Health Evaluation in the Context of Satisfaction with Medical Services among Patients with Osteoarthritis: Descriptive Cross-Section Survey.

Osteoarthritis (OA) is one of the most common causes of rehabilitation benefits and senior disability. It generates high costs of treatment and increasing demand for medical staff and care of geriatric profile. The aim of the study was to determine the relationship between health evaluation and satisfaction with medical services among individuals with OA in rehabilitation outpatient clinics. The survey was carried out from June 2017 to May 2018, among patients being provided with services of five outpatient rehabilitation clinics in Lublin. The surveyed group comprised 328 respondents. The following tools were utilized: the List of Health Criteria (LHC), the Multidimensional Health Locus of Control Scale (version B) (MHLC), the authors' own questionnaire compiled for the study, and the Servperf Method. According to the respondents, the most important health criterion is "not to experience any ailments" (M = 1.56). In an assessment of a clinic, the respondents rated neatness (cleanliness) of the staff highest (M = 4.38) and the appearance of a building where a clinic is located lowest (M = 3.42). The better the evaluation of medical services in an outpatient rehabilitation clinic in comparison to other settings, the better the evaluation of the quality of service (rho S = 0.593; p < 0.000). The study conducted in outpatient rehabilitation clinics showed great demand for outpatient specialist care of geriatric profile. Undoubtedly, there is need for continuation and expansion of studies on patients with OA in other rehabilitation settings.

The influence of breast milk and infant formulae hydrolysates on bacterial adhesion and Caco-2 cells functioning.

The aim of the study was to determine the concentration of BCM7 in human milk and infant formulae (IF) before and after eznymatic hydrolysis, and to evaluate the effect of obtained hydrolysates on interleukin-8 (IL-8) secretion and on proliferation of enterocytes in the in vitro model (Caco-2 cells). This study evaluates also the effect of hydrolysates on the adhesion of intestinal microbiota isolated from faeces of both healthy (H) and allergic (A) infants. In the study we investigated breast milk delivered by mothers of healthy ('healthy milk'; HM) and allergic ('allergic milk'; AM) infants. Three infant formulae were investigated: from hydrolysed cow casein (IF1), from hydrolysed cow whey (IF2) and from whole cow milk (IF3). Intestinal bacteria: Bifidobacterium, lactic acid bacteria, Enterobacteriaceae, Clostridium and Enterococcus were isolated from faeces of five healthy and five allergic infants. Mixtures of bacterial isolates and bacteria adhering to Caco-2 cells were characterised qualitatively with PCR-DGGE, and quantitavely with FISH. Concentration of BCM7 in breast milk and infant formulae was 1.6 to 8.9 times higher after enzymatic hydrolysis in comparison to undigested samples. The presence of this peptide resulted in alteration of intestinal epithelial proliferation and increase in secretion of IL-8. The quantitative profile of adherred bacteria applied as a mix of all isolates from healthy infants (H-MIX) was unchanged in the presence of HM hydrolysate and was modulated (increased number of beneficial Bifidobacterium and reduced commensal Enterobacteriaceae) in the presence of all IF hydrolysates. The presence of IF hydrolysates affected the profile of adhering isolates obtained from allergic infants (A-MIX) and reduced the adhesion of Enterobacteriaceae; the IF2 and IF3 hydrolysates decreased also the total number of adhering bacteria (TBN). However, a stimulating effect of AM hydrolysate on A-MIX adhesion (increased TBN) was observed.

Epidemiological and clinical picture of parasitic infections in the group of children and adolescents from north-east region of Poland.

The epidemiological and clinical purview of parasite diseases is constantly evolving, mainly due to the changes in human behavior and our environment. The aim of this study was frequency analysis of certain parasite infections, risk factors and clinical symptoms in children and adolescents of north-eastern Poland. 120 children were tested due to the symptoms resembling parasite infection from December 2008 to May 2009. 90 patients (the tested group) aged from 5 months to 18 years were found to be infected with one or more than one of the following parasites: Ascaris lumbricoides, Giardia lamblia, Toxocara spp., Strongyloides stercoralis or Enterobius vermicularis. 30 children with no infections found were the control group. Parasites were found by means of microscope decantation stool tests, RIDA Quick Giardia stool test and ELISA blood test (Toxocara IgG). The patients' parents filled out the survey concerning the probability factors of infection and the ailments that were the cause of parasitical diagnosis. High percentage of either isolated or co-invasive parasite infections was ascertained in the tested group--75%. The prevalence of ascariasis was 55.83%, toxocariasis--16.67%, giardiasis--12.5%, strongyloidiasis--5.83% and of enterobiasis--3.33%. The statistical significance of higher dirty hands-mouth contact frequency and more frequent presence of domestic animals in the tested group than in the control group was ascertained. A highly important correlation between the infection and the occurrence of symptoms from at least 3 various systems was ascertained. The presence of habits involving dirty hands-mouth contact and having domestic animals are significant risk factors of parasite infections. The presence of symptoms from at least 3 systems should compel to parasite infection diagnosis with proper differential diagnosis.

