Interleukin 6: Biological significance and role in inflammatory bowel diseases.

Cytokines affect a number of processes in the living body. Interleukin 6 (IL-6) is a cytokine involved in inflammation, infection response and also regulation of metabolism. It stimulates target cells through a membrane-bound IL-6 receptor. Inflammatory bowel diseases (IBD) are autoimmune diseases whose incidence and prevalence are increasing worldwide. It is a group of chronic gastrointestinal disorders characterized by multifactorial, still unknown pathogenesis, varied symptomatology, course with periods of exacerbation and remission, and polymorphic infiltration in histopathological examination. As it is known, pro-inflammatory cytokines, including IL-6, in IBD initiate, intensify and support the development of the inflammatory process in the intestine. Our knowledge of IL-6 biology has important consequences for therapeutic strategies. Elevation of IL-6 concentration can be considered as an early and sensitive, although non-specific marker for various inflammatory conditions and may be used in the diagnosis and monitoring of patients with IBD.

Interleukin 10 and interleukin 10 receptor in paediatric inflammatory bowel disease: from bench to bedside lesson.

BACKGROUND: The differences between adults and children in inflammatory bowel disease (IBD) phenotype, severity, complications, co-morbidities, and response to the therapy resulted in the extraction of paediatric IBD. It has been revealed that the substantial role in the development of IBD in children under 6 years of age plays a single genetic mutation (monogenic IBD). On the other hand, in older children and adolescents IBD is usually associated with number of interactions between susceptibility loci (polygenic IBD). MAIN BODY: Until now there have been described about 60 monogenic defects which affect the variety of immune mechanisms in IBD pathogenesis including epithelial barrier, function of neutrophil granulocytes and phagocytes, T- and B-cell selection and activation, immune inhibitory mechanisms, or apoptosis. Il-10 is an anti-inflammatory cytokine which modulates innate and adaptive immunity affecting expression of pro-inflammatory molecules and function of the variety of immune cells. Patients with identified defects in Il-10 pathway manifest with life-threating colitis with perianal lesions which occurs within first months of life. Allogenic hematopoietic stem cell transplantation is curative therapy in children with Il-10 signalling defects. CONCLUSION: Clinical awareness of Il-10 signalling defects enables early recognition and prompt management of the disease.

Acute Pancreatitis as a Complication of Antiepileptic Treatment: Case Series and Review of the Literature.

Acute pancreatitis (AP) appears to be rare disease in childhood. In children, it has a different aetiology and course, and requires different management than in adult patients. The diagnosis of AP is based on at least two of the three criteria, which include typical clinical symptoms, abnormalities in laboratory tests and/or imaging studies of the pancreas. There are many known causes leading to AP in children including infections, blunt abdominal trauma, genetic factors, gallstone disease, metabolic disorders, anatomical defects of the pancreas, systemic diseases, as well as drugs, including antiepileptic drugs, and especially preparations of valproic acid. In our study, we present four cases of young patients diagnosed with acute pancreatitis as a complication of valproic acid therapy and we present a review of the literature. We believe that the activity of pancreatic enzymes should be monitored in children treated with valproate preparations in the case of clinical symptoms suggesting AP.

Alcohol intoxication among adolescents and children in urban and rural environments - a retrospective analysis.

INTRODUCTION AND OBJECTIVE: Drinking alcohol by adolescents and children poses a risk of long-term psychological and sociological consequences, often leading to addiction in adulthood. A steady increase in the number of young people reaching for alcohol is worrying. The study analyzes the age and gender of the children, concentration of alcohol in the blood, depending on the origin of the youth (urban or rural). MATERIAL AND METHODS: The study was a retrospective analysis of 402 patients hospitalized due to alcohol intoxication in the Department of Paediatrics at Medical University in Lublin, Poland between 2004 - 2013. RESULTS: During the study period a continuous increase in admissions of patients after alcohol consumption was observed: from 27 children in 2004 to 53 in 2012 and 2013. The youngest patient hospitalized after drinking was 7.6 years old and came from the rural environment, the oldest 18 years old and came from the urban environment. In 2004 - 2007, boys dominated among children intoxicated with alcohol; since 2008, a slight prevalence of girls has been observed, especially in the urban environment. Among patients coming from the country, boys always predominated. In the study period there was noted a similar number of children consuming alcohol from rural and urban environments. CONCLUSIONS: The results suggest the need to introduce appropriate educational programmes in schools to prevent the consumption of alcohol at a young age.

