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Deficitul primar de IgA este cea mai frecventă imunodeficienţă congenitală definită de valori ale IgA serice sub 0,07 g/l şi valori normale ale IgG şi IgM. Marea majoritate a cazurilor sunt asimptomatice, doar 10-15% se manifestă prin infecţii sinopulmonare persistente sau recidivante, boli autoimune, alergii, malignităţi. Unele cazuri dezvoltă în timp imunodeficienţă comună variabilă. Apariţia anticorpilor anti-IgA justifică administrarea cu prudenţă a transfuziilor de sânge, plasmă sau imunoglobuline intravenoase. Autorii prezintă un caz de deficit primar selectiv de IgA la care severitatea exacerbărilor infecţioase pare a fi determinată de asocierea unui deficit de IgG4 şi discută posibilităţile şi limitele terapiei în lumina datelor recente din literatură.

Rinosinuzita cronică (RSC), este o patologie rară în pediatrie comparativ cu adultul. Manifestările clinice sunt în relaţie, pe de o parte, cu particularităţile anatomice, iar pe de altă parte, cu cele de răspuns imun corelate cu vârsta copilului. Alergia constituie cauza principală în 50% dintre rinitele copilului, 40% dintre acestea debutând precoce până la vârsta de 6 ani. Expresia clinică a rinosinuzitei alergice la copil poate fi uneori însoţită de manifestări ale comorbidităţilor alergice asociate sau de complicaţii de vecinătate. Alterarea clearance-ului mucociliar poate fi însă indus şi de alte situaţii patologice mai rare care produc modificarea proprietăţilor reologice ale mucusului, ca în mucoviscidoză (FC). Prin heterogenitatea de expresie clinică în relaţie pe de o parte cu particularităţile de răspuns imunogenetic şi anatomice raportate la vârsta copilului şi pe de altă parte cu diversitatea factorilor etiologici inductori (de la foarte frecvenţi, precum alergia, la foarte puţin frecvenţi, FC), RSC impune un diagnostic corect, precoce şi un tratament adecvat prin colaborarea în echipă multidisciplinară.

Otita medie seroasă cronică, cauză majoră a hipoacuziei în perioada copilăriei, este frecvent asociată cu sensibilizarea alergică. Prevalenţa în continuă creştere a atopiei la această vârstă implică o abordare multidisciplinară a copiilor cu adenoidite, otite recurente şi disfuncţii tubare, în vederea unui management patogenic complex. Obiectivul studiului a constat în determinarea asocierii otitelor medii cu bolile alergice, şi implicaţiile acestei asocieri în tratamentul şi evoluţia pacienţilor. Material şi metodă. S-a realizat un studiu retrospectiv care a inclus 92 de copii, cu vârste cuprinse între 6 luni şi 6 ani internaţi în Clinica II Pediatrie, Spitalul Clinic de Copii „Sf. Maria“, Iaşi, cu diagnosticul de otită medie, pe o perioadă de 1 an (ianuarie 2015 – ianuarie 2016). Rezultate. Majoritatea cazurilor au fost otite supurate (61 de pacienţi), 31 de cazuri au fost otite seroase, dintre care 23 au fost recurente. Asocierea cu bolile alergice a fost mai frecventă la copiii cu otită seroasă (26/31 cazuri). 4 pacienţi cu otită supurată au prezentat reacţii adverse la antibiotice, cu implicaţii majore în evoluţia cazurilor. Asocierea cu refluxul gastroesofagian a fost relativ asemănătoare între cele 2 loturi (11/61 de cazuri şi respectiv 10/31 de cazuri), la 10 pacienţi atopici, obiectivându-se alergia la proteinele laptelui de vacă. În concluzie, copiii cu otite medii, în special cei cu otite medii seroase recurente ar trebui investigaţi pentru determinarea coexistenţei atopiei şi a refluxului gastroesofagian, eventual cu dozarea markerilor de inflamaţie alergică sau a pepsinei în exsudatul otic, în vederea unui management terapeutic ţintit.