[The clinical manifestation of duodeno-gastroesophageal reflux (DGER) in the children and adolescents]. / Objawy kliniczne u dzieci i mlodziezy z refluksem zólciowym.

UNLABELLED: The development of the new techniques and methods enabled to investigate the role of duodenal reflux in the pathogenesis of gastroesophageal reflux disease (GERD) therefore there is a need to establish the most common symptoms occurring in patients with duodenal reflux. THE AIM OF THE STUDY: To determinate the type of manifestation and the prevalence of duodeno-gastroesophageal reflux in children and adolescents confirmed in Bilitec 2000 method. MATERIALS AND METHODS: 59 patients (37 girls, 22 boys) aged 7-17 years (mean 14.7) with the symptoms of GER there were divided into 2 groups: subgroups: A--18 children with confirmed duodeno-gastroesophageal reflux in Bilitec 2000TM method and B--control consisted of 15 children with short stature referred to endoscopy due to celiac disease exclusion. In accordance to the endoscopic finding there were selected 3 subgroups: 20 patients with duodenal reflux, 19 patients with esophagitis and 20 children presenting those both disorders simultaneously. In all patients from group B the endoscopy, Bilitec 2000 and esophagitis pH metric findings haven't showed any abnormality. RESULTS: The most common complain--in 16 (88.89%) patients was recurrent and/or chronic abdominal pain, next- heartburn in 12 (66.67%), vomits and/or regurgitations in 10 (55.56%) children. CONCLUSIONS: The clinical manifestation of duodenal reflux was very much alike as in acid gastroeophageal reflux in the examined group. Therefore the functional gastrointestinal tract examinations have to be included in the diagnostic procedure.

Content of beta-casomorphins in milk of women with a history of allergy.

The prevalence of food allergies increased over the past decade. Most symptoms of food allergy appear during the first 2 yr of life. The aim of this study was to determine the beta-casomorphin-5 and -7 (BCMs) in colostrum and milk of 12 breast-feeding women with a history and clinical manifestation of food allergy. The results were compared with the data obtained from a control group of healthy age-matched breast-feeding women. The level of BCM in women with food allergy was constant during lactation, whereas the highest level of opioid peptides was found in colostrums of healthy women with a subsequent rapid decrease in mature milk. These differences in BCMs profile between allergic and healthy breast-feeding women suggest that BCM content in the human milk may be an indicator of allergic conditions.

Changes of beta-casomorphin content in human milk during lactation.

Milk is the best, complete food important for the development and nourishment of a neonate. Except for nutrients, milk contains biologically active opioid peptides derived from beta-casein, named beta-casomorphins (BCMs), which can exert effects in the gastrointestinal tract as well as in the whole body of neonates. The content of beta-casomorphins in human milk during maturation phases has not been studied so far. The aim of this study was to determine the content of beta-casomorphin-5 and -7 in human milk in different phases of lactation. A significantly higher concentration of both beta-casomorphins was found in colostrum than in mature milk. The concentration of beta-casomorphin in milk collected in the second month of lactation was similar to the level obtained in the fourth month of lactation. The content of beta-casomorphins in human milk was observed with the period of lactation. The level of opioid peptides may depend on the function of these peptides in neonate's body and may be associated with the maturation process.

Serum activity of dipeptidyl peptidase IV (DPPIV; EC 3.4.14.5) in breast-fed infants with symptoms of allergy.

Beta-casomorphins, opioid peptides present in mother's milk, are a good substrate for DPPIV (EC 3.4.14.5) which is a major factor limiting the half-life of biologically active peptides. Serum DPPIV activity of two groups of infants (healthy and atopic dermatitis) and contents of beta-casomorphin-5 and -7 in their mothers' milk were determined in the study. We have found correlation between those two parameters in the group of children with atopic dermatitis syndromes, while no such a correlation was found in the control group.

[Bartter syndrome--case report]. / Zespól Barttera--opis przypadku.

The authors present the case of 4-month-old girl, who was admitted to our hospital with hypokalemia, metabolic alkalosis, hyperaldosteronism, hyperreninism with normal blood pressure and high urine concentration of PGE2. All the clinical and biochemical features have led to the diagnosis of Bartter syndrome. Treatment consisted of 15% KCI, spironolacton and indometacin.

[Gastroesophagopharyngeal reflux in infants and children with recurrent symptoms of the upper respiratory tract]. / Refluks zoladkowo-przelykowo-gardlowy u niemowlat i dzieci z nawracajacymi objawami z górnych dróg oddechowych.

