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The goal of this study was to assess the pulmonary sequelae of COVID-19 pneumonia in children.Children (0-18 years old) diagnosed with COVID-19 pneumonia hospitalized between March 2020 and March 2021 were included in this observational study. All children underwent follow-up visit 3 months post-discharge, and if any abnormalities were stated, a second visit after the next 3 months was scheduled. Clinical assessment included medical history, physical examination, lung ultrasound (LUS) using standardized protocol, and pulmonary function tests (PFTs). PFTs results were compared with healthy children.41 patients with COVID-19 pneumonia (severe disease n=3, mechanical ventilation n=0) were included in the study. Persistent symptoms were reported by seven (17.1%) children, most common were decreased exercise tolerance (57.1%), dyspnea (42.9%), and cough (42.9%). The most prevalent abnormalities in LUS were coalescent B - lines (37%) and small subpleural consolidations (29%). The extent of LUS abnormalities was significantly greater at the first than at the second follow-up visit (p=0.03). There were no significant differences in PFTs results neither between the study group and healthy children, nor between the two follow-up visits in the study group.Our study shows that children might experience long-term sequelae following COVID-19 pneumonia. In the majority of cases these are mild and resolve over time. This article is protected by copyright. All rights reserved.

OBJECTIVE The literature provides some evidence of peripheral airways key role in the pathogenesis of asthma. However, the extent to which lung periphery including acinar zone contribute to asthma activity and control in pediatric population is unclear. Therefore, the aim of the study was to estimate peripheral airways involvement in children with asthma exacerbation and stable asthma simultaneously via different pulmonary function tests. METHODS Children with asthma exacerbation (n = 20) and stable asthma (n = 22) performed spirometry, body plethysmography, exhaled nitric oxide, impulse oscillometry (IOS), and multiple-breath washout (MBW). RESULTS Peripheral airway's function indexes were increased in children with asthma, particularly in group with asthma exacerbation when compared with stable asthma group. The prevalence of abnormal results was significantly higher in asthma exacerbation. All children with asthma exacerbation had conductive ventilation inhomogeneity; 76% had acinar ventilation inhomogeneity. According to IOS measurements, resistance and reactance were within normal range, but other IOS parameters were significantly higher in children with asthma exacerbation compared with stable asthma group. The 36% of children with acute asthma had air trapping. CONCLUSION Significant involvement of peripheral airways was observed in children with asthma, particularly in asthma exacerbation, which determine lung periphery as important additional target for therapy and provide new insights into pathophysiological process of pediatric asthma.

Data on the prevalence and type of lung function impairment in preschool and school-aged children previously diagnosed with persistent tachypnea of infancy (PTI) are scarce. Therefore, this study aims to assess pulmonary function in this age group.Children diagnosed with PTI over 3 years old were admitted for follow-up visits and healthy controls were enrolled. The study group included children who were able to complete pulmonary function tests (PFTs). Medical history, physical examination, and pulmonary function (spirometry, body plethysmography, impulse oscillometry, nitrogen multiple breath washout test, diffusing capacity for carbon monoxide [DLThirty-seven children (26 boys, 11 girls; median age: 5.6 years) diagnosed with PTI and 37 healthy controls were recruited. Forced expiratory volume in 1 s and forced vital capacity were significantly lower (-1.12 vs. 0.48, p = 0.002 and -0.83 vs. 0.31, p = 0.009, respectively); respiratory resistance at 5 Hz (0.06 vs. -0.62, p = 0.003), resonant frequency (1.86 vs. 1.36, p = 0.04), residual volume (RV) (2.34 vs. -1.2, p 0.0001), RV%TLC (total lung capacity) (2.63 vs. -0.72, p 0.0001), and specific airway resistance (5.4 vs. 2.59, p = 0.04) were significantly higher in PTI patients as compared with controls (data were presented as median z-score). Air trapping was found in 60.0%, and abnormally high lung clearance index and DLThis study demonstrated that lung function is affected in most children with PTI. PFTs showed that peripheral airways are the major zone of functional impairment.