Introducere. Boala fi catului gras non-alcoolic (NAFLD), cea mai frecventă cauză a bolii hepatice cronice la copii, cuprinde un spectru de afecţiuni variind de la steatoză simplă până la steatohepatită (NASH). Acidul ursodeoxicolic (UDCA) a fost utilizat la pacienţi adulţi cu NASH, demonstrându-şi efi cacitatea în doze crescute. Scop. De a evalua efectul tratamentului cu doze crescute de UDCA asupra parametrilor funcţiei hepatice la copii cu NASH. Metode. Lotul de studiu a fost constituit din 18 copii cu NASH cu vârste cuprinse între 2,5 şi 17 ani. NASH a fost operaţional defi nit ca fi catul difuz hiperechogenic la ecografi e cu valori persistent crescute (> 35 UI/l) ale alanin aminotransferazei (ALAT) sau aspartat aminotransferazei (AST), după excluderea cauzelor virale, drog sau alcool induse, colestatice sau genetice ale bolii hepatice. Pacienţii au fost trataţi cu acid ursodeoxicolic (20 mg/kg/zi), timp de şase luni. Rezultate. Tratamentul cu UDCA a determinat scăderea semnifi cativă a valorilor transaminazelor hepatice. Nivelurile ALT au variat între 68,5 (50-166) iniţial vs 47 (29-104) după şase luni, p < 0,001, AST între 43 (29-101) vs 34 (17-75), p < 0,001, şi GGT între 41,5 (11-150) vs. 22 (8-55). La sfârşitul tratamentului, niveluri ALT s-au normalizat la 4 dintre pacienţi. De asemenea, concentraţiile de colesterol au fost semnifi cativ reduse după tratament. Concluzii. Tratamentul cu doze crescute de acid ursodeoxicolic imbunătăţeşte parametrii funcţiei hepatice la copii cu NASH.

Atât obezitatea, cât şi astmul bronşic reprezintă boli puternic impactante în morbiditatea pediatrică a căror incidenţă înregistrează un trend ascendent în pofi da eforturilor terapeutice actuale. Studiul îşi propune aprecierea interrelaţiei dintre severitatea astmului bronşic şi obezitate precum şi impactul acesteia asupra incidenţei şi gradului de severitate a exacerbărilor astmatice refl ectate în calitatea vieţii bolnavilor. Concluzii: Dereglările nutriţionale complexe din cadrul obezităţii antrenează mecanisme patogenice interferente cu cele din astmul bronşic, agravând evoluţia acestuia refl ectată în modifi carea calităţii vieţii bolnavilor.

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.

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.

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.

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.

Having increased popularity during the Covid-19 pandemic, vitamin D3 is currently impressing thanks to the numerous researches aimed at its interactions with the body’s homeostasis. At the same time, there is a peak in terms of recommendations for supplementation with it. Some of the studies focus on the link between autoimmune diseases and nutritional deficiencies, especially vitamin D3. Since the specialized literature aimed at children (patients between 0-18 years old) is far from equal to the informational diversity of the adult-centered branch, this review aims to bring up to date the relationship between the microbial and nutritional balance and the activity of pediatric systemic lupus erythematosus (pSLE). The desired practical purpose resides in a better understanding and an adequate, individualized management of the affected persons to reduce morbidity. The center of the summary is to establish the impact of hypovitaminosis D in the development and evolution of pediatric lupus erythematosus. We will address aspects related to the two entities of the impact played by vitamin D3 in the pathophysiological cascade of lupus, but also the risk of toxicity and its effects when the deficiency is over supplemented (hypervitaminosis D). We will debate the relationship of hypovitaminosis D with the modulation of immune function, the potentiation of inflammatory processes, the increase of oxidative stress, the perfusion of cognitive brain areas, the seasonal incidence of SLE and its severity. Finally, we review current knowledge, post-pandemic, regarding the hypovitaminosis D – pSLE relationship.

Recent research has generated awareness of the existence of various pathophysiological pathways that contribute to the development of chronic diseases; thus, pro-oxidative factors have been accepted as significant contributors to the emergence of a wide range of diseases, from inflammatory to malignant. Redox homeostasis is especially crucial in liver pathology, as disturbances at this level have been linked to a variety of chronic diseases. Hepatitis is an umbrella term used to describe liver inflammation, which is the foundation of this disease regardless of its cause. Chronic hepatitis produces both oxidative stress generated by hepatocyte inflammation and viral inoculation. The majority of hepatitis in children is caused by a virus, and current studies reveal that 60–80% of cases become chronic, with many young patients still at risk of advancing liver damage. This review intends to emphasize the relevance of understanding these pathological redox pathways, as well as the need to update therapeutic strategies in chronic liver pathology, considering the beneficial effects of antioxidants.

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.

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.

Bronchial asthma is one of the most common chronic conditions in pediatric practice, with increasing prevalence hampered by poor socioeconomic impacts, leading to major public health issues. Considered as a complex heterogeneous syndrome, not a single disease, the management of the disease is a real challenge, impacting medical staff, patients and caregivers. Over the decades, a significant number of diagnostic and treatment regimen have been developed to achieve good standards, sustaining balanced control of the disease. This paper attempts a review on the establishment of new trends in the management of bronchial asthma in the pediatric age group.

