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The medical world carries a major burden in terms of specialized human resource and infrastructure. The recent COVID-19 pandemics revealed an urgent need for specialized medical professionals in order to preempt future natural disasters. The aim of this review was to underline the best teaching model for training specialist nurses. Thus, the healthcare systems should work along with national agencies for designing and implementing complex curricula for training specialists in providing healthcare such as specialist nurses or advanced practice nurses involved in the decision-making process. The educational process for these nurses should be based on an international standard involving digital education techniques such as e-learning platform, interactive approaches of the course content, as well as an interactive teaching system based on figures, graphics or videos. Moreover, virtual reality based-medical models should also represent an important aspect of the training program in order to provide the future students with the opportunity to deal with real-life medical situations in advance. These techniques will form the basis of the specialist nurses’ up-skilling process resulting in crucial life savior medical competences. The trainers should embrace their new roles in the educational process being aware that the nowadays teaching concept is no longer based on a governance approach, but they should rather mediate, guide and organize the educational process becoming shadow partners of their students in achieving the desired skills. The assessment of the students should also comply to the digitalization process by including novel evaluation techniques such as quizzes, individual and team assignments, objective structured clinical examination in order to objectively mirror the student’s progress during the training program. Therefore, this review synthetized current insights in learning and training techniques that should be implemented for addressing the needs of innovation in medical education. [ABSTRACT FROM AUTHOR]

Human Immunodeficiency Virus (HIV) infection during pregnancy poses significant risks to both maternal and child health, with potential adverse effects on perinatal outcomes. This study aimed to compare perinatal outcomes, including birth weight, length, Apgar scores, and prematurity rates, between HIV-exposed, uninfected (HEU) children and HIV-unexposed, uninfected (HUU) children. A total of 204 neonates were included in the study, comprising 102 born to HIV-positive mothers and 102 born to uninfected mothers. Our findings revealed significant differences in birth weight (p < 0.001), length (p < 0.001), and Apgar scores at both 1 min (p = 0.003) and 5 min (p < 0.001) between HIV-exposed and -unexposed children. The HIV-exposed group exhibited lower birth weights and lengths, along with lower Apgar scores, indicating potential neonatal health challenges. No significant disparities were observed in the prematurity risk between the two groups (OR = 2.58, p = 0.126), but the risk of being born small for gestational age (SGA) in the case of HEU newborns was significantly high (OR = 17.41, p < 0.001). The significant differences in birth weight, length, and Apgar scores underscore the need for tailored healthcare interventions and support for neonates born to HIV-positive mothers. These findings contribute to our understanding of the complex interplay between maternal HIV infection and perinatal outcomes, guiding healthcare professionals in delivering targeted care for this vulnerable population. [ABSTRACT FROM AUTHOR]

Introduction: Cytomegalovirus (CMV) infection is present in a latent state in 70–90% of the immunocompetent population, and its reactivation might be triggered by inflammatory conditions such as post-COVID multisystem inflammatory syndrome (MIS-C) or by immunosuppression induced by steroids. The aim of this paper was to highlight the unexpected complications associated with SARS-CoV-2 infection that require a complex clinical approach for accurate diagnosis. Materials and Methods: We present the case of a 4-year-old male patient who, during an initially favorable course of PIMS, experienced symptoms of respiratory failure. Results: The patient initially presented with clinical and paraclinical signs of PIMS with cardiac involvement, for which high-dose corticosteroid therapy was initiated, followed by gradual tapering, along with immunoglobulins, anticoagulants, antiplatelet agents, and symptomatic treatment. After 10 days of favorable progress, the patient's general condition deteriorated, showing tachypnea, desaturation, and a ground-glass appearance on thoracic CT. Negative inflammatory markers and favorable cardiac lesion evolution ruled out MIS-C relapse. The presence of anti-CMV IgM antibodies and viral DNA in the blood confirmed acute CMV infection, likely triggered by prior severe-acute-respiratory-syndrome-related coronavirus 2 (SARS-CoV-2) infection and secondary immunosuppression due to steroids. Non-specific immunomodulatory treatment was initiated but led to worsening of pulmonary lesions, prompting the initiation of specific antiviral treatment with ganciclovir, resulting in rapid clinical and imaging improvement. Conclusions: CMV infection can be reactivated by immunosuppression induced by corticosteroid therapy for MIS-C and may require specific etiological treatment. [ABSTRACT FROM AUTHOR]

