemerin nor the cytokine levels correlated with parameters of nutritional status in our cohort. No statistically significant correlation was found between the serum chemerin and the inflammatory cytokines: IL-1b, IL-6, and TNFα. Conclusions: Our results show that chemerin is not associated with the nutritional status in children with cystic fibrosis. Chemerin has no impact on the levels of IL-1b, IL-6, TNFα in CF patients. IL-1b, IL6, TNFα and also IL10 are upregulated in cystic fibrosis.

Background Juvenile idiopathic arthritis (JIA) is a chronic, heterogenous inflammatory disease of unclear pathogenesis. JIA is hypothesized to be linked to a defective immune regulation. Anti-inflammatory cytokines belong to the best known regulatory factors. T-regulatory cells are a crucial cellular component of immune tolerance. One of their functions is synthesis of interleukin 10 (IL-10) and transforming growth factor beta1 (TGF-ß1).The aim of this study was to determine the proportion of T-regulatory cells (CD4+CD25highFOXP3+) in peripheral blood, and serum levels of TGF-ß1 and IL-10 in patients with JIA.Methods: The study included 25 patients with newly diagnosed JIA: oligoarthritis (n=17) and polyarthritis (n=8). Control group was comprised of 17 healthy children. CD4+CD25highFOXP3+ T cells in peripheral blood were quantified by means of three-color flow cytometry. Serum concentrations of TGF-ß1 and IL-10 were estimated with ELISA.Results: The proportion of peripheral CD4+CD25highFOXP3+cells in patients with JIA was significantly higher than in the controls (p=0.04). The two groups did not differ significantly in terms of their TGF-ß1 and IL-10 concentrations.Conclusions: At the time of the diagnosis, children with JIA present with elevated proportion of T-regulatory cells (CD4+CD25highFOXP3+) in peripheral blood. Anti-inflammatory cytokines, IL-10 and TGF-ß1, are not upregulated in the serum of patients with JIA, and therefore should not be considered as biomarkers of this condition.

Spinal muscular atrophy (SMA) is a severe neuromuscular disorder due to a defect in the survival motor neuron 1 (SMN1) gene. Its incidence is approximately 1 in 11,000 live births. In 2007, an International Conference on the Standard of Care for SMA published a consensus statement on SMA standard of care that has been widely used throughout the world. Here we report a two-part update of the topics covered in the previous recommendations. In part 1 we present the methods used to achieve these recommendations, and an update on diagnosis, rehabilitation, orthopedic and spinal management; and nutritional, swallowing and gastrointestinal management. Pulmonary management, acute care, other organ involvement, ethical issues, medications, and the impact of new treatments for SMA are discussed in part 2.

The aim of this study was to verify if serum chemerin in children correlates with body weight, fat mass, selected inflammatory markers, parameters of liver function, lipid and glucose metabolism.The study included children aged 5-17 years with normal body weight (85th BMI percentile, n=43) or overweight (≥85th BMI percentile, n=58). Serum concentrations of chemerin were determined with ELISA.Children with excess body weight presented with significantly higher serum concentrations of chemerin. Serum chemerin correlated positively with body weight, absolute BMI and its percentile, fat mass, systolic blood pressure, CRP, ALT, insulin and HOMA-IR.Serum level of chemerin may serve as a measure of ongoing obesity-related inflammation, early marker of subclinical liver dysfunction and metabolic syndrome in overweight pediatric patients.

Obesity is associated not only with an array of metabolic disorders (e.g. insulin resistance, hiperinsulinemia, impaired tolerance of glucose, lipid disorders) but also skeletal and joint abnormalities. Recently, a pleiotropic role of vitamin D has been emphasized. Obese children frequently present with vitamin D deficiency, and greater fat mass is associated with lower serum concentration of this vitamin. Although some evidence suggests that weight loss may affect vitamin D status, this issue has not been studied extensively thus far. The aim of a double-blind placebo-controlled study is to assess long-term health effects of vitamin D supplementation in vitamin D deficient obese children participating in an integrated weight-loss programme. A randomized double-blind, placebo-controlled trial analysing the effects of vitamin D3 supplementation in overweight or obese vitamin D deficient (

