Metallothioneins in Inflammatory Bowel Diseases: Importance in Pathogenesis and Potential Therapy Target.

Immunological disorders, increased oxidative stress, and damage to the epithelial barrier play an important role in the pathogenesis of inflammatory bowel diseases (IBDs). In the treatment of patients with Crohn's disease (CD) and ulcerative colitis (UC), it is increasingly common to use biological drugs that selectively affect individual components of the inflammatory cascade. However, administering the medicines currently available does not always result in obtaining and maintaining remission, and it may also lead to the development of resistance to a given agent over time. Metallothioneins (MTs) belong to the group of low molecular weight proteins, which, among others, regulate the inflammation and homeostasis of heavy metals as well as participating in the regulation of the intensity of oxidative stress. The results of the studies conducted so far do not clearly indicate the role of MTs in the process of inflammation in patients with IBD. However, there are reports that suggest the possibility of using MTs as a potential target in the treatment of this group of patients.

Oral exclusive enteral nutrition for induction of clinical remission, mucosal healing, and improvement of nutritional status and growth velocity in children with active Crohn's disease - a prospective multicentre trial.

INTRODUCTION: Undernutrition and growth failure are common problems in paediatric patients with active Crohn's disease (CD). AIM: The aim of exclusive enteral nutrition (EEN) commencement is not only to induce clinical remission and promote mucosal healing but also to initiate weight and growth gain, especially in patients with poor nutritional status. We assessed the effectiveness of treatment with EEN and its impact on nutritional status in children with active CD. MATERIAL AND METHODS: Twenty children (male/female: 14/6) in median age of 14 years with active CD had EEN with polymeric industrial diet (Modulen IBD) applied for 6 weeks. The daily caloric intake was established according to the age and nutritional status. In patients with undernutrition, it was increased to 120-150% relative to recommendations for the healthy peers. The Paediatric CD activity index (PCDAI) - a marker of clinical remission, faecal calprotectin (FCP) - a marker of mucosal healing (MH), and nutritional status were assessed at baseline and 4 weeks following the end of the therapy (week 10). RESULTS: In the studied group the mean decrease in PCDAI score was statistically significant (from 25.6 ±12 to 5.4 ±10, p < 0.05). Full remission (defined as PCDAI < 10) was achieved in 65% of patients, and clinical response in another 30% of them. Only 5% of children did not respond to the treatment. Mean decline in FCP level was statistically significant as well (from 3380 ±7746 to 1046.6 ±1219, p < 0.05). All patients, apart from one who was fed with a nasogastric tube, accepted oral intake of industrial formula. EEN was generally well tolerated. Initially, in 20% of patients the symptoms of intolerance to the industrial diet were observed, but they receded within the first days of the therapy. The recommended daily intake of the formula was achieved in 95% of children. Only one child was unable to intake the prescribed amount of the diet due to intolerance. At baseline, undernutrition was observed in 30% of patients, which was established by a body mass index (BMI) score below the third percentile according to the recommended charts for the Polish paediatric population. In all patients, improvement in BMI status was reported at the end of the treatment. The mean increase in BMI score was 0.91, and it was greater in the malnourished group compared to patients with normal nutritional status (1.19 vs. 0.62). After the treatment two-thirds of children with malnutrition achieved a BMI score within the normal range. In 25% of patients, growth deficit was observed (defined as growth below the third percentile according to the Polish charts) before the EEN introduction. An increase in body height was obtained generally in 55% of children and in 80% of those with initial growth failure. The mean increase in growth was 1 cm, and it was greater in the group with initial growth deficit relative to patients with baseline normal height (1.5 cm vs. 0.8 cm, respectively). CONCLUSIONS: A 6-week course of oral EEN was an effective and well-tolerated method of treatment in children with active CD. Nutritional therapy not only induced full clinical remission and led to decline in FCP level (as a marker of MH) in the majority of patients, but also contributed to the improvement in their nutritional status and growth velocity. These are very important observations because proper development is crucial for paediatric CD patients.

[Occurrence of Toxocara spp. eggs in household environment of children with diagnosed toxocariasis in Lódz voivodeship]. / Czestosc wystepowania jaj inwazyjnych Toxocara spp. w srodowisku przydomowym dzieci ze zdiagnozowana toksokaroza w woj. lódzkim.

