2020, Vol 16, No 2
Current recommendations for the treatment of rhinosinusitis. Role of cefuroxime axetil
Pediatr Med Rodz 2020, 16 (2), p. 143–147
DOI: 10.15557/PiMR.2020.0027

Rhinosinusitis is among the most prevalent respiratory infections occurring both in children and adults. The disease characteristically presents with nasal obstruction and discharge, pain or pressure and tenderness in the face, decreased sense of smell, and coughing. Based on the duration of symptoms, the type of nasal secretion, and the natural course of the disease, it can be classified into three types: acute viral rhinosinusitis, acute post-viral rhinosinusitis, and bacterial rhinosinusitis. Recommended non-pharmacological interventions in affected patients include maintaining adequate hydration and ensuring access to fresh moist air. Patients can also benefit from symptomatic therapy with antipyretics, anti-inflammatory agents, analgesics, mucosal decongestants and anti-secretion agents. Antibiotic treatment is indicated only for acute bacterial rhinosinusitis. In Poland, the first-line antibiotic therapy is based on high doses of amoxicillin. Second-line antibiotics include cefuroxime axetil, amoxicillin with clavulanic acid, and anti-pneumococcal fluoroquinolones. The treatment should last 10 days. Cefuroxime axetil is an effective and safe antibiotic in the treatment of patients with rhinosinusitis. The drug is used primarily when first-line therapy proves unsuccessful, and always in cases of non-immediate hypersensitivity reactions to penicillins. The development of symptoms indicative of sinusogenic, orbital or intracranial complications requires the initiation of systemic treatment in the hospital setting.

Keywords: rhinosinusitis, treatment, antibiotic, cefuroxime axetil
Rational antibiotic therapy of respiratory tract infections in a primary care setting
Pediatr Med Rodz 2020, 16 (2), p. 148–153
DOI: 10.15557/PiMR.2020.0028

Respiratory infections are one of the main reasons for visits to general practitioners. The ability to make quick decisions on whether to include antimicrobial treatment in these infections is of key importance. If antibiotic therapy is used, then the choice of appropriate antimicrobial, dose and treatment duration is important. Expert recommendations developed as part of the National Program for Protection of Antibiotics provide guidance for primary care practitioners. The aim of this paper was to discuss the treatment of choice and the management in the case of first-line treatment failure in different communityacquired respiratory tract infections in children and adults. Since a large proportion of these infections are caused by viruses, we remind scores and guidelines developed to facilitate the diagnosis of these cases. If antibiotic therapy is needed, its choice should be based on the current epidemiological situation. Streptococcus pneumoniae is still the most common cause of respiratory tract infections. Therefore, despite pneumococcal resistance to penicillin derivatives, amoxicillin will be an optimal option to fight these pathogens if used at appropriately high doses. Amoxicillin-clavulanate or cephalosporins are generally used as second-line treatment, while macrolides are recommended in the case of immediate hypersensitivity to beta-lactams or suspected atypical aetiology of infection.

Keywords: amoxicillin, antibiotics, respiratory tract infection
Diagnosis and management of neurogenic lower urinary tract dysfunction
Pediatr Med Rodz 2020, 16 (2), p. 154–158
DOI: 10.15557/PiMR.2020.0029

Neurogenic lower urinary tract dysfunctions are a common cause of urination disorders, such as difficulty voiding, incontinence, and overactive bladder. Spinal injury, cerebrovascular accidents, multiple sclerosis, and dementias are the most common causes of neurogenic lower urinary tract dysfunction. The clinical picture may vary significantly in different types of neurogenic lower urinary tract dysfunction. The essence of this disease consists in detrusor and urethral sphincter muscle dysfunction in the form of either overactivity or underactivity. The diagnosis should involve precise neurological assessment, which is often of key importance for determining the aetiology. Urodynamic testing allows for an objective evaluation of lower urinary tract function. It is currently believed that upper and lower urinary tract protection and improving the quality of life of patients should be the primary treatment goals. Conservative treatment is mainly based on antimuscarinics (cholinolytics), which reduce the resting tension and the frequency of uncontrolled muscle contractions, thus limiting bladder overactivity. Minimally-invasive treatment methods for overactive bladder include botulinum toxin injections into the bladder detrusor muscle and intravesical infusion of cholinolytics. Intermittent catheterisation is considered the gold standard of care for voiding dysfunction. Some patients require surgical management – cystoplasty or urinary diversion. Since neurogenic bladder poses diagnostic and therapeutic difficulties, cooperation between general practitioners, urologists, and neurologists is crucial.

