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Malabsorption syndrome encompasses a variety of gastrointestinal disorders that impair nutrient absorption in children, presenting wide range of clinical manifestations. This study focused on characteristics of the clinical manifestations and underlying etiologies of malabsorption syndrome in pediatrics population. Material and methods: A prospective cohort study was conducted involving 29 children presenting with symptoms suggestive of malabsorption syndrome. Clinical data, including symptoms, growth parameters, and nutritional status, laboratory both at the time of admitting and during treatment were collected. Diagnostic investigations included serological tests, stool analysis, imaging studies, and histopathological examination. Results: The most frequent clinical manifestations were abdominal symptoms (85%), respiratory infections (65 %), anemia (45 %) and vitamin deficiencies (58%). Celiac disease (51%), cystic fibrosis (32%), and Cow’s milk protein allergy (17%) were the leading causes. Conclusions: Serological tests are important for celiac disease diagnosis, while stool analysis is used to identifying lactose intolerance and infections. Diarrhea and weight loss are prevalent clinical manifestations of pediatric malabsorption syndrome.

Diarrhea is a leading cause of illness and death in children under five years old. Severe cases of diarrhea, particularly those resulting in dehydration, are a major factor in high mortality rates. Rotavirus is a significant pathogen contributing to dehydrating diarrhea and hospitalizations in children under five. The aim of this study was to investigate the role of vaccination in preventing the progression of gastroenteritis, with a focus on rotavirus-induced gastroenteritis. Material and methods: The present study was conducted within the Pediatric Department of The Emergency Clinical Hospital “St. Apostle Andrew” in Constanța, including 307 patients diagnosed with acute gastroenteritis during the period of January 1 and December 31, 2023. Results: The prevalence declined with age: 183 infants, 67 patients were between 1 and 3 years old, 42 were aged 3 to 7, and the smallest group, 15 patients, were between 7 and 16 years old, and 201 of the 307 children did not receive the Rotarix or Rotateq vaccines, while 106 patients completed the full vaccination regimen. As for the etiology of the disease, 160 patients were diagnosed with acute viral enterocolitis, with 142 cases attributed to Rotavirus. An increase in dehydration and electrolyte imbalances was observed in subjects who had not received the preventive Rotavirus vaccine. Conclusion: The role of the vaccine in preventing the severe progression of gastroenteritis, particularly that caused by Rotavirus, is highlighted by the reduced frequency of dehydration, electrolyte imbalances, and shorter hospital stays in patients who received the Rotarix/Rotateq vaccine.

Diabetes is a complex condition with a rising global incidence, and its impact is equally evident in pediatric practice. Regardless of whether we are dealing with type 1 or type 2 diabetes, the development of complications following the onset of the disease is inevitable. Consequently, contemporary medicine must concentrate on understanding the pathophysiological mechanisms driving systemic decline and on finding ways to address them. We are particularly interested in the effects of oxidative stress on target cells and organs, such as pancreatic islets, the retina, kidneys, and the neurological or cardiovascular systems. Our goal is to explore, using the latest data from international scientific databases, the relationship between oxidative stress and the development or persistence of systemic damage associated with diabetes in children. Additionally, we highlight the beneficial roles of antioxidants such as vitamins, minerals, polyphenols, and other bioactive molecules; in mitigating the pathogenic cascade, detailing how they intervene and their bioactive properties. As a result, our study provides a comprehensive exploration of the key aspects of the oxidative stress-antioxidants-pediatric diabetes triad, expanding understanding of their significance in various systemic diseases.

The autoimmune process that induces type 1 diabetes can also affect other organs, leading to the development of additional autoimmune diseases in patients, thus hindering diabetes control. The most common comorbidities include autoimmune thyroid diseases and celiac disease. Globally, this subject is increasingly drawing the attention of researchers, given the magnitude and severity of the association between autoimmune diseases and type 1 diabetes. The aim of the present study is to assess the prevalence of autoimmune diseases, with the primary focus on celiac disease, associated with type 1 diabetes in children and adolescents, as well as their impact on the progression of type 1 diabetes. Material and methods: The present study was conducted within the Pediatric Section, Pediatric Diabetology Department of the Emergency Clinical Hospital “St. Apostle Andrew” in Constanța, including 15 cases diagnosed with type 1 diabetes in children during the period 2017-2022. Results: The patients included in the study are aged between 1 and 13 years highlighting the age group of 3-6 years as the most commonly encountered. The most commonly encountered HbA1c values are in the range of 10-12%, accounting for 53% of the total, we can thus observe a prevalence of high and very high HbA1c values. In order to confirm the diagnosis of type 1 diabetes, specific antibodies were sampled, 97% of patients being tested positive for at least one antibody. Conclusions: The association between diabetes mellitus and another autoimmune disease is encountered at a relatively high percentage. Higher levels of HbA1c at the onset of type 1 diabetes have been associated with an increased risk of long-term complications.

