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Background/Objectives: Viral gastroenteritis can have a potentially fatal outcome at young ages and the recognition of severe cases could be aided by clinically derived severity scores. Methods: This observational study intended to conduct a comparative assessment of the utility of the Vesikari and modified Vesikari score in the evaluation of viral gastroenteritis severity and for the possible prediction of the dehydration degree. A total number of 113 children diagnosed with gastroenteritis were retrospectively enrolled and divided based on viral etiology into group 1 (34 children with unknown viral etiology), group 2 (60 children with rotavirus) and group 3 (19 children with adenovirus). Results: The highest mean Vesikari and modified Vesikari scores were found in group 2 (p < 0.01; p = 0.01). A significant increase in liver enzymes was also identified in patients infected with rotavirus. The highest mean diarrhea, vomiting duration and body temperature were found in group 3 (p < 0.01; p < 0.01; p = 0.02), as well as the highest mean inflammatory markers, such as C-reactive protein (CRP; p = 0.01) and the erythrocyte sedimentation rate (p < 0.01). Significant linear associations were found between pH, bicarbonate level, base excess and the Vesikari scores, whereas urea, CRP and aspartate aminotransferase levels were associated with both severity scores. ROC curve analysis revealed a significant correlation between the Vesikari scores and dehydration degree (p < 0.01), with numeric cut-off values of 11.5 being proposed for the differentiation between mild and moderate gastroenteritis and 13.5 for the distinction between moderate and severe gastroenteritis. Conclusions: Both severity scores are useful in clinical settings, but more studies enrolling populations with various enteral infections could provide more insight into their etiology-based performance and reflection of paraclinical changes. [ABSTRACT FROM AUTHOR]

The gut microbiome is essential for children's normal growth and development, with its formation aligning closely with key stages of growth. Factors like birth method, feeding practices, and antibiotic exposure significantly shape the composition and functionality of the infant gut microbiome. Small intestinal bacterial overgrowth (SIBO) involves an abnormal increase in bacteria within the small intestine. This overgrowth can interfere with digestion, impair nutrient absorption, and lead to both local and systemic inflammation, potentially contributing to malnutrition. In this review, we provide a comprehensive overview of the current understanding of the relationship between SIBO and malnutrition, with a particular focus on the pediatric population. SIBO seems to play an important role in nutrient malabsorption through the gut microbiome imbalance, local inflammation, and disruption of the mucosal intestinal barrier. Additionally, SIBO is more prevalent in digestive disorders linked to malabsorption and malnutrition. Different therapeutic strategies for addressing malnutrition-related SIBO have been proposed. While antibiotics are the primary treatment for SIBO, their effectiveness in promoting weight gain among malnourished children remains uncertain. Hence, future research directed at the impact of microbiome imbalance on nutrient intake and absorption could bring to light new strategies for the effective prevention and treatment of malnutrition. [ABSTRACT FROM AUTHOR]

