Acute rotavirus diarrhea in pediatric patients

Rotavirus is the most common cause of gastroenteritis. He is responsible for non-hospital and hospital gastrointestinal infections. It is a major epidemiological threat especially in the pediatric population. Acute diarrhea and dehydration cause 2 million hospitalizations and cause deaths of around 440,000 children annually. Rotavirus is also one of the most common aetiological factors of nosocomial infections in pediatric wards. The incidence of hospital RV infections ranges from 2.5 to 7.9 per 1000 days of hospitalization. It extends the stay from 1.7 to 7 days depending on the country [1,2,3,4]. Between 13 and 80% of children with RV infection require infusion therapy [1,2,5]. One of the most effective ways to reduce the incidence of RV infection is to immunize the body. There is evidence of the effectiveness of vaccination programs in both industrialized and developing countries [6

Clostridium difficile infection a public health problem

Clostridium difficile is a Gram-positive rod that produces spores that are commonly found in animals, humans and the environment. Asymptomatic carriage of Clostridium difficile occurs in 3 15% of healthy adult population and increases up to 20-30% in hospitalized patients [1,2]. The number of nosocomial and non-hospital infections caused by the Clostridium difficile is increasing. The number of relapses is also increasing. In older patients with multi-organism, the serious course of the disease is more and more often observed. Multi-organism and the associated necessity to apply therapeutic activities disturb the homeostasis of the intestinal microbiome. Important factors disturbing the balance, favoring the occurrence of diarrhea symptoms and Clostridium difficile infection are: pharmacotherapy (mainly antibiotics, steroids, proton pump inhibitors) and past inflammations and procedures of the gastrointestinal tract. Fast identification of a pathogen in a stool sample taken from a patient with diarrhea is of therapeutic and, above all, epidemiological significance. Awareness of the existing threat, the use of effective prevention and isolation of infected patients and effective decontamination of the hospital environment gives hope for reducing the incidence of CDI

Probiotic as a bioactive ingredient in functional foods

Consuming fermented milk drinks dates back to ancient times. Probiotics are one of the bioactive components that decide to give the food product the title of functional food. The viability of probiotic bacteria throughout the product's lifecycle depends on the pH, storage temperature and quality of the constituents of the basic product. Therefore, strains that are a functional component added to foods must additionally meet technological requirements. The first products in the form of fermented beverages containing the Lactobacillus acidophilus intestinal strain were produced by the industry in the second and third decade of the 20th century. Food products are a more effective carrier of probiotic bacteria than pharmaceutical preparations. Often the name "probiotic product" does not mean a cause and effect relationship between a food product and the human body, but only testifies to the presence of a probiotic in its composition and mainly serves marketing purposes

Association between asthma control test, pulmonary function tests and non-specific bronchial hyperresponsiveness in assessing the level of asthma control

Introduction: Global Initiative for Asthma (GINA) reports emphasize the use of validated and simple tools in order to assess the level of asthma control, as the Asthma Control Test (ACT). However, an ACT does not include assessment of airway inflammation, which is better reflected when measuring nonspecific bronchial hyperresponsiveness (BHR). The authors aimed to find out if the level of asthma control quantified by an ACT correlates with BHR and pulmonary function tests. Material and methods: 118 asthmatics participated in the study. All patients completed an ACT. The scores of the ACTs were compared with pulmonary function tests and BHR assessed with the methacholine challenge test and expressed as a provocative concentration of methacholine, inducing a 20% decline in the FEV1 (PC20 M in mg/ml). Results: Patients with controlled asthma amounted to 52 (44%) while those with uncontrolled asthma amounted to 66 (56%). In patients with controlled asthma (ACT score ≥ 20) the mean geometric value of PC20M was 2.72 mg/ml (range from 0.25 to > 8.0), whereas 0.94 mg/ml (range from 0.28 to 8.0) (p = 0.02) was observed in patients with uncontrolled asthma (ACT score < 20). Almost 64% (21/33) of uncontrolled asthmatics achieved normal lung function (FEV1 > 80% pred. value) while 19% (5/26) patients with controlled asthma presented an FEV1 < 80% predicted value. Asthma duration in years in controlled asthmatics was significantly shorter than in uncontrolled patients (6.2 ± 8.9 vs. 12.0 ± 11.4, p = 0.005) Conclusion: In determining the most accurate level of asthma control it is reasonable to use an ACT in conjunction  with BHR, which provides more accurate assessment of bronchial inflammation than ventilatory parameters alone

