Search

[b]introduction[/b]. Microbiota plays an integral part in maintaining organism homeostasis, through eliminat pathogens, anti-cancer activity, synthesis of digestive enzymes and vitamins, maintaining the continuity of the intestinal epithelium and stimulation of the gastrointestinal immune system, and encourage a quicker and more efficient immune response. Changes in the microbiota composition is often observed in patients with allergy, atopy, irritable bowel syndrome and other diseases, which is the reason for a growing interest in methods of identification of the gut microbial complex. objective. The aim of the study was to compare the state of current knowledge about two methods used in the study of intestinal microorganisms complex: the traditional culture method and genetic analysis. [b]description of the state of knowledge[/b]. Both techniques have advantages and disadvantages. The biggest limitation of the culture method is its inability to detect a significant number of the intestinal microbes. Using the microbiological technique we can only detect identifiable bacteria that can be grown on available substrates. For an accurate quantitative and qualitative investigation of the total microbiota, the more expensive genetic method is required. Due to genetic analysis it is possible to identify the vast number of new microorganisms and identify the dominant bacterial groups in different parts of the gastrointestinal tract. [b]summary[/b]. Each of the presented techniques plays specific role in medicine and science. The combination of both methods may become a critical element for understanding the ecosystem of intestinal bacteria.

The incidence of autism spectrum disorders is steadily growing. The ultimate cause of the disease still has not been determined. However with a high probability it is known that the pathogenesis of characterized disorders is multifactorial. One of the aspects that could have a negative impact on the patient's behavior is abnormal distribution of gluten, casein, and probably another nutrients, which is the result of epithelium of the small intestine enzymes deficiency. On this basis, so called opioid theory assumes that enzymatic deficiency leads to the formation of exorphins – substances with opioid activity. With proven coexistence of increased intestinal permeability in ASD patients, improperly digested food particles may be transported to the central nervous system (cerebrospinal axis – intestinal), adversely affecting the child's behavior. Reports of opioids food potential effects on the child's behavior, as well as frequently reported gastrointestinal disorders in ASD patients are the cause of the elimination diet implementation by a large group of parents and carers of children with ASD. Meanwhile, there is still no objective, randomized clinical trials, indicating elimination diet real impact for the patient with ASD. Reports regarding the effectiveness of nutritional therapy are derived mainly from therapists and parents/carers of children with autism spectrum disorders. The potential benefits, which may result from the possible modification of diet, point to the urgent need for well-designed clinical studies in this field.

Endoscopic procedures involving the gastrointestinal tract have been successfully developed in paediatric practice over the last two decades, improving both diagnosis and treatment in many children's gastrointestinal diseases. In this group of patients, experience and co-operation between paediatricians/endoscopists and paediatric anaesthesiologists should help to guarantee the quality and safety of a procedure and should additionally help to minimise the risk of adverse events which are greater the smaller the child is. This principle is more and more important especially since the announcement of the Helsinki Declaration on Patient Safety in Anaesthesiology in 2010, emphasising the role of anaesthesiology in promoting safe perioperative care. The Helsinki Declaration has been endorsed by all European anaesthesiology institutions as well as the World Health Organisation's 'Safe Surgery Saves Lives' initiative including the 'Surgical Safety Checklist'. Although most of these procedures could be performed by paediatricians under procedural sedation and analgesia, children with congenital defects and serious coexisting diseases (ASA ≥ III) as well as the usage of anaesthetics (e.g. propofol) must be managed by paediatric anaesthesiologists. We have reviewed the specific principles employed during qualification and performance of procedural sedation and analgesia for gastrointestinal endoscopy in paediatrics. We have also tried to answer the questions as to how, with what, and by whom, procedural sedation for gastrointestinal endoscopy in children should be performed.

