Effects of subtalar arthroereisis in children, assessed on the basis of quality-of-life questionnaires.

INTRODUCTION AND OBJECTIVE: Subtalar arthroereisis is a procedure commonly performed in children with flat feet. The procedure is performed when conservative treatment did not have the desired effect,or when the patient's abnormal symptoms are very severe and make it difficult for them to function normally in daily life. The aim of this study was to assess whether subtalar arthroereisis and physiotherapy improve the quality of life among children with flat feet. MATERIAL AND METHODS: The study comprised 79 patients (140 operated feet) diagnosed with a flat foot defect who underwent a subtalar arthroereisis procedure. A self-administered questionnaire and a shortened version of the standardised WHOQOL-BREF questionnaire were used in the research. RESULTS: The study confirmed that the patients' quality of life after surgery was high in all the areas regarding the somatic, psychological, social and environmental domains. In the group of children assessed 13-24 months after surgery. it was also found that rapid fatigue after exercise (30% ± 9%) and Achilles tendon contracture (7% ± 4%) were significantly reduced. The results of the study confirmed that subtalar arthroereisis contributes to a decreased demand for orthoses in children (9% ± 6%) and for orthopaedic footwear (11% ± 5%) than before surgery. CONCLUSIONS: The employment of subtalars arthroereisis has a positive effect on the quality of life of children with flat feet. The surgery contributes to a reduction in pain and other abnormal symptoms that are associated with flat feet. In addition, physiotherapy performed after the procedure had a positive effect on the healing process and contributed to the improvement of the children's quality of life.

Toxic Streptococcal Infection in Children: Report on Two Cases with Uncharacteristic Course of Scarlet Fever.

INTRODUCTION: Scarlet fever is usually a mild childhood disease caused by type A streptococci. This disease is spread by droplets, mainly through direct contact with an infected person or the objects they have used. In pediatrics, these are significant risk factors for the transmission of infectious diseases. However, it is important to remember the possibility of serious complications in the course of scarlet fever. AIM: This paper provides a discussion of two pediatric cases in order to determine the possibilities of diagnosis, differentiation, and treatment of patients with severe, non-obvious courses of scarlet fever. METHODS: The case reports of two patients hospitalized in a pediatric department due to Streptococcus pyogenes infection were examined. RESULTS: The patients were admitted to the emergency room with symptoms not directly indicative of type A streptococcal infection, which required further diagnosis. Both patients complained of weakness at the time of presentation. They had an elevated temperature, were dehydrated during the course of gastroenteritis, and passed liquid stools without pathological admixtures. Further stages of diagnosis and treatment required hospitalization in the pediatric department. Therapeutic benefit from the implemented treatment was obtained, and the patients were discharged in good general condition with further recommendations. CONCLUSIONS: Medical history, which is often very detailed, can be the key to making the final diagnosis and can supplement the data collected on the basis of laboratory tests. Scarlet fever does not always occur with a mild course, and sometimes its course can be quite non-specific and may require a thorough diagnosis.

The influence of maternal vaginal flora on the intestinal colonization in newborns and 3-month-old infants.

AIM: The role of maternal vaginal bacteria on the colonization of neonatal gut is still a matter of discussion. Our aim was to estimate the role of maternal vaginal flora on the development of intestinal flora in neonates and 3-month-old infants. METHODS: Seventy-nine maternal-neonatal pairs were included in the study. Vaginal swabs were taken before the rupture of membranes after admission to the delivery ward. First neonatal stool (meconium) and stool at 3-month-old infants were collected and cultured. All samples were subjected to microbiological analysis for Streptococcus, Staphylococcus, Bifidobacterium, Clostridium (including C. difficile), Lactobacillus, Escherichia coli, Klebsiella pneumoniae, and Candida. RESULTS: Maternal vagina was colonized mainly by streptococci (67%) followed by lactobacilli (58%) and Candida spp. (39%). Vaginal streptococci influenced the intestinal colonization in infants with staphylococci, C. difficile, and candida. CONCLUSION: Vaginal lactobacilli influenced colonization with C. difficile, and Candida. Vaginal flora is a potent factor influencing the development of bacterial flora in the neonatal and infantile gut. The extension of the observation period until 3 months of life allow to discover the potential changes in the intestinal flora of children.

Chlamydia trachomatis infection in women with lichen sclerosus vulvae and vulvar cancer.

OBJECTIVE: Chronic infections in the urogenital area often precede or coexist with vulvar cancer. A strong connection between some tumours and the-appearance of Chlamydia trachomatis infection has been observed, but there is little information concerning a connection of that infection with vulvar cancer and lichen sclerosus vulvae (LS). The aim of this study was the analysis of frequency of antigens appearance and antibodies of IgM and IgG Chlamydia trachomatis in patients with vulvar cancer and LS and we wanted to find the correlation between Chlamydia trachomatis infection and vulvar cancer and LS. METHODS: 80 women treated in the Clinic of Vulva Diseases at the Department and Clinical Ward of Gynaecology, Obstetrics and Oncological Gynaecology in Bytom, in the Silesian Medical University in Katowice were divided into two groups - 30 were treated for vulvar cancer and 50 were treated because of LS. We took bacterial smears vagina and cervical smears for presence of Chlamydia trachomatis antigens and peripheral blood to mark antibodies of IgM and IgG Chlamydia trachomastis. RESULTS: Chlamydia trachomatis antigen was found in 20% women with vulvar cancer and in 12% women with LS (p>0.05). In 13,3% cases with vulvar cancer we observed IgM Chlamydia trachomatis antibodies. In the group with LS IgM antibodies appeared in 16% women (p>0.05). In 50% patients with vulvar cancer in blood serum we observed IgG Chlamydia trachomatis antibodies, and in 16% women with LS (p<0.001). CONCLUSIONS: Previous Chlamydia trachomatis infection can lead to vulvar carcinogenesis.

