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Cel pracyCelem realizowanego projektu była ocena częstości występowania zaburzeń poznawczych oraz ustalenie związków pomiędzy ich występowaniem a zmiennymi klinicznymi i socjodemograficznymi u dzieci i młodzieży z wertykalnym zakażeniem HIV.MetodaW badaniu udział wzięło: 50 dzieci z wrodzonym zakażeniem HIV (PHIV+), w wieku 6-18 lat, 24 zdrowych dzieci urodzonych przez matki zakażone HIV (PHEU) oraz 43 zdrowych dzieci zdrowych rodziców (HIV-nA). Do oceny zaburzeń poznawczych użyto baterii testów CANTAB Research Suite.WynikiU osób z grupy PHIV+ stwierdzono, istotnie gorsze wyniki w porównaniu z grupą HIV-nA w zakresie przełączania uwagi, elastyczności poznawczej, wykorzystywania informacji zwrotnych oraz pamięci roboczej, a w stosunku do grupy PHEU - dłuższy czas planowania podczas wykonania zadania. Analiza wyników dla grupy wiekowej 12-18 lat wskazuje na pogorszenie funkcji wykonawczych w grupie PHIV+ w stosunku do grupy HIV-nA, widoczne dla każdego z testów. Wyższy logarytm wiremii na początku wdrożonego leczenia ARV związany był ze słabszymi wynikami w zakresie korzystania z informacji zwrotnej, przerzutności uwagi i elastyczności poznawczej oraz z wolniejszym przetwarzaniem.WnioskiWyniki badań wskazują na gorsze funkcjonowanie poznawcze młodzieży PHIV+, przy czym deficyty te są związane z zaawansowaniem infekcji przed leczeniem oraz narastają wraz z czasem trwania neuroinfekcji.

Cel pracyOcena częstości występowania zaburzeń psychicznych, behawioralnych, emocjonalnych oraz ustalenie związków ze zmiennymi klinicznymi i socjodemograficznymi u dzieci i młodzieży z wertykalnym zakażeniem HIV.MetodaW badaniu udział wzięło 56 dzieci z wrodzonym zakażeniem HIV (grupa PHIV+), 24 zdrowych dzieci urodzonych przez matki zakażone HIV (grupa PHEU) oraz 43 zdrowych dzieci zdrowych rodziców (grupa HIV-nA), w wieku 6-18 lat. Do oceny zaburzeń behawioralnych i emocjonalnych zastosowano Kwestionariusz dla Rodziców CBCL/4-18 oraz Kwestionariusz Samooceny YSR, do oceny objawów zaburzeń psychicznych półustrukturyzowany wywiad diagnostyczny K-SADS-PL.WynikiWykazano wyższą częstość występowania zaburzeń psychicznych w ciągu życia w grupie PHIV+ oraz grupie PHEU w porównaniu z grupą HIV-nA. Najczęściej diagnozowano zaburzenia lękowe oraz zaburzenia nastroju. Występowanie objawów zaburzeń emocjonalnych i behawioralnych w grupie PHIV+ oraz w grupie PHEU było związane z podobnymi zmiennymi socjodemograficznymi (m.in. płeć męska, niezamieszkiwanie z opiekunem biologicznym, doświadczenie stresującego wydarzenia w życiu). Zaburzenia psychiczne występowały częściej u osób, u których leczenie antyretrowirusowe (ARV) rozpoczęto dopiero po 12 m.ż. Stwierdzono dodatnią korelację pomiędzy wynikiem dla części skal YSR i CBCL/4-18, a liczbą limfocytów CD4 w momencie przeprowadzania badania oraz wyższym logarytmem wiremii na początku leczenia ARV i w momencie ustalenia rozpoznania zakażenia HIV.WnioskiW grupie dzieci PHIV+ oraz PHEU, stwierdzono wyższą częstość występowania zaburzeń psychicznych. Cięższy przebieg zakażenia HIV i jego nasilenie przed rozpoczęciem leczenia wiąże się z większym nasileniem problemów internalizacyjnych.