The present treatments for bronchiectasis, which is defined by pathological dilatation of the airways, are confined to symptom relief and minimizing exacerbations. The condition is becoming more common worldwide. Since the disease’s pathophysiology is not entirely well understood, developing novel treatments is critically important. The interplay of chronic infection, inflammation, and compromised mucociliary clearance, which results in structural alterations and the emergence of new infection, is most likely responsible for the progression of bronchiectasis. Other than treating bronchiectasis caused by cystic fibrosis, there are no approved treatments. Understanding the involvement of the microbiome in this disease is crucial, the microbiome is defined as the collective genetic material of all bacteria in an environment. In clinical practice, bacteria in the lungs have been studied using cultures; however, in recent years, researchers use next-generation sequencing methods, such as 16S rRNA sequencing. Although the microbiome in bronchiectasis has not been entirely investigated, what is known about it suggests that Haemophilus, Pseudomonas and Streptococcus dominate the lung bacterial ecosystems, they present significant intraindividual stability and interindividual heterogeneity. Pseudomonas and Haemophilus-dominated microbiomes have been linked to more severe diseases and frequent exacerbations, however additional research is required to fully comprehend the role of microbiome in the evolution of bronchiectasis. This review discusses recent findings on the lung microbiota and its association with bronchiectasis.

Connective tissue represents the support matrix and the connection between tissues and organs. In its composition, collagen, the major structural protein, is the main component of the skin, bones, tendons and ligaments. Especially at the pediatric age, its damage in the context of pathologies such as systemic lupus erythematosus, scleroderma or dermatomyositis can have a significant negative impact on the development and optimal functioning of the body. The consequences can extend to various structures (e.g., joints, skin, eyes, lungs, heart, kidneys). Of these, we retain and reveal later in our manuscript, mainly the respiratory involvement. Manifested in various forms that can damage the chest wall, pleura, interstitium or vascularization, lung damage in pediatric systemic inflammatory diseases is underdeveloped in the literature compared to that described in adults. Under the threat of severe evolution, sometimes rapidly progressive and leading to death, it is necessary to increase the popularization of information aimed at physiopathological triggering and maintenance mechanisms, diagnostic means, and therapeutic directions among medical specialists. In addition, we emphasize the need for interdisciplinary collaboration, especially between pediatricians, rheumatologists, infectious disease specialists, pulmonologists, and immunologists. Through our narrative review we aimed to bring up to date, in a concise and easy to assimilate, general principles regarding the pulmonary impact of collagenoses using the most recent articles published in international libraries, duplicated by previous articles, of reference for the targeted pathologies.

Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations of the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR). In 1949, it's been identified as a monogenic disease and was thought to primarily affect individuals of Northern European descent. It was the most prevalent autosomal recessive disease that shortens life. With the availability of multiple testing methodologies nowadays, there is a chance to create novel and enhanced treatment options. Even in the absence of a high sweat chloride test (SCT) result, the discovery of two causal mutations is diagnostic for cystic fibrosis (CF). For a CF diagnosis, however, at least two positive E sweat chloride tests are still required. In order to achieve early and active intervention to manage cystic fibrosis (CF) and its comorbidities, treatment regimens for pediatric patients should be evaluated, improved, and closely monitored. New developments in the treatment of cystic fibrosis (CF) have led to the development of medications derived from molecules that target the pathogenetic pathway of the illness. These options are very efficient and allow pediatric patients to receive individualized care. However, in order to better direct patient care and enhance patient outcomes, it is crucial to research uncommon CF mutations, which can provide crucial information about the prognosis of the disease and the relationships between genotype and phenotype. To ensure the success of creating novel, safer, and more efficient treatment approaches, a deeper understanding of the pathogeny of the illness is required. In the age of customized medicine, genetic research will be essential to improving patient care and quality of life for those with uncommon mutations.

