Katarzyna Bąk-Drabik

Introduction and objective: This pilot study aimed to evaluate the feasibility of attenuated total reflectance – Fourier transform infrared spectroscopy (ATR FTIR) as a rapid, non-invasive method for detecting biochemical alterations in the fingernails of paediatric patients with inflammatory bowel disease (IBD). Materials and methods: ATR FTIR spectra were acquired from fingernail clippings obtained from 10 children diagnosed with IBD and from 10 age-matched healthy controls. Spectral analysis focused on characteristic vibrational bands associated with keratin structure, including N–H stretching vibrations, asymmetric CH₂ and CH₃ stretching modes, and symmetric CH₃ vibrations. Results: Comparative spectral analysis revealed subtle but consistent differences between the IBD and control groups. Shifts in bands related to keratinassociated amino acids were observed, particularly in the regions corresponding to N–H and C–H stretching vibrations. The most pronounced difference was detected at 1,745 cm⁻¹, attributed to C = O stretching vibrations, suggesting alterations related to oxidative processes in the fingernails of children with IBD. Conclusions: ATR FTIR spectroscopy demonstrated potential for identifying disease-related biochemical changes in the fingernails of paediatric patients with IBD. The observed spectral differences indicate keratin derangements associated with oxidative stress and visible nail alterations. These preliminary findings justify further investigation of ATR FTIR fingernail analysis in larger cohorts and its potential role in monitoring disease-related biochemical changes and dietary interventions, including antioxidant strategies.

Chronic constipation in children is a significant problem not only for the child but also for the family and caregivers in institutional settings. Constipation is a common clinical symptom, accounting for nearly one-third of consultations in pediatric gastroenterology clinics. In the vast majority of cases, the cause is functional constipation, whose pathogenesis is complex but usually benign. The greatest challenge lies in identifying organic causes within this patient group, for which ultrasound is particularly well suited as a non-invasive tool for exclusion. Transabdominal intestinal ultrasound is an ideal diagnostic tool due to its non-invasive, cost-effective, and repeatable nature, and its ability to be performed during routine outpatient visits. It enables objective assessment of fecal retention by measuring rectal diameter (RD), rectal wall thickness, and degree of colonic filling. In addition, ultrasound may be useful for assessing stool consistency and colonic transit. Perianal ultrasonography is a complementary method to transabdominal intestinal ultrasound, enabling a more detailed evaluation of anal canal structures. Ultrasound may therefore represent a valuable adjunct in the diagnosis and management of pediatric constipation, although further standardization of methodology and diagnostic criteria is required.

Aim: This study aimed to evaluate point‐of‐care ultrasound (POCUS) findings in children with functional constipation who achieved complete clinical improvement following standard treatment in accordance with international guidelines. Material and Methods: The study included 58 children (31 boys) aged 0.9–16.1 (mean age 5.22 ± 3.24), diagnosed with functional constipation, who attended two visits: First due to constipation‐related symptoms and second to evaluate the treatment response. Each patient underwent a complete abdominal ultrasound examination before or during the first visit and a POCUS assessment at follow‐up. Results: The median time to follow‐up was 3.7 months (IQR: 2.5–7.4), with a range of 0.9–29.2 months. The mean rectal diameter decreased from 38.93 ± 10.7 mm at baseline to 24.46 ± 11.54 mm after treatment. Initially, hard stool predominated in the rectal ampulla (96.6%) and sigmoid colon (93.1%). At follow‐up, hard stool decreased to 63.7% in the rectum and 45.5% in the sigmoid colon. Although symptom resolution and physical examination would suggest continuing the current treatment, it was intensified in 51.7% of patients based on POCUS findings. Conclusion: In the studied children with functional constipation, POCUS findings provided additional, clinically meaningful information for evaluating treatment response.

This case report describes a 17-year-old boy previously hospitalised in Belarus, with significant dilatation of the small intestine in the course of stricturing-type Crohn’s disease. Upon admission, the boy was severely malnourished. Magnetic resonance enterography revealed stenosis at the level of the distal ileum with massive prestenotic dilatation of the loops. During the gastrointestinal passage examination, signs of subobstruction of the gastrointestinal tract and dilatation of several ileal loops were noted. Surgical treatment was recommended, but the parents opposed the decision. Six months later, the boy was hospitalised again due to an exacerbation of the disease. After obtaining parental consent, ileocaecal resection was performed. The patient was discharged in good condition. Biological therapy was initiated. This case report highlights the importance of appropriate treatment of Crohn’s disease. Decisions regarding surgical intervention can be difficult to accept for parents, so, understandably, they require the support of a hospital psychologist.

