Search

Although rarely diagnosed in the pediatric population, deep vein thrombosis (DVT) is experiencing a growing incidence, while continuously acquiring different nuances due to the widening range of risk factors and lifestyle changes in children and adolescents.

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]

Aplastic Anaemia is a severe potentially fatal haematological syndrome, characterised by peripheral pancytopenia and bone marrow hypoplasia, with an occurrence rate of 2-6 cases per million per year. This case report is about a 9 year-old boy, with no pathological known antecedents, and a sudden onset, apparently without any pathological associated conditions, who was diagnosed with severe Idiopathic Aplastic Anaemia, and a fulminate evolution. The lack of compliance of the parents regarding the therapy, and also the lack of a protective child's legislation, led to patient's death in a very short time. [ABSTRACT FROM AUTHOR]

Introduction: Infectious complications are the main cause of morbidity and mortality in onco-pediatric patient, being caused both by the immunosuppressive background, and by the cytostatic treatment. Aims and Objectives: To observe correlations between infectious complications occurring in the onco-pediatric patient, and the presence of a Central Venous Catheter (CVC). Material and Method: We conducted a descriptive, retrospective study of 18 pediatric patients with oncological pathology, who were diagnosed and treated in the Department of Hemato-Oncology at the Pediatric Clinic I of the Tirgu Mures Emergency County Hospital during the period January 2015-December 2017. Results: Within the study group, the most frequent diagnostics were haematological: 61% (Acute Lymphoblastic Leukemia- ALL, Lymphoma), compared to solid tumors - Wilms tumors (16.7%), neuroblastomas (11.1%), Ewing sarcomas (5.6%). Infectious complications were 52 episodes: ALL (50%), peripheral T-cell lymphomas (19.23%) and Neuroblastomas (13.46%). Lower airway infections were the most frequent infectious complications (34.6% -18 cases), followed by Sepsis (26.9% -14 cases) and upper airway infections (21.2% -11 cases). In 67.3% of cases (35), the infectious episode developed during the presence of CVC, but only 7 cases were labeled as Catheter sepsis. The infectious episode also developed in the presence of a CVC, but only 7 cases of infection (20%) were labeled as a catheter Sepsis. They accounted for 50% of all cases of Sepsis, so there was no increased risk for Sepsis in CVC-bearing patients (RR = 0.48, p = 0.10). Conclusions: Lower airway infections were the most common infectious complications, followed by Sepsis. The central venous catheter is an additional infectious risk factor, but with specific prophylaxis methods, infections can be avoided. [ABSTRACT FROM AUTHOR]

Epilepsy is a brain pathology that consists in the development of recurrent epileptic seizures, and more than half of the cases present the onset during childhood. We present the case of a 3-year-old male patient, with heredocollateral antecedents of epilepsy and personal history of neuropsychomotor retardation, who was admitted in our clinic presenting generalized tonic clonic seizures, initially febrile and afterwards afebrile. The laboratory tests and the neuroimagistic ones did not identify an underlying cause. The initial EEG did not point out anything pathological. Despite the anticonvulsant treatment, the patient's evolution was unfavorable, presenting multiple short term recurrences, being readmitted multiple times in our clinic. Once we introduced the second anticonvulsant drug, levetiracetam, in his treatment, the seizures disappeared, and the patient presented long term favorable evolution. The case particularity consists in the development of generalized tonic clonic seizures in a patient with significant family history, and personal history of neuropsychomotor retardation that appear initial under febrile context, and afterwards in the lack of fever, repeating cyclic, with unfavorable evolution despite the treatment with valproic acid that disappear only after initiating treatment with levetiracetam. [ABSTRACT FROM AUTHOR]

Enteropatia exudativă (EE) reprezintă o pierdere proteică anormală la nivelul mucosei tractului digestiv, fiind în majoritatea cazurilor secundară altor patologii gastro-intestinale sau extraintestinale. Cu toate acestea, există, de asemenea, cauze primare, genetice asociate cu EE. Prezentăm cazul unui copil mic, de sex feminin, în vârstă de 1 an şi 1 lună, cu un episod de enterocolită infecţioasă cauzată de Escherichia coli enteropatogen în antecedente, care s-a internat în clinica noastră cu edeme palpebrale matinale de aproximativ 1 săptămână. Analizele de laborator au evidenţiat hipoalbuminemie, hipogamaglobulinemie de tip A şi G, leucocitoză cu eozinofilie, şi anemie. Testul pentru detectarea hemoragiilor oculte din scaun a fost pozitiv, precum şi alfa-1 antitripsina şi calprotectina fecală. Am identificat, de asemenea alergie la proteinele laptelui de vacă, pe care am interpretat-o ca fiind secundară patologiei intestinale. Astfel, am stabilit diagnosticul de enteropatie exudativă după un episod de enterocolită acută cauzat de E. coli enteropatogen, şi am administrat tratament substitutiv cu albumină umană şi corticosteroizi, cu evoluţie favorabilă. Particularitatea cazului constă în diagnosticarea unui caz sever de enteropatie exudativă la un copil mic cu edeme palpebrale matinale, şi nivele scăzute ale albuminei serice, după un episod de enterocolită cauzat de E. coli enteropatogen, care s-a remis fără tratament etiologic. [ABSTRACT FROM AUTHOR]