Background Although COVID-19 is associated with a mild course in children, a certain proportion requires admission to hospital due to SARS-CoV-2 infection and coexisting diseases. The prospective multicenter study aimed to analyze clinical factors influencing the length of the hospital stay (LoHS) in children with COVID-19. Methods The study included 1283 children from 14 paediatric infectious diseases departments with diagnosed SARS-CoV-2 infection. Children were assessed in respective centres regarding indications for admission to hospital and clinical condition. History data, clinical findings, laboratory parameters, treatment, and outcome, were collected in the paediatric SARSTer register. The group of children with a hospital stays longer than seven days was compared to the remaining patients. Parameters with a statistically significant difference were included in further logistic regression analysis. Results One thousand one hundred and ten children were admitted to the hospital, 763 children were hospitalized >24 h and 173 children >7 days. 268 children had comorbidities. Two hundred and eleven children had an additional diagnosis with coinfections present in 135 children (11%). Factors increasing the risk of higher LoHS included pneumonia [odds ratio—OR 3.028; 95% confidence interval—CI (1.878–4.884)], gastrointestinal symptoms [OR = 1.556; 95%CI (1.049–2.322)], or rash [OR = 2.318; 95%CI (1.216–4.418)] in initial clinical findings. Comorbidities [OR = 2.433; 95%CI (1.662–3.563)], an additional diagnosis [OR = 2.594; 95%CI (1.679–4.007)] and the necessity of the empirical antibiotic treatment [OR = 2.834; 95%CI (2.834–6.713)] were further factors related to higher LoHS. Conclusions The clinical course of COVID-19 was mild to moderate in most children. Factors increasing the risk of higher LoHS included pneumonia, gastrointestinal symptoms, comorbidities, an additional diagnosis, and the empirical antibiotic treatment.

Introduction: in the review, we aimed to present current knowledge about the risk of infection, standards of care, and postexposure prophylaxis (PEP) in pediatric patients after non-vertical exposures to HIV, HBV, and HCV infection. Materials and Methods: the latest available literature and recommendations of Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), European recommendations for the management of HIV and administration of non-occupational PEP, and Polish AIDS Society were reviewed. Results: the majority of cases of non-vertical exposure to blood-borne viruses in the pediatric population consist of sexual exposition and injection with unsterilized sharp objects (usually needlestick injuries). The risk HIV, HBV, and HCV transmission depend on several factors, and each exposure should be evaluated individually with consideration of the patient’s medical history. It is crucial to start antiretroviral therapy within 48 h from exposure. Treatment is continued for 28 days, and a 3-drugs regiment is recommended in the majority of cases. Decisions on hepatitis B and tetanus PEP are based on a history of vaccination. There is no PEP for hepatitis C infection, follow-up testing aims for early identification of disease and consideration of treatment options. Conclusion: all children after the non-vertical exposure to HIV, HBV, and HCV infection should be evaluated by the Infectious Disease specialist as soon as possible after the incident and qualified to post-exposure prophylaxis. Systematic diagnostic and follow-up on children after significant needlestick exposure should be maintained. Children after sexual exposure need a multidisciplinary approach. Response to reported event must be rapid and treatment must be comprehensive.

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.

We present the efficacy and safety of 12 weeks of therapy with a fixed dose of ledipasvir/sofosbuvir in 2 teenagers with HIV/hepatitis C virus coinfection. Patient 1 presented with compensated cirrhosis, whereas patient 2 had evidence of previous hepatitis B virus infection. Both patients achieved a sustained virologic response 12 weeks after the end of treatment. No serious adverse effects were reported.

Chronic hepatitis C (CHC) is a global health burden. Mother-to-child transmission (MTCT) accounts for most HCV infections in pediatric patients. Spontaneous viral clearance may occur in early childhood but is uncommon thereafter. Infection is usually asymptomatic during childhood, although without an effective treatment, vertically infected children may develop serious liver complications including cirrhosis and hepatocellular carcinoma in adulthood. Despite the lack of vaccine against hepatitis C and effective post-exposure methods of prevention of MTCT, treatment with direct-acting antiviral agents (DAAs) raised the prospect of eliminating HCV on a population level. Highly effective, well-tolerated, oral, and interferon-free regimens of short duration have revolutionized treatment of CHC. However, access to these therapies might be limited because of its high cost. In this review, we provide the current state of knowledge on the epidemiology, testing, monitoring and treating of HCV in children. We outline the remaining gaps in therapy and barriers to disease eradication.Chronische Hepatitis C (CHC) stellt eine globale Gesundheitsbelastung dar. Die Mutter-Kind-Übertragung (MTCT) ist für die meisten HCV-Infektionen bei pädiatrischen Patienten verantwortlich. Eine spontane Virusfreisetzung kann in der frühen Kindheit auftreten, ist danach aber selten. In der Regel verläuft die Infektion während der Kindheit asymptomatisch, obwohl unbehandelte vertikal infizierte Kinder schwere Leberkomplikationen wie Zirrhose und Leberzellkarzinom im Erwachsenenalter entwickeln können. Trotz des Fehlens eines Impfstoffs gegen Hepatitis C und wirksamer Methoden zur Prävention von MTCT nach der Exposition hat die Behandlung mit direkt wirkenden antiviralen Wirkstoffen (DAA) die Aussicht auf eine Eliminierung von HCV auf Bevölkerungsebene erhöht. Hochwirksame, gut verträgliche, orale und kurzzeitige interferonfreie Therapien haben die Behandlung von CHC revolutioniert. Der Zugang zu diesen Therapien könnte jedoch aufgrund der hohen Kosten begrenzt sein. In diesem Überblick stellen wir den aktuellen Stand des Wissens über Epidemiologie, Testung, Überwachung und Behandlung von HCV bei Kindern dar. Wir skizzieren die verbleibenden Therapielücken und Hindernisse bei der Ausrottung der Krankheit.

