Coronaviruses are a large family of viruses with an envelope and a single RNA strand. They are common in animals, some of them are pathogenic for humans. In the last several years few novel coronaviruses emerged causing mainly severe respiratory infections. The article describes common and novel coronaviruses, summarizes epidemiologic, clinical and laboratory findings in children. It introduces as well therapeutic options and preventive measures. 

Opracowanie na podstawie: Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19. An overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. Pediatr Infect Dis J 2020;39:355-368.
 

The article presents expert recommendations on diagnostic and therapeutic management in patients with spinal muscular atrophy (SMA). The authors of the recommendations summarized the current state of knowledge and presented the most important changes regarding SMA diagnostics, rehabilitation and orthopedic procedures and nutritional support. 

Opracowanie na podstawie: Mercuri E, Finkel RS, Muntoni F i wsp. Diagnosis and management of spinal muscular atrophy: Part 1: Recommendations for diagnosis, rehabilitation, orthopedic and nutritional care. Neuromuscular Disord 2018;28:103-115.
 

The article summarizes the results of a systemic review of data concerning prevention and treatment of infantile colic, which was conducted by Hjern et al. The authors of the publication from Acta Paediatrica identified 10 original randomized clinical trials and 2 metanalyses, which met the inclusion criteria. The systemic review indicates that there is moderately strong evidence for Lactobacillus reuteri DSM 17938 efficacy in infantile colic treatment, however more populous studies are still required to confirm it. 

Opracowanie na podstawie: Hjern A, Lindblom K, Reuter A i wsp. A systematic review of prevention and treatment of Infantile colic. Acta Paediatr 2020;DOI:10.1111/apa.15247.

In the age of coronavirus pandemic, the aspect of child nutrition and in particular breastfeeding raises much controversy. In a few studies of women with confirmed COVID-19 or infected with other coronavirus (SARS-CoV), the virus was not confirmed in breast milk. Are the current recommendations unambiguous? Is the transmission of infection definitely not followed by the milk of mothers with COVID-19? The article presents current recommendations of UNICEF, CDC, UENSP and Chinese experts in this field. The summary contains information that can help you make a decision depending on the development of the epidemic status as well as personal and hardware capabilities. The study was prepared on the basis of data on 29.03.2020. 

Ibuprofen is the principal non-steroidal anti-inflammatory drug (NSAID) for the treatment of inflammation, mild to moderate pain, and fever in children. It is also the only NSAID that can be used in three months old infants. During the SARS-CoV-2 pandemic, it has been suggested that the use of NSAIDs may worsen 
 the course of infection. So far, there are no clinical or population studies to assess the risk of NSAID use in COVID-19 patients directly. The EMA and WHO 
 do not recommend avoiding NSAID, including ibuprofen, for clinical indications for its administration. Favorable safety profile and effectiveness of ibuprofen 
 made the drug more and more often used in children and became available without medical prescription. The universal, unrestricted availability of the drug may cause abuse and side effects. The paper presents a summary of data on ibuprofen from medical literature from recent years. Pharmacokinetics, efficacy, and safety of the therapy have been taken into account, paying attention to clinical situations that increase the risk of side effects and thus to improve the safety of the drug available to OTC. Gastrointestinal side effects are rare, whereas kidney damage occurs mainly in dehydrated patients; therefore, ibuprofen should not be administered to children who vomit and have diarrhea. Similarly, alternate use of ibuprofen and paracetamol is no longer 
 recommended, nor should ibuprofen be administered to children with hypersensitivity to NSAIDs, including children with wheezing and suspected bronchial 
 asthma. While paracetamol can replace ibuprofen as an antipyretic, ibuprofen remains the treatment of choice for inflammation in children. 

Gastroesophageal reflux (GER) is a common and normal physiological process in children that accompanies the passage of gastric contents into the esophagus 
 with or without regurgitation and vomiting. Infant regurgitation is a common, physiological, transient process occurring in 50% healthy children. Persistent regurgitation is a frequent reason for parenteral concern, feeding distress and formula changes. The first-line management should focus on parental 
 education, reassurance and nutritional advice. Nutritional advice should stress the benefits of continuing breastfeeding for non-breastfed infants, while special AR infant formulas may be considered for non-breastfed infants. Alginates and antiacids are not recommended for uncomplicated infantile regurgitation. 

Polish system of post-transplant care is based on long-term follow-up of patients after renal transplantation in certified transplant centers. Several centers in the country are involved in adult post-transplant care, however there is a single pediatric center in-charge in this term (Children’s Memorial Health Institute). Many patients, living far away from Warsaw, must attend local primary care clinics, which solve their current ongoing medical problems. Medical issues are related to vaccination programs, managing respiratory, intestinal or urinary  infections, providing prescriptions for  generic immunosuppressants and a risk 
 of excess in regular pharmacotherapy resulting in non-adherence. Children after renal transplantation are specific patients and may present different 
 medical patterns compared to general pediatric population. 

