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Small intestinal bacterial overgrowth (SIBO) is characterized by an increase in the bacterial population of the small intestine due to an imbalance between the amount of bacteria and the intestinal barrier. Pediatric SIBO presents with a wide spectrum of symptoms, ranging from mild gastrointestinal complaints to malabsorption or malnutrition. Breath tests are commonly used as noninvasive diagnostic tools for SIBO, but a standardized methodology is currently unavailable. Intestinal flora produces methane which slows intestinal transit and increases the contractile activity of small intestine. Emerging literature suggests a correlation between overgrowth of methanogenic bacteria in the intestines and constipation. Treatment of SIBO involves administration of antibacterial therapy in addition to management of underlying conditions and optimal dietary adjustments. However, research on antibiotic treatment for pediatric patients with constipation and SIBO is limited and has yielded conflicting results. In the current review, we summarize the state-of-the-art of the field and discuss previous treatment attempts and currently used regimens for SIBO patients with constipation, with a focus on pediatric populations.

Human Immunodeficiency Virus (HIV) infection during pregnancy poses significant risks to both maternal and child health, with potential adverse effects on perinatal outcomes. This study aimed to compare perinatal outcomes, including birth weight, length, Apgar scores, and prematurity rates, between HIV-exposed, uninfected (HEU) children and HIV-unexposed, uninfected (HUU) children. A total of 204 neonates were included in the study, comprising 102 born to HIV-positive mothers and 102 born to uninfected mothers. Our findings revealed significant differences in birth weight (p < 0.001), length (p < 0.001), and Apgar scores at both 1 min (p = 0.003) and 5 min (p < 0.001) between HIV-exposed and -unexposed children. The HIV-exposed group exhibited lower birth weights and lengths, along with lower Apgar scores, indicating potential neonatal health challenges. No significant disparities were observed in the prematurity risk between the two groups (OR = 2.58, p = 0.126), but the risk of being born small for gestational age (SGA) in the case of HEU newborns was significantly high (OR = 17.41, p < 0.001). The significant differences in birth weight, length, and Apgar scores underscore the need for tailored healthcare interventions and support for neonates born to HIV-positive mothers. These findings contribute to our understanding of the complex interplay between maternal HIV infection and perinatal outcomes, guiding healthcare professionals in delivering targeted care for this vulnerable population.

Introduction: Cytomegalovirus (CMV) infection is present in a latent state in 70–90% of the immunocompetent population, and its reactivation might be triggered by inflammatory conditions such as post-COVID multisystem inflammatory syndrome (MIS-C) or by immunosuppression induced by steroids. The aim of this paper was to highlight the unexpected complications associated with SARS-CoV-2 infection that require a complex clinical approach for accurate diagnosis. Materials and Methods: We present the case of a 4-year-old male patient who, during an initially favorable course of PIMS, experienced symptoms of respiratory failure. Results: The patient initially presented with clinical and paraclinical signs of PIMS with cardiac involvement, for which high-dose corticosteroid therapy was initiated, followed by gradual tapering, along with immunoglobulins, anticoagulants, antiplatelet agents, and symptomatic treatment. After 10 days of favorable progress, the patient’s general condition deteriorated, showing tachypnea, desaturation, and a ground-glass appearance on thoracic CT. Negative inflammatory markers and favorable cardiac lesion evolution ruled out MIS-C relapse. The presence of anti-CMV IgM antibodies and viral DNA in the blood confirmed acute CMV infection, likely triggered by prior severe-acute-respiratory-syndrome-related coronavirus 2 (SARS-CoV-2) infection and secondary immunosuppression due to steroids. Non-specific immunomodulatory treatment was initiated but led to worsening of pulmonary lesions, prompting the initiation of specific antiviral treatment with ganciclovir, resulting in rapid clinical and imaging improvement. Conclusions: CMV infection can be reactivated by immunosuppression induced by corticosteroid therapy for MIS-C and may require specific etiological treatment.

Acute gastroenteritis in pediatric patients represents a major cause of morbidity and mortality in children. Interleukins 6 (IL-6) and 8 (IL-8) have been intensely studied in relation to various inflammatory conditions, including acute gastroenteritis, as they are activated in response to infection. This review aims to evaluate the ability of IL-6 and IL-8 to distinguish between bacterial and viral etiologies of acute gastroenteritis in children and to assess whether their levels correlate with the severity of this condition in light of currently available data. A scientific database search was performed to identify studies that investigated the role of IL-6 and IL-8 in acute gastroenteritis in the pediatric population. We identified nine studies that matched the review’s objective. Both cytokines show increased values in acute gastroenteritis, but IL-6 levels are significantly higher in cases of bacterial infections. IL-8 levels do not present an increase to the same extent in cases of bacterial diarrhea in children but seem to be associated with the severity of the disease. The lack of sufficient research focusing on IL-6 and -8 as diagnostic, prognostic and severity biomarkers of acute gastroenteritis in children leaves room for further research on this topic, which must include larger cohort studies.

It is an honor and a privilege to have helped bring this Special Issue titled “Multidisciplinarity and Trandisciplinarity in the Diagnosis and Treatment of Pediatric Gastrointestinal Diseases” to you [...]

Helicobacter pylori (H. pylori) is the most common bacterial infection worldwide, usually being acquired during childhood, and its persistence into adulthood represents one of the main contributors of gastric carcinogenesis. Based on these statements, it would be of great importance to know if the most early premalignant transformation occurs in children or later since, this would enable the development of effective anti-tumorigenesis strategies. The interplay between H. pylori virulence factors, the host’s responses modified by this infection, and the gastric microecology are complex and eventually lead to the development of gastric cancer in susceptible individuals. Several biomarkers were identified as major contributors of this long-lasting process, such as pepsinogens, gastrin 17, lipid-, glucose- and iron-metabolism parameters, immunity players, aberrant bacterial DNA methylation, H. pylori virulence factors, and hallmarks of gastric dysbiosis. Several of these biomarkers were also identified in children with H. pylori infection, independently of the presence of premalignant lesions, which were also proven to be present in a subgroup of H. pylori-infected children, especially those carrying extremely virulent strains. Therefore, the most incipient premalignant gastric changes might indeed occur early during childhood, opening a promising research gate for further studies to delineate the border between infection and cancer.

Childhood obesity is a major public health problem worldwide with an increasing prevalence, associated not only with metabolic syndrome, insulin resistance, hypertension, dyslipidemia, and non-alcoholic fatty liver disease (NAFLD), but also with psychosocial problems. Gut microbiota is a new factor in childhood obesity, which can modulate the blood lipopolysaccharide levels, the satiety, and fat distribution, and can ensure additional calories to the host. The aim of this review was to assess the differences and the impact of the gut microbial composition on several obesity-related complications such as metabolic syndrome, NAFLD, or insulin resistance. Early dysbiosis was proven to be associated with an increased predisposition to obesity. Depending on the predominant species, the gut microbiota might have either a positive or negative impact on the development of obesity. Prebiotics, probiotics, and synbiotics were suggested to have a positive effect on improving the gut microbiota and reducing cardio-metabolic risk factors. The results of clinical trials regarding probiotic, prebiotic, and synbiotic administration in children with metabolic syndrome, NAFLD, and insulin resistance are controversial. Some of them (Lactobacillus rhamnosus bv-77, Lactobacillus salivarius, and Bifidobacterium animalis) were proven to reduce the body mass index in obese children, and also improve the blood lipid content; others (Bifidobacterium bifidum, Bifidobacterium longum, Lactobacillus acidophilus, Lacticaseibacillus rhamnosus, Enterococcus faecium, and fructo-oligosaccharides) failed in proving any effect on lipid parameters and glucose metabolism. Further studies are necessary for understanding the mechanism of the gut microbiota in childhood obesity and for developing low-cost effective strategies for its management.

In adults with immune thrombocytopenic purpura (ITP), the identification of H. pylori infection and its subsequent eradication proved to aid platelet recovery. Similar findings, at a smaller scale, were allegedly reported by some pediatric studies. This review’s objective was to establish the influence of H. pylori infection and its eradication upon platelet count and recovery in pediatric ITP. Three databases, namely Pubmed, Scopus and Web of Science, were searched for pediatric studies which investigated a link between H. pylori infection and thrombocytopenia. The search results retrieved a number of 21 articles which complied to the inclusion and exclusion criteria. Some studies report lower platelet values among children with ITP and documented H. pylori infection, as well as an improve in platelet numbers after H. pylori treatment. However, results are controversial, as multiple authors failed to identify a higher prevalence of H. pylori among children with ITP or a lack of significant change in therapeutic outcome with the addition of an eradication regimen to standard treatment. The main limitations of current pediatric studies remain the small study samples and the short follow-up periods of the included subjects. Hence, the long-term impact of H. pylori in children with ITP is still uncertain.

