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Background: European countries have included healthcare workers (HCWs) among priority groups for COVID-19 vaccination. We established a multi-country hospital network to measure the SARS-CoV-2 incidence and effectiveness of COVID-19 vaccines among HCWs against laboratory-confirmed SARS-CoV-2 infection. Methods: HCWs from 19 hospitals in 10 countries participated in a dynamic prospective cohort study, providing samples for SARS-CoV-2 testing at enrolment and during weekly/fortnightly follow-up. We measured the incidence during pre-Delta (2 May–6 September 2021), Delta (7 September–14 December 2021), and Omicron (15 December 2021–2 May 2023) waves. Using Cox regression, we measured the relative vaccine effectiveness (rVE) of the first COVID-19 booster dose versus primary course alone during Delta and Omicron waves. Results: We included a total of 3015 HCWs. Participants were mostly female (2306; 79%), with a clinical role (2047; 68%), and had a median age of 44 years. The overall incidence of SARS-CoV-2 infection was 3.01/10,000 person-days during pre-Delta, 4.21/10,000 during Delta, and 23.20/10,000 during Omicron waves. rVE was 59% (95% CI: −25; 86) during Delta and 22% (1; 39) during Omicron waves. rVE was 51% (30; 65) 7–90 days after the first booster dose during the Omicron wave. Conclusions: The incidence of SARS-CoV-2 infection among HCWs was higher during the Omicron circulation period. The first COVID-19 vaccine booster provided additional protection against SARS-CoV-2 infection compared to primary course vaccination when recently vaccinated

Background: Acute viral respiratory tract infections constitute a significant challenge in pediatric healthcare globally, with rhinovirus representing one of the primary etiological agents. In this context, we conducted a study with the objective of identifying the clinical characteristics and outcomes of rhinovirus infection in comparison with other respiratory viruses in children hospitalized in one of the largest pediatric hospitals in the capital of Romania. Methods: We conducted a retrospective study among children hospitalized for influenza-like illness symptoms and who were tested by multiplex RT-PCR with a nasopharyngeal swab between May 2020 and December 2021. Results: A total of 496 children were eligible for inclusion in the study, and the positivity rate for at least one virus was 58.5%. The rhinovirus was identified in 138 patients (median age 12.5 months), representing 27.8% of all children tested and 49.3% of all positive samples. Although the clinical features of children with rhinovirus were dominated by cough (63.7%) and dyspnea (51.6%), no symptoms were identified that were strongly associated with rhinovirus infection in comparison to other respiratory viruses. The probability of receiving an antibiotic prescription was 1.92 times lower (p = 0.011) in children who tested positive for rhinovirus compared to children with negative RT-PCR results. The incidence of acute bronchiolitis or acute bronchitis, acute respiratory failure, and acute otitis media was higher among rhinovirus-positive children than among those who tested negative via RT-PCR. However, the incidence of these conditions was similar among children who tested positive for other respiratory viruses. Conclusions: Rhinovirus was the most prevalent virus identified in children hospitalized with influenza-like illness symptoms. The utilization of multiplex RT-PCR molecular tests is instrumental in elucidating etiology with precision and implementation of these advanced diagnostic methods, which can bring significant benefits in practice. A positive result for rhinovirus helps to reduce the unnecessary administration of antibiotics and optimizes patient management, thus decreasing the risk of severe complications such as acute respiratory failure and acute otitis media.

Background: Our study aimed to explore the way artificial intelligence (AI) utilization is perceived in pediatric medicine, examining its acceptance among patients (in this case represented by their adult parents), and identify the challenges it presents in order to understand the factors influencing its adoption in clinical settings. Methods: A structured questionnaire was applied to caregivers (parents or grandparents) of children who presented in tertiary pediatric clinics. Results: The most significant differentiations were identified in relation to the level of education (e.g., aversion to AI involvement was 22.2% among those with postgraduate degrees, 43.9% among those with university degrees, and 54.5% among those who only completed high school). The greatest fear among respondents regarding the medical use of AI was related to the possibility of errors occurring (70.1%). Conclusions: The general attitude toward the use of AI can be considered positive, provided that it remains human-supervised, and that the technology used is explained in detail by the physician. However, there were large differences among groups (mainly defined by education level) in the way AI is perceived and accepted.

