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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.

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.

Boutonneuse fever (BF) is an eruptive disease and is classified as a spotted fever, which is endemic in the Mediterranean basin (i.e., Marseille fever or Mediterranean spotted fever) and the Black Sea, caused by Rickettsia conorii, with dog ticks being a vector (i.e., Rhipicephalus sanguineus). In Romania, although the first reported outbreak of BF occurred during the summer of 1931 in Constanta, the disease was discovered in 1910. Although the disease has occurred most frequently in the two counties of the Dobruja region (Constanta and Tulcea), a region of the Balkan Peninsula, during the last few years, other counties in southeastern Romania have started to report BF cases. In a period of 9 years, 533 cases were registered in Constanta county, while in a period of 11 years, 339 cases were registered in Bucharest county. In this review, we describe the bacterial tick-borne disease caused by R. conorii in southeastern Romania, focusing on its history and epidemiology, pathophysiology, clinical aspects, diagnosis, treatment and preventive measures in the context of climate changes. Although R. conorii is the principal etiologic agent of BF in southeastern Romania, we should take into consideration that other Rickettsia spp. could be present and involved in disease transmission.

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.

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.

We reported a case of nephrotic syndrome in a child presenting undiagnosed hydronephrosis and unilateral renal agenesis in a 3 years and 9 months old male patient presenting features of nephrotic syndrome, with left hydronephrosis and unilateral renal agenesis. The association of nephrotic syndrome with congenital anomalies is extremely rare. The importance of this unusual combination was discussed respecting the literature. [ABSTRACT FROM AUTHOR]

Background: Achondroplasia is a generalized skeletal dysplasia, characterized by rhizomelic dwarfism, disproportionately neonatal large skull, facial dysmorphia and radiological characteristic aspects. This disease is the most common cause of short stature, it is encountered at approximately 1 of 10,000 newborns and, most often, it is diagnosed right at birth, based on clinical signs and radiological examination. Achondroplasia is caused by a mutation in the gene FGFR3, characterized by stopping the growth of the long bones of fetal period. Intelligence and life span in this disease are usually near normal, compared with other types of dwarfism. Objective: The main purpose of our presentation is to establish a diagnostic algorithm for children with disharmonic dwarfism, based on characteristic clinical and radiographic findings in most affected children or, concerning the individuals in whom there is diagnostic uncertainty or atypical findings, identification of a mutation in the gene FGFR3 can establish the diagnosis. Material and methods: We are going to present the clinical cases of three children, aged 6, 9 and 10 years, with poor postnatal growth, who are hospitalized in the department of pediatrics, at County Clinical Emergency Hospital of Constanta, for the evaluation of the stature's and weight's hypotrophy. Results: In these three case reports, molecular genetic testing was unnecessary, because the children have typical findings. Thus, the diagnostic was confirmed by clinical examination that reveals proximal shortening of the arms, macrocephaly with frontal bossing, short fingers, in trident, exagerated lumbar lordosis. Radiological investigations have been performed just for one of these three children, the results showing robust tubular bones, square ilia, horizontal acetabula, proximal femoral radiolucency. Conclusions: Short stature is often associated with stigma or anomalies that make it possible to fit into a genetic disease or syndrome, confirmed by genetic testing, a suitable therapeutic approach and a competent genetic counseling. [ABSTRACT FROM AUTHOR]