Acute gastroenteritis in pediatric patients represents a major cause of morbidity and mortality in children. Interleukins 6 (IL-6) and 8 (IL-8) have been intensely studied in relation to various inflammatory conditions, including acute gastroenteritis, as they are activated in response to infection. This review aims to evaluate the ability of IL-6 and IL-8 to distinguish between bacterial and viral etiologies of acute gastroenteritis in children and to assess whether their levels correlate with the severity of this condition in light of currently available data. A scientific database search was performed to identify studies that investigated the role of IL-6 and IL-8 in acute gastroenteritis in the pediatric population. We identified nine studies that matched the review's objective. Both cytokines show increased values in acute gastroenteritis, but IL-6 levels are significantly higher in cases of bacterial infections. IL-8 levels do not present an increase to the same extent in cases of bacterial diarrhea in children but seem to be associated with the severity of the disease. The lack of sufficient research focusing on IL-6 and -8 as diagnostic, prognostic and severity biomarkers of acute gastroenteritis in children leaves room for further research on this topic, which must include larger cohort studies. [ABSTRACT FROM AUTHOR]

Small intestinal bacterial overgrowth (SIBO) is characterized by an increase in the bacterial population of the small intestine due to an imbalance between the amount of bacteria and the intestinal barrier. Pediatric SIBO presents with a wide spectrum of symptoms, ranging from mild gastrointestinal complaints to malabsorption or malnutrition. Breath tests are commonly used as noninvasive diagnostic tools for SIBO, but a standardized methodology is currently unavailable. Intestinal flora produces methane which slows intestinal transit and increases the contractile activity of small intestine. Emerging literature suggests a correlation between overgrowth of methanogenic bacteria in the intestines and constipation. Treatment of SIBO involves administration of antibacterial therapy in addition to management of underlying conditions and optimal dietary adjustments. However, research on antibiotic treatment for pediatric patients with constipation and SIBO is limited and has yielded conflicting results. In the current review, we summarize the state-of-the-art of the field and discuss previous treatment attempts and currently used regimens for SIBO patients with constipation, with a focus on pediatric populations. [ABSTRACT FROM AUTHOR]

Background: Conflictual results regarding the relationship between plasmatic level of visfatin and obesity could be explained by the influence of the gene variants involved in the synthesis or action of these hormones.

Childhood obesity is a major public health problem worldwide with an increasing prevalence, associated not only with metabolic syndrome, insulin resistance, hypertension, dyslipidemia, and non-alcoholic fatty liver disease (NAFLD), but also with psychosocial problems. Gut microbiota is a new factor in childhood obesity, which can modulate the blood lipopolysaccharide levels, the satiety, and fat distribution, and can ensure additional calories to the host. The aim of this review was to assess the differences and the impact of the gut microbial composition on several obesity-related complications such as metabolic syndrome, NAFLD, or insulin resistance. Early dysbiosis was proven to be associated with an increased predisposition to obesity. Depending on the predominant species, the gut microbiota might have either a positive or negative impact on the development of obesity. Prebiotics, probiotics, and synbiotics were suggested to have a positive effect on improving the gut microbiota and reducing cardio-metabolic risk factors. The results of clinical trials regarding probiotic, prebiotic, and synbiotic administration in children with metabolic syndrome, NAFLD, and insulin resistance are controversial. Some of them (Lactobacillus rhamnosus bv-77, Lactobacillus salivarius, and Bifidobacterium animalis) were proven to reduce the body mass index in obese children, and also improve the blood lipid content; others (Bifidobacterium bifidum, Bifidobacterium longum, Lactobacillus acidophilus, Lacticaseibacillus rhamnosus, Enterococcus faecium, and fructo-oligosaccharides) failed in proving any effect on lipid parameters and glucose metabolism. Further studies are necessary for understanding the mechanism of the gut microbiota in childhood obesity and for developing low-cost effective strategies for its management. [ABSTRACT FROM AUTHOR]