Introduction: Iron-deficiency anemia is a prevalent hematological condition in children, characterized by low hemoglobin levels often caused by inadequate iron intake or blood loss. However, there are cases where anemia persists despite adequate iron therapy, being classified as iron-refractory feriprival anemia. The objective of this case report is to highlight the crucial role of a rigorous diagnostic approach in the management of refractory iron-deficiency anemia in children, focusing on identifying the underlying cause. Case Report: We present the case of a 10-year-old boy diagnosed with autism spectrum disorder and iron deficiency anemia for approximately 2 years, who underwent oral iron therapy without any improvement. The patient presents with severe normochromic, normocytic anemia, elevated ferritin levels, as well as increased inflammatory markers (ESR, C-reactive protein). Suspicion of malabsorption arises, as the patient was tested negative for Helicobacter pylori infection and celiac disease, but elevated calprotectin levels were discovered. Subsequent findings raise suspicion of an inflammatory bowel disease. Also, antinuclear antibodies (ANA) were tested and found to be at the upper limit of normal. Following this, the patient was scheduled for a colonoscopy; however, prior to the procedure, a test for Clostridium difficile was conducted, yielding a positive result. Discussions : These findings led to the suspicion of an inflammatory bowel disease, potentially underlying the refractory iron-deficiency anemia in this patient. The importance of a meticulous diagnostic approach is highlighted, focusing on identifying the underlying cause to ensure appropriate management and prevent potential complications. Conclusions: This case exemplifies the critical role of meticulous diagnostic investigations in elucidating the complex etiology of refractory iron-deficiency anemia in pediatric patients. Despite initial therapeutic efforts targeting iron deficiency, the persistent anemia prompted a comprehensive diagnostic workup, revealing potential underlying factors such as malabsorption and inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal meningitis is an uncommon pathology with high morbidity and mortality. In industrialised countries the most frequent pathogen involved is group B Streptococcus, while in underdeveloped nations neonatal meningitis is more commonly caused by Gram negative pathogens. Case presentation: A 9 days old newborn girl was admitted to our clinic with fever starting two days prior to presentation, initially treated at home with antipyretics. Personal and family history were unremarkable. Clinical examination showed an influenced general condition and a parieto-occipital cefalhematoma, no bulging fontanelle. Inflammatory markers were positive (CRP>300 mg/l) and the cerebrospinal fluid (CSF) examination showed increased proteins (2.170mg/l) and leucocytes (9216/μl) and decreased glucose (7 mg/dl). Empiric antibiotic treatment with Ceftriaxone and Ampicillin was initiated for the suspected diagnosis of bacterial meningitis. CSF cultures were positive for Escherichia Coli K1 and the antibiotic treatment was changed to Ceftriaxone, Gentamicin and Ampicilin/Clavulanic acid, according to the antibiogram. Hemocultures were negative. The patient presented fever for 3 days under antibiotic treatment. The control lumbar puncture showed a marked decrease in proteins and leucocytes and an increase in glucose, no bacterial growth. Clinical and paraclinical control after 4 weeks showed no signs of infection and no complications. Conclusions: Neonatal meningitis may occur in newborns without predisposing factors. Lumbar puncture and CSF examination is mandatory in case of fever in the neonatal period, regardless of the clinical aspect. [ABSTRACT FROM AUTHOR]

Introduction: Cystic fibrosis is a multisystemic disease whit an autosomal recesive transsmition, manifestatons depends upon which organs ar affected, common presentations include chronic respiratory infections and malabsorption. Case presentation: We present a case of cystic fibrosis in a 7-year-old boy, diagnosticated during the infant period, when he presents generalized edema, dystrophy and recurent respiratory infection. The case presentation follows the evolution of the patient from the moment of diagnosis to the present. Conclusion: Cystic fibrosis is a rare pathology, but should be considered as a differential diagnosis when a patient presents digestive and respiratory manifestations. [ABSTRACT FROM AUTHOR]

Burkitt lymphoma, a subtype of non-Hodgkin lymphomas, appears especially in small ages and it presents the most rapid tumor growth encountered in the human beings. We present the case of a 5 year-old child who presents diffuse, abdominal pain, abdominal distension and decreased consistency stools, and who is transferred in the Pediatrics Clinic 1 Targu-Mures, with the diagnosis of severe malnutrition and hypoproteinemia edema of unknown etiology. The laboratory investigations performed showed leukocytosis, mildly increased erythrocyte sedimentation rate, anemia, decreased level of serum proteins, and also an increased level of LDH. The abdominal ultrasound revealed intraperitoneal fluid, and the abdominal CT exam showed free fluid between the intestinal loops, 2 fistulas, one between the duodenum and the colon, and the other one between the jejunum and the colon, but also enlarged lymph nodes. The surprise during the surgery is the discovery of a tumor mass which involves the duodenum, the jejunum and the colon, and the pathological exam establishes the diagnosis of Burkitt lymphoma, extranodal type, with evolution after surgery burdened by multiple complications. After the third surgical intervention, the chemotherapy is initiated. Even though in some cases, the clinical picture is not suggestive for the severity of the pathology, the clinician's perseverance is the one that finally leads to the establishment of the diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Hepatoblastoma is a rare tumor characteristic of pediatric patients under the age of 3 years. Thrombocytosis and elevated alpha-fetoprotein levels are often associated with this pathology, and other types of tumors or malformations are more common. Case presentation: A 2-year-old patient was admitted to our clinic for an abdominal tumor mass. Ultrasound and computer tomography revealed a solid liver tumor. Due to thrombocytosis and elevated alpha-fetoprotein levels, a suspicion of a hepatoblastoma was raised, confirmed histopathologically. Chemotherapy was initiated, followed by two-stage surgery: ligation of the right branch of the portal vein and subsequent tumor resection. At 6 months post-intervention, the patient presented a relapse requiring hepatic transplantation. The subsequent evolution was favorable with multimodal therapy, the patient did not present a relapse for 2 years. Conclusions: Surgery is the mainstay of hepatoblastoma therapy. Hepatic transplantation may be the last solution in the case of relapses or large, multifocal tumors. [ABSTRACT FROM AUTHOR]