Bronchiolitis is the most common lower respiratory tract infection among children less than 2 years old and in most cases it is caused by the RS virus.A revised guideline on diagnosis, treatment and prevention of bronchiolitis was issued by the American Academy of Pediatrics (AAP) in 2014. Accordingto the publication, diagnosis of bronchiolitis should be based on history and physical examination. Treatment options with a proved efficiency includethe administration of nebulised hypertonic saline, the administration of supplemental oxygen in case of hypoxemia and the administration of nasogastricor intravenous fluids to dehydrated patients. Changes from the 2006 guideline include that testing for the RSV should no longer be routinely conductedand that salbutamol should not be used, as evidence shows that it does not change the course of the disease.

The paper presents current knowledge on taste development and sums up the possible methods of influence in specific life periods. It underlines the roleof breastfeeding in new food acceptance in infancy. Authors also present most common problems met during weaning and give practical guidelines howto solve and prevent them.

Obesity is currently the most common metabolic disease in developed countries, which is an important health problem. It concerns not only adultsbut also children and adolescents. In recent years, bariatric surgery has gained increasing acceptance as one of the types of treatment for children andadolescents who have failed to lose weight following dietary modification and health behaviors. The purpose of the diet after surgery is to reduce weightwhich can be achieved by lowering the amount of food, resulting in negative energy balance. However, an indispensable condition is to provide all thenutrients in appropriate amounts and mutual proportions that are necessary for proper functioning and human development.

Pathophysiology of acute otitis media and otitis media with effusion is similar. Both diseases occur when Eustachian Tube function is impaired and middleear space is infected. Acute otitis media (AOM) etiology is usually mixed and spreads by direct invasion from the nasopharynx. When child is feverish,presents ear pain, wakes up crying and in otoscopy fluid is visible behind bulging tympanic membrane an AOM diagnosis is possible. Conservativesymptomatic treatment and antibiotic therapy is the standard procedure. However, cases requiring surgical procedures do happen. Complications arerare when treated properly. Otitis media with effusion (OME) is characterized by effusion in tympanic cavity without localized and general symptoms ofacute inflammation. In some cases child might present hearing loss, vertigo or ear stuffiness but in many cases are asymptomatic. Spontaneous recoveryin OME is common. If surgical intervention is indicated, tympanostomy tube is inserted. OME is the main cause of hearing loss in children.

In Europe urolithiasis in children occurs in about 2%. Pathophysiology of stone formation is still unclear. Typical clinical symptoms, such as renal colic,appears in children older than 10 years. Symptoms and signs in infants and younger children are not characteristic. To make diagnosis detailed historyof illness signs and family history as well as radiologic and laboratory tests are necessary. The goal of renal colic treatment is to alleviate symptoms andto facilitate passage of stones. Endoscopic methods are necessary nowadays to remove bigger stones. Optimal preservative methods and recurrenceprevention depends on type of stone and type of renal tubular abnormalities. The most important are optimal dilution of urine and increasing ofcrystallization inhibitors activity in urine.

Complaints on sleep disorders in children are often reported to pediatricians by parents. Insomnia, sleep-disordered breathing, parasomnias are someof the commonly encountered sleep disorders in this age group. The impact of not getting enough sleep may negatively affect children’s physical andemotional health and may adversely influence cognitive and social development.This review is meant to familiarize pediatricians with some of the more commonly encountered sleep disorders in this age group, and to review theirmanagement.

Acute pharyngotonsillitis is one of the most frequent upper respiratory tract infections. It is mainly a virus infection, it has self-limitating character andpasses during a few days. Diagnosis of pharyngotonsillitis in children demands identification of group A β-hemolytic streptococcal infection becausein those cases antimicrobial therapy is necessary. This paper presents differential diagnosis of pharyngotonsillitis and management of streptococcalpharyngotonsillitis in children.