Keywords: neurogenic lower urinary tract dysfunctions, neurogenic bladder, urinary incontinence, voiding disorders
Bariatric surgery
Pediatr Med Rodz 2020, 16 (2), p. 159–164
DOI: 10.15557/PiMR.2020.0030

Obesity, which is becoming a lifestyle disease, is a significant social problem due to its growing frequency and its complications, primarily cardiovascular diseases. The recommended conservative treatment of obesity, consisting in the use of a weight reduction diet and physical activity, is often not effective or the effect of these actions does not last long. Bariatric surgery is an emerging field of surgery that can be used to treat obesity in a selected group of patients. Different operative methods of bariatric procedures are available. They allow one to achieve a significant weight loss. However, their application requires proper preparation of the patient before surgery and changes in eating habits and often chronic use of dietary supplements after surgery. This method of treatment should be considered in patients in whom conservative treatment has not produced the desired effect. Bariatric treatments are aimed not only at achieving weight loss, but also at improving the course of diseases often coexisting with obesity, such as type 2 diabetes or hypertension.

Keywords: obesity, type 2 diabetes, bariatric operations, diet
Laser therapy in paediatric surgery
Pediatr Med Rodz 2020, 16 (2), p. 165–170
DOI: 10.15557/PiMR.2020.0031

Advances in laser techniques used in medicine significantly expanded the pool of procedures as well as increased the frequency and ease of their use. Paediatric surgery is one of the branches of medicine open to use the dynamically developing laser technologies. Based on the current literature and our own experiences, we present a cross-sectional review of modern applications of laser therapy in the paediatric population. Laser therapy is often used complementary to other treatment methods and, in many cases, it becomes the main treatment approach in a variety of conditions. It is an indispensable element in the management of many diseases, both those health- and life-threatening as well as those responsible for cosmetic defects directly contributing to reduced quality of life of patients. This allows for a very short recovery time, with a low risk of adverse effects. The method is gaining popularity and is continuously improved. It is used, among other things, in the management of congenital and acquired vascular lesions, pilonidal sinuses, and scars. Undoubtedly, the future use of laser therapy in paediatric surgery will definitely expand to include further disease entities. A brief overview of therapeutic options for conditions in which laser therapy has become the leading therapeutic strategy can help general practitioners and paediatricians choose the optimal treatment strategy for their patients. Raising the awareness of general practitioners of indications for laser therapy may bring significant benefits for paediatric patients. Laser is becoming an increasingly available tool, which, considering the efficacy of laser therapy and a large number of indications, encourages referring patients to specialists performing such procedures.

Keywords: laser therapy, paediatric surgery, vascular malformations, scars, pilonidal sinus
Double face of stem cells in paediatrics: therapeutic applications of mesenchymal stem cells and threats from cancer stem cells
Pediatr Med Rodz 2020, 16 (2), p. 171–174
DOI: 10.15557/PiMR.2020.0032

Decades of research have shown that many, if not all, fully developed and differentiated organs and tissues contain a subpopulation of undifferentiated stem cells or progenitors of stem cells, which under natural or experimental conditions can self-renew and differentiate into specialised cells. These findings have opened countless possibilities of novel therapeutic applications for the treatment of adult and child diseases. The main sources of stem cells used in paediatric therapies are umbilical cord and umbilical cord blood, amniotic fluid, placenta, bone marrow, adipose tissue, urine, and induced pluripotent stem cells derived from the patient’s cells. Here, we describe some of the paediatrically applicable stem cell therapies. We focus our attention on the therapeutic applications of mesenchymal stem cells in paediatric diseases. An important but negative effect of stem cell therapies is the risk of oncogenic potential of therapeutically applied stem cells. Under certain circumstances, these stem cells can lead to tumour development. In addition, the majority of adult and paediatric tumours contain a subpopulation of cancer stem cells which are privileged therapeutic targets for numerous paediatric cancers. In this article, we review these two opposite properties (“double face”) of stem cells in general and paediatric medicine.