Introduction. Due to their dynamic character, allergic conditions pose challenges for modern medicine and constitute a public health problem. Nearly 40% of the general Polish population is estimated to suffer from an allergy. We would like to emphasize that allergies are not some extraordinary ailments; instead, they commonly coincide with or are complications of other systemic conditions. Hence, national health policies should prioritize the development and implementation of ready-to-use protocols that focus mainly on prevention rather than treatment. Conclusions. In an outpatient setting the care for individuals who suffer from allergies is facilitated by therapeutic teams. Allergy nurses play a special role in this framework, with the scope of their professional duties including diagnostic procedures, treatment, being a mediator for patient education initiated by the therapeutic team. This article focuses on three important types of allergy nurses‘ responsibilities: diagnostic procedures (e.g. skin prick tests), therapeutic procedures (allergen-specific immunotherapy), and selected aspects of medical record-keeping.

Periostin is considered to be a marker of eosinophilic inflammation in patients with asthma. However, there are no literature data on exhaled breath condensate (EBC) periostin level in pediatric patients with asthma. The aim of this study was to analyze EBC periostin concentration in children with mild asthma and to evaluate the potential usefulness of EBC periostin level as a biomarker for the disease.EBC and serum periostin concentrations were measured by enzyme-linked immunosorbent assay in 23 children with asthma and 23 healthy controls.EBC periostin concentration was 250- to 780-fold lower than that found in serum. No significant differences between serum nor EBC periostin concentration in asthmatics and the control group were showed. The comparison between children with Th2 and non-Th2 type of asthma did not show significant differences in periostin concentration, both in serum and EBC. Serum periostin concentration inversely correlated with BMI and age not only in asthma patients but also in controls.In children with mild asthma, periostin may be measured not only in serum but also in EBC. The low periostin level in patients with mild asthma and lack of difference between asthmatic subjects and controls indicate that EBC periostin may not be useful as an asthma biomarker in this group.

Background Recent studies indicate that chronic kidney disease (CKD) is a comorbidity in patients with obstructive sleep apnea (OSA). We hypothesized that the use of the classical muscle-dependent, creatinine-based equation to estimate glomerular filtration rate (GFR) in patients with OSA may be inaccurate due to the extreme body mass index (BMI) of some patients. The aim of this study was to establish the role of cystatin-C-based estimation of GFR for the detection of CKD in patients with OSA and typical comorbidities. Methods Two hundred and forty consecutive patients with newly diagnosed OSA were enrolled into this cross-sectional study. In all patients estimated GFR (eGFR) was calculated with chronic kidney disease-epidemiology collaboration group (CKD-EPI) equations using creatinine and cystatin-C. All patients were examined for comorbidities. Results In obese patients with OSA significant differences between GFR estimations based on creatinine and cystatin were found: eGFR based on muscle-dependent creatinine measurement was significantly higher than the muscle-independent eGFR based on cystatin-C measurement. Conclusions GFR can be routinely screened for using creatinine-based estimations (eGFRcreat). In a selected group of patients with OSA with BMI over 30 kg/m2 the addition of cystatin-C for assessment of eGFR is suggested.

The inert gas washout (IGW) is a noninvasive measurement applicable in evaluation of peripheral airway function. This technique offers information about pulmonary ventilation inhomogeneity and provides insight into the evolution of pathological processes by assessing the efficiency of inert gases washout. The method can be performed by two techniques: single breath washout (SBW) test which involves a vital capacity maneuvers and over a series of tidal breathes termed a multiple breath washout test (MBW). The utility of IGV was demonstrated in diagnosis and management of chronic pulmonary conditions particularly in cystic fibrosis and asthma. It is characterized by a higher sensitivity than spirometry in detecting early lung function abnormalities. Despite this, the widespread application of IGW in clinical setting is limited by poor availability of devices and lack of clearly defined international recommendation for the interpretation of the results. The article represents a theoretical background and clinical utility of this method.