Taking into account previous data that sustain a relationship between vitamin D deficiency and higher H. pylori infection positivity rates, this review aims to assess the influence of vitamin D deficiency and/or insufficiency upon the prevalence of H. pylori infection and its eradication success. Three major databases were searched for articles that analyzed a relationship between vitamin D status and H. pylori infection. The literature search retrieved a total of 37 reports, after the article selection process. Hypovitaminosis D emerged as a potential risk factor for H. pylori infection, given the higher prevalence of vitamin D deficiency and/or insufficiency among H. pylori-positive subjects. Furthermore, the same type of micronutrient deficiency has been directly linked to H. pylori eradication failure. An inverse linear relationship between vitamin D status and gastric cancer risk exists, but the additional involvement of H. pylori in this correlation is still in question. The potential benefit of oral supplements in enhancing the success of classical therapeutic regimens of H. pylori still requires future research. Future population-based studies from larger geographical areas are warranted to address this subject in more depth.

Communication is definitely one of the most important contributing factor for an ideal doctor-patient relationship. The major importance of communication is to build a proper relationship with the patients, in which the empathy and respect play an essential role and can be taught and improved with proper training. This process is defined as cross-culture communication and it has to be taught during medical school. Patient-centered communication is a concept closely related to cross-culture communication and it might be defined by the physician’s ability to tailor communication to each patient’s need and level of understanding in order to provide patient-centered care. Training of clinical communication skills in medical students is an incontestable emergency for the patient’s outcome. Medical education formerly focused on training students for solving only the medical problems by providing the treatment for their organic problems. Medical schools recently included in undergraduate curricula clinical communication courses in order to improve student’s and future physician’s the ability to obtain relevant information from their patients, to build strong doctorpatient relationships and provide patient-centered care. Various models were elaborated for teaching and assessing clinical communication skills, which were found to improve multiple aspects of physician-patient communication among which counseling, interviewing techniques and prescription. Medical schools should properly address to clinical communication skills by including training courses in each year of education focused on the specific of the learned medical fields. It is crucial for implementing proper assessment methods in order to prevent and diminish as much as possible the factors that might negatively impact the development of doctor-patient relationship. Proper medical training in terms of clinical communication skills should be initiated during medical school in all students that deal with patients, but also after the graduation, periodically in all health care providers for assuring an ideal outcome for their patients.

Cȃştigul ponderal excesiv al femeii gravide este un factor predictiv pentru obezitatea maternă, cu implicații asupra greutății nou-născuților și posibile complicații pe termen scurt și lung. Cȃştigul ponderal ȋn sarcină depinde de factori etnici, sociali şi de paritate. Exceptând factorii menționați anterior, nu este de neglijat nici impactul major al susceptibilității genetice, punându-se în evidență că există trei perioade principale ce influenţează evoluţia fetală, și anume periconcepţională, intrauterină şi postnatală. Mediul intrauterin deține un rol esenţial în dezvoltarea optimă a fătului, având efect asupra structurilor şi funcţiilor organelor produsului de concepţie, considerându-se în acest moment că bolile adultului îşi au originea în copilărie. Astfel, este bine cunoscută legătura dintre câștigul ponderal gestațional excesiv și obezitatea sau bolile metabolice la copil. Mai mult, unele dintre cele mai noi informații din literatură sugerează că alergiile, wheezing-ul sau astmul copilului ar putea avea, la rândul lor, legătură cu statusul nutrițional matern. În concluzie, excesul ponderal gestațional deține un rol decisiv în apariţia obezităţii şi bolilor metabolice la copil, de aici rezultând importanţa majoră a unei diete echilibrate pe perioada sarcinii pentru a favoriza un câștig ponderal optim, cu efect pozitiv asupra bunăstării fetale, care să prevină riscul metabolic al produsului de concepţie.

Although initially the evolution of Coronavirus disease 2019 (COVID-19) seemed less severe in pediatric patients, in the three years since the beginning of the pandemics, several severe cases have been described, pediatric inflammatory multisystem syndrome (PIMS) has been defined, pathogenesis is being continuously studied, and many aspects regarding the long-term evolution and multi-organ damage are still unexplained. Cardiac injuries in COVID-19 represent most-likely the second cause of mortality associated with the infection. A wide-spectrum of cardiac abnormalities were reported to be associated with COVID-19 in children including ventricular dysfunction, acute myocardial dysfunction, arrhythmias, conduction abnormalities, coronary artery dilation or aneurysms, and less common pericarditis and valvulitis. Risk factors for severe COVID-19 in children should be identified, laboratory tests and imaging techniques should be performed to reveal cardiac injury as soon as possible. The aim of this review was to highlight the great value of repeated cardiological monitoring in patients with COVID-19, underlining also the peculiarities in terms of pediatric population. This review is looking for answers on questions like ‘Why do some, but not all, patients with COVID-19 develop cardiac injury or severe hyperinflammatory status?’, ‘Which factors are involved in triggering COVID-19 associated cardiac injury?’, ‘What are the mechanisms involved in the etiology of cardiac injury?’, ‘Is there a clear relationship between hyperinflammation and cardiac injury?’, ‘Is hyperinflammatory status the pre-stage of cardiac injury in COVID-19 patients?’ which still lack clear answers. The understanding of mechanisms involved in the development of COVID-19 associated cardiac injury might shed light on all the above-mentioned mysteries and might increase the likelihood of favorable evolution even in severe cases.

(1) Background: Immunization of pregnant women (PWs) against Bordetella pertussis infection is still a challenging health matter. (2) Methods: We gathered questionnaire data from 180 PWs regarding their expectancies and current opinion on infectious disease prevention. For the group of PWs who agreed to further investigations, the serum levels of Ig G anti-B. pertussis antibodies (IgG-PT) titer were measured and analyzed. (3) Results: A total of 180 PWs completed the questionnaire and 98 (54.44%, study group) accepted to perform the laboratory tests. During the first two pregnancy trimesters, PWs were found to be more willing (compared with the control group) to test for identifying high-risk situations that could affect themselves and their future infant (p < 0.001). Most of the participating PWs (91, 91.9%) had low levels of anti-pertussis antibodies (values < 40 IU/mL). Declared vaccine coverage of the PWs newborn infants for DTaP-1 and Prevenar 13 (at 2 months) and DTaP-2 and Prevenar 13 (at 4 months) vaccination reached 100% in the study group, while in the control group only 30/82 (36.59%) PWs accepted to be vaccinated during pregnancy, none of them providing data on their infants’ vaccine coverage. (4) Conclusions: Enrolled PWs faced a waning immunity against the B. pertussis infection. By raising maternal confidence in the protective role of vaccines against infectious diseases, better vaccine acceptance and better infant vaccine coverage can be achieved.

Boala celiacă (BC) este o afecțiune sistemică mediată imun determinată de dieta cu gluten la indivizii susceptibili genetic. Criza celiacă este o afecțiune rară, dar cu potențial letal, care poate apărea în cadrul bolii celiace sau ca prima manifestare a acesteia. Prezentarea cazului. Adolescent în vârstă de 15 ani, cu istoric personal de anemie pentru care nu a urmat tratament corespunzător, s-a internat pentru scaune semiconsistente steatoreice, scădere ponderală, inapetență, fatigabilitate, somnolență, cu debut de aproximativ 10 zile. Analizele de laborator efectuate în momentul prezentării au evidențiat următoarele: trombocitoză, anemie feriprivă, ușoară creștere a transaminazelor, hiperbilirubinemie mixtă, cu predominanța celei indirecte, hiponatremie. A fost exclusă o etiologie infecțioasă a simptomatologiei, iar markerii serologici pentru boala celiacă au fost pozitivi. S-a stabilit diagnosticul de criză celiacă, ca formă de debut a bolii celiace, pe baza simptomatologiei, a valorii crescute a anticorpilor antitransglutaminază (> 10x valoarea normală) și a celor de tip antiendomisium pozitivi. Pe parcursul internării, s-a administrat tratament simptomatic, tratament de reechilibrare hidroelectrolitică și a fost inițiată dieta fără gluten. La 3 luni de la inițierea dietei fără gluten, evoluția clinică a pacientului a fost favorabilă, iar parametrii de laborator s-au ameliorat considerabil, cu negativarea anticorpilor antiendomisium și scăderea marcată a valorii anticorpilor antitransglutaminază. Concluzii. Criza celiacă trebuie luată în considerare în diagnosticul diferențial al tuturor pacienților care prezintă diaree cu debut brusc, tulburări metabolice și scădere în greutate după ce a fost exclusă o etiologie infecțioasă, iar recunoașterea acesteia este importantă și facilitează tratamentul prompt.