Exercise-induced bronchoconstriction (EIB) is a dysfunction of the respiratory tract consisting of transient airflow obstruction that occurs during or immediately after physical exercise, being the preferred term to define what was known for years as exercise-induced asthma. Symptoms develop when airways narrow as a result of physical activity. As many as 90 percent of people with asthma also have EIB, but not everyone with EIB has asthma. EIB is defined as the coexistence of at least two of the following symptoms: dyspnea, cough, wheezing, shortness of breath and chest pain, combined with the decrease of forced expiratory volume in one second (FEV1). Perception of these symptoms may restrain children’s ability and willingness to exercise. The pathophysiology of the process and the severity of bronchospasm depend on the level of ventilation, temperature and humidity of the inspired air. The mechanism is related to thermal hyperemia and congestion of small vessels in the bronchial wall. Most of the symptoms are non-specific, the differential diagnosis including chronic lung diseases and certain cardiovascular diseases or gastroesophageal reflux. For the diagnosis of this entity, a series of challenge tests can be used: at graded exercise, voluntary hyperpnea, methacholine, mannitol, hypertonic saline or histamine, FEV1 decreasing by 10-20% depending on the chosen test. Effective treatment includes preventive therapy – prior administration of a beta 2 agonist and/or antileukotriens, or regular CSI treatment in children with asthma that reduce the number of mast cells required for this type of response.

Vasculitis are disorders characterized by the presence of an inflammatory process in the blood vessel wall, resulting in damage or necroses of certain tissues or organs. Numerous clinical symptoms, ranging from acute localized hypersensitivity reactions to severe auto-immune systemic disorders that are incurable and life-threatening, can be attributed to the types and locations of affected arteries as well as the level of inflammation. Typical oral or facial symptoms of several forms of vasculitis can help in an early diagnosis of vasculitis. IgA vasculitis and Kawasaki disease (KD) are the two predominant types of pediatric vasculitis that involve the mouth, followed by ANCA vasculitis. Furthermore, SLE, a connective tissue disease, is one of the most prevalent autoimmune illnesses in children and can proceed rapidly across multiple organs or start mildly and gradually. Numerous more systemic conditions, such as infection, autoinflammatory disorders and neoplasia, can also primary or secondary localize in the oral cavity, infections being more frequent. Many various professionals, including dentists, family physicians, pediatricians, rheumatologists, hematologists, gastroenterologists, and otorhinolaryngologists, examine and treat children with oral symptoms. In 87.7% of patients overall and over 90% of patients with KD and IgA vasculitis (formerly known as Henoch-Schönlein purpura), cutaneous involvement was observed. Recurrent oral aphthous ulcers were present in all Behçet syndrome patients (1).

Being defined as an autoimmune, chronic pathology, frequently encountered in any age group, but especially in pediatrics, celiac disease (also called gluten enteropathy), is gaining more and more ground in terms of diagnosis, but also interest in research. The data from the literature of the last decades attest the chameleonic way of its presentation, there may be both classic onset symptoms and atypical symptoms. Given the impact played by celiac disease, especially in the optimal growth and development of children, the current narrative review aims to highlight the atypical presentation methods, intended to guide the clinician towards the inclusion of the pathology in the differential diagnosis scheme. To these we add the summary presentation of the general data and therapeutic lines regarding the underlying condition and the existing comorbidities. In order to place the related information up to date, we performed a literature review of the recent articles published in international databases. We bring forward the current theories and approaches regarding both classic celiac disease and its atypical manifestations. Among these we note mainly constitutional, skin or mucous, bone, neuro-psychic, renal, reproductive injuries, but also disorders of biological constants and association with multiple autoimmunities. Knowing and correlating them with celiac disease is the key to optimal management of patients, thus reducing the subsequent burden of the disease.