Keywords: mesenchymal stem cells (MSCs), cancer stem cells (CSCs), stem cells therapies, glioma stem cells (GSCs), leukaemia stem cells (LSCs)
The utility of ultrasound in juvenile idiopathic arthritis
Pediatr Med Rodz 2020, 16 (2), p. 175–180
DOI: 10.15557/PiMR.2020.0033

Juvenile idiopathic arthritis is a heterogeneous group of idiopathic inflammatory arthropathies affecting children younger than 16 years of age and persisting for six weeks or longer. Introduction of novel biological medications has dramatically changed the prognosis of juvenile idiopathic arthritis. Their ability to inhibit the main mechanisms responsible for persistent inflammation prevents joint damage and chronic joint dysfunction. Achieving this is only possible with a prompt diagnosis and treatment. Ultrasonography is one of the main imaging methods used in the diagnosis of juvenile idiopathic arthritis. In this article, we review the latest literature on ultrasound imaging in juvenile idiopathic arthritis. Musculoskeletal ultrasound is a constantly developing imaging technique and becomes an even more useful adjunct in clinical practice. For juvenile idiopathic arthritis, it enables evaluation of a number of peripheral joints and identification of features of active arthritis, such as synovitis, tenosynovitis, enthesitis, and destructive lesions, such as erosions, subchondral and subcortical cysts, and cartilage loss. Musculoskeletal ultrasound is used for the early diagnosis, treatment monitoring and identification of disease remission or its complications. Contrary to other imaging methods, it is widely available and safe (no exposure to radiation). It does not require the patient to be motionless, and can be performed in a dynamic way, providing additional information on e.g. tendon sliding. Furthermore, a number of procedures can be performed under ultrasound guidance.

Keywords: juvenile idiopathic arthritis, ultrasound, juvenile spondyloarthropathy, musculoskeletal system
Serum zinc levels in children with recurrent infections and atopic diseases
Pediatr Med Rodz 2020, 16 (2), p. 181–185
DOI: 10.15557/PiMR.2020.0034

Zinc is a trace element necessary in many processes of cell metabolism and the catalytic activity of over 100 enzymes in humans. It plays a role in the immune system, protein synthesis, wound healing, DNA synthesis and cell division. Its immunomodulatory and anti-inflammatory effects have been evaluated in many studies. Zinc deficiency inhibits both innate and specific immunity, interferes with phagocytosis, intracellular killing and cytokine production by macrophages. Even minor zinc deficiencies can impair macrophage and neutrophil function. As one of the most important micronutrients included in many enzymes, zinc has an impact on the synthesis of proteins, hormones and red blood cells as well as proper functioning of the skin and mucous membranes. Zinc deficiency is a risk factor for developing asthma. Recent studies have shown that zinc supplementation can effectively suppress chronic inflammation and that zinc therapy effectively inhibits anaphylaxis. The aim of the study was to assess serum zinc levels in children hospitalised due to recurrent upper and lower respiratory tract infections and atopic diseases. The study showed lower zinc levels in 30% of children. This deficiency was greater in children with recurrent infections compared to children with atopic diseases. It was observed that the higher the specific IgE levels, the higher the serum zinc level in children. Our results suggest that hospitalised children are characterised by lower zinc levels, which may indicate its participation in the regulation of immune responses in patients with immune disorders.

Keywords: zinc, children, infections, atopy
Sensitivity of acid-fast bacilli smear, erythrocyte sedimentation rate, and Mantoux test in diagnosing tuberculous cervical lymphadenopathy
Pediatr Med Rodz 2020, 16 (2), p. 186–189
DOI: 10.15557/PiMR.2020.0035

Objective: To evaluate the sensitivity of acid-fast bacilli smear, erythrocyte sedimentation rate and Mantoux test in diagnosing tuberculous lymphadenitis in comparison to the gold standard confirmatory histology examination using fine needle aspiration cytology. Materials and methods: Retrospective study conducted in a tertiary hospital between 2001 and 2016, involving patients confirmed as tuberculous lymphadenitis diagnosed via fine needle aspiration cytology. Results of Mantoux test, erythrocyte sedimentation rate and acid-fast bacilli in each of the patients were collected and data were analysed using IBM SPSS version 22.0. Results: Mantoux test had the highest sensitivity (77.37%) in diagnosing tuberculous lymphadenitis. On the other hand, erythrocyte sedimentation rate had the lowest sensitivity (32.31%). Acid-fast bacilli smear also showed to be a poor prognostic test (51.32%) for tuberculous as it was only able to differentiate around half of the positive cases. Conclusion: Mantoux test has the highest sensitivity followed by acid-fast bacilli smear and erythrocyte sedimentation rate

Keywords: extrapulmonary tuberculosis, cervical lymphadenitis, fine needle aspiration, erythrocyte sedimentation rate
Parental education and better sleep in infants: a systematic review
PEDIATR MED RODZ Vol. 16 No. 2, p. 190–197
DOI: 10.15557/PiMR.2020.0036