Infants are a unique pediatric group due to their high hospitalization rates and unfavorable outcomes from acute infectious diseases. Understanding the clinical differences and aftereffects of SARS-CoV-2 in comparison to other prevalent viruses in this age group, like RSV, is crucial for effective management. We conducted a retrospective case–control study of infants hospitalized with SARS-CoV-2 or respiratory syncytial virus (RSV) infection in one year, in a tertiary pediatric hospital in Bucharest, Romania. A total of 188 infants were included in the analysis in a 1:1 ratio (94 with SARS-CoV-2 infection and 94 with RSV infection). Infants with COVID-19 were 10.2 times more likely to have fever (p < 0.001) and 2.4 times more likely to have diarrhea (p = 0.016). Conversely, infants with RSV were 2.5 times more likely to have a cough (p < 0.001), 3.0 times more likely to have nasal congestion (p < 0.001), and 14.7 times more likely to present with dyspnea (p < 0.001). Increased lymphocyte count was more common in infants with RSV (p = 0.008), while lymphopenia was more frequent in infants with SARS-CoV-2 (p = 0.011). The median length of hospital stay was one day longer in infants with RSV infection (5 days vs. 4 days). Overall, infants with RSV infection had a 27.3-fold increased risk of developing respiratory failure (p < 0.001), while infants with COVID-19 had a 5.8-fold increased risk of laryngitis (p = 0.003). Our findings suggest that infants with SARS-CoV-2 infection may present with polymorphic symptoms, mostly dominated by fever, whereas infants with RSV often present with respiratory symptoms. Laboratory differentiation between the two infections is challenging; therefore, the use of rapid antigen or molecular diagnostic tests is crucial for accurate diagnosis, epidemiologically appropriate measures, and effective management. Continued surveillance of both viruses in infants, and beyond, and the implementation of specific control measures are needed to mitigate their impact on this vulnerable pediatric group.

One of the affected organs in cystic fibrosis (CF) is the pancreas, mainly translated into exocrine pancreatic insufficiency. Although rare, acute pancreatitis (AP) has been described, mostly in pancreatic sufficient patients. Objectives. Estimating AP prevalence in CF pediatric population of the I.N.S.M.C. „Alessandrescu Rusescu” CF centre. Material and methods. 5 year retrospective study (2011-2016) including INSMC CF centre pediatric population aged 3-18 years. PA diagnosis was established on the presence of minimum 2 criteria between: characteristic abdominal pain, x3 normal value for age elevation of amylase/lipase, medical imaging evaluation suggestive for AP. Patients were evaluated with different criteria including PIP score of predicting AP risk. Outcomes. 48 patients were included with a slight female predominance (54%). 3 of them presented diagnostic criteria for AP (6,25%), all heaving pancreatic insufficiency and high PIP score (low risk of developing AP); 2 of them have low compliance with pancreatic enzymes substitution therapy; one of them presented recurrent episodes of AP. Conclusions. AP is a rare CF complication. It can be easily missed due to a large number of abdominal pain and emesis causes in CF patients. Although it is usually associated with pancreatic sufficiency, all our patients were pancreatic insufficient.

Malnutrition continues to be a major issue concerning pediatric cystic fibrosis patients’ medical care. Supplementary diagnostic association with food allergy in a cystic fibrosis patient leads to worse nutritional status decline. This particular association determines low quality of life and life expectance impairment. Low caloric intake, recurrent pulmonary infections, maldigestion and malabsorption, low treatment adherence, genetic susceptibility and chronic infections are all risk factors and/or causes of malnutrition in cystic fibrosis patients. The aim of our study was to evaluate the prevalence of IgE mediated food allergies in cystic fibrosis patients. A secondary objective was to assess nutritional status in cystic fibrosis patients with food allergies after exclusion diet. In order to accomplish our objectives, we conducted a descriptive, retrospective study on a 68 pediatric patient cohort with cystic fibrosis (CF). All children were diagnosed and followed in the Regional center for CF of INSMC “Alessandrescu-Rusescu”, Bucharest, between 2011 and 2016. After data collection and statistic analysis we observed a prevalence of 11.7% of food allergies in our cystic fibrosis patients cohort. Also, specific exclusion diet impact on nutritional status was evaluated.