Community-acquired pneumonia in children is still an important health problem, even in high-income countries. In adults, a combination of clinical signs, symptoms and laboratory tests (e.g. CURB-65) is used to estimate the severity and prognosis. In children, the assessment of severity is based mainly on clinical symptoms and there is no objective, universal score system for this purpose. Therefore, authors undertook a study which aimed at the evaluation of whether N-terminal pro-brain natriuretic peptide (NT-proNB), as a marker of myocardial stress, can be used to differentiate children with severe and non-severe pneumonia. Material and methods: The study included children with a diagnosis of pneumonia, divided into two groups severe/non-severe pneumonia according to clinical symptoms. All patient underwent clinical evaluation, chest x-ray and laboratory tests: blood morphology, c-reactive protein (CRP) and NT-proBNP. Results: Forty-three patients were included in the study (mean age 89.5 ± 61.7 months, 44.2% males). There was 13/30 severe/non-severe pneumonia diagnosis respectively. The median duration of hospitalization was 8.5 days (2 - 35 d.) and it was significantly longer in the group with severe pneumonia (20 vs.8 d.). NT-proBNP was elevated in 29 patients (67%), including all 13 patients with severe pneumonia and 16 with non-severe. The NT-proBNP concentration, CRP and leucocyte count was significantly higher in the group with severe pneumonia (p= 0.00067, p = 0.0394 and p = 0.0229 respectively). The length of hospitalization was positively correlated with NT pro-BNP concentration (r = 0.354 p Conclusion: NT-proBNP seems to be a promising marker for the childhood pneumonia severity stratification.

This is a retrospective study whose main objective was to analyze the influence of the Polish Guidelines for the Management of Respiratory Tract Infections of 2010 (PGMRTI) on in-hospital treatment of children with community-acquired pneumonia (CAP). Files from four Warsaw hospitals were reviewed to identify children with uncomplicated CAP, treated before (2008-2009) (pre-PGMRTI) and after (2011-2012) (post-PGMRTI) publication of the guidelines. Predefined data on the management were compared. A cohort of 2,359 children (1,081 pre-PGMRTI and 1,278 post-PGMRTI) was included. We found that co-amoxiclav was the most common first-line therapy in children3 months of age (34.6% and 40.4% pre- and post-PGMRTI, respectively), followed by cefuroxime (31.8% and 20.9% pre- and post-PGMRTI, respectively; p 0.0001) and macrolides (17.4% and 24.5% pre- and post-PGMRTI, respectively; p 0.0001). Amoxicillin was rarely used (5.4% and 4.9%, pre- and post-PGMRTI, respectively). The study revealed an overuse of inhaled bronchodilators, corticosteroids, and mucoactive drugs. Blood diagnostic tests were applied to a significant percentage of patients: blood cultures (41.2% and 44.5% pre-and post-PGMRTI, respectively) and serology for atypical pathogens (27.9% and 44.9% pre-and post-PGMRTI, respectively; p 0.0001). The number of follow-up chest X-rays increased (30.5% and 53.8% pre- and post-PGMRTI, respectively; p 0.0001). In conclusion, the study demonstrates an unsatisfactory influence of the guidelines on in-hospital management of CAP in children. Despite an explicit recommendation for the use of amoxicillin, it was still underused. Other methods of education and guideline dissemination are needed to optimize the prescribing of antibiotics.

Introduction: Connective tissue diseases (CTDs) of childhood are rare inflammatory disorders, involving various organs and tissues including respiratory system. Pulmonary involvement in patients with CTDs is uncommon but may cause functional impairment. Data on prevalence and type of lung function abnormalities in children with CTDs are scarce. Thus, the aim of this study was to asses pulmonary functional status in children with newly diagnosed CTD and follow the results after two years of the disease course. Material and methods: There were 98 children (mean age: 13 ± 3; 76 girls), treated in Department of Pediatric Rheumatology, Institute of Rheumatology, Warsaw and 80 aged-matched, healthy controls (mean age 12.7 ± 2.4; 50 girls) included into the study. Study procedures included medical history, physical examination, chest radiograph and PFT (spirometry and whole body-plethysmography). Then, the assessment of PFT was performed after 24 months. Results: FEV1, FEV1/FVC and MEF50 were significantly lower in CTD as compared to control group, there was no difference in FVC and TLC. The proportion of patients with abnormal lung function was significantly higher in the study group, 41 (42%) vs. 9 (11%). 24-months observation didn’t reveal progression in lung function impairment. Conclusions: Lung function impairment is relatively common in children with CTDs. Although restrictive ventilatory pattern is considered typical feature of lung involvement in CTDs, airflow limitation could also be an initial abnormality.