Ostra duszność krtaniowa jako pierwszy objaw ziarniniakowatości z zapaleniem naczyń

Granulomatosis with polyangiitis (GPA) is a multi-organ disease which mostly affects lungs, kidney, and head and neck region. We report a rare case of acute laryngeal dyspnea and rapidly progressive pulmonary changes as first manifestations of disease. A 53 year-old woman presented with symptoms of two-week dyspnea, which aggravated rapidly in the preceding hours. Laryngological examination revealed subglottic infiltrations and vocal fold oedema which required urgent tracheotomy. During few days she developed gingival ulcerations and pulmonary infiltration with negative serum c-ANCA titers. The histopathological examination of subglottic and gingival biopsies and the clinical picture established the diagnosis of GPA. She was treated with prednisone and cyclophosphamide with recovery; however, during over 3 years of follow-up, pulmonary symptoms relapsed and subglottic stenosis persisted. The difficulties in diagnosis and treatment in this unusual presentation of GPA are outlined with conclusion that in patients with subglottic infiltration, which develops rapidly, even when this is a sole presentation of the disease, and when c-ANCA are negative, GPA should always be considered.Ziarniniakowatość z zapaleniem naczyń (GPA) jest wielonarządową chorobą, która najczęściej dotyczy płuc, nerek oraz regionu głowy i szyi. Autorzy przedstawiają rzadki przypadek ostrej duszności krtaniowej jako pierwszego objawu choroby. Kobieta lat 53 zgłosiła się z powodu trwającej od 2 tygodni duszności, która nasiliła się znacznie na kilka godzin przed przyjęciem. W badaniu laryngologicznym stwierdzono naciek okolicy podgłośniowej i obrzęk fałdów głosowych, wymagające pilnej tracheotomii. W kolejnych dniach u chorej wystąpiły owrzodzenia dziąseł i nacieki w płucach, przy braku obecności przeciwciał c-ANCA. Na podstawie badania histopatologicznego wycinków z okolicy podgłośniowej i dziąseł oraz obrazu klinicznego ustalono rozpoznanie GPA. W leczeniu zastosowano prednison z cyklofosfamidem i uzyskano poprawę, w okresie ponad 3-letniej obserwacji wystąpił jednak nawrót objawów płucnych, utrzymywało się zwężenie podgłośniowe. W pracy zwrócono uwagę na trudności w postępowaniu diagnostyczno-terapeutycznym podkreślając rolę podgłośniowego obrzęku krtani jako jedynej początkowo manifestacji GPA, nawet przy braku obecności przeciwciał c-ANCA

Asymmetric dimethylarginine versus proton pump inhibitors usage in patients with stable coronary artery disease : a cross-sectional study

A recent experimental study suggested that proton pump inhibitors (PPI), widely used to prevent gastroduodenal complications of dual antiplatelet therapy, may increase the accumulation of the endogenous nitric oxide synthesis antagonist asymmetric dimethylarginine (ADMA), an adverse outcome predictor. Our aim was to assess the effect of PPI usage on circulating ADMA in coronary artery disease (CAD). Plasma ADMA levels were compared according to PPI use for ≥1 month prior to admission in 128 previously described non-diabetic men with stable CAD who were free of heart failure or other coexistent diseases. Patients on PPI tended to be older and with insignificantly lower estimated glomerular filtration rate (GFR). PPI use was not associated with any effect on plasma ADMA (0.51 ± 0.11 (SD) vs. 0.50 ± 0.10 µmol/L for those with PPI (n = 53) and without PPI (n = 75), respectively; p = 0.7). Additionally, plasma ADMA did not differ between PPI users and non-users stratified by a history of current smoking, CAD severity or extent. The adjustment for patients’ age and GFR did not substantially change the results. Thus, PPI usage does not appear to affect circulating ADMA in non-diabetic men with stable CAD. Whether novel mechanisms of adverse PPI effects on the vasculature can be translated into clinical conditions, requires further studies

