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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]

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]

Pulmonary abscess or lung abscess is a lung infection which destroys the lung parenchyma leading to cavitations and central necrosis in localised areas formed by thick-walled purulent material. It can be primary or secondary. Lung abscesses can occur at any age, but it seems that paediatric pulmonary abscess morbidity is lower than in adults. We present the case of a one year and 5-month-old male child admitted to our clinic for fever, loss of appetite and an overall altered general status. Laboratory tests revealed elevated inflammatory biomarkers, leukocytosis with neutrophilia, anaemia, thrombocytosis, low serum iron concentration and increased lactate dehydrogenase level. Despite wide-spectrum antibiotic therapy, the patient’s progress remained poor after seven days of treatment and a CT scan established the diagnosis of a large lung abscess. Despite changing the antibiotic therapy, surgical intervention was eventually needed. There was a slow but steady improvment and eventually, the patient was discharged after approximately five weeks.

Helicobacter pylori and Giardia lamblia are common worldwide. Helicobacter pylori is a favoring factor for the presence of Giardia lamblia in the stomach due to the neutralization of the gastric pH through the secretion of urease. We present the case of a 5-year-old child, with intermittent gastro-intestinal symptoms in the recent personal pathological history, admitted in the Pediatrics Clinic 1 Târgu Mureș for abdominal pain, nausea, loss of appetite and hematemesis. The superior digestive endoscopy revealed multiple hemorrhagic lesions of the gastric mucosa, and the pathological exam of the antral gastric mucosa identified the coexistence of Helicobacter pylori and Giardia lamblia. The evolution of the patient was favorable under the eradication therapy of the infection with Helicobacter pylori and the antiparasitic drugs, the control endoscopy revealing a gastric mucosa without macroscopically obvious modifications, and the pathological re-evaluation pointed out regenerative modifications of the gastric mucosa. The particularity of the case is represented by the identification of the parasite Giardia lamblia in the gastric mucosa, a physiologically acid environment, alkalinized by the urease secreted by Helicobacter pylori, therefore providing favorable conditions for the development of this parasite in a 5-year-old child, from a favorable socio-economic environment, with intermittent gastrointestinal symptoms in his recent personal pathological history.

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

Objectives. Approaching acute diarrheal disease (ADD) in pediatric patient, we have set as a primary objective a throughout evaluation of etiology and risk factors and, on the other hand the risk/benefit assessment regarding the justification of antibiotic therapy in the treatment of ADD in pediatric patient. Material and method. We performed an analytic, descriptive study, in which we included 125 patients admitted in the 1st Pediatrics Clinic of Tg. Mureș during 2016 (January to December), diagnosed with ADD. Results. The study group comprised 125 patients, out of which a bacterial etiology was noticed in 23 cases (18.4%). On the other hand, it was observed that 84 patients received antibiotics (67.2%), 110 patients (88%) received symptomatic treatment, and in 60% of the cases (75 patients), a probiotic was associated. The medium hospitalization length was of 5 days, depending on the presence/absence of risk factors such as fever, inflammatory syndrome, hydro-electrolytical imbalances or acute dehydration syndrome, risk factors that increased the medium hospitalization length with up to 2 days (p < 0.05). Conclusions. Antibiotics must be used rationally and justified in the treatment of ADD, analyzing carefully the risk/benefit ratio. Taking into account the self-limiting character and the favorable prognosis of this disorder, we conclude that we face an abuse of antibiotics in case of pediatric patients diagnosed with ADD. [ABSTRACT FROM AUTHOR]

Inferior vena cava (IVC) agenesis is an extremely rare malformation, most times diagnosed randomly, representing an important risk factor in the development of spontaneous deep venous thrombosis (DVT) in children and young adults. We present the case of an 8-year-old male child admitted in our clinic for the following complains: right lumbar pain with paravertebral irradiation. The personal pathological history revealed a recent appendectomy. At the time of admission, an abdominal ultrasound was performed which revealed right nephromegaly, and also raised the suspicion of IVC agenesis. We performed a thoraco-abdominal angio-CT exam with contrast enhancement which confirmed the diagnosis of IVC agenesis and right common iliac vein, venous thrombosis of the right external iliac vein, right common femoral vein and right superficial femoral vein. We excluded a potential antiphospholipid syndrome or a thrombophilia, and the genetic tests ruled out the possibility of a family predisposition. We initiated anticoagulant therapy with close monitoring of the coagulation parameters, the evolution being favorable. Despite the very low frequency of this malformation, the early and correct diagnosis is essential for these patients' management and prognosis. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux (GER) represents the involuntary passage of the gastric contents into the esophagus and is one of the most common symptoms in both children and adults. The symptoms vary very much and the severe complications are rather uncommon in children nowadays due to a widely available treatment. We present the case a 12-year-old male patient, admitted in our clinic for morning vomiting after meals, with abundant mucus, dysphagia for solid food, epigastric pain, food refusal, nocturnal agitation associated with sleep disorders for approximately 1 month, and weight loss (2-3 kg in the last 6 months), whose personal history revealed multiple acute upper airways infections during the first year of life and gastroesophageal reflux diagnosed approximately at the age of 1 year, which improved without treatment until the age of 3 years. The esophagogastroduodenoscopy and barium transit exam established the diagnosis of esophageal stenosis and gastroesophageal reflux with favorable evolution after a prolonged treatment with proton pump inhibitors. The particularity of the case consists in diagnosing a peptic esophageal stenosis in a 12-year-old child, with onset of symptoms approximately 1 month ago, whose personal history revealed multiple acute upper airways infections during the first year of life and gastroesophageal reflux at 1 year of age which apparently solved without treatment until the age of 3 years. [ABSTRACT FROM AUTHOR]

