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Introduction: Iron deficiency (ID) is one of the most common causes of anemia in children. Although it is frequently encountered in a clinician's daily practice, the multifactorial etiology of ID still represents a challenge in terms of long-term management. In overweight and obese children, adiposity related inflammation causes ID by decreasing transferrin saturation on one hand and by increasing hepcidin production on the other hand, which in turn decreases iron absorption. Dietary uptake of iron and other micronutrients is also impaired in these children. Aim of the study: To investigate the link between overweight, obesity and iron deficiency in pediatric patients. Materials and methods: A retrospective observational study was conducted over a 1-year period (1st April 2018-31th March 2019), in the Endocrinology Department of "Louis Turcanu" Children's Emergency Clinical Hospital Timisoara. After applying the inclusion criteria, a total of 78 overweight and obese children were enrolled in the study. The Ethics Committee of the "Louis Turcanu" Children's Emergency Clinical Hospital approved the study. Results: The CDC BMI- charts matched for age and sex were used in order to define overweight and obesity (overweight 85th - 95th and obesity > 95th percentiles). According to age patients were divided in 3 groups: toddlers 6% (age 1-5 years); preadolescents 40% (age 5-12 years) and adolescents 54% (age 12-18 years). Overall, the overweight/ obesity ratio in the studied groups was as follows: 20:80 in toddlers, 13:87 in preadolescents and 45,6:54,4 in adolescents. The highest percentage of ID- patients was found in toddlers (60%), followed by preadolescents with half as much patients (32%), and the lowest percentages was observed in adolescents (14%). Although there was a correlation between iron levels and BMI throughout our sample, these obese and overweight children did not associate significant anemia. Conclusions: The negative correlation between BMI and iron levels, even in the absence of anemia, should raise awareness with regard to the micronutrient imbalance that exists in these children from a very young age. Children with elevated BMI may need to be screened for iron deficiency. There is an acute need to expand the studies to establish the cause of ID among children and adolescents. [ABSTRACT FROM AUTHOR]

Gabriela, 8 years old, was admitted in the 1st Pediatric Clinic, Timisoara for the evaluation of cholestasis syndrome. She was known with hypotonic cerebral palsy, epilepsy with polymorphic seizures partial controlled by anticonvulsants and 5 atraumatic leg fractures occurred in the last 3 years. At admission, she had pale skin, absent subcutaneous tissue and muscle atrophy with muscle atrophy. She had splint cast in the left lower limb and pseudoarthrosis in the 1/3 distal of the right leg. The biological investigations revealed normal liver enzymes except alkaline phosphatase, an abnormal coagulation and bone markers and the presence of starch and fiber in the stool, while the other tests were normal. The radiography of extremities showed osteolysis injuries and old left clavicle, upper third diaphysis of left humerus and femur and lower third diaphysis of right tibia fractures, with vicious callus secondary to Osteogenesis Imperfecta. We considered that all these fractures were manifestations of osteoporosis secondary to malabsorption syndrome, malnutrition, vitamin D and K deficiencies, chronic anticonvulsant therapy and Osteogenesis Imperfecta. The evolution was favorable under treated with calcium gluconate, vitamin D and K with the reduction of alkaline phosphatase and normalization of coagulation. The initiation of bisphosphonate therapy was taken into account. Case particularity: The association of osteoporosis and Osteogenesis Imperfecta responsible for the production of fractures in a patient with cerebral palsy and epilepsy. [ABSTRACT FROM AUTHOR]

Stickler syndrome is a connective tissue disorder that can include ocular findings of myopia, cataract and retinal detachment. It can also cause hearing loss that is both conductive and sensorineural. Under-development of the middle part of face, ogival palate, spondylo-epiphyseal dysplasia and/or precocious arthritis can also occur. The authors present the case of a 7 months old infant with failure to thrive associated to a particular phenotype; facial dysmorphism and congenital cataract, who was referred for admission presenting an upper respiratory tract infection. Corroborating the clinical examination with the paraclinical evaluation and genetic assessment, including the karyotype, the authors established in this case the diagnosis of Stickler syndrome. [ABSTRACT FROM AUTHOR]

