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Cystic fibrosis (CF) is a very complex disease that raises significant health and social problems, being considered internationally an important public health problem. Known as a multi-organ disease that affects the following organs: salivary glands, lung, digestive tube, liver, pancreas, kidneys, reproductive organs, CF also has an impact on the oral health (structural abnormalities, abnormalities of the teeth eruption, damage to the enamel, accumulation of tartar, gingivitis, cavities, malocclusions, oropharyngeal candidiasis). The authors show the main implications of the disease at teeth level.

Departajarea refluxului gastro-esofagian (RGE) fiziologic (cel mai frecvent) de boala de reflux gastro-esofagian (BRGE) în primul an de viaţă este obligatorie pentru a evita farmacoterapia agresivă. La toate vârstele copilăriei se aplică criterii moderne de evaluare clinică, sumând simptome digestive şi/sau extradigestive şi rezultatele unor investigaţii moderne. Tratamentul igieno-dietetic (suficient in RGE fiziologic), obligatoriu în toate cazurile, şi inhibitorii de pompă protonică dupa vârsta de un an induc remisiune în majoritatea cazurilor de RGE. Evoluţia cronică/recidivantă şi rezistenţa la tratamentul comun impun intervenţia chirurgicală, domeniu îmbogaţit recent la copil cu miotomia perorală endoscopică (POEM).

In children’s first year of life it is mandatory to make a difference between physiological gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD), in order to avoid an aggressive pharmacologic therapy. All ages of childhood benefit from modern criteria of clinical evaluation, by corroborating the digestive or extra digestive symptoms with the results of modern investigations. The dietary measures (sufficient in GER but mandatory in all cases) together with proton pump inhibitors administration after one year of age induce remission in majority of GER cases. The chronic and recurrent evolution of the disease or failure of the common treatment require surgical intervention, recently enriched in children with peroral endoscopic myotomy (POEM).

Cytomegalovirus infection is a major public health problem, because annually there are born increasingly more children with this infection. Numerous studies have shown that cytomegalovirus infection is an important cause of hearing loss. Cytomegalovirus infection specific symptoms present at birth are a strong predictor for hearing loss, even in populations with low maternal seroprevalence rate. The severity of deafness due to cytomegalovirus infection is variable. Pathophysiology of deafness caused by cytomegalovirus infection is not well known, the mechanisms possible involved being impaired endolymphatic structures, cytopathic effect of the virus and the host response to the inner ear structures. The relationship between viral load and increased likelihood of deafness in infants supports the role of antiviral therapy in decreasing the incidence and the severity of deafness caused by cytomegalovirus. We consider that monitoring children with congenital cytomegalovirus infection should include also hearing monitoring.

Currently, chronic hepatitis C (HCV) is a major global problem with high impact on patients and their families. The liver influences the nutritional status through his role in the intermediary metabolism of macronutrients and micronutrients. Hepatitis C infection affect digestion and nutrient absorption, storage and metabolism, which can lead to deficiencies of vitamins, minerals and malnutrition. The authors present nutritional recommendations for children with HCV, a balanced diet of these patients containing all the nutrients is an important component of health, influencing treatment response and side effects.

Helicobacter pylori infection is the most frequent bacterian infection and the main cause of duodenal ulcerations. The prevalence in patients with cysic fibrosis is controversial. The paper present generale data about Helicobacter pylori and the particularities of this infection in cystic fibrosis (cystic fibrosis paradox). The authors concluded that although the prevalence of Helicobacter pylori and its role in gastroduodenal disease in cystic fibrosis are controversial, however, its role should not be underestimated.