Gastroesophageal reflux (GER) plays an important role in pathogenesis of recurrent/chronic disorders of the respiratory tract. Atypical symptoms of GER can be suggested to be cause of the otorhinolaryngological problems. For these last manifestations no cause-effect relationship has yet been proven. There are many therapeutic studies, in which treatment of GERD is examined for its impact on coexisting respiratory disorders. The aim of our study was to confirm the presence of acid reflux by using 24-hour intraesophageal pH monitoring. From the group of 29 patients with recurrent episodes of the pharyngitis, laryngitis and tracheitis, we evaluated 18 children aged 3 months to 8 years (mean, 4.23 +/- 2.85) with coexisting reflux symptoms. The protocol included a parenteral interview, physical examination, roentgenograms of the chest and larynx, laryngoscopy, as well as 24-hour simultaneous proximal and distal esophageal pH monitoring. The most significant differences between examined patients and control subjects was noted in terms of the lowest pH value, number of reflux episodes and index reflux while pH dropped below 4. Every significant drop under pH 6 recorded in proximal esophagus was simultaneous with reflux episode in distal esophagus. We found increased both sensitivity and specificity of the simultaneous pH monitoring in the distal and proximal part of the esophagus comparing to monitoring by the single probe. We confirmed the presence of gastroesophagopharyngeal reflux in patients with recurrent disorders of pharynx, larynx and/or trachea.

[Bartter's syndrome]. / Zespól Barttera.

Bartter syndrome is an uncommon tubular disorder inherited as an autosomal recessive entity. It is associated with hypokalemic metabolic alkalosis with high renin and aldosterone plasma concentration with low or normal blood pressure. Recent studies have demonstrated genetic heterogeneity in Bartter syndrome. Mutations of two genes encoding the Na/K/2Cl cotransporter and potassium channel ROMK are responsible for clinical features of neonatal Bartter syndrome. Mutations of gen encoding the chloride channel ClC-Kb is identified as being causative for the classic Bartter syndrome. And dysfunction of Na/Cl cotransporter in the distal convoluted renal tubule is described as Gitelman syndrome.

[Long-term clinical observation of infants with gastroesophageal reflux]. / Dlugotrwala obserwacja kliniczna niemowlat z rozpoznanym refluksem zoladkowo-przelykowym.

The aim of the study was long-term observation of patients with gastroesophageal reflux (GER), diagnosed in their infancy, in aspect of spontaneous resolution of this disorder. 290 symptomatic infants aged 5 weeks to 11 months (mean--5.8 months) underwent 24-hour esophageal pH monitoring. In 243 (83.8%) patients, abnormal reflux score was observed. After one year of conservative therapy, follow-up study by esophageal pH-monitoring has been performed in 136 (46.9%) children and still showed pathological GER in 95 (69.8%) subjects. After 2 years, 45 (15.5%) patients has been investigated--14/45 (31.0%) of them had normal reflux score. At the following five-year clinical observation was available group of 28/290 (9.6%) patients. In the 2-3 year of their life, 13 of them had resolved symptoms and had normal acid reflux parameters, whereas 9 patients still had pathological GER. In the following years, basing of results of 24-hour pH monitoring, pathological GER persisted: in 7 children in age 4, in 5 subjects in age 5 and in 3 children over fifth year of life. Long-term clinical follow-up of these children is necessary because of risk of GER complications.

[Environmental factors as a cause of food allergy in childhood]. / Srodowiskowe uwarunkowania alergii pokarmowej u dzieci i mlodziezy.

There is increasing evidence that both the prevalence and severity of atopic diseases are progressively increasing in developed countries. Similar trends are also observed in rural societies which are in the process of urbanization. If allergy is really malaise of modern society, what are the environmental and societal factors responsible for it's emergence? Authors discuss this problems underlining causative role of both factors in the development of allergic disease including food allergy.

[Dual simultaneous esophageal pH monitoring in infants with gastroesophageal reflux]. / Podwójne monitorowanie pH przelyku u niemowlat z objawami refluksu zoladkowo-przelykowego.

The aim of the current study was to analyse selected parameters of pH monitoring in the proximal and distal parts of esophagus. One hundred and twelve infants aged 1.25 to 18 months (mean = 5.6) with symptoms and signs suggesting gastroesophageal reflux (GER) were evaluated. The results are presented of the measurement of reflux index (RI), the number of reflux episodes and the duration of the longest reflux episode in patients classified into the following groups: group I--39 children with vomiting/excessive regurgitation, group II--29 infants with persistent distress/inconsolable crying, group III--16 children with Apparent Life Threatening Events (ALTE), group IV--28 infants with chronic/recurrent respiratory system diseases. No statistically significant difference was noted between the groups in pH parameters at the distal esophageal level, whereas at the proximal level the differences included only the number of reflux episodes. However, we found, that by using the ANOVA test, the incidence was higher in group IV than in group II. As determined by applying Mann-Whitney rank sum test, reflux episodes occurred most frequently in group IV, than in other groups of patients (including controls). None of the reflux parameters recorded at the proximal level among children presenting with ALTE was statistically significantly different than in other groups.