Introducere. Colita ulcerativă (CU) este o patologie mai severă la copil decât la adult, cu o incidenţă în creştere la vârste mici. Exacerbările cele mai frecvente sunt datorate infecţiei cu Clostridium difficile (CD) şi pot duce la complicaţii severe. Prezentarea cazului. Prezentăm cazul unui pacient în vârstă de 6 ani, diagnosticat cu colită ulcerativă la vârsta de 5 ani, internat în clinica noastră pentru scaune diareice apoase cu sânge, dureri abdominale, inapetenţă, scădere ponderală. Examinările paraclinice la internare au evidenţiat anemie, leucocitoză cu neutrofilie, tulburări hidro-electrolitice, hipoalbuminemie severă. Testul de detecţie a toxinelor A şi B pentru CD din materiile fecale a fost pozitiv, coprocultura negativă. Datele anamnestice, clinice şi paraclinice au stabilit diagnosticul de infecţie cu CD asociată cu exacerbarea CU. Iniţial, evoluţia sub puls-terapie cu Solu-Medrol şi antibioterapie cu Metronidazol iv a fost uşor favorabilă, însă cu perioadă de declin la 5 zile după trecerea per os a corticoterapiei. Astfel încât a fost nevoie de reluarea corticoterapiei iv şi asocierea Vancomicinei. Sub tratamentul instituit, simptomatologia s-a ameliorat, cu normalizarea parametrilor paraclinici, iar după 21 de zile de internare pacientul a fost externat. Concluzii. Coexistenţa infecţiei cu CD la pacienţii pediatrici cu CU rămâne o adevărată provocoare, din cauza ratei mari de recurenţă şi a mortalităţii mai crescute faţă de populaţia generală. Evoluţia ondulantă sub tratament, dar şi profilul psihologic al pacientului au particularizat cazul.

Introducere. Aproximativ 12 milioane de copii mor anual ȋn țările ȋn curs de dezvoltare, iar o treime din aceste decese sunt cauzate de pneumonii. Evaluarea modificărilor radiologice în dinamică are un rol major în stabilirea diagnosticului de pneumonie stafilococică. Scopul lucrării este de a sublinia dificultățile de diagnostic și tratament într-un caz de pneumonie stafilococică la copil. Prezentarea cazului. Prezentăm cazul unui pacient, de sex masculin, în vârstă de 2 ani și 6 luni, internat în clinica noastră pentru hiperpirexie, tuse productivă, rinoree și inapetență. Examenul clinic la internare a pus ȋn evidență stare generală influențată, facies palid, suferind, febră, tuse productivă, rinoree, murmur vezicular diminuat pe partea dreaptă, saturație ȋn oxigen 97%, și inapetență, iar analizele de laborator leucocitoză marcată cu neutrofilie, anemie și markeri inflamatori intens crescuți. Radiografia toracică a pus ȋn evidență un focar congestiv la nivelul lobului inferior drept. Hemocultura a fost negativă. S-a inițiat tratament simptomatic și antibiotic (Ceftriaxonă), dar datorită evoluției nefavorabile, radiografia de control a arătat o zonă de condensare bazal drept asociind o colecție pleurală ȋnchistată bazal și laterotoracic drept. Am efectuat și computer tomografie (CT) toracică, evidențiindu-se un proces pneumonic bisegmentar ȋn lobul inferior drept, cu câteva pneumatocele grupate subpleural, asociind ȋn ambii plămâni arii de hiperinflație lobulară. Astfel, se ridică suspiciunea unei pneumonii verosimil stafilococice, motiv pentru care se asociază Vancomicină iv, cu evoluție favorabilă. Concluzii. Pneumonia stafilococică este o patologie bine definită şi cunoscută ȋn literatură, dar rămâne totuşi o patologie contemporană, impunând multiple dificultăţi legate de diagnosticul şi managementul cazurilor pediatrice.

Helicobacter pylori (H. pylori)-associated inflammatory status is no longer a debatable topic in children. The aim of our study was to to compare the inflammatory status in pediatric patients with H. pylori gastritis and non-H. pylori gastritis versus control group. We performed a prospective study on 68 children with dyspeptic symptoms which were divided into 3 groups: 14 children with H. pylori gastritis (group 1), 26 children with non-H. pylori gastritis (group 2) and 28 children with no pathological findings—control group (group 3). Several laboratory parameters, histopathological and immunohistochemistry tests were performed in all children for detecting inflammatory status. We noticed a significant difference in terms of rural area between the three groups (p = 0.0404). Comparing the laboratory parameters between the three groups, we noticed significant differences in terms of serological tests (p = 0094), and NLR (p = 0.0253), the latter being significantly higher in children with H. pylori-induced gastritis as compared to those with non-H. pylori gastritis (0.0107). According to the Dunn’s Multiple Comparison Test, we noticed a significantly elevated neutrophil level in children with H. pylori-induced gastritis when compared to non-H. pylori gastritis group (p = 0.0146), as well as a significantly increased eosinophil count in patients with non-H. pylori gastritis as compared to control group (p = 0.0417). The immunohistochemistry method pointed out no significant variation concerning interleukin (IL 6) between children with gastritis and control group [RR = 1.283, IC (95%): 0.9404–1.751, p = 0.0988]. Additionally, children with gastritis regardless of the etiology have a significant risk of associating increased gastric expression of tumor necrosis factor alpha (TNF α) [RR = 3.967; CI (95%): 1.283–12.263; p = 0.0063]. Moreover, TNF α was significantly associated with presence of H. pylori gastritis (p = 0.0002). The early detection of local inflammation triggered by this infection might preempt gastric carcinogenesis, while identifying H. pylori-induced systemic inflammation lowers the risk of severe extraintestinal manifestations.

Helicobacter pylori (H. pylori) has acquired several resistance mechanisms in order to escape the currently used eradication regimens such as mutations that impair the replication, recombination, and transcription of DNA; the antibiotics capability to interact with protein synthesis and ribosomal activity; the adequate redox state of bacterial cells; or the penicillin-binding proteins. The aim of this review was to identify the differences in pediatric H. pylori antimicrobial-resistance trends between continents and countries of the same continent. In Asian pediatric patients, the greatest antimicrobial resistance was found to metronidazole (>50%), probably due to its wide use for parasitic infections. Aside from the increased resistance to metronidazole, the reports from different Asian countries indicated also high resistance rates to clarithromycin, suggesting that ciprofloxacin-based eradication therapy and bismuth-based quadruple therapy might be optimal choices for the eradication of H. pylori in Asian pediatric population. The scarce evidence for America revealed that H. pylori strains display an increased resistance to clarithromycin (up to 79.6%), but not all studies agreed on this statement. Pediatric patients from Africa also presented the greatest resistance rate to metronidazole (91%), but the results in terms of amoxicillin remain contradictory. Nevertheless, the lowest resistance rates in most of the African studies were found for quinolones. Among European children, the most frequent antimicrobial resistance was also noticed for metronidazole and clarithromycin (up to 59% and 45%) but with a predominance for clarithromycin as compared to other continents. The differences in antibiotic use among continents and countries worldwide is clearly responsible for the discrepancies regarding H. pylori antimicrobial-resistance patterns, emphasizing the crucial role of global judicious antibiotic use in order to control the increasing resistance rates worldwide.