Background The aim of this prospective study was to analyze liver fibrosis in teenagers with chronic hepatitis C (CHC) using noninvasive methods. Methods Thirty-five patients with CHC, 12-17 years of age (mean 14.2 ± 1.8 years; 22/35, 63% male) were included. Most of them (29/35, 83%) were infected vertically, 21/35 (60%) were treatment-naive, 30/35 (86%) were infected with genotype 1 and 5/35 (14%) were infected with genotype 4 HCV. In all patients, evaluation of liver fibrosis was performed using transient elastography (TE) and measurement of the following serum biomarkers: aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis-4 index (FIB-4). Using liver stiffness measurement (LSM) results as a reference, the diagnostic performance of APRI and FIB-4 was assessed by calculating area under the receiver operating characteristics curve. Results Transient elastography results revealed no or mild fibrosis (F0/1 in METAVIR scale) in 31/35 (89%) patients. In 4/35 (11%) patients, significant fibrosis was observed (F ≥ 2), including 3/35 (9%) with cirrhosis (F4). The median APRI was 0.32, and the median FIB-4 was 0.32. LSM was associated with both APRI and FIB-4 [r = 0.61, 95% confidence interval (CI) 0.35-0.79, P = 0.0001; and r = 0.60, 95% CI 0.32-0.78, P = 0.0002, respectively]. For the diagnosis of significant fibrosis, the area under the receiver operating characteristics (95% CI) for both APRI and FIB-4 was 0.855 (0.695-0.951). APRI, with a cutoff >0.374, predicted significant fibrosis, with 100% sensitivity and 67.7% specificity, whereas FIB-4, with a cutoff >0.402, predicted significant fibrosis, with 75.0% sensitivity and 90.3% specificity. Conclusions Significant fibrosis, including cirrhosis, may occur in teenagers with CHC. Serum biomarkers (APRI, FIB-4) correlate positively with LSM.

Background: There are limited data available on the influence of direct-acting antivirals used to treat chronic hepatitis C (CHC) on growth in children. In this study, we aimed to analyze the growth parameters in children treated with ledipasvir/sofosbuvir (LDV/SOF). Methods: We included 38 patients (16 girls and 22 boys) aged 10–17 years treated with LDV/SOF for CHC (33 infected with genotype 1 and 5 with genotype 4; 36 were treated for 12 weeks, and 2 for 24 weeks according to the current guidelines). Patient weight and height were measured at baseline, after 4 weeks of treatment, at the end of the treatment (EOT), and 12 weeks and one year after the EOT. Body mass index (BMI), BMI z and height-for-age (HA) z scores were calculated according to the WHO Child Growth Standards and Growth reference data using the WHO anthropometric calculator AnthroPlus v. 1.0.4. In addition, correlations between BMI z scores and liver fibrosis (liver stiffness measurement, LSM), the aspartate transaminase (AST)-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4) and liver steatosis (controlled attenuation parameter, CAP) were analyzed. Results: At baseline, 5/38 (13%) patients were obese (BMI z score >2 SD), 4/38 (11%) were overweight, and 29 (76%) were normal. A significant increase was observed in mean weight, height and BMI both 12 weeks and one year after the treatment compared to the baseline, whereas no differences were observed for BMI z scores and HA z scores. Baseline BMI z scores correlated with alanine aminotransferase levels (r = 0.33, 95% CI 0.01–0.58, p = 0.04), LSM (r = 0.40, 95% CI 0.09–0.65, p = 0.01), the APRI (r = 0.33, 95% CI 0.02–0.59, p = 0.03), and the CAP (r = 0.40, 95% CI 0.08–0.64, p = 0.01). No similar correlations were reported at 12 weeks posttreatment. Conclusions: Treatment with LDV/SOF in children with CHC (genotypes 1 and 4) did not negatively influence the patients’ growth. However, higher baseline BMI z scores correlated with more advanced liver fibrosis and steatosis in children with CHC.