Celiac disease, firstly described in children, is a type of T-cell enteropathy that occurs in individuals genetically predisposed to gluten exposure. The estimated global prevalence of celiac disease is continuously increasing. Although, traditionally, celiac disease was diagnosed in children with failure to thrive and digestive issues, it is now recognized that may present with a wide range of symptoms beyond gastrointestinal ones. Celiac disease continues to pose significant challenges due to the continuous advancement of knowledge in understanding its pathophysiology, diagnosing the condition, managing its effects, and exploring potential therapeutic approaches. The prevalence of celiac disease is increased among individuals with chronic kidney disease, also. The most frequent associations are with diabetic nephropathy, IgA nephropathy and urolithiasis. A gut-kidney axis has been recognized to play a significant role in chronic kidney diseases. This literature review aims to review the chronic renal pathology associated with celiac disease, with emphasis on childhood.

This study explores the antibacterial efficacy and cytotoxicity of ciprofloxacin-functionalized bioceramic implants. We synthesized hydroxyapatite-ciprofloxacin (HACPXCS) composites and applied them to titanium substrates (Ti-HA-CPX), evaluating their performance in vitro against Staphylococcus aureus (ATCC 25923) and Escherichia coli (ATCC 25922). Antibacterial activity was assessed using the Kirby-Bauer disc diffusion method, while cytotoxicity was tested using mesenchymal stem cells. The results demonstrated that Ti-HA-CPX exhibited superior antibacterial activity, with inhibition zones of 33.5 mm (MIC 0.5 µg/mL) for Staphylococcus aureus (ATCC 25923) and 27.5 mm (MIC 0.25 µg/mL) for Escherichia coli (ATCC 25922). However, Ti-HA-CPX showed moderate cytotoxicity (80% cell viability). HACPXCS composites, whether chemically synthesized or mechanically mixed (HACPXMM), also displayed significant antibacterial activity, but with cytotoxicity ranging from low to moderate levels. Molecular docking studies confirmed strong binding affinities between ciprofloxacin and bacterial proteins, correlating with enhanced antibacterial efficacy. These findings suggest that Ti-HA-CPX composites offer a promising approach for single-stage surgical interventions in treating chronic osteomyelitis and infected fractures, balancing antibacterial effectiveness with manageable cytotoxicity.

Asthma and adolescence are two sensitive points and are difficult to manage when they coexist. The first is a chronic respiratory condition, with frequent onset in early childhood (between 3 and 5 years), which can improve or worsen with age. Adolescence is the period between childhood and adulthood (12–19 years), marked by various internal and external conflicts and a limited capacity to understand and accept any aspect that is delimited by the pattern of the social circle (of the entourage) frequented by the individual. Therefore, the clinician is faced with multiple attempts regarding the management of asthma encountered during the adolescent period, starting from the individualization of the therapy to the control of compliance (which depends equally on the adverse reactions, quality of life offered and support of the close circle) and the social integration of the subject, communication probably having a more important role in the monitoring and evolution of the condition than the preference for a certain therapeutic scheme. Current statistics draw attention to the increase in morbidity and mortality among children with bronchial asthma, an aspect demonstrated by the numerous hospitalizations recorded, due either to an escalation in the severity of this pathology or to faulty management. The purpose of this article is to review the delicate aspects in terms of controlling symptoms and maintaining a high quality of life among teenagers.

Background: The implications of gastroesophageal reflux disease in respiratory tract infections have been investigated over time. The aim of our study was to evaluate the relationship between these two pathologic entities and the outcome after proper antireflux treatment. Methods: A group of 53 children with recurrent respiratory tract infections admitted in the gastroenterology clinic of a children’s hospital in North-East Romania was investigated for gastroesophageal reflux disease through 24 h pH-metry. Those with a Boix-Ochoa score higher than 11.99 received proton pump inhibitor treatment and were reevaluated after 2 months. Results: A total of 41 children were found with a positive Boix-Ochoa score. After 2 months of antireflux therapy, eight patients still had a positive Boix-Ochoa score. Conclusions: Recurrent respiratory tract infections with symptoms resistant to treatment should be considered a reason to investigate for gastroesophageal reflux, because the symptoms may be due to micro- or macro-aspiration of the gastric refluxate or to an esophageal-bronchial reflex mediated through the vagal nerve.