Mitochondrial disease is the most common inborn errors of metabolism. They are caused by defects in respiratory chain in mitochondria, leading to a deficit of ATP production in the process of oxidative phosphorylation. Clinical symptoms are very different and most often include organs that need a lot of 
 energy to function – including nervous system, skeletal muscles, heart, liver, organ of vision and hearing. There is no sensitive and specific biochemical marker, the Nijmegen scale is useful to assess the likelihood of mitochondrial disease. The vast majority of these diseases are only symptomatic treatment, but you should be aware of the disease entities in which specific treatment is possible. 

Antibiotics are life-saving drugs whose excessive and unreasonable use leads to the increase of the bacteria resistance. The problem of modern medicine is more and more often the emergence of new multi-drug resistant bacterial strains, which pose a huge threat to patients. There is an increase in the incidence and deaths caused by pathogens worldwide, which until recently could have been treated using the first-line antibiotics. This problem also affects pediatric patients. In the face of these problems, it is extremely important to skillfully prescribe antibiotics and constantly expand knowledge associated with rational antibiotic therapy. 

Dermatoses occurring with the appearance of papular lesions on the child’s skin are a large and heterogeneous group of diseases. When 
 making a diagnosis, one should carefully collect and analyze the medical history of not only skin lesions, but also other symptoms presented, previous treatment, chronic diseases, vaccinations or trips. In the assessment of efflorescence, their morphology, the affected area of skin or mucous membranes, the order and speed of appearance of changes, their evolution and the way of regression should be considered. The article 
 describes selected disease entities, paying attention to the most important aspects of given diseases, to help readers interpret the clinical 
 picture, make the correct diagnosis and implement appropriate treatment. 

Focal nodular hyperplasia (FNH) is a rare, benign, liver tumor most commonly found accidentally during ultrasound examination. The lesion may be well delineated or isoechoic. Visualization of the so-called central scar and sorrounding arterial vessels by color doppler confirms diagnosis. It is advisable however to extend the diagnosis to other imaging examinations, MR or CT scan as much more reliable. Only in case of doubt, biopsy of the lesion is recommended 
 for definitive diagnosis. AFP is normal. Other primary liver tumors as well as well vascularized liver metastases should be considered in FNH differential diagnosis. To date, no tumor transformation has been described for FNH. 

Vascular Rings (VR) is a group of congenital malformations of the circulatory system. VR do not cause hemodynamic consequences. Abnormally formed aortic arch and its surrounding blood vessels can encircle trachea and/or oesophagus (like a ,,ring”), which can lead to breathing and swallowing difficulties. The typical symptoms of VR are stridor, wheezing, susceptibility to infections and dysphagia, but most of the patients remain asymptomatic. The most serious clinical course is associated with double aortic arch and pulmonary sling. Surgery is definitive treatment for VR. It is indicated in all symptomatic patients. The results of surgery are generally very good, but delayed treatment may result in permanent narrowing of the trachea or esophagus due to their impaired development. 

Invasive pneumococcal disease (IPD) and pneumococcal pneumonia can be associated with severe outcomes such as death and admission to intensive care. Guidance on routine immunization services during the COVID-19 pandemic in the WHO European Region of 20 March 2020 underlines that immunization services are an essential component of health services. Therefore, routine immunization sessions should be maintained as long as COVID-19 response measures allow. WHO prioritizes pneumococcal and seasonal influenza vaccines for the vulnerable population groups. In this article, we present children and adults belonging to risk groups who benefit most from using a vaccine with the broadest coverage of Streptococcus pneumoniae serotypes, which are responsible for IPD.  

Torsion dystonia type 1 (DYT1) is a rare, autosomal dominant disorder of extrapyramidal system which is also the most common type generalized dystonia of developmental age. The first symptoms develop usually at the age of 14 and are characterized by isolated – dystonic movements of one of the lower limbs, less often the upper limbs. With disease progression, the symptoms advance to the other limbs and trunk to become generalized (generalized dystonia) which leads to different types of physical disabilities. Current treatment of DYT1 is generally symptomatic and it is aimed to involuntary movements reduction, contractures prevention, and motor skills and quality of life improvement. 

• COVID-19 – epidemiologia, obraz kliniczny oraz postępowanie z ciężarną i noworodkiem
• COVID-19 a karmienie piersią
• Przebieg COVID-19 u dzieci  – stan wiedzy na marzec 2020
• Zakażenia koronawirusowe u dzieci, z uwzględnieniem COVID-19
• Stosowanie ibuprofenu w czasie pandemii SARS-CoV-2 – co warto wiedzieć?
• Grupy ryzyka inwazyjnych zakażeń pneumokokowych w trakcie pandemii COVID-19
   

Glutamine, glutamic acid and glutamates are a group of compounds occurring in nature and obtained synthetically. These compounds play an important role in building the structure of protein peptides and participate in important metabolic pathways in the human, animal and plant body. This group of compounds includes monosodium glutamate (MSG), which, in addition to the properties described above, is attributed a specific “umami” taste. Monosodium glutamate has been used for many years as a condiment to highly processed food products. This paper describes the natural sources of these compounds as well as their biological properties. The principles of using glutamine and sodium glutamate (MSG) as food ingredients or compounds added to amino acid milk-free formulas, based on international and Polish legal regulations are also given. 