Endoscopic procedures of the gastrointestinal tract were successfully introduced into paediatric practice in the 1970s. Recent expansive development has become useful for improvement of both diagnosis and treatment in many children with gastrointestinal diseases. Most of these procedures are performed under procedural sedation (PSA) knowing anatomical, physiological and psychological differences and requiring good experience from the paediatrician and anaesthesiologist. These principles help to provide the procedure safely and minimise adverse events, which are greater the smaller the child is. Procedural sedation and analgesia in healthy children can be performed by a paediatrician, but children with congenital defects and serious coexisting diseases (ASA ≥ III) and also during the usage of anaesthetics (e.g. propofol), should be managed by an anaesthesiologist.

The development of allergy process is caused by the negative influence of various factors on human organism. The reason for food allergy in a predisposed group of people is immunological mechanisms, which are classified in four types (according to Gell-Coombs). It is said that 50% of food allergy reaction is caused by IgE-dependent mechanism (immediate reaction). In the remaining group it is a retarded reaction (IgE-independent) or mixed (IgE-independent and IgE-dependent). It is claimed that an increase in the level of antibodies against particular food allergens could be one of reasons behind the development of the gastrointestinal symptoms. It should be emphasized that the role of IgG-dependent allergy is still being discussed and the results of research are inconclusive. Yet, there are analyses which show that an elimination diet based on the results of the study of specific IgG antibodies against the food antigens is beneficial in treatment of IBS, IBD and psychiatric disorders. That is why the authors of the above analysis decided to review the current data concerning the effectiveness of a diet based on the results of IgG-dependent allergy research in reducing the symptoms of particular health problems.

Summary Background There are many factors influencing postoperative health-related quality of life of adolescent idiopathic scoliosis patients, including the degree of the deformity, culture, differences in geography, rural versus urban living environments, and social factors. The objective of this study was to analyze the significance of geographic factors and their differences influencing the postoperative quality of life in females with adolescent idiopathic scoliosis residing in urban and rural environments, by use of the Polish version of the SRS-24 questionnaire. Material/Methods Forty urban and 20 rural postoperative patients with adolescent scoliosis with a minimum 2-year follow-up period after surgery were included in the study. The process of cross-cultural adaptation was performed according to the IQOLA Project. Results General results of the Polish SRS-24 equalled 4.1 (SD 0.5) and 4.0 (SD.0.5) in the rural and urban groups of patients, respectively. The 2 groups do not differ in incidence of floor and ceiling effects. The Cronbach’s alpha values are excellent for the general result of SRS-24 in urban and rural groups (0.85 and 0.85, respectively). The sub-groups differed significantly in the self-image after surgery domain (p=0.048). Conclusions Patients from the rural group scored higher in the self-image after surgery domain but reported higher pain levels when compared to urban patients. The associations between SRS-24 results and radiographic parameters in the rural group of patients were strong, compared with moderate relations reported in the urban group.