Infection with Treponemapallidumis often missed disease in pediatrics. It can be transmitted vertically, from mother to child, the other optionis sexually transmitted infection. The knowledge about serology of this disease allows to establish diagnosis. In practice there are two methods used:direct visualization of Treponemapallidum and serological tests. Among them there are non-treponemal tests, such as VDRL or USR, and treponemaltests.It is important that serology varies depending on stage of disease. Nontreponemal tests monitor treatment response and eventual relapses.Treponemal tests can be reactive for the lifetime although the treatment was properly performed. When diagnosing child born from mother sufferingfrom syphilis it is essential to control the seroreversion of the tests, what should happen until the 12 month of life.

We present an interesting case of a six-year-old girl suffering from late latent syphilis. In infancy she was hospitalized many times with symptomssuggesting congenital syphilis. Due to diagnostic complications, many other diagnoses, complicated treatment, syphilis was properly recognizedwhen she was six years old. This article is designed for pediatricians and GPs who take care about newborns and infants to raise attention and test thisgroup of children to syphilis.

Nearly all cells and organs of human body are adapted to using the active form of vitamin D as a co-regulator of many important physiological pathwaysand as an enhancer of their normal actions. Insufficient vitamin D status has been proven to be a source of perturbances in mineral metabolism resultingin rickets and osteomalatia. There are also reasons to believe that vitamin D insufficiency and deficit, underlies such problems as certain kinds of cancer,kidney and heart diseases, diabetes, high blood pressure, obesity, fractures, osteoporosis, dental problems, respiratory tract infections, and central nervoussystem malfunctions.Human body has been adopted during the evolution to use skin synthesis as the main source of vitamin D. As a result, this process has become a difficultto replace component of the vitamin D supplementation system for the contemporary human body especially in societies living far from the equator. Thereare well founded stipulations for using the solar ultraviolet rays as a stimulant of vitamin D synthesis as it is known that this can promote dangerous skincancers. It is also known that this can be avoided by applying „reasonable” rudiments and avoiding the excessive exposition to sun rays.

The use of vitamin D in a daily practice of dermatologist is not limited to the topical treatment of skin diseases, particularly psoriasis. The risk of vitamin Ddeficiency in patients with photosensitivity, which require photoprotection because of primary photodermatoses, such as solar urticaria, polymorphouslight eruption, actinic prurigo, chronic actinic dermatitis, and also in secondary photodermatoses, which are manifestation of systemic diseases, includingporphyrias, pemphigus, dermatomyositis, and systemic lupus erythematosus justifies the usage of oral supplementation with vitamin D. The next groupof patients with the justified supplementation includes patients undergoing long-term glucocorticoid therapy because of autoimmune blisteringskin diseases and autoimmune connective tissue diseases, primary systemic vasculitis, and pyoderma gangrenosum. The knowledge of mechanismsresponsible for vitamin D action, and also metabolic consequences of its deficiency, makes possible the wide usage of both vitamin D and its analoguesin a daily practice of dermatologist.

Human skin is not only a natural source of vitamin D, but also place of its metabolism and immediate aim of its biological activities. Under physiologicalconditions, vitamin D regulates proliferation and differentiation of keratinocytes, thus is involved in the regulation of the renewal of epidermal barrier.Moreover, vitamin D modulates the immune response in the skin. Given the multidirectional activities of vitamin D in the skin, it should not besurprising that reduced level of vitamin D in the body, caused by improper supplementation, or by specific genetics background affects developmentor worsen the symptoms of many skin diseases. Thus, vitamin D and its analogs are increasingly used in the treatment of skin diseases; typically asa part of a combination therapy. It should be emphasized that vitamin D analogs such as: commonly used in psoriasis calcipotriol or analog recentlytested 20-hydroxyvitamin D do not affect the calcium and phosphate levels and can therefore be safely used in the therapy. In addition to psoriasis,the vitamin D analogs are currently extensively investigated in the treatment of atopic dermatitis, vitiligo, or skin lesions associated with scleroderma.Furthermore, vitamin D analogs can be successfully used directly on the skin as an ointment. Great hope is also associated with the use of vitaminD and its analogs in the treatment of skin cancers, including the most dangerous of them melanoma. A series of laboratory tests, preclinical andclinical studies indicated that these compounds inhibit growth of cancer cells. It should be noted that, maintaining optimal level of vitamin D(30-50 ng/mL in serum) reduces the probability of development of skin diseases, including cancer and improves treatment. It should be emphasizedthat the best source of vitamin D is our skin exposed to the sunlight, but extensive exposure to ultraviolet radiation, may lead to skin cancer andtherefore supplementation should be considered. In conclusion, vitamin D plays a key role in the physiology of the skin in human, and its deficiencyis observed in multiple skin diseases. Thus, vitamin D should be an important element in the prevention and treatment of skin diseases, includingcancer.