Abstract.The aim of the present study was to determine the effect of vitamin C supply in the diet of lactating women on vitamin C concentrations in human milk (n = 97) sampled at different stages of lactation. Vitamin C levels were measured by liquid chromatography. Dietary intake of vitamin C was determined based on 3-day food dairies kept by breastfeeding mothers. Maternal dietary intakes of vitamin C from natural sources on lactation day 90 (n = 18) were significantly higher than on lactation days 15 (n = 42) and 30 (n = 37). The number of women taking vitamin C supplements decreased in successive stages of lactation. The average daily intake of vitamin C was estimated at 119 mg, but nearly 20% of mothers consumed less than 50 mg of vitamin C per day. No significant correlations were observed between lactation stage and vitamin C levels in breast milk (r = 0.110, p = 0.064). The average vitamin C concentrations in human breast milk were determined at 50.9 mg / L, and were not higher than 80.6 mg / L regardless of lactation stage and maternal intake of vitamin C. Vitamin C excretion into breast milk is regulated to prevent exceeding saturation level. The vitamin C concentration in milk was positive correlated with maternal intake of vitamin C from food, in the case of non-supplemented diet (r = 0.402, p = 0.041). Our results suggest that vitamin C occurring in food is much better absorbed and passes into breast milk than vitamin C from supplements.

[b][/b][b]Introduction. [/b]The most prevalent inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn’s disease (CD). Immune processes play a vital role in the etiopathogenesis of these conditions, involving both cellular and humoral response mechanisms. The aim of this study was to quantify CD40- and CD80-positive cells in the biopsy specimens of large intestinal mucosa from children with IBD. [b]Materials and method. [/b]The study comprised 38 children aged between 3–17 years (mean 11.5±3.7 years) – 20 boys (52.6 %) and 18 girls (47.4%). Eighteen patients were diagnosed with UC on the basis of clinical manifestation, endoscopic and histopathological findings. Mean age of this subgroup was 11.55±4.07 years. A group of 10 children (mean age 12.30±2.83) diagnosed with CD was also included. The control group comprised 10 IBD-free children (mean age 10.28±4.07 years). The surface expressions of CD40 and CD80 were analyzed in large intestine mucosa biopsy specimens, fixed in formaldehyde, embedded in paraffin, and cut with a microtome into 4 µm slices. [b]Results. [/b]The number of CD40- and CD80-positive cells in the large intestinal mucosa of children with Crohn’s disease and ulcerative colitis was significantly higher than in the controls. The highest number of CD40+ and CD80+ cells was observed in the caecal mucosal membrane of Crohn’s disease patients and in the rectal mucosa of individuals with ulcerative colitis. [b]Conclusion.[/b] IBD is characterized by elevated, segment-specific, expression of CD40 and CD80.

Introduction: Newborn infants and small children require large amounts of calcium and phosphate in a low volume of solution which can increase the risk of precipitation of calcium phosphate. Calcium gluconate is the predominant calcium salt form employed in parenteral nutrition (PN) compounding due to its solubility profile with phosphate. Unfortunately, calcium gluconate contains higher levels of aluminum contamination than calcium chloride, resulting in an increased potential for aluminum toxicity in patients receiving traditional PN. The physicochemical stability of 30 total parenteral admixtures containing inorganic calcium salts was evaluated. Methods: Parenteral admixtures were prepared in one-chamber ethylene vinyl acetate bags: amino acids, glucose, electrolytes including only inorganic calcium salt and 20% (w/w) lipid emulsions (SMOFlipid(r), Omegaven(r) or Lipofundin MCT/LCT(r)) were placed together in a one chamber bag. Admixtures were stored at +4 °C for up to eight days after preparation. Visual observations, globule size distribution (using optical microscopy, laser diffraction and photon correlation spectroscopy methods), pH analysis and zeta potential measurements were performed. Results: The physicochemical stability of 29 of parenteral admixtures in the presence of inorganic calcium salt was confirmed. One admixture was deemed unsuitable for use in clinical practice due to the coalescence of oil droplets. Conclusion: Despite the presence of inorganic calcium salts, pediatric parenteral admixtures were stable up to eight days of storage. Due to presence of multiple components and a high risk of incompatibilities, physicochemical studies should be performed for each admixture before use in clinical practice. Resumen Introducción: los recién nacidos y los lactantes precisan aportes elevados de calcio y fósforo en soluciones con pequeño volumen lo que aumenta el riesgo de formar precipitados de fosfato cálcico. La principal sal de calcio empleado en nutrición parenteral (NP) es el gluconato cálcico, debido a su perfil de solubilidad con el fosfato. Lamentablemente el gluconato cálcico contiene unas concentraciones elevadas de aluminio mayores que el cloruro cálcico, lo que resulta en riesgo potencial de toxicidad por aluminio en pacientes que reciben NP. En este trabajo se evalúa la estabilidad fisicoquímica de 30 mezclas de NP con sales de calcio inorgánico. Métodos: las mezclas de NP se prepararon en bolsas de acetato de etilenvinilo. En una bolsa unicameral se mezclaron aminoácidos, glucosa, y electrolitos incluyendo una sal de calcio inorgánico y una emulsión lipídica al 20% (SMOFlipid(r), Omegaven(r) o Lipofundin MCT/LCT(r)). Las mezclas se almacenaron a +4 ° C hasta 8 días tras la elaboración. Se realizó un examen visual, estudio de la distribución del tamaño de los glóbulos (mediante microscopía óptica, difracción por láser y espectroscopia fotónica), análisis de pH y medición del potencial zeta. Resultados: se confirmó la estabilidad fisicoquímica de 29 mezclas de NP que contenían sales de calcio inorgánico. Sólo una de las preparaciones se consideró inválida para su uso clínico debido a la coalescencia de las gotas de grasa. Conclusión: a pesar de la presencia de sales de calcio inorgánico, las mezclas de NP pediátrica fueron estables hasta 8 días de almacenamiento. La presencia de múltiples componentes y el riesgo elevados de incompatibilidades hace recomendable el estudio de estabilidad fisicoquímica de cada mezcla antes de su empleo en la clínica.