Background and Objectives: Childhood obesity has been increasing at a worrisome pace and emerging as a non-infectious pandemic in the pediatric population in recent years. Raising awareness on this problem is of utmost importance, in order to take action to control body weight from an early age. Materials and Methods: We performed a retrospective study among overweight or obese children evaluated on an outpatient basis in the Department of Pediatric Endocrinology of a tertiary care hospital in Bucharest Romania in 2021 in order to identify laboratory changes occurring according to age and sex. Results: A total of 268 children were included in the analysis, with a median age of 10.9 years (IQR: 8.3, 13.3 years); 61.8% were obese and 38.2% overweight. We identified a subclinical pro-inflammatory status characterized by increased neutrophil count (12.7%) and increased C-reactive protein (16.4%). Biochemically, we identified the highest increases for uric acid (35.4%). More than half of the children included in the study had dyslipidemia-specific changes: high low-density lipoprotein cholesterol (LDL) (50.0%), low high-density lipoprotein cholesterol (HDL) (58.9%) and increased triglyceride levels (12.7%), especially children with a body mass-index (BMI) percentile above 95%. Increased thyroid stimulating hormone (TSH) was identified in 20.3% and low thyroxine (T4) level in 13.4%, especially in females. Conclusions: Early measures to control excess body weight are needed since preventing obesity is easier than treating it. However, this is often difficult to do in our country because parents frequently do not recognize the problem until it is advanced. Furthermore, doctors are not always adequately prepared and sometimes they do not have the support of the health systems to provide children in need with the adequate care. Educational strategies and awareness of issue should be revisited in current post-pandemic context that facilitates increase of obesity prevalence in children. Increase of efficient communication could be achieved by pointing to these objective findings.

Human adenovirus causes infections with a very heterogeneous clinical picture, and children are often the most frequently affected group. Interest in adenovirus has increased with the 2022 outbreak of severe acute hepatitis of unknown etiology as human adenovirus was considered as one of the possible etiological agents. We conducted a retrospective study over a 5-year period in two major tertiary hospitals in the Romanian capital with the aim to characterize the clinical picture and the dynamics of liver function tests in children with confirmed adenovirus infection. The study included 1416 children with a median age of 1.1 years (IQR: 0.3, 2.3 years). Digestive symptoms were predominant in 95.2% of children, mainly diarrhea (90.5%) and vomiting (50.5%), and 38.0% had respiratory symptoms. Increased transaminases were identified in 21.5% of patients. Age over 1 year, lethargy, vomiting and dehydration significantly increased the odds of liver cytolysis independent of other risk factors such as chronic conditions or co-infections. Aspartate aminotransferase (AST) was more commonly increased compared to alanine aminotransferase (ALT). Only six children had transaminase increases above 500 U/L, three of which had co-infections with rotavirus, Epstein–Barr virus (EBV), or respiratory syncytial virus (RSV). Liver function tests should be part of routine monitoring for pediatric patients with adenovirus infection. The current study fills a gap in current knowledge related to the frequency and the extent of liver involvement in human adenovirus infection among pediatric patients.

