Application of the oral carbohydrate solution allows to avoid preoperative fasting, attenuates postoperative stress and is beneficial for postoperative course. In spite of the acknowledged algorithm of carbohydrate solution administration in adults notifications considering paediatric patients are rare and are lacking in reference to children’s orthopedic surgery. Aim of this study was to estimate a possibility, safety, tolerance and complications risk of oralcarbohydrate solution load in children before elective orthopedic surgery. We analysed data of 49 patients (age 2-18 years old), who got carbohydratesolution (PreOp®,N.V. Nutricia, Zoetermeer, Holland) orally two hours before the operation. Complications especially aspiration, subjective feeling of nausea, hunger and thirst before and after the procedure were estimated, as well as objective children’s behavior, psychomotor excitement and crying. Data obtained were analyzed with age-body mass indicator using the χ² test. Mean age of patients was 12,2 ± 4 years, and mean body mass 49,7 ± 20kg. 81,25% of studied belonged to group between 3 and 97 centile, whereas 18,75% were outside this range. There were not observed episodes ofaspiration or any other perioperative complications due to anaesthesia. None of those studied reported preoperative hunger or thirst, while after the procedure only two children felt thirsty. Postoperative vomiting was observed in 2 (4,2%) patients, both from the group outside the 3-97 percentile (p<0,05). Oral carbohydrate solution loading is effective, safe and well tolerated method to avoid preoperative fasting in children and adolescents in orthopedic surgery. However care should be taken in those with obesity and undernourished. The obtained data can be a starting point for further studies considering modern preoperative management in children.

Background:
Elevated aspartate aminotransferase (AST) may be due to the presence of macroAST. MacroAST is a benign condition that results fromunusual combination of molecules of AST with serum macroglobulins. Our experience shows that macroAST should be suspected in asymptomaticpatients with persistent hypertransaminasemia.

Objective:
The aim of this study was to evaluate the prevalence of macroenzymes in children with increased aspartate aminotransferase activity.

Methods:
247 children mean aged 6.2 years (from 0,03 to 16,19 years) with isolated hypertransaminasemia were included in the study. The presence of macroenzymes was based on polyethylene glycol precipitation (PEG), a method developed by Levitt and Ellis.

Results:
In 26% of children with elevated AST aspartate aminotransferase macroAST was found.

Conclusions:
MacroAST has to be considered in differential diagnosis of increased AST activity.

The nutrition standards for Polish population that have been obligatory until 2008/2012 were amended in order to meet the recommendations ofreducing the energy and protein intake and increasing the supply of vitamin D, calcium and dietary fiber. These changes form the basis for modifyingfood rations for children. The aim of the study was to elaborate a model food ration for children aged 2-3 years on the basis of revised nutritionalstandards and introduce this model for planning of children’s diets.

Early and precise detection of IFI (invasive fungal infections) cause is important to select appropriate antifungal therapy. Traditional approaches suchas direct microscopic examination, histopathological evaluation and culture are considered to be still a gold standard of the IFI diagnostic. However, they are often not sufficiently sensitive and/or specific, and their usefulness depends on the quality of the sample. Patient’s clinical condition not always allows obtaining adequate material for microbiological testing. These limitations contribute to the development of alternative methods based on the detection of fungal infection biomarkers, such as fungal antigens and fungal nucleic acids. For some patients, these are the only diagnostic tools for IFIs.

The aim of this study was to provide practical clinical aspects of PFAPA syndrome (periodic fever syndrome, aphthous stomatitis, pharyngitis, adenitis)- autoinflammatory disease of unknown pathogenesis and genetic background. Knowledge of the syndrome among physicians, both primary care and specialists in the field of immunology, rheumatology, ENT and dentistry is very important because early detection is the basis of the correct differential diagnosis and treatment. The article presents the current knowledge about PFAPA and the proposals for steps in diagnostic and therapeutic decisions.

Autoimmune encephalitis (AE) is a heterogeneous group of diseases characterized by a wide range of neurological and psychiatric symptoms, in which antineuronal antibodies are present. There are also specific forms of AE that are related to cell-mediated immune response e.g. multiple sclerosis. AE incidence is not precisely known, but it is estimated that it could be higher than 20% of all the encephalitides. AE are often a paraneoplastic syndrome. Inflammatory changes can occur in any part of the brain, and determines the clinical symptoms. The treatment is based on immunosuppressive agents, and the prognosis depends on definited disease and antibodies.This article characterizes some antineuronal antibodies, demonstrates the classification, clinical course and most common types of AE.

This part of paper presents different strategies of acute pediatric pain management including postoperative and procedural pain, based on recent Polish, British and World Health Organization recommendations.

Trans fatty acids are unsaturated fatty acids that contain one or more double bonds in which the hydrogen ions attached to the carbon atoms at the double bond are on opposite site of the molecule. Trans isomers are formed from cis unsaturated fatty acids during biohydrogenation by rumen microorganisms (natural source) and by commercial partial hydrogenation during the processing of vegetable and fish oils (industrial source). Numerous studies have shown that trans fatty acids demonstrate atherogenic effect and may increase serum level of low density lipoprotein cholesterol (LDL). The consumption of trans isomers of fatty acids has been associated with increase of plasma LDL-cholesterol and decrease high densitylipoprotein cholesterol (HDL) concentration. Additionally trans fatty acids may increase plasma lipoprotein (a) level, which is independent factor in cardiovascular disease. Special attention has also been given to the potential impairment of trans fatty acids in asthma, allergic rhinitis and atopic dermatitis development in infants and young children. It seems likely that fetal exposure to trans fatty acids is an important determinant of early childhood allergic diseases.

Inflammatory bowel disease (IBD) which includes Crohn’s disease (CD) and ulcerative colitis (UC) is a chronic condition of the intestine characterized by intestinal inflammation and increased intestinal permeability. Until now, endoscopic evaluation with histopathological sampling has been consideredin dispensable in the investigation of patients with suspected IBD. However, latest studies indicate a very important role of non-invasive diagnostic tools for both diagnostic and monitoring of patients with IBD. Calprotectin (CLP), a calcium-binding protein found in the cytosol of neutrophils is one of such markers. Its increased level is found in patients with both CD and UC, whereas normal values are found in healthy subjects and in patients with irritable bowel syndrome (IBS). Increase in CLP level is a marker of increased intestinal permeability and is higher in active disease, thus correlates with clinical deterioration.

The authors present the selected reports of problems associated with liver transplantation in children, presented at the 7th Congress of the International Pediatric Transplantation Society, which took place in Warsaw in June 2013.