Wstęp: Nieswoiste choroby zapalne jelit (inflammatory bowel diseases - IBD), zwłaszcza choroba Leśniowskiego-Crohna (Crohn’s disease - CD), są narastającym problemem w gastroenterologii pediatrycznej. Dostępne dane dotyczące klinicznych i demograficznych aspektów choroby w Polsce są ograniczone. Cel: Zebranie rzetelnych danych o klinicznych i demograficznych aspektach choroby Leśniowskiego-Crohna u dzieci w Polsce na podstawie utworzonego internetowo prospektywnego rejestru choroby mających pomóc w opracowaniu najbardziej optymalnych strategii terapeutycznych dla tej grupy pacjentów. Materiał i metody: We wrześniu 2005 roku został utworzony w Internecie ogólnopolski rejestr pacjentów z chorobą Leśniowskiego-Crohna. Do projektu włączono 10 jednostek szpitalnych (9 szpitali akademickich, 1 rejonowy szpital referencyjny). W celu zebrania danych demograficznych i klinicznych zastosowano dostępny internetowo kwestionariusz, który następnie przesyłano do centralnego rejestru do prospektywnej analizy. Ocenie poddano następujące dane: demografia, historia rodzinna, lokalizacja i postać choroby, objawy pozajelitowe, choroby współistniejące, diagnostyka oraz leczenie (włączając w to interwencje chirurgiczne). Wyniki: Przez 4 lata 320 pacjentów (płeć męska : płeć żeńska - 191 : 129) w wieku poniżej 16 lat ze zdiagnozowaną CD (średni wiek w momencie postawienia diagnozy: 9,2 ±6,8 roku) zostało zarejestrowanych w bazie danych. Tak zwany wczesny początek choroby (wiek przy rozpoznaniu poniżej 5 lat) stwierdzono u 68 dzieci (21,25%). Rodzinne występowanie (obciążony wywiad rodzinny) odnotowano u 16 pacjentów (5%). Główne miejsce zmian chorobowych (według Klasyfikacji montrealskiej: L1 - jelito cienkie, L2 - jelito grube, L3 - ileocolon, L4 - górny odcinek przewodu pokarmowego) stanowiła lokalizacja krętniczo-kątnicza (L3) - 217 (67,8,%). Postać niepenetrująca bez zwężeń była przeważającą postacią choroby - 225 (70,32%) pacjentów. Objawy pozajelitowe zaobserwowano u 20 chorych (6,25%). Wnioski: Badanie dostarcza pełnych informacji dotyczących aspektów demograficznych i klinicznych choroby Leśniowskiego-Crohna w Polsce. Uzyskane dane są zgodne z doniesieniami z innych krajów. Wnioski z badania są następujące: zbierane informacje muszą być dobrze zdefiniowane i określone już na samym początku badania, weryfikowane oraz aktualizowane systematycznie w trakcie jego trwania, aby usprawnić pracę i uzyskać jak najbardziej wiarygodne wyniki. Introduction: Inflammatory bowel disease, particularly Crohn’s disease (CD), is a rising problem in pediatric gastroenterology. Limited information is available on demographic and clinical aspects of pediatric CD in Poland. Aim: Preliminary data on demographic and clinical characteristic of pediatric CD in Poland based on the web-based prospective registry in order to gather reliable information to identify appropriate treatment strategies. Material and methods: In September 2005 a web-based prospective registry of CD patients was initiated in Poland. Ten institutes (9 academic centers, 1 referred regional hospital) took part in the project with the object of obtaining the demographic and clinical data of pediatric CD patients across the country. With this end in view, a computerized questionnaire was used and the collected data were sent prospectively to a central registry for analysis. The following data were analyzed: demographics, family history, location and behavior of disease, extraintestinal manifestation, coexisting diseases, diagnostic work-up, and medical treatment including surgical intervention. Results: Through the period of 4 years, 320 patients (male : female - 191 : 129) aged below 16 years with CD diagnosed at the mean age of 9.2 ±6.8 years were incorporated in the registry. Early onset of disease (age at diagnosis below 5 years) was recorded in 68 children (21.25%). Positive family history was reported for 16 patients (5%). The predominant localization of lesions described using the Montreal classification (L1 for small intestine, L2 for colon, L3 for ileocolon, and L4 for the upper gastrointestinal tract) was ileocolon (L3) - 217 patients (67.8%). The predominant behavior of disease was non-stricturing and non-penetrating - 225 patients (70.32%). Extraintestinal manifestation was reported in 20 patients (6.25%). Coexisting diseases occurred in 35 patients (10.93%). The predominant initial therapy was mesalazine (227 patients - 70.1%). Seventeen patients (5.31%) required a surgical intervention. Conclusions: This study provides comprehensive information on demographic and clinical aspects of pediatric CD in Poland. Our results are consistent with the previously published reports from other countries in terms of age of onset and male predominance in pediatric CD patients. Our conclusions are as follows: information needs to be well defined, validated at entry, and updated at every visit, which facilitates our work and makes the data more reliable.