Helicobacter pylori infection is one of the main causes of dyspepsia, but it is not the only cause. Esophageal inlet patches are areas of heterotopic gastric mucosa within the esophagus and are commonly located in the cervical part of the esophagus. We report the case of a 16-year-old female, previously known to display symptoms of anxiety, who was admitted to our clinic for dyspeptic symptoms lasting for approximately 1 month in spite of the treatment with proton pump inhibitors. The clinical exam revealed only abdominal tenderness in the epigastric area, while routine laboratory tests showed no abnormalities. The upper digestive endoscopy revealed a well-circumscribed salmon-pink-colored oval lesion of approximately 10 mm in the cervical esophagus, along with hyperemia of the gastric mucosa and biliary reflux. The histopathological exam established the diagnosis of esophageal inlet patch with heterotopic antral-type gastric mucosa and also revealed regenerative changes within the gastric mucosa. We continued to treat the patient with proton pump inhibitors, as well as ursodeoxycholic acid, with favorable evolution. Although rare or underdiagnosed, esophageal inlet patches should never be underestimated and all gastroenterologists should be aware of their presence when performing an upper digestive examination in a patient with dyspeptic symptoms.

Probiotics represent viable microorganisms which are found within the normal gut microbiota, that exert strain-specific benefits in the management of several gastrointestinal disorders in children, including acute gastroenteritis. This review aims to evaluate the pathogen-specific role of probiotic supplementation in childhood diarrhea. A search of scientific databases was conducted to identify studies which investigated efficacy of probiotics and synbiotics in influencing outcome of acute gastroenteritis of known etiology. We identified 32 studies, most of which analyzed impact of probiotic supplementation in rotavirus gastroenteritis, while a very limited number of these conducted a separate analysis on bacterial diarrhea. Lactobacillus rhamnosus (L. rhamnosus), L. reuteri and S. boulardii still remain the most researched strains, with a proven role in decreasing diarrhea and hospitalization duration, especially in the setting of rotavirus infection. Combined products containing at least one of the aforementioned strains also performed similarly and might also influence rotavirus fecal shedding. Rotavirus immunization status has also been proposed as a significant influencing factor of probiotic use impact. The paucity of research focusing on bacterial etiologies, as well as of clinical trials conducted within ambulatory care units leaves room for further research on the matter, which needs to include larger cohort studies.

Vitamin D is a cyclopentane polyhydrophenanthrene compound involved mainly in bone health and calcium metabolism but also autophagy, modulation of the gut microbiota, cell proliferation, immune functions and intestinal barrier integrity. The sources of vitamin D include sunlight, diet and vitamin D supplements. Vitamin D3, the most effective vitamin D isoform is produced in the human epidermis as a result of sunlight exposure. Vitamin D undergoes two hydroxylation reactions in the liver and kidney to reach its active form, 1,25-dihydroxyvitamin D. Recent studies highlighted a complex spectrum of roles regarding the wellbeing of the gastrointestinal tract. Based on its antimicrobial effect, it was recently indicated that vitamin D supplementation in addition to standard eradication therapy might enhance H. pylori eradication rates. Moreover, it was suggested that low levels of vitamin D might also be involved in the acquisition of H. pylori infection. In terms of celiac disease, the negative effects of vitamin D deficiency might begin even during intrauterine life in the setting of maternal deficiency. Moreover, vitamin D is strongly related to the integrity of the gut barrier, which represents the core of the pathophysiology of celiac disease onset, in addition to being correlated with the histological findings of disease severity. The relationship between vitamin D and cystic fibrosis is supported by the involvement of this micronutrient in preserving lung function by clearing airway inflammation and preventing pathogen airway colonization. Moreover, this micronutrient might exert anticatabolic effects in CF patients. Inflammatory bowel disease patients also experience major benefits if they have a sufficient level of circulating vitamin D, proving its involvement in both induction and remission in these patients. The findings regarding the relationship between vitamin D, food allergies, diarrhea and constipation remain controversial, but vitamin D levels should be monitored in these patients in order to avoid hypo- and hypervitaminosis. Further studies are required to fill the remaining gaps in term of the complex impact of vitamin D on gastrointestinal homeostasis.

It is well documented that Helicobacter pylori (H. pylori) can cause both gastrointestinal and extraintestinal manifestations. The latter one represents a major burden in terms of diagnosis and treatment. H. pylori-associated systemic subclinical inflammation is mostly responsible for the development of extraintestinal manifestations, and its early eradication might result in preventing all adverse events related to their occurrence. Thus, it was suggested that H. pylori might be associated with iron deficiency anemia, thrombocytopenia (immune thrombocytopenic purpura), Schonlein Henoch purpura, failure to thrive, vitamin B12 deficiency, diabetes mellitus, body mass index, cardiovascular diseases, as well as certain neurological conditions. Nevertheless, studies showed both pros and cons in terms of the role of H. pylori in the development of previously mentioned clinical entity underlining the crucial need for further studies on these topics. Although most of these extraintestinal manifestations occur during adulthood, we must not forget that H. pylori infection is acquired mainly during childhood, and thus its early diagnosis and eradication might represent the cornerstone in the prevention of H. pylori-induced inflammatory status and consequently of all related extraintestinal conditions.

COVID-19 and PIMS represent two novel pathologies that have challenged the medical world during the last two years on account of their being very similar, but yet very different. Our aim was to comparatively assess children with SARS-CoV-2 infection and PIMS in terms of symptoms, clinical findings, laboratory parameters, echocardiography, and evolution. Our retrospective study included 46 children with COVID-19 (group 1), and 20 children with confirmed PIMS (group 2). We found no significant differences in terms of age, gender, and originating area between the two groups. We noticed that fever was significantly more common in the PIMS group as compared to COVID-19 group (p = 0.0217). In terms of laboratory parameters, increased bilirubin and creatinine were significantly more frequent in children with COVID-19 (p = 0.0064/p = 0.0064), while hypoalbuminemia and elevated ESR were significantly more common in those with PIMS (p < 0.0001/p = 0.0127). Moreover, prognosis parameters such as D-dimers, NT-proBNP, and CK-MB were also found to be significantly higher in the PIMS group as compared to COVID-19 group (p = 0.0003/p = 0.0182/p = 0.0007). In terms of complications, most were identified in PIMS group, among which cardiac and liver impairment along with dehydration were significantly more common in children diagnosed with PIMS as compared to those detected with COVID-19. Similarly, children with PIMS had a significantly higher chance to have pathological echocardiography changes. Although difficult, the distinction between COVID-19 and PIMS is crucial for the patient’s long-term outcome.

Helicobacter pylori is usually acquired during childhood. The reports from the last two decades pointed out a decrease in H. pylori prevalence across geographical areas worldwide compared to previously reported data. Most of the studies performed in America found an overall H. pylori infection prevalence of approximately 50%. The most important risk factors in America include being male, poor adherence or difficult access to treatment, and the lack of in-home water service. Despite the descending trend in prevalence worldwide, the overall prevalence in Africa remains very high (70%). Nevertheless, the prevalence of H. pylori in children without gastrointestinal who underwent screening was reported to be only 14.2%. The main risk factors in Africa are having a traditional pit or no toilet, poverty, birth order, source of drinking water, or being a farmer. Asia seems to have the widest variations in terms of H. pylori prevalence. Several risk factors were reported in Asia to be associated with this infection, such as lower income and educational level, house crowding, rural residence, ethnicity, the use of tanks as water supplies, alcohol drinking, active smoking, eating spicy food or raw uncooked vegetables, poor living conditions and sanitation. The overall prevalence of H. pylori infection in European children is almost 25%. Portugal has the highest prevalence of all European countries at 66.2% in children 13 years of age. The risk factors in European individuals consist of living in rural areas, eating unwashed fruits and vegetables, not washing hands after school, low parental education and unemployment, and short education duration. Further studies are required to identify the precise mechanisms involved in the discrepancies of H. pylori prevalence worldwide.

Hepatoblastomul este o patologie rară la pacienţii pediatrici, afectând 5-10/un milion de copii anual. Prezentăm cazul unui pacient în vârsta de doi ani care a fost internat în Clinica noastră pentru investigarea unei formaţiuni tumorale abdominale. Ecografia şi tomografia computerizată (CT) au evidenţiat o tumoră hepatică solidă de dimensiuni mari, asociind tromboza venei porte drepte. Nivelul alfa-fetoproteinei serice (AFP) şi numărul de trombocite au fost mult crescute. Examinarea histopatologică a biopsiei hepatice a confirmat diagnosticul de hepatoblastom tip epitelial. Chimioterapia a fost iniţiată, urmată de o intervenţie chirurgicală în două etape: ligatura ramului portal drept şi rezecţia tumorală ulterioară. La şase luni după intervenţia chirurgicală o recidivă tumorală a fost suspectată, confirmată de examenul CT şi de nivelurile ridicate ale AFP. Pacientul a beneficiat de un transplant hepatic „de salvare“, cu evoluţie ulterioară favorabilă şi fără recădere de 3 ani. Nivelurile crescute ale alfa-fetoproteinei şi trombocitoza sugerează diagnosticul de hepatoblastom. Transplantul hepatic este opţiunea finală în cazul tumorilor inoperabile, de dimensiuni mari sau al recăderilor.