Background/Objectives: The rising global prevalence of inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, has resulted in an increase in the number of affected patients requiring dental care. The heightened risk of Clostridioides difficile infection (CDI) in IBD patients, particularly when exposed to commonly used dental antibiotics, is attributable to their altered gut microbiota and frequent immunosuppressive therapy. The objective of this review is to evaluate current antibiotic strategies for dental management in IBD and to identify safe and effective alternatives that minimise CDI risk. Methods: A narrative review was conducted in accordance with the SANRA guidelines. A comprehensive analysis of literature sourced from PubMed, Embase, Scopus, and Google Scholar was conducted. Results: The available evidence suggests that first- and second-line dental antibiotics—amoxicillin, ampicillin, and clindamycin—carry the highest risk of CDI. In contrast, metronidazole, which exhibits a comparable antimicrobial spectrum, has been shown to possess significantly reduced CDI potential and minimal disruption of gut microbiota. The utilisation of emerging local delivery systems, such as platelet-rich fibrin (PRF), has the potential to further reduce systemic antibiotic exposure. The adjunctive use of probiotics, prebiotics and synbiotics has been demonstrated to have the capacity to maintain microbial balance during therapy. Conclusions: Tailored, microbiome-conscious antibiotic strategies are essential in dental management of IBD patients. Further clinical research is needed to develop evidence-based guidelines and validate promising adjunctive approaches.

Background and objective: Thiopurines (azathioprine (AZA) and 6-mercaptopurine (6-MP)), used to maintain remission in inflammatory bowel diseases (Crohn’s disease (CD), ulcerative colitis (CU)) and autoimmune hepatitis (AIH), are responsible for a number of adverse effects. One is leukopenia, mainly due to neutropenia and less known lymphopenia. This study aimed to assess the incidence rate of lymphopenia in pediatric patients with CD, CU, and AIH treated with azathioprine (AZA) and to evaluate the impact of lymphopenia on the occurrence of opportunistic infections and its relationship with disease activity, treatment, and nutritional status. Materials and methods: A retrospective analysis was carried out in ninety-eight (98) paediatric patients, suffering from CD, CU, or AIH and treated with AZA, in order to assay blood cell count and thiopurine metabolite levels, assess the mean AZA dose, measure the anthropometric parameters, evaluate disease activity vs. the treatment administered, and to find out concomitant infections. Results: Lymphopenia was diagnosed in twenty-two (22) children and evaluated as severe in two (2) cases, which were associated with treatment discontinuation. The percentage of patients with lymphopenia in the CD group (34.5%) was significantly higher vs. the CU (3.7%) and AIH (7.7%) groups. The prevalence rates of the patients with low and moderate-to-high disease activity were 13.9% and 46.1%, respectively. The patients with lymphopenia demonstrated higher prevalence rates of mild respiratory tract and skin infections (identified in 32%). No cases of opportunistic infections were reported. Conclusions: Lymphopenia affected approximately one-quarter of the patients observed, the condition being transient in most cases and not demanding any therapy modifications. In no case was it associated with the occurrence of any opportunistic infections. It was significantly more common in the patients with Crohn’s disease and the subgroup with a more intense course of the disease, obviously suggesting a need for more frequent follow-up of the patients in those subgroups. The AZA therapy did not seem to be associated with lymphopenia occurrence in any significant way.

This case report presents a paediatric patient diagnosed with lymphocytic colitis – a histological subtype of microscopic colitis. The disease is characterised by chronic, watery, non-bloody diarrhoea, a normal endoscopic image, but abnormal histopathological findings. While this condition predominantly affects adults, there are few published cases of lymphocytic colitis in the paediatric population. A five-year-old male patient with vitiligo and nephrotic syndrome was admitted for further diagnostic evaluation of chronic diarrhoea. Remission of the diarrhoea had previously been observed during steroid therapy for nephrotic syndrome, but the symptom recurred after discontinuation of treatment. A thorough differential diagnosis was conducted. Endoscopic examination revealed no macroscopic abnormalities. Only the histopathological examination confirmed the diagnosis of lymphocytic colitis. Although the association between microscopic colitis and certain autoimmune diseases is well-established, there are no reports of coexisting vitiligo or nephrotic syndrome in a child with lymphocytic colitis.