Lipoid nephrosis or idiopathic nephrotic syndrome (INS) is a syndrome characterized by an increase in glomerular permeability followed by massive proteinuria, hypoproteinemia, hypogammaglobulinemia and dyslipidemia. Clinical expression of these biological changes is the installation of massive edema and oliguria. INS etiology is currently unknown but numerous studies are pointing out the connection between INS and atopic diatheses. Based on this finding some authors have tried a diet of exclusion which resulted in decreased proteinuria but not significantly reduced the number of relapses. The link between diet and altered intestinal permeability and the decisive role of diet in the regulation of intestinal microflora and the modulation of intestinal and systemic inflammatory response is currently demonstrated by many authors. The presence in serum of patients with INS of antibodies to food, either IgE, or IgG4 may be considered a marker of increased intestinal permeability, local inflammation and intestinal microbiota disturbance. In our experience, exclusion from the diet of patients with INS of gluten, dairy products and of food for which there is an immune response (sIgE or sIgG4) resulted in a rapid decrease of proteinuria, allowed us to reduce the total length of corticosteroid therapy and prevented relapse of the illness over a period of one year. Changing the treatment protocol from administration of anti-inflammatory medication (glucocorticoid drugs) to restoration of a balanced intestinal microbiota, improvement of intestinal permeability and modulation of the gut inflammatory response must be the primary objective in the management of the child INS. [ABSTRACT FROM AUTHOR]

A 7 year old patient known from his medical history with visual impairment from the age 2 years and 6 months, which have progressed once the child began school. Careful examination revealed the presence of a tumor formation with selar location, which proved to be craniopharyngioma. Postoperative evolution was relatively good, but a redoubtable complication appeared, namely diencephalic obesity. [ABSTRACT FROM AUTHOR]

Introduction: Necrotising enterocolitis (NEC) is an acquired gastrointestinal disease associated with significant morbidity and mortality in preterm newborns. Taking into account the catastrophic development of this disease, it is necessary to focus research on prevention strategies and identify predictive risk factors for its occurrence. Aim: The aim of this study was to determine the incidence of NEC and to identify the main risk factors associated with NEC in preterm infants with gestational age(GA) ≤32 weeks admitted to neonatal intensive care units(NICUs) in Romania. Material and methods: This was a retrospective study based on the data collected in a standardised format for all preterm infants with GA ≤32 weeks born over a period of 2 years (January 2010-december 2011) and admitted to 12 tertiary-level NICUs in Romania. It was used data registered in the National Registry of Neonatal Respiratory Distress (NRNRD). A diagnosis of NEC was made based on clinical, radiological and/or histopatological evidence of stage II or III, acording to Bell's criteria. Logistic regression analysis was performed to determine the significant risk factors associated with NEC. Results: There were 1696 neonates under 32 weeks of gestation that met inclusion criteria; 1605 did not have NEC, while 91(5,3%) met criterion for NEC. Lenght of hospital stay and mortality were higher in neonates with NEC than those without NEC. Logistic regression analysis showed that smal for gestational age(SGA) and nosocomial infections were the most important risk factors for NEC. Other factors that were associated with an increased risk of NEC were bronchopulmonary displasia (BPD), use of nasal continuos positive airway pressure (CPAP), sepsis, apnea of prematurity, the lack of antenatal glucocorticoids and outborn pacients. Male gender and PDA were not statistical significantly correlated with NEC (borderline statistical significance). Conclusions: The incidence of NEC was higher in this study (5,3%). Low birth weight, nosocomial infections, BPD, CPAP, apnea and lack of antenatal glucocorticoids were associated with an increased risk of NEC in Romanian preterm infants under 32 weeks of gestation. Male gender and PDA were not statistical significantly correlated with NEC (at the limit of statistical significance). [ABSTRACT FROM AUTHOR]

Aim. To assess how children requiring endotracheal intubation are mechanically ventilated in First Pediatric Intensive Care Unit (PICU), Timisoara. Material and methods. A four years observational study (January 2010 - December 2012) was conducted in the Fist PICU of Emergency Hospital for Children "Louis Turcanu" Timisoara and included all mechanically ventilated children > 24 hours, aged 0-18 years. Results. One hundred eight patients met the inclusion criteria. The mean age of the patients was 27 months and median duration of mechanical ventilation was 9 days. The mean PRISM III score on admission was 17. The mean duration of mechanical ventilation was 9.36 days. Major indication for mechanical ventilation was acute respiratory failure. We used pressurelimited conventional modes of ventilation. Mean peak inspiratory pressure (PIP) values were constant < 30 cmH2O, with 12% of the patients having a maximum PIP > 30 cmH2O, but < 35 cmH2O. There was little variability with positive end-expiratory pressure (PEEP) choice, with a mean value of 5 cmH2O. Mean levels of tidal volume (VT) was 8.16 ml/kg, and medium inspiratory fraction of oxygen (FiO2) was < 0.6. Arterial blood gases analyses showed normo- and hypocapnia. Sixty-seven percent of the patients fulfilled the oxygenation criteria for ARDS, but only half of them had bilateral pulmonary infiltrates. No mechanical complication as pneumothorax was noted. Ventilator associated pneumonia was encountered in 39% of patients. A total of 34 (32%) children died. Conclusions. Pressure ventilation modes were standard in our PICU. Describing the standard care and how mechanical ventilation is performed in children can be useful for future clinical trials. [ABSTRACT FROM AUTHOR]

