Over the last years there is an increase in number of hospitalized pediatric patients with venous thrombosis. This rise is considered to be a result of advances in intensive care, longer survival of children with chronic conditions and improvement in diagnostic techniques. The majority of pediatric patients with thromboembolism have underlying coexisting risk factors. Regardless of the presence or absence of genetic predisposition, it is thought that acquired factors play the most significant role. Symptoms such as pain and oedema of the extremity may suggest thrombosis and require immediate diagnostics and treatment in the hospital. Anticoagulation treatment and prophylaxis in children are mainly extrapolated from adult studies. Anticoagulants most frequently used in children are low-molecular-weight heparin (LMWH), unfractionated heparin (UFH), oral vitamin K antagonists (VKA) and thrombolytic agents. Consequences of thrombosis might be very serious and life-threatening. Complications of thromboembolism includepost-thrombotic syndrome. Inspite of anticoagulation prophylaxis, thrombosis recurrence is being observed.

Strabismus is the cause of binocular vision disorders in children. The etiology of strabismus is varied and main reasons of the occurring are refractive errors, genetic factors, developmental changes, inflammatory and traumatic disorders, ocular tumors and associated abnormality of the nervous system. Treatment of strabismus should begin as early as possible to avoid permanent reduction in visual acuity and to obtain proper binocular vision. After failure of conservative treatment, surgical treatment should be removed.

The intestinal microbiome has become the source of attention for many researchers and clinicians from different fields in addition to industry becauseits role in modulating immunity, controlling inflammation and energy homeostasis and the potential of bacteriotherapy. The fetus is already exposed to the influence of bacteria from their mother’s microbiome and further input takes place at the time of delivery. The infant is exposed to their mother’s vaginal and fecal flora which helps establish the infant’s own intestinal microbiota. Babies delivered by Cesarean section (CS) are not exposed to such bacteria and therefore colonization of their intestines differs from that of vaginally delivered babies. Birth by CS has been associated to increased incidence of certain illnesses in addition to childhood obesity. Obesity and intestinal bacteria have an interrelationship where both affect each other. Attempts have been made to modify the intestinal microbiome by administration of therapeutic bacteria (probiotics). In addition to the well know uses of probiotics in acute diarrhea of childhood, probiotics are being used more and more frequently for the prevention of necrotizing enterocolitis despiteof the fact that studies may be still insufficient to recommend their routine use. Several papers now indicate that certain probiotics may be useful inpreventing manifestations of atopic disease, shorten incidence and duration of childhood diarrhea, antibiotic associated diarrhea, incidence and severity of necrotizing enterocolitis, ameliorate infantile colic and treat constipation. Because of the role of the microbiota in obesity, some probiotics have been used and shown to be effective in reducing body mass. More recently, fecal transplantation has been used to treat relapsing infection by Clostridium difficile. This review discusses some of the relevant information on intestinal microbiota, its development, function, dysfunction and potential ways to correct them.

There is no universally accepted definition of acute-on-chronic liver failure (ACLF). It usually occurs in patients with chronic but previously wellcompensated liver disease in whom an acute liver dysfunction occurs. Factors releasing ACLF differ among geographic regions and investigated population. ACLF is often associated with the development of multi-organ failure leading to high mortality. Authors present up to day knowledge of this syndrome from the clinical, pathophysiologic and prognostic perspectives.

The article is a review of the literature on preferences of fruits and vegetables and feeding behaviors of children in infancy and early childhood. The review was based on literature review and results of HabEat project. The article discusses factors determining the feeding behaviors and preferences of fruits and vegetables which directly affect their share in the diet. Particular attention was paid to the role of breastfeeding and its duration, complementary feeding of infants and identifies ways to enhance the acceptance and preferences of new products, including vegetables in infants and toddlers. Finally, the role ofeducation and parental feeding practices were discussed and recommendations for infants and children - materials for parents and health professionals prepared within the project HabEat - were presented.

The univentricular heart accounts for 7,7-7,8 % of all congenital cardiac malformations. One well developed ventricle and the second one rudimentary orhypoplastic or even lack of it, are common for this type of lesions. There are four anatomic variants depending on the morphology of the dominant ventricle. Their complexity is even bigger thanks to different types of the atrioventricular connection and the concomitant intra- and extracardiac anomalies. Clinical manifestation hinge on the type of hemodynamic disturbances. There are three types of hemodynamic disturbances: decreased pulmonary perfusion, decreased systemic perfusion and balanced pulmonary and systemic perfusion. Echocardiography is the most useful diagnostic modality, while medical management comprises of farmacological treatment, catheter-based interventions and staged surgical procedures. Orthotopic heart transplant is the only alternative option. The above-mentioned approach improved considerably the long-term survival in patients with single functional ventricle. According toother papers many patients with univentricular hearts report a satisfactory quality of life just after finishing staged surgical therapy. The aim of this review was to pay attention to cardiologists and other medical professionals who are challenged by the growing population of children, adolescents and adults with one functional ventricle and need to apply multidisciplinary approach.