This review presents current updates of pancreatic enzyme replacement therapy in children with cystic fibrosis based on literature published in the last decade and some special considerations regarding pancreatic enzyme replacement therapy in the era of new therapies, such as cystic fibrosis transmembrane conductance regulator modulator therapies. Few articles evaluate the efficacy of pancreatic enzyme replacement therapy in the pediatric population, and most studies also included children and adults with cystic fibrosis. Approximately 85% of cystic fibrosis patients have exocrine pancreatic insufficiency and need pancreatic enzyme replacement therapy. Fecal elastase is the most commonly used diagnostic test for exocrine pancreatic insufficiency, although this value can fluctuate over time. While it is used as a diagnostic test, it cannot be used for monitoring the effectiveness of pancreatic enzyme replacement therapy and for adjusting doses. Pancreatic enzyme replacement therapy, the actual treatment for exocrine pancreatic insufficiency, is essential in children with cystic fibrosis to prevent malabsorption and malnutrition and needs to be urgently initiated. This therapy presents many considerations for physicians, patients, and their families, including types and timing of administration, dose monitoring, and therapy failures. Based on clinical trials, pancreatic enzyme replacement therapy is considered effective and well-tolerated in children with cystic fibrosis. An important key point in cystic fibrosis treatment is the recent hypothesis that cystic fibrosis transmembrane conductance regulator modulators could improve pancreatic function, further studies being essential. Pancreatic enzyme replacement therapy is addressed a complication of the disease (exocrine pancreatic insufficiency), while modulators target the defective cystic fibrosis transmembrane conductance regulator protein. Exocrine pancreatic insufficiency in cystic fibrosis remains an active area of research in this era of cystic fibrosis transmembrane conductance regulator modulator therapies. This new therapy could represent an example of personalized medicine in cystic fibrosis patients, with each class of modulators being addressed to patients with specific genetic mutations.

In a fast-paced medical reality, biosciences and bioengineering have become essential components in medical research and development. The aim of this paper is to characterize the recent progresses made in fighting antimicrobial resistance, particularly in relation to WHO’s priority pathogens, by providing an in-depth review of novel antimicrobials, drug delivery systems for targeted antimicrobial action and novel antivirulence targets. We systematically searched the ClinicalTrials.gov database to identify clinical trials targeting WHO’s priority 1 (critical) pathogens: carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant ESBL-producing Enterobacteriaceae. We identified a limited number of clinical trials, specifically for: one novel betalactamase inhibitor for Acinetobacter spp., one anti-virulence human monoclonal antibody for Pseudomonas spp. and no novel antimicrobials for carbapenem-resistant Enterobacteriaceae. We also performed a review of field literature to exemplify the main applications of drug delivery systems in infectious diseases, particularly in achieving targeted antibiotic distribution, in enhancing local activity with reduced off-target effects, triggered antibiotic release and triggered antibacterial photodynamic therapy. We conclude by presenting novel targets for antivirulence therapeutics that act by disrupting quorum sensing, inhibiting bacterial adherence and biofilm formation, silencing virulence traits and neutralizing bacterial toxins. Furthermore, the main principles of rational antimicrobial use are highlighted, in an effort to describe potential areas for targeted intervention, from diagnostic stewardship to antimicrobial stewardship.

Introduction Severe asthma is a rare disease in children, for which three biologicals, anti-immunoglobulin E, anti-interleukin-5 and anti-IL4RA antibodies, are available in European countries. While global guidelines exist on who should receive biologicals, knowledge is lacking on how those guidelines are implemented in real life and which unmet needs exist in the field. In this survey, we aimed to investigate the status quo and identify open questions in biological therapy of childhood asthma across Europe. Methods Structured interviews regarding experience with biologicals, regulations on access to the different treatment options, drug selection, therapy success and discontinuation of therapy were performed. Content analysis was used to analyse data. Results We interviewed 37 experts from 25 European countries and Turkey and found a considerable range in the number of children treated with biologicals per centre. All participating countries provide public access to at least one biological. Most countries allow different medical disciplines to prescribe biologicals to children with asthma, and only a few restrict therapy to specialised centres. We observed significant variation in the time point at which treatment success is assessed, in therapy duration and in the success rate of discontinuation. Most participating centres intend to apply a personalised medicine approach in the future to match patients a priori to available biologicals. Conclusion Substantial differences exist in the management of childhood severe asthma across Europe, and the need for further studies on biomarkers supporting selection of biologicals, on criteria to assess therapy response and on how/when to end therapy in stable patients is evident.

