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Childhood obesity is one of the most important problems of public health. Searching was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from January 2022 to June 2022, for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Five main topics were defined in a consensus join statement of the Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes and Polish Association for the Study on Obesity: (1) definition, causes, consequences of obesity; (2) treatment of obesity; (3) obesity prevention; (4) the role of primary care in the prevention of obesity; (5) Recommendations for general practitioners, parents, teachers, and regional authorities. The statement outlines the role of diet, physical activity in the prevention and treatment of overweight and obesity, and gives appropriate recommendations for interventions by schools, parents, and primary health care. A multisite approach to weight control in children is recommended, taking into account the age, the severity of obesity, and the presence of obesity-related diseases. Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education are effective in improving metabolic and anthropometric indices. More actions are needed to strengthen the role of primary care in the effective prevention and treatment of obesity because a comprehensive, multi-component intervention appears to yield the best results.

The present study aimed to investigate how those who had been chronic victims of bullying perceive their bullying experience from their initial attacks to their bullying exit, how they understood processes and actions causing a situation to become progressively worse, and how they interpreted their own coping behaviors. Nine individuals who were victimized for at least 6 years were interviewed. The grounded theory approach was used to analyze the data, which generated a grounded theory of the downward spiral of bullying, demonstrating hidden aspects of bullying-the victims inner process as a response to external victimizing and accompanying events. The interdependence of those processes is presented in a timeline to show their cumulative nature as new vicious circles of bullying involving maladaptive coping strategies (e.g., self-blame), which form an overriding pattern of behavior that renders victims unable to break it even if they enter a new peer group. In terms of policy implications, the findings suggest the need to introduce school transition programs supporting school adaptation, identify chronic victims, and take every victimhood narrative seriously. Funding Agencies|Ministry of Science and Higher Education in PolandMinistry of Science and Higher Education, Poland [012/RID/2018/19]

Background Gastrointestinal tract function and it’s integrity are controlled by a number of peptides whose secretion is influenced by severe inflammation. In stomach the main regulatory peptide is ghrelin. For upper small intestine cholecystokinin and lower small intestine glucagon-like peptide- 1 are secreted, while fibroblast growth factor-21 is secreted by several organs, including the liver, pancreas, and adipose tissue [12]. Hematopoietic stem cell transplantation causes serious mucosal damage, which can reflect on this peptides. Methods The aim of the study was to determine fasting plasma concentrations of ghrelin, cholecystokinin, glucagon- like peptide-1, and fibroblast growth factor-21, and their gene expressions, before and 6 months after hematopoietic stem cell transplantation.27 children were studied, control group included 26 healthy children. Results Acute graft versus host disease was diagnosed in 11 patients (41%, n = 27). Median pre-transplantation concentrations of gastrointestinal peptides, as well as their gene expressions, were significantly lower in studied group compared with the control group. Only median of fibroblast growth factor-21 concentration was near-significantly higher before stem cell transplantation than in the control group. The post–hematopoietic transplant results revealed significantly higher concentrations of the studied peptides (except fibroblast growth factor-21) and respective gene expressions as compare to pre transplant results. Median glucagone like peptide-1 concentrations were significantly decreased in patients with features of acute graft versus host disease. Moreover, negative correlation between glucagone like peptide-1 concentrations and acute graft versus host disease severity was found. Conclusions Increased concentrations and gene expressions of gastrointestinal tract regulation peptides can be caused by stimulation of regeneration in the severe injured organ. Measurement of these parameters may be a useful method of assessment of severity of gastrointestinal tract complications of hematopoietic stem cell transplantation.

To present the sonographic follow-up of intrathyroidal ectopic thymus (IET) in children and adolescent patients. Out of the 507 children referred to FNAB between 2006 and 2018, 30 (5.9%) pediatric patients (10 females), mean age 5.7 years (1.2–13.8, median 4.9 years) were diagnosed with IET. A retrospective analysis of medical files of patients diagnosed with IET between 2006 and 2018. Assessed data included ultrasound characterisation, elastographic strain ratio (SR) results and hormonal evaluation. Analysis of thyroid US scans revealed that the mean age at the first thyroid ultrasound was 5.7 (1.2–13.8, median 4.9) years, and at the last US 10.7 (3.7–18, median 10.5) years. The mean time of the IET observation was 59.6 (2–148, median 53.5) months. On US, IET was hypoechoic with multiple linear and punctate echoes, hypovascular, fusiform on longitudinal plane and round or polygonal on an axial plane, more common in the right thyroid lobe (66.7%) and located in the posterior part of the lobes (54.5%), bilateral in two patients and multifocal in one patient. SR of IET was similar to the surrounding normal thyroid tissue. Complete regression of IET was observed in 12/30 patients after a mean time of 81.7 months (median 76.5), at the mean age of 13.7 (9.2–18, median 13.9) years. FNAB was performed in 10/30 and a hemithyroidectomy in 1/30 IET patients. In the FNAB (+) group, patients were younger (5.08 vs 6.08 years) and lesions were larger (0.12 ml vs 0.05 ml) than in the FNAB (−) group. All patients with IET were euthyroid with negative TPOAb and TgAb levels. The reproducibility of unique ultrasound features of IETs allows for safe long-term follow-up of these benign lesions in the majority of pediatric patients: not only monitoring the regression of IET but also screening towards the rare occurrence of a tumor arising from the IET.

Severe early-onset obesity (SEOO) in children is a common feature of monogenic obesity. Nowadays, mutations in at least 50 genes are known to be related to monogenic obesity, and many others are tested. Part of them is involved in the leptin–proopiomelanocortin pathway. The aim of the project is to establish the Polish database of severely obese children and adolescents and to evaluate the prevalence of monogenic forms of obesity in this cohort, with a special focus on leptin–proopiomelanocortin pathway abnormalities. The secondary project aim is to identify new population-specific mutations in obesity-related genes in severely obese Polish children and adolescents. This is a prospective multi-center clinical study performed in four Polish centers. The estimated sample size is 500 patients aged 1–18 years, with severe obesity, hyperphagia, and food-seeking behaviors. In each patient, the medical history regarding the obesity duration in the patient and obesity and its complication existence in the family will be taken. Next, the questionnaire regarding the symptom characteristic of specific mutations, which we are going to test, will be performed. Hyperphagia will be assessed on the basis of age-specific questionnaires. The physical examination with anthropometric measurement, basic biochemical and hormonal tests, and leptin and biologically active leptin measurements will be performed. Finally, genetic analysis will be performed using next-generation sequencing with sequencing libraries prepared to include obesity-related genes. The genotyping findings will be confirmed with the use of classic sequencing (Sanger’s method). In the future, the pathogenicity of new mutations in obesity-related genes identified in our cohort is planned to be confirmed by functional testing in vitro. Nowadays, there are no data regarding the prevalence of severe obesity or monogenic obesity in Polish children. This project has the potential to improve understanding of obesity etiology and may contribute to implementing attribute mutation-specific treatment. Moreover, it may lead to a finding of new, population-specific mutations related to SEOO.

Obesity is a chronic disease, that in adolescents may lead to serious consequences affecting somatic and mental health. This study aimed to assess the prevalence of depressive symptoms and anxiety in adolescents with obesity and their parents. The relationships between depressive and anxiety symptoms and the somatic consequences of obesity were also analyzed. Material and Methods19 patients with obesity (BMI Z-SCORE 2.1-5.5), at the age 16-17, and their parents answered validated questionnaires (Children’s Depression Inventory 2, The State-Trait Anxiety Inventory), and a survey assessing everyday functioning. ResultsThere were no significant differences in the occurrence of symptoms of depression in children and their parents: for the overall scale score of T-score (p=0.331), for the emotional problems (p=0.281) subscale, and the functional problems (p=0.147) subscale. The comparison of the results between boys and girls revealed no significant differences. A significantly higher level of anxiety was found in parents of children who gained weight in the year preceding the study (p = 0.046), and both in children and parents of children with metabolic-associated fatty liver disease – MAFLD (p=0.022 and p=0.007). According to adolescents, obesity affects the most leisure activities.ConclusionObesity, like any chronic disease, can have a significant impact on the emotional state of children and adolescents as well as the possibility of realizing interests and spending free time. Much more important than depressive disorders are anxiety disorders concerning both patients and their parents.