Depressed systemic arterial compliance is associated with the severity of heart failure symptoms in moderate-to-severe aortic stenosis : a cross-sectional retrospective study

Background: Patients with aortic stenosis (AS) may develop heart failure even in the absence of severe valve stenosis. Our aim was to assess the contribution of systemic arterial properties and the global left ventricular afterload to graded heart failure symptoms in AS. Methods: We retrospectively reviewed medical records of 157 consecutive subjects (mean age, 71±10 years; 79 women and 78 men) hospitalized owing to moderate-to-severe degenerative AS. Exclusion criteria included more than mild aortic insufficiency or disease of another valve, atrial fibrillation, coronary artery disease, severe respiratory disease or anemia. Heart failure symptoms were graded by NYHA class at admission. Systemic arterial compliance (SAC) and valvulo-arterial impedance (Zva) were derived from routine echocardiography and blood pressure. Results: Sixty-one patients were asymptomatic, 49 presented mild (NYHA II) and 47 moderate-to-severe (NYHA III-IV) heart failure symptoms. Mild symptoms were associated with lower SAC and transvalvular gradients, while more severe exercise intolerance coincided with older age, lower systolic blood pressure, smaller aortic valve area and depressed ejection fraction. By multiple ordinal logistic regression, the severity of heart failure symptoms was related to older age, depressed ejection fraction and lower SAC. Each decrease in SAC by 0.1 ml/m² per mmHg was associated with an increased adjusted odds ratio (OR) of a patient being in one higher category of heart failure symptoms graded as no symptoms, mild exercise intolerance and advanced exercise intolerance (OR: 1.16 [95% CI, 1.01-1.35], P=0.045). Conclusions: Depressed SAC may enhance exercise intolerance irrespective of stenosis severity or left ventricular systolic function in moderate-to-severe AS. This finding supports the importance of non-valvular factors for symptomatic status in AS

Pheochromocytoma in 8-year observation at a single endocrinological center in Wroclaw