Aim The aim of this study was to identify the frequency and prevalence of comorbidities in sarcoid patients and to assess their influence on overall mortality in the cohort of patients with sarcoidosis. Materials and methods A cohort of 557 patients with histologically confirmed sarcoidosis diagnosed between 2007 and 2011 and a group of non-sarcoid controls were observed. All patients were carefully observed for comorbidities and mortality. Results 291 males (52.2%) and 266 females (47.8%) with mean age 48.4 ± 12.0 years in sarcoidosis group and a group of 100 controls with mean age (49.25 ± 10.3) were observed. The mean number of comorbidities in both groups was similar (0.9 ± 0.99 vs 0.81 ± 0.84 NS). The frequency of thyroid disease was significantly higher in sarcoidosis group comparing to controls at the time of diagnosis (OR = 3.62 P = 0.0144). During the observation period (median 58.0 months), 16 patients died (2.9%). The mean number of comorbidities was significantly higher in the groups of non-survivors as compared to survivors (2.8 ± 1.0, vs 0.8 ± 0.9), P

Background: In 2010 in Poland was published Recommendations for Management of Respiratory Tract Infections (RMRTI) which support medical practitioners in every aspect of management of community acquired pneumonia (CAP). Objective: To analyze the impact of RMRTI on antibiotic prescribing in children with CAP. Material and Methods: We assessed prehospital and hospital antibiotic use in CAP in 4 pediatric hospitals before (2008-2009) and after (2011-2012) RMRTI publication. Results: A group of 2359 children with CAP was enrolled. In outpatients the most common first-line antibiotics were: second generation cephalosporins (CEF), co-amoxiclav and macrolides. There were no differences between pre-recommendation group (PreRG) (n=1081) and post-recommendation group (PostRG) (n=1278). In hospitalized children significant change in first-line therapy was observed in PreRG and PostRG periods: CEF (57.1% vs 16.5% p Conclusion: The study showed that publishing recommendations is not a sufficient form of education. Despite recommendations amoxicillin is still rarely prescribed in CAP in children. Other forms of active teaching are needed to convince clinicians to adhere to the guidelines.

The paper points out that in polish population dental and orthodontic prophylaxis is not widely propagated. It indicates the role of pediatricians in parents education of oral health prophylaxis and shows the role of primary health professionals in early detection and prevention of malocclusions and oral defects. In this paper the overall knowledge on dental prophylaxis was systemized. Dental caries and malocclusions are the particular problems concerning small patients. Epidemiological studies showed that the prevalence of malocclusions among polish children and adolescents is around 61.8%. Parafunctions together with dysfunctions and milk tooth early loss are the most common and significant etiological factors of acquired malocclusions. Pediatricians are able to detect many of that bad habits during out patients visits. Prevention is particularly important at the early stage of growing, because this is the time when stomatognatic system is the most susceptible for deformations. Thus, it is worth to remember that oral health is strongly related to general child’s health.

Summary. Background: Although inflammatory bowel diseases (IBD) affect mainly the gastrointestinal tract, the extra-intestinal manifestations are not uncommon. Different diagnostic methods have been applied to assess pulmonary involvement in patients with IBD, but majority of these methods show significant limitations in children. The aim of our study was to evaluate the usefulness of exhaled breath condensate (EBC) measurements of pro-inflammatory cytokines in children with IBD. Material and Methods: Twenty-two children with Crohn’s disease (CD) (mean age 13.8 � 3.3 years), 25 with ulcerative colitis (UC) (mean age 14.1 � 3.3 years) and 37 healthy volunteers (mean age 13.9 � 3.6 years) were studied. IBD activity was assessed using appropriate scoring systems. None of the patients had signs or symptoms of pulmonary disease. Exhaled breath condensate was collected and EBC concentration of interleukin 6 (IL-6), tumor necrosis factor-a (TNF-a), interleukin-1b (IL-1b), and interleukin 8 (IL-8) was measured. Results: The concentrations of all the assessed cytokines were significantly higher in the study group as compared to controls. A negative correlation between IL-1b and CD activity index was found. There were no significant relationships between TNF-a, IL-6, or IL-8 level and CD activity index as well as between IL-1b, TNF-a, IL-6, IL-8 and UC activity index. No significant correlation between the concentration of IL-1b, TNF-a, IL-6, IL-8, and IBD duration or treatment duration was found. Conclusions: Elevated concentration of pro-inflammatory cytokines in EBC in children with IBD maysuggestthepresenceofasymptomaticinflammationinthelowerairways.PediatrPulmonol.

