Juvenile idiopathic arthritis (JIA) is the most commoninflammatory arthropathy in childhood. It is characterizedby persistent joint inflammation. The onset of thedisease is before the age of 16, arthritis lasts for more 6weeks and its causes are unknown. The main role in thepathogenesis of JIA play the proinflammatory cytokineslike tumor necrosis factor and interleukin 1.The present classification consists of six types of thedisease’s onset. The course of the disease varies andcan lead to several complications. The plan of therapeuticmanagement depends on the form of the diseaseand its activity.The article presents classification, diagnostic criteria,clinical picture, course and present therapeuticmethods in JIA.

Haemophagocytic syndrome (HS) represents a rare,life‑threatening condition, caused by congenital oracquired defect in cellular cytotoxicity that leads touncontrolled hypercytokinaemia and infiltration of differentorgans with cytotoxic T‑lymphocytes and hyperactivatedmacrophages. Cardinal symptoms include prolonged fever, hepatosplenomegalyand duo- or pancytopenia. Among biochemicalaberrations there are elevated serum ferritin,hypertriglyceridemia and hypofibrinogenemia. Morphologicalhallmark – haemophagocytosis, observedin hyperactivated macrophages, may not be found inthe initial bone marrow smears or lymph node examination.HS is divided into primary HS caused by genetic defectsor inborn errors of metabolism, and secondary HS dueto infections, neoplasms and autoaggressive diseases.Because both, primary and secondary HS, are most oftentriggered by infection, especially by EBV or CMV, thepresence of infection does not exclude primary forms ofHS, such as familial haemophagocytic syndrome (FHL).The onset of FHL is most common below 2 years of age,but it has been also reported in teenagers and youngadults. Secondary HS has been found in all ages.Although diagnostic guidelines have been developed,it still remains difficult to establish the diagnosis of HSin its early stages, especially in older children whohave been healthy before. The prognosis in untreatedHS is poor. Therapeutic management is based onprotocol HLH-2004, including the use of etoposide,glicocorticosteroids, cyclosporine A and metothrexate.In primary HS and therapy‑resistant secondary HS,the last step of treatment, after achievement of completeor partial remission, is haematopoietic stem celltransplantation.

In the article principles of symptomatic treatment of upperand lower respiratory tract infections were discussedin the light of evidence based medicine. Widelyantypyretic, painkilling, decongestant, antitussic andsecretolytic therapies were discussed. Symptomatic treatmentof bronchiolitis was also presented. Literatureoverview concerning different aspects of symptomatictreatment was also briefly outlined.

The abdominal pain is one of the most common and importantsymptom of abdominal diseases in children andadults. It can also be a symptom of systemic disordersand disease of organs outside abdominal cavity (abdomen-and extraabdomen-derived abdominal pain).Patients with acute abdominal pain need immediatesurgery very often. Wrong diagnosis can delay surgicaltreatment and lead to complications and unfavourableprognosis. Precise localization and character of abdominalpain (organic, functional, psychogenic pain) arevaluable diagnostic indicators. Each general practitionerand specialist should acquire the ability of properassessment of symptomatology, differential diagnosticsand complex therapy of abdominal pain. Not only gastroenterologicalconsultation is necessary in patientwith abdominal pain, also consultations of other specialists(neurologist, surgeon, urologist, gynaecologistetc.) are very important.

In this paper current law acts concerning the informationplaced on the food labels are discussed, as well asprinciples of the related EU directives, which are still inpreparation. It is considered whether label data like generalproduct’s information or sustenance can influenceproduct’s selection and realization of the health-promotingdiet. The emphasis is placed on food productsdestined for children. It is pointed out that moderateconsumption, diverse diet and avoidance of the „emptycalories” presents basis of balanced nutrition.

Authors present the mechanisms of action, dosing andresults of immunosupresants as azathioprine, 6-merkaptopurine,methotrexate, cyklosporine, tacrolimus,biological agents as infliximab and adalimumab andinvasive treatment as aferesis. They can be prescribedafter sulfasalazine and 5-aaminosalicylates are regardedas insufficient. Due to wide range of adverse eventsthey should be used in specialist sites with surgeryprovided, which may be applied to patients with IBDwith no effect of immunosuppressive therapy.