Phenylketonuria (PKU) is the most common error of amino acid metabolism in Poland with an incidence 1 in 8000 live births. The nutrition of patients with PKU adapted to metabolic condition, determines the proper psychomotor development. The “golden standard” treatment for phenylketonuria is alow phenylalanin diet. The purpose of this revive is to provide clinicians with current updated information about dietetic treatment of PKU patients and the importance of intense expert dietary counseling.

Doctors remain at the same risk of common diseases as normal population. However, they are very specific, difficult and petulant patients. Similar attitudeis presented when a doctors’ family member is the patient. The background of this phenomenon is as following:- they often demand rapid (“short-cut”) diagnosis from their fellow-doctors suggesting immediately their opinion on diagnosis;- once given medical advice they modify these recommendations upon their own opinion;- often treat themselves (or their family) empirically having easy access to the drugs on prescription. All this leads to misunderstandings, drug abuse and diagnostic and therapeutic failures. Being treated by independent specialist only would be a solution,however not acceptable to many doctors.

Objective:
The aim of this study is to present infectious triggers, clinical symptoms, additional work-up and treatment of children with secondary hemophagocytic lymphohistiocytosis (HLH). Material and Methods:
Retrospective analysis of 25 children with secondary HLH hospitalized in the Department of Pediatrics, Nutrition and Metabolic Diseases in The Children’s Memorial Health Institute, in the years 2005-2013. The diagnosis was based on the criteria of HLH-2004 Study Group, Ravellior expert opinion. Treatment in all cases was individualized. Patients with secondary HLH were divided into four groups 1) systemic connective tissuediseases, 2) infections, 3) neoplastic diseases, 4) without a predetermined cause. Statistical analysis of selected laboratory parameters and clinicalsymptoms was performed.
Results:
Seventeen girls (68 %) and eight males (32%) had HLH. Macrophage activation syndrome in the course of systemic onset juvenile idiopathic arthritis (JIA) (48%) and HLH of unknown cause (24%) were the most common form of HLH. Viruses and intracellular bacterias (Mycobacterium, Mycoplasma) were the main infectious triggers. The predominant clinical symptom was fever (n = 25, 100%), the other features were: hepatomegaly (n =23, 92%), skin lesions (n = 22, 88%) and splenomegaly (n = 19, 76%). Subsequently, there were symptoms of respiratory (n = 16, 64%) and cardiovascular (n= 15, 60%) dysfunction, lymphadenopathy (n = 12, 48%), swelling or pain of extremities (n = 12, 4 %) in HLH patients. Nearly one third of patients presented with gastrointestinal symptoms (n = 8, 32%), and less than ¼ - nephropathy (n = 6, 24%) and neurological symptoms (n = 6, 24 %). Median number of leukocytes was 14.8 x 10*3 cells/ul, platelets - 96 x 10*3 cells/ul, hemoglobin - 8,7 g/dl, ferritin - 18040 ug/ml, fibrinogen - 1 g/l , C-reactive protein - 13mg/dl, procalcitonin 5,5 ng/ml, aspartate transaminase - 120 u/l , alanine transaminase - 130 u/l. Steroids were used in all patients, cyclosporine received88% of the children, intravenous immunoglobulins - 80%. There were no deaths among patients, there was no long-term complications and recurrences. Thirteen children require chronic treatment of the underlying disease (JIA).
Summary:
There were no significant differences in the frequency characteristic clinical symptoms and additional work-up findings between differentforms of secondary HLH. The most common form of secondary HLH is macrophage activation syndrome in the course of JIA. The clinical course ofsecondary HLH is very heterogeneous with multiple organ manifestations (fever, hepatosplenomegaly, skin lesions, cardiovascular and respiratoryfailure). Elevated serum concentrations of C-reactive protein, procalcitonin and leukocytosis with the presence of band forms may occur in HLH patientsand these laboratory abnormalities may erroneously suggest other conditions (e.g., sepsis, SIRS, MODS). Hemophagocytic syndrome is a life-threateningcondition because of rapid clinical course with multiorgan failure. The treatment includes immunosuppressive drugs combined with antibiotics. In severecases, patients may require the treatment in the intensive care unit, biological agents, hemofiltration, plasma exchange.