Goals To evaluate the efficacy of Lactobacillus rhamnosus GG (LGG) supplementation in eliminating the gastrointestinal carrier state of vancomycin-resistant enterococci (VRE) in colonized children, and to evaluate the affect of the probiotic on Lactobacillus spp. counts in the gastrointestinal tract. Study A randomized, single-blind, placebo-controlled study. Children (0 to 18 y old) hospitalized at the wards of the children's hospital who were diagnosed with gastrointestinal carrier state of VRE were randomized to group receiving 3 billion colony forming unit of LGG/day or placebo for 21 consecutive days. A total of 61 children completed the study (32 in the treatment group and 29 in the control group). Rectal swabs for VRE and Lactobacillus spp. were collected at baseline, during supplementation at weekly intervals and 1 month after supplementation. Antibiotic supply was controlled throughout the duration of the analysis. Results A significant difference in the number of children colonized with VRE between the groups was observed at 3 weeks (P = 0.002). The VRE carrier state was lost by 20 of 32 participants in the treatment group and 7 of 29 in the control group. We also observed increased gastrointestinal counts of Lactobacillus spp. in children receiving LGG. A statistically significant difference in the occurrence of bacteria was observed from week 1 onwards, whereas in the aspect of growth intensity from week 2 onwards. Conclusions LGG supplementation temporarily eliminates the VRE carrier state and increases gastrointestinal counts of Lactobacillus spp. in children versus placebo.

W pracy wyjaśniono pojecie probiotykow, prebiotykow oraz probiozy. Dodatek probiotykow i/lub prebiotykow do diety zywionych sztucznie niemowląt wplywa na modyfikacje ekosystemu jelitowego oraz stan zdrowia dzieci. Probiotyki i prebiotyki wywierają wielokierunkowy, korzystny wplyw na organizm dzialając zarowno profilaktycznie, jak i leczniczo.

Wstep Stan odzywienia dzieci czesto pogarsza sie po przyjeciu do szpitala. Celem pracy byla ocena wplywu pobytu szpitalnego na stan odzywienia dzieci oraz znalezienie czynnikow ryzyka dla pojawienia sie niedozywienia w czasie pobytu szpitalnego. Pacjenci i metody Badaniem objeto 281 dzieci: 118 dziewczynek (42,35%) i 162 chlopcow (57,65%), średnia wieku 87,7 miesiecy (od 2 tygodni do 18 lat; mediana: 66 miesiecy), hospitalizowanych w Klinice Gastroenterologii Dzieciecej i Chorob Metabolicznych Akademii Medycznej w Poznaniu pomiedzy 1 stycznia a 31 grudnia 2005 r. Kryterium kwalifikacyjnym byl co najmniej 5-dniowy pobyt w szpitalu i wiek powyzej 2 tygodni. Ze wzgledu na ciezkośc choroby wyodrebniono 3 grupy pacjentow. Analizowano: diagnoze, dlugośc pobytu szpitalnego, plec, BMI, leczenie oraz sposob karmienia. Wyniki Odnotowano: ubytek masy ciala u 112 dzieci (39,86%), wiekszy niz 2% u 56 pacjentow (19,9%); przyrost masy ciala u 107 dzieci (38,08%), a u 62 dzieci (22,06%) brak zmiany masy ciala. Niedozywienie (masa ciala Wnioski Ubytek masy ciala powyzej 2% wystąpil u dzieci z ciezkimi, przewleklymi chorobami (np. mukowiscydoza, zapalenie jelit, celiakia) oraz u tych, ktore przebywaly w szpitalu ponad 2 tygodnie. Dobrze odzywione dzieci nie byly zagrozone niedozywieniem z innych medycznych przyczyn. Pacjenci z lagodnym niedozywieniem przy przyjeciu powinni byc objeci szczegolną opieką, gdyz wydają sie byc w grupie najwyzszego ryzyka ujemnego wplywu hospitalizacji na stan odzywienia.

