Children sustain high levels of skin DNA photodamage, with a modest increase of serum 25-hydroxyvitamin D3 , after a summer holiday in Northern Europe.

BACKGROUND: Childhood solar ultraviolet radiation (UVR) exposure increases the risk of skin cancer in adulthood, which is associated with mutations caused by UVR-induced cyclobutane pyrimidine dimers (CPD). Solar UVR is also the main source of vitamin D, essential for healthy bone development in children. OBJECTIVES: To assess the impact of a 12-day Baltic Sea (54° N) beach holiday on serum 25-hydroxyvitamin D3 [25(OH)D3 ] and CPD in 32 healthy Polish children (skin types I-IV). METHODS: Blood and urine were collected before and after the holiday and assessed for 25(OH)D3 and excreted CPD, respectively, and personal UVR exposure was measured. Diaries were used to record sunbathing, sunburn and sunscreen use. Before- and after-holiday skin redness and pigmentation were measured by reflectance spectroscopy. RESULTS: The average ± SD daily exposure UVR dose was 2·4 ± 1·5 standard erythema doses (SEDs), which is borderline erythemal. The mean concentration of 25(OH)D3 increased (× 1·24 ± 0·19) from 64·7 ± 13·3 to 79·3 ± 18·7 nmol L-1 (P < 0·001). Mean CPD increased 12·6 ± 10·0-fold from 26·9 ± 17·9 to 248·9 ± 113·4 fmol µmol-1 creatinine (P < 0·001). Increased 25(OH)D3 was accompanied by a very much greater increase in DNA damage associated with carcinogenic potential. Overall, skin type had no significant effects on behavioural, clinical or analytical outcomes, but skin types I/II had more CPD (unadjusted P = 0·0496) than skin types III/IV at the end of the holiday. CONCLUSIONS: Careful consideration must be given to the health outcomes of childhood solar exposure, and a much better understanding of the risk-benefit relationships of such exposure is required. Rigorous photoprotection is necessary for children, even in Northern Europe.

Clinical evaluation of proinflammatory cytokine inhibitors (sTNFR I, sTNFR II, IL-1 ra), anti-inflammatory cytokines (IL-10, IL-13) and activation of neutrophils after burn-induced inflammation.

The study was aimed at evaluating the involvement of sTNFR I, sTNFR II, IL-1 ra, IL-10, IL-13 and reactive oxygen species (ROS) in systemic inflammatory response syndrome (SIRS) development in severely burned children and at assessing the prognostic value of the immunological markers studied. The study comprised 37 patients (17 burned children and 20 controls). Serum levels of the markers determined by means of ELISA and respiratory burst of neutrophils as well as p55 and p75 tumour necrosis factor-alpha (TNF-alpha) receptor expression using flow cytometry were evaluated twice. The burned children presented significantly higher levels of IL-10 and cytokine inhibitors within the first 6-24 h after injury compared with controls (P < 0.05). The decreased oxygen metabolism of neutrophils and increased TNF-alpha receptor expression were found on admission. Moreover, a significant decrease in initially high sTNFR I, sTNFR II, IL-1 ra, IL-10, IL-13 concentrations (P < 0.05) and reduced expression of TNF-alpha receptors (P < 0.05) were observed after burn therapy, whereas ROS generation evidently augmented (P < 0.05). Four of our children who developed hypovolaemic shock revealed a significantly lower ROS generation and higher concentrations of soluble TNF-alpha receptors and IL-1 ra together with IL-10, IL-13 compared with children with good outcome (P < 0.05). Our results revealed the involvement of both ROS, soluble TNF-alpha receptors and IL-1 ra in the development of SIRS in burned children; their monitoring allows for an assessment of the systemic inflammatory reaction activity. The neutrophil BURSTTEST and IL-1 ra might have been clinically helpful markers of SIRS prognosis.

[Sepsis in children caused by gram-negative bacteria: own observation]. / Posocznice u dzieci wywolane przez bakterie gram-ujemne--obserwacje wlasne.

