Childhood asthma is a specific disease that requires special treatment depending on patient’s symptoms and age. A PRACTALL consensus prepared by expertsfrom Europe and USA gives practicing physicians first complex report about childhood asthma. Authors present second part of PRACTALL guidelines particularly concerning diagnosis and treatment of bronchial asthmain the different age groups of children.

The present asthma guidelines do not recommended daily treatment of children with mild intermittent asthma. However, in the course of disease, many of them have severe asthma exacerbations which require hospital admission.What is the risk of lack of regular treatment in this patients’group? Which of patients with mild intermittent asthma are in the risk group of chronic asthma? Are there any parameters indicating the regular treatment necessity inmild intermittent asthma? Which medications could be effective? The answer on these and others questions on the basis of current papers and publications was undertaken.

Adequate vitamin D intake and its status are importantn ot only for bone health and Ca-P metabolism, but for optimal function of many organs and tissues of the body. Due to documented changes in the dietary habits and physical activity level, observed in growing children and adults, the prevalence of vitamin D insufficiency is continuously increasing. In consequence, there is anurgent need to establish and provide actual vitamin D supplementation scheme, including proposed doses ofdaily vitamin D intake for infants, toddlers, children and adolescents as well as for adults, including pregnantand breastfeeding women.

Recommendations on infant nutrition are mainly based on clinical trials which assessed direct effect offeeding on infant health. Recently, long term effects for health are also taken into consideration. Many prospective observations of the kohorts of infants who underwent nutritional intervention are performed and thus, long term consequences of early feeding can beestimated.

The immune-enhancing ingredients of diet such as arginine, glutamine, ω-3 fatty acid and nucleotides are now attracting considerable interest. This article introduces the mechanism of action, potential role and based on the medical trial’s results of applying them to patients of pediatric intensive care.

Medical errors, which include also errors of nutritional therapy, result in a significant number of complications. Their occurrence varies from 20 to 50%, depending on the specific ward. Nutritional therapy may be inappropriate due to incorrect admixture ingredients, its preparation and dosage or erroneous monitoring, but also concomitant diseases. The article presents basic reasons of erroneous nutritional therapy.

The aim of this article is to review the rationale and evidence of polyunsaturated fatty acids (PUFA) supplementationin enterally fed children. Data regarding the advantage of PUFA supplementation in formula fedpreterm and term infants are inconsistent. PUFA supplementationin the prevention and treatment of metabolic syndrome, allergic diseases, and infectious diseases may be beneficial but further studies are required.

Efficacy and safety of more then half of today licensed medicines in Europe have not been testedin pediatric population. It leads to the frequent “off-label” and unlicensed use of medicines in this group of patients, especially in hospitals. The lack of pediatric data leads to increase the risk of adverse effects. Most frequently, dosage and route of administration prescribed in children are not compliant with authorization documents or available forms, however use in children medicines registered onlyfor adults is less frequent. In 2007 new Pediatric Regulation was introduced in European Union changing authorization procedures for pediatric medicines and creating new requirements and motivation systems for pharmaceutical industry promoting clinical trials in this area. According to the Regulation, Pediatric Committee in EMEA was established, whichis responsible for scientific advise, evaluation of applications and plans of clinical trials in pediatric population. Additionally, European network for pediatricmedicines was introduced, coordinating trials undertaken in member states. In clinical practice, in case of absence strict contra-indication of use particular medicine in children, decision concerning “off-label” use should be based on detailed risk benefitanalysis according to scientific data and expertopinion. Active promotion of “off-label” use of medicines is illegal and should be reported to the authorization agency.

5-months-old infant with normal birth history, fed with modified milk formula, was admitted to the hospital because of fever and suspicion of acute infection. She presented with dyspnoe, tachycardia, oliguria, small oedema, hypernatremia (Na – 178 mmol/l, K – 4,2 mmol/l), impaired renal function (creatinine – 1,5 mg/dl, urea– 141 mg/dl), metabolic acidosis, glucosuria and increased inflammatory markers. Antibiotics, hydration, low dose furosemide and low sodium diet led to clinical and laboratory improvement. We used the modified milk formula with 30% lower sodium content in comparison with the age-appriopriate milk formula. We found that the child was chronically fed with hyperosmolar formula containing over three fold higher sodium and osmolyte load caused by inappropriate preparation of formula – instead of recommended 3 doses of formula pulver pro 100 ml water it was 10 – pro 100 ml. Conclusion: inappropriate preparation of milk formula forin fants may cause metabolic disturbances including acute renal failure.