Newborn infants and small children require large amounts of calcium and phosphate in a low volume of solution which can increase the risk of precipitation of calcium phosphate. Calcium gluconate is the predominant calcium salt form employed in parenteral nutrition (PN) compounding due to its solubility profile with phosphate. Unfortunately, calcium gluconate contains higher levels of aluminum contamination than calcium chloride, resulting in an increased potential for aluminum toxicity in patients receiving traditional PN. The physicochemical stability of 30 total parenteral admixtures containing inorganic calcium salts was evaluated.Parenteral admixtures were prepared in one-chamber ethylene vinyl acetate bags: amino acids, glucose, electrolytes including only inorganic calcium salt and 20% (w/w) lipid emulsions (SMOFlipid®, Omegaven® or Lipofundin MCT/LCT®) were placed together in a one chamber bag. Admixtures were stored at +4 °C for up to eight days after preparation. Visual observations, globule size distribution (using optical microscopy, laser diffraction and photon correlation spectroscopy methods), pH analysis and zeta potential measurements were performed.The physicochemical stability of 29 of parenteral admixtures in the presence of inorganic calcium salt was confirmed. One admixture was deemed unsuitable for use in clinical practice due to the coalescence of oil droplets.Despite the presence of inorganic calcium salts, pediatric parenteral admixtures were stable up to eight days of storage. Due to presence of multiple components and a high risk of incompatibilities, physicochemical studies should be performed for each admixture before use in clinical practice.INTRODUCCIÓN: los recién nacidos y los lactantes precisan aportes elevados de calcio y fósforo en soluciones con pequeño volumen lo que aumenta el riesgo de formar precipitados de fosfato cálcico. La principal sal de calcio empleado en nutrición parenteral (NP) es el gluconato cálcico, debido a su perfil de solubilidad con el fosfato. Lamentablemente el gluconato cálcico contiene unas concentraciones elevadas de aluminio mayores que el cloruro cálcico, lo que resulta en riesgo potencial de toxicidad por aluminio en pacientes que reciben NP. En este trabajo se evalúa la estabilidad fisicoquímica de 30 mezclas de NP con sales de calcio inorgánico. MÉTODOS: las mezclas de NP se prepararon en bolsas de acetato de etilenvinilo. En una bolsa unicameral se mezclaron aminoácidos, glucosa, y electrolitos incluyendo una sal de calcio inorgánico y una emulsión lipídica al 20% (SMOFlipid®, Omegaven®o Lipofundin MCT/LCT®). Las mezclas se almacenaron a +4 ° C hasta 8 días tras la elaboración. Se realizó un examen visual, estudio de la distribución del tamaño de los glóbulos (mediante microscopía óptica, difracción por láser y espectroscopia fotónica), análisis de pH y medición del potencial zeta. RESULTADOS: se confirmó la estabilidad fisicoquímica de 29 mezclas de NP que contenían sales de calcio inorgánico. Sólo una de las preparaciones se consideró inválida para su uso clínico debido a la coalescencia de las gotas de grasa. CONCLUSIÓN: a pesar de la presencia de sales de calcio inorgánico, las mezclas de NP pediátrica fueron estables hasta 8 días de almacenamiento. La presencia de múltiples componentes y el riesgo elevados de incompatibilidades hace recomendable el estudio de estabilidad fisicoquímica de cada mezcla antes de su empleo en la clínica.