In the paper the analysis of the clinical course of sepsis caused by Gram negative bacteria in 45 children hospitalized in Institute of Pediatrics at Medical University of Lodz in 1995-1998 was performed. Sepsis was diagnosed by bacterial analysis of blood serum, urine, stool and the ending of central venous tract. The most often etiological factor of sepsis in analysed group of children were Klebsiella and Pseudomonas. The respiratory failure requiring artificial ventilation and circulatory failure appeared significantly more often in infants than in children upper 1 year of life.

Clinical evaluation of patients with idiopathic juvenile osteoporosis.

The aim of this study is to evaluate the occurrence of idiopathic juvenile osteoporosis by clinical, radiographic and biochemical methods in 7 patients aged 10 years to 18 years. The prevailing clinical symptoms included pain in the lower limbs and spine, gait disturbances and weak muscles; confirmed fractures were seen in four out of seven patients. In all patients, bone mineral density was determined by dual-energy X-ray absorptiometry and calcium-phosphorus metabolism assays were performed. Clinical evaluation of our patients revealed a wide variety of classic clinical symptoms, and also radiographic and biochemical features. In this complex evaluation, we can distinguish two types of disease occurrence, mild and acute.

Proinflammatory cytokine inhibitors, TNF-alpha and oxidative burst of polymorphonuclear leukocytes in the pathogenesis of sepsis in newborns.

This study was to evaluate the levels of the proinflammatory cytokine tumor necrosis factor alpha (TNF-alpha) and the cytokine inhibitors soluble TNF-alpha receptor (sTNFR) and interleukin (IL-1) receptor antagonist (IL-1ra), as well as the intensity of oxidative metabolism of peripheral blood polymorphonuclear leukocytes in the course of sepsis in newborns. An increase of TNF-alpha, sTNFR and IL-1ra concentrations was found in the blood serum of the patients at the time of diagnosis. This was further accompanied by polymorphonuclear leukocyte stimulation and, as a consequence of prolonged bacterial antigen stimulation, functional exhaustion of these cells and their diminished oxidative metabolism was observed. Within the same time period, an enhanced expression of p55 and p75 TNF-alpha receptors on polymorphonuclear leukocyte cell surfaces was found. It was indicated that the applied pharmacotherapy caused a decrease of the initially elevated concentrations of TNF-alpha and proinflammatory cytokine inhibitors (sTNFR, IL-1ra). The intensive therapy of sepsis was associated with the increased oxidative burst of polymorphonuclear leukocytes along with the decrease of p55 and p75 expression on their cell surfaces.

[Frequency of antibodies against Trichinella spiralis and Echinococcus ssp. appearance in children with atopic diseases]. / Czestosc wystepowania przeciwcial przeciwko Trichinella spiralis i Echinococcus spp. wsród dzieci z chorobami atopowymi.

Parasitic infestation and atopic diseases have common features. The aim of our study was to evaluate the occurrence of Trichinella and Echinococcus seropositivity in children with atopic diseases. The study group involved 72 children aged from 2,5 to 18 years with asthma and allergic rhinitis. The control group comprised 30 children without allergic diseases. In 12 children with atopic diseases the serological tests were positive for Trichinella spiralis, in II for Echinococcus spp. and in 5 both for Trichinella and Echinococcus. In control group the serological tests were positive in 3, 6 and 3 children respectively. There were no differences in occurrence of positive results of serological tests in children with atopy and children without allergic diseases.

Proinflammatory cytokines (IL-6, IL-8), cytokine inhibitors (IL-6sR, sTNFRII) and anti-inflammatory cytokines (IL-10, IL-13) in the pathogenesis of sepsis in newborns and infants.

The levels of the proinflammatory cytokines interleukin 6 (IL-6) and IL-8, and the anti-inflammatory cytokines IL-10 and IL-13 were studied in child patients with sepsis. The changes of the cytokine inhibitors soluble IL-6 receptor and soluble p75 TNF-alpha receptor were also investigated in the patients' sera. An increase of pro- and anti-inflammatory cytokine levels was demonstrated at the time of diagnosis. Pharmacotherapy was accompanied by a decrease of the elevated concentrations of both cytokines and their inhibitors. The time pattern of changes in cytokine and cytokine inhibitor serum concentrations along with the time course of acute phase indices, including procalcitonin and C-reactive protein, allows for an evaluation of the system inflammatory response and may support diagnostic and prognosis methods.