Wstęp: Guz chromochłonny występuje rzadko, powoduje zwykle nadciśnienie tętnicze i różnorodne, zmienne objawy kliniczne, co często utrudnia wczesne rozpoznanie i leczenie. Celem niniejszej pracy było przedstawienie danych klinicznych, efektywności diagnostyki i leczenia chorych z pheochromocytoma w ośrodku wrocławskim w okresie 8 lat. Materiał i metody: Wśród 37 chorych z pheochromocytoma leczonych w latach 2000-2007 w Klinice Endokrynologii, Diabetologii i Leczenia Izotopami Akademii Medycznej we Wrocławiu były 23 kobiety (23-75 lat) oraz 14 mężczyzn (17-74 lat). Zbadano częstość występowania poszczególnych objawów klinicznych, przydatność zastosowanych metod diagnostycznych i efekty leczenia. Wyniki: Czas trwania choroby do momentu rozpoznania wynosił od 2 miesięcy do 16 lat. Najczęstsze objawy to: nadciśnienie tętnicze napadowe lub stałe, tachykardia, bóle głowy, wzmożona potliwość, niepokój. Najczulszą laboratoryjną metodą diagnostyczną był pomiar stężenia metoksypochodnych katecholamin w moczu dobowym. Tomografia komputerowa u wszystkich chorych wykazała obecność guza nadnercza, częściej prawego; w 1 przypadku guz był umiejscowiony w ścianie pęcherza moczowego. Po operacji nadciśnienie tętnicze ustąpiło u 59% pacjentów, obniżyło się u 26,8%, a u 13,9% nie obserwowano poprawy. U 2 chorych guz był złośliwy, 1 kobieta zmarła po zabiegu. U 8 stwierdzono zespół MEN 2A. Wnioski: Rozpoznania pheochromocytoma zwykle dokonuje się po długim czasie trwania choroby. Najbardziej typowym objawem jest nadciśnienie tętnicze napadowe, które występuje jedynie u około 40%, inne objawy są niespecyficzne. Najbardziej przydatne diagnostycznie jest stwierdzenie podwyższonego wydalania metoksykatecholamin w moczu dobowym. Z badań obrazowych najbardziej efektywna jest tomografia komputerowa. Chorzy z pheochromocytoma powinni być rutynowo diagnozowani w kierunku współistnienia innych endokrynopatii, a szczególnie raka rdzeniastego i pierwotnej nadczynności przytarczyc - składowych zespołu MEN 2A.Introduction: Pheochromocytoma is rare tumor with a highly variable clinical presentation. This report provides clinical picture, efficiency of diagnostics and treatment of pheochromocytoma in 8-years in the endocrinological center in Wroclaw. Material and methods: The records of 37 patients with pheochromocytoma were identified, who were treated in 2000-2007 in the Department of Endocrinology, Diabetology and Isotope Treatment in Wroclaw. There were 23 women (age 23-75 year) and 14 men (age 17-74). We studied frequency of clinical signs, usefulness of diagnostic methods and efficacy of treatment. Results: The duration of the clinical history ranged from 2 months to 16 years. The most frequent symptoms were: hypertension paroxysmal and constant, palpitations, headache, sweating and anxiety. The most sensitive diagnostic method was increased concentration of urinary metanephrine in 24-hour urine. Computed tomography was the most widely used method for tumor localization. Adrenal pheochromocytoma was detecting by CT in all patients, predominated in right adrenal, in 1 case in urinary bladder. Surgery caused remission of hypertension in 59%, improvement in 26.8%, and no changes in 13.9% of patients. Malignancy was reported in 2 cases, 1 woman died after surgery. MEN 2A occur in 21.6%. Conclusions: The diagnosis of pheochromocytma is usually made after long duration of the disease. The study confirms that clinical presentation of pheochromocytoma is variable and nonspecific, this finding makes the diagnosis very difficult. The most typical symptom is paroxysmal hypertension, which is present only in 40%, other symptoms are nonspecific. The measurement of 24-hour urinary metanephrines was the best indicator. CT was almost always successful in localizing the tumor. Patients with pheochromocytoma should be consider for other endocrine diseases especially medullary carcinoma, primary hyperparathyroidism and other component of MEN 2A

The importance of nutrition in the course of celiac disease

Celiac disease is one of the most common autoimmune diseases.It is estimated that it is the cause of health disorders in about 1% of the general population.It is increasingly diagnosed in adults.New diseases affect about 60% of this group, of which 15-20% concern people>60 years of age.The pathogenesis of celiac disease is conditioned by many factors. Cereal proteins referred to collectively as gluten are an important factor that reveals the presence of celiac disease.Consumption of gluten causes an abnormal stimulation of the immune system in genetically predisposed people.Gluten-induced immune system causes the atrophy process to prevail over the regenerative processes in the small intestine. This disorder leads to atrophy of the intestinal villi. The only commonly accepted method of treating visceral disease is the elimination of gluten from food. Proper management of a lifelong disease is based on the continuous acquisition of knowledge and skills that improve the quality of life in all its spheres

Intestinal infections and probiotics

The creator of the concept of probiotic - increasing the amount of bacteria beneficial to the body - was Miecznikov. In Poland in 1899, Brudziński described for the first time the treatment with lactic acid-producing bacteria, which later became the "probiotic". Research on the influence of these bacteria on the organism has shown many health effects over the last 20 years, including: prevention and support of intestinal infections, immune stimulation, restoration of eosinophilia, and inhibition of carcinogenesis. The effectiveness of probiotics depends on the type of strains. The article presents the importance of probiotic strains in supporting the treatment of gastrointestinal diseases on the basis of the literature. The probiotic strains contained in medicinal preparations have efficacy in the treatment of infectious diarrhoea in children, intestinal functional disorders and intestinal resistance regulation. They can be used in inflammatory bowel diseases to achieve remission. Not all products containing certain probiotic strains reduce the risk of post-antibiotic diarrhoea. Probiotics are generally considered safe for the body but in certain health situations they may have a negative impact