Effectiveness of photodynamic therapy in the treatment of lichen sclerosus: cell changes in immunohistochemistry.

BACKGROUND: Vulvar lichen sclerosus (LS) affects primarily women at postmenopausal age and its background remains unknown. One of the treatment modalities is photodynamic therapy (PDT). The aim was to investigate the efficacy of PDT in women with LS and the analysis of protein expression before and after PDT. MATERIAL AND METHODS: From 04.2006-01.2008 28 women, with LS underwent photodynamic diagnosis and next PDT: six-courses every second week with using 5-aminolevulinic acid (ALA) as a photosensitizer. Punch biopsies were taken before and after treatment and immunohistochemistry was done with Ki67,CD44,CD34 and CD3. RESULTS: Before PDT all patients suffered from pruritus and after in 89.3% the relief was noted. The histological examination showed that 35.7% patients hadn't LS after therapy completion. Anti-CD44 staining intensities was scored qualitatively - there were no statistical difference at the expression of protein CD44 in the epidermis (p>0.05) before and after therapy. Microvessel density was assessed at the hot spots, marked with anti-CD34. Statistical difference in AVD before and after therapy: (p<0.05). The staining intensity of Ki-67 didn't differ before and after PDT (p>0.05). The expression of CD3 on T lymphocytes showed statistical difference of the lymphocytic infiltration before and after PDT ( p<0.05). CONCLUSION: The immunohistochemical staining in vulvar LS showed increasing microvessel density and decreasing lymphocytic infiltration. There were a clinical, and less histological improvement in patients with LS. We suggest that the photodynamic therapy is an effective, alternative treatment in some but not all patients with LS. Therefore, further studies are needed.

Prenatal priming of cord blood T lymphocytes by microbiota in the maternal vagina.

PROBLEM: In the vagina of women at the reproductive age, more than 170 strains of bacteria and yeasts are found. The effect of vaginal flora on neonatal T cells is yet to be investigated. METHOD OF STUDY: We analyzed CD45RA and CD45RO expression on neonatal CD4+ T cells and cytokine production in CBMC cultures (interferon-gamma (IFN-gamma ), interleukin-4 (IL-4) and IL-12) related to vaginal bacteria isolated from a maternal vagina. We collected vaginal swabs from 36 women at the first stage of the delivery and cord blood from their newborns. IFN-gamma, IL-4, and IL-12 in stimulated CBMC were measured and the expression of CD45RA/CD45RO on CD4+ T cells was assessed. RESULTS: We noted the difference in CD45RO CD4+ expression and IL-12 levels between the newborns whose mothers were or were not colonized with Lactobacillus in the vagina (newborns whose mothers were colonized with Lactobacillus: CD45RO-10%+/-3; IL-12-0.2 pg/mL +/- 0.05; newborns whose mothers were not colonized with Lactobacillus: CD45RO-6%+/-3; IL-12-2.0 pg/mL +/- 0.7). CONCLUSION: Our results may indicate that lactobacilli in maternal vagina influence the development of neonatal immune system. Yet, more research is needed using specified bacterial antigens.

CD30 on stimulated CD4+ T lymphocytes in newborns regarding atopic heredity.

CD30 was initially described as Ki-1 Ag on Reed-Sternberg cells of Hodgkin's lymphoma and its and CD30L(+) expression on T cells in placenta were equally frequent in the atopic and non-atopic women. In this article we present a study of CD30 mean fluorescence intensity (MFI) on CB T CD4(+) cells. We tested the hypothesis that in newborns with atopy family history there is a changed CB T cells response after antigen stimulation comparing with those without atopy family history. The study population consisted of 31 newborn babies (29-breastfed, two non-breastfed) and their mothers. Eleven of them had positive and 20 had negative atopy family history. Performed tests included cord blood, which was a subject to flowcytometry analysis and was cultured for 24 h, cytokine production was measured (IFN- gamma, IL-4 and IL-12). Secondly, we measured total maternal and cord blood IgE levels. We studied CD30 MFI as in our studies in larger group of newborns, CD30 expression on CD4(+) T cells appeared to be very low. MFI of CD4(+) CD30(+) after PHA-stimulation (213.55: range: 41.77-434.51) was significantly increased compared to MFI of CD4(+) CD30(+) before PHA-stimulation (43.63: range 28.67-134.67)(p 0.05). After PHA stimulation MFI of CD4(+) CD30(+) in non-atopic (273.05 (range: 42.9-434.51) was significantly increased compared with the atopic newborns to MFI of 87.1 (range: 41.78-241.42) (p = 0.00). We have not found any correlation between MFI of CD4(+) CD30(+) and total maternal and total CB IgE levels. The role of CD30 in immunological response needs further research studies.