Serum insulin/like growth factor I, bone mineral density and biochemical markers of bone metabolism in children with idiopathic osteoporosis.

OBJECTIVE: To determine whether the serum concentration of insulin-like growth factor I (IGF-I) correlates with the occurrence of idiopathic osteoporosis in children, and whether serum levels of IGF-I correlate with selected bone metabolism markers in patients with osteoporosis. METHODS: The study comprised 24 patients aged 7-18 years, including 12 with idiopathic osteoporosis and 12 control children. Bone mineralisation disorders were diagnosed on the basis of complex clinical, densitometric and biochemical evaluation. In all children serum concentration of IGF-I was estimated by radioimmunoassay and the third fraction of IGF binding proteins (IGFBP3) by immunoradiometry. In children with osteoporosis the indices of bone metabolism were also assessed, e.g. serum levels of osteocalcin and activity of bone isoenzyme of alkaline phosphatase (bone formation markers) and urine concentration of pyridinoline and deoxypyridinoline and collagen type I crosslinked C-telopeptyde (resorption markers). RESULTS: It was found that in children with osteoporosis IGF-I concentration was significantly lower than in the control group (mean values were 583 and 850 ng/ml, respectively; P<0.05). These differences were independent on biological age of the studied children and were present in all adolescence stages. Concentrations of IGFBP3 did not differ significantly between groups (3593 vs. 3955 ng/ml), while that of IFG-I correlated positively with total and spinal bone mineral density (R=0.85 and R=0.80, respectively; P<0.00001). In children with osteoporosis there was also a significant relationship between IGF-I concentration and elimination of pyridinoline and deoxypyridinoline with urine (R=0.64 and R=0.65, respectively; P<0.05). There was no significant correlation between the concentration of IGF-I and IGFBP3 and other studied bone metabolism markers. CONCLUSIONS: The conducted study revealed that lower IFG-I concentrations correlate with higher bone resorption markers values and decreased mineralisation. These results suggest the importance of insulin-like growth factor in the ethiopathogenesis of idiopathic osteoporosis, which needs to be confirmed in further studies.

[Developmental osteopenia: decrease of bone mineral density or systemic impairment?]. / Osteopenia w wieku rozwojowym--obnizenie mineralizacji koscca czy zaburzenie ogólnoustrojowe?

In the quantitative evaluation of bone osteopenia is defined as a decrease of mineral density by more than 1 SD from the established normal values (age, sex, peak bone mass...). The border of osteopenia and osteoporosis is demarcated by -2.5 SD (T-score) in adults, while in children the most proper is considered to be -2.0 SD (Z-Score). The aim of the study was to determine whether developmental osteopenia is accompanied by biochemical abnormalities and what are clinical symptoms concomitant with this condition. The studies include 28 children aged 5-17 years, in whom no chronic disease, especially of locomotor system, was found. The basis for diagnosis was densitometric examination of bone, with DEXA method (densitometer by Lunar), vertebral column (Spine) in the pediatric program or for adults. The most frequent causes for referring to the examination were pain in the spine, limbs or history of multiple bone fractures. In the performed biochemical examinations hypomagnesemia, decreased concentration of 25OHD and PTH in blood serum, increased activity of bone isoenzyme of alkaline phosphatase as well as increased excretion of hydroxyproline in urine, were found in several children. In about 1/3 of the children low body mass, and in some cases also retardation of the bone age was revealed. The results of our studies allow a conclusion, that in children with certain clinical abnormalities from locomotor system osteopenia may take place. This disturbance is concomitant with various deviations in calcium-phosphate metabolism and requires adequate therapy. It may be supposed, that in the majority of children, osteopenia was caused by low dietary calcium intake, together with reduced physical activity and vitamin D deficiency. The observations and conclusions from the study are of important practical significance, because children with osteopenia are the risk group for the appearance of osteoporosis in their future life.

[Clinical observation of osteoporosis in adolescents]. / Spostrzezenia kliniczne dotyczace osteoporozy w wieku rozwojowym.