Colorectal polyps are found in about 6% of all paediatric colonoscopies and 12–15% of those performed for lower gastrointestinal bleeding. The purpose of this report is to describe the experience of ultrasound detection of colorectal polyps in children and evaluate the diagnostic value of ultrasonography. The paper includes a case report of five Polish children with rectal bleeding. The children had a median age of 5.25 years (range: 2–14), and four were girls. Symptoms had been present for 3–6 months before diagnosis. The common ultrasound finding for all polyps was an isolated oval or roundish, well-vascularised structure of varying sizes. Earlier visualisation of the polyp allowed for more accurate and safer therapeutic decisions. Ultrasound is a convenient, non-invasive, and feasible method for diagnosing colonic polyps.

Background: Raman spectroscopy is a well-known tool used in criminology, molecular biology, and histology. It is also applied to diagnose bone mineral disorders by taking advantage of the similarity of the structure of keratin and bone collagen. Raman spectroscopy can also be used in dermatology and diabetology. The purpose of the present review is to critically evaluate the available research about the use of Raman spectroscopy in the mentioned areas of medicine. Methodology: PubMed was searched for peer-reviewed articles on the subject of use of Raman spectroscopy in bone mineral disorders, dermatology, and diabetes mellitus. Results: Nail keratin and bone collagen are related structural proteins that require disulfide bond for structural stability. Therefore, Raman spectroscopy of keratin may have potential as a diagnostic tool for screening bone quality and distinguishing patients at risk of fracture for reasons different from low bone mineral density (BMD) in the adult women population. Raman spectroscopy can also investigate the changes in keratin’s structure in nails affected by onychomycosis and distinguish between healthy and onychomycosis nail samples. It could also reduce the need for nail biopsy by distinguishing between dermatophytic and non-dermatophytic agents of onychomycosis. Additionally, Raman spectroscopy could expedite the diagnostic process in psoriasis (by assessing the secondary structure of keratin) and in diabetes mellitus (by examining the protein glycation level). Conclusions: In adult populations, Raman spectroscopy is a promising and safe method for assessing the structure of fingernails. However, data are scarce in the pediatric population; therefore, more studies are required in children.

Introduction and objective: Crohn’s disease (CD) and ulcerative colitis (UC), which often impact individuals in their youth, significantly affect quality of life. This study analyses anthropometric data and clinical presentations of CD and UC over a 13-year period in newly diagnosed patients at the Department of Paediatric Gastroenterology and Hepatology in Zabrze, Poland. Materials and methods: Seventy-four CD patients and 90 UC patients were analysed, and categorised into four groups based on disease type and diagnosis period: Group A (CD, 2008–2011), Group B (CD, 2018–2021), Group C (UC, 2008–2011), and Group D (UC, 2018–2021). Collected data encompassed gender, age, weight, height, body mass index (BMI), duration of symptoms before diagnosis, disease location, and activity. Results: Among patients diagnosed between 2018 and 2021 (Groups B and D), CD exhibited a higher prevalence in boys (67.57% vs. 32.43%), while UC was more prevalent in girls (61.40% vs. 38.60%). Groups A and B demonstrated lower mean weight standard deviation scores (SDS) and BMI-SDS compared to Groups C and D. Symptom duration before diagnosis was shorter in Group C than in Group A (5 vs. 10 months) and in Group D compared to Group B (6 vs. 11 months). Severe CD activity at diagnosis was higher in Group A than in Group B (35.14% vs. 5.41%). The results were statistically significant – p < 0.05. Conclusions: UC diagnoses remain faster than CD, possibly due to more alarming symptoms. Patients diagnosed with CD demonstrate lower body weight and BMI compared to UC patients. The incidence of severe CD activity has significantly decreased over 13 years, potentially due to enhanced paediatric care and expedited diagnosis.