UNLABELLED: The aim of the study is to systematically evaluate data from randomized controlled trials (RCTs) on the efficacy of using intrapleural fibrinolytic agents in the treatment of complicated parapneumonic effusions or empyema in children. The Cochrane Library, MEDLINE and EMBASE databases were searched in July 2009. Four RCTs, involving 194 children, were included. In two RCTs, intrapleural fibrinolytic treatment was compared with normal saline. One of these RCTs showed a significantly reduced hospital stay in those treated with urokinase compared with those treated with normal saline. Otherwise, no fibrinolytic agent had an effect on any other outcome. Two RCTs that compared fibrinolytic treatment with video-assisted thoracoscopic surgery (VATS) revealed no benefit of VATS. CONCLUSION: There is little evidence that intrapleural fibrinolysis is more effective than normal saline in the local treatment of complicated parapneumonic effusions or empyema in children. There is no evidence that VATS is more effective than fibrinolytic treatment. Only a limited number of trials were available for analysis, so some caution must be exercised in interpreting the strength of the evidence presented.

Aim The aim of this study was to evaluate the factors that could predict the development of local complications (parapneumonic effusion/pleural empyema, necrotizing pneumonia, and lung abscess) in children with community-acquired pneumonia (CAP). Methods Demographic, clinical, and laboratory data were prospectively collected and compared in children with noncomplicated and complicated CAP. Results Two-hundred and three patients aged from 2 months to 17 years were enrolled. There were 141 and 62 children with noncomplicated and complicated CAP, respectively. Significantly longer duration of fever and a higher level of acute phase reactants were demonstrated in complicated when noncomplicated to complicated CAP. Asymmetric chest pain as well as prehospital treatment with ibuprofen and acetaminophen were significantly more common in patients with complicated CAP (P

Exposure to environmental tobacco smoke (ETS) has been shown to increase symptoms of allergic bronchial asthma, but direct effects on the expression of inflammatory markers have not been demonstrated thus far.The aim of this study was to assess the correlation of ETS exposure with the expression of proinflammatory mediators in airway secretions, including IFN-gamma and IL-12, as well as IL-5 and IL-13, in allergic asthmatic schoolchildren and healthy control subjects.By using the nasopharyngeal aspiration technique, airway secretions were collected from 24 atopic children with asthma (age, 6-16 years) and 26 healthy control subjects, and the concentration of cytokines was measured with immunoenzymatic methods.IL-13 levels were highly increased in patients with asthma (P.005), and parental tobacco smoke resulted in a significant increase in airway IL-13 secretion in these children compared with that seen in nonexposed children and healthy control subjects (median, 860 pg/mL vs 242 pg/mL and 125 pg/mL, respectively). Furthermore, a positive correlation between IL-13 levels and serum IgE concentrations (r(s) = 0.55) was found in children with allergic asthma.These results indicate that ETS augments the expression and secretion of IL-13 in allergic asthma and that nasopharyngeal aspiration is a suitable method to assess cytokine measurements in airways in children. Measurements of IL-13 in secretions might be taken into account as a noninvasive marker of airway inflammation and to assess the detrimental effects of ETS.