Objectives Coexistence of arterial hypertension (AH) in children with obesity increases morbidity and shortens life. Its role as an indicator of coexisting metabolic complications is however less known. The objective of the study was to compare metabolic profiles of children with obesity and with or without AH. Methods We included patients aged 10–18 with the BMI Z-score ≥2. Diagnosis of AH was based on the European Society of Hypertension criteria (2016). Metabolic profiles were assessed by glucose and insulin levels taken before and after glucose load, fasting levels of triglycerides (TG), total (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, and HOMA-IR. Results Of 534 patients, 33.5% were diagnosed with AH. The AH patients, as compared to non-AH, had higher fasting insulin levels (22 vs. 19.7 mIU/L, p=0.04), HOMA-IR (4.5 vs. 4.0, p=0.029), and post-load glucose level (6.3 vs. 5.7, p=0.000041). No differences in the post-load insulin levels (113 vs. 100 mIU/L, p=0.056), fasting glucose (4.5 vs. 4.5 mmol/L, p=0.5), or lipids were found (TC: 4.4 vs. 4.4 mmol/L, p=0.9; LDL: 2.7 vs. 2.7, p=0.2; TG: 1.4 vs. 1.4 mmol/L, p=0.5; HDL: 1.1 vs. 1.2, p=0.3. Conclusions Concomitance of AH in children with obesity may be an indicator of coexisting metabolic complications.

Background: Home isolation during the coronavirus 2019 (COVID-19) pandemic lockdown strongly impacted everyday life, affecting, in particular, eating habits and everyday activity. The aim of this study was to analyze the impact of the pandemic on behaviors and subsequent changes in body mass index (BMI) in children from Southern Poland. Methods: The study included 206 participants (104 females and 102 males) with a complete analysis of 177 participants (96 females and 81 males) with a mean age of 12.8 ± 2.6 years admitted to three pediatric endocrinology clinics (Rzeszów, Kraków, and Katowice) due to simple obesity, type 1 diabetes mellitus, somatotropin pituitary deficiency on growth hormone replacement therapy, and other endocrine and metabolic disorders between June and September 2020. The study used a self-prepared questionnaire regarding eating habits, physical activity, screen time, and sleep before and during the lockdown. Anthropometric measurements were performed under clinical settings twice (before the pandemic in January–March 2020, and in June–September 2020). Results: During the lockdown, BMI z-scores increased over the whole group, especially in obese children (0.073 ± 0.18, p = 0.002). The number of children who declared low and high physical activity of more than 60 min per day declined from 41.2% and 18.6% to 31.1% and 6.2% (p = 0.03 and p < 0.001), respectively; sleep times over 8 h increased (46.9% vs. 60.4% p = 0.007); screen times over 5 h daily increased (14.7% to 46.9%, p < 0.001). Eating habits did not change significantly. Conclusions: Daily physical activity and sleep levels were affected by the pandemic leading to the increase of BMI, especially in obese patients with endocrine disorders. During the COVID-19 pandemic, forward-thinking strategies must be developed to prevent childhood obesity.

Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of ‘tracking’ of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed.

Insulin-like growth factors (IGF-1 and IGF-2) and insulin-like growth factor-binding proteins (IGFBP-1 to -7) are involved in the regulation of cell proliferation and differentiation and may be associated with various metabolic parameters. The aim of our study was to compare levels of IGFs and IGFBPs and the expressions of their genes in children before and after hematopoietic stem cell transplantation (HSCT) to assess their potential as markers of late metabolic complications of HSCT. We also conducted additional comparisons with healthy controls and of correlations of IGF and IGFBP levels with anthropometric and biochemical parameters. We analyzed 19 children treated with HSCT and 21 healthy controls. We found no significant differences in the levels of IGFs and IGFBPs and expressions of their genes before and after HSCT, while IGF and IGFBP levels were significantly lower in children treated with HSCT compared with controls. We conclude that our results did not reveal significant differences between the levels of IGFs and IGFBPs before and after HSCT, which would make them obvious candidates for markers of late complications of the procedure in children. However, due to the very low number of patients this conclusion must be taken with caution and may be altered by further research.

Coronavirus disease 2019 (COVID-19) is associated with systemic inflammation. A wide range of adipokines activities suggests they influence pathogenesis and infection course. The aim was to assess concentrations of chemerin, omentin, and vaspin among COVID-19 patients with an emphasis on adipokines relationship with COVID-19 severity, concomitant metabolic abnormalities and liver dysfunction. Serum chemerin, omentin and vaspin concentrations were measured in serum collected from 70 COVID-19 patients at the moment of admission to hospital, before any treatment was applied and 20 healthy controls. Serum chemerin and omentin concentrations were significantly decreased in COVID-19 patients compared to healthy volunteers (271.0 vs. 373.0 ng/ml; p p = 0.01, respectively). There were no correlations of analyzed adipokines with COVID-19 severity based on the presence of pneumonia, dyspnea, or necessity of Intensive Care Unit hospitalization (ICU). Liver test abnormalities did not influence adipokines levels. Elevated GGT activity was associated with ICU admission, presence of pneumonia and elevated concentrations of CRP, ferritin and interleukin 6. Chemerin and omentin depletion in COVID-19 patients suggests that this adipokines deficiency play influential role in disease pathogenesis. However, there was no relationship between lower adipokines level and frequency of COVID-19 symptoms as well as disease severity. The only predictive factor which could predispose to a more severe COVID-19 course, including the presence of pneumonia and ICU hospitalization, was GGT activity.

Background Few studies indicate the occurrence of abnormal nocturnal dipping of blood pressure (BP) in 35-50% of children and adolescents with obesity. The relation between that phenomenon and metabolic complications of obesity remains unclear. To evaluate the association between disorders of glucose and lipid metabolism, and nocturnal non-dipping in pediatric patients with obesity. Methods In 207 children (53.14% girls, mean age 14 (range 2-17), mean BMI Z-SCORE 4.38, range 2.07-10.74) standard 24-h Ambulatory Blood Pressure Monitoring was performed. Normal dipping was defined as a ≥ 10% decline in BP during the night. Results There were 106 (51.21%) cases of non-dippers. The mean 24-h nocturnal systolic BP (SBP) reduction (%) was 9.9 ± 5.5. The mean 24-h nocturnal diastolic BP (DBP) reduction (%) was 15.8 ± 8.5. There was a significant correlation between BMI Z-SCORE and mean day-time SBP (r = 0.14 P = .042). There are positive correlations between 24-h heart rate (beats/min) and BMI Z-SCORE (r = 0.15, P = .027), between fasting glucose and systolic BP Z-SCORE (r = 0.17, P = .03) and between mean diastolic BP and LDL cholesterol (r = 0.23, P = .004). Total cholesterol level was significantly higher in non-dippers (4.34 vs. 3.99 mmol/L, P = .034). There were no significant differences between non-dippers and dippers regarding fasting glucose (4.6 vs. 4.8 mmol/L), 120'post load glucose (5.7 vs. 5.9 mmol/L), insulin (19 vs. 20.2 µIU/mL), HOMA-IR (2.36 vs. 2.44), LDL cholesterol (2.64 vs. 2.51 mmol/L), HDL cholesterol (1.06 vs. 1.03 mmol/L) or triglycerides (1.36 vs. 1.34 mmol/L) levels. Conclusion Nocturnal non-dipping is frequent in pediatric patients with obesity. It is associated with higher total cholesterol levels.

Endometriosis is a disease whose underlying cause is the growth of the endometrium outside the uterine cavity. The disease is characterised by unpleasant pain in the pelvic region, irrespective of the phase of the woman’s cycle. Physiotherapy in its various forms can be an excellent complement to the gynaecological treatment of endometriosis, by virtue of reducing inflammation, alleviating pain and thus significantly improving women’s quality of life. Physiotherapy in endometriosis should include kinesiotherapy, manual therapy including visceral therapy, physical therapy, spa treatment including balneotherapy, and hydrotherapy. The aim of this study is to present the use of physiotherapy as an adjunct therapy in the treatment of endometriosis. A review of the available literature in the Medline, PubMed and Google Scholar databases was performed without being limited by the time frame of available publications on the forms of physiotherapy used in the treatment of endometriosis.

Insulin-like growth factors (IGFs) and insulin-like growth-factor-binding proteins (IGFBPs) regulate cell proliferation and differentiation and may be of importance in obesity development. The aim of the study was to analyze the expression of chosen IGF-axis genes and the concentration of their protein products in 28 obese children (OB) and 34 healthy control (HC), and their correlation with essential parameters associated with childhood obesity. The gene expression of IGFBP7 was higher, and the expression of IGF2 and IGFBP1 genes was lower in the OB. The expression of IGFBP6 tended to be lower in OB. IGFBP4 concentration was significantly higher, and IGFBP3 tended to be higher in the OB compared to the HC, while IGFBP1, IGFBP2, and IGFBP6 were significantly lower, and IGFBP7 tended to be lower in OB. We found numerous correlations between IGFs and IGFBP concentration and obesity metabolic parameters. IGFBP6 correlated positively with apelin, cholecystokinin, glucagone-like peptide-1, and leptin receptor. These peptides were also significantly lower in obese children in our study. The biological role of decreased levels of IGFBP6 in obese children needs further investigation.