Introduction: The aim of this study was to assess the role of TNF-α 308 G>A gene polymorphism in children's overweight risk so as to correlate this polymorphism with anthropometric and biochemical variables. Materials and method: A cross-sectional study was carried out on 188 Romanian children ages 5–18 years, who were classified into controls (Group 1; n = 109) and overweight children (Group 2; n = 79). Results: Higher values of MUAC and TST (p A polymorphism and weight status in the studied population (p = 0.009). There was also a positive association between the variant genotypes (GA or AA) of TNF-α 308G>A gene polymorphism and weight status, which was more frequently found among normal weight than overweight children (74.5% versus 25.5%, respectively). The final logistic multivariable included five independent variables (TNF-α genotype, gender, cholesterol, ASAT, and ALAT), which were statistically significant predictors with negative/positive effects on children's overweight risk; this model explained 30% of the variance in the outcome variable. Conclusion: The variant genotype of TNF-α 308G>A gene polymorphism was more frequent among normal weight children. In the presence of other covariates, such as age, gender, cholesterol, LDL cholesterol, ALAT, and glycemia, the TNF-α 308 G>A gene polymorphism remained an independent protective factor for children's overweight status. Key Words: children, overweight risk, TNF-α 308 G>A polymorphism

Helicobacter pylori (H. pylori) is the most common bacterial infection worldwide, is usually acquired during childhood and is related to gastric carcinogenesis during adulthood. Therefore, its early proper diagnosis and subsequent successful eradication represent the cornerstones of gastric cancer prevention. The aim of this narrative review was to assess traditional and modern diagnostic methods in terms of H. pylori diagnosis. Several invasive and non-invasive methods were described, each with its pros and cons. The invasive diagnostic methods comprise endoscopy with biopsy, rapid urease tests, histopathological exams, cultures and biopsy-based molecular tests. Among these, probably the most available, accurate and cost-effective test remains histology, albeit molecular tests definitely remain the most accurate despite their high costs. The non-invasive tests consist of urea breath tests, serology, stool antigens and non-invasive molecular tests. Urea breath tests and stool antigens are the most useful in clinical practice both for the diagnosis of H. pylori infection and for monitoring the eradication of this infection after therapy. The challenges related to accurate diagnosis lead to a choice that must be based on H. pylori virulence, environmental factors and host peculiarities.

H. pylori is involved in the development of 80% of gastric cancers and 5.5% of all malignant conditions worldwide. Its persistence within the host’s stomach causes chronic inflammation, which is a well-known hallmark of carcinogenesis. A wide range of cytokines was reported to be involved in the initiation and long-term persistence of this local and systemic inflammation. IL-8 was among the first cytokines described to be increased in patients with H. pylori infection. Although, this cytokine was initially identified to exert a chemoattracting effect that represents a trigger for the activation of inflammatory cells within H.-pylori-infected mucosa, more recent studies failed in encountering any association between IL-8 and H. pylori infection. IL-6 is a multifunctional, pleiotropic and multipotent cytokine involved in mediating the interaction between innate and adaptive immunity with a dichotomous role acting as both a proinflammatory and an anti-inflammatory cytokine depending on the signaling pathway. IL-1α functions as a promoter of angiogenesis and vascular endothelial cell proliferation in gastric carcinoma since it is closely related to H.-pylori-induced inflammation in children. IL-1β is an essential trigger and enhancer of inflammation. The association between a low IL-1β level and an increased TNF-α level might be considered a risk factor for peptic ulcer disease in the setting of H. pylori infection. IL-10 downregulates both cytotoxic inflammatory responses and cell-mediated immune responses. H. pylori uses the immunosuppressive role of IL-10 to favor its escape from the host’s immune system. TGFβ is a continuous inflammatory mediator that promotes the adherence of H. pylori to the host’s cells and their subsequent colonization. The role of H.-pylori-induced inflammatory responses in the onset of gastric carcinogenesis seems to represent the missing puzzle piece for designing effective preventive and therapeutic strategies in patients with H.-pylori-associated gastric cancer.

Background: Children born with single-ventricle hearts require surgery in order to survive. Liver fibrosis is a known complication of Fontan surgery for univentricular hearts. Methods: In this study on 13 post-Fontan and 21 post-Glenn patients, we used elastography (shearwave and transient elastography) as well as serum biochemical fibrosis markers to evaluate the degree of liver fibrosis in comparison to 32 controls. Results: The mean Emedian and Vmedian values determined by shear wave elastography in the Fontan Group were significantly higher than the controls (4.85 kPa vs. 3.91 kPa and 1.25 m/s vs. 1.12 m/s, respectively). Fontan patients had significantly increased Fibrotest, Actitest, AST-to-Platelet Ratio index, ALT and GammaGT levels compared to controls. For post-Glenn patients, the mean Emedian and Vmedian values were similar to healthy controls, whereas the Fibrotest, Actitest and AST-to-Platelet Ratio index were significantly increased. Using transient elastography, we found significantly higher values for Emedian and Vmedian in Fontan patients compared to Glenn patients. Conclusions: Elastography and biochemical fibrosis markers are valuable non-invasive tools for screening and monitoring liver fibrosis in patients with Fontan and Glenn interventions.

Acidul folic şi cobalamina sunt vitamine din grupul B, care joacă un rol esenţial în numeroase procese celulare. Deficienţa uneia sau a ambelor vitamine provoacă anemie megaloblastică, o anemie foarte rară la copii, caracterizată prin prezenţa megaloblaştilor. Deficienta de vitamina B12 poate fi determinată de un aport redus, scăderea absorbţiei sau afectarea utilizării. Prezentăm cinci cazuri de anemie megaloblastică care ilustrează apariţia anemiei la vârste diferite şi în patologii diferite. Concluzionăm astfel că anemia megaloblastică este o anemie rar diagnosticată la copii, cu multiple cauze, producându-se în contextul unei diete vegetariene sau asociată unei boli autoimune, dar şi prin malnutriţia protein-calorică a mamei în timpul sarcinii şi prezenţa anemiei megaloblastice la mamă, asociată cu lipsa de substituţie în timpul sarcinii şi în timpul alăptării.

The well-documented systemic inflammation associated to pediatric obesity might act as an augmenting factor for other inflammatory conditions, such as pediatric inflammatory multisystem syndrome (PIMS) associated to COVID-19. We report the case of 9-year-old boy admitted in our clinic for fever, anorexia, and fatigability. The clinical exam revealed influenced general status, palpebral edema, non-exudative conjunctivitis, and abdominal tenderness. The patient weighed 45 kg. The laboratory tests at the time of admission pointed out anemia, lymphopenia; elevated inflammatory biomarkers, NT-proBNP, D-dimers, and troponin; high liver enzymes and lactate dehydrogenase levels, as well as hypoalbuminemia. The patient tested positive for both RT-PCR and serology for SARS-CoV-2 infection. We initiated intravenous immunoglobulin and methylprednisolone, associated with empirical antibiotic, anticoagulation therapy, and symptomatic treatment. The patient was discharged on the 7th day of admission with the recommendation to continue enoxaparin and methylprednisolone at home tapering the dose for the next week. The subclinical inflammatory status associated to obesity might serve as an unfortunate trigger factor for the development of COVID-19 severe forms in children. Therefore, clinicians should be aware that children with obesity and COVID-19 represent a peculiar group that should be closely monitored and thoroughly assessed in order to preempt life-threatening complications, such as PIMS.

Helicobacter pylori (H. pylori), the most common infection of childhood, results in life-threatening complications during adulthood if left untreated. Most of these complications are related to H. pylori-induced chronic inflammation. The dysbiosis caused by H. pylori is not limited to the gastric microenvironment, but it affects the entire gastrointestinal tract. Eradication of H. pylori has recently become a real challenge for clinicians due to both the persistent increase in antibiotic resistance worldwide and the wide spectrum of side effects associated with the eradication regimens resulting; therefore, there is an urgent need for more effective and less noxious treatment options. Thus, probiotics might be a promising choice in both adults and children with H. pylori infection since their role in improving the eradication rate of this infection has been proved in multiple studies. The positive effects of probiotics might be explained by their abilities to produce antimicrobial compounds and antioxidants, alter local gastric pH, and subsequently decrease H. pylori colonization and adherence to gastric epithelial cells. Nevertheless, if used alone probiotics do not considerably increase the eradication rate.