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

This document is an editorial introducing a special issue titled "Multidisciplinarity and Transdisciplinarity in the Diagnosis and Treatment of Pediatric Gastrointestinal Diseases." The field of pediatric gastroenterology has seen significant development in recent years, with advancements in diagnostic and therapeutic techniques. The special issue aims to provide new insights into pediatric gastrointestinal diseases, covering a wide range of conditions such as celiac disease, inflammatory bowel disease, and food allergies. The issue also highlights the importance of multidisciplinary teams in managing these diseases. The editorial emphasizes the need for accurate diagnosis and management to improve patient care and reduce healthcare costs. It discusses specific challenges in pediatric gastrointestinal diseases, including gastroesophageal reflux disease, eosinophilic esophagitis, Helicobacter pylori infection, cystic fibrosis, and inflammatory bowel disease. The document concludes by stating that the articles in the special issue contribute to the progress in the field and provide valuable information for clinicians and researchers. [Extracted from the article]

In adults with immune thrombocytopenic purpura (ITP), the identification of H. pylori infection and its subsequent eradication proved to aid platelet recovery. Similar findings, at a smaller scale, were allegedly reported by some pediatric studies. This review's objective was to establish the influence of H. pylori infection and its eradication upon platelet count and recovery in pediatric ITP. Three databases, namely Pubmed, Scopus and Web of Science, were searched for pediatric studies which investigated a link between H. pylori infection and thrombocytopenia. The search results retrieved a number of 21 articles which complied to the inclusion and exclusion criteria. Some studies report lower platelet values among children with ITP and documented H. pylori infection, as well as an improve in platelet numbers after H. pylori treatment. However, results are controversial, as multiple authors failed to identify a higher prevalence of H. pylori among children with ITP or a lack of significant change in therapeutic outcome with the addition of an eradication regimen to standard treatment. The main limitations of current pediatric studies remain the small study samples and the short follow-up periods of the included subjects. Hence, the long-term impact of H. pylori in children with ITP is still uncertain. [ABSTRACT FROM AUTHOR]

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

Helicobacter pylori și Giardia lamblia sunt răspândite în întreaga lume. Helicobacter pylori este un factor favorizant pentru prezența Giardia lamblia în stomac datorită neutralizării pH-ului gastric prin secreția de urează. Prezentăm cazul unui copil în vârstă de 5 ani, cu simptome gastro-intestinale intermitente în antecedentele personale patologice recente, care s-a internat în clinica Pediatrie 1 Târgu Mureș pentru dureri abdominale, grețuri, inapetență și hematemeză. Endoscopia digestivă superioară a evidențiat multiple sufuziuni hemoragice ale mucoasei gastrice, iar examenul histopatologic al mucoasei gastrice antrale a identificat coexistența infecției cu Helicobacter pylori și Giardia lamblia. Evoluția pacientului a fost favorabilă sub terapia de eradicare a infecției cu Helicobacter pylori și tratamentul antiparazitar administrat, endoscopia de control arătând o mucoasă fără modificări vizibile macroscopic, iar reevaluare histopatologică evidențiind modificări regenerative ale mucoasei gastrice. Particularitatea cazului este reprezentată de identificarea prezenței parazitozei cu Giardia lamblia în mucoasa gastrică, mediu fiziologic acid, alcalinizat de ureaza secretată de Helicobacter pylori, asigurând astfel condiții favorabile dezvoltării acestui parazit la un copil în vârstă de 5 ani, dintr-un mediu socio-economic favorabil, cu simptome gastro-intestinale intermitente în antecedentele personale patologice recente.