Background Etravirine (ETR) is approved as a component of second or third-line antiretroviral treatment (ART) for children living with HIV. We assessed the outcomes of ETR-based ART in children in routine care in Europe and Thailand. Methods Data on children aged Results 177 children ever received ETR. At ETR start, median [IQR] age was 15 [12,16] years, CD4 count 480 [287, 713] cells/mm3, 70% had exposure to ≥3 ART classes and 20% had viral load (VL) 3. Overall, 81 (46%) discontinued ETR by last follow-up. Median time to discontinuation was 23 [8, 47] months. Common reasons for discontinuation were treatment simplification (19%), treatment failure (16%) and toxicity (12%). Eight children (5%) had AEs causally associated with ETR, all dermatological/hypersensitivity reactions. Two were SAEs, both Stevens–Johnson Syndrome in children on regimens containing ETR and darunavir and were causally related to either drugs; both resolved following ART discontinuation. Conclusion Children receiving ETR were predominantly highly treatment-experienced, over two-thirds were virally suppressed at 12 months.

Purpose: There are currently only scarce data available describing imaging manifestations in children with COVID-19. The aim of this study was to analyse pulmonary lesions on chest radiography (CXR) in paediatric patients infected with SARS-CoV-2 and to compare the CXR results with clinical and laboratory data. Material and methods: In this prospective single-centre study we included 118 consecutive paediatric patients with COVID-19. CXR was performed in 107 patients. Clinical and laboratory evaluations were performed on the same day as CXR, immediately (0 to 2 days) after the COVID-19 diagnosis had been established. Results: Pulmonary lesions were found in 24/107 (23%) children, including 14/24 (58%) with bilateral abnormalities. Compared to patients with normal CXR, children presenting with pulmonary lesions were significantly younger (7.0 ± 4.5 vs. 9.5 ± 4.5 years, p = 0.03) and more commonly presented with an elevated D-dimer level (6/24, 25% vs. 5/81, 7%; p = 0.008). Almost half (46%) of the children with pulmonary lesions were asymptomatic, and 11/60 (18%) of all asymptomatic patients presented with abnormal CXR. Conclusions: Pulmonary lesions in the course of COVID-19 are more common in younger children and those presenting with an elevated D-dimer level. A significant proportion of asymptomatic COVID-19 patients develop CXR abnormalities.

This study aimed to analyze the differences in severity and clinical characteristics of COVID-19 in infants hospitalized in Poland in 2021, when the dominance of variants of concern (VOCs) alpha and delta was reported, compared to 2020, when original (wild) SARS-CoV-2 was dominant (III–IV vs. I–II waves of the pandemic, respectively). In addition, the influence of the presence of comorbidities on the clinical course of COVID-19 in infants was studied. This multicenter study, based on the pediatric part of the national SARSTer database (SARSTer-PED), included 940 infants with COVID-19 diagnosed between March 1, 2020, and December 31, 2021, from 13 Polish inpatient centers. An electronic questionnaire, which addressed epidemiological and clinical data, was used. The number of hospitalized infants was significantly higher in 2021 than in 2020 (651 vs. 289, respectively). The analysis showed similar lengths of infant hospitalization in 2020 and 2021, but significantly more children were hospitalized for more than 7 days in 2020 (p < 0.009). In both analyzed periods, the most common route of infection for infants was household contact. There was an increase in the percentage of comorbidities, especially prematurity, in children hospitalized in 2021 compared to 2020. Among the clinical manifestations, fever was predominant among children hospitalized in 2021 and 2020. Cough, runny nose, and loss of appetite were significantly more frequently observed in 2021 (p < 0.0001). Severe and critical conditions were significantly more common among children with comorbidities. More infants were hospitalized during the period of VOCs dominance, especially the delta variant, compared to the period of wild strain dominance, even though indications for hospitalization did not include asymptomatic patients during that period. The course of COVID-19 was mostly mild, characterized mainly by fever and respiratory symptoms. Comorbidities, particularly from the cardiovascular system and prematurity, were associated with a more severe course of the disease in infants.

Hepatitis B (HBV) and C (HCV) infections are the major causes of chronic liver disease and are associated with significant morbidity and mortality [...]

This prospective multicenter cohort study aimed to analyze the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) in children. The study, based on the pediatric part of the Polish SARSTer register, included 1283 children (0 to 18 years) who were diagnosed with COVID-19 between 1 March 2020 and 31 December 2020. Household contact was reported in 56% of cases, more frequently in younger children. Fever was the most common symptom (46%). The youngest children (0–5 years) more frequently presented with fever, rhinitis and diarrhea. Teenagers more often complained of headache, sore throat, anosmia/ageusia and weakness. One fifth of patients were reported to be asymptomatic. Pneumonia was diagnosed in 12% of patients, more frequently in younger children. During the second wave patients were younger than during the first wave (median age 53 vs. 102 months, p &lt, 0.0001) and required longer hospitalization (p &lt, 0.0001). Significantly fewer asymptomatic patients were noted and pneumonia as well as gastrointestinal symptoms were more common. The epidemiological characteristics of pediatric patients and the clinical presentation of COVID-19 are age-related. Younger children were more frequently infected by close relatives, more often suffered from pneumonia and gastrointestinal symptoms and required hospitalization. Clinical courses differed significantly during the first two waves of the pandemic.