Introduction: The numerous evidence showing spectrum of vitamin D effects on human health resulted in the amendment of vitamin D supplementation guidelines, and raised discussion on the risk of hypercalcaemia as a result of the dissemination of novel recommendations. The aim of this study was toanalyze the scope of serum 25-hydroxyvitamin D levels change over the last 30 years of activity of a single pediatric clinic.

Materials and methods: Calcium-phosphate metabolism markers and 25(OH)D levels were investigated in a group of 3657 children aged 0-18 years,divided into 2 age groups. Group I consisted of newborns and infants aged 0-18 months (n = 2990; mean age 8.0 ± 3.0 months). The second groupconsisted of children aged 1.5-18.3 years (n = 667; mean age 8.3 years; 99.1 months ± 63.9).

Results: In neonates and infants (group I) 25(OH)D < 20 ng/ml were noted in 20.2% (n = 605), 20-30 ng/ml in 707 (23.6%) and 30-50 ng/ml in 1067 (35.7%).In group II (1.5-18.3 years) 25(OH)D < 20 ng/ml were found in 270 patients (40.2%), 20-30 ng/ml in 202 (30.1%) and 30-50 ng/ml in 142 patients (21.1%).In group I the mean 25(OH)D was 37,0 ng/ml. In group II, the highest 25(OH)D levels were noted in a subgroup aged 1.5-3 years (35.9 ng/ml). In thefollowing age groups within group II an age-related 25(OH)D level decrease was noted, with a minimum observed at the age 14-15 years (16.59 ng/ml).Severe vitamin D deficiency (25(OH)D < 10 ng/ml) was found in 161 neonates and infants (5.4%) and in 66 patients (9.9%) from group II. In both groupsrevealing 25(OH)D < 10 ng/ml a normal calcaemia (2.25-2.65 mmol/l) was noted in 82.8% of neonates and infants (n = 134) and in 56 patients (84.8%) ingroup II. In group I 78 subjects had 25(OH)D above 100 ng/ml, with co-existing calcaemia range: 2.6 mmol/l up to 4.38 mmol/l (mean Ca = 2.70 mmol/l).In group II 9 subjects revealed 25(OH)D above 100 ng/ml, accompanied by calcaemia range: 2.06 mmol/l up to 2.54 mmol/l (mean Ca = 2.35 mmol/l).The prevalence of hypocalcaemia (Ca < 2.25 mmol/l) was a higher in group II (10.1%, n = 68) compared to group I (0.5%, n = 14). In group I 425 patientshad Ca levels > 2.65 mmol/l (14.6%). In group II Ca > 2.65 mmol/l were noted in 3.7% (n = 25). In general, the average values calcium-phosphate markerswere within the range of reference values for age.

Conclusions: 40.2% of cases from group II, and 20.2% of neonates and infants (group I) revealed a vitamin D deficiency (25(OH)D < 20 ng/ml). VitaminD supplementation appeared effective in children aged 3 years and younger. A direct relation between low 25(OH)D levels and hypocalcaemia was notobserved. Hypercalcaemia concomitant to high 25(OH)D levels (> 100 ng/ml) was reported more frequently in neonates and infants (group I).