The COVID-19 pandemic, through the restrictions and the non-pharmaceutical interventions implemented, has importantly impacted the circulation and epidemiology of respiratory viruses. Specifically, the 2020/21 season was entirely dominated by SARS-CoV-2, while influenza activity reached an all-time low, despite initial warnings that a double concurrent epidemic could be possible. The current season, 2021/22, started with the shift of circulating SARS-CoV-2 variants from delta to omicron, which then rapidly spread globally, as most countries, including Romania, removed all restrictions and compulsory non-pharmaceutical interventions. In this report we present the clinical reality observed in March 2022 in a tertiary paediatric hospital in Bucharest, Romania, where we observed a sudden surge in influenza cases, after two consecutive years (March 2020 to March 2022) when influenza had stopped circulating in our country. Thus, in March 2022 the positivity rate of rapid influenza antigen tests unexpectedly increased to 33.5%, paralleled by a decrease to 7.5% in the positivity rate of rapid SARS-CoV-2 antigen tests. This significant increase in the influenza attack rate was observed from the first week (14.9% positivity rate), through the fourth week of March (42.1% positivity rate, p < 0.001), while the COVID-19 attack rate displayed a significant decreasing trend (from 11.2% to 4.8%, p < 0.001). These data serve as a warning about relaxing restrictions in a precipitous approach with minimised vigilance. The evolution of these observations needs to be followed very carefully in all countries, particularly in settings where epidemiological interactions and non-pharmaceutical interventions have so far led to the extensive circulation of only one of these viruses, and we should now be prepared to perform a correct differential diagnosis between influenza and COVID-19, in order to ensure the best quality of care and personalized management of each case of respiratory infection. The results of active influenza surveillance studies for the whole 2021/22 season are awaited, in order to quantify the joint influenza—COVID-19 burden among children.

The COVID-19 pandemic has had a significant impact on the pediatric population, particularly on their access to health services. We conducted a retrospective study to assess the influence that the pandemic, and its related containment and mitigation public health measures, had on pediatric emergencies and hospitalizations in a major tertiary pediatric hospital in Bucharest, Romania, during the first six months of the pandemic, March–August 2020, compared to the same period in 2019. In these first 6 months of the COVID-19 pandemic, the number of pediatric emergencies decreased 2.8-fold compared to the same period in 2019, but the proportion of major emergencies increased significantly (p < 0.001). The number of admissions also decreased 3.3-fold in 2020, compared to 2019, but the risk of admission for lower respiratory tract infections and respiratory failure increased 1.3- and 2.3-fold, respectively. In conclusion, the restrictions imposed by the pandemic containment and mitigation plan not only had a significant impact on reducing emergency department presentations, but also on pediatric admissions in Romania. These data highlight the importance of maintaining optimal access to child health services when confronted with a public health threat, such as the COVID-19 pandemic. Active communication with parents, involving general practitioners, pediatricians, and authorities, is essential for managing children with acute signs of illness in the case of future restrictions or lockdown measures.

Vaccination is one of the most useful medical interventions for controlling certain infectious diseases. The aim of current research is to identify some of the drivers of vaccine hesitancy or acceptance in a rather skeptical European population by addressing parental perception on optional vaccination (OV) perception. Novel tools, delivered by social media, were used in our research attempt. A validated questionnaire was distributed online among parents. Parental knowledge, attitudes and perceptions of OV were analyzed. The majority of parent respondents (55.1%) showed very good knowledge about vaccination and vaccine-preventable diseases, and 76.0% stated that they had given at least one optional vaccine to at least one of their children. The most common optional vaccine administered was the rotavirus vaccine. The level of knowledge appeared to be related to compliance with OV. Concurrently, the rate of vaccine acceptance in the NIP (National Immunization Program) was not correlated with the level of parental knowledge. In total, a high percentage of parents (77.6%) believed that OV can bring an additional health safety benefit to their children. This study shows the need to involve the medical community in a steady dialogue with parents about OV. Raising awareness by presenting clear and understandable information could be a game-changing intervention in mitigating the public health impact of OV-preventable diseases.