Coronavirus disease 2019 (COVID-19) is a complex infectious disease caused by the SARS-CoV-2 virus, and it currently represents a worldwide public health emergency. The pediatric population is less prone to develop severe COVID-19 infection, but children presenting underlying medical conditions, such as diabetes mellitus, are thought to be at increased risk of developing more severe forms of COVID-19. Diabetic children face new challenges when infected with SARS-CoV-2. On one hand, the glycemic values become substantially more difficult to manage as COVID-19 is a predisposing factor for hyperglycemia. On the other hand, alongside other risk factors, high glycemic values are incriminated in modulating immune and inflammatory responses, leading to potentially severe COVID-19 cases in the pediatric population. Also, there are hypotheses of SARS-CoV-2 being diabetogenic itself, but this information is still to be confirmed. Furthermore, it is reported that there was a noticeable increase in the number of cases of new-onset type 2 diabetes among the pediatric population, and the complications in these patients with COVID-19 include the risk of developing autoimmune diseases under the influence of stress. Additionally, children with diabetes mellitus are confronted with lifestyle changes dictated by the pandemic, which can potentially lead to the onset or exacerbation of a potential underlying anxiety disorder or depression. Since the literature contains a series of unknowns related to the impact of COVID-19 in both types of diabetes in children, the purpose of our work is to bring together the data obtained so far and to identify potential knowledge gaps and areas for future investigation regarding COVID-19 and the onset of diabetes type 1 or type 2 among the pediatric population.

(1) Background: Immune thrombocytopenia (ITP) is an acute autoimmune blood disorder that is the main cause of thrombocytopenia in children. It is characterized by a decrease in platelets below 100 × 109/L, and limited evolution with severe complications such as intracranial hemorrhage. The chronic form is defined by the persistence of thrombocytopenia more than 12 months after diagnosis. (2) Methods: We performed a retrospective study over a period of 10 years (1 January 2011–31 December 2020) at the Emergency Clinical Hospital for Children “Sf. Maria”, Iasi. The aim of the study was to describe the clinical characteristics and to determine the prognostic factors in immune thrombocytopenia in children. (3) Results: In this study we included 271 children with ITP, comprising 123 females (45.4%) and 148 males (54.6%). The remission rate was higher in males, being 68.9% compared to 56.1% in females. Children with ITP under 9 years of age had a higher remission rate. Children with a platelet count > 10 × 109/L at diagnosis had a higher likelihood-of-remission rate compared to patients who presented initial platelet count below this value. (4) Conclusions: The risk factors highly suggestive for chronicity are: age at diagnosis, female sex, and the number of platelets at the onset of the disease.

While the majority of children with recently diagnosed ITP have a benign, self-limiting condition, most often with a spontaneously recovery, 40% of children with ITP progress toward persistent ITP and 10–20% goes toward chronicity. Several clinical scores have been developed with the aim to perform a better monitoring outcome or to differentiate transient vs. persistent ITP (e.g., Donato score). Our paper aims to describe and to compare the most important scores used in the management of ITP in children: bleeding severity scores and chronicity prediction scores. These scores include a combination of different already known risk factors: age, gender, presence of a previous infections or vaccination, bleeding grade, type of onset, platelet count at diagnosis. The real utility of these scores has been a matter of debate and no consensus has been reached so far as to their necessity to be implemented as compulsory tool in the care of children with ITP.

Heart failure is a worldwide health problem with important consequences for the overall wellbeing of affected individuals as well as for the healthcare system. Over recent decades, numerous pieces of evidence have demonstrated that the associated gut microbiota represent an important component of human physiology and metabolic homeostasis, and can affect one’s state of health or disease directly, or through their derived metabolites. The recent advances in human microbiome studies shed light on the relationship between the gut microbiota and the cardiovascular system, revealing its contribution to the development of heart failure-associated dysbiosis. HF has been linked to gut dysbiosis, low bacterial diversity, intestinal overgrowth of potentially pathogenic bacteria and a decrease in short chain fatty acids-producing bacteria. An increased intestinal permeability allowing microbial translocation and the passage of bacterial-derived metabolites into the bloodstream is associated with HF progression. A more insightful understanding of the interactions between the human gut microbiome, HF and the associated risk factors is mandatory for optimizing therapeutic strategies based on microbiota modulation and offering individualized treatment. The purpose of this review is to summarize the available data regarding the influence of gut bacterial communities and their derived metabolites on HF, in order to obtain a better understanding of this multi-layered complex relationship.