The aim of this study was to analyze the usefulness of the serum concentration of neopterin (NPT) as a marker of juvenile idiopathic arthritis (JIA). The study included 67 children with JIA (36 girls and 31 boys), aged between 3.8 and 17.9 years (mean 13.7±3.4 years), and 105 healthy controls (47 girls and 58 boys) of similar age, with no evidence of acute or chronic inflammation. Serum NPT was determined immunoenzymatically. The median serum concentration of NPT and prevalence of elevated serum NPT (>11 nmol/L) were significantly higher in children with JIA than in the controls: 6.044 vs. 4.734 nmol/L (p11 nmol/L (50% vs. 0%, p

Impaired immune regulation has been suggested as an underlying mechanism of inflammatory bowel disease. Indoleamine 2,3-dioxygenase (IDO) and regulatory T cells expressing FOXP3 are crucial elements of immune regulation. Conversion of FOXP3- lymphocytes to Tregs is one of the functions of IDO. The aim of this study was to evaluate the number of cells expressing FOXP3 and IDO in the lamina propria of intestinal mucosa and to evaluate correlations between these parameters and disease activity. Sixty-six children newly diagnosed with inflammatory bowel disease (41 patients with ulcerative colitis and 25 patients with Crohn’s disease) were included in the study. Clinical activity of the disease was assessed by the Pediatric Ulcerative Colitis Activity Index and the Pediatric Crohn’s Disease Activity Index. Histopathological activity was scored according to the system described by Geboes. The infiltration of FOXP3+ and IDO+ cells was evaluated by immunohistochemistry. Sixteen patients with a diagnosis of irritable bowel syndrome (IBS) served as a control group. Lamina propria demonstrated a significantly higher infiltration of FOXP3+ and IDO+ cells in inflammatory bowel disease compared to the control group (p=0.001, p=0.004, respectively). The number of IDO+ and FOXP3+ cells correlated with clinical and histopathologic activity of Crohn’s disease. A positive correlation between the number of IDO+ and FOXP3+ cells was found in both types of inflammatory disease but not in patients with IBS. We conclude that indoleamine dioxygenase and FOXP3+ cells are upregulated in the intestinal mucosa of children with inflammatory bowel disease. IDO mediated conversion of FOXP3 -T cells to Tregs predominantly occurs in inflammation.

Pediatric parenteral nutrition enables normal growth even of preterm infants. Those children require, however, tailored parenteral nutrition and the creation of such can be challenging due to the risk of instability and shortages.Prototypical parenteral admixtures were created using different calcium salts (organic and inorganic) and different lipid emulsions and tested for stability. 36 of parenteral admixtures containing two types of calcium salts: chloride or gluconolactobionate and different lipid emulsions (SMOFlipid® or Lipofundin MCT/LCT®) were under investigation.Preliminary admixtures were prepared in two-chamber bags whereas lipid emulsions were placed separately in the second chamber. Pre-admixtures were stored for up to 21 days at +4ºC. Contents of the two chambers were combined at t = 0 or after 21 days of storage. Physical analysis of completed admixtures (visual inspection, microscopic observation, pH measurement and determination of the size distribution of oily droplets) was carried out after 21 days of the storage. Stability of lipid, commercial emulsions stored in ethylene vinyl acetate (EVA) bags for 42 days was also studied.Irrespectively of the time of storage of preadmixtures and type of calcium salt and different lipid emulsions among 36 total parenteral admixtures only one showed signs of destabilization after preparation and one was unstable when stored for longer than 14 days. All other formulations were qualified to be stable during the study. All investigated commercial lipid emulsions were physically stable in EVA bags even when stored at room temperature.The study proved that it was possible to store pre-admixture in EVA bags for 21 days at 4°C as well as that CAN (critical aggregation number) and CaxP (the products of multiplication of calcium and phosphate ions concentration) should not be used as reliable indicators of admixture physical stability. No influence of the type of calcium salts on stability of admixtures was observed.INTRODUCCIÓN: La nutrición parenteral pediátrica permite un crecimiento normal incluso en lactantes pretérmino. Sin embargo, estos niños requieren una nutrición parenteral a medida y la formulación de tal nutrición puede suponer un reto por el riesgo de inestabilidad y el desabastecimiento.Se crearon mezclas parenterales prototípicas utilizando diferentes sales de calcio (orgánicas e inorgánicas) y diferentes emulsiones lipídicas probando su estabilidad. Se investigaron 36 mezclas parenterales que contenían dos tipos de sales de calcio (cloruro o gluconolactobionato) y diferentes emulsiones lipídicas (SMOFlipid® o Lipofundin MCT/LCT®). MÉTODOS: Se prepararon unas pre-mezclas en bolsas bicompartimentales mientras que las emulsiones lipídicas se colocaron de forma separada en la segunda cámara. Las pre-mezclas se almacenaron hasta 21 días a +4º C. Se combinaron los contenidos de ambas cámaras en t = 0 o después de 21 días de almacenamiento. El análisis físico de las mezclas completadas (inspección visual, observación microscópica, medición del pH y determinación de la distribución por tamaño de las gotitas lipídicas) se realizó a los 21 días de almacenamiento. También se estudió la estabilidad de las emulsiones lipídicas almacenadas en bolsas comerciales de acetato de etilen vinilo (AEV) durante 42 días.Independientemente del tiempo de almacenamiento de las pre-mezclas y el tipo de sal de calcio y de las diferentes emulsiones lipídicas de entre el total de 36 mezclas parenterales, sólo en una se vieron signos de desestabilización tras la preparación y una fue inestable cuando se almacenó más de 14 días. El resto de las formulaciones se consideraron estables durante el estudio. Todas las emulsiones lipídicas comerciales investigadas fueron estables físicamente en las bolsas de AEV, incluso cuando se almacenaron a temperatura ambiente. CONCLUSIÓN: El estudio mostró que es posible almacenar pre-mezclas en bolsas de AEV durante 21 días a 4° C. También se vio que el NAC (número de agregación crítica) y el CaxP (los productos de la multiplicación de las concentraciones de los iones calcio y fósforo) no deberían utilizarse como indicadores fiables de la estabilidad física de las mezclas. No se observó ninguna influencia del tipo de sal de calcio sobre la estabilidad de las mezclas.