The aim of the study was to evaluate the occurrence of clinical and biochemical symptoms of osteoporosis in 15 children aged from 10 to 18 years. In this group were 7 children with idiopathic juvenile osteoporosis, 2--with osteogenesis imperfecta and 6 children with secondary osteoporosis. The diagnosis of osteoporosis was based on the result of densitometric examination. The examination was performed with dual-energy X-ray absor-ptiometry (DEXA), with modality by Lunar. Anamnesis and clinical symptoms supported by X-ray examination of the painful region were used as a standard procedure. Biochemical examinations of calcium-phosphorus metabolism included ions and PTH concentrations in blood serum, and the activity of bone isoenzyme of AP. Besides, ions excretion and total hydroxyproline in 24 hrs collection of urine were assessed. The results of our investigations showed that in children with osteoporosis clinical and biochemical abnormalities were various. Pain in the lower limbs and weakening of muscle strength were the most frequently observed clinical symptoms. Among biochemical indices, urine excretion of hydroxyproline and increased concentration of isoenzyme of alkaline phosphatase were of the greatest practical significance.

[Bone mineralization and calcium/phosphate metabolism in children with nephrotic syndrome]. / Ocena stanu mineralizacji koscca i gospodarki wapniowo-fosforanowej u dzieci z zespolem nerczycowym.

The study was carried out in 20 children aged 6-18 years receiving long-term corticosteroid treatment for nephrotic syndrome. In these children densitometric evaluation of bone by DEXA method (total body and spine) and ultrasound measurement of heel were performed. Moreover, basic parameters of calcium-phosphate metabolism were determined. Osteoporosis and osteopenia were diagnosed in 6/20 (30%) patients. Disturbances of bone mineralisation were accompanied by hyperhydroxyprolinuria, hypercalciuria, hypocalcemia and also by some clinical symptoms. The results of these pilot investigations point at necessity periodical assessment of bone mineralisation and calcium-phosphate metabolism in children with nephrotic syndrome receiving corticosteroid treatment.

[Clinical course and etiologic factors of sepsis in children from different age groups]. / Przebieg kliniczny i czynniki etiologiczne posocznicy u dzieci w róznych grupach wieku.

The analysis was performed of aetiological factors and clinical course of sepsis in children admitted to the Institute of Pediatrics of Medical University of Lódz in 1995-1998. Staphyloccocus epidermidis was the most frequently found pathogen in neonates, whereas Neisseria meningitidis in infants and children over 1 year. Candida sp. was responsible for 25% of sepsis in infants. The severity of the disease correlated significantly with increased leucocytosis and shift to the left in the white cell profile as well as elevated levels of bilirubin and transaminases, especially GOT. Lower correlations were found between severity of clinical course and coagulological disturbances or inflammatory changes in the spinal cerebral fluid.

Use of the quinolones in treatment of severe bacterial infections in premature infants.

In spite of introducing the new derivatives of fluoroquinolones into treatment in late 70's, the application this kind of chemotherapeutics in children is still controversial. The aim of our study was the evaluation of treatment efficacy and adverse effects associated with the application of ciprofloxacin in premature infants within first months of life. The investigations were performed on 36 premature infants delivered between 25-35 gestational age with birth weight varied from 750-2050 grams, hospitalized in 1993-1999 in Emergency Unit and Department of Pediatric Propedeutics of Institute of Pediatrics of the Medical University of Lódz. At the beginning of the therapy the age of our patients varied from 10 to 202 days. Ciprofloxacin 13.8 mg/kg/day in two or three divided doses was administered. The time of treatment varied from 3 to 20 days. Sepsis was the most frequent cause of application of this drug. The following treatment of ciprofloxacin was performed on three children within one, two and three months. The efficacy was assessed as good in 66% cases of treatment course. The following adverse effects were observed during and after the treatment: thrombocytopenia (5 cases), elevated transaminases (3 cases), hyperbilirubinemia (3 cases), the elevation of creatinine concentration varied from 0.2 mg% to 0.6 and from 0.1 to 0.95 mg% in two patients. Moreover one child developed femoral osteitis. Longitudinal studies concerning physical development and health state of these patients are being done.

Hepatitis B vaccination in preterm infants.