The first year of the child’s life can be overwhelming. One of the major problems faced by parents relates to the infant’s crying and sleeping habits, potentially leading to exhaustion, with implications for their health. Information is crucial, so our aim was to assess the relevance and impact of parental education on children’s sleep problems in the first year of life. To this end, we conducted a systematic review, using as keywords references to “parental education,” “parenting,” “sleep hygiene,” “infant,” and “newborn,” looking for original articles published over the past 10 years in English and Portuguese. We found nine original articles. Results suggest that preventive intervention improves infants’ sleep quality. Parental education programmes included infant sleep patterns, parental behaviour, and strategies facilitating self-soothing. Placing down the infant while still awake, and minimising parental responsiveness by active extinction and graduated extinction techniques, were shown to be the most successful strategies. Cognitive-behavioural interventions proved to improve both parents’ and infants’ symptoms. Incorporating formal parental education into children’s sleeping pattern and parents’ behaviours in children’s health routines in regular medical practice is a cost-effective strategy for increasing the empowerment of families to deal with the problem.

Keywords: parental education, infant sleep, depression, fatigue, first year of life
Paediatric extrasystole in numbers – single-centre arrhythmic experience
Pediatr Med Rodz 2020, 16 (2), p. 198–203
DOI: 10.15557/PiMR.2020.0037

Aim: Supraventricular and ventricular extrasystole are the most common form of arrhythmia in paediatric cardiology, but still they may be confusing for paediatricians and family doctors. The aim of the study was to assess the scale of the problem based on the data from a single-centre department of paediatric cardiology. Materials and methods: This single-centre retrospective study analysed medical documentation of a total of 90 children hospitalised in the Department of Paediatric Cardiology due to suspected or diagnosed extrasystole from January 1st to December 31st 2019. Results: The study group of 90 children aged between 3 days and 17.8 years (57% male, mean age 11.1 ± 5.7 years) accounted for 4% of all hospitalisations. This was a new diagnosis in 35 (39%) patients, and 17 (19%) cases were referred as an emergency. Clinical symptoms were observed in 26 (29%) children. Extrasystole were registered in 74 patients (82%) using 24-hour Holter electrocardiographic monitoring. Premature ventricular extrasystole was the most common form of arrhythmia. Complex arrhythmias were registered in 18 (24%) patients. In 3 patients, arrhythmic burden exceeded 20%. Echocardiography showed no abnormalities in 67 (74%) children. A total of 11 children had a history of surgery due to congenital heart defects. In none of patients arrhythmia increased on exertion during treadmill test. A life-threatening cause of arrhythmia was detected in only 2 cases. A total of 18 patients required antiarrhythmic therapy. Conclusions: Supraventricular and ventricular extrasystoles are a common, but rarely life-threatening condition in children. It is important to establish the diagnosis and identify high-risk patients requiring treatment or close follow-up.

Keywords: extrasystole, supraventricular arrhythmia, ventricular arrhythmia, children
Complications of urinary tract trauma: case reports
Pediatr Med Rodz 2019, 16 (2), p. 204–209
DOI: 10.15557/PiMR.2020.0038

Trauma is the most common cause of death among children and adolescents. It is estimated that every year trauma accounts for approximately 830,000 children’s deaths worldwide. Urinary tract trauma is relatively rare: it accounts for approximately 3% of all hospitalisations at trauma centres. It usually occurs as a result of high-energy blunt force trauma to the abdomen and pelvis and most commonly coexists with other internal organ injuries. Abdominal trauma causes damage to the upper levels of the urinary tract: the kidneys and ureters. It may be complicated by haemodynamic disturbances, development of urinoma or kidney loss. Pelvic injuries often coexist with damage to the lower level of the urinary tract and lead to intramural complications of the urinary bladder, urethral stenosis, urinary incontinence or erectile dysfunction. In addition, trauma to any level of the urinary tract can result in urinary tract infection, lesser pelvis tissue inflammation, peritonitis or septic shock. Late complications include urolithiasis, vesicoureteral reflux, hydronephrosis and, consequently, renal failure. From the urinary tract perspective, important consequences of spinal injury also include neurogenic bladder and the associated lower urinary tract dysfunction. The article discusses clinical cases of children presenting with early and late complications of urinary tract injury as a result of multiple high-energy trauma.

