[The analysis of the hepatitis C virus infection course and efficacy of treatment dependence on HLA A antigens in children and youth]. / Analiza zwiazku przebiegu zakazenia wirusem zapalenia watroby typu C oraz skutecznosci leczenia dzieci i mlodziezy z antygenami HLA A.

UNLABELLED: The hepatitis C virus (HCV) infection course and efficacy of treatment may be depended on HLA antigens. The aim of the study is attempt to define dependence between the course of HCV infection and efficacy its treatment and HLA A antigens in children and youth. PATIENTS AND METHODS: To the study included 61 patients (51 after treatment for HCV infection and 10 not treated). The average age was 13.77 years (range 5-18 years). Patients were divided to subgroups in depend on effect of the treatment: virusological and biochemical response. Antigens HLA A were molecularly typed on the low resolution method. To statistical analysis we applied the chi-square test. RESULTS: We demonstrated no statistical significant dependences between HCV infection course and efficacy of its treatment children and youth HLA A antigens. However we observed following tendencies: antigens HLA A *01 and HLA A *02 can be related to unprofitable course of infection and unsuccessful antiviral therapy; HLA A *03 can be favorable prognostic factor for HCV infection course and response to treatment; HLA A *24 can be related to mild course of infection and profitable response to treatment; HLA A *11 can be favorable prognostic factor for course of infection; HLA A *30 can be profitable for efficacy of treatment and HLA A *25 can be disadvantage for it. Probably study performed with larger group of patients could gain dependencies statistical significant. CONCLUSIONS: It is possible that course if HCV infection and efficacy of antiviral treatment are depended on HLA A antigens.

Lipid metabolism in children with chronic hepatitis C, A preliminary report.

BACKGROUND/AIMS: The importance of lipid metabolism in the pathogenesis of chronic hepatitis C has been recognized in recent years. Bearing in mind remote sequelae of chronic hepatitis C in children, it seems reasonable to seek to determine potential risk factors for the development of cirrhosis and carcinogenesis. The aim of the study was to assess lipid metabolism in children with chronic HCV-related hepatitis. METHODOLOGY: The study comprised 16 children with chronic hepatitis C and 16 healthy controls. In all the children anthropometric data and after, overnight fasting, serum levels of total bilirubin, AST, ALT, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were investigated. In the study group biopsy specimens were assessed. RESULTS: Macrovesicular steatosis in numerous hepatocytes was found in 3 children. Total cholesterol level in children with chronic hepatitis was significantly lower than in control group (p < or = 0.05). Mean values of body mass, height, body mass index (BMI), levels of bilirubin, HDL-cholesterol, LDL-cholesterol, triglycerides and HDL/C index did not differ significantly between the two groups. No correlation between lipid parameters and histological markers, hepatic enzymes, patient age, weight, height or BMI was found. CONCLUSIONS: Neither obesity nor hyperlipidemia, which are recognized risk factors for steatosis were found in children with HCV-related hepatitis. Lower cholesterol levels in children with chronic HCV infection compared to the controls and only scarce signs of steatosis which were noted could suggest the risk, existing already in such young patients, of developing fatty liver disease with its consequences including cirrhosis and neoplastic disease.

[Haemophilus influenzae infections in children]. / Zakazenia haemophilus influenzae u dzieci.

Haemophilus influenzae is a gram-negative bacteria. The capsular form of this bacteria, mainly type b, is responsible for severe bacterial meningitis. In the study course of Haemophilus influenzae meningitis in two children was presented. In one of these children the clinical course of meningitis was particularly serious. The child was unconscious, the generalized swellings, pneumonia, increase and damage of liver, diarrhoea, heavy anaemia as well as disorders of blood coagulation were observed. In second child the beginning of disease was not characteristic, what delayed the proper diagnosis. The duration of children treatment was from 16 to 18 days. The permanent damages of central nervous system were not observed in both children

[Evaluation of the somatic development in children with chronic virus hepatitis]. / Ocena rozwoju somatycznego dzieci z przewleklym wirusowym zapaleniem watroby.