Objective:
The aim of this study was to determine the CLABSI rate in the Neonatal Intensive Care Unit in the Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw in 2011. We compared our results with data collected in 2011 and published by the US Centers for Disease Control and Prevention (CDC).
Methods:
Data were collected retrospectively. The analysis included infants admitted to the department from January 1, 2011 to December 31, 2011,in whom parenteral nutrition was administered through a peripherally inserted central venous catheter (PICC). We defined central line-associated bloodstream infection (CLABSI) using the criteria recommended by CDC. The incidence of CLABSIs was calculated according to the formula recommended by CDC and expressed as a number of CLABSIs per 1000 catheter-days.
Results:
We analyzed a total of 216 PICCs placed in 169 neonates. We identified 23 cases of CLABSI which occurred over 2523 catheter-days. The most frequently isolated pathogen within those cases was methicillin-resistant coagulase-negative staphylococcus (21 cases). The rate of CLABSI was 11.8 per 1000 catheter-days for infants with birth weight ≤ 750 g, 7.44 for infants with birth weight 751-1000 g, 7.71 in the range of 1001-1500 g and 12.17 in therange of 1501-2500 g.
Conclusions:
The results of our study indicate a high incidence of CLABSIs in our department and the need to introduce changes in the care of patients with central access. Quality improvement programs in this area should include continuing education of medical care providers, supervision of sterile procedures performed by staff and the selection of appropriate equipment and materials.

Objectives:
The purpose of this retrospective study was evaluation of epidemiology, histological findings of the breast masses in young girls andverification of indications to surgical intervention.
Material and methods:
In retrospective study of breast masses over a period of 11 years (2001-2011) we encountered 36 girls younger than 18 years. Relevant clinical history such physical exam, duration of symptoms, presence of associated symptoms and signs such as pain, discharge or inflammatory changes were also reviewed. The history of malignancy and family history of breast cancer were also collected. Sonographic findings were characterized according to location, multiplicity, size, shape, echogenicity and Doppler vascularity.
Results:
8 patients were not operated on because of stable size or resolution of the breast mass and required only clinical examination and possibly observation. Hemangiomas of the breast in two infants undergo regression after the local treatment with steroids. 5 girls were diagnosed by fine-needle aspiration and they didn’t require surgery treatment. Surgical intervention was required for the 21 girls and for 20 of them fibroadenomas was diagnosed. No instances of primary breast malignancy were noted.Conclusions: the majority of breast masses in girls are benign and fibroadenoma is the most common lesion encountered. Modern ultrasound is reliabletechnique to diagnose breast masses and allowed to avoid operative procedures in girls.

Background:
Evidence from epidemiological studies suggests a serious problem of vitamin D deficits worldwide with the prevalence reaching 90% of populations. Published data on vitamin D status in Poland are still very limited. Therefore, we aimed to carry-out a large cross sectional study to evaluate the vitamin D status, based on serum 25-hydroxyvitamin D levels, among adult population in urban areas of Poland.
Material and Methods:
In late February 2014, a total of 2687 adult volunteers (2091 women, 596 men) aged 54.2 ± 16.1 years (range: 15.6 + 89.8) from 10 major Polish cities were enrolled in the study. Serum concentrations of 25(OH)D were determined in all these participants using the Liaison XL system (DiaSorin; CLIA method), and anthropometric measurements (weight, height, body mass index) were also performed.
Results:
Mean 25(OH)D concentration in the studied population was 17.7±10.1 ng/ml while 67.5% had 25(OH)D level < 20 ng/ml, other 22,8% + had suboptimal level of 20-30 ng/ml, and only 8.4% demonstrated adequate level (30-50 ng/ml). In 90.3% of the population, a severe or moderate deficit i.e. 25(OH)D level below 30 ng/ml was found. A better vitamin D supply was observed among older population than in young adults. Furthermore, obesity understood as BMI over 30 kg/m2 was associated with greater vitamin D deficits (15.1±8.2 vs 18.2 ±10.3 ng/ml; p<0,0001). In summary, such factors as younger age, male sex, higher body weight and increased BMI conferred a risk of lower 25(OH)D.
Conclusions:
Our data encompassing the most representative sample size in Poland consistently support the evidence reported elsewhere, and demonstrate that the vast majority of Polish urban population is vitamin D deficient. This suggests a poor and insufficient supply of vitamin D among adults, at least during winter season, and the need of preventive strategies for most of the society.