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Background: Iron deficiency (ID) is a global problem that affects women more prevalently, causing vast health consequences. Screening by hemoglobin and serum ferritin is currently applied for ID. Recently, interest in complete blood count parameters (CBC) has emerged for its close relationship with body iron stores. Objectives: to examine whether hematological indices of CBC [namely red cell distribution width-coefficient of variation (RDW-CV) and platelets distribution width-coefficient of variation (PDW-CV)] can serve as a predictor for ID in Iraqi women. Subjects and Methods: A cross-sectional study at the National Center of Hematology recruited 200 women into a study group: 100 anemic women and 100 healthy controls. Their demographics, hematological indices, and iron indicators (serum ferritin, iron, total iron binding capacity (TIBC), and transferrin saturation) were collected. Results: The RDW-CV and platelet counts were statistically higher in the IDA cases, while PDW was lower. RDW had significant correlation to serum ferritin (r=-0.2, P=0.04), while PDW was significantly linked to serum ferritin (0.22, P=0.03) TIBC (r=-0.24, P=0.02) and TSP (r-0.23, P=0.02). RDW had the highest positive and negative predictive values, with 84 and 97 %, respectively, followed by platelet counts, which scored 72 and 78 %, respectively. RDW-CV cutoff value scored the highest sensitivity, 97%, and specificity, 82%, in discriminating ID cases from healthy controls with an area under the curve of 0.98 and P

The autoimmune process that induces type 1 diabetes can also affect other organs, leading to the development of additional autoimmune diseases in patients, thus hindering diabetes control. The most common comorbidities include autoimmune thyroid diseases and celiac disease. Globally, this subject is increasingly drawing the attention of researchers, given the magnitude and severity of the association between autoimmune diseases and type 1 diabetes. The aim of the present study is to assess the prevalence of autoimmune diseases, with the primary focus on celiac disease, associated with type 1 diabetes in children and adolescents, as well as their impact on the progression of type 1 diabetes. Material and methods: The present study was conducted within the Pediatric Section, Pediatric Diabetology Department of the Emergency Clinical Hospital “St. Apostle Andrew” in Constanța, including 15 cases diagnosed with type 1 diabetes in children during the period 2017-2022. Results: The patients included in the study are aged between 1 and 13 years highlighting the age group of 3-6 years as the most commonly encountered. The most commonly encountered HbA1c values are in the range of 10-12%, accounting for 53% of the total, we can thus observe a prevalence of high and very high HbA1c values. In order to confirm the diagnosis of type 1 diabetes, specific antibodies were sampled, 97% of patients being tested positive for at least one antibody. Conclusions: The association between diabetes mellitus and another autoimmune disease is encountered at a relatively high percentage. Higher levels of HbA1c at the onset of type 1 diabetes have been associated with an increased risk of long-term complications.

Background: In the pediatric intensive care unit (PICU), sepsis, sepsis syndromes, septic shock, and multiorgan system failure are frequently encountered and are considered important conditions; Methods: This is a retrospective, observational study over a period of 3 years, that is aimed to investigate the predictive role of lactate levels at admission in order to evaluate disease progression of pediatric patients with septic shock syndrome with the role to identify whether lactate levels at admission could serve as a significant predictor of adverse outcomes. The sample consisted of 21 patients between 1 and 36 months, diagnosed and treated for hemodynamic shock in a tertiary center; Results: The study found that lactate level at admission greater than or equal to 4.95 was associated with 32.5 times increased odds of serious evolution. The study also identified other potential predictors, such as lactate level 12 hours after admission, hemodynamic parameters, and demographic factors; Conclusions: These findings suggest that monitoring lactate levels at admission can provide important information to predict mortality and guiding treatment decisions in pediatric patients with shock syndrome.

The most frequent hyperglycemic emergency is diabetic ketoacidosis (DKA), which puts individuals with diabetes mellitus at the highest risk of mortality that may be avoided. DKA affects people with type 1 diabetes more frequently than type 2, with 30% of occurrences in patients who have already been diagnosed with type 2 diabetes. High blood sugar level, ketosis and metabolic acidosis are symptoms of DKA. The aim of the study is to emphasize the main manifestation of type 1 diabetes which is diabetic ketoacidosis, as well as, to analyze the factors predisposing to recurrent episodes of diabetic ketoacidosis. Material and Methods. The retrospective study was conducted on a period between 2017-2022, including hospitalized children aged between 0-16 years with recurrent diabetic ketoacidosis within the Pediatric Clinic of Clinical Emergency Hospital “St. Andrew the Apostle” Constanta, aiming to analyze the factors predisposing to recurrent episodes of diabetic ketoacidosis according to age, sex, environment, socio-economic status, heredo-collateral antecedents, symptoms, personal pathological history, clinical and laboratory data. Results. It was observed that the incidence of episodes of diabetic ketoacidosis increased considerably since 2019, the maximum being recorded in 2020, while the lowest percentage is in 2017. During 2020–2021, the age group of 10–14 years presented. Genetic sex remains a nonmodifiable risk factor that is thought to play a role in terms of glycemic control, but also the occurrence of complications in patients with type 1 diabetes. It was shown that 37% of the causes of the recurrence of DKA episodes were found to be diet variation, 28% to be viral diseases, 26% to be insulin administration errors, 6% to be trauma, and only 3% to be Mauriac syndrome. Conclusions. Numerous research from the medical literature have supported the hypothesis that SARS-CoV-2 may be a catalyst for autoimmunity in the pathogenesis of type 1 diabetes, indicating a causal connection between the two illnesses. It has been established that diet non-compliance is the primary cause of recurrent episodes of ketoacidosis.