Thrombotic microangiopathy can present itself in the form of several clinical entities, representing a real challenge for diagnosis and treatment in pediatric practice. Our article aims to explore the evolution of two rare cases of pediatric thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS) with extremely similar clinical pictures, which, coincidentally, presented at approximately the same time in our hospital. These cases and our literature review demonstrate the multiple facets of thrombotic microangiopathy, which can produce various determinations and salient manifestations even among the pediatric population. TTP and aHUS may represent genuine diagnostic pitfalls through the overlap of their clinical and biological findings, although they develop through fundamentally different mechanisms that require different therapeutic approaches. As a novelty, we underline that COVID-19 infection cannot be excluded as potential trigger for TTP and aHUS in our patients and we predict that other reports of such an association will follow, raising a complex question of COVID-19’s implication in the occurrence and evolution of thrombotic microangiopathies. On this matter, we conducted literature research that resulted in 15 cases of COVID-19 pediatric infections associated with either TTP or aHUS. Taking into consideration the morbidity associated with TTP and aHUS, an elaborate differential diagnosis and prompt intervention are of the essence.

(1) Background: The correlation between infection with Helicobacter pylori (H. pylori) and headache has been argued and explored for a long time, but a clear association between the simultaneous presence of the two in children has not been established yet. In this study, we aimed to explore this relationship in children from the Northeast region of Romania. (2) Methods: A retrospective study exploring the correlation between children having H. pylori infection and headache or migraine was conducted on a batch of 1757 children, hospitalized over 3 years in a pediatric gastroenterology department in Northeast Romania. (3) Results: A total of 130 children of both sexes had headache. From 130 children, 54 children (41.5%) also presented H. pylori infection. A significant association between headache and H. pylori infection (χ2; p < 0.01) was noticed. (4) Conclusions: More studies are needed on this relationship, and we emphasize the importance of further analyses, as they present great clinical importance for both prompt diagnosis and treatment.

Background: Hantaviruses are infectious etiological agents of a group of rodent-borne hemorrhagic fevers, with two types of clinical manifestations in humans: hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS). According to available statistics, the disease occurs mainly in adults, but the lower incidence in the pediatric population might also be related to a lack of diagnosis possibilities or even unsatisfactory knowledge about the disease. Materials and Methods: The purpose of this study was to evaluate the cases of hemorrhagic fever with renal syndrome diagnosed and treated in the Department of Nephrology at St. Mary’s Emergency Hospital for Children in Iasi, Romania, representative of the North-East of Romania. We also reviewed the specialized literature on the topic. Results: Between January 2017 and January 2022, eight cases of HFRS, all men, and seven from rural areas, aged 11–18 years old, were referred to our clinic because of an acute kidney injury (AKI). Seven cases were identified as Dobrava serotype while one case was determined by Haantan serotype. Conclusions: HFRS should always be considered as a differential diagnosis when faced with a patient with AKI and thrombocytopenia. Dobrava serotype is the most common hantavirus subtype in the Balkans. For the specific prevention of human infections, mainly in high-risk groups, vaccines are needed. As far as we know, this is the first study on HFRS in Romanian children.

Diamond–Blackfan anemia is a rare (6–7 million live births), inherited condition manifesting as severe anemia due to the impaired bone marrow production of red blood cells. We present the unusual case of a six month old infant with a de novo mutation of the RPS19 gene causing Diamond–Blackfan anemia who additionally suffers from severe sinus bradycardia. The infant was diagnosed with this condition at the age of four months; at the age of 6 months, she presents with severe anemia causing hypoxia which, in turn, caused severe dyspnea and polypnea, which had mixed causes (hypoxic and infectious) as the child was febrile. After correction of the overlapping diarrhea, metabolic acidosis, and severe anemia (hemoglobin < 3 g/dL), she developed severe persistent sinus bradycardia immediately after mild sedation (before central venous catheter insertion), not attributable to any of the more frequent causes, with a heart rate as low as 49 beats/min on 24 h Holter monitoring, less than the first percentile for age, but with a regular QT interval and no arrhythmia. The echocardiogram was unremarkable, showing a small interatrial communication (patent foramen ovale with left-to-right shunting), mild left ventricular hypertrophy, normal systolic and diastolic function, and mild tricuspid regurgitation. After red cell transfusion and appropriate antibiotic and supportive treatment, the child’s general condition improved dramatically but the sinus bradycardia persisted. We consider this a case of well-tolerated sinus bradycardia and foresee a good cardiologic prognosis, while the hematologic prognosis remains determined by future corticoid response, treatment-related complications and risk of leukemia.