The aim of the study was an evaluation of the somatic development of children with chronic hepatitis B, C and HBs antigen positive and finding the correlation between the nutrition status, the duration of disease and the aminotransferase activity. The somatic development was examined on the basis of body height and weight measurement and calculation of body mass index and Cole's index. Lowered body height and weight was observed in 25% of the children with chronic HCV infection. In the group of children with chronic hepatitis B there was no body weight loss, but a lowered body height was observed in 9.1%. No correlation between the duration of the disease and the nutrition status in children with chronic hepatitis B and C was proved.

[Sustained virological response in children with chronic hepatitis C treated with interferon alpha and ribavirin]. / Trwala odpowiedz wirusologiczna u dzieci z przewleklym zapaleniem watroby typu C leczonych interferonem alfa i rybawiryna.

UNLABELLED: The aim of the study was to assess the effect of IFN-alpha and ribavirine combined therapy of chronic hepatitis C in children. The study comprised 37 children (22 boys and 15 girls) aged between 4 and 18 years (mean 12 years and 6 months) with chronic hepatitis C, diagnosed on the basis of serological, virological and histological criteria. The treatment included Intron A (Schering Plough) administered subcutaneously 3 M.U. 3 times a week and ribavirin (Rebetol-Schering Plough) orally 15 mg/kg body weight daily for the period of 12 months. In all children liver biopsy was performed before the beginning of treatment. Tests for the presence of HCV RNA in serum were performed after 12-weeks therapy (EVR), after 6-months therapy, immediately on its completion (ETR) and 6 months afterwards (SVR), after the end of treatment. In the course of applied treatment, ALT activity, hemoglobin levels, leukocyte and trombocyte counts in the peripheral blood were determined every 4 week. EVR was obtained in 25 children and in these chidren genetic material of HCV in serum of blood was not observed both, after 6-months therapy, as well after the end of treatment. In this group a sustained virological response (SVR) was observed in 21 children. In 12 children without EVR, the elimination of HCV RNA was not achieved in the course of further treatment. CONCLUSIONS: 1. Twelve-months of combined IFN-alpha and ribavirine therapy enables to obtain a sustained virological response in about 56% of the treated children. 2. The frequency of recurrences of HCV infection in children amounts to 16%. 3. During the combined IFN-alpha and ribavirine treatment numerous side effects were observed, which in individual cases were the reason for treatment modification.

[Neutrophil oxidative metabolism in children with chronic hepatitis C]. / Metabolizm tlenowy neutrofilów u dzieci z przewleklym zapaleniem watroby typu C.

A growing number of data suggest the role of reactive oxygen species (ROS) in the pathogenesis of chronic type c hepatitis. Activated neutrophils, macrophages and Kupffer cells are basic sources of ROS in the course of the inflammatory process in the liver. The aim of the study was to assess the metabolism of neutrophil oxygen in children with chronic hepatitis C. MATERIAL AND METHODS: The study comprised 14 children with chronic hepatitis C (group 1), 4 children with positive serum anti-HCV antibodies and negative HCV RNA as well as normal ALT activity (group II) and 6 healthy children 9 (group III). Production of reactive oxygen species by neutrophils using the method of chemiluminescence (CL) with luminol (MLX Microtitier Plate Luminometr, Dynex, USA) was assessed. We estimated chemiluminescence response (CL max and CL total) of neutrophiles both unstimulated and stimulated by formyl-methionyl-leucyl-phenyloalanine (fMLP), opsonized zymosan (OZ), phorbol-myristate-acetate (PMA) without and after priming with tumor necrosis factor alpha (TNF-?) was estimated. RESULTS: CL max f MLP stimulated without preactivation was significantly lower in group I and II than in group III (p<0.04, p<0.06, respectively). CL max OZ stimulated was significantly higher in group I in comparison to group II (p<0.04) and it tended to be higher in group I than in group III. CL max PMA stimulated was lower in group I compared to group III (p<0.08). CL total fMLP stimulated was lower in group II (p<0.07) compared to group I and it tended to be lower in group I and II compared to group III. CL total OZ stimulated was significantly higher in group I than in group II (p<0.05) and group III (p<0.03). CL max and CL total OZ stimulated and preactivated with TNFalpha was significantly lower in group I compared to group III (p<0.02 and p<0.04, respectively). SUMMING UP: In the course of chronic hepatitis C in children, both neutrophil preactivation and inhibition of neutrophil release of reactive oxygen species, which occur as a result of different mechanisms, are observed.