Objectives: To emphasize the negative role of chronic kidney disease in impaired growth and development of a female 7 year old patient, with chronic renal failure associating sexual developmental disorder - adrenogenital syndrome. Methods: The patient came to monthly follow-ups for the evaluation of her the anthropometric, nutritional and biological status. She was treated with a replacement therapy comprising of growth hormones and cortisone. Results: The girl was diagnosed at birth with polycystic kidney disease and sexual development disorder, karyotype 46XX - adrenogenital syndrome, salt-losing form. Cortisone replacement therapy was initiated in the neonatal period, under hormonal monitoring. At the age of 4 she had a creatinine clearance (Schwartz formula) of 17 ml/min/m2, height: H2009 = 83 cm, weight: W2009 = 8 kg and the therapy with growth hormones was initiated. In the following years, the increase in height was 12 cm and in weight 3 kg (H2010 = 95 cm, W2010 = 11 kg), while requiring the initiation of peritoneal dialysis. Currently, H2013 is 104 cm and W2013 is 13 kg. Conclusions: Progression of chronic kidney disease causes retardation of growth and development by: inadequate production of erythropoietin with secondary anemia, bone and mineral disease secondary to renal dysfunction, chronic metabolic acidosis and disruption of the hypothalamic-pituitary growth hormone axis. Adrenogenital syndrome association is an additional factor for impaired growth and development. [ABSTRACT FROM AUTHOR]

Introduction: Anorexia nervosa (AN) is an eating disorder and also a psychiatric disorder, characterized by a weight well below the standard weight due to a distorted image of the body with obsessive fear of weight gain. Material and method: We present the case of a 10 years old girl weighing 16 kg (body mass index BMI = 8.16 kg/m2), who was hospitalized in the Pediatric Clinic for loss of appetite, inability to walk and maintain orthostatism, with motor deficit on the right side of the body. The onset was affirmative five months ago, after separation from the mother (gone abroad), the child being left in the care of a grandmother. Twenty-four hours after admission, the girl experienced periods of voluntary apnea, requiring endotracheal intubation and mechanical ventilation. Results: Endocrine balance showed in this case: elevated cortisol levels, low levels of follicle stimulating hormone (FSH), estradiol and testosterone; high levels of growth hormone (GH) and low levels of insulin-like growth factor (IGF-I); low levels of thyroid hormones (T3 and T4) and slightly decreased thyroid-stimulating hormone (TSH). During the 96 days of hospitalization, the patient required the placement of a tube tracheostomy to continue mechanical ventilation and a PEG (percutaneous endoscopic gastrostomy tube) for enteral nutrition. Weight gain was 4 kg. The patient died due to infectious complications after 6 months following hospitalization in another center. Conclusions: Endocrine changes that occur in AN are secondary to physiological adaptation of the body to a state of starvation. AN and the associated malnutrition that occurs through self-imposed starvation can cause severe organic and psychological complications and can even lead to death. [ABSTRACT FROM AUTHOR]

Prader-Willi syndrome (PWS) is a genetic disorder characterized by absence of the active genes on chromosome 15. Symptoms appear since intrauterine development with decreased fetal movements, low birth weight and persist after birth with hypotonia, feeding difficulties and failure to thrive in the neonatal period. From infancy until adulthood, patients have short stature, become severely obese, with an insatiable appetite and food-seeking behavior. They also have psychiatric disorders, behavioral problems and learning disabilities. Treatment of these patients is multidisciplinary and several drugs have been studied in order to control appetite and reduce the morbidity of obesity, including cardiovascular and metabolic side-effects. The following paper offers an insight in the difficult management of the co-morbidities of Prader-Willi syndrome. [ABSTRACT FROM AUTHOR]