UNLABELLED: Preterm infants, especially those with very low birth weight, are at risk of hepatitis B virus infection. They often require invasive diagnostic methods in their first weeks of life, intensive treatment and long-term hospitalisation. Therefore, hepatitis B vaccination is particularly justified in these patients. Our aim was to determine the reaction of preterm children to hepatitis B vaccination. The study comprised 64 preterm children whose birth weight ranged from 700 g to 2460 g (mean 1776.6 g +/- 480.4 g) and whose gestational age was between 25 and 36 weeks. A 10 microg dose of the recombinant vaccine Engerix-B (SmithKline Beecham) was given at intervals of 0, 1, 2 and 12 months. In 49.2% of the children vaccination was administered on the 1st day of life, and in the remaining cases between the 2nd and 119th days post delivery. One month after vaccination completion the levels of anti-hepatitis B surface antigen (HBs) antibodies were evaluated. In 98.4% of the vaccinated preterm infants the level of antibodies was > 10 mIU/ml. Mean level of anti-HBs antibodies in the group of children with birth weight < or = 2000 g was 2431.4 mIU/ml, while in those with birth weight >2000 g it was 4803.9 mIU/ml. In children with a birth weight < or = 1000 g, the mean level of anti-HBs antibodies was significantly lower than in those with birth weight >2000 g. The level of anti-HBs antibodies in children who started vaccination > 1 st day of life was significantly lower in preterm children with a birth weight < or = 2000 g than in those with a birth weight >2000 g. Although vaccination was started on the 1st day of his life, one child with birth weight of 2300 g developed a hepatitis B virus infection. One child did not respond to vaccination (anti-HBs < 10 mIU/ml) and in three cases the response was very poor (11 100 mIU/ml). These patients were given a supplementary booster double dose of Engerix B (20 microg). After 1 month the level of anti-HBs antibodies was evaluated again and high values of 657 mIU/ml to 14520 mIU/ml were observed. In the group of children with a birth weight < or = 1000 g the response to vaccination was weaker as compared to children with a birth weight >2000 g (P < 0.05). In systematic mass vaccination programmes, monitoring of antibody levels is not recommended unless the patient is at risk. However, in extremely preterm infants (< 1000 g at birth), especially after very serious infections, monitoring the level of anti-HBs antibodies after complete immunisation should be considered. In preterm infants who show very low postvaccination levels of anti-HBs antibodies, stimulation with an additional double booster dose of vaccine gives positive results. CONCLUSION: The majority of preterm infants (98.4%) responded well to hepatitis B vaccination given at intervals of 0, 1, 2 and 12 months and developed a protective level of antibodies. The level of anti-hepatitis B surface antigen antibodies in children with a birth weight >2000 g was higher than in those with a birth weight < or = 1000 g.

[AIDS syndrome in an eight-month-old infant]. / Zespól AIDS u 8-miesiecznego niemowlecia.

The paper presents multiorgan manifestations of AIDS syndrome in an infant at the age of 8 months. The child was admitted to the Clinic with enteric disorder, anaemia, hepatosplenomegaly and pneumonia. The diagnosis of those anomalies and the treatment of pneumonia took much time. Infection with CMV was recognized but, despite the treatment and elimination of the virus, the child's condition did not improve and general emaciation progressed. The diagnosis of AIDS syndrome was based upon indicator illnesses: chronic recurrent pneumonia, cytomegaly and emaciation syndrome as well as upon the results of additional examinations, first of all including the presence of p24 antigen in the serum. In children with chronic diseases and manifesting non-specific multiorgan symptoms we should take into consideration AIDS syndrome in the differential diagnosis.

Long-term follow-up study of somatic development in prematurely born twins after life-threatening episodes.

The study comprised 14 pairs of twins. All the children were prematurely born between the 27 and the 33 weeks of pregnancy with birth weight 600-1900 g. Somatic development was assessed on the basis of the body weight, length/height measurements taken in the 6th and 12th months of the corrected age and in the 24th month of the calendar age. Body mass index was also calculated as weight in kilograms divided by the square of the height in meters. The obtained results were compared with the regional norms for children from Lodz. Moreover, in each child individual measurements and body mass index were normalized as compared to the arithmetic mean and the standard deviation for the established age norm. The percentage of children with body mass deficiency and decreased body length/height was relatively high. Individual assessment of somatic development, taking into account the normalized values enable observation of the direction of changes within the range of somatic features in individual children. Retardation of somatic development of prematurely born twins should be first of all associated with their very low birth weight. Severe complications of prematurity affect physical development of the children examined by us, especially in the first two years of life.