Necrotizing pneumonia (NP) is an emerging complication of community acquired pneumonia (CAP) in children. This study aimed at the evaluation of etiology, clinical features, treatment, and prognosis of NP. The institutional database of children with CAP treated between April 2008 and July 2013 was searched to identify children with NP. Then, data on the NP characteristics were retrospectively reviewed and analyzed. We found that NP constituted 32/882 (3.7%) of all CAPs. The median age of children with NP was 4 (range 1-10) years. The causative pathogens were identified in 12/32 children (37.5%) with Streptococcus pneumoniae being the most common (6/32). All but one patient developed complications: parapneumonic effusion (PPE), pleural empyema or bronchopleural fistula (BPF), which required prompt local treatment. The median duration of hospital stay and antibiotic treatment was 26 (IQR 21-30) and 28 (IQR 22.5-32.5) days, respectively. Despite severe course of the disease no deaths occurred. A follow-up visit after 6 months revealed that none of the patients presented with any signs and symptoms which could be related to earlier pneumonia. Chest radiographs showed complete or almost complete resolution of pulmonary and pleural lesions in all patients. We conclude that necrotizing pneumonia is a relatively rare but severe form of CAP that is almost always complicated by PPE/empyema and/or BPF. It can be successfully treated with antibiotics and pleural drainage without major surgical intervention.

Interpretation of spirometry strongly depends on the applied predicted values. New Global Lung Initiative (GLI) reference values have recently been published but their influence on spirometry interpretation in children has not been widely evaluated. The aim of the study was to compare the interpretation of spirometry using GLI-2012 vs. Polish-1998 reference values. Spirometry results of 315 Caucasian children aged 4-18 were analyzed. Airway obstruction was defined as FEV1/FVCLLN (lower limit of normal: 5th percentile, -1,64 standard deviation), while restrictive ventilatory pattern as FVCLLN and FEV1/FVCLLN. The findings were that FEV1 and FVC expressed as GLI-2012 or Polish-1998 z-scores differed significantly (p0.05). The mean FEV1 z-score was -0.68±1.25 vs. -0.13±1.70 and the mean FVC was -0.34±1.08 vs. 0.30±1.15 for GLI-2012 and Polish-1998, respectively. There was no difference for FEV1/FVC z-scores. Obstructive and restrictive ventilatory patterns were diagnosed in 20.3% and 7.6% children using GLI-2012 values compared with 17.5% and 3.8% when using Polish-1998 reference values, respectively. In conclusion, the use of GLI-2012 reference values in the population of Polish children increases the number of detected lung function abnormalities compared with Polish-1998 reference values.

Interpretation of spirometry strongly depends on the applied predicted values. New Global Lung Initiative (GLI) reference values have recently been published but their influence on spirometry interpretation in children has not been widely evaluated. The aim of the study was to compare the interpretation of spirometry using GLI-2012 vs. Polish-1998 reference values. Spirometry results of 315 Caucasian children aged 4–18 were analyzed. Airway obstruction was defined as FEV1/FVC LLN. The findings were that FEV1 and FVC expressed as GLI-2012 or Polish-1998 z-scores differed significantly (p < 0.05). The mean FEV1 z-score was −0.68 ± 1.25 vs. −0.13 ± 1.70 and the mean FVC was −0.34 ± 1.08 vs. 0.30 ± 1.15 for GLI-2012 and Polish-1998, respectively. There was no difference for FEV1/FVC z-scores. Obstructive and restrictive ventilatory patterns were diagnosed in 20.3 % and 7.6 % children using GLI-2012 values compared with 17.5 % and 3.8 % when using Polish-1998 reference values, respectively. In conclusion, the use of GLI-2012 reference values in the population of Polish children increases the number of detected lung function abnormalities compared with Polish-1998 reference values.

Necrotizing pneumonia (NP) is an emerging complication of community acquired pneumonia (CAP) in children. This study aimed at the evaluation of etiology, clinical features, treatment, and prognosis of NP. The institutional database of children with CAP treated between April 2008 and July 2013 was searched to identify children with NP. Then, data on the NP characteristics were retrospectively reviewed and analyzed. We found that NP constituted 32/882 (3.7 %) of all CAPs. The median age of children with NP was 4 (range 1–10) years. The causative pathogens were identified in 12/32 children (37.5 %) with Streptococcus pneumoniae being the most common (6/32). All but one patient developed complications: parapneumonic effusion (PPE), pleural empyema or bronchopleural fistula (BPF), which required prompt local treatment. The median duration of hospital stay and antibiotic treatment was 26 (IQR 21–30) and 28 (IQR 22.5–32.5) days, respectively. Despite severe course of the disease no deaths occurred. A follow-up visit after 6 months revealed that none of the patients presented with any signs and symptoms which could be related to earlier pneumonia. Chest radiographs showed complete or almost complete resolution of pulmonary and pleural lesions in all patients. We conclude that necrotizing pneumonia is a relatively rare but severe form of CAP that is almost always complicated by PPE/empyema and/or BPF. It can be successfully treated with antibiotics and pleural drainage without major surgical intervention.