Atypical hemolytic-uremic syndrome (aHUS) is a rare disease, a member of thrombotic microangiopathies family. Genetic or autoimmune defect of complement system regulation is underlying mechanism. Clinical pattern is a consequence of acute ischemia of  target organs, including kidneys, central nervous system, pancreas and liver, accompanied by acute hemolysis and thrombocytopenia. General management includes fresh frozen plasma transfusions (or therapeutic exchange) and dialysis in renal failure. Targeted treatment is based on repeated administration of monoclonal antibody, blocking complement system (eculizumab), which breaks the underlying mechanism, however does not cure the primary defect.

Macro- and micronodular adrenal hyperplasia are benign proliferative lesions that together with adrenal adenoma and adrenal carcinoma are responsible for 10-20% of all cases of Cushing’s syndrome (CS). Classical symptoms of CS can occur (such as: weight gain, central obesity, and slower growth rate as well as round face, stretch marks and hypertension), however, the presentation of the disease can be atypical. The classification into macro- and micronodular forms was made on the basis on the size of the nodules on high-resolution computed tomography to: smaller than 1 cm (micronodular hyperplasia) or larger 
 than 1 cm (macronodular hyperplasia). Primary pigmented nodular adrenocortical disease, which is a microdular disease, may occur as part of Carney 
 complex with co-existent heart and skin myxomas, lentigines of skin and mucosa, breast fibroadenomas, and other endocrine gland tumours. Diagnosis of adrenal hyperplasia consists of confirming hypercortisolemia, and, in the next stage, confirming ACTH-independent CS and lack of cortisol suppression in the high-dose dexamethasone suppression test (in most patients with primary pigmented and isolated micronodular adrenocortical disease a paradoxical increase of cortisol level after high dose of dexamethasone is observed). As a treatment, many authors suggest bilateral adrenalectomy in patients with overt CS, others recommend in some cases unilateral adrenalectomy and suggest considering a removal of the second adrenal gland in case of the recurrence of hypercortisolemia. The Endocrine Society recommends a one-stage bilateral adrenal resection. In the case of unilateral adrenalectomy, glucocorticosteroid substitution is necessary until the normal function of the hypothalamic – pituitary – adrenal axis is maintained; after bilateral adrenalectomy, glyco- and mineralocorticoid substitution is necessary throughout life. 

Introduction and aim: Invasive meningococcal disease, most often caused by meningococcus B, remains a major health problem worldwide and in Poland, where only a dozen or so percent of children are vaccinated against meningococcus B. Our study aimed to determine the reasons why parents do not decide to immunize their children.

Material and methods: We examined with the questionnaire 100 parents of generally healthy children hospitalized at Warsaw Medical University Hospital. Demographic data, parents’ knowledge of the disease and vaccinations, as well as reasons for not choosing immunization, were evaluated. The questionnaire included one of two randomly selected information texts on the condition – one of emotional (A) and one of scientific (B) nature. It was assessed whether reading the information text affected the parents’ opinion on the inclusion of meningococcal B vaccination in the mandatory vaccination calendar.

Results: The survey was filled in by 93 parents. The majority of respondents indicated a doctor as the primary source of knowledge about vaccination, with 41% of them not receiving information about the possibility of protection against meningococcus B. The most frequently reasons for not vaccinating a child against meningococcus B included: rare occurrence and low risk of the disease (25%), high price of the vaccine (24%), lack of knowledge about availability of the vaccine (20%) and too many vaccinations (20%). After reading the information text, regardless of its nature, the percentage of parents declaring the necessity of obligatory vaccination against meningococcus B in their children increased significantly from 62 to 75%.

Conclusions: Doctors, who remain the most important source of information about immunizations for parents in Poland, too rarely offer vaccination against meningococcus B. Brief written information about invasive meningococcal disease and available vaccines is an effective tool for parents. A reimbursement of the meningococcal B vaccine should increase the percentage of vaccinated children in Poland. 

The common European viper (Vipera berus) is the only venomous snake in Poland. It occurs in several varieties. In case of a viper bite, hospital observation is recommended. The severity of poisoning depends mainly on the amount of toxin injected into the body in relation to the victim’s body weight. Therapy includes procedures aimed at delaying venom absorption, application of an effective antidote and selected drugs. The following case of a 12-year-old boy hospitalized in a children’s ward after a viper bite became an inspiration to develop a practical workflow of subsequent stages of medical care.