Greater knowledge on the social complexities of bullying is crucial to reduce actual bullying behavior. Two main approaches have been used to study bullying: the participant role approach and the bullying circle. In this study, we explored bullying through interviewing adults who had been victims of school bullying in the past, investigating how they perceived their experiences, and how they interpreted the bullying context and their surrounding peer relations. We interviewed 20 participants (more than 18 years old), all of whom had experience of being bullied for more than 1 year. The interview data were then analyzed with a thematic analysis. We found that participants had a different definition of bullying compared with the standard definition formulated by researchers. They also confirmed the fluidity of participants’ roles and the changes in behavioral patterns toward victims, depending on the peer context. Most importantly, we revealed a new participant in the bullying circle: the frenemy, whose intervention style changes from pro-victim when alone with the victim to neutral or pro-aggressor when surrounded by members of the bullying circle. This new addition adds to our understanding of the bullying process and the relationships within the bullying circle, which may help with more effective prevention.

The occurrence of childhood obesity is influenced by both genetic and epigenetic factors. FTO (FTO alpha-ketoglutarate dependent dioxygenase) is a gene of well-established connection with adiposity, while a protooncogene PLAG1 (PLAG1 zinc finger) has been only recently linked to this condition. We performed a cross-sectional study on a cohort of 16 obese (aged 6.6–17.7) and 10 healthy (aged 11.4–16.9) children. The aim was to evaluate the relationship between methylation and expression of the aforementioned genes and the presence of obesity as well as alterations in anthropometric measurements (including waist circumference (WC), body fat (BF_kg) and body fat percent (BF_%)), metabolic parameters (lipid profile, blood glucose and insulin levels, presence of insulin resistance) and blood pressure. Expression and methylation were measured in peripheral blood mononuclear cells using a microarray technique and a method based on restriction enzymes, respectively. Multiple regression models were constructed to adjust for the possible influence of age and sex on the investigated associations. We showed significantly increased expression of the FTO gene in obese children and in patients with documented insulin resistance. Higher FTO expression was also associated with an increase in WC, BF_kg, and BF_% as well as higher fasting concentration of free fatty acids (FFA). FTO methylation correlated positively with WC and BF_kg. Increase in PLAG1 expression was associated with higher BF%. Our results indicate that the FTO gene is likely to play an important role in the development of childhood adiposity together with coexisting impairment of glucose-lipid metabolism.

INTRODUCTION Although the diagnostic criteria for diabetes in children and adolescents should be widely known to all healthcare professionals, many cases of type 1 diabetes (DM1) are still not recognized in time. The aim of this study was to compare the experiences with the diagnosis of DM1 of young doctors during training and specialists working as primary health care physicians in Poland. MATERIAL AND METHODS 50 specialists in paediatrics or family medicine (average professional experience of 14.6 years) and 50 doctors, and those without specialization (up to 4 years after graduating from medical studies, average professional experience of 1.4 years) participated in the survey. The questionnaires were conducted from November 2019 to November 2020. RESULTS Most of the study participants correctly answered the questions about the diagnostic criteria of diabetes and its management at the moment of diagnosis, except for the question regarding diagnostic criteria for diabetes in oral glucose tolerance test. The correct answers varied from 96% to 72% among medical specialists and physicians during the training, respectively. What is interesting is the relatively small number of diagnosed cases of DM1 during the entire professional career of specialists (0-12 cases), compared to the doctors without specialization (0-5 cases). Medical specialists declared more frequently the use of a glucometer in their daily practice (mean 6 vs. 1, p < 0.05), but after taking into account the years of experience, the difference was insignificant. CONCLUSIONS It is important to educate primary care physicians, despite their professional experience. Practical education of physicians is also necessary.

Background: The relationship between obesity, arterial hypertension, and excessive salt intake has been known for a long time; however, the mechanism of this relationship remains not clear. Methods: The paper presents a current literature review on the relationship between salt consumption and the development of arterial hypertension in children and adolescents with obesity. Results: In addition to the traditional theory of hypertension development due to the increase in intravascular volume and disturbances of sodium excretion, recent studies indicate the existence of a complex mechanism related to excessive, pathological secretory activity of adipocytes, insulin resistance, and impaired function of the renin–angiotensin–aldosterone axis. That makes obese children and adolescents particularly vulnerable to the development of salt-sensitive arterial hypertension. Studies performed in many countries have shown that children and adolescents consume more sodium than recommended. It is worth noting, however, that the basis for these recommendations was the extrapolation of data from studies conducted on adults. Moreover, more important than sodium intake is the Na/K ratio and water consumption. Conclusion: Regardless of the population-wide recommendations on reducing salt intake in children, specific recommendations for overweight and obese patients should be developed.

Introduction: The influence of growth hormone (GH) treatment on amino acids (AAs) profile in patients with Turner syndrome (TS) was investigated. Material and methods: The study group included girls with TS: treated with GH (GH+) and girls with no GH treatment (GH−). The control group consisted of healthy girls. Free plasma AAs were measured by the LC/MS/MS. Results: The plasma concentrations of glutamine, threonine were significantly higher in group GH+ than in group GH− (p < 0.05). In group GH− the values of glutamine, alanine, isoleucine, glutamic acid were significantly different than in the control (p < 0.05–p < 0.008). Conclusion: AAs profile in girls with TS might be characteristic for the disease but also depends on GH treatment.

Wprowadzenie: Samoistne dojrzewanie występuje u 30% pacjentek z zespołem Turnera (ZT), a jego brak jest wskazaniem do rozpoczęcia hormonalnej terapii zastępczej (HRT). Dotychczas nie określono wiarygodnych markerów określających prawdopodobieństwo wystąpienia samoistnego dojrzewania w tej grupie pacjentek. Cel pracy: Ocena przydatności oznaczeń stężeń hormonu antymüllerowskiego i inhibny B jako markerów czynności jajników i predyktorów wystąpienia samoistnego dojrzewania u pacjentek z ZT. Materiał i metody: Do badania włączono 35 pacjentek z ZT leczonych ludzkim rekombinowanym hormonem wzrostu w wieku fizjologicznego dojrzewania płciowego (10-12 lat, średni wiek 10,5 roku). Przed wprowadzeniem HRT oceniono oś gonadalną (LH, FSH, estradiol). Dodatkowo oznaczono stężenie AMH i inhibiny B. Podczas obserwacji pacjentki podzielono na dwie grupy: z samoistnym początkiem dojrzewania (SP) lub bez (WP). Samoistne dojrzewanie zdefiniowano jako rozwój piersi oceniony na stopień II lub wyższe w skali Tannera. Wyniki: Pacjentki z grupy WP pozostawały w obserwacji do średniego wieku 16 lat. Samoistny początek dojrzewania wystąpił u 16 pacjentek (średni wiek 10 lat). U pacjentek z grupy SP stwierdzono istotnie mniejsze stężenia FSH (1,14-91,1 mIU/ml, śr. 24,5 mIU/ml vs 7,7-196,4 mIU/ml, śr. 66,5 mIU/ml, p = 0,002), większe stężenia estradiolu (10,5-68,8 pg/ml, śr. 28,4 pg/ml vs 6,1-26,0 pg/ml, śr. 14,9 pg/ml, p = 0,005), AMH (0,0-3,11 ng/ml, śr. 0,8 vs 0,0-0,002 ng/ml, śr. 0,003 ng/ml, p = 0,001) i inhibiny B (0,0-110,0 pg/ml, śr. 29,1 pg/ml vs 0,0-11,0 pg/ml, śr. 1,06 pg/ml, p = 0,026). U trzech pacjentek z grupy SP bez zwiększonego stężenia FSH (FSH < 35 mIU/ml) stwierdzono zerowe stężenia AMH i inhibiny B. Kariotyp mozaikowy (nie 45,X) stwierdzono u 87,5% pacjentek z grupy SP i tylko u 47% pacjentek z grupy WP. Wnioski: Ocena stężeń AMH i inhibiny B może być wnieść dodatkową wartość podczas oceny funkcji jajników u pacjentek z ZT. Małe stężenia tych markerów mogą wskazywać na ryzyko niewydolności jajników nawet u pacjentek, które rozpoczęły dojrzewanie samoistnie i u których nie stwierdzono hipogonadyzmu hipergonadotropowego. Introduction: Spontaneous puberty occurs in 30% of patients with Turner Syndrome. Its absence is an indication for hormone replacement therapy (HRT). No reliable markers of spontaneous puberty have been defined to date. Aim of the study: To evaluate the usefulness of antymüllerian hormone (AMH) and inhibin B assessment in predicting ovarian function and spontaneous puberty in girls with TS. Material and methods: The study included 35 TS patients treated with human recombinant growth hormone (rhGH). Gonadal axis function parameters (LH, FSH and estradiol) were evaluated at the age of physiological puberty (10-12 years, mean 10.5 years), before introduction of HRT. Additionally AMH and inhibin B levels were assessed. In follow up patients were divided into 2 groups: with (SP) and without (WP) spontaneous puberty. Spontaneous puberty was defined as Tanner stage 2 or higher breast development. Results: WP patients were observed until the mean age of 16y. SP occurred in 16 patients (mean age 10 years). Patients with SP presented with significantly lower mean FSH level (1.14-91.1 mIU/ml, mean mIU/ml 24.5 vs. 7.7-196.4 mIU/ml, mean 66.5 mIU/ml, p = 0.002), higher mean estradiol (10.5-68.8 pg/ml, mean 28.4 pg/ml vs. 6.1-26.0 pg/ml, mean 14.9 pg/ml, p = 0.005), AMH (0.0-3.11 ng/ml, mean 0.8 ng/ml vs. 0.0-0.002 ng/ml, mean 0.003 ng/ml, p = 0.001) and inhibin B (0.0-110.0 pg/ml, mean 29.1 pg/ml vs. 0.0-11.0 pg/ml, mean 1.06 pg/ml, p = 0.026) levels. In three SP patients without elevated FSH level (FSH < 35 mIU/ml) we found zero concentration levels of AMH and inhibin B. SP patients had mosaic (non 45,X) karyotype in 87.5% and WP patients only in 47%. Conclusions: AMH and inhibin B assessment may be a valuable complement to the diagnosis of ovarian function in patients with TS. Low levels of these parameters may indicate a risk of ovarian failure even in patients with spontaneous puberty and without hypergonadotropic hypogonadism.