Patients with chronic lung conditions, including cystic fibrosis, may be prone to severe COVID-19. Therefore, therapeutic intervention should be prompt and tailored to all associated comorbidities. We report the case of a 17-year-old male adolescent with cystic fibrosis and multiple chronic conditions (bronchiectasis, exocrine pancreatic insufficiency, chronic multidrug resistant Pseudomonas aeruginosa colonization, nasal polyposis, chronic sinusitis, ventricular extrasystoles and multiple drug allergies), who presented with an acute episode of productive cough, and was confirmed with moderate COVID-19 based on positive RT-PCR for SARS-CoV-2 and lung imaging showing isolated foci of interstitial pneumonia. Intravenous treatment with the monoclonal antibody cocktail casirivimab and imdevimab was administered. The evolution was favorable, with rapid remission of the inflammatory syndrome and gradual decrease of cough, without progression to severe or critical COVID-19, but with complications such as repeated hemoptysis, which was due to the patient’s underlying conditions, and which required close monitoring for timely adjustment of the patient’s chronic treatment.

Introduction. Community acquired pneumonia is a common disease that accounts for 16% of all deaths in children aged 5 years or younger. The purpose of the study was to identify potential modifiable factors in relation with parental perception of pneumonia management in children. Outlining such factors would allow development of approaches in order to reduce pneumonia-associated morbidity. Methods. A cross-sectional study was conducted between 25th and 27th August 2016. It consisted in distributing a Google Form to parents of children aged between 4 months and 5 years via online social platforms. The questionnaire was structured in 5 sections with 26 questions. Data collection and statistical analysis were done using Microsoft Office Excel Worksheet. Results. 1083 parental answers were received and analyzed. Regarding vaccinal status we received following data: 973 (89.8%) children were vaccinated according to Romanian Ministry of Health Schedule and 90 children are incompletely vaccinated or unvaccinated. 378 children were never breastfed or exclusively breastfed for less than 4 months. 32% (352) were complementary fed before the age of 4 months and 19% (201) after 6 months. 46.91% (508) of children had experienced in the past Acute Respiratory Tract Infections and 42.41% (215) of them were admitted. The most frequent two symptoms that would cause parents to generate an unscheduled ED visit were fever [in 47.83% (518)] and cough [in 19.58% (212)]. 38.87% (421) of respondents gave their child medication without physician’s advice and 61.3% (358) used analgesics and antipyretics. Pneumonia has been recognized as a serious illness, potentially life threatening, by 69.07% (748) of parents. Discussion. There is evidence of correlation between morbidity and mortality in childhood pneumonia and parental educational and socio-economic status. Aim of our study was to explore other factors that impact parental perception, in this era of significant changes in social behavior and communication. Conclussion. The decrease in the vaccine coverage rate in Romania (89% in this group selected by patients with access to Social Media) led to a decrease below the threshold for maintaining herd immunity. Romanian parents responding to this questionnaire achived a good score in symptom recognition and severity assessment of pneumonia. A large number of respondents surveyed in a short time is an indicator of parental desire to be informed and involved in deccision-making. This recent change in parental behavior in our country could generate alternatives to existing educational strategies. Developing medical information platforms for Social Media, translated in local language, could impact parental perception and child pneumonia morbidity in our country.