Vitamin D metabolism is complex and features multiple metabolites, many still without clear biological functions. These vitamin D metabolites are synthesized
by a set of specific cytochrome P450 enzymes, gene deletion of which have helped us to understand which vitamin D metabolites are the most important.
The central pathway involves the main circulating metabolite, 25(OH)D3 made by CYP2R1 and the hormonal form, 1,25(OH)2D3 produced by CYP27B1.
Mutations of these two enzymes result in rickets. 25(OH)D3 and 1,25(OH)2D3 remain the principal biomarkers of vitamin D; 25(OH)D3 as an indicator of vitamin D supply and 1,25(OH)2D3 as an indicator of biological action. Another emerging biomarker is 24,25(OH)2D3, made by the catabolic CYP24A1, which is an indicator of vitamin D degradation. Mutations of CYP24A1 result in hypercalcemia. All three of these biomarkers can be assayed in serum/plasma by either a combination of antibody-based assays or simultaneously by LCMS/MS. A variety of other vitamin D metabolites can be measured but have limited
usefulness because of unknown function. These include: vitamin D3 itself, 3-epi-25(OH)D3, 25,26(OH)2D3, 25(OH)D3-26,23-lactone, 1,24,25(OH)3D3.
Recently, there has been a resurgence of interest in assaying the levels of bioavailable or free 25(OH)D3 and free 1,25(OH)2D3 as measures of the amount of
steroid unbound to the plasma proteins, DBP or albumin and available to enter cells and produce biological effects. The utility of each of these biomarkers
will be discussed.

Introduction: Vitamin D deficiency and insufficiency are widespread conditions, especially in elderly population with concomitant musculoskeletal
disorders. Correction of vitamin D status is crucial to reduce pain, increase mobility and gait stability, and improve overall quality of life in such patients.
Objectives: to assess the efficacy and safety of individual targeted vitamin D therapy in postmenopausal women with skeletal diseases (systemic
osteoporosis and osteoarthritis).
Methods: Due to high prevalence of vitamin D deficiency in Ukraine it was developed the individual targeted therapy of vitamin D deficiency.
The individual targeted therapy consists of two periods – saturation period and maintenance therapy period, during which patients take it constantly.
Duration of saturation therapy is calculated by the formula:
Saturation therapy duration (days) = (100 – VDL) х BW/100,
where: VDL is blood 25(ОН)D level (ng/mL), BW is body weight (kg).
The therapy for saturation includes combined calcium (1000 mg of calcium and 800 IU of vitamin D) and 3000 IU of vitamin D per day. Maintenance
therapy includes 2 000 IU of vitamin D per day.
The study involved 70 postmenopausal women aged 46-87 years with skeletal diseases (systemic osteoporosis and osteoarthritis). All subjects were
subdivided into two groups: main - 50 women who took individual targeted vitamin D therapy (50 subjects, 65.1±8.8 years old, BMI 27.22±4.51 kg/m2)
and control (20 subjects, 64.5±11.1 years old, BMI 26.68±4.95 kg/m2). The duration of the treatment consists of 3 months starting on the 1st Oct 2013.
25(ОН)D total and iPTH levels were assessed by electrochemiluminescent method using Elecsys 2010 analytical system (Roche Diagnostics, Germany) and
test-systems cobas. The serum levels of calcium, phosphor, alkaline phosphatase levels were evaluated for safety reasons.
Results: In 3 months after the start of the treatment there was a significant (p < 0.001) increase in 25(OH)D levels in the treatment group:
35.60±8.21 nmol/L as compared to baseline levels of 25.20±9.76 nmol/l. Remarkably, the treatment was most effective in the oldest subgroup (> 70 yrs.),
as well as in subjects with the BMI 25-28,99 kg/m2. After the treatment, there were no changes in calcium levels.
Conclusions: The suggested individual targeted vitamin D therapy was proven to be effective in postmenopausal women. As the treatment turned out to
be effective, relatively quick, and had a reasonable safety profile it may be beneficial for all vitamin D deficient postmenopausal women.