Aim:
The aim of the study was to assess the frequency of NOD2/CARD15 mutations in Polish children and torelate them to clinical presentation.

Methods:
57 children, 28 with ulcerative colitis (UC) and 29 with Crohn disease (CD) were enrolled to the study and genotyped for three disease‑associated single nucleotide polymorphisms of NOD2/CARD15 gene (SNP13 3020InsC;SNP8 R702W; SNP12 G908R). The SNP presence was correlatedto CD phenotype (localization, behavior, extraintestinal presentation, steroid response, surgery performed).The control group was 32 healthy volunteers.

Results:
12 out of 29 (41%) CD patients and 4 out of 28(17%) (p<0.05) UC patients and 2 out of 32 volunteers(6%) (p<0.05) had CARD 15 variants detected. Three 3020InsC variants and one G908R were found in UC patients whereas ten 3020InsC variants and 3 G908Rin CD patients (one patient carries two variants). No difference was found in CD phenotype between SNP carriers and non‑carriers. The details were as follows: localization (L1/L2/L3): SNP carriers 4/4/4 vs. 3/3/11 in SNP non‑carriers; behavior (B1/B2/B3): 11/1/0 vs. 13/3/1;extraintestinal presentation (no/yes): 11/1 vs. 11/6; steroid response (yes/no): 12/0 vs. 14/3; surgery performed (no/yes): 8/4 vs. 13/4, respectively.

Discussion/Conclusion:
1. The NOD2/CARD15 gene mutations are common in polish pediatric CD patients and frequency (41%) is similar to those reported in other countries in middle Europe. 2. The frequency of NOD2/CARD15 gene mutations is higherin pediatric CD than UC patients and healthy volunteers. 3. The presence of NOD2/CARD15 gene mutations seems not to correlate with CD phenotype.

Transition of an adolescent with a chronic disease to the adult health care institution seems to be not only alogistic problem. The aim of the article is to present the psychological difficulties associated with this fact in the background of common adolescence-related problems.The article also describes some methods how to facilitate the patient’s adaptation to a new health care institution.

Upper respiratory tract infections are the most common reason of outpatient visits in the first years of child’s life. Epidemiologic data shows that their average incidence is 6–12 per year, they are usually treated with antibiotics. Immunostimulants are commonly used inpediatric practice to improve function of the immunity system. In this article authors discuss the administration schedule, clinical efficacy and safety of bacterial immunostimulants in prevention of upper respiratory tract infections in children.

In the article human intestinal ecosystem was discussed, especially its unique pattern. The human microbiotahas not been completely characterised yet and little is known about its diversity. Genetic analysis showed, that human intestinal microbiota is host-specific. Metagenomic analysis showed that bacterial populations in different parts of the intestines present an enormous diversification. Moreover it changes with ageingand thus can be modified by many environmental and host-specific factors. The most favourable way of modification of the intestinal microbiota is an appropriate diet and prebiotic or probiotic preparations. The host specificintestinal microbiota of healthy humans do not discriminate the probiotic preparation recommended for a person, due to the fact that tested microbiota do not reflect its real state in human faeces. Beneficial effect of pre- and probiotics on people’s health must be demonstrated in clinical trials in humans.

The number of law suits filed by patients in relation to injuries caused by hospital-acquired infections is increasing. Polish judicial decisions assume liberal evidence standards with regard to the liability of healthcare institutions for such infections. These standards allow for the so-called factual presumptions or presumptions prima facie. Prima facie evidence may be conducted inmany ways and it significantly decreases the hospital’s chance of effective defense. This article presents a range of arguments which may be used by the parties ofa dispute in such circumstances.

The author judges the relations between a doctor-mentor and a trainee-doctor. He strongly criticizes those doctors who kill animals as hunters. The author believes that truth is a superior value to corporate loyalty.