Wstęp: Choroby tkanki łącznej (ChTŁ) należą do grupy rzadkich chorób zapalnych, w przebiegu których dochodzi do zajęcia różnych narządów, w tym układu oddechowego. Mimo że zajęcie układu oddechowego nie jest częste, może być przyczyną niewydolności czynnościowej tego narządu. Istnieje niewiele danych na temat częstości występowania oraz rodzaju zaburzeń czynnościowych układu oddechowego u dzieci z ChTŁ. Celem pracy była ocena czynności układu oddechowego u dzieci z nowo rozpoznaną chorobą tkanki łącznej oraz po 2 latach od rozpoznania. Materiał i metody: Do badania włączono 98 dzieci (średni wiek 13 ± 3; 76 dziewcząt) leczonych w Klinice Reumatologii Wieku Rozwojowego, Instytutu Reumatologii w Warszawie. Grupę kontrolną stanowiło 80 zdrowych dzieci (średni wiek 12.7 ± 2.4; 50 dziewcząt). Procedury badania obejmowały badania podmiotowe i przedmiotowe, zdjęcie przeglądowe klatki piersiowej oraz badania czynnościowe układu oddechowego—spirometrię i body-pletyzmografię. Badania czynnościowe układu oddechowego powtórzono po 24 miesiącach leczenia. Wyniki: Stwierdzono, że FEV1, FEV1/FVC oraz MEF50 są istotnie niższe u dzieci z ChTŁ w porównaniu z grupą kontrolną, nie stwierdzono różnicy dla FVC oraz TLC. Odsetek nieprawidłowych wyników badania czynnościowego układu oddechowego był istotnie wyższy w grupie dzieci chorych: 41 (42%) v. 9 (11%). Po 24 miesiącach obserwacji nie stwierdzono progresji upośledzenia czynności układu oddechowego wśród chorych dzieci. Wnioski: Zaburzenia czynnościowe układu oddechowego u dzieci z ChTŁ występują stosunkowo często. Mimo że za typowe dla ChTŁ uważa się zaburzenia o charakterze restrykcji, we wstępnej fazie choroby może wystąpić upośledzenie przepływu w drogach oddechowych.

The aim of the study is to systematically evaluate data from randomized controlled trials (RCTs) on the efficacy of using intrapleural fibrinolytic agents in the treatment of complicated parapneumonic effusions or empyema in children. The Cochrane Library, MEDLINE and EMBASE databases were searched in July 2009. Four RCTs, involving 194 children, were included. In two RCTs, intrapleural fibrinolytic treatment was compared with normal saline. One of these RCTs showed a significantly reduced hospital stay in those treated with urokinase compared with those treated with normal saline. Otherwise, no fibrinolytic agent had an effect on any other outcome. Two RCTs that compared fibrinolytic treatment with video-assisted thoracoscopic surgery (VATS) revealed no benefit of VATS.There is little evidence that intrapleural fibrinolysis is more effective than normal saline in the local treatment of complicated parapneumonic effusions or empyema in children. There is no evidence that VATS is more effective than fibrinolytic treatment. Only a limited number of trials were available for analysis, so some caution must be exercised in interpreting the strength of the evidence presented.