Introduction. Gut microbiota is a microecosystem with a dynamic complexity, influenced by multiple factors, with impact on the composition and long-term health. An imbalance in gut microbiota, often termed as ‘dysbiosis’, is associated with a wide variety of pediatric diseases, including allergies, diabetes mellitus, autoimmune diseases, autism spectrum disorders and celiac disease. The aim of the study is to emphasize the main clinical manifestations and to analyze the risk factors of gut dysbiosis in the first three years of life. Material and Methods. The retrospective study was conducted on a period between 2020-2022, including children aged between 0-3 years with intestinal dysbiosis, aiming to analyses the factors predisposing to imbalance in gut composition according to age, gender, environmental factors, personal medical history, clinical manifestations, and laboratory data. Results and Discussions. Main clinical manifestations of dysbiosis in the first three years of life are represented by abdominal pain, vomiting, irritability, diarrheal stools and stools with mucus. C-section represents a major risk factor for the occurrence of gut dysbiosis in infants. Low birth weight is a risk factor due to imbalance of intestine function and high susceptibility to dysbiosis. Infant formulas determine a low concentration of beneficial bacteria. Urban area represents an environmental factor with increased susceptibility of subjects for gut dysbiosis. Antibiotherapy in the first year of life is a factor which determines a low microbial diversity in infants. Conclusions. The interplay between intestinal microbiota, environment and host is a multidirectional relationship. Factors such as mode of delivery, type of feeding, weight, living conditions and antibiotherapy have an influence on the modulation of the microbiological milieu in the first three years of life, with impact on long-term health.

Aim of the study. This study aimed to evaluate malondialdehyde status and dyslipidemia in diabetic children. In children, type 1 diabetes mellitus (T1DM) is considered one of the most common chronic autoimmune diseases. The first step is detecting insulin deficiency expressed by hyperglycemia. The short- and long-term effects are significant and affect all body parts: blood vessels, eyes, kidneys, brain, heart, and nerves. Persistent hyperglycemia generates reactive oxygen species (ROS) / free radicals through metabolic abnormalities such as glucose autooxidation and non-enzymatic glycation. Materials and methods. This study included 50 children with T1DM with a mean age of 7.6 years. Important elements were evaluated to establish clear indicators of atherosclerotic activity (lipoperoxidation, protein oxidation, changes in the status of antioxidant defense systems, plasma oxygen radical absorbance capacity (ORAC), glycated hemoglobin (HbA1c), total cholesterol, and triglycerides). Results. Malondialdehyde (MDA) and lipid levels were correlated and significantly higher (0,87 ± 0.2 versus 1,8 ± 0,87 µmol/L, 66,33 +/-14,21 versus 43,33 +/- 7,2 respectively; P < 0.001), and a significant reduction in plasma total antioxidant capacity. Conclusions. MDA levels presented elevated values, indicating the negative connection between atherosclerotic risk factors and MDA. This important conclusion can be drawn every time a patient with type 1 diabetes presents LDL excess levels, therefore representing an increased lipid peroxidation resulting in higher MDA levels. From this point, the correlation between hyperglycemia (the main source of increased oxidative stress) in patients with poor metabolic control and MDA is not the only path to anticipate the risk of atherosclerotic complications.