Introduction and aim. Acute diarrhea is the most common gastrointestinal disease in infants and young children. It is defined as an increase in the number of stools, watery, as a result of disruption of water and electrolytes transport in the gastrointestinal lumen and of the accelerated transit. Our study was retrospective, case-control type and tried to determine the cumulative risk factors underlying the emergence and evolution of diarrheal disease in infants and small children. Material and method. We studied a group of 197 children, with the age between 0-4 years, from „Sf. Maria“ Emergency Children’s Hospital from Iasi, which presented with acute diarrhea. Results. The bacterial etiology was confirmed in 44 cases. The most common germ involved was Campylobacter jejuni (27 cases). 31% of children had different degrees of dystrophy. In most cases (76%), the dehydration was isonatremic. Conclusions. In the acute diarrheal disease, dehydration remains the worst to fear consequence of this disease, but with an adequate attitude that includes restoring fluid and electrolyte balance and proper nutrition, diarrheal episode limits itself to an interval approximately of 72 hours.

The infection with Helicobacter pylori (H pylori) represents an important issue of public health. Aim. Establishing the prevalence of H. pylori infection in children and presenting the cases according to the gastritis type by performing upper digestive endoscopies. Material and method. The retrospective study referred to a period of 5 years and included 1269 children evaluated by upper endoscopy to establish the H. pylori infection rate. Results. The frequency of H. pylori in the case of acute gastritis was significantly more reduced (34.78%) than in the case of chronic gastritis (54.94%). Referring to the 10 types of gastritis, the most frequent ones are purpuric (43.66%), nodular purpuric (25.93%) and nodular antral (15.84%). At the other end, atrophic and hypertrophic gastritis were positioned. The most frequent associations pointed out endoscopically are those with 1st degree esophagitis - 51.6%, duodenitis – 45.07% and purpuric duodenitis – 24.74%.Conclusions. The H. pylori infection is the most frequent etiologic factor for chronic gastritis (54.94%). The early identification of the infection is essential to destroy the bacteria and to prevent the development of various types of gastritis that are later on endoscopically identified.

Infecţia cu Helicobacter pylori (H. pylori) este o problemă comună şi semnificativă de sănătate publică. Obiectiv. Determinarea prevalenţei infecţiei cu H. pylori la copiii cu simptomatologie sugestivă şi conturarea cazurilor în funcţie de tipul şi felul gastritei prin efectuarea de endoscopii digestive superioare. Material şi metodă. Studiu retrospectiv realizat pe o perioadă de 5 ani pe 1.269 de copii cu simptomatologie gastrică, la care s-au efectuat endoscopii cu biopsie, stabilindu-se rata de infecţie cu H. pylori prin examen direct sau testul ureazei. Rezultate. Frecvenţa H. pylori în cazul gastritei acute a fost semnificativ mai mică (34,78%) comparativ cu frecvenţa acesteia în cazul gastritei cronice (54,94%). În cadrul celor 10 tipuri de gastrită, cele mai frecvente sunt formele purpurice (43,66%), nodular purpurică (25,93%) şi nodular antrală (15,84%), la polul opus situându-se gastrita atrofi că şi hipertrofică. Asocierile cele mai frecvente decelate endoscopic sunt cu esofagita gr I în 51,6%, duodenita în 45,07% şi forma purpurică în 24,74%. Concluzii. Infecţia cu H. pylori este cel mai frecvent asociată gastritei cronice (54,94%). Identificarea precoce a infecţiei este esenţială pentru eradicarea bacteriei şi prevenirea apariţiei diferitelor tipuri de gastrită identifi cate endoscopic.

Deepening the knowledge about genetic and epigenetic mechanisms studies (environmental caused) regarding atopy, brought revelations about intrauterine onset of allergies, proven by the presence of IgE in umbilical cord blood. Detection of these newborns and their inclusion in a specific care program further reduces the morbidity of allergic march with the undeniable effects on quality of life and healthcare costs. The dramatic increase in the prevalence of atopy in recent decades suggests the importance of IgE in umbilical cord determinations. The use of umbilical cord blood for diagnostic purposes requires clear laws and rules and this is the subject we suggest to debate in this paper.