Background Studies of Australian infants have reported that more than 80% of those with moderate atopic eczema (AE) have high levels of IgE food sensitization (IgE-FS) that are commonly associated with IgE food allergy.Objectives To explore the relationship between high levels of IgE-FS and AE in a large cohort of young children with eczema participating in a multi-centre, international study.Methods Two thousand one hundred and eighty-four subjects (mean age 17.6 months, range 11.8-25.4; 1246 males) with active eczema from atopic families from 94 centres in 12 countries were studied. Clinical history, Scoring Atopic Dermatitis index as a measure of eczema severity and CAP-FEIA measurements for total IgE and IgE antibody levels to cow milk, egg and peanut were entered into a database. If CAP-FEIA levels exceeded previously reported age-specific cut-off levels for 95% positive predictive values (PPVs) for food allergy, subjects were defined as having high-risk IgE-FS (HR-IgE-FS).Results Serum was available from 2048 patients; 55.5% were atopic. The frequency of HR-IgE-FS to milk, egg and/or peanut was the greatest in patients whose eczema developed in the first 3 months of life and the least in those whose eczema developed after 12 months (P Conclusion Early-onset severe eczema in infancy was associated with HR-IgE-FS. Clinical implications Food allergies should be routinely assessed in infants with moderate or severe eczema. Capsule summary In eczematous infants, the earlier the age of onset, and the greater the severity of eczema, the greater the frequency of associated high levels of IgE-FS.

Summary Background Since extraintestinal sites of inflammation have been demonstrated in patients with Crohn's disease (CD) and ulcerative colitis (UC), both entities are regarded as systemic disorders. There are only scarce data on the prevalence of inflammatory bowel disease (IBD)-associated lung involvement in children. Objectives The aim of our study was to investigate pulmonary involvement in pediatric patients with IBD. Material and methods Fifty children with IBD (25 UC and 25 CD, mean age 14.2 ± 3.2 yrs) and 39 age-matched, healthy, control subjects were included in the study. Pulmonary function testing, methacholine bronchial challenge, fractional exhaled nitric oxide (FeNO) and high resolution computed tomography (HRCT) were used to detect functional and/or structural pulmonary involvement. Results There were no differences in spirometric parameters, lung volumes or lung diffusion capacity for carbon monoxide between IBD patients and control subjects. Highly significant differences were found in FeNO between CD, UC and control patients (mean 9.3 ± 3.3, 27.7 ± 14.8 and 16.6 ± 9.28, respectively; p = 0.000). Bronchial hyperresponsiveness was diagnosed in six IBD cases (14.6%). HRCT (performed in 32 patients from the study group) revealed mild bilateral bronchiectasis in one patient. Conclusions The prevalence of pulmonary involvement in children with IBD is low. Screening for pulmonary involvement in children and young adults with IBD may enable early detection of IBD-related pulmonary diseases which, seems to be notably more common in adult patients. Elevated FeNO could probably be regarded as a marker of airway involvement in non-smoking UC pediatric patients. This requires further studies.

There are frequent concerns about early immunizations among the parents of children at heightened risk for atopy. The study assessed the effect of vaccine immunization before the first birthday on eczema severity and allergic sensitization in the second year of life.A total of 2184 infants, aged 1-2 years, with established atopic dermatitis and a family history of allergy, from 97 study centres in 10 European countries, South Africa and Australia were included. Exposure to vaccines (diphtheria, tetanus, pertussis, polio, Haemophilus influenzae Type B, hepatitis B, mumps, measles, rubella, varicella, BCG, meningococci and pneumococci) and immunization dates were recorded from immunization cards. Immunoglobulin E (IgE) was determined by RAST and eczema severity was assessed by scoring atopic dermatitis (SCORAD).Immunization against any target was not associated with an increased risk of allergic sensitization to food or inhalant allergens. Varicella immunization (only 0.7% immunized) was inversely associated with total IgE30 kU/l (OR 0.27; 95% CI 0.08-0.87) and eczema severity (OR 0.34; 95% CI 0.12-0.93). Pertussis immunization (only 1.7% nonimmunized) was inversely associated with eczema severity (OR 0.30; 95% CI 0.10-0.89). Cumulative received vaccine doses were inversely associated with eczema severity (P = 0.0107). The immunization coverage of infants before and after the onset of atopic dermatitis was similar.In children at heightened risk for atopy, common childhood immunization in the first year is not associated with an increased risk of more severe eczema or allergic sensitization. Parents of atopic children should be encouraged to fully immunize their children.