MOGAD-transverse myelitis is a rare disorder in children and adults, but with a higher incidence in pediatric patients. We report a case of MOGAD-transverse myelitis in a boy who was admitted to hospital with bilateral motor deficit of the lower limbs associated with the impossibility of defecating and urinating. The symptoms progressively developed with severe fatigue within the week prior to admission, with the impossibility to stand occurring 36 h before admission. The anamnesis found that he was vaccinated for COVID-19 approximately 6 weeks before admission to our clinic. The laboratory tests revealed a normal complete cellular blood count, without any signs of inflammation or infection, except for both cryoglobulins and IgG anti-MOG antibodies. MRI showed a T2 hypersignal on vertebral segments C2-C5, Th2-Th5 and Th7-Th11, confirming the diagnosis of longitudinally extensive transverse myelitis. The patient received intravenous high-dose methylprednisolone (1 g) for 5 days, associated with prophylactic antibiotic treatment, subcutaneous low-molecular-weight heparin and other supportive treatment. The patient was discharged on the 12th day of admission, able to walk without support and with no bladder or bowel dysfunction. We can conclude that an early diagnosis was essential for improving the patient’s long-term outcome.

The era of pediatric obesity is no longer a myth. Unfortunately, pediatric obesity has reached alarming incidence levels worldwide and the factors that contribute to its development have been intensely studied in multiple recent and emerging studies. Gut microbiota was recently included in the wide spectrum of factors implicated in the determination of obesity, but its role in pediatric obese patients is far from being fully understood. In terms of the infant gut microbiome, multiple factors have been demonstrated to shape its content, including maternal diet and health, type of delivery, feeding patterns, weaning and dietary habits. Nevertheless, the role of the intrauterine environment, such as the placental microbial community, cannot be completely excluded. Most studies have identified Firmicutes and Bacteroidetes as the most important players related to obesity risk in gut microbiota reflecting an increase of Firmicutes and a decrease in Bacteroidetes in the context of obesity; however, multiple inconsistencies between studies were recently reported, especially in pediatric populations, and there is a scarcity of studies performed in this age group.

Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP) are two atypical pathogens that may result in mild, moderate or severe acute respiratory infections. We report the case of a 2 years and 9-month-old male child admitted with prolonged fever, dry cough, and shortness of breath for which he underwent symptomatic treatment. The laboratory tests showed leukocytosis with neutrophilia, anemia, and elevated inflammatory biomarkers and the thoracic radiography revealed pleural effusion raising the suspicion of inferior right pneumonia. Although we the initial evolution was favorable being treated with 3rd class cephalosporin and Oxacillin, on the 8th day of admission the fever and the acute phase reactants levels increased as well as the quantity of the pleural effusion, requiring surgical drainage. We ruled out lung tuberculosis, but we identified positive IgM for both MP and CP. Based on these findings we changed the antibiotic therapy on Levofloxacin for 10 days with favorable evolution. MP and CP are two atypical pathogen that are difficult to be diagnosed due to their slow-growing pattern. Despite their self-limiting feature, the association between them might carry a vital risk in small children, especially in the lack of a proper and timely diagnosis.

Objective This study aimed to compare energy and macronutrient intake, birth weight, and anthropometric parameters (mid-upper arm circumference or tricipital skin-fold thickness) between women who had adequate and excessive gestational weight gain (GWG) during pregnancy. Methods We studied 115 pregnant women and divided them according to GWG into two groups: adequate GWG (n = 49) and excessive GWG (n = 66). We assessed the medical history, clinical examinations, and dietary habits through a detailed 7-day dietary recall using myfitnesspal software. Results Weight, body mass index, mid-upper arm circumference, and tricipital skin-fold thickness were significantly higher at the time of delivery in women with excessive GWG compared with those with adequate GWG. A lipid-based diet was a risk factor for excessive GWG (relative risk: 1.488, 95% confidence interval: 1.112–1.991), whereas a protein-based diet was a protective factor (relative risk: 0.6723, 95% confidence interval: 0.4431–1.020). We found no significant relationship between a carbohydrate-based diet and GWG. The total energy intake was significantly higher in the excessive GWG group than in the adequate GWG group. Conclusions Mainly a lipid-based diet in pregnant women might represent a risk factor for excessive GWG. However, a protein-based diet is a protective factor for excessive GWG.

Sarcoidosis (SD) is a systemic granulomatous condition that is especially encountered in young adults and rarely in children, affecting predominantly the lungs and lymph nodes. We report the case of a 14-year-old teenage boy admitted to our clinic for nausea, vomiting, and weight loss. Clinical examination at the time of admission revealed malaise, pallor, and abdominal tenderness in the epigastric area at palpation. Laboratory tests revealed an elevated level of hemoglobin, mild thrombocytosis, increased erythrocyte sedimentation rate, and a mild increase in creatinine and urea levels along with hypercalcemia. An abdominal ultrasound revealed a right ectopic kidney, whereas the upper digestive endoscopy showed intense hyperemia and edema of the gastric mucosa. Thoracic computed tomography scan revealed giant hilar and mediastinal lymphadenopathy, along with multiple micronodules within the lung parenchyma and ground-glass aspect. The level of angiotensin-converting enzyme was high, parathormone was normal, and vitamin D level was low. Pathological examination of the bronchial, mediastinal, and lung biopsies established the diagnosis of SD. We administered oral corticosteroids for 2 months with outstandingly favorable outcome and no signs of recurrence 6 months after the cessation of the therapy.

The aim of this study was to define the relationship between several environmental, laboratory, and genetic factors, i.e., TLR2 and NLRP3 polymorphisms, and Helicobacter pylori (H. pylori) infection in children, by comparing three different groups of pediatric subjects: H. pylori-induced gastritis, non-H. pylori gastritis, and healthy controls. Our final study sample included 269 children, which were divided into three groups according to the histopathological exam: group 1 with 51 children with H. pylori-induced gastritis, group 2 with 103 children with H. pylori-negative gastritis, and group 3 (control group) with 115 children without any histopathological changes. All children underwent a thorough anamnesis, clinical exam, laboratory tests, and upper digestive endoscopy with gastric biopsy for rapid urease test, histopathological exam, and genetic analysis of TLR2 rs3804099, TLR2 rs3804100, and NLRP3 rs10754558 gene polymorphisms. We noticed a significant association between living conditions and the type of gastritis (p < 0.0001). Both rapid urease and serological tests were significantly associated with the presence of H. pylori (p < 0.0001). The CT variant genotype of TLR2 rs380499 was significantly associated with neutrophil count (p = 0.0325). We noticed a significant association between the CC variant genotype of NLRP3 rs10754558 and leucocytes, neutrophils, eosinophils, as well as ALT (p = 0.0185, p = 0.0379, p = 0.0483, p = 0.0356). Based on these findings, we state that poor living conditions and rural areas represent risk factors for H. pylori infection. The rapid urease test is a reliable diagnostic tool for this infection. CT and TT carriers of TLR2 rs3804099, as well as CC carriers of NLRP3 rs10754558, might display a more severe degree of systemic inflammation.

Agenezia de VCI este o malformaţie extrem de rară, de cele mai multe ori descoperită întâmplător, reprezentând un important factor de risc în dezvoltarea trombozei venoase profunde (TVP) spontane la copii şi adulţii tineri. Prezentăm cazul unui copil, de sex masculin, în vârstă de 8 ani, internat în clinica noastră pentru următoarele acuze: durere în regiunea lombară dreaptă cu iradiere paravertebrală. Din antecedentele personale patologice, menţionăm o apendicectomie recentă. La momentul internării, s-a efectuat ecografie abdominală, care a evidenţiat nefromegalie dreaptă şi a ridicat suspiciunea de agenezie de venă cavă inferioară. S-a efectuat angioCT toraco-abdominal cu substanţă de contrast, care a confirmat diagnosticul de agenezie de venă cavă inferioară şi venă iliacă comună dreaptă, tromboză venoasă la nivelul venei iliace externe drepte, venei femurale comune drepte şi venei femurale superficiale drepte. Au fost excluse diagnosticele de sindrom antifosfolipidic şi trombofilie, iar testele genetice au eliminat posibilitatea unei predispoziţii familiale. S-a instituit terapie anticoagulantă cu monitorizarea atentă a timpilor de coagulare, evoluţia fiind favorabilă. În ciuda incidenţei foarte scăzute a acestei malformaţii, diagnosticul precoce, prompt şi corect este esenţial în ceea ce priveşte managementul şi prognosticul acestor pacienţi.