Birth is a physiological act that is part of the morpho-functional economy of the maternal body. Each stage in the act of birth has a predetermined pathway that is neurohormonally induced and morpho-functionally established through specific and characteristic adaptations. Like maternity, childbirth also has an important impact on the maternal body as a biological structure and psycho-emotional behavior. Cesarean section performed at the request of the mother with no medical underlying conditions besides the prolonged hospitalization risk can also cause breathing problems in children, delayed breastfeeding, and possible complications in a future pregnancy. Vaginal birth remains the path of choice for a physiological evolution pregnancy. Although erroneously considered safe and easy today, cesarean section delivery must remain an emergency procedure or a procedure recommended for pregnancies where birth is a risk to the mother and to the child, as cesarean section itself is a risk factor for negative outcomes for both mother and baby. This review summarizes the impact that both cesarean section and natural birth have on mother and newborn in their attempt to adapt to postpartum events and extrauterine life.

Pediatric systemic lupus erythematosus is a chronic autoimmune disorder with a highly variable course and prognosis. It results in functional abnormalities in the immune system due to intrinsic factors and the use of immunosuppressive therapies associated with underlying comorbidities seem to increase the risk of severe COVID-19 and poor outcomes of the disease in pediatric systemic lupus erythematosus (SLE) patients. The aim of this review is to obtain a better understanding of the existing link between this new viral infection and pediatric lupus. We have analyzed the characteristics of newly diagnosed cases of pediatric SLE following COVID-19 which have been reported in the literature and which describe the impact that COVID-19 has on patients already suffering with pediatric SLE.

(1) Background: Gastroesophageal reflux disease (GERD) can cause several complications as a result of the acidic pH over various cellular structures, which have been demonstrated and evaluated over time. Anemia can occur due to iron loss from erosions caused by acidic gastric content. In children, anemia has consequences that, in time, can affect their normal development. This study evaluates the presence of anemia as a result of pediatric gastroesophageal reflux disease. (2) Methods: 172 children were diagnosed with gastroesophageal reflux in the gastroenterology department of a regional children’s hospital in northeast Romania by esophageal pH-metry and they were evaluated for presence of anemia. (3) Results: 23 patients with GERD from the studied group also had anemia, showing a moderate correlation (r = −0.35, p = 0.025, 95% confidence interval) and lower levels of serum iron were found in cases with GERD, with statistical significance (F = 8.46, p = 0.012, 95% confidence interval). (4) Conclusions: The results of our study suggest that there is a relationship between anemia or iron deficiency and gastroesophageal reflux due to reflux esophagitis in children, which needs to be further studied in larger groups to assess the repercussions on children’s development.

Organizing a viable irrigation system in the context of climate change at the level of Romanian agriculture is a priority. Currently, only 12% of the total agricultural area is irrigated. In order to benefit from irrigation, Romanian farmers must be members of the Organization of the Irrigation Water Users (OUAI), assigned to the area in which they own land or conclude seasonal contracts. A survey addressed to the OUAI in Galati County attempted to identify the relations between the members that can lead to the association not only for irrigation, but also for agricultural activities. An analysis of the data obtained from the survey was carried out, using the „fuzzy set comparative qualitative analysis” (fsQCA) method, in the context of land fragmentation, in conjunction with supporting national and European programs for the association and development of the irrigation infrastructure. The results of the study are important because it reflects the main issues highlighted by the farmers in the analyzed area regarding the association.

The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with an actual or potential tissue injury that is described as such, emphasizing the subjective nature. The cognitive-behavioural therapy has begun to be applied for psychosomatic problems in dental problems. There are several types of techniques: relaxation, biofeedback, exposure and cognitive restructuring. In general, therapists may combine several of the above techniques to treat patients with dental anxiety.

Very rare in children, the brown tumor, or osteoclastoma, is an understudied ectopic entity that causes severe debilitation in patients with chronic renal insufficiency. We report two cases who developed particular forms with different evolutions of severe renal osteodystrophy.