[Carbohydrate metabolism in children with chronic hepatitis C]. / Gospodarka weglowodanowa u dzieci z przewleklym zapaleniem watroby typu C.

UNLABELLED: The importance of carbohydrate metabolism in the pathogenesis of chronic hepatitis C has been recognized in recent years. The aim of the study was to assess carbohydrate metabolism in children with chronic HCV-related hepatitis. MATERIAL AND METHODS: The study was comprised of 16 children with chronic hepatitis C and 16 healthy controls. In all the children anthropometric data and, after overnight fasting, serum levels of glucose and insulin were investigated and insulin resistance index HOMA IR was calculated. In the study group biopsy specimens were assessed. RESULTS: Macrovesicular steatosis in numerous hepatocytes was found in 3 children. Mean values of body mass, height, body mass index (BMI), levels of glucose, insulin and HOMA IR did not differ significantly between the two groups. We found correlation between serum levels of glucose and fibrosis (r=0.64, p<0.01) or staging (r= 0.7, p<0.004) in children with chronic hepatitis C. CONCLUSION: Neither obesity, which is recognized as a risk factor for diabetes mellitus and steatosis was found in children with HCV-related hepatitis. Correlation between serum levels of glucose and fibrosis or staging in children with chronic hepatitis C suggests the participation of carbohydrate metabolism in the pathogenesis of this disease and the risk, existing already in such young patients, of developing hepatic fibrosis with its consequences.

[Results of 12-month lamivudine therapy of chronic hepatitis B in children]. / Wyniki 12-miesiecznej terapii lamiwudyna przewleklego zapalenia watroby typu B u dzieci.

UNLABELLED: The aim of this study was to assess the results of 12-month lamivudine therapy in children with chronic hepatitis B. MATERIAL AND METHODS: The study included 24 children (14 boys and 10 girls) aged from 7 to 18 years with chronic hepatitis B diagnosed according to current criteria. Lamivudine was administred in a daily dose of 3-5 mg/kg up to 100 mg for twelve months. The efficiency of treatment was estimated on the basis of absence of HBV DNA in blood serum, loss of HBeAg and normalization of ALT activity. RESULTS: Total virusological response and biochemical response were achieved in 6 children after twelve months of lamivudine therapy. In 4 children, absence of HBV DNA without the loss of HBeAg and without the normalization of ALT activity were observed. Fourteen children did not respond to 12-month of lamivudine therapy (the lack of HBV DNA elimination and the lack of HBeAg loss). None of the children showed elimination of HBsAg and production of HBs antibodies. CONCLUSIONS: The treatment is very well tolerated and does not cause undesired side effects.

[Cytotoxic activity of natural killer cells in children with chronic type C hepatitis]. / Aktywnosc cytotoksyczna komórek NK u dzieci chorych na przewlekle zapalenie watroby typu C.

UNLABELLED: The aim of this study was to evaluate the activity of NK cells in peripheral blood in children with chronic type C hepatitis, and to determine the correlation between the activity of NK cells and histopathological changes in the liver. The study included 25 children with chronic type C hepatitis. The control group consisted of 10 children without liver diseases in past medical history and normal activity of amino-transferases. In all children the activity of NK cells was evaluated in relation to leukaemic cells of erytroleukaemia K-562 without stimulation and after stimulation with IL-2 (in vitro), and the percentage and absolute count of NK cells in peripheral blood were determined by flow cytometry. RESULTS: In the studied group of children NK cells accounted for 11.68 +/- 6.73% of peripheral white blood cells, and their count was 241.08 +/- 128.56/ml. The cytotoxic activity of NK cells was 91.8 +/- 1.07% in solution E:T 25:1; and 6.72 +/- 3.68% in solution E:T 12.5:1. After stimulation with IL-2 it was 92.8 +/- 1.01% and 7.58 +/- 3.95%, respectively. The count of NK cells in serum and cytotoxic activity of NK cells in the studied group were not different from those of the control group. CONCLUSIONS: Key parameters of NK cells activity are not changed in children with chronic type C hepatitis.