The aim of the study was to compare the difference in stress levels between adolescent female groups of patients from urban and rural areas who were treated conservatively with an idiopathic scoliosis. The study comprised 2 groups of patients, 34 from an urban and 30 from a rural area, with a minimum application of a Cheneau brace for 12 hours a day, for a minimum of 1 month. Two study groups completed the Polish version of both Bad Sobernheim Stress Questionnaire-Deformity and Bad Sobernheim Stress Questionnaire-Brace. Both groups of patients felt moderate stress connected with conservative treatment and low stress related to trunk deformation. No difference was observed in stress level related to body disfigurement and conservative treatment between the 2 groups of patients. In the rural group of patients, a correlation between the apical translation and stress related to deformity was observed. No significant differences were stated in stress levels and coping mechanisms between patients from rural and urban areas, treated conservatively due to idiopathic scoliosis. A difference was observed, however, regarding the correlation connected with the apical translation and stress level.

The aim of our research was to evaluate TPS concentration as a marker of proliferative processes and the levels of CEA in children and adults with ulcerative colitis (UC) and in adults with colorectal adenocarcinoma (AC), to find out if there is any interdependence between TPS and CEA concentrations in these patients and to evaluate the usefulness of TPS as a marker of neoplastic risk in patients with UC.The study was carried out in 3 groups of patients: Group I consisted of 15 children, ages 10-18, treated for UC; Group II, 22 adults, ages 23-40, treated for UC; and Group III, 14 patients, ages 40-60, in whom AC was diagnosed.In Group II, the mean TPS concentration was significantly higher than in Group I (p0.00001). In Group III, adults with AC, the mean TPS concentration was 1074.00+/-1356.87 U/l. Thus there was a statistically significant difference between TPS concentrations in adults with UC and adults with AC (p0.00005). There was no statistically significant difference between CEA levels in children and adult groups with UC. However, a statistically significant difference occurred between CEA concentrations in children and adults with UC and the group of adults with AC (p0.00001).It would appear that testing for TPS concentration in patients with UC is helpful in monitoring the proliferative process, whereas in patients with neoplastic processes it serves as a screening examination, enabling early detection of recurrences, full evaluation of neoplastic growth, and evaluation of therapeutic effectiveness.

An adequate mode of nutrition is among the most important environmental factors affecting the development of Man and maintenance of a good health status. An improper selection of nutrients and irregular consumption of meals may lead to overweight and obesity.The characteristics of health behaviours of the examined population of schoolchildren, with consideration of nutrition and body weight disorders. A comparison of the opinions of schoolchildren and their parents concerning health behaviours. Development of guidelines for educational programmes carried out in the place of residence of the population of schoolchildren and their parents.The survey covered a randomised group of schoolchildren attending elementary and secondary schools in the Kalisz Province and province of the city of Kalisz. The study was conducted in May and June 2009, in a randomly selected representative group of 1,100 boys and girls from classes V and VI of elementary schools, and 1,100 secondary school adolescents aged 16-19 and their parents. The studies of schoolchildren attending elementary and secondary schools were compared with the all-Polish studies of junior high school adolescents in the school year 2006-2007.The respondents most often consumed 3-4 meals; however, as many as 26% of junior high school adolescents and 27% of secondary school adolescents admitted that they consume only one meal daily. The schoolchildren show inadequate nutritional habits concerning an insufficient consumption of fruits, vegetables and fish, in favour of high calorific meals and sweet snacks and drinks. Parents improperly assess the body weight of their children and perceive them as slimmer, which is not confirmed by the BMI value for age and gender.Systematic monitoring and analysis of changes in the health behaviours of adolescents should be a basis for planning health education and promotion programmes. Educational programmes concerning various aspects of health should be implemented in an organized and complementary way, directed not only at schools, but also at entire families and local communities. Knowledge, beliefs, skills and attitudes towards health acquired during the period of adolescence decide about life style in adulthood.