Patterns of Poisoning in Urban and Rural Children: A Single-Center Study.

BACKGROUND: Poisoning among children is a current issue in pediatrics. The pattern and risk factors of poisoning are heterogeneous and vary within the same country. OBJECTIVES: The aim of the study was to analyze the determinants in the incidence and nature of poisoning between urban and rural children, in order to identify children at higher risk. MATERIAL AND METHODS: The study entailed a retrospective analysis of the medical records of 848 children admitted to the Department of Pediatrics at the Medical University of Lublin, Poland, due to exposure to poison from July 2008 to December 2012. The patients were divided into urban and rural. RESULTS: The majority of the subjects came from urban areas (64.50%). In both groups the most numerous were children aged ≤ 5 years and 14-15 years. Among urban boys, children younger than 5 years old predominated, while among urban girls, teenagers aged 14-15 years comprised the largest group (p = 0.00). In the rural population children younger than 5 years were the most prevalent regardless of gender. The incidence of intentional intoxication increased with age, while the incidence of accidental poisoning decreased with age (p = 0.00). Among urban children there was a significant association between gender and the nature of poisoning (p = 0.00). The most common cause of poisoning was the use of non-pharmaceuticals, with alcohol predominating. CONCLUSIONS: The study indicates that poisoning is more likely in urban children. Among urban children there is a bimodal gender distribution with a preponderance of pre-school boys in accidental poisoning and of teenage girls in intentional ones. However, among rural children the most prevalent was accidental poisoning by improperly stored medicines and household chemicals. Urban children commonly use alcohol and narcotics.

Intentional poisonings in urban and rural children - a 6-year retrospective single centre study.

INTRODUCTION: Intentional poisonings among children and adolescents are a problem not only for paediatricians, but also constitute a big issue for public health. In many countries worldwide, including Poland, an increase has been observed in suicidal behaviours at developmental age. OBJECTIVE: The aim of the study was a retrospective evaluation of patients hospitalized due to intentional poisoning in the Department of Paediatrics, Children's University Hospital in Lublin, Poland, in 2007-2012. MATERIALS AND METHODS: In the study period, 149 patients were hospitalized in the Paediatric Department of the Children's University Hospital in Lublin, due to intentional poisoning with medicines or other chemical substances. The study group comprised 135 girls and 14 boys; The majority of patients (n=105) were urban inhabitants, and only 44 lived in the rural areas. Medical records were analyzed, with consideration of medical, psychological and psychiatric examinations. RESULTS: Girls constituted as much as 90.6% of the study group. The majority of patients lived in urban areas - 70.46%. A total of 16.77 % of patients came from incomplete families. Alcohol problem occurred in 19 families. The most frequent cause of a suicide attempt was conflict in the family, followed by school problems. During the 6-year-study period, an upward tendency in the incidence of intentional poisoning was observed, particularly in the first 4 years. DISCUSSION AND CONCLUSION: Suicide attempts in adolescents were mostly undertaken by girls from the urban environment. The majority of those attempts were caused by family problems, including alcoholism.

Inflammatory and Lipid-Associated Markers of Cardiovascular Diseases in Children with First Exacerbation of Inflammatory Bowel Disease.