Introducere. Pneumonia comunitară este foarte frecventă şi este responsabilă de 16% dintre decesele la copiii cu vârstă de pană la 5 ani. Scopul prezentului studiu a fost să identifice potenţiali factori modificabili/influenţabili în legătură cu percepţia parentală privind managementul pneumoniei la copil. Conturarea unor astfel de factori ar permite elaborarea unor strategii de scădere a morbidităţii asociate pneumoniei în România. Materiale şi metode. A fost realizat un studiu transversal în perioada 25.08.2016 – 27.08.2016 ce a constat în distribuirea la nivelul platformelor de socializare a unui formular de tip Google Form pentru părinţii copiilor cu vârstă între 4 luni şi 5 ani. Chestionarul a cuprins 26 întrebări distribuite în 5 secţiuni. Colectarea datelor şi analiza statistică a fost realizată prin intermediul Microsoft Office Excel Worksheet. Rezultate. Au răspuns 1.083 de părinţi. La întrebarea privind statusul vaccinal am primit următoarele răspunsuri: 973 de copii sunt vaccinaţi (89.8%) conform Schemei Ministerului Sănătăţii şi 90 sunt vaccinaţi incomplet sau nevaccinaţi. 378 de copii au fost alimentaţi natural mai puţin de 4 luni sau niciodată. 32% (352) au diversificat la o vârstă mai mică de 4 luni şi 19% (201) după 6 luni. 46,91% (508) din copii au avut infecţii acute de căi respiratorii şi 42,41% (215) dintre aceştia au avut nevoie de internare. Pe primele două poziţii ale simptomelor care i-ar determina să se prezinte cu copilul la medic se află febra 47,83% (518) şi tusea 19,58% (212). 38,87% (421) dintre respondenţi au administrat medicamente fără a cere sfatul unui medic, iar 61,3% (358) din respondenţi administrat analgezice şi antipiretice. Pneumonia a fost recunoscută drept o boală gravă care poate determina uneori deces de către 69,07% (748) dintre respondenţi. Discuţii. Deoarece în literatură există dovezi ale unei corelaţii a morbidităţii şi mortalităţii în pneumonia copilului mic cu statusul socio-economic şi cu cel educaţional familial, am dorit să explorăm şi alţi factori potenţial incriminabili, în această epocă de semnificative modificări de percepţie parentală şi de comportament social sau de comunicare. Concluzii. Scăderea ratei de acoperire vaccinală în România (89% la acest grup selectat de pacienţi cu acces la Social Media) a dus la coborârea sub pragul la care se menţine imunitatea de grup. Părinţii din România care au răspuns la chestionar au obţinut un scor bun la recunoaşterea simptomelor şi aprecierea gravităţii pneumoniei. Numărul mare de respondenţi incluşi în studiu într-un timp scurt este un indicator al dorinţei părinţilor de a se informa. Această schimbare de comportament a noii generaţii de părinţi din ţara noastră ar putea genera alternative la strategiile educaţionale existente. Elaborarea unor surse Social Media de informaţii medicale în limba romană precum şi îndrumarea părinţilor către acestea ar putea duce la îmbunătăţirea calităţii informaţiilor deţinute de părinţi.

Introduction: The most common clinical manifestation of mango allergy is contact dermatitis, which can be localized or systemic. The sensitising substances that have long been suspected are alk(en)yl catechols and/or alk(en)yl resorcinols. Methods: We reviewed the original articles published on Pubmed, Embase and Cochrane Library before 15 September 2021, on the topic of contact allergy induced by mango and we synthesized the key data. Results: We found 12 case reports and four case series, with a total of 37 patients. Only seven of these cases were reported in patients from mango-cultivating countries, the other 30 were from countries where mango cultivation does not occur, and 26 were also from countries where poison ivy/oak are commonly found. We found that contact dermatitis may occur on the first exposure to mango due to previous sensitisation to urushiol-containing plants. The diagnosis was confirmed by patch testing in some of the cases. There was great heterogeneity between the reagents used. Conclusion: Mango fruit is frequently consumed, but mango induced contact dermatitis, the main hypersensitivity reaction induced by mango, is rare. Further data is necessary for a better understanding of sensitising substances and, consecutively, standardization of patch test reagents.