Objective: One of the hypothesized reasons for the observed increase in type 1 diabetes incidence in children is weight gain, causing accelerated disease development in predisposed individuals. This so-called accelerator hypothesis is, however, controversial. The aim was to analyze whether, in the ethnically homogeneous population of Lesser Poland, an increase in the number of cases of diabetes among children was associated with younger age and higher body mass index-standard deviation score (BMI-SDS) at the time of diagnosis. Methods: Retrospective data analysis from medical records of all patients

Introduction and Objective Vitamin D deficiency is common in obesity; however, its contribution in the development of metabolic complications remains uncertain. The aim of the study was to examine the relationships between vitamin D status and metabolic complications. Material and Methods The results of blood pressure measurements, biochemical tests and ultrasound of the liver were compared in both groups. The study was conducted at the Children’s University Hospital in Krakow, Poland. 30 obese adolescents (mean 13.23y.o.); 18 with 25OHD levels 20 ng/mL. Results The vitamin D deficient group presented with significantly higher values of the diastolic blood pressure (125.9vs.115mmHg), uric acid level (384.7vs.301.5umol/L) and lower phosphorus level (1.4vs.1.65mmol/L), higher prevalence of arterial hypertension (44vs.8.3%), and liver steatosis (25vs.8.3%); lower, but not significantly, levels of fibroblast growth factor 23 and fibroblast growth factor 19. Conclusions Hypovitaminosis D in obese adolescents is associated with higher prevalence of arterial hypertension, liver steatosis, elevated serum uric acid and low phosphorus levels. The potential contribution of the fibroblast growth factor 23 and fibroblast growth factor 19 in these complications development needs further investigation.

Purpose The metabolic effects of prepubertal low-dose estrogen replacement (LE) therapy in Turner syndrome (TS) have not been fully investigated to date. The present study aimed to compare glucose and lipids metabolism in adolescents with TS on LE and conventional estrogen replacement (CE). Methods In 14 TS (mean age 13.8), LE (17β-estradiol, 62.5 μg daily) was introduced before age 12 (mean age 10.5), and followed by a pubertal induction regimen after age 12, and in 14 CE was started after age 12 (mean 14, SD 1.96). Before, and 3 years after starting 17β-estradiol growth velocity, bone age, BMI, and selected parameters of glucose and lipids metabolism were assessed. Results There were no significant differences between LE and CE in the mean levels of any parameter before introduction of 17β-estradiol [total cholesterol (TC): 4.1 vs 4.3 mmol/L, LDL cholesterol (LDLc): 2.2 vs 2.4 mmol/L, HDL cholesterol (HDLc): 1.6 vs 1.4 mmol/L, triglycerides: 0.9 vs 1.0 mmol/L, fasting glucose: 4.2 vs 4.4 mmol/L, post-load glucose: 4.8 vs 5.5 mmol/L; fasting insulin: 6.8 vs 8.0 post-load insulin: 21.3 vs 67.0 μIU/mL, HOMA-IR 1.3 vs 1.6]. After three years of treatment, TC and LDLc levels were significantly lower in LE group (3.8 vs 4.4 mmol/L, p = 0.004; 1.9 vs 2.4 mmol/L, p = 0.03). The other parameters did not differ significantly. There was no negative impact on growth course and bone age advancement nor on BMI in LE group. Conclusion Prepubertal LE is associated with healthier lipid profile than CE in girls with TS.

Wstęp: Rozpoznanie pourazowego przerwanie szypuły przysadki, będącego stanem zagrożenia życia, jest często opóźnione. W literaturze można znaleźć nieścisłe informacje dotyczące różnicowania tego stanu z genetycznie uwarunkowanym zespołem przerwania szypuły przysadki (pituitary stalk interruption syndrome - PSIS). Opis przypadku: Przedstawiono przypadek pacjentki z pourazowym przerwaniem szypuły przysadki skutkującym wielohormonalną niedoczynnością przysadki (combined life-threatening pituitary hormone deficiency - CPHD) i typowym obrazem w rezonansie magnetycznym (magnetic resonance imaging - MRI): atroficznymi, niewidocznymi szypułą i płatem tylnym przysadki oraz hipotroficznym płatem przednim oraz - najbardziej charakterystycznym dla tego zaburzenia - hiperintensywnym sygnałem dystalnego regenerującego aksonu podwzgórza (pseudo płat tylny) w miejscu wyniosłości pośrodkowej. Ta ostatnia nieprawidłowość bywa często mylona z ektopowo położonym płatem tylnym widocznym w przypadku genetycznie uwarunkowanego PSIS. Wnioski: Obraz MRI wraz z urazem głowy w wywiadzie pozostającym w związku czasowym z wystąpieniem przejściowej moczówki prostej oraz objawami wielohormonalnej niedoczynności przysadki, jak również brak pozaprzysadkowych zaburzeń linii środkowej ciała różnicuje pourazowe przerwanie szypuły przysadki (post-traumatic pituitary stalk transection syndrome - PSTS) i genetycznie uwarunkowany PSIS. W każdym przypadku ciężkiego urazu głowy należy dokonać oceny hormonalnej funkcji przysadki oraz MRI okolicy podwzgórzowo-przysadkowej. Introduction: The diagnosis of post-trauma pituitary stalk transection, which is often life-threatening condition, is frequently delayed. In medical literature still exist conflicting data concerning distinguishing this pathology with genetic developmental pituitary stalk interruption syndrome (PSIS). Case presentation: We present a case of patient with post-trauma pituitary stalk transection resulting in combined life-threatening pituitary hormone deficiency (CPHD) and typical MRI picture: atrophic not visible stalk and posterior pituitary and hypotrophic anterior pituitary with most typical for this disorders hyperintense signal of distal regenerating axon of hypothalamus (pseudo posterior lobe) at median eminence with not visible posterior pituitary. This latter finding is often confused with ectopic posterior lobe in genetically determined PSIS. Conclusions: MRI image together with medical history of the head trauma and its strict temporal relation with transient diabetes insipidus and the occurrence of CPHD signs, as well as the lack of extrapituitary midline defects differentiate posttraumatic pituitary stalk transection syndrome (PSTS) from genetic PSIS. In every case of severe traumatic head injury hormonal evaluation and MRI of hypothalamic-pituitary axis should be performed.

Background Elevated chemerin level is observed in patients with arterial hypertension. The aim of the study was to determine the relationship between chemerin level, and parameters of blood pressure and arterial stiffness in children and adolescents with obesity but without arterial hypertension. Methods In 23 children with obesity (13 girls, mean age 9.3, SD 1.9, mean BMI SDS 3.9, SD 1.7) 24 h ABPM (Spacelabs 90,217, USA), common carotids and abdominal aorta intima media thickness measurements (Voluson 730, GE Medical System 8.5 and 3.5 MHz probes), body composition analysis (Tanita BC 418 S MA, Tokyo, Japan) were performed. Glucose, triglycerides, total, LDL and HDL cholesterol, liver enzymes, uric acid, creatinine, sodium, insulin and chemerin levels were assessed in blood sample taken after a 12-h fasting period. Results There was a significant correlation of circulating chemerin level with systolic blood pressure load in ABPM (r=0.5, p Conclusion Elevated chemerin level may be associated with increased systolic blood pressure in obese children.