Mother and Child Medicine Department 2‘Gr.T.Popa’ University of Medicine and Pharmacy Iasi, Romania Public Health and Management Background and aims The restriction in dietary management of phenylketonuria (PKU) can lead to essential element’s deficiency, anaemia and failure to thrive. The aim of our retrospectiv study was to determine the incidence of iron deficiency in children undergoing specific nutritional therapy for PKU. Methods: The studied lot was formed by 15 children diagnosed with PKU in the Regional Centre for the diagnosis and treatment of PKU from Iasi-Romania and who were at least 12 months under dietetic treatment. Nutritional status, nutrient intake and the laboratory tests (haemoglobin, hematocrit, MCV, MCH, MCHC, red blood cells count, iron, reticulocytes) were assessed at baseline and every 3 months. We also made correllation with the nutritional status of the patients. The patients diagnosed with iron deficiency anaemia were treated with iron 5 mg/kg/day for 3 months. Results: The clinical exam showed presence of palor in 7 cases, anorexia in 6 cases, irritability in 4 cases. Anaemia was confirmed in 10 PKU patients. Haematological parameters correlated with nutritional status revealed more severe anaemia in patients with malnutrition or obesity. After 3 months of treatment, the haematologic parameters normalised in 9 cases. Conclusions: We suggest that the clinical management of patients with PKU include routine evaluation of iron status indices. Prevention or early treatment of iron deficiency may improve cognitive development and behaviour of children with PKU.

Nonsteroidal anti-inflammatory agents (NSAIDs) produce gastric lesions through two mechanisms: local irritation and systemic action. A 2 year and 10 months old female received NSAID for acute upper respiratory infection for 2 days and she developed coffee ground vomitus one day later. Upper gastrointestinal endoscopy revealed a gastric ulcer. She was negative for H. pylori infection, and she was diagnosed with NSAID – induced acute gastric ulcer in the absence of other causes of gastric ulcer. Gastric ulcers develop very rarely after a short-term administration of NSAIDs, which prompted us to report this case. Balancing the risk and the benefit of eradication therapy, it is indicated, for every patient who must follow a chronic treatment with anti-inflammatory drugs, to look for possible associated risk factors.

Human cytomegalovirus (CMV) is a herpesvirus, a member of the beta-herpesvirus subfamily. Infection with CMV represents a major cause of congenital infection, and also a cause of perinatal infection. We present the case of a 3 months-old sugar with breast milk jaundice and hepatic cytolysis, in our evidence from one month. At the age of 6 weeks, at the second evaluation, the laboratory tests showed a mild increase of lymphocytes and monocytes, minimum hepatic cytolysis and positive CMV immunoglobulin M (IgM) assays. Our decision was to follow up the case, without antiviral therapy, because the acute CMV infection was asymptomatic. Therefore, the hepatic cytolysis may precede the presence of CMV in blood, because the immune mediated response to CMV involve specific antibodies type IgM few weeks after the moment of infection.

Agenţii antiinflamatori nesteroidieni (AINS) produc leziuni gastrice prin intermediul a două mecanisme: iritaţia locală şi acţiunea sistemică. Un copil în vârstă de 2 ani şi 10 luni, sex feminin, a primit AINS timp de 2 zile pentru o infecţie acută a tractului respirator superior şi a prezentat vărsături în „zaţ de cafea“ o zi mai târziu. Endoscopia digestivă superioară a evidenţiat o leziune de ulcer gastric. Biopsia gastrică a fost negativă pentru infecţia cu H. pylori, iar pacienta a fost diagnosticată cu ulcer gastric acut indus de consumul de AINS în absenţa altor cauze de ulcer gastric. Ulcerele gastrice se dezvoltă foarte rar după o administrare pe termen scurt de AINS, fapt ce a determinat raportarea acestui caz. Luând în considerare atât riscurile cât şi beneficiile terapiei cu AINS, este indicat ca în cazul fiecărui pacient care trebuie să urmeze un tratament cronic cu medicamente antiinflamatorii să fie căutaţi posibilii factori de risc asociaţi.