[Osteoporosis in developmental age: diagnostic and therapeutic problems]. / Osteoporoza w wieku rozwojowym--problemy diagnostyczne i terapeutyczne.

In children and the youth it is secondary osteoporosis (OP) rather than idiopathic one which occurs more often; its multidirectional pathogenesis is usually ascertainable. Secondary OP, mostly generalised, is diagnosed in the course of such hormonal disturbances as: primary hyperparathyroidism, hyperthyroidism, hyperadrenalocorticalism. Another group of diseases implicating OP are connective tissue pathologies: congenital (osteogenesis imperfecta, collagenopathies) and acquired (juvenile chronic arthritis). A serious problem for a paediatrician is the iatrogenic OP resulting from a long-term use of some medicines (glucocorticosteroids) or long-lasting immobilization for surgical and orthopaedic reasons, or from chronic general diseases. Osteoporosis accompanying pathological states of the skeletal and nervous systems (with paralyses and pareses) is particularly intensive and difficult for treatment. Osteoporosis in developmental age may cause disturbances in natural development of the skeleton, which leads to deformities in the skeletal system and to the formation of faulty postures. Lower body height is a frequent complication resulting from OP in children and the youth. In OP diagnostics the densitometry test is of the basic importance, the most common method is dual energy X-ray absorptiometry (DEXA) and the diagnosis criterion is the decrease of bone mineral density (BMD) greater than 2 SD. It should be taken into account also the X-ray and clinical symptoms, which are similar as those observed in adults. Osteoporosis biochemical markers, however are, less significant in children because for the most of then the reference values are not determined. The OP treatment is indispensable in developmental age and it should include pharmacological therapy and the proper diet and rehabilitation as well.

[Analysis of factors affecting HBV and HCV infections in premature children]. / Analiza czynników sprzyjajacych zakazeniom HBV i HCV u dzieci przedwczesnie urodzonych.

Premature children with the very low birth weight, who need a long hospital treatment after the birth, belong to the group of the highest risk of HBV and HCV infections. The study includes 32 premature children, 14 girls and 18 boys, who were born between 26 and 35 week of pregnancy with the birth weight from 800 to 2400 g. Chronic hepatitis were found in these children; 11 children had HBV infection, 10 children had HCV infection, and both HBV and HBC infections were found in 11 children. Blood transfusions, parenteral nutrition, parenteral antibiotics, surgical treatment and other medical interventions were considered as the most important factors affecting HBV/HBC infections. All these factors should be taken into consideration in efforts to reduce the frequency of HBV and HBC infections in premature children.

[Osteoporosis during development--selected problems]. / Osteoporoza w wieku rozwojowym--wybrane zagadnienia.

In children and the youth it is secondary osteoporosis (OP) rather than idiopathic one which occurs more often; its multidirectional pathogenesis is usually ascertainable. Secondary OP, mostly generalized, is diagnosed in the course of such hormonal disturbances as: primary hyperparathyroidism, hyperthyroidism, hyperadrenalocorticalism, hyperpituitarism (with excess of growth hormone) and in hypogonadism. Another group of diseases implicating OP are connective tissue pathologies: congenital (osteogenesis imperfecta, collagenopathies) and acquired (Juvenile chronic arthritis). A serious problem for a pediatrician is the iatrogenic OP resulting from a long-term use of some medicines (glucocorticosteroids, hydantoin derivatives, barbiturates), or long-lasting immobilization for surgical and orthopaedic reasons, or from chronic general diseases. Osteoporosis accompanying pathological states of the skeletal and nervous systems (with paralyses and pareses) is particularly intensive and difficult for treatment. Osteoporosis in developmental age may cause disturbances in natural development of the skeleton, which leads to deformities in the skeletal system and to the formation of faulty postures. Lower body height is a frequent complication resulting from OP in children and the youth.