Obese children are exposed to short and long-term health consequences, such as dyslipidemia, hypertension and diabetes mellitus. For these reasons, the prevention and treatment of obesity in the pediatric population is a challenge for health care professionals. The aim of this study was to evaluate whether an intensive intervention based on diet and physical activity has a better impact on the auxological and biochemical parameters than standard care (intervention). The study included 20 children (six boys, 14 girls), of the mean age 8.9 (SD 1.4) before puberty. The participants were randomly assigned to two groups: Group I (starting treatment with intensive intervention), and II (starting treatment with standard intervention). After three months, the groups were switched. The comparison of the two interventions in the study group indicates a better effectiveness of intensive intervention in the improvement of anthropometric parameters and majority of biochemical ones (except for insulin concentration, HOMA IR index and LDL cholesterol). As the result of intensive intervention, the mean % of weight-to-height excess and hip circumference decreased significantly (p &lt, 0.005). Our results confirm that complex intervention based on systematic control visits, including personalized dietitian counselling and physician care, during the weight reduction process is more effective than a one-off standard visit.

Wstęp: Zaburzenia funkcji osi tarczycowej są częste u pacjentów otyłych. Ich znaczenie w rozwoju metabolicznych powikłań otyłości pozostaje niejasny. Cel badania: Ocena wpływu zaburzeń funkcji tarczycy u pacjentów otyłych na wystąpienie u nich powikłań metabolicznych. Materiały i metody: Ocena funkcji tarczycy w grupie 100 pacjentów (59 dziewcząt, 41 chłopców; średni wiek 13,5 roku) z otyłością prostą (średni BMI SDS u chłopców 4,175 i u dziewcząt 4,723) z zespołem metabolicznym rozpoznanym na podstawie kryteriów IDF 2007 ZM (ZM, 25 pacjentów) i bez. U wszystkich wykonano oznaczenie stężeń TSH, fT4, fT3 przeciwciał przeciw tyreoperoksydazie tarczycowej (TPOAb) i przeciwciał przeciwko tyreoglobulinie (TGAb) w pojedynczej próbce krwi. Wyniki: W analizowanej grupie nie stwierdzono przypadku jawnej niedoczynności tarczycy. Nie było istotnych statystycznie różnic (p > 0,05) średniej wartości TSH, fT4 i fT3 u pacjentów z ZM i bez ZM (odpowiednio: 2,7 μIU/ml vs 3,0 μIU/ml, 14,5 vs 14,0 pmol/l i 5,6 vs 6,2 pmol/l). W grupie spełniającej kryteria ZM (n = 25) tylko dwie osoby (2/25; 8%) miały stężenie TSH powyżej górnej granicy normy (N: 0,3-4,0 μIU/ml). W grupie bez ZM zwiększone stężenie TSH stwierdzono u 18 (18/75; 24%) pacjentów. Maksymalną wartość TSH (10,44 μIU/ml) odnotowano u chłopca bez ZM. Dodatnie miano przeciwciał przeciwtarczycowych (TPOAb i/lub TGAb) było obecne u 11% pacjentów: 2 pacjentów (2/25; 8%) z ZM i u 9 (9/75; 12%) bez ZM. Wnioski: Izolowane zwiększenie stężenia TSH jest częste u otyłych nastolatków, chociaż nie występuje zależność pomiędzy stężeniem TSH, fT3 ani fT4 a wartością BMI SDS. Izolowane zwiększenie stężenia TSH nie ma związku z występowaniem ZM u młodzieży. Introduction: Thyroid axis abnormalities are common in obese patients. Their contribution in the development of metabolic obesity complications remains unclear. Aim of study: To assess the influence of thyroid axis dysfunction on the occurrence of metabolic obesity complications. Material and methods: A cross-sectional review of the thyroid function in 100 obese patients (59 girls and 41 boys, mean age 13.5 years) with alimentary obesity (mean standardised body mass index [BMI SDS] in boys 4.175 and girls 4.723) complicated by metabolic syndrome (MS) diagnosed on the basis of the IDF 2006 criteria (MS, 25 patients) and uncomplicated (75 patients). TSH, fT4, fT3 thyroid peroxidase antibodies (TPOAb), and thyroglobulin antibodies (TGAb) were assessed in a single fasting blood sample. Results: There was no case of overt thyroid disease within the whole analysed group. There were no significant differences in mean TSH, fT4, and fT3 levels in patients with and without MS (2.7 μIU/ml vs. 3.0 μIU/ml, 14.5 vs. 14.0 pmol/l, and 5.6 vs. 6.2, respectively; p > 0.05). In the MS group only two patients (8%) presented with a TSH level above the upper limit of the normal range; in the group without MS elevated TSH was noticed in 18 (24%) patients. The maximal value of TSH (10.44 μIU/ml) was noticed in one boy without MS. Positive TPOAb and/or TGAb were present in 11% of all patients: two patients (8%) with MS and nine (12%) without MS. Conclusions: Isolated increased TSH level is common in obese adolescents, although there is no correlation between TSH, fT3, and fT4 levels and BMI SDS value. Isolated increased TSH level is not associated with the occurrence of MS in obese adolescents. The occurrence of asymptomatic autoimmune thyroiditis (AITD) in obese adolescents is more common than in the general population.

Background and Objectives: Top-level sports performance places heavy physical and psychological demands on elite-level athletes, which can be a source of increased levels of stress. Therefore, high-level volleyball players may present altered cardiovascular and endocrinological stress response during stressful events. Although many previous studies have examined the response to stress on athletes, most of them regarded only males, while the impact of the female menstrual cycle has rarely been taken into account. We aimed to study psychophysiological response to anticipatory stressor through analysis of heart rate, self-reported anxiety level, and salivary cortisol in healthy young female athletes by minimalizing the effect of confounders. Materials and Methods: A total of 55 females (25 members of the best league for female volleyball players in Poland and 30 sedentary-lifestyle control subjects) in the follicular phase of their menstrual cycle were exposed to mental arithmetic tasks as an experimental imitation of the stressor. Volleyball players were significantly taller than sedentary individuals (177.1 &plusmn, 3.4 cm vs. 173.3 &plusmn, 3.4 cm, respectively, p = 0.034), but did not differ in weight (73.6 &plusmn, 5.2 kg vs. 70 &plusmn, 4.23 kg, respectively, p = 0.081), body mass index (BMI) (23.5 &plusmn, 1.13 vs. 24.1 &plusmn, 1.45, respectively, p = 0.060), and age (22 &plusmn, 1.11 vs. 23 &plusmn, 1.14 years, respectively, p = 0.2). Their stress responses were assessed through self-reported anxiety levels and physiological measurements of salivary cortisol concentrations and heart rate (HR). Results: For HR, significant effects of time (F(2,120) = 21.34, p &lt, 0.001, &eta, 2 = 0.26) were found, but not for training status (F(1,60) = 2.69, p = 0.106, &eta, 2 = 0.04). For cortisol levels, the analysis showed the main effects of time (F(3,180) = 11.73, p &lt, 2 = 0.16) and training status (F(1,60) = 4.69, p = 0.034, &eta, 2 = 0.07) and a significant interaction between training status and time (F(3,180) = 3.07, p = 0.029, &eta, 2 = 0.05). Post-hoc analyses showed higher cortisol concentrations among volleyball players following the math task (all p &lt, 0.001), as well as higher cortisol concentrations in S2, S3, and S4 compared to S1 in volleyball players (all p &lt, 0.001). We observed also a significant increase in state anxiety in both groups (all p &lt, 0.001), but no differences in state anxiety levels between groups. Conclusion: Female volleyball players may not differ in subjective graduation of stressors, however, exposure to training-based stressors seems to promote cortisol response to the anticipated stressor.