[Evaluation of specific humoral response to hepatitis C core antigen in children]. / Ocena swoistej odpowiedzi humoralnej przeciw antygenowi rdzeniowemu wirusa C zapalenia watroby u dzieci.

HCV infection triggers a strong humoral and cellular response, which can be directed against specific virus antigens expressed on the surface of infected hepatocytes cellular membrane. Amongst the variety of produced antibodies a special role is attributed to antibodies against the core antigen, which are the first ones produced in early response to HCV infection. The aims of this research were evaluation of the occurrence of IgM antibodies against HCV core antigen in children with hepatitis C and analysis of the correlation between these antibodies presence and HCV RNA presence in children with chronic hepatitis C. The study comprised 30 children (10 girls, 20 boys) aged from 3 years and 7 months to 18 years. In all of them chronic hepatitis C was diagnosed basing on the current criteria. The control group comprised 10 children with anti-HCV antibodies in whom HCV RNA was not detected. In all the children the presence of antibodies against HCV, HCV RNA and antibodies against core antigen was tested. The conducted examinations revealed the presence of IgM antibodies against HCV core antigen in 13 out of 30 children (43.3%) with HCV RNA. These antibodies were not detected in any of the children from the control group. The research demonstrated a correlation between the presence of IgM anti-core antibodies and the presence of HCV RNA in children with chronic HCV infection. The correlation between the presence of HCV RNA and IgM anti-core suggests that these antibodies may be used as a serological marker of replicative activity of virus in children with chronic hepatitis C.

[Fungal infection in the course of acute liver failure]. / Zakazenia grzybicze w przebiegu ostrej niewydolnosci watroby.

Fungal infection is a common, serious and underestimated complication, which contributes significantly to high mortality in patients with acute liver injury. The features accounting for the incidence of fungal infection include defects of immune response, routine use of H2 antagonists, frequent use of broad-spectrum antibiotics and invasive monitoring. Clinical deterioration characterized by increasing coma grade after initial improvement, increasing prothrombin time, pyrexia unresponsive to antibiotics, renal failure and elevated white cell count make up the clinical picture of the disease which suggests coexistence of fungal infection in acute liver injury. Candida albicans is the principal etiological agent of fungal infection and this pathogen is frequently isolated from the respiratory tract within a week of admission. The mortality among untreated patients with acute liver injury complicated with mycotic infection reaches 100%. The early application of the specific treatment in cases suspected of mycotic infection in patients with liver injury could markedly reduce mortality in this group of patients.

[Mycotic complications of shunt infection in children with primary hydrocephalus]. / Grzybicze powiklania zakazen ukladu zastawkowego u dzieci z wodoglowiem wrodzonym.

Recently, the incidence of fungal infections in children, including children with shunt-dependent hydrocephalus, has increased. The analysis comprised 8 children treated in the III Clinic of Pediatrics of ICZMP during the period of 12 months (12% of all infectious complications of the shunt system). The clinical picture of fungal infection included symptoms of shunt dysfunction: febrile conditions, vomiting, distress and loss of appetite. The most common pathogens isolated from the cerebro-spinal fluid were fungi from the Candida species. Mean value of pleocytosis in the cerebro-spinal fluid was 812 cell/microl, and mean protein concentration was 311 mg/dl. Treatment consisted of monotherapy with Diflucan, monotherapy with Ancotil or combined treatment with Ancotil and Amphotericine B. The drugs were administered intravenously and intraventricularly after removal of the shunt and application of external drainage. Sterility of cerebro-spinal fluid was obtained in the shortest time with the use of Ancotil. Prophylactic application of antifungal drugs decreases the frequency of infections in children with shunt-dependent hydrocephalus.