Obiective. În abordarea problematicii bolii diareice acute (BDA) la pacientul pediatric, ne-am fixat ca obiectiv principal o evaluare amănunţită a etiologiei şi factorilor de risc şi, pe de altă parte, evaluarea raportului risc/ beneficiu în ceea ce priveşte justificarea antibioterapiei în tratamentul BDA la pacientul pediatric. Material şi metodă. Am efectuat un studiu analitic descriptiv, retrospectiv, pe un lot de 125 pacienţi, internaţi în Clinica Pediatrie I Tg. Mureş pe parcursul anului 2016 (ianuarie-decembrie) cu diagnosticul de boală diareică acută (BDA). Rezultate. Din totalul de 125 de pacienţi, s-a identificat o etiologie bacteriană a BDA în 23 de cazuri (18,4%). Pe de altă parte, s-a observat faptul că 84 de pacienţi au primit tratament antibiotic (67,2%), 110 pacienţi (88%) tratament simptomatic iar în 60% din cazuri (75 pacienţi) s-a asociat şi tratament probiotic. Durata medie de spitalizare a fost de 5 zile, durată influenţată de prezenţa/absenţa unor factori de risc precum febra, sindromul inflamator, tulburările hidroelectrolitice sau sindromul de deshidratare acută, factori care au prelungit perioada de spitalizare cu până la 2 zile (p

Non-alcoholic fatty liver disease has become the most common chronic liver disease in children due to the alarmingly increasing incidence of pediatric obesity. It is well-documented that MAFLD prevalence is directly related to an incremental increase in BMI. The multiple hits theory was designed for providing insights regarding the pathogenesis of steatohepatitis and fibrosis in MAFLD. Recent evidence suggested that the microbiome is a crucial contributor in the pathogenesis of MAFLD. Aside from obesity, the most common risk factors for pediatric MAFLD include male gender, low-birth weight, family history of obesity, MAFLD, insulin resistance, type 2 diabetes mellitus, obstructive sleep apnea, and polycystic ovarium syndrome. Usually, pediatric patients with MAFLD have nonspecific symptoms consisting of fatigue, malaise, or diffuse abdominal pain. A wide spectrum of biomarkers was proposed for the diagnosis of MAFLD and NASH, as well as for quantifying the degree of fibrosis, but liver biopsy remains the key diagnostic and staging tool. Nevertheless, elastography-based methods present promising results in this age group as potential non-invasive replacers for liver biopsy. Despite the lack of current guidelines regarding MAFLD treatment in children, lifestyle intervention was proven to be crucial in the management of these patients.

Background: Pediatric COVID-19 is a current health burden mostly due to the lack of knowledge in terms of symptoms, clinical course and management. COVID-19-associated coagulopathy is one of the most recently described complications among adults, along with acquired thrombophilia resulting in an increased risk for venous, arterial and microvascular thrombosis. Case presentation: We report the case of a 4-year-old male child, admitted to our clinic for generalized seizures being intubated and mechanically ventilated before admission, with a personal history of ureterovesical junction obstruction, mild hydronephrosis, and an episode of generalized seizures. The laboratory tests revealed anemia, an increased number of monocytes, and a mildly increased C-reactive protein. A real-time polymerase chain reaction (RT-PCR) of the oropharyngeal swab was performed and it tested positive for SARS-CoV-2 in the child and both of his parents. The thoracic CT showed consolidation in the lower lobe of the left lung associated with an opacity in the right apex, suggesting possible atelectasis. We initiated antibiotic, antiviral, corticosteroids, as well as anticoagulants and antipyretics, continuing the chronic anticonvulsant therapy. The patient’s condition deteriorated progressively, and, after 72 h of hospitalization, he developed desaturation and bradycardia. The laboratory parameters on the third day showed leucopenia, neutropenia, increased creatine kinase, a high ferritin level, hypoalbuminemia, a prolonged prothrombin time and an increased international normalized ration. The patient died on the fourth day of admission. Conclusion: In spite of its low incidence and frequent benign clinical course, COVID-19 complications such as coagulopathy might represent a leading cause of death, even in pediatric patients.

Introducere. Insuficienţa respiratorie acută prezintă morbiditate şi mortalitate foarte crescute în rândul pacienţilor pediatrici, fiind una dintre cele mai frecvente cauze de apelare la serviciile de urgenţă şi de spitalizare. Material şi metodă. Am realizat un studiu retrospectiv, de tip transversal, pe un lot de 153 de pacienţi diagnosticaţi cu insuficienţă respiratorie acută, cu vârsta cuprinsă între 2 săptămâni şi 17 ani, internaţi în Clinica Pediatrie I a Spitalului Clinic Judeţean de Urgenţă Târgu Mureş, în perioada ianuarie 2015-decembrie 2016. Rezultate. Raportul între sexe a fost în favoarea fetelor 1,12:1. În ceea ce priveşte vârsta, 4,57% au fost nounăscuţi, 32,67% sugari, 27,45% copii între 1 şi 3 ani, 22,87% preşcolari (4-6 ani), iar 12,41% au avut între 7 şi 17 ani. Datele de laborator au evidenţiat leucocitoză în 65,35% dintre cazuri, neutrofilie în 70,58%, 20,91% au prezentat limfocitoză, iar 5,22% au exprimat eozinofilie. Valoarea proteinei C-reactive s-a corelat semnificativ statistic cu valoarea vitezei de sedimentare a hematiilor (p = 0,002) şi cu valoarea trombocitelor (p = 0,01), dar nu şi cu valoarea hemoglobinei (p = 0,15). Markerii inflamatori nu s-au corelat semnificativ statistic cu gravitatea insuficienţei respiratorii. Radiografia toracică a arătat modificări patologice la 75,16% din pacienţi, dintre care 13,91% cu aspect tipic de condensare pulmonară, iar 86,09% de pneumonie interstiţială. Pentru stabilirea gravităţii patologiei, cât şi a evoluţiei pacienţilor, am calculat un scor prognostic. Conform acestuia, 10,45% au avut prognostic foarte bun, 68,62% prognostic bun şi restul de 20,93% prognostic rezervat. Concluzii. Diagnosticul de insuficienţă respiratorie acută la pacienţii de vârstă pediatrică prezintă atât un determinism complex şi multifactorial, cât şi o etiologie diversă.

Pediatric obesity is not only an energetic imbalance, but also a chronic complex multisystem disorder that might impair both the life length and quality. Its pandemic status should increase worldwide awareness regarding the long-term life-threatening associated complications. Obesity related complications, such as cardiovascular, metabolic, or hepatic ones, affect both short and long-term wellbeing, and they do not spare pediatric subjects, defined as life-threatening consequences of the systemic inflammatory status triggered by the adipose tissue. The energetic imbalance of obesity clearly results in adipocytes hypertrophy and hyperplasia expressing different degrees of chronic inflammation. Adipose tissue might be considered an immune organ due to its rich content in a complex array of immune cells, among which the formerly mentioned macrophages, neutrophils, mast cells, but also eosinophils along with T and B cells, acting together to maintain the tissue homeostasis in normal weight individuals. Adipokines belong to the class of innate immunity humoral effectors, and they play a crucial role in amplifying the immune responses with a subsequent trigger effect on leukocyte activation. The usefulness of complete cellular blood count parameters, such as leukocytes, lymphocytes, neutrophils, erythrocytes, and platelets as predictors of obesity-triggered inflammation, was also proved in pediatric patients with overweight or obesity. The dogma that adipose tissue is a simple energy storage tissue is no longer accepted since it has been proved that it also has an incontestable multifunctional role acting like a true standalone organ resembling to endocrine or immune organs.