Introduction: Amiodarone is an important antiarrhythmic drug used in paediatric practice, mainly in children with complex congenital cardiac diseases and/or severe arrhythmias. One of the side effects of amiodarone therapy is thyroid dysfunction, which is observed in about 20% of patients. The thyroid dysfunction may present with various forms: from subclinical changes in hormone levels to amiodaroneinduced thyrotoxicosis (AIT) and amiodarone-induced hypothyroidism (AIH). Material and methods: We reported six patients in the age range from two weeks to 14 years, with complex congenital cardiac diseases and severe arrhythmias, who developed amiodarone-induced thyroid dysfunctions: thyrotoxicosis or hypothyroidism or both together. The clinical signs and symptoms of all thyroid dysfunctions were atypical, most patients presented with an aggravation of heart insufficiency. Our patients with thyrotoxicosis were treated with combined therapy including thionamides and corticosteroids due to the presentation of mixed-identified type of AIT. Results: Currently, five patients (one patient’s status is unknown) are in biochemical and clinical euthyreosis; however, in one of them it was impossible to discharge amiodarone treatment. Three of them are still treated with levothyroxine, and two do not need thyroid treatment. Conclusions: Amiodarone-induced thyroid dysfunction is usually atypical; therefore, monitoring of thyroid status before, during, and after amiodarone is demanded. AIH could significantly influence the development of the child, while AIT could significantly deteriorate the clinical status of children with complex cardiac diseases. Early and proper diagnose of AIT and AIH allows the introduction of immediate and appropriate treatment considering the cardiac condition of the young patient.

The most common cause of hypothalamic-pituitary-adrenal axis suppression is systemic glucocorticoids administration. A 14- year-old boy with juvenile idiopathic arthritis receiving repeated intra-articular steroids for last 3 years developed fever, fatigue, nausea and abdominal pain. Stimulation with lowdose Synathen revealed low adrenal reserve, suggesting secondary adrenal insufficiency. Temporary hydrocortisone substitution therapy improved condition. Intra-articular steroids may cause potentially life-threatening suppression of the hypothalamic-pituitary-adrenal axis.

Objective Elevated liver function tests (LFTs) are common in adult Turner syndrome (TS) patients. Data regarding children and adolescents are lacking. To investigate the prevalence of abnormal LFTs in children and adolescents with TS during several years of observation; to evaluate the potential impact of increased body mass index (BMI) and sex hormone replacement therapy (HRT) on LFTs. Methods The analysis included 100 girls with TS, aged 4-16 years, all of whom were receiving recombinant human growth hormone therapy. A longitudinal study was conducted which included 81 patients. Results Mean BMI-standard deviation (SD) score of the subjects was 0.63 (SD: 1.53). Forty-four were being treated with HRT. Elevated LFTs were found in 34% of the patients overall (32% not receiving HRT vs 36% on HRT). The relative risk of increased LFTs was not higher in obese vs normal weight [odds ratio (OR): 0.2; 95% confidence interval (CI): 0.1-0.36, p=0.38 vs OR: 0.16; 95% CI: 0.08-0.3, p=0.1]. HRT did not increase the risk of abnormal LFTs activity (OR: 0.8; 95% CI: 0.5-1.2, p=0.37 vs OR: 0.7; 95% CI: 0.4-1.1, p=0.27). During the follow-up period (mean±SD=4.31±0.82 years), no patient developed overt liver disease. There was no significant increase nor decrease of abnormal LFT frequency in the subsequent years of follow up. Conclusion Constantly elevated LFTs in TS are common in children and adolescents with TS. However the causes and clinical significance remain unclear. This study suggests that obesity and HRT do not increase the risk of elevated LFTs.

Purpose To present the outcomes of ultrasound (US) follow-ups in children with autoimmune thyroid disease who did not have a thyroid nodule on admission but developed papillary thyroid carcinoma (PTC) and to characterize the parenchymal changes in the thyroid gland prior to the development of PTC. Methods A retrospective thyroid US scan review of 327 patients diagnosed with AIT was performed. Forty patients (40/327, 12.2%) presented nodular AIT variant with a normoechogenic background. Eleven patients (11/327, 3.4%, 11/40, 27.5%) presenting this variant were diagnosed with PTC (nine females—mean age 15.3 years; two males aged 11 and 13 years). In five of 11 patients, the suspicious nodule that was later confirmed to be PTC was detected on the initial US at presentation. For the remaining six females (6/11) who developed PTC during the follow-up, we retrospectively analysed their US thyroid scans and these patients were selected for analysis in this study. Results On admission, the US evaluation revealed an enlarged normoechogenic thyroid gland in three patients and a hypoechogenic thyroid gland with fibrosis as indicated by irregular, chaotic hyperechogenic layers in three patients. No thyroid nodules were identified. Ultrasound monitoring revealed increasing echogenicity of the thyroid parenchyma during the follow-up. PTC developed in a mean time of 4.6 years (1 9/12–7 4/12 years) since referral to the outpatient thyroid clinic and 2.9 years (6/12–6 9/12) since the last nodule-free US thyroid scan. Conclusions Sonographic follow-up assessments warrant further exploration as a strategy to determine PTC susceptibility in the paediatric population.

Introduction Bullying is a universal phenomenon observed in all schools worldwide, with as many as 35% of students being involved in bullying. Group context is crucial for understanding and preventing bullying, as peers are often present in bullying situations and have key roles in maintaining, preventing, or stopping it. The aims of this study were to investigate school bullying as a social phenomenon in Poland and to understand how Polish adolescents perceive, discuss, and make sense of bullying in their communities. Methods I carried out fieldwork at three public secondary schools in a city in southern Poland, and conducted in-depth semi-structured interviews with 26 students aged 16/17 (16 girls, 10 boys). I used the grounded theory approach to analyze the data, as it offered an opportunity for deeper understanding of adolescents' social context and culture, with intragroup interactions playing a central role. Results & conclusions The results suggest that a parallel culture of bullying at the micro level is created at these schools, which includes norms; a multi-stage process of victim creation; and rituals confirming the victim's status, group coherence, and other students' attitudes and roles in the bullying. In terms of policy implications, the findings suggest that it could prove beneficial to plan anti-bullying programs with adolescents themselves, as they could clarify the contexts, situations, or triggers that might lead to bullying.

This article introduces ABBL, the anti-bullying program for the transition to middle school, which was designed as a free, feasible, and easily applicable solution for teachers who, for any reason, cannot take advantage of comprehensive anti-bullying school-based programs. The ABBL, based on the identification of the causal risk factors and mechanisms that lead to bullying, aims to influence the peer group in such a way that students do not reward antisocial behaviors and are, instead, able to create supportive class atmospheres and strong networks of personal attachments. The evaluation of the program effectiveness showed that it reduced bullying in the classroom. Indications for wider implementations are presented together with the ready-to-use ABBL anti-bullying program (see http://blizej.org/abbl-antibullying-program/ ).

The clinical value of the diagnosis of metabolic syndrome (MS) in children and adolescents remains unclear. The aim of the present study was to assess the occurrence of metabolic complications, other than included in 2007 IDF MS definition, in obese children and adolescents METHODS: The study included 75 (33 boys) obese adolescents (mean age 13.9 years, mean BMI SDS 4.49). Classical (fasting glucose, TGL, HDL, blood pressure) and non classical (insulin resistance [HOMA-IR], creatinine, AST, ALT, uric acid, fibrinogen, liver US and 24h BP profile) risk factors were compared between groups with and without MS. 15(8 boys) met the 2007 IDF criteria for MS.Patients with MS presented with significantly lower: BMI SDS (4.2 vs. 5.8, p=0.02), mean 24h SBP (0.8 vs. 1.0, p=0.03), and uric acid level (352.1 vs. 414.0, p=0.01). In both groups a significant percentage of abnormal results of 24hABPM (up to 42.9 and 57.6%), insulin resistance (85.7 % and 61.1%), non alcoholic fatty liver disease (57.4 % and 38.9 %) and hyperuricemia (69.2 % and 55.3%) was observed.Recognizing the metabolic syndrome in adolescents does not provide any additional clinical benefits. It seems that in every obese child a wide, personalized diagnostic work-up should be performed.