Background: Vitamin D is an organic compound with an important role in bone metabolism and ability to modulate the immune function. Epidemiology research have recently suggested vitamin D’s role in the etiology of type 1 and type 2 diabetes in children. Vitamin D controls insulin secretion in pancreatic islets and insulin sensitivity in several peripheral metabolic organs by acting through the vitamin D receptor (VDR). Recent studies have reported an increased prevalence of vitamin D deficiency among patients diagnosed with type 1 diabetes. The aim of the study is to identify the correlation between vitamin D deficiency and the frequency, severity, and control of type 1 diabetes in children. Material and Methods: The retrospective study was performed on 40 subjects with type 1 diabetes, which associated vitamin D deficiency at the onset of the disease or during the investigation period, at Pediatric Clinic of Constanta County Clinical Emergency Hospital. The strategy used involved the collection of certain parameters from the observation sheets, in order to evaluate, compare and illustrate the correlation between vitamin D deficiency and type 1 diabetes. Results: Male subjects represented the majority of cases (55%). The seasonal incidence may be explained by exposure to a reduced amount of ultraviolet radiation in the cold season, which contributes to the decrease in the level of 25-hydroxyvitamin D. Viral infections had an increased incidence in the winter, which may contribute to the onset of type 1 diabetes. An optimal level of serum 25-hydroxyvitamin D was found in 17% cases, insufficient level in 63% cases and deficiency in 20% cases. In evolution, 24 cases had poor glycemic control, registering values higher than 7% of glycosylated hemoglobin. The dosage of 25 hydroxyvitamin D in these subjects indicated vitamin D deficiency in 7 cases and insufficiency in 17 cases. None of the patients with a glycosylated hemoglobin value >7 had an optimal 25-hydroxyvitamin D level. Out of 16 patients with optimal glycosylated hemoglobin values (

The most common inherited condition that results in death, particularly in those of Caucasian heritage, is cystic fibrosis (CF). Of all the young adults diagnosed with cystic fibrosis, 20% will develop hyperglycemia as a complication, later classified as a disease associated with cystic fibrosis. Impaired insulin secretion and glucose intolerance represent the primary mechanisms associated with diabetes (type 1 or type 2) and cystic fibrosis. Oxidative stress represents the imbalance between oxygen-reactive species and antioxidant defense mechanisms. This pathogenic mechanism is vital in triggering other chronic diseases, including cystic fibrosis-related diabetes. It is essential to understand oxidative stress and the significant impact it has on CFRD. This way, therapies can be individually adjusted and tailored to each patient’s needs. This review aims to understand the connection between CFRD and oxidative stress. As a subsidiary element, we analyzed the effects of glycemic balance on complications and their evolution over time, providing insights into their potential benefits in mitigating oxidative stress-associated complications.

The gut microbiota (GM) plays a vital role in human health, with increasing evidence linking its imbalance to chronic kidney disease and end-stage kidney disease. Although the exact methods underlying kidney-GM crosstalk are not fully understood, interventions targeting GM were made and lay in three aspects: diagnostic, predictive, and therapeutic interventions. While these interventions show promising results in reducing uremic toxins and inflammation, challenges remain in the form of patient-specific GM variability, potential side effects, and safety concerns. Our understanding of GMs role in kidney disease is still evolving, necessitating further research to elucidate the causal relationship and mechanistic interactions. Personalized interventions focusing on specific GM signatures could enhance patient outcomes. However, comprehensive clinical trials are needed to validate these approaches’ safety, efficacy, and feasibility.

The first 1000 days after birth represent a critical window for gut microbiome development, which is essential for immune system maturation and overall health. The gut microbiome undergoes major changes during this period due to shifts in diet and environment. Disruptions to the microbiota early in life can have lasting health effects, including increased risks of inflammatory disorders, autoimmune diseases, neurological disorders, and obesity. Maternal and environmental factors during pregnancy and infancy shape the infant gut microbiota. In this article, we will review how maintaining a healthy gut microbiome in pregnancy and infancy is important for long-term infant health. Furthermore, we briefly include fungal colonization and its effects on the host immune function, which are discussed as part of gut microbiome ecosystem. Additionally, we will describe how potential approaches such as hydrogels enriched with prebiotics and probiotics, gut microbiota transplantation (GMT) during pregnancy, age-specific microbial ecosystem therapeutics, and CRISPR therapies targeting the gut microbiota hold potential for advancing research and development. Nevertheless, thorough evaluation of their safety, effectiveness, and lasting impacts is crucial prior to their application in clinical approach. The article emphasizes the need for continued research to optimize gut microbiota and immune system development through targeted early-life interventions.

Acute respiratory tract infections (ARTIs) are one of the main reasons that the pediatric population goes to the doctor. The connection between ARTI and vitamin D (VD) is currently debated by the medical community, and so far, there has been little agreement with regard to the ideal level of 25(OH)D concentration that would provide protection for the respiratory tract, or the effectiveness of its administration in the treatment of respiratory infections. The purpose of this literature review was to bring attention to the immunomodulatory and antiviral function of vitamin D and its relation to the respiratory system by examining the main ARTIs, including SARS-CoV-2. The latter has affected the pediatric population in different ways, from asymptomatic patients to severe forms with multisystem inflammatory syndrome in children (MIS-C). Although there are not much clinical data on the SARS-CoV-2 disease in the pediatric population worldwide, we tried to find out whether there is a connection between the severity of this disease, other ARTIs, and vitamin D supplementation. We also aimed to find out if 25OHD deficiency had an adverse effect on the evolution of the disease and the recovery period in the case of younger patients affected by COVID-19. For this literature review, the PICO framework was selected as the methodological approach. Our results demonstrated many methods by which this vitamin may lower the risk of ARTI with regard to the COVID-19 infection. Despite these significant advancements, more research is needed to support the idea that 25(OH)D concentration can influence the evolution of respiratory tract infections in children.