Sepsis is a systemic inflammatory response (SIRS) characterized by two or more of the following: fever > 38.5 °C or

Scop: evaluarea nivelelor serice de micronutrienţi la copii cu tulburări de nutriţie, şi aprecierea corelaţiei dintre acestea şi măsurătorile antropometrice. Material şi metode: Studiul a fost realizat pe 125 copii (0-18 ani); lotul de lucru a constat în copii cu scoruri Z < -2 deviaţii standard pentru cel puţin o măsurare antropometrică, copii fără tulburări de creştere fiind consideraţi lot de control. Astfel, pentru fiecare măsurare antropometrică am avut diferite loturi de lucru/control, folosite pentru evaluarea corelaţiei cu rezultatele de laborator. Am urmărit opt parametri antropometrici şi relaţia lor cu cinci micronutrienţi (Ca, Mg, Fe, Zn şi Cu). Rezultate: nu s-au găsit diferenţe semnificative între nivelurile serice de micronutrienţi nici în funcţie de sex, nici în funcţie de mediul de provenienţă. Cel mai frecvent, nivelurile serice medii de micronutrienţi au fost mici la copiii cu scoruri Z < -2 deviaţii standard (cu excepția Cu). Mg şi Ca s-au corelat pozitiv cu majoritatea măsurătorilor antropometrice. Pentru Fe, Zn şi Cu nu am găsit nici o corelaţie, cu niciuna dintre măsurile antropometrice. Diferenţe între nivelurile serice medii au fost găsite pentru Mg, cu valori mai scăzute la copii cu greutate scăzută pentru vârstă şi pliu tricipital redus, respectiv pentru Cu, cu niveluri mai ridicate la copii pliu tricipital redus. Indicii eritrocitari au fost corelaţi pozitiv cu nivelurile de Fe şi Zn. Concluzii: corelaţii între nivelul seric de micronutrienţi şi scorurile de evaluare antropometrică au fost găsite pentru Mg şi Ca, dar nu pentru Fe şi Zn, care în schimb s-au corelat direct cu indicii eritrocitari. Mg, Fe şi Zn tind să prezinte valori serice mici la copiii cu deficite de creştere. Având în vedere costurile, evaluarea de rutină a nivelurilor serice de Zn şi Cu la copii cu suspiciune de tulburări de creştere nu este justificată în zona noastră geografică.

Although initially the evolution of Coronavirus disease 2019 (COVID-19) seemed less severe in pediatric patients, in the three years since the beginning of the pandemics, several severe cases have been described, pediatric inflammatory multisystem syndrome (PIMS) has been defined, pathogenesis is being continuously studied, and many aspects regarding the long-term evolution and multi-organ damage are still unexplained. Cardiac injuries in COVID-19 represent most-likely the second cause of mortality associated with the infection. A widespectrum of cardiac abnormalities were reported to be associated with COVID-19 in children including ventricular dysfunction, acute myocardial dysfunction, arrhythmias, conduction abnormalities, coronary artery dilation or aneurysms, and less common pericarditis and valvulitis. Risk factors for severe COVID-19 in children should be identified, laboratory tests and imaging techniques should be performed to reveal cardiac injury as soon as possible. The aim of this review was to highlight the great value of repeated cardiological monitoring in patients with COVID-19, underlining also the peculiarities in terms of pediatric population. This review is looking for answers on questions like 'Why do some, but not all, patients with COVID-19 develop cardiac injury or severe hyperinflammatory status?', 'Which factors are involved in triggering COVID-19 associated cardiac injury?', 'What are the mechanisms involved in the etiology of cardiac injury?', 'Is there a clear relationship between hyperinflammation and cardiac injury?', 'Is hyperinflammatory status the pre-stage of cardiac injury in COVID-19 patients?' which still lack clear answers. The understanding of mechanisms involved in the development of COVID-19 associated cardiac injury might shed light on all the above-mentioned mysteries and might increase the likelihood of favorable evolution even in severe cases. [ABSTRACT FROM AUTHOR]