Introducere şi scopul studiului. În ultimii ani, se înregistrează in România o creştere impresionantă a numărului de copii care beneficiază de administrarea medicaţiei pe cale inhalatorie. Acest fenomen a apărut în condiţiile modificării comportamentului general de informare, cu deplasarea centrului de greutate către mediul online. Autorii doresc să analizeze comportamentul actual al părinţilor şi medicilor români în ceea ce priveşte administrarea medicaţiei inhalatorii. Materiale şi metodă. Pentru prezentul studiu au fost utilizate două chestionare online distribuite într-un grup naţional reprezentativ de părinţi români (Spitalul Virtual de Copii), care are peste 60.000 de urmăritori. Rezultate. Chestionarele au avut peste 4.000 de respondenţi, atât părinţi, cât şi medici. 94,4% au confirmat utilizarea medicaţiei inhalatorii la copil. Particular este aspectul utilizării dexametazonei din fiola de uz injectabil pentru nebulizare umedă în 67,8% dintre cazuri. Iar 7% precizează că, deşi le-a fost recomandată dexametazona în scopul nebulizării, aceştia nu au utilizat-o. Concluzii. După ştiinţa autorilor, acesta este primul articol din România care se adresează utilizării off-label a dexametazonei sub forma nebulizată. Aproape toti copiii din Romania primesc medicaţie inhalatorie, iar calea nebulizării este percepută de părinţi ca un tratament de scurtă durată şi care poate utiliza aproape orice fel de soluţie fluidă. 75% dintre copiii români care au făcut nebulizări au primit recomandare medicală pentru administrarea off-label a dexametazonei.

Background and aim. In the last decade a significant increase of nebulized medication usage has been documented in Romania. Authors are aiming to describe parental and physician’s change of perspective regarding nebulized medication in the new era of online communication and education. Material and methods. Two different questionnaires were posted in a large and representative group (more than 60,000 followers) of Romanian parents and physicians, Virtual Children’s Hospital („Spitalul Virtual de Copii”). Results. More than 4,000 answers were submitted. 94.4% responders confirmed using at least once wetnebulized medication in children. A particular aspect documented was dexamethasone off-label usage via nebulizer in 67.8% children. Additional 7% of responders confirmed that they received an indication to nebulize a normal saline suspension with dexamethasone phosphate for parenteral usage, but they didn’t follow the indication and used an approved treatment. Conclusions. Upon our knowledge this is the first large study on nebulized dexamethasone in Romanian literature. 95% of Romanian children receive nebulized medication. Nebulizer is regarded by parents as a simple and friendly tool that can solve virtually all issues related to airway diseases in our country. 75% of children that received nebulized medication had a prescription for off-label use of dexamethasone.

Little is known about the incidence and dynamics of occult bacteremia (OB) among infants/young children following the introduction of pneumococcal conjugate vaccines (PCVs) into the national immunization program in Israel in 2009–2010. The aim of this study was to characterize the epidemiologic and microbiologic picture of OB among febrile infants/children aged 3–36 months in southern Israel, before and after PCVs introduction. Methods: Retrospective study enrolling all infants/young children attending the emergency room of a tertiary medical center in southern Israel with fever without source, discharged, and reported with a positive blood culture. Results: Of 453 true bacteremias, 89 (19.6%) were defined as OB. OB rate was 0.22%; a significant decrease was recorded in OB rates, with the highest rate during 2005 (0.34%) and the lowest during 2011 (0.15%). OB cases decreased in post-PCV (2010–2012) versus prevaccination period (2005–2009) from 66/22,256 cases (0.3%) to 23/13,213 cases (0.17%; p = 0.03). Most frequent single OB pathogens were Streptococcus pneumoniae, Streptococcus viridans spp., and Kingella kingae (39.3%, 10.1%, and 9.0%, respectively); Enterobacteriaceae spp. were isolated in 10 cases (11.2%). No changes were recorded in S. pneumoniae-OB cases; K. kingae-OB decreased significantly (p = 0.047). None of the S. pneumoniae serotypes isolated during 2011–2012 belonged to 13-valent PCV (PCV13). An increase in non PCV13 serotypes was recorded during 2011–2012 (3/3, 100% vs. 7/32, 21.9%, p = 0.01). Conclusion: OB rates decreased significantly following the introduction of PCVs. S. pneumoniae was the most frequent isolated pathogen in OB, but in lower percentages compared with the medical literature. No PCV13 serotypes were detected as a cause of OB during 2011–2012.