The study aimed to analyse the clinical course of COVID-19 in 300 infants, selected from 1283 children diagnosed with COVID-19 between March and December 2020, registered in the SARSTerPED multicenter database. Most of the infants were registered in October and November 2020. 44% of the group were girls, and 56% were boys. At diagnosis, the most common symptoms were fever in 77% of the children, cough in 40%, catarrh in 37%. Pneumonia associated with COVID-19 was diagnosed in 23% of the children, and gastrointestinal symptoms in 31.3%. In 52% of the infants, elevated levels of D-dimers were observed, and in 40%, elevated levels of IL-6 serum concentration were observed. During the second wave of the pandemic, 6 times more infants were hospitalized, and the children were statistically significantly younger compared to the patients during the first wave (3 months vs 8 months, p

Background: Available real-world data on the efficacy and safety of ledipasvir/sofosbuvir (LDV/SOF) in pediatric patients are limited. In this prospective, open-label, single-center study, we aimed to present our real-life experience with a fixed dose of LDV/SOF (90/400 mg) for the treatment of chronic hepatitis C (CHC) genotypes 1 and 4 in children aged 12 to 17 years. Methods: We analyzed intention-to-treat (ITT) and per-protocol (PP) rates of sustained virological response (SVR), defined as undetectable HCV viral load at posttreatment week 12, in 37 participants treated with LDV/SOF according to the HCV genotype, baseline liver fibrosis, duration of treatment, and experience of the previous ineffective antiviral treatment. There were 32 patients infected with genotype 1 and 5 with genotype 4. Fourteen (38%) participants were treatment-experienced, two were coinfected with HIV, and three were cirrhotic. Two patients qualified for 24 weeks of therapy, and the remaining 35 received 12 weeks of LDV/SOF treatment. Results: The overall ITT SVR12 rate was 36/37 (97%). One patient was lost to follow-up after week 4 of therapy when his HCV RNA was undetectable. All 36 patients who completed the full protocol achieved SVR (36/36, 100%). PP analyses of SVR12 rates according to the HCV genotype, baseline liver fibrosis, duration of the treatment, and previous ineffective treatment were all 100%. A significant decrease in aminotransferase serum levels was observed in the subsequent weeks of the treatment and at SVR assessment compared to baseline. No serious adverse events were reported. Conclusions: The results of this study confirm previous observations of a suitable efficacy and safety profile of LDV/SOF for the treatment of CHC genotypes 1 and 4 in adolescents.

In this case report we present a nine-year-old boy from a family cluster with SARS-CoV-2 and influenza virus co-infection He presented with the most common manifestations of COVID-19 reported in paediatric population - fever and cough Severe acute respiratory syndrome coronavirus 2 infection was diagnosed by RT-PCR assay, and influenza type A by rapid immunochromatic assay testing The course of disease was mild, despite co-infection with two viruses In the time of COVID-19 pandemic testing for influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 in suspected cases is essential for establishing a diagnosis, and it has important implications for patient management © Creative Commons Attribution-NonCommercial-ShareAlike 4 0 International (CC BY-NC-SA 4 0)

Background Mother-to-child transmission is one of the main sources of hepatitis C virus (HCV) infection in children. However, because of the asymptomatic course of the illness, certain women may not be aware of their infection. Objectives The aim of this study was to estimate the significance of epidemiological anamnesis in diagnoses of HCV infection in women of reproductive age and to evaluate how screening among pregnant women impacts the detection of HCV infection. Material and methods Epidemiological interviews of 432 mothers infected with HCV (but free of human immunodeficiency virus (HIV)) were conducted in the Warsaw Hospital for Infectious Diseases (Poland) from 1998 to 2012. Results Complaints or abnormalities in laboratory tests were the reasons for anti-HCV antibody testing in 28.2% of mothers, whereas specific interview responses or occupational health care services group affiliation were the reasons for testing in 35.6%. However, in a large group of women, infection was only detected because of screening examinations. The introduction of routine screening for pregnant women (since 2010 in Poland) has led to the increased detection of HCV infection in women who did not present with infection risk factors (9.9% before 2010 vs 46.1% after 2010). This practice has also led to an increase in the percentage of women diagnosed during pregnancy (21.5% before 2010 vs 30.8% after 2010). Conclusions Establishing HCV infection risk factors during the interview process is the most common indicator for serological testing; however, not all infected cases can be diagnosed in this manner. Screening for anti-HCV antibodies in pregnant women increases the detection of HCV infection in this group.