Leucemia acută limfoblastică (LAL) reprezintă unul dintre cele mai comune tipuri de neoplazii la copii, dar, în acelaşi timp, unul dintre cancerele cu cel mai bun prognostic. Pancitopenia tranzitorie a fost descrisă ca fiind o entitate foarte rară, definită ca o stare preleucemică la copii şi adolescenţi. Prezentăm cazul unui copil în vârstă de 2 ani, de sex masculin, cu infecţie a tractului respirator de 2 săptămâni, fără ameliorare după antibioterapie, internat în clinica noastră cu febră, stare generală influenţată, tuse productivă, paloare marcată, edeme palpebrale şi abces perianal. Analizele de laborator au evidenţiat anemie severă, leucopenie uşoară şi markeri inflamatori crescuţi. Radiografia toracică a pus în evidenţă o pneumonie masivă dreaptă. Copilul a fost externat după 3 săptămâni de antibioterapie cu spectru larg, prezentând evoluţie favorabilă. Hemoleucograma de control după aproximativ 2 săptămâni de la externare a arătat leucocitoză marcată, iar imunofenotiparea măduvei osoase a stabilit diagnosticul de leucemie acută limfoblastică cu celule pre-B. Toţi pacienţii care au primit tratament pentru pancitopenie trebuie monitorizaţi adecvat în pe termen lung pentru a exclude dezvoltarea ulterioară a unei potenţiale LAL.

Lipoamele sunt tumori benigne compuse din ţesut adipos, tipic localizate subcutanat, mai frecvent în partea superioară a spatelui, la nivelul umerilor, mâinilor şi feselor. Mai rar, lipoamele pot fi întâlnite în profunzimea coapselor. Majoritatea lipoamelor sunt de dimensiuni mici, cântărind doar câteva grame, diametrul maxim fiind sub 2 cm, însă lipoamele gigante au cel puţin 10 cm diametru şi minimum 1.000 g. Prezentăm cazul unei paciente de sex feminin, în vârstă de 14 ani, care observă, de aproximativ două luni şi jumătate, apariţia unei formaţiuni tumorale pe faţa anterioară a coapsei stângi, internându-se pentru investigaţii în Clinica Pediatrie I Tîrgu Mureş, Compartiment Hemato-Oncologie, cu suspiciunea de tumoră de părţi moi. Examenul de rezonanţă magnetică (RMN) efectuat a evidenţiat un lipom intramuscular al coapsei stângi, cu dimensiuni maxime de 66/44/125 mm, fiind transferată în Clinica de Chirurgie şi Ortopedie Pediatrică pentru excizie. Examenul histopatologic a evidenţiat aspectul de fibrolipom.

Enteropatia exudativă (EE) reprezintă o pierdere proteică anormală la nivelul mucosei tractului digestiv, fiind în majoritatea cazurilor secundară altor patologii gastro-intestinale sau extraintestinale. Cu toate acestea, există, de asemenea, cauze primare, genetice asociate cu EE. Prezentăm cazul unui copil mic, de sex feminin, în vârstă de 1 an şi 1 lună, cu un episod de enterocolită infecţioasă cauzată de Escherichia coli enteropatogen în antecedente, care s-a internat în clinica noastră cu edeme palpebrale matinale de aproximativ 1 săptămână. Analizele de laborator au evidenţiat hipoalbuminemie, hipogamaglobulinemie de tip A şi G, leucocitoză cu eozinofilie, şi anemie. Testul pentru detectarea hemoragiilor oculte din scaun a fost pozitiv, precum şi alfa-1 antitripsina şi calprotectina fecală. Am identificat, de asemenea alergie la proteinele laptelui de vacă, pe care am interpretat-o ca fiind secundară patologiei intestinale. Astfel, am stabilit diagnosticul de enteropatie exudativă după un episod de enterocolită acută cauzat de E. coli enteropatogen, şi am administrat tratament substitutiv cu albumină umană şi corticosteroizi, cu evoluţie favorabilă. Particularitatea cazului constă în diagnosticarea unui caz sever de enteropatie exudativă la un copil mic cu edeme palpebrale matinale, şi nivele scăzute ale albuminei serice, după un episod de enterocolită cauzat de E. coli enteropatogen, care s-a remis fără tratament etiologic

Introducere. Durerile musculoscheletale sunt printre cele mai obişnuite acuze ale copilului, cele mai multe episoade fiind autolimitate. Cu toate acestea, în unele cazuri reprezintă primul semn al unei boli maligne. Obiective. Evaluarea frecvenţei şi caracteristicile acuzelor musculoscheletale ca simptome iniţiale prezente la copiii nou-diagnosticaţi cu cancer. Material şi metodă. Studiu retrospectiv care a inclus 231 de copii cu diferite boli maligne diagnosticaţi şi trataţi în Clinica de Pediatrie I, Târgu Mureş, în perioada 2000-2015. Datele colectate au fost: vârsta la diagnostic, caracteristicile clinice prezentate, constatările de laborator, precum şi diagnosticele finale. Rezultate. 23% dintre copiii cu cancer au avut simptome musculoscheletale la prima prezentare. Timpul mediu dintre debutul bolii şi diagnosticul final a fost de 60 de zile. Acuzele cele mai frecvente au fost artralgia (50%) implicând articulaţiile mari. Artrita reumatoidă juvenilă a fost cel mai frecvent diagnostic iniţial, la 7 din cei 54 de pacienţi (13%). Anemia a fost cea mai frecventă modificare hematologică iniţială. Toţi pacienţii au avut valori crescute ale VSH-ului şi LDH-ului. Malignităţile diagnosticate au fost: leucemie acută limfoblastică sau mieloblastică, limfoame şi tumori solide. Concluzii. Diagnosticul precoce al cancerului şi tratamentul adecvat sunt esenţiale pentru imbunătăţirea prognosticului şi se poate realiza incluzând boala malignă în diagnosticul diferenţial al afecţiunilor reumatice la copiii care acuză iniţial dureri musculoscheletale.

Refluxul vezico-ureteral reprezintă refluarea conţinutului vezicii urinare în ureter şi sistemul pelocaliceal cu dilatarea consecutivă a acestora. Majoritatea cazurilor de infecţie de tract urinar la copil se asociază cu reflux vezico-ureteral. Prezentăm cazul unei paciente în vârstă de 3 ani, cu multiple infecţii de tract urinar simptomatice în antecedente care s-a internat în clinica noastră pentru investigaţii de specialitate şi stabilirea unei conduite terapeutice adecvate. Examenul obiectiv şi analizele de laborator nu au evidenţiat elemente patologice. Ecografia abdominală nativă a fost fără modificări, în timp ce ecografia abdominală cu substanţă de contrast a evidenţiat reflux vezico-uereteral bilateral. Scintigrafia renală cu DMSA a arătat hipofuncţie renală dreaptă, de 39%, cu duplicitate a sistemului colector şi moderată dilataţie a pielonului superior şi funcţie normală a rinichiului stâng. Recomandările au constant în chimioprofilaxie pe termen lung, ecografie cu substanţă de contrast anual şi monitorizare nefrologică o dată la 6 luni. Particularitatea cazului constă în diagnosticarea unui reflux vezico-ureteral bilateral prin ecografie cu substanţă de contrast la o pacientă cu multiple infecţii de tract urinar în antecedente, la care ecografia renală nativă nu a evidenţiat modificări patologice.

Timomul este un neoplasm format din celule epiteliale timice, fiind rar întâlnit la copii. Aproximativ două treimi din tumorile mediastinale sunt asimptomatice la copii, diagnosticul fiind suspicionat în urma efectului de compresie a masei tumorale asupra căilor respiratorii. Prezentăm cazul unui pacient de sex masculin, în vârstă de 7 ani şi 8 luni, care se prezintă în serviciul de urgenţă acuzând oboseală la eforturi mici/repaus, tuse seacă, dispnee marcată, ortopnee, tahipnee, durere toracică, de unde se transferă de urgenţă la Clinica de Cardiologie Pediatrică, Tîrgu Mureş, cu diagnosticele: pericardită lichidiană, tamponadă cardiacă şi pleurezie dreaptă. Examenul computer tomografic toracic descrie o masă solidă inomogenă de 100/89/111 mm, la nivelul mediastinului anterior înglobând timusul şi parţial structurile vasculare ale mediastinului mijlociu. Se practică pericardectomie parţială, prelevare de ţesut tumoral şi citoreducţie tumorală extensivă, examenul histopatologic fiind Timom B3. Se iniţiază chimioterapie conform protocolului VENUTA Tymom, urmat de radioterapie adjuvantă, cu remisie clinică şi radiologică. Particularitatea cazului este dată de faptul că timomul este o tumoră rară la vârsta pacientului, creând dificultăţi de diagnostic, fiind fără complicaţii în timpul tratamentului, cu evoluţie favorabilă, cu remisie clinică şi radiologică la 1,9 ani.