Pneumonia represents an inflammation of the pulmonary parenchyma that despite the multiple antibiotic classes available and despite the medical progresses, still leads to an increased mortality rate, especially in children. Deltfia acidovorans and Stenotrophomonas maltophilia are Gram-negative bacilli that can lead to respiratory infections. We present the case of a 2 years and 3-month old male patient, admitted in our clinic for the following reasons: productive cough, fever and loss of appetite. Based on the clinical exam, laboratory and paraclinical investigations, we established the diagnosis of right pneumonia associated with pleural effusion and we administered wide spectrum antibiotics. Nevertheless, the evolution was unfavorable, needing pleurotomy and drainage. From the pleural fluid, there were isolated two strains of bacteria, Delftia acidovorans and Stenotrophomonas maltophilia. We adjusted the antibiotic regimen according to antibiogram, with afterwards slowly favorable evolution. The particularity of the case consists in diagnosing a pneumonia with pleural effusion in a 2 years and 3-month-old child, without risk factors, who needed pleurotomy with thoracic drainage, in whom the pleural fluid revealed 2 germs usually encountered in immunocompromised individuals, with favorable evolution after the initiation of antibiotics regimen according to the antibiogram. [ABSTRACT FROM AUTHOR]

Introduction: The increased frequency of functional constipation (FC) in pediatric ages makes it one of the most frequent reasons for pediatrician referral. The management of this pathology involves multiple therapeutic options. Material and method: Multiple studies focused on identifying the optimal therapeutic option in children's FC. Results: In case of children, FC reaches a prevalence of 14%, with a peak of incidence at the time of acquiring the toilet defecation reflex. There are no differences between genders regarding FC. Nevertheless, it seems that fecal incontinence is most frequent in males comparatively to females. Constipation leads to the accumulation of stools into the rectum resulting in fecal incontinence by overfilling. In time, the child loses the rectal sensation and the normal need of defecation. All these will lead to the decrease of bowel motility, anorexia, abdominal distension and pain, thus creating a vicious circle. In case of every child that presents constipation, the presence of alarming signs may indicate an organic pathology. The brain-gut tract own a major role in the development of functional abdominal pathologies. The management of FC consists in education, diet, the elimination of stressful factors and pharmacological therapy. The studies proved that education has the same importance and pharmacological therapy. The prognosis is burdened by uncertainty because only 50% of the children present long-term favorable outcome and can cease the laxative therapy. Conclusions: FC presents both medical and psychological implications. The proper management leads to a long-term favorable outcome only in a half of patients with FC. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis of neoplasia is very important to be established as soon as possible because the early diagnosis improves considerably the prognosis. The clinical and biological data are sometimes suggestive for the diagnosis, but other times are inconclusive. Material and method: Ultrasonography is the one that may often offer the key for the diagnosis, or requires complementary imagistic tools, being the first choice among the imagistic methods in child's malignancies. Results: Ultrasound allows: the classification of tumors into solid or cystic, establishing the benign or malignant character, organ origin, the presence/absence of Doppler flow with the assessment of neoformation vessels, the dynamic monitoring of this tumors under treatment. Among the most frequent tumors that can be diagnosed in child using ultrasonography, we mention hemangioendothelioma, hepatoblastoma, hepatic metastases, Hodgkin and non-Hodgkin lymphomas, neuroblastoma, nephroblastoma, but also more rare tumors such as teratoma, sarcoma or ovarian ones. Elastography and contrast-enhanced ultrasound may bring real benefits in differentiating benign tumors from the malignant ones. Contrast-enhanced ultrasound along with 2B ultrasound represent two useful methods in characterizing tumors. Conclusions:Ultrasonography has an essential role in the fast and accurate diagnosis, but also in what concerns the possibility of monitoring the evolution of child's cancer under treatment. [ABSTRACT FROM AUTHOR]

Background. Obesity associates multiple complications, as consequence of chronic inflammation and insulin-resistance, changes induced by adipocytes products. Aim. Determination of serum-levels of inflammation adipokines in obese children and assessment of their relationship with anthropometric and biochemical parameters. Methods. prospective study including 110 obese children assessed between 1 October 2010-1 March 2013. We determined the leptin levels, adiponectin, interleukins (IL6-8), looking for their correlations with anthropometric and metabolic parameters. Results. Leptin was 16.79±1.39ng/ml in obese, higher than in control-group (2.78 ± 0.43 ng/ml), while adiponectin was 14871.07 ± 713.17 ng/ml in controls and 9883.49 ± 562.54 ng/ml in obese, with statistically significant differences (p < 0.0001 for both). IL6 and IL8 were also higher in obese group. There were significant correlations between the adipokines and anthropometric indices. Dyslipidemia was found in 20% of obese, 8.18% with increased LDLCholesterol, 26.36% hypertriglyceridemia and 9.09% low HDL-Cholesterol. Conclusions. inflammatory adipokines are elevated in obese children, correlated with dyslipidemia, and adiponectin decreases, suggesting that marked adiposity in children also can play a role in the pathogenesis of complications. [ABSTRACT FROM AUTHOR]