According to updated evidence-based national recommendations which have been published recently vitamin D deficiency remains still highly prevalent in Poland and requires supplementation.was to evaluate the effectiveness of implementation of the new national recommendations into daily practice.An analysis of medical records of 100 children aged from 6 months to 14 years admitted to the Department of Pediatrics, Hospital in Brzesko, Lesser Poland, from 1st July 2018 to 31st August 2018.41% patients declared vitamin D supplementation. Among patients under 1 year of age 3 (60%) received recommended supplementation of 400-600 IU daily, in the group of 1-11 years old 15 (19.5%) used a 600-1000 IU dose daily, 13 (17%)600 IU/daily, and 2 (2.5%)1000 IU daily, 1 patient did not remember the dose. In the group11 years of age 6 (37.5%) supplemented 800-2000 IU/day, 1 (6.3%) less than 800 IU, no one overdosed supplementation. In the group without supplementation, there were 3 patients with a de-creased 25(OH)D blood serum level (20 ng/ml). Mean 25(OH)D serum level was significantly higher in the group with vitamin D supplementation (42 vs. 33.9 ng/ml; p = 0.0006). There was no significant difference between mean 25(OH)D level in patients receiving adequate (40.5 ng/ml), to low (43 ng/ml), or to high vitamin D doses (49 ng/ml). There was no significant correlation between vitamin D dose and the 25(OH)D serum level [R = (-) 0.24, p0.05)].There is an urgent need for physicians to provide an education concerning general rules of vitamin D supplementation, because the pre-sent guidelines of the vitamin D supplementation are not implemented well enough.Zgodnie z opublikowanymi ostatnio polskimi, opartymi na dowodach naukowych, zaleceniami niedobór witaminy D występuje po-wszechnie i konieczna jest jej suplementacja.Realizacja nowych polskich zaleceń w codziennej praktyce.Analizie poddano dokumentację medyczną 100 pacjentów w wieku od 6 miesięcy do 14 lat hospitalizowanych na Oddziale Dziecięcym Szpitala w Brzesku w Małopolsce w okresie od 1 lipca 2018 r. do 31 sierpnia 2018 r.Suplementację witaminy D zadeklarowało 41% pacjentów. Wśród pacjentów poniżej 1. roku życia 3 (60%) otrzymywało rekomendo-waną dawkę suplementacyjną, tj. 400–600 IU dziennie. W grupie 1–11 lat 15 pacjentów (19,5%) stosowało rekomendowaną dawkę 600–1000 IU dziennie, 13 (17%)600 IU dziennie i 2 (2,5%)1000 IU dziennie, w przypadku 1 pacjenta nie udało się ustalić dawki. W grupie11 lat 6 pacjentów (37,5%) stosowało dawkę 800–2000 IU dziennie, 1 (6,3%) mniej niż 800 IU, nikt nie stosował dawki większej niż rekomendowana. U 3 osób spośród niestosujących suplementacji stwierdzono zmniejszone stężenie 25(OH)D w surowicy krwi (20 ng/ml). Średnie stężenie 25(OH)D w surowicy był istotnie większe w grupie stosującej suplementację (42 vs 33,9 ng/ml; p = 0,0006). Nie stwierdzono natomiast istotnej różnicy między średnim stężeniem 25(OH)D u pacjentów otrzymujących dawkę rekomen-dowaną (40,5 ng/ml), w porównaniu z przyjmującymi mniejszą (43 ng/ml) lub większą (49 ng/ml) dawkę niż zalecana. Nie stwierdzono istotnej korelacji między dawką witaminy D a stężeniem 25(OH)D w surowicy [R = (–) 0,24; p0,05)].Istnieje pilna potrzeba wprowadzenia właściwej edukacji pacjentów w zakresie zasad suplementacji witaminy D na poziomie podsta-wowej opieki zdrowotnej, ponieważ obecnie codzienna praktyka znacząco odbiega od zaleceń ekspertów.

Background The prevalence of autoimmune thyroiditis (AIT) and papillary thyroid carcinoma (PTC) is rising in children and adolescents, and the coincidence of AIT and PTC is as high as 6.3–43%. Objective To investigate the ultrasound manifestation of AIT in relation to PTC development in paediatric patients. Patients 179 paediatric patients (133 females), mean (SD) age: 13.9 (3.03) years diagnosed with AIT and referred for ultrasound evaluation. Eight patients were diagnosed with PTC (6 females). Methods Retrospective analysis of thyroid ultrasound scans of patients diagnosed with AIT. Thyroid and autoimmune status was assessed based on TSH, fT4, fT3 and increased aTPO and/or aTG and/or TRAB levels. In patients with PTC, total thyroidectomy was performed. Results Analysis of thyroid US scans revealed that the following five ultrasound variants of AIT were observed in 179 patients: the most common in 35.2%—diffuse thyroiditis with hypoechogenic background and normoechogenic parenchyma, in 30.2%—diffuse thyroiditis with irregular background, in 18.9% nodular variant with normoechogenic background, in 11.7%—micronodulations and in 3.9%—diffuse hypoechogenic background. Eight cases of PTC were diagnosed in nodular variant of AIT with normoechogenic irregular background. Conclusion Patients with AIT and nodular variant with normoechogenic irregular background of the thyroid gland on US scans are in the risk group of developing PTC and should be followed up with regular neck US assessment.

Infections, high temperature and many of the toxic substances can cause kidney damage. Acute kidney injury is a well known complication of some work-related diseases, e.g., lead intoxication. Chronic kidney disease can also be caused by some occupational factors. Three work-related nephropathies, in which causal connection with work has been proved, are discussed in this article. There are different risk factors of nephrolithiasis, lead nephropathy and silica nephropathy, but each of them can cause chronic kidney disease. Prevention of these nephropaties seems to be relatively simple. The principles of protection from the toxic effects of heavy metals and silica dust are very specific. The most important prevention of kidney stones is correct fluid intake. In addition to providing adequate quantities of drinking water, it is also important to educate exposed workers and assure enough rest breaks at work.Zakażenia, wysoka temperatura otoczenia i wiele toksycznych substancji mogą wywoływać uszkodzenie nerek. Dobrze znane jest występowanie ostrej niewydolności nerek w przebiegu chorób zawodowych, np. zatrucia ołowiem. Czynnikami związanymi z pracą może być spowodowana także przewlekła choroba nerek. W publikacji omówiono 3 przewlekłe nefropatie, w których przypadku związek z pracą został udowodniony. Kamica moczowa, nefropatia ołowicza i nefropatia krzemowa różnią się czynnikami ryzyka, jednak każda z tych chorób może prowadzić do rozwoju przewlekłej choroby nerek. Zapobieganie tym nefropatiom jest stosunkowo proste. Zasady ochrony przed toksycznym wpływem metali ciężkich i pyłu krzemionki są ściśle określone. W profilaktyce kamicy nerkowej najważniejsza jest prawidłowa podaż płynów. Poza zapewnieniem odpowiedniej ilości wody pitnej ważna jest edukacja narażonych pracowników i zapewnienie im wystarczającej liczby przerw w pracy.

Lifelong steroid therapy and exposure to adrenal androgen excess in 21-hydroxylase deficient (21-OHD) congenital adrenal hyperplasia (CAH) children and adolescents may modify circadian blood pressure profile and result in vascular complications. The objective of the study was to evaluate vascular abnormalities in 21-OHD children and adolescents in relation to their genotypes.A cross-sectional study conducted at a tertiary referral center.Seventy patients with 21-OHD CAH (27 boys), aged from 3 to 17.9 years: 9 with nonclassic CAH, 61 with classic CAH: 10 with simple virilising (SV) and 51 with salt wasting CAH (13-Del/Del, 8-Del/I2G, 7-I2G/I2G and 23-other genotypes).The assessment of systolic and diastolic BP (SBP, DBP) loads, night dip% and arterial ambulatory stiffness index (AASI) in 21-OHD CAH patients.

Purpose Pharmacological inhibition of the renin-angiotensin-aldosteron system (RAAS) may have a beneficial impact on proteinuria and chronic kidney diseases (CKD) progression. Despite recent progress by means of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB), there is still no optimal therapy which can stop progression of the nephropathy. Recently introduced aliskiren is the first orally bioavailable direct renin inhibitor approved for the treatment of hypertension. The purpose was to evaluate the extent of oxidative stress and tubular injury after the direct renin inhibitor, aliskiren compared with placebo and perindopril in patients with non-diabetic chronic kidney disease (NDCKD). Material/methods A randomized, double-blind, cross-over trial was performed in 14 patients receiving 300 mg aliskiren, 10 mg perindopril and placebo in random order. The end point was a change in the urinary excretion of N-acetyl-β-D-glucosaminidase (NAG) and α1-microglobulin (α1m) and 15-F 2α -isoprostane. Results Aliskiren reduced excretion of 15-F 2α -isoprostane ( p = 0.03) and α1m ( p = 0.01) as compared to placebo. There were no differences between aliskiren and perindopril in this regard. NAG urine excretion did not change after aliskiren and perindopril. Conclusions Aliskiren attenuates oxidative stress and may improve functional status of tubules in patients with NDCKD.