Numerous interrelationships are known in the literature that have the final effect of unmasking or influencing various pathologies. Among these, the present article aims to discuss the connection between systemic lupus erythematosus (SLE) and the human microbiome. The main purpose of this work is to popularize information about the impact of dysbiosis on the pathogenesis and evolutionary course of pediatric patients with SLE. Added to this is the interest in knowledge and awareness of adjunctive therapeutic means that has the ultimate goal of increasing the quality of life. The means by which this can be achieved can be briefly divided into prophylactic or curative, depending on the phase of the condition in which the patient is. We thus reiterate the importance of the clinician acquiring an overview of SLE and the human microbiome, doubled by in-depth knowledge of the physio-pathogenic interactions between the two (in part achieved through the much-studied gut-target organ axes—brain, heart, lung, skin), with the target objective being that of obtaining individualized, multimodal and efficient management for each individual patient.

Neonatal diabetes mellitus is a rare genetic disease that affects 1 in 90,000 live births. The start of the disease is often before the baby is 6 months old, with rare cases of onset between 6 months and 1 year. It is characterized by low or absent insulin levels in the blood, leading to severe hyperglycemia in the patient, which requires temporary insulin therapy in around 50% of cases or permanent insulin therapy in other cases. Two major processes involved in diabetes mellitus are a deformed pancreas with altered insulin-secreting cell development and/or survival or faulty functioning of the existing pancreatic beta cell. We will discuss the cases of two preterm girls with neonatal diabetes mellitus in this research. In addition to reviewing the literature on the topic, we examined the different mutations, patient care, and clinical outcomes both before and after insulin treatment.

The intestinal microbiota is a diverse and complex microecosystem that lives and thrives within the human body. The microbiota stabilizes by the age of three. This microecosystem plays a crucial role in human health, particularly in the early years of life. Dysbiosis has been linked to the development of various allergic diseases with potential long-term implications. Next-generation sequencing methods have established that allergic diseases are associated with dysbiosis. These methods can help to improve the knowledge of the relationship between dysbiosis and allergic diseases. The aim of this review paper is to synthesize the current understanding on the development of the intestinal microbiota in children, the long-term impact on health, and the relationship between dysbiosis and allergic diseases. Furthermore, we examine the connection between the microbiome and specific allergies such as atopic dermatitis, asthma, and food allergies, and which mechanisms could determine the induction of these diseases. Furthermore, we will review how factors such as mode of delivery, antibiotic use, breastfeeding, and the environment influence the development of the intestinal flora, as well as review various interventions for the prevention and treatment of gut microbiota-related allergies.

A new hyper-inflammatory syndrome in children was identified after SARS-CoV-2 infection as a post-infectious complication that is temporally associated with coronavirus disease (COVID-19). Fever, rash, conjunctival hyperemia, and gastrointestinal problems are all clinical manifestations of multisystem inflammatory syndrome in children. This condition, in some cases, causes multisystem involvement, affecting multiple organ systems and necessitating admission to a pediatric intensive care unit. Due to limited clinical studies, it is necessary to analyze the characteristics of the pathology in order to improve the management and long-term follow-up of high-risk patients. The objective of the study was to analyze the clinical and paraclinical characteristics of children diagnosed with MIS-C. The clinical study is a retrospective, observational, descriptive research work that includes patients diagnosed with MIS-C, temporally associated with coronavirus disease, and it contains clinical characteristics, laboratory data, and demographic information. The majority of patients had normal or slightly increased leukocyte counts, which were associated with neutrophilia, lymphocytopenia, and significantly elevated inflammatory markers, including high levels of C-reactive protein, fibrinogen, the erythrocyte sedimentation rate, serum ferritin, and IL 6 and elevated levels of the cardiac enzymes NT-proBNP and D-dimers, owing to the cardiovascular system involvement in the pro-inflammatory process. At the same time, renal system involvement led to raised creatinine and high proteinuria in association with hypoalbuminemia. This characteristic of the pro-inflammatory status as well as multisystem impairment are highly suggestive of the post-infection immunological reaction of the multisystem syndrome temporally associated with SARS-CoV-2 infection.