Due to their anti‑inflammatory and immunosuppressiveproperties corticosteroids are prescribed in manyvarious disorders. Topical corticosteroids in comparisonto systemic corticosteroids have less side effectsand not rarely show similar efficacy. Authors presentmechanism of action and indications for use of corticosteroidsin selected diseases.

There is an increasing appreciation that multiple sclerosis(MS) can affect children. Up to 10% of MS patientsexperience their first symptoms before the age of 16.The natural history of MS in childhood differs from theone that is observed in adult patients. The differentialdiagnosis of MS in children should also encompasssome pediatric diseases. Recently, the diagnostic criteriafor MS in children were published, including MRIcriteria for MS in childhood. Due to high frequency ofrelapses and the risk of disability at young age, earlydiagnosis and treatment of MS in children is veryimportant. This work presents recent data regardingepidemiology, pathogenesis, natural course, diagnosisand treatment of MS in children.

Inhaled allergy is a common medical problem. The mainclinical manifestations are allergic rhinitis and/or bronchialasthma. Proper diagnosis and treatment are cornerstoneduring childhood because those two manifestationscan be prolonged to the adulthood.

Allergic rhinitis is one of the most prevalent medicalconditions. Therapy of allergic rhinitis and conjunctivitisincludes allergen avoidance, pharmacotherapy and immunotherapy.The basis of allergic rhinitis treatment isthe reduction of the contact of nasal mucosa with allergens.Antihistamines and intranasal corticosteroids aremajor elements of therapy. The goal of management isto achieve optimal symptom control. Antihistaminesand intranasal corticosteroids are widely recognized asthe most effective pharmacotherapy for allergic rhinitis,in adults and children.

The neurotransmitter disorders represent a groupof rare neurometabolic defects characterized by abnormalitiesof neurotransmitter synthesis and breakdown.This review focuses on the clinical disordersof biogenic amines and GABA metabolism. There arefollowing known disorders of dopamine and serotoninsynthesis: tyrosine hydroxylase deficiency (TH),tryptophan hydroxylase (TPH), aromatic amino aciddecarboxylase deficiency (AADC), as well as defects oftetrahydrobiopterin synthesis: guanosine triphosphatecyclohydrolase(CHGTP), dihydropteridine reductase(DHPR), 6-pyruvoil tetrahydro-pterin syntase (PTPS)and sepiapterin reductase (SR) deficiencies. The disordersof GABA metabolism require an increased index ofclinical suspicion. There are following known disordersof GABA synthesis: glutamate decarboxylase (GAD),GABA transaminase (GABA-T) and succinylsemialdehydedehydrogenase (SSADH). All these defects requirecerebrospinal fluid (CSF) analysis. Analyses of pterinmetabolism in CSF and in urine, assessment of enzymaticactivities and oral phenylalanine loading testat dose of 100 mg/kg are applied for the differentialdiagnosis.There is an improvement in recognition of neurotransmitterdisorders in the pediatric population nowadays.Neurotransmitter disorders are treatable conditionswith a potentially widening spectrum but with a prognosisdependent on early intervention. Clinical and biochemical characteristics of neurotransmitterdisorders are shown in this study.

In this paper we described pathological lesions in periodontiumand oral mucosa in children with primary andsecondary immunodeficiency or caused by undesirableeffects of drugs and therapeutic methods.Various systemic diseases, drug administration andtherapeutic methods are often linked with presenceof pathological lesions in periodontal tissues and oralmucosa. Systemic factors may cause direct cell/tissueinjury or indirect defect of local immune defense, increasedtissue susceptibility, increased risk of pathologicalfactors. Local defense may be impaired due to immunesystem dysfunction or unfavourable changes inoral cavity ecosystem, especially amount and qualityof saliva.

Wilson’s disease is a metabolic disorder caused byexcessive accumulation of copper in tissues, mainlyin the liver and in the central nervous system. Penicylamineand zinc are used in therapy. We presenttwo case reports of girls with Wilson’s disease whoseserum total bilirubin level was periodically elevatedin spite of therapy. In both cases molecular geneticanalysis confirmed Gilbert’s syndrome. Patients withWilson’s disease in whom complete normalization ofbilirubin and liver tests was not obtained should undergofurther diagnostic evaluation for concomitantdiseases.