Background/Objectives: To analyse the approach to diagnose gastroesophageal reflux (GER) and the qualification criteria for anti-reflux (AR) procedures in Polish children fed via gastrostomy between 2000 and 2010. Subjects/Methods: An electronic questionnaire containing questions on the demographic and clinical data of patients with gastrostomies was distributed to six Polish centres of nutritional therapy. The portion pertaining to GER included data on clinical exponents, diagnostic procedures (pH-metry, pH-impedance, scintigraphy and upper gastrointestinal (GI) series) and AR. Results: In total, 348 children (M199/F149; age at gastrostomy 5.78±5.49 years) were included. Data on the diagnosis of GER and the AR criteria were available for 343 and 336 subjects, respectively. Percutaneous endoscopic gastrostomy was performed in 258/348 patients (74.1%), while surgery was performed in 80/348 patients (23%). The data from 10/348 (2.9%) cases were unavailable. At least one of the tests for GER was conducted in 177/343 (51.6%) of patients: pH-metry in 74/343 (21.6%), pH-impedance in 17/343 (5.0%), scintigraphy in 60/343 (17.5%) and upper GI series in 102/343 (29.7%). GER was reported in 114/343 cases (33.2%), and fundoplication was performed in 87 children (76.3% of patients with GER). The highest congruence between a positive test result and the decision to perform fundoplication was documented in cases of scintigraphy and upper GI series (P=0.00000 and P=0.00191, respectively). A significant increase in the prevalence of simultaneous gastrostomy and AR was observed over the decade analysed (r=0.8, P=0.009). This study revealed a centre-specific attitude towards the diagnosis of GER and the assessment of qualifications for fundoplication in Polish gastrostomy-fed children. Conclusions: The unified diagnostic algorithm of GER and the universal qualification criteria for AR procedures need to be defined for gastrostomy-fed children.

Background/Aims: To determine the proportion of T-regulatory cells (CD4+CD25highFOXP3+ cells) in peripheral blood and the number of FOXP3+ cells in intestinal mucosa of children with inflammatory bowel disease (IBD), and to verify whether these parameters correlate with the activity of the disease.Material and methods: 24 patients newly diagnosed for IBD were included in the study: ulcerative colitis (UC; n = 13) and Crohn’s disease (CD; n = 11). Seventeen healthy controls (HC) and 16 patients with irritable bowel syndrome (IBS) served as a control group for peripheral and intestinal Tregs assessment, respectively. The disease activity was assessed by Pediatric Ulcerative Colitis Activity Index (PUCAI) and Pediatric Crohn’s Disease Activity Index (PCDAI). Quantification of regulatory T cells of CD4+CD25highFOXP3+ phenotype in peripheral blood was based on three-color flow cytometry. Mucosal Tregs represented by FOXP3+ cells were evaluated using immunohistochemistry.Results: Median proportion of CD...