Toxocariasis is a zoonosis due to infection of humans by dog or cat roundworm (Toxocara canis, T. cati). Humans become infected by ingestion of infective eggs either from soil, dirty hands, raw fruits and vegetables or larvae from undercooked meat of paratenic hosts. The aim of the study was to evaluate the level of contamination of soil samples from households of children with diagnosed toxocariasis in rural and urban areas of Lódz voivodeship. In the years 2004-2007 toxocariasis was confirmed in 178 patients of the Polish Memorial Hospital in Lódz. The soil samples were collected from 53 courtyards of patients' domiciles. Toxocara spp. eggs were isolated from the samples using flotation technique (Dada 1979). The examinations revealed the high prevalence of ground contamination with Toxocara eggs in both, rural (30.4%) and urban areas (23.3%). The presence of Toxocara eggs in households enlarges the risk of re-infection for children with diagnosed toxocariasis, especially in rural areas where the high level of contamination was detected.

[Estimation of eosinophilia, immunoglobulin E and eosinophilic cationic protein concentration during the treatment of toxocariasis]. / Ocena eozynofilii, stezenia immunoglobuliny E i eozynofilowego bialka kationowego podczas leczenia toksokarozy.

Toxocara canis and Toxocara cati do not transform in human organism into a mature form and they circulate reaching various organs and tissues causing characteristic symptoms. Activated eosinophils, which play a significant role in parasitic invasion, contain in their granules eosinophilic cationic protein (ECP) of strong pro-inflammatory activity. The aim of the study was to estimate the concentration of immunoglobulin E, peripheral blood eosinophilia and serum concentration of eosinophilic cationic protein in children treated for toxocariasis and the analysis of their value as the markers of active invasion and the therapy efficacy. The study included 45 children, aged from 3 to 18 years with Toxocara canis infection diagnosed for the first time. The children were diagnosed and treated at the Department of Gastroenterology, in the Outpatient Gastrointestinal and Allergologic Clinic, Institute Polish Mother Health Centre. T. canis larva infection was diagnosed based on serological investigation using immunoenzymatic ELISA test (Bordier Affinity Products, Switzerland). The tests (percentage of eosinophilia in peripheral blood, ECP, IgE) were performed after diagnosis and every 3 months since the beginning of the therapy. In children with toxocariasis its covert form was diagnosed and mebendazole was administered. Among the children with toxocariasis eosinophilia was found in 14 (31.1%) before therapy. Mean percentage of peripheral blood eosinophils was 5.58% in children with toxocariasis. The concentration of IgE was elevated in these children and was significantly higher than in the control group (p=0.002). Mean IgE concentration after 3-and 6-month therapy decreased IgE(I) vs IgE(III) (p=0.01), but it was still higher than normal value. In children with toxocariasis the ECP concentration was 30.19 microg/l before the therapy and was significantly higher than in the control group (p<0.05); after 6 months of the therapy it decreased significantly (p<0.05). Eosinophilic cationic protein and eosinophilia can be the markers of Toxocara canis infection activity. The determination of immunoglobulin E and eosinophilic cationic protein concentration may be useful for toxocariasis therapy monitoring.

[Detrusor pseudohyperactivity syndrome in children with constipation]. / Zespól rzekomej nadreaktywnosci wypieracza u dzieci z zapaciami.

THE AIM OF THE STUDY: was the evaluation of dependencies occurring between constipation and observed nocturia, pressing tenesmus and daytime urinary incontinence. MATERIAL AND METHODS: the studies were conducted in 51 children aged between 3 and 17 years including 25 girls and 26 boys hospitalized in the Clinical Department because of nocturia, pressing tenesmus and daytime urinary incontinence. In all children a complex diagnostic work up of the urinary system and the lower segment of alimentary tract was performed. Results of the examinations were compared to the control group. RESULTS: analysis of the results of the conducted examinations indicates that the overblown rectal ampulla, through the pressure exerted on the urinary bladder, seemingly decreases its volume causing the occurrence of pressing tenesmus, nocturia and daytime urinary incontinence. This process leads to the formation of detrusor hyperactivity syndrome characterized by: chronic constipation, increase of miction frequency and simultaneous decrease of volume of each portion of urine, nocturia and/or daytime urinary incontinence. CONCLUSIONS: chronic constipation disturbs the functional-morphological equilibrium between the end segment of alimentary tract and the urinary bladder. By influencing the process of filling and accumulation of urine in the bladder they lead to the formation of detrusor hyperactivity syndrome.