Diagnosis of vertigo, dizziness and equilibrium disturbancesin children is a challenge for physiciansbecauseof multipotential etiology. Moreover developmentalprocess of the balance body system is stilllasting through the childhood. Limited communicationskills are also a problem. The study presentsa 5‑year‑old girl with episodes of true vertigo and dizzinesscaused by epilepsy. The differential diagnosiswas complicated because of positive medical history(coexistence of hearing loss, headache, brain injure,perinatal risk factors of brain damage). Final diagnosiswas establishedbased on the electroencephalographywhich was definitely abnormal and audiological andotoneurological tests. After proper treatment (farmacotherapy)all symptoms diseappeared. Also the hearingaid was recommended. Evaluation of vertigo inchildren should consist of medical history and an otoneurologicalexamination as well as multidisciplinaryteam members.

According to experts recommendations optimal nutritionfor infants is exclusive breastfeeding for first 6months of life and continuation of breastfeeding duringintroduction of complementary foods as long as babyand mother wish. There are situations when a neonateor an infant needs supplementation, for example infantsucks a breast ineffectively, a mother has an insufficientmilk supply, a mother and a baby are separated.The supplementation may be necessary for a certainperiod of time or till the end of breastfeeding. It shouldbe carried on the way that provides suitable nutritionfor an infant, but also maintains mother’s lactationat optimal level and makes possible the return tobreastfeeding. It is important to choose the propermethod of giving the supplement according to theage and state of the infant, the planned period andamount of supplementation, the type of suckling mechanismdysfunction if found. The method should beaccepted and possible to apply by parents and hygienicrules must be complied. The paper discussesin details the indications for using all of the knownalternative feeding methods, their advantages anddisadvantages.

Objectives: The aim of this study was to assess thenumber of Candida spp. yeast in saliva and dental plaque,the interleukin‑2 concentration in saliva to thecondition of gums in patients with ALL before chemotherapyhad been started and during antineoplastictreatment.Materials and methods: The clinical examination included78 children aged 2–18 suffering from ALL. Childrenwere examined in three stages: the first examinationtook place before antineoplastic treatment, the secondexamination within the period of one to five months ofantineoplastic treatment, the third examination fromhalf to one and a half year after chemotherapy wasstarted. The clinical examinations were assessed thecondition of gums with GI index. The number of Candida spp. yeast was determined in saliva and in dentalplaque and IL‑2 concentration in the saliva was determinedby ELISA.Results: The average value of GI index in examination1, 2 and 3 were as follows: 0,08 ±0,34, 0,007 ±0,04, 0,02±0,13. In examination 1 number of Candida spp. coloniesin saliva corresponding to 104CFU/ml was observedin 32,07% of children however number of Candidaspp. colonies in dental plaque corresponding to105CFU/ml was observed in 33,96% of children withALL. The average IL‑2 concentration in saliva in examination1, 2 and 3 were: 2,4 ±1,0, 2,5 ±1,84, 3,1 ±1,78U/ml.Conclusions: The high values of the average GI indexwere observed, typical for inflammatory conditions ofgums and high number of Candida species colonies wasobserved in children with ALL. It was demonstrated thatthere is a significant correlation between the numberof yeast colonies of Candida species in oral cavity andthe interleukin‑2 concentration in saliva in children sufferingfrom ALL. Increase in IL‑2 concentration in salivaand often appearing high titer of Candida spp. colony inthe oral cavity during chemotherapy can cause a numberof mucosal infections, including oral candidiasis inchildren with ALL.

Enteral nutrition in prematurely born infants was assessedon the basis of questionnaire sent in 2008. Answerswere received from 23 PICU (pediatric intensivecare units) and 117 NW (neonatal wards): 80 NW of thesecond degree of reference and 37 NW of third degreeof reference. In conclusion: 1. Assessment of gastric residuals should be applied in the majority of NW andnearly half of PICU. 2. Current feeding practices in prematureswith PDA reflect lack of commonly acceptedrules. 3. Diluted milk is still used in 1/3 PICU and in someNW, despite the knowledge that it is not beneficial forneonates. 4. Studies concerning safety of enteral nutritionin neonates with umbilical catheter are required.