Purpura Henöch-Schönlein (PHS) este o afecţiune a vaselor mici caracterizată printr-un răspuns anormal al sistemului imun: imunoglobulina A (IgA), fracţiunea a 3-a a complementului şi depunerea de complexe imune circulante în pereţii arteriolelor, venulelor şi a capilarelor. Sunt afectaţi predominant copiii, dar simptomatologia poate apărea şi la vârsta adultă. Boala este mai frecventă la pacienţii de sex masculin. Etiologia purpurei nu este deocamdată cunoscută, însă se pare ca există anumiţi factori de risc pentru apariţia acesteia: agenţi infecţioşi (Streptococ, parvovirusuri), înţepături de insecte, alimente sau medicamente (antibiotice, antihistaminice). Sus ceptibilitatea la PHS poate avea origine genetică. Numeroase rapoarte sugerează că defi cienţa complementului (C4) datorată deleţiei genelor ce codează sinteza acestei fracţiuni determină predispoziţia la nefropatie IgA şi la nefrita Henöch-Schönlein.

Henöch-Schönlein purpura is a small-vessel vasculitis characterized by an abnormal response of the immune system: immunoglobulin A (IgA), C3 and immune complex deposition in arterioles, capillaries and venules. The syndrome is mostly seen in children, but it may affect people of any age. It is more common in boys than in girls. The etiology of Henöch-Schönlein purpura is unknown. Multiple infectious agents as well as drugs, foods, and insect bites may trigger Henöch-Schönlein purpura. Susceptibility to HSP may have a genetic origin. Several reports suggest that defi ciency of complement 4 (C4) from deletion of C4 genes predisposes patients to IgA nephropathy and HSP nephritis.

Pain is a subjective concept which is ever-present in the medical field. Health professionals are confronted with a variety of pain types and sources, as well as the challenge of managing a patient with acute or chronic suffering. An even bigger challenge is presented in the pediatric population, which often cannot quantify pain in a numerical scale like adults. Infants and small children especially show their discomfort through behavioral and physiological indicators, leaving the health provider with the task of rating the pain. Depending on the pathophysiology of it, pain can be classified as neuropathic or nociceptive, with the first being defined by an irregular signal processing in the nervous system and the second appearing in cases of direct tissue damage or prolonged contact with a certain stimulant. The approach is generally either pharmacological or non-pharmacological and it can vary from using NSAIDs, local anesthetics, opiates to physical and psychological routes. Unfortunately, some pathologies involve either intense or chronic pain that cannot be managed with traditional methods. Recent studies have involved nanoparticles with special characteristics such as small dimension and large surface area that can facilitate carrying treatments to tissues and even offer intrinsic analgesic properties. Pediatrics has benefited significantly from the application of nanotechnology, which has enabled the development of novel strategies for drug delivery, disease diagnosis, and tissue engineering. This narrative review aims to evaluate the role of nanotechnology in current pain therapy, with emphasis on pain in children.

Celiac disease (CeD) is an enteropathy caused by the complex interaction between genetic, environmental, and individual immunological factors. Besides the hallmark of intestinal mucosal damage, CeD is a systemic disorder extending beyond the gastrointestinal tract and impacting various other organs, causing extraintestinal and atypical symptoms. The association between CeD and liver damage has been classified into three main categories: mild and asymptomatic liver injury, autoimmune liver injury, and liver failure. We present a case of severe liver damage with cirrhotic evolution in an obese 12-year-old boy who had been admitted due to generalized jaundice and localized abdominal pain in the right hypochondrium. In the course of investigating the etiology of severe liver disease, toxic, infectious, metabolic, obstructive, and genetic causes were excluded. Despite the patient’s obesity, a diagnosis of CeD was established, and in accordance with autoimmune hepatitis (AIH) criteria, the patient was diagnosed with autoantibody-negative AIH associated to CeD.

Helicobacter pylori (H. pylori) is a bacterium that colonizes the gastric mucosa and which is known for its ability to survive in the acidic environment of the stomach, thanks to its unique spiral shape and the presence of multiple flagella. Thus, H. pylori infection may present under the shape of multiple clinical entities and understanding its various facets is crucial for effective diagnosis and treatment. The importance of H. pylori infection in children lies in its potential to cause significant morbidity and long-term complications. This article aims to provide an overview of the importance of H. pylori infection in children, including its epidemiology, clinical manifestations, and treatment. Through a better understanding of this common infection, healthcare providers can work towards improving the diagnosis and management of H. pylori infection in children, ultimately improving the long-term health outcomes of affected individuals.