Introduction/background: The constant global rise in the occurrence of overweight and obesity among all ages is accompanied by a higher incidence in serious health risks, such as type 2 diabetes, asthma, and the growth of cardiovascular diseases, which is now potentially present at an early age. Aims: To examine correlation and differences of overweight in school-aged children (10-13 years old-yo) according to their health lifestyle factors and depending on demographic repartition in our district, using two materials (Raport DSP 2008-2009 and Timiș Save the children survey 2010-2011). Material and methods: A cross-sectional survey including pupils (n= 1003, 7-17 yo) from the Timis county was carried-out. Height and weight were measured and a questionnaire regarding nutritional behavior was completed. Results were compared in terms of Rural/Urban appurtenance by sex and age compared with the median 10-13 yo from our group (585 children) and Timișoara 6th grade pupils (1220 children). We use CDC Atlanta BMI charts and Excel analysis. Results: From rural group, girls medium height was 1.51 m and medium weight 46.6 kg and for boys 1.49 m and 44.2 kg, comparative with the urban group, girls medium height was 1.55 m and medium weight 44.9kg and for boys 1.54 m and 46.6 kg. Rural: 15.04% are overweight, 14.36% obese; urban: 17% overweight/obese from which 4% obese. Conclusions: Rural SC Timiș survey: 15.04% overweight, 14.46% obese, the difference boys-girls=3.71% statistically significant, pupils percentage with a BMI over 85 percentile (overweight and obese) for the urban group is 17%. Girls in urban group 13% are overweight or obese and 4% obese. [ABSTRACT FROM AUTHOR]

Introduction: Juvenile idiopathic arthritis (JIA) is the most important rheumatic disease of childhood. Aim: To study the correlations between biomarkers and the therapeutic response in JIA. Material and methods: In 58 children, diagnosed and classified according to ILAR (International League of Associations for Rheumatology), evaluation consisted in clinical and laboratory examination (ESR, CRP, RF-rheumatoid factor, alpha2-and gammaglobulins, total IgM and IgG, immunoglobulins, anticyclic citrullinated peptide antibody- ACPA, antinuclear antibodies-ANAs, interleukins - ILs). The outcome was assessed by ACR Pedi (American College of Rheumatology)score. Results: Patients distribution regarding diagnosis was: of patients was: 1 systemic JIA, 17 polyarthritis, 18 oligoarthritis, 22 spondyloarthropathies. There was a good, but inverted correlation between the ESR, CRP, serum immunoglobuline values and the ACR Pedi30 scores on NSAID treatment. ACPA was found positive in 6 cases, all associating important inflammation at the onset, but no correlations with ACR scores. ANAs was found positve in just 3 cases of extended oligoarthritis, all associating ocular complications. Plasma levels of IL- 1alpha, IL-1betha, IL-6 pro-inflammatory interleukins was determined in 8 cases. Both fractions of IL-1 were increased in two cases of reactive arthritis and one juvenile spondylitis (with normal IL-6 levels). Enhancement of IL-6 (and normal IL-1 values) was observed in 3 children with polyarthritis. Conclusions: Important biologic inflammatory syndrome at the moment of JIA diagnosis suggests a highly active disease, indicating a more aggressive therapeutic approach. Positive ACPA is less prevalent than in rheumatoid arthritis, but its positivity denotes an erosive course of JIA. ANAs were correlated with extended oligoarthritis and ocular complications. Interleukins could be correlated with clinical form of JIA (IL-1 with spondyloarthropaty, IL-6 with polyarthritis) and could suggest the timing of biological therapy withdrawal. Further studies are needed to sustain these observations. [ABSTRACT FROM AUTHOR]

Introduction: Sexual development disorders (DSD) are a group of relative rare diseases, induced by genetic or endocrine abnormalities that affect de endocrine and reproductive systems. Material and Methods: Patients with DSD diagnosed in the Pediatric Endocrinology Department, Timisoara between 2010 and 2014 were included in this study. It consisted in a rigorous anamnesis, a complex physical examination including anthropometrical measurements and examination of the patient's genitalia. General and specific biological tests and karyotype were necessary and in some situations, the gene SRY was also determined. The paraclinic consisted in gynecological consult, an abdominal ultrasound or MRI. Results: Out of 31 patients included in the study, 6 patients were identified as having congenital adrenal hyperplasia associating salt loss and dehydration, one patient was diagnosed with definitive urogenital sinus, while another patient had a reductase deficiency. Four patients were 46XY DSD and 20 patients 46XX DSD. Regarding the therapy prescribed, it was according to their genetic structure and their hormonal constellation. Conclusions: 1. At this time sexual development disorders are underdiagnosed. 2. The implementation of a neonatal screening for 21-hydroxylase deficiency is a must. 3. The creation of a national and European register is necessary. [ABSTRACT FROM AUTHOR]

The adrenogenital syndrom is a group of autosomal recessive diseases which causes the disturbance of the synthesis of suprarenal corticoids. We present the case of a newborn, age 2 days, female, born prematurely, gestational age 36 weeks, with a malformation of the external genitalia, which shows at age of 1 week deterioration of general condition, loss of appetite, weight loss, severe dehydration syndrome, hyponatremia, hyperkalemia. We suspected the adrenogenital syndrome, which was later confirmed. With a specific treatment the evolution was favorable. [ABSTRACT FROM AUTHOR]