Long-term outcomes of therapy with ledipasvir/sofosbuvir (LDV/SOF) in children with chronic hepatitis C (CHC) and significant liver fibrosis were evaluated. Among 35 patients aged 12-17 years treated with LDV/SOF, there were four participants with significant fibrosis: one with a fibrosis score of F2 in the METAVIR scale, and three with cirrhosis (F4) evaluated with transient elastography (TE) at baseline. Patients were followed every 4 weeks during the treatment, at the end of the therapy, week 12 posttreatment, and one year after the end of treatment. One year after the end of treatment, the hepatitis C viral load was undetectable in three patients. In 2/4 patients, a significant regression of liver fibrosis was observed (from stage F4 and F2 to F0-F1 in the METAVIR scale). In one patient, the liver stiffness measurement median increased 12 weeks after the end of the treatment and then decreased but still correlated with stage F4. One patient was lost to follow-up after week 4. A one-year observation of teenagers with CHC and significant fibrosis treated with LDV/SOF revealed that regression of liver fibrosis is possible, but not obligatory. Further observations in larger groups of patients are necessary to find predictors of liver fibrosis regression.

Recent advances in antiviral drug development towards the hepatitis C virus(HCV) have revolutionized the therapy and paved the way towards the elimi­nation of chronic hepatitis C (CHC). Difficulties in achieving time-bound elimination targets of the World Health Organization’s Global Strategy on viral hepatitis might be overcome through a novel micro-elimination approach. A new, emerging strategy focuses elimination efforts on high-risk and ignored populations, and therefore allows for quick, efficient targeting of treatment and prevention services. So far, gaps in antenatal and/or paedia­tric care, and a lack of reimbursement and approval of direct-acting antivirals (DAA) in the paediatric population have been a barrier to accessing treatment, leading to marginalization of children and adolescents. Recently approved DAAs for use in children aged ≥ 3 years seem to be the cornerstone of HCV elimination by reducing the risk of future horizontal and vertical transmission, firstly on a national, and ultimately on a global level.

Difficulties in achieving elimination targets of the World Health Organization’s Global Strategy on viral hepatitis might be overcome through a new micro-elimination approach that allows for a quick, efficient targeting of treatment and prevention services. Particular focus on identification of high-risk and so far marginalized populations, such as children and adolescents, increases chances for HCV elimination on a country, and ultimately on a population level. Therefore, a broad access to safe and highly effective direct-acting antiviral drugs is of upmost importance in the pediatric population.

BACKGROUND Therapy with pegylated interferon and ribavirin (PEG-IFN+RBV) for chronic hepatitis C (CHC) still remains the only option available for children in many Eurasian and European countries. Our aim was to evaluate the influence of host and viral factors on response to IFN-based therapy to optimize it for those in whom directly acting antivirals (DAA) are currently unavailable. METHODS Seventeen vertically infected, treatment naive children (10 male and 7 female) aged 5-16 years with CHC underwent a course of PEG-IFN+RBV. The end point was sustained virologic response (SVR). Host and virus factors were divided into pre- and ontreatment predictors of response to therapy. RESULTS Eleven patients obtained SVR (64%), 4 were nonresponders (23%), and 2 were relapsers (12%). Significant relationship was found between HCV RNA elimination and following variables: virus genotype and early virologic response (EVR) (p< .037, p< .029 respectively). Higher eradication rate was observed in patients infected with genotype 3 HCV (100% vs. 65% with genotype 1 or 4), and in those with undetectable HCV RNA by week 12 (88% vs. 66% with viremia). EVR was associated with SVR (83% vs. 0% in nonresponders; p< .004). C allele of IL28B rs12979860 was a predictor of EVR (p < .043). The SVR rates among CC, CT, and TT carriers were as follows: 75%, 67%, and 33%. CONCLUSIONS Detection of favourable HCV and IL28B genotype prior to commencement of PEG-IFN+RBV, and continuing it in patients with EVR is of major importance for those in whom DAA are still unavailable.