Keywords: trauma, urinary tract infection, children, kidney trauma, urinary bladder trauma
Primary ciliary dyskinesia. From symptoms to diagnosis. A case report of a 4.5-year-old girl
Pediatr Med Rodz 2020, 16 (2), p. 210–216
DOI: 10.15557/PiMR.2020.0039

Primary ciliary dyskinesia is a rare genetic disease. Early diagnosis is aimed at delaying pulmonary complications, such as bronchiectasis, reducing lung dysfunction and hearing impairment, as well as providing optimal treatment of rhinitis and sinusitis. The awareness of the disease is still poor, and primary ciliary dyskinesia is often underdiagnosed or confused with other diseases, such as asthma. Chronic productive cough and rhinitis, which are the main symptoms, develop already in infancy. Therefore, differential diagnosis is a key element of the diagnostic and therapeutic process. The area of search depends on patient’s age, the nature of symptoms (type of cough, time of symptom onset, repeatability of symptoms), concomitant symptoms and family history. We present a case report of a 4.5-year-old girl with recurrent lower respiratory tract infections and chronic cough, monitored for asthma and unsuccessfully treated with antiasthmatics.

Keywords: primary ciliary dyskinesia (PCD), diagnosis, chronic cough
Unilateral vocal cord palsy: a never-ending diagnostic dilemma
Pediatr Med Rodz 2020, 16 (2), p. 217–220
DOI: 10.15557/PiMR.2020.0040

Aim of the study: We would like to highlight the diagnostic challenges and the management of idiopathic unilateral vocal cord paresis in a young girl. Hoarseness is a common presentation to the otorhinolaryngology department. Nevertheless, this entity keeps many physicians in a quandary, especially when it is secondary to vocal cord paresis without history of head and neck surgery, given the intricate anatomy of the vagus nerve. Case study: Herein, we are reporting a case of possible idiopathic unilateral vocal cord paresis in a young girl who presented with one-week history of hoarseness and cough. The patient had a prior surgery for the repair of transposition of the great arteries done in infancy. Flexible endoscopy revealed unilateral vocal cord immobility. Computed tomography revealed no new finding causing vocal cord paresis. The patient was referred to a tertiary centre for injection laryngoplasty. Conclusion: Unilateral vocal cord paresis may be caused by a myriad of aetiologies, which adds to the complexity of diagnosing and treating this entity. We would like to highlight various possibilities for the management of this condition.

Keywords: unilateral vocal cord paresis, hoarseness, dysphonia
Traumatic dental extraction with severe complications
Pediatr Med Rodz 2020, 16 (2), p. 221–223
DOI: 10.15557/PiMR.2020.0041

Parapharyngeal abscess is a serious life-threatening complication of dental infection which warrants immediate surgical intervention and management. Dental infections leading to parapharyngeal abscess are not uncommon. Herein, we are reporting the case of an elderly man who presented with left cheek swelling post dental extraction which led to an extensive parapharyngeal abscess with airway obstruction. The patient required incision and drainage twice, and the complication subsequently resolved with dressing and intravenous antibiotics. Despite being a common procedure, dental extraction ought to be performed with care due to its potentially devastating complications, as in our case.

Keywords: dental extraction, dental abscess, parapharyngeal abscess
Calcified triticeal cartilage: a red herring
Pediatr Med Rodz 2020, 16 (2), p. 224–226
DOI: 10.15557/PiMR.2020.0042

Aim: To illustrate the importance of awareness of calcified triticeal cartilage which may mimic a foreign body. Unintentional foreign body ingestion, albeit common, still remains a quandary to many physicians, particularly otorhinolaryngologists. Case study: Herein, we are reporting the case of a middle-aged female who presented to us post ingestion of a duck bone. The patient had no obstructive symptoms. A lateral soft tissue neck radiograph revealed an opaque foreign body at the level of the fourth and fifth cervical vertebrae, which was removed under general anaesthesia. Repeated lateral neck radiography revealed a foreign body which turned out to be calcified triticeal cartilage. Conclusion: Familiarity with the problem of calcified laryngeal cartilage is imperative amongst clinicians so as to prevent misdiagnosis which may even jeopardize the patient’s life.

Keywords: calcification, laryngeal cartilage, foreign body ingestion
Porencephaly as a rare cause of nystagmus
Pediatr Med Rodz 2020, 16 (2), p. 227–229
DOI: 10.15557/PiMR.2020.0043

Nystagmus is a condition of involuntary oscillatory movement of the eyes that may present in various patterns. These different types of movement and direction of nystagmus along with associated signs and symptoms can give a clue as to the location of the site of lesion, and indicate possible aetiologies. In paediatric patients, most of the causes of nystagmus are infantile or congenital, and only a small percentage may be acquired. We describe the case of a boy with spontaneous nystagmus noted since he was 3 years old and having a learning disability without other otological or neurological problems. Magnetic resonance imaging of his brain showed a porencephalic cyst which is a very rare occurrence.

Keywords: nystagmus, porencephalic cyst, spontaneous nystagmus, learning disability