BACKGROUND Adult patients with inflammatory bowel disease (IBD) are at increased risk of early atherosclerosis and atherosclerosis-driven cardiovascular diseases. However, data on the development of early, subclinical atherosclerosis in children with IBD are scarce. The aim of this study was to assess selected biomarkers of atherosclerosis in children with IBD. MATERIAL AND METHODS The study group comprised 30 children with first exacerbation of IBD. Twenty healthy children were enrolled into the control group. Total cholesterol, triglycerides, low-density lipoproteins (LDL), high-density lipoproteins (HDL), lipoprotein (a) (Lp(a)), interleukin 6 (Il-6), high sensitivity C-reactive protein (hs-CRP), and oxidized LDL (ox LDL) were determined. RESULTS There were no significant differences in lipids profiles in IBD children and controls. Mean IL-6 level (8.996 pg/ml) was significantly higher in the IBD group compared to controls (3.502 pg/ml). Mean hs-CRP concentration was significantly higher in IBD children than in controls (7.648 and 1.290 µg/ml, respectively). In the IBD group, mean ox-LDL concentration (144.837 ng/ml) was lower than in controls (162.352 ng/ml), but the difference was non-significant (P=0.4). Mean Lp(a) serum level was higher in patients with IBD (19.418 mg/dl) than in controls (10.970 mg/dl), but it was also non-significant. CONCLUSIONS No significant differences were found in biomarkers of atherosclerosis in children with IBD compared to controls. Elevated IL-6 and hs-CRP level are well-established inflammatory markers. Further studies are needed to fully determine cardiovascular risk factors in IBD children.

[Ulcerative colitis in a 6-year-old boy with severe coeliac disease - a case report]. / Wrzodziejace zapalenie jelita grubego u szescioletniego chlopca z ciezka postacia celiakii klasycznej - opis przypadku.

Coeliac disease is a chronic immune-mediated inflammation of the small intestine elicited by the gluten ingestion in genetically susceptible people. In coeliac patients there is higher incidence of other autoimmune disorders like type 1 diabetes or Hashimoto's thyroiditis. The coexistence of coeliac disease and inflammatory bowel disease is rare. The spectrum of presentation of coeliac disease and inflammatory bowel disease may be similar. However, those disorders require various therapeutic approaches. Thus, early recognition of the overlap between coeliac disease and inflammatory bowel disease is crucial to apply appropriate treatment and to prevent possible complications. We report a case of a 6-year-old boy with a delay in physical and psychomotor development, rickets, severe anaemia and bloody diarrhoea. He was diagnosed with coeliac disease and ulcerative disease. The coexistence of both disorders is extremely rare in childhood. However, ulcerative colitis should be considered in coeliac children on restrictive gluten-free diet with persistent diarrhoea or bleeding from lower gastrointestinal tract. Screening for coeliac disease should be considered in children with ulcerative colitis with impaired physical development and lack of remission despite of proper treatment.

[Coexistence of coeliac disease and inflammatory bowel disease in children]. / Wspólwystepowanie celiakii i nieswoistych zapalen jelit u dzieci.

Coeliac disease and inflammatory bowel disease are chronic inflammatory conditions of gastrointestinal tract with complex aetiology with genetic, environmental and immunological factors contributing to its pathogenesis. It was noted that immune-mediated disorders often coexist. There is well-known association between coeliac disease and type 1 diabetes and ulcerative colitis and primary sclerosing cholangitis. However, growing body of literature suggests the association between coeliac disease and inflammatory bowel disease, particularly ulcerative colitis. This is an extremely rare problem in paediatric gastroenterology. To date there have been reported several cases of children with coexisting coeliac disease and inflammatory bowel disease. Herewith we present review of current literature on coexistence of coeliac disease and inflammatory bowel disease in children.

Acute acalculous cholecystitis in a 17-year-old girl with Epstein-Barr virus infection.

Acute cholecystitis is most frequently concomitant with cholelithiasis, whereas acute acalculous cholecystitis is usually of an infectious aetiology. Among the aetiological factors, Epstein-Barr virus (EBV) infection is also mentioned. The case of a 17-year-old girl is described, hospitalised in the Children's Clinical Hospital, Paediatric Clinic, at the Medical University in Lublin, due to fever, upper abdomen pain lasting for a week, and nausea for several days. Based on the diagnostic - laboratory tests performed and ultrasonographic examination, acute acalculous cholecystitis was diagnosed, taking course with elevated aminotransferase activity and features of cholestasis. Serological tests confirmed an acute infection with Epstein-Barr virus. After 2 weeks of hospitalisation, the patient, receiving conservative treatment, was discharged home in good condition. A follow-up examination performed 2 weeks later did not show deviation from normal.

Intentional and accidental paracetamol poisoning in childhood - a retrospective analysis.