Data on the novel coronavirus disease 2019 (COVID-19) in children are limited, and studies from Europe are scarce. We analyzed the clinical severity and epidemiologic aspects of COVID-19 in consecutive children aged 0 – 18 years, referred with a suspicion of COVID-19 between February 1, and April 15, 2020. RT-PCR on a nasopharyngeal swab was used to confirm COVID-19. 319 children met the criteria of a suspected case. COVID-19 was diagnosed in 15/319 (4.7%) patients (8 male; mean age 10.5 years). All of them had household contact with an infected relative. Five (33.3%) patients were asymptomatic. In 9/15 (60.0%) children, the course of the disease was mild, and in 1/15 (6.7%), it was moderate, with the following symptoms: fever (46.7%), cough (40%), diarrhea (20%), vomiting (13.3%), rhinitis (6.7%), and shortness of breath (6.7%). In the COVID-19-negative patients, other infections were confirmed, including influenza in 32/319 (10%). The clinical course of COVID-19 and influenza differed significantly based on the clinical presentation. In conclusion, the clinical course of COVID-19 in children is usually mild or asymptomatic. In children suspected of having COVID-19, other infections should not be overlooked. The main risk factor for COVID-19 in children is household contact with an infected relative.

Data on the novel coronavirus disease 2019 (COVID-19) in children are limited, and studies from Europe are scarce. We analyzed the clinical severity and epidemiologic aspects of COVID-19 in consecutive children aged 0–18 years, referred with a suspicion of COVID-19 between February 1, and April 15, 2020. RT-PCR on a nasopharyngeal swab was used to confirm COVID-19. 319 children met the criteria of a suspected case. COVID-19 was diagnosed in 15/319 (4.7%) patients (8 male; mean age 10.5 years). All of them had household contact with an infected relative. Five (33.3%) patients were asymptomatic. In 9/15 (60.0%) children, the course of the disease was mild, and in 1/15 (6.7%), it was moderate, with the following symptoms: fever (46.7%), cough (40%), diarrhea (20%), vomiting (13.3%), rhinitis (6.7%), and shortness of breath (6.7%). In the COVID-19-negative patients, other infections were confirmed, including influenza in 32/319 (10%). The clinical course of COVID-19 and influenza differed significantly based on the clinical presentation. In conclusion, the clinical course of COVID-19 in children is usually mild or asymptomatic. In children suspected of having COVID-19, other infections should not be overlooked. The main risk factor for COVID-19 in children is household contact with an infected relative.

Amelogenesis Imperfecta (henceforth: AI) is a term used to determine congenital qualitative and quantitative enamel defects, concerning both deciduous and permanent dentition. Classification of AI is based on the phenotype of lesions and is included in numerous types of classifications, among which the Witkop classification is the most popular. Apart from enamel abnormalities, patients afflicted with AI may also have other disorders, e.g. congenital deficiencies of tooth buds, pulp calcification, root and crown resorption, open bite. Aesthetic defects of dentition, pain reported when consuming acidic and hot foods, difficulties in obtaining satisfactory hygiene - all these significantly affect the quality of life of patients with AI. Care provided to these patients is highly specialised and starts as early as in early childhood. Aim. The aim of the study was to describe familial clustering, types, symptoms and treatment of Amelogenesis Imperfecta in members of two families treated at the Department of Orthodontics at the Medical University of Warsaw. Material and methods. The material comprised two unrelated families with clinically manifested symptoms of AI, treated at the Department of Orthodontics at the Medical University of Warsaw. A detailed interview, clinical examination and analysis of radiological documentation were conducted in each family. Results. All patients in the study were suffering from hypoplastic AI, their hygiene was satisfactory, four in five patients had an open bite. Reported symptoms did not differ from those most commonly described in the literature, and included discomfort while eating acidic and hot food, and excessive enamel abrasion. Conclusions. Treatment of patients with AI is multi-stage, multidisciplinary, and aims to restore proper functions of the dentition, as well as to obtain a correct occlusion, skeletal relationships, and to reduce hypersensitivity to thermal and chemical stimuli. Preventive measures are important, and should be introduced early, during the stage of the deciduous dentition, and be related to hygiene briefing and monitoring. (Kornet A, Kornet M, Domańska R, Perkowski K, Marczyńska-Stolarek M, Zadurska M. Familial clustering of Amelogenesis Imperfecta – a case study. Orthod Forum 2018; 14: 61-72)

One-year outcomes after therapy with ledipasvir/sofosbuvir (LDV/SOF) in children with chronic hepatitis C (CHC) presenting with and without significant liver fibrosis were analyzed. We included patients aged 12–17 years treated with LDV/SOF, presenting with significant fibrosis (F ≥ 2 on the METAVIR scale) in transient elastography (TE) at the baseline and we compared the outcomes with that of patients without fibrosis. Patients were followed every 4 weeks during the treatment, at the end of the therapy, at week 12 posttreatment, and one year after the end of treatment. Liver fibrosis was established using noninvasive methods: TE, aspartate transaminase-to-platelet ratio index (APRI), and Fibrosis-4 index (FIB-4). There were four patients with significant fibrosis at baseline: one with a fibrosis score of F2 on the METAVIR scale, and three with cirrhosis (F4) at baseline. One year after the end of treatment, the hepatitis C viral load was undetectable in three of them. One patient was lost to follow-up after week 4. In two out of the four patients, a significant improvement and regression of liver fibrosis was observed (from stage F4 and F2 to F0-F1 on the METAVIR scale). In one patient, the liver stiffness measurement median increased 12 weeks after the end of the treatment and then decreased, but still correlated with stage F4. An improvement in the APRI was observed in all patients. In four patients without fibrosis, the treatment was effective and no progression of fibrosis was observed. A one-year observation of teenagers with CHC and significant fibrosis treated with LDV/SOF revealed that regression of liver fibrosis is possible, but not certain. Further observations in larger groups of patients are necessary to find predictors of liver fibrosis regression.

