The role of the family physician in the diagnosis and treatment of allergic diseases in children in the light of current guidelines. Part 2 — allergic rhinitis, allergic conjunctivitis, asthma

W pierwszej części artykułu poruszone zostały problemy chorób alergicznych wieku niemowlęcego, do których możemy także zaliczyć astmę i alergiczny nieżyt nosa. Zgodnie ze stanowiskiem ekspertów Polskiego Towarzystwa Alergologicznego lekarz podstawowej opieki zdrowotnej może podejmować diagnostykę i leczenie zarówno astmy, jak i alergicznego nieżytu nosa. Jedynym warunkiem postawionym przez ekspertów jest działanie w oparciu o rzetelną, aktualną wiedzę i doświadczenie. W aktualnych wytycznych po raz pierwszy został jasno sprecyzowany zakres obowiązków specjalisty i lekarza rodzinnego, których wzajemne uzupełnianie pozwala przez długie lata prawidłowo leczyć dziecko z alergią. Eksperci zwracają także uwagę na kluczową rolę edukacji i profilaktyki w długofalowym postępowaniu z chorym.In the first part of this article we discuss allergic diseases in infancy, which include asthma and allergic rhinitis. According to the Polish Society of Allergology, primary care physicians can make diagnosis and conduct treatment of both asthma and allergic rhinitis. The only condition made by the experts is that they need to act in accordance with competent, current knowledge and expertise. Current guidelines for the first time clearly define the area of responsibilities of both specialist and family physician whose complementarity allows for proper, long-term treatment of a child with allergy. Experts also point to the crucial role of education and prevention in the long-term management of patients

The role of the family physician in the diagnosis and treatment of allergic diseases in children in the light of current guidelines. Part 1 — food allergy, atopic dermatitis

Choroby alergiczne są obecnie uznawane za najczęstsze choroby przewlekłe XXI wieku. Według najnowszego badania ECAP (Epidemiologia Chorób Alergicznych w Polsce 2006–2008) prawie 49% populacji dziecięcej ma objawy chorób alergicznych. Do najczęstszych i najważniejszych chorób alergicznych u dzieci zalicza si ę: alergiczny nieżyt nosa i alergiczne zapalenie spojówek, astmę, atopowe zapalenie skóry oraz alergię pokarmową. Rozpoznanie i nadzorowanie długotrwałego leczenia chorób alergicznych w głównej mierze powinno być prowadzone przez lekarza rodzinnego będącego często pierwszym ogniwem w kontaktach dziecka ze służbą zdrowia. Wczesne rozpoznanie, wdrożenie odpowiedniego leczenia i realizowanie programów profilaktycznych pozwala zarazem zahamować rozwój choroby, jak i zmniejszyć koszty leczenia oraz poprawić jakość życia dziecka i jego rodzin. Lekarz rodzinny powinien dobrze znać aktualne możliwości diagnostyczne, profilaktyczne, jak i lecznicze chorób alergicznych w warunkach swojej praktyki. Oprócz stałego poszerzania wiedzy niekwestionowaną rolę w skutecznym długoletnim postępowaniu z takim chorym odgrywa także prawidłowa współpraca lekarza rodzinnego z alergologiem, laryngologiem, dermatologiem czy gastroenterologiem.Allergies are now considered the most common chronic diseases of the twenty-first century. According to a recent study (ECAP 2006–2008) almost 49% of child population show symptoms of allergic diseases. The most frequent and the most important children’s allergies include: allergic rhinitis and allergic conjunctivitis, asthma, atopic dermatitis, and food hypersensitivity. Diagnosis and management of long-term treatment of allergic diseases should generally be in the hands of a family doctor, who is frequently the first person in the child’s contact with health care. Prompt diagnosis, implementation of appropriate treatment and adhering to prevention programs allows for both checking the progression of the disease, reducing treatment cost, and improving the patient’s a nd their family’s quality of life. A family doctor should be well familiar with current diagnostic, prophylactic, and therapeutic capabilities of their practice as regards allergic diseases. Apart from constantly updating their knowledge, one cannot overestimate the role of a dequate cooperation of a family doctor with an allergologist, laryngologist, dermatologist, or gastroenterologist in efficient long-term management of such patients

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe.  The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough. This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments. The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax. This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient

Relationships between body weight and percentage body fat in the body and the development of osteopenia and osteoporosis

Obesity nowadays is a significant problem in developing countries and developed ones. Both the percentage of adipose tissue in the body and the proportion of muscle tissue affect the condition of the skeletal system. The common origin of adipose tissue and muscle tissue shows that overweight and obesity are not indifferent to the metabolism of bone tissue. Both malnutrition and obesity can lead to unfavorable health effects, contributing to the development of bone disorders and the occurrence of osteopenia, osteopenia with sarcoidosis, osteoporosis or osteoarthritis. Increased percentage of adipose tissue and/or muscle tissue during menopause may have an osteoprotective effect and thus prevent or relieve the effects of menopause in women or andropause in men. Research aimed at measuring the content of adipose tissue as a supplement to other diagnostic tests may contribute to the early detection and even prevention of osteoporosis. Key words: BMI, obesity, osteoporosis, osteopeni