To present symptoms, complications and proposition of management protocol in children diagnosed with adipsic diabetes insipidus (aDI). Clinical and biochemical analysis of six pediatric patients diagnosed with aDI, four boys aged 5, 13, 16, and 17 y and two girls aged 2.5 and 10 y. The etiology of aDI was germinoma (n = 2), extensive surgery due to optic glioma (n = 1) and astrocytoma (n = 1), congenital brain malformations (n = 1) and complications secondary to bacterial meningitis (n = 1). Two patients had severely impaired vision and two had hemiparesis. In all the patients, loss of thirst reflex was observed. The serum electrolytes in all patients showed sodium concentration from 159 to 176.6 mmol/L with plasma osmolality from above 297 mOsmol/kg. Polyuria was absent in three most severely dehydrated patients on admission. In two patients in whom DDAVP (1-desamino-8-D-arginine vasopressin; Desmopressin) therapy was withdrawn based on lack of polyuria deep venous thrombosis developed. Lack of polydipsia and polyuria, the key symptoms of diabetes insipidus (DI), may delay the diagnosis of aDI and may lead to severe complications of chronic hyperosmolar status. The fluid intake in patients diagnosed with aDI need to be supervised daily based on calculated constant volume of oral fluids, daily measurements of fluid balance, body weight and sodium levels, especially in patients whose vision is compromised or who are physically unable to take care of themselves.

Preterm ovarian hyperstimulation syndrome (POHS) is a rare condition in which immaturity of the gonadal axis is accepted as the cause. Based on our case and 8 cases from the literature, we made an attempt to specify the mechanisms underlying the syndrome and its pathognomonic signs. All POHS newborns were born between 24 and 31 weeks postconception age (WPCA) and developed vulvar, hypogastric and upper leg swelling, and ovarian follicular cyst/cysts (10–40 mm in diameter) with mildly or considerably elevated E2 concentrations (80–5,300 pmol/l) between 35 and 39 WPCA. The GnRH test, performed in 5 cases, confirmed gonadal axis activation. In our case the observed normalization of elevated gonadotropin values by 43 WPCA, accompanied by a simultaneously increasing E2 value (approximately 800 pmol/l), could correspond with the maturation of the gonadal steroid-dependent negative-feedback mechanism. The continuously increasing E2 levels after this period (maximum 1,300 pmol/l) suggest its autonomous secretion. In all the cases, including 3 neonates treated with medroxyprogesterone and surgery, the swelling resolved by 6 months. Conclusions: A pathognomonic sign of POHS is swelling which develops around 37 ± 3 WPCA, and the syndrome is only infrequently diagnosed when the swelling is profound. The direct etiologic factor here is not E2. POHS does not require therapy as long as there is no danger of cyst torsion.

Turner syndrome (TS) is a congenital disease caused by absence or structural abnormalities of sex chromosomes resulting in gonadal dysgenesis. Spontaneous pregnancies occur in 2-8% of patients, especially with mosaic kariotypes, however they are associated with increased risk of poor outcome both for mother and fetus. We report a 4-day-old male infant delivered by women with mosaic TS who was admitted to the pediatric intensive care unit and presented with severe panhypopituitarism as the early manifestation of pituitary stalk interruption syndrome (PSIS). To the best of our knowledge this is the first report of severe panhypopituitarism in a newborn borne by women with TS.

The assessment of the health consequences associated with obesity in young children is challenging. The aims of this study were: (1) to compare insulin resistance indices derived from OGTT in obese patients and healthy control (2) to analyze central obesity and Type 2 Diabetes genes expression in obese children, with special attention to the youngest group ( 10 years old).The study included 49 children with obesity (median age 13.5 years old), and 25 healthy peers. Biochemical blood tests and expression of 11 central obesity and 33 Type 2 Diabetes genes was assessed.A significant difference in insulin resistance between obese and non-obese adolescents was observed in all studied indices (mean values of the insulin levels: 24.9 vs. 9.71 mIU/L in T0, 128 vs. 54.7 mIU/L in T60 and 98.7 vs. 41.1 mIU/L in T120 respectively; AUC: 217 vs. 77.2 ng/ml*h, mean values of B% (state beta cell function), S% (insulin sensitivity), and IR were 255 (±97) vs. 135 (±37.8), 46.6 (±37.3) vs. 84.2 (±29.6) and 3 (±1.55) vs. 1.36 (±0,56); HIS, WBIS and ISIBel median 3.89, 44.7, 0.73 vs. 8.57, 110, 2.25. All comparisons differed significantly p0.001). Moreover, insulin sensitivity was significantly better in the older obese group (10 years old): median AUC 239 vs. 104 ng/ml*h, and HIS, WBIS and ISIBel 3.57, 38, 0.67 vs. 6.23, 75.6, 1.87 respectively in the obese older compared to the obese younger subgroup, p0.05. The expression of 64% of the central obesity genes and 70% of Type 2 Diabetes genes was higher in the obese compared to control groups. The differences were more pronounced in the younger obese group.Insulin resistance may develop in early stage of childhood obesity and in very young children may be associated with higher expression of the central obesity and Type 2 Diabetes genes.

A systematic growth in the number of the elderly among hospitalized patients, including the number of patients in the oldest age group, is being observed over the last few years. A stay in hospital conditions is connected with deterioration of their fitness, reduction of their independence. It also entails the risk of hallucination, falls and hospital-acquired infections. The present analysis concerns 60 patients who fell during their hospitalization in the Internal Diseases and Geriatrics Unit of University Hospital in Krakow in 2012 and 2013 (in the total of 6,061 patients admitted to the Unit in this period), which was recorded in the registry of adverse events. An attempt at characterization of this group was made on the basis of medical record, assessment of fall circumstances and its consequences. This was followed by an attempt at tracing the later outcomes of these patients both during their stay in the unit as well as after the discharge from hospital (telephone contact with patient or with person indicated as contact). Analysis of the data (probably underevaluated due to the lack of unambiguous definition of a fall as well as a retrospective character of study) reveals a relation between falls in hospital and various degrees of body injuries, extended hospitalization time, increasing disability and, in some cases, even death. In the face of the observed growth in the number of hospitalized patients in advanced age, a clear definition and careful monitoring of falls as well as an attempt at an early identification of people at risk of falls may prove to be an effective means of their prevention.

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

An increased risk of insulin resistance, hypertension and liver dysfunction is related to obesity (Ob), but may be also present in normal-weight Turner syndrome (TS) patients. The aim of the study was to compare metabolic risk in adolescents with TS and Ob. The study included 21 non-obese with TS (all receiving human recombinant growth hormone, 17/21 estrogen/estrogen–progesterone), and 21 age-matched Ob girls (mean age 13.9 years). Glucose and serum insulin levels were assessed fasting and in 120′ of standard oral glucose tolerance test. Levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, alanine aminotransferase (ALT), FGF19, FGF21 and FGF23 levels were measured fasting. Mean BMI SDS was significantly lower in TS patients (0.1 vs 4.8 SD, p

In accordance to the regulation of the Minister of Transport, Construction and the Maritime Economy [1], the University Centre of Maritime and Tropical Medicine (UCMTM) in Gdynia was designated to provide distance assistance and support for seafarers as a Maritime Telemedical Assistance Service (TMAS). The TMAS is responsible for giving medical advices via radio, especially for help in proper diagnosis and treatment, making recommendations comprising the ship course or immediate transport to shore-based medical facility with regard to the patient condition. Moreover, TMAS cooperates with Search and Rescue Service providing medical advice, when necessary. In 2013, 28 patients were assisted by TMAS. Chest pain, fever and work accidents were the most frequent (17% each of them) cases, followed by mental disorder, anuria and parasitic diseases. These results are similar to reports from different TMAS services — injuries are less common than diseases [2, 3]. These data, together with the fact that cardiovascular disease is the most frequent cause of death of seafarers [4] indicates the importance of preventive examinations in this field. It seems that proper periodic medical examination, together with the general cardiovascular death risk assessment (SCORE), should reduce the possibility of making wrong decisions when evaluating the capacity for work [5]. During the first year of activity, TMAS met with considerable interest from sailors and shipowners. The number of notifications in 2014 continues to grow along with the dissemination of information about the TMAS activities.

Objective In this paper, the etiology, differential diagnosis, and therapy of testicular adrenal rest tumors (TARTs) is presented based on a patient presentation and an overview of the most recent literature concerning this subject. Methods Retrospective analysis of the clinical and biochemical data of an 18-year-old male patient diagnosed at the age of 2 weeks with the classic salt-wasting form of congenital adrenal hyperplasia that has been monitored in the pediatric and adolescent outpatient department since the age of 4 years. Results The results of adrenal hormone tests (17-hydroxyprogesterone, 17-ketosteroids, and pregnanes) had been unsatisfactory, particularly over the previous 5 years. Scrotal ultrasound detected TARTs bilaterally. After increasing the dose of hydrocortisone and introducing dexamethasone, considerable regression of the tumors was noted. Conclusion Lack of complete regression of the lesions is caused by fibrosis and is probably due to decreased sensitivity of adrenocorticotropic hormone and angiotensin II receptors in this tissue. (Endocr Pract. 2014;20:e219-e224)