Aim of the study Recently, novel serum markers modified by the body mass index z-score (BMI z-score) were proposed as a reliable noninvasive alternative for the detection of significant fibrosis and steatosis in children with chronic hepatitis C (CHC). The aim of this study was to evaluate the clinical usefulness of these biomarkers. Material and methods Thirty children aged 9.4 ± 3.7 years (14 males, 16 females) with CHC were included in this study. In all patients, histopathological evaluation of the liver fibrosis was performed using a 5-point METAVIR scoring system (≥ 2 points = significant fibrosis). Significant steatosis was diagnosed with > 33% of hepatocytes affected. The following noninvasive markers of liver disease were calculated: the modified aspartate transaminase (AST)-to-platelet ratio index (M-APRI: BMI z-score × APRI), the modified Fibrosis-4 index (M-FIB-4: BMI z-score × FIB-4), and a novel marker, B-AST (BMI z-score × AST). The clinically useful cut-offs for each marker were selected as simple round numbers, indicating significant fibrosis and steatosis. Results Significant fibrosis was detected in 7/30 (23%) cases, and significant steatosis was observed in 4 (13%) patients. Comparison with the histopathological evaluation revealed that B-AST < 0 excluded significant fibrosis, and < 100 excluded all patients with significant steatosis. For the M-APRI, < 0 excluded significant fibrosis, and < 0.5 excluded significant steatosis. For the M-FIB-4, < 0 excluded significant fibrosis and < 0.2 excluded significant steatosis. Conclusions Negative values of all three markers that included the BMI z-score excluded all patients with both significant fibrosis and significant steatosis.

Introduction The risk of CNS changes in vertical HIV infection is high. The frequency and severity of disorders are connected to disease stage, the age of first symptoms, progression, child's actual age and medications’ neurotoxicity. The aim of the study The aim of the study is to identify and determine the frequency of neurological disorders, and to identify factors influencing the occurrence of those disorders. Materials and Methods The study was retrospective and partially prospective. It included 67 children vertically infected with HIV, aged from 2 months to 20 years of age. Neurological disorders were assessed by physical examination, including a detailed neurological examination. In the study, virological laboratory tests (VL HIV RNA) and percentage of CD4 + T lymphocytes (immunological classification) were analyzed. Results Abnormal neurological examination was observed in 18 patients. In 10 of the 18 patients, neurological disorders were found in their first year of life. The most common neurological complication was HIV encephalopathy (HE). Conclusion The occurrence of neurological disorders is influenced by the degree of immunodeficiency, HIV viral load at diagnosis, and age of initiation of ARV therapy. Starting ARV treatment

Aim of the study Was to evaluate liver disease severity in children with chronic viral hepatitis using the FibroTest and ActiTest (FT/AT), and compare the results with the liver biopsy. Material and methods The study included 11 treatment-naive children [mean age, 9.0 ± 3.0 years, 10 infected with hepatitis C virus (HCV), and 1 with hepatitis B virus (HBV)] who underwent an FT/AT. Ten of the children underwent a liver biopsy. The histopathological evaluation was based on the METAVIR scoring system. The FT/AT and METAVIR scores were considered concordant if the necroinflammatory activity or the fibrosis did not differ by more than one grade or stage. To analyze the agreement between the FT/AT and the histopathological evaluation, the inter-rater agreement (kappa) was used. Results In the histopathological evaluation, most children presented with mild necroinflammatory activity (METAVIR A1) and with minimal to mild fibrosis (METAVIR F1-2). Both the AT and FT values did not show any linear increases with advancing METAVIR scores A and F, respectively. A discordance between the FT and METAVIR scores was observed in 3/10 (30%) cases; concordance between the AT and METAVIR scores was found in 9/10 cases. The inter-rater agreement test showed poor agreement between the FT/AT and the histopathological evaluation (kappa for AT: 0.0667, and kappa for FT: 0.176). Conclusions The FT and AT values poorly correlate with histopathological evaluation. Further studies on non-invasive methods to evaluate liver disease severity in children with chronic viral hepatitis are needed.