INTRODUCTION: Paracetamol is one of the most commonly used analgesics and antipyretics available without limits as preparations of the OTC group (over the counter drugs). Overdose and poisoning with this drug always brings about the risk of acute hepatic failure. The objective of the study was a retrospective evaluation of patients hospitalized in the Paediatric Clinic during the period 2004-2012 due to poisoning with paracetamol. MATERIAL AND METHODS: The analysis covered 44 patients hospitalized in the Paediatric Clinic during 2004-2012 due to poisoning with paracetamol. Patients were divided into three groups: intentional poisonings, accidental poisonings, and drug overdose. RESULTS: During the period of the study, 44 patients aged 2.1-17.1, poisoned with paracetamol, were hospitalized. Among these patients there were 30 (68.2%) cases of intentional poisonings, 10 (22.7%) of accidental poisonings, and only 4 patients (9.1%) were children hospitalized after a paracetamol overdose. The majority of patients in all groups were females (93.3%). DISCUSSION: Paracetamol intoxication may occur after exceeding a single allowable dose, in the case of intentional poisoning, more rarely after exceeding the daily dose, in the case of intense pain complaints, or in the treatment of persistent fever. Based on the analysis performed, an increase was observed in the frequency of poisoning with paracetamol, especially intentional poisoning. Unlimited access to paracetamol as an OTC drug should be reconsidered.

From hypertransaminasemia to mucopolysaccharidosis IIIA.

UNLABELLED: ᅟ: Mucopolysaccharidosis type III (MPS III; Sanfilippo syndrome) is a metabolic disorder characterized by the deficiency of a lysosomal enzyme catalyzing the catabolic pathway of heparan sulphate. MPS III presents with progressive mental deterioration, speech delay and behavioural problems with subtle somatic features, which can often lead to misdiagnosis with idiopathic developmental/speech delay, attention deficit/hyperactivity disorder or autism. We report a case of a 5-year-old boy with developmental delay and behaviour problems admitted to the Department of Paediatrics due to chronic hypertransaminasemia. The patient developed normally until the age of 2 years when he was referred to a paediatric neurologist for suspected motor and speech delay. Liver function tests were unexpectedly found elevated at the age of 3.5 years. Physical examination revealed obesity, mildly coarse facial features and stocky hands. He showed mental retardation and mild motor delay. The clinical picture strongly suggested mucopolysaccharidosis. The diagnosis of MPS IIIA was confirmed by decreased activity of heparan N-sulfatase in leucocytes. CONCLUSION: We strongly recommend screening for MPS III in children with severe behavioural abnormalities with hyperactivity, psychomotor or speech deterioration and failure to achieve early developmental milestones particularly with facial dysmorphism.

[Chronic constipation in children--typical and atypical diagnosis--case reports]. / Przewlekle zaparcia u dzieci--typowe i nietypowe rozpoznania--opis przypadków.

Constipation in children is a common health problem. It accounts for 3% of visit to general pediatrics clinics and 30% of visits to pediatric gastroenterologist. Fun(TK)ional constipation is the most common causa of contipation in children. We present three cases with chronic contstipation.

[Evaluation of invasive tests in diagnosis of Helicobacter pylori infection and their correlation with endoscopic features in children with chronic gastritis]. / Ocena wybranych testów inwazyjnych w rozpoznawaniu zakazenia Helicobacter pylori w powiazaniu z obrazem endoskopowym w przewleklym zapaleniu zoladka u dzieci.

Fifty children aged 8-17 years with histologically confirmed chronic gastritis were investigated for Helicobacter pylori (H. pylori) presence in gastric mucosa bioptates taken during endoscopy. Three invasive tests (histology, rapid urease test and culture) were done. H. pylori was stated in 26 patients (56%). In this group the positive results were as follows: histology--96.4%, urease test--82.1%, culture--60.7%. The consistency of positive results ranged from 60.7% to 78.6%, being most often for histology and urease test. In 91% of non-infected patients the endoscopic features were limited to erythematous, oedematous and exsudative changes of gastric mucosa, whereas in patients with H. pylori infection the prevalence of antral nodularity was noted in 60.7%. The probable causes of non compatible test results are discussed.