The medical world carries a major burden in terms of specialized human resource and infrastructure. The recent COVID-19 pandemics revealed an urgent need for specialized medical professionals in order to preempt future natural disasters. The aim of this review was to underline the best teaching model for training specialist nurses. Thus, the healthcare systems should work along with national agencies for designing and implementing complex curricula for training specialists in providing healthcare such as specialist nurses or advanced practice nurses involved in the decision-making process. The educational process for these nurses should be based on an international standard involving digital education techniques such as e-learning platform, interactive approaches of the course content, as well as an interactive teaching system based on figures, graphics or videos. Moreover, virtual reality based-medical models should also represent an important aspect of the training program in order to provide the future students with the opportunity to deal with real-life medical situations in advance. These techniques will form the basis of the specialist nurses’ up-skilling process resulting in crucial life savior medical competences. The trainers should embrace their new roles in the educational process being aware that the nowadays teaching concept is no longer based on a governance approach, but they should rather mediate, guide and organize the educational process becoming shadow partners of their students in achieving the desired skills. The assessment of the students should also comply to the digitalization process by including novel evaluation techniques such as quizzes, individual and team assignments, objective structured clinical examination in order to objectively mirror the student’s progress during the training program. Therefore, this review synthetized current insights in learning and training techniques that should be implemented for addressing the needs of innovation in medical education. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This document is an editorial introducing a special issue titled "Multidisciplinarity and Transdisciplinarity in the Diagnosis and Treatment of Pediatric Gastrointestinal Diseases." The field of pediatric gastroenterology has seen significant development in recent years, with advancements in diagnostic and therapeutic techniques. The special issue aims to provide new insights into pediatric gastrointestinal diseases, covering a wide range of conditions such as celiac disease, inflammatory bowel disease, and food allergies. The issue also highlights the importance of multidisciplinary teams in managing these diseases. The editorial emphasizes the need for accurate diagnosis and management to improve patient care and reduce healthcare costs. It discusses specific challenges in pediatric gastrointestinal diseases, including gastroesophageal reflux disease, eosinophilic esophagitis, Helicobacter pylori infection, cystic fibrosis, and inflammatory bowel disease. The document concludes by stating that the articles in the special issue contribute to the progress in the field and provide valuable information for clinicians and researchers. [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 widespectrum 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Gastritis is a condition marked by inflammation of the gastric mucosa, can arise from various sources, including infection with due H.Pylori bacteria (a prevalent cause) or the usage of other factors as: medications such as NSAIDs or corticosteroides, excessive alcohol intake, stress or autoimmune factors. Objective: The aim of the study is to assess the differences concerning the symptoms, paraclinical parameteres of hemograms (hemoglobin, neutrophils, lymphocytes, platelets) and histopatological changes between H.Pylori gastritis and Non-H.Pylori gastritis. Material and methods: We performed a retrospective study on 163 patients aged between 3 to 18 years, hospitalized in the Pediatric Clinic I Târgu-Mureş diagnosed with Gastritis between 01.01.2019 and 01.01.2024. The children were divided into 2 groups: H.Pylori group and Non-H.Pylori group. An upper digestive endoscopy with gastric biopsies and a complete blood count was performed in each case. Results : The most frequently affected age group was the category between 14-18 years (58%) and the least frequently involved were children between 3-5 years (3%), additionally the majority of pacients were women (63%). Children from rural areas were the most frequent patients in the total group (52%). The epigastric pain (p=0,0457) was significantly associed with H.Pylori group. Pacients in the Non-H.Pylori group had diffuse abdominal pain at the level of the right hypochondrium, the entire upper abdominal floor or periumbilical (48%). Futhermore, we underscored a statistically significant difference in the duration of hospitalization (p=0,0054) and incidence of emesis (p=0,0253) in the Non-H.Pylori group. In the group with H.Pylori, the most frequent endoscopic appearance was a congested, edematous gastric mucosa type, with a predominantly antral nodular/folicular appearance (n=54) and a histopathological appearance of an inflammatory infiltrate with polymorphonuclear neutrophils in the gastric submucosa (n=54). In the group with Non-H.Pylori, the most frequent endoscopic appearance was represented by hyperemic, edematous gastric mucosa (n=39) and a histopathological appearance of an inflammatory infiltrate with neutrophils and superficial erosions (n=40). We found no statistically significant differences regarding laboratory results between the two groups. Conclusions: According to the result, children's gastritis manifest itself with various clinical and pathological characteristics, influenced by factors such as: age, gender, geographic factors and etiological agents, such as H.Pylori that playing significant roles. Moreover, differences in clinical outcomes and histopathological characteristics between H.Pylori and Non-H.Pylori cases highlight the importance of accurate diagnosis and tailored management approaches. [ABSTRACT FROM AUTHOR]

Background: Abdominal pain is a commonly encountered issue in children and adolescents, often posing a diagnostic challenge due to the diverse range of potential underlying causes. Given its high prevalence, understanding these causes is essential for prompt diagnosis and appropriate management. Objective: The purpose of this study is to identify the primary etiologies of abdominal pain in the pediatric population, while stratifying them by age groups and the affected organ system. Additionally, the study aims to discern critical warning signs that may endanger the child's well-being. Material and methods: In this descriptive retrospective study, the observation records of 117 children admitted to the County Emergency Clinical Hospital of Târgu Mureş, on the pediatric ward, complaining of abdominal pain were evaluated. Demographic data, medical history, laboratory and paraclinical test results were collected and processed. Results: We categorized the participants into five age groups: newborns, <2 years, 2-5 years, 5-14 years, and 14-18 years. Among these, the 5-14 age group exhibited the highest prevalence of abdominal pain (47.01%, n=55). Females constituted the majority in our study population, including 61.54% (n=72) of the participants. Gastrointestinal etiologies emerged as the predominant cause of abdominal pain (71.79%, n=84), with gastritis being the most prevalent gastrointestinal condition observed (31%, n=26), followed by gastroenteritis (13%, n=11) and constipation (10%, n=8). Other etiologies for the pain that were observed were, in order of frequency: hepatobiliary and pancreatic (11.11%, n=13), genitourinary (5.98%, n=7), hematological, respiratory, and toxic causes. Conclusions: The study's findings underscored a notable incidence of abdominal pain in the 5-14 age bracket, primarily attributed to gastrointestinal disorders, with gastritis being particularly prominent. Additionally, the study revealed a predominance of female participants. Noteworthy was the presence of gastroenteritis and constipation as significant contributors to abdominal discomfort in pediatric patients. These insights emphasize the importance of thorough evaluation and management of abdominal pain in this demographic. [ABSTRACT FROM AUTHOR]