The primary deficit of IgA is the most common congenital immunodeficiency defined by the values of serum IgA below 0.07 g/l and normal values of IgG and IgM. Most cases are asymptomatic, only 10-15% is manifested by recurrent or persistent sinopulmonary infections, autoimmune diseases, allergies, malignancies. Some cases develop over the time a common variable immunodeficiency. The frequency of anti-IgA antibody justifies the cautiously use of transfusions of blood, plasma or intravenous immunoglobulin. The authors present a case of primary selective IgA deficiency, where the severity of infectious exacerbations appears to be due to the combination of a lack of IgG4, and discuss the possibilities and limits of therapy in light of recent data from the literature.

Chronic rhinosinusitis is a rare pathology in pediatric pathology versus adult patients. Clinical manifestations are related, on the one hand, with the anatomical particularities and, on the other hand, with the immune response correlated with the age of the child. Allergy is the main cause in 50% of child rhinitis, 40% of them debuting early until the age of 6 years. The clinical expression of allergic rhinosinusitis in children can sometimes be accompanied by comorbidity manifestations or complications. Impaired mucociliary clearance can be induced by other rare pathological situations that produce mucus rheology modification, as in cystic fibrosis (CF). Through, the clinical heterogenicity of expression is in relation, on the one hand, with immunogenic response and anatomical particularities relative to age of the child, and secondly with the diversity of inducing factors (from very frequent like allergy to the least frequent, CF). It requires a correct diagnosis, early and appropriate treatment by a multidisciplinary team collaboration.

Chronic otitis, one of the major causes of pediatric hypoacusia is frequent associated with some allergic diseases. The continuous rice of atopic diseases prevalence in childhood, involves a multidisciplinary approach of Eustachian tube dysfunction, adenoid inflammation or recurrent otitis, for a complex pathogenic management. The objective of this study was to determinate the association between otitis media and the allergic diseases with the implication in the treatment and evolution of this patients. Methods. Retrospective study on 92 children, between 6 month and 6 years, admitted in II Pediatric Clinic, Clinical Hospital of Children “Sf. Maria” Iasi with diagnosis of acute otitis media, for a period of 1 year. Results. Majority of cases (61patients) have been suppurate otitis, 31 cases have been otitis media with effusion out of which 23 have been recurrent. Association with allergic diseases has been more frequent in children with serous otitis media (26/31 cases). 4 cases with suppurate otitis media have developed adverse reaction to antibiotics with major implication in the cases evolution. Association with gastroesophageal reflux was relatively similar between cases with serous otitis and the suppurate ones (10/31 cases and 11/61 cases). From the atopic patients with gastroesophageal reflux, 10 presented cow’s milk protein allergy. In conclusion, the children with otitis media, especially those with recurrent none suppurate form should be investigated for atopy and, eventually, for gastroesophageal reflux, possibly with determination of the allergic markers or of pepsin in the otic exudates, in order to a targeted therapeutic management.

Introduction: Obesity, as a nutritional chronic disease, has an alarmingly rising prevalence in children, with a major risk for complications. Dyslipidemia is responsible for many comorbidities of obesity and its evaluation and management are compulsory. Objective: To evaluate the presence and prevalence of various dyslipidemic changes in obese children and adolescents, as well as evaluating their lipid profiles and the effects of specific therapeutic measures. Material and methods: The study group included 130 obese children aged 5 to 18 years, followed over 188 admissions in the 2nd Pediatric Clinic - Emergency Hospital for Children "St. Maria" Iaşi, Romania from January 2008 to January 2012. The inclusion criteria were the diagnosis of overweight and obesity. Patients were divided into three subgroups for therapeutic reasons, according to age: subgroup I - 5-9 years, subgroup II - 10-13 years and subgroup III - 14-18 years. There were performed anthropometric measurements to classify patients according to the degree of obesity and biological determinations. Results: Blood lipids were modified in more than 50% of obese children, in most cases hypertriglyceridemia, increased LDL-C and decreased HDL-C. Therapeutic measures were lifestyle changes and administration of ursodeoxycholic acid, vitamin E and probiotics. In 5 children was administered rosuvastatin. Conclusions: Obesity in children represents not only a nutritional risk, but also possible lifelong diseases. Evaluation of blood lipids and proper therapeutic measures can reduce the risk of metabolic syndrome. [ABSTRACT FROM AUTHOR]