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Background: Known also as Osler’s triad, Austrian syndrome is a complex pathology which consists of pneumonia, meningitis and endocarditis, all caused by the haematogenous dissemination of Streptococcus pneumoniae. The multivalvular lesions are responsible for a severe and potential lethal outcome.

Staphylococcal scalded skin syndrome (SSSS) is the medical term used to define a skin condition induced by the exfoliative toxins produced by Staphylococcus aureus. The disorder is also known as Ritter disease, bullous impetigo, neonatal pemphigus, or staphylococcal scarlet fever. The disease especially affects infants and small children, but has also been described in adults. Prompt therapy with proper antibiotics and supportive treatment has led to a decrease in the mortality rate.

Introducere. Boala Wilson (BW) este o boală autozomală recesivă a metabolismului cuprului, ce implică ficatul, sistemul nervos și alte organe. La copii, forma cea mai frecventă este cu afectare hepatică, având manifestări variabile, de la creșterea ușoară a transaminazelor până la insuficiență hepatică acută (IHA). În adolescență, în principal la fete, BW poate debuta ca anemie hemolitică nonimună cu IHA. Această prezentare de caz își propune să crească gradul de conștientizare cu privire la insuficiența hepatică acută ca formă severă de prezentare a bolii Wilson la copii. Prezentarea cazului. Raportăm cazul unei adolescente de 13 ani care a fost internată cu dureri abdominale și icter. Parametrii de laborator au evidențiat anemie hemolitică, o creștere ușoară a transaminazelor, un nivel foarte ridicat al bilirubinei și coagulopatie severă. Nivelul ceruloplasminei serice a fost de 6 mg/dl. Am stabilit diagnosticul de boală Wilson cu anemie hemolitică nonimună și insuficiență hepatică acută. Rezultatele genetice au confirmat diagnosticul de boală Wilson, pacienta fiind cu status homozigot pentru varianta p.Lys844Ter (c.2530A>T) a genei ATP7B. S-a iniţiat terapia chelatoare cu D-penicilamină, alături de terapia intensivă de susținere. Pacienta a fost transferată către Institutul Fundeni din București pentru transplant hepatic, care a fost efectuat cu succes cinci zile mai târziu. Concluzii. Insuficiența hepatică acută este o formă rară, dar foarte severă a bolii Wilson, cu un risc ridicat de deces, în lipsa unui transplant hepatic. Diagnosticul precoce și transferul către un centru specializat pentru transplant hepatic sunt vitale la acești pacienți. Terapia chelatoare poate fi salvatoare, iar suportul hepatic extracorporeal poate fi utilizat până când transplantul hepatic de urgență este disponibil. Cuvinte-cheie: boala Wilson, hemoliză nonimună, insuficiență hepatică acută, transplant hepatic, adolescență [ABSTRACT FROM AUTHOR]

Introducere. Incidenţa fumatului atinge cote alarmante la nivel mondial, iar adolescenţii reprezintă grupa de vârstă cea mai predispusă la procesul de iniţiere a fumatului. Consecinţele sunt numeroase, atât prin complicaţii medicale, cât şi prin costurile implicite. Situaţia exactă în ceea ce priveşte fumatul la adolescenţi la nivel naţional nu este cunoscută, dar intensificarea intervenţiilor la vârstă pediatrică este absolut necesară. Material şi metode. Studiul s-a bazat pe un chestionar care a cuprins un număr de 10 întrebări, aplicat la 371 profesionişti (medici pediatri, medici de familie etc.) în domeniul sănătăţii. Aceştia au semnat un consimţământ informat privind participarea la studiu. Studiul a fost aprobat de Comisia de Etică a Societăţii Române de Pediatrie. Rezultatele au fost centralizate şi prelucrate statistic. Rezultate şi discuţii. Majoritatea respondenţilor cunosc noţiunile referitoare la fumat şi consecinţele acestui obicei asupra stării de sănătate. Peste 90% dintre cei chestionaţi insistă asupra aspectelor legate de fumat în discuţiile cu pacienţii şi cu părinţii acestora, încercând identificarea cât mai rapidă a elementelor de risc. Fumatul în timpul sarcinii şi în perioada de alăptare a fost identificat în 82% dintre chestionarele realizate. Concluzii. Magnitudinea fumatului la populaţia pediatrică este îngrijorătoare, plasând România pe locul 4 în Uniunea Europeană în ceea ce priveşte numărul adolescenţilor de 13 ani care fumează săptămânal. Combaterea acestui fenomen trebuie realizată în bună parte de către profesioniştii din domeniul medical prin informarea corectă, completă şi permanentă a adolescenţilor şi, deopotrivă, a părinţilor, utilizând argumente ştiinţifice medicale şi, totodată, evaluând periodic această categorie de adolescenţi în vederea identificării apariţiei precoce a patologiilor derivate în urma fumatului. [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]

In this paper, the authors presents the results of their research made in south west of Romania to evidence the level of foodstuffs and feedstuffs contamination with Fusarium sp. and zearalenone. The authors considers that this type of studies is very important because the foodstuffs and feedstuffs that were infected with different fungi could be contaminated with mycotoxins and these products could produce different affections to the people and to the animals. This is the reason because the contaminated food and feed must be eliminated of the people and animal consumption, if exceeds the maximum levels imposed by legislation. The results are synoptically presented in tables, comparatively with other author's results. [ABSTRACT FROM AUTHOR]

Prin incidența sa mare, morbiditățile asociate – unele constituind și cauze principale de mortalitate - , implicațiile psihologice, stigmatizarea și discriminarea asociate, obezitatea constituie o importantă problemă de sănătate publică. Numeroase aspecte etice intervin în discuțiile legate de obezitate; nutriția și activitățile fizice se impletesc cu numeroși alți factori, de la reglementările guvernamentale la interesele comerciale. Aspectele etice de bază în legătură cu obezitatea copilului sunt: necesitatea unei echipe medicale care să comunice şi să colaboreze cu pacienţii şi familiile acestora (respectând normele deontologiei profesionale) pentru a preveni obezitatea, a diagnostica şi trata boala de bază (în obezitatea secundară) şi a alege cel mai eficient management cand obezitatea s-a instalat; alt aspect este educarea, informarea şi consilierea pacienţilor şi părinţilor de către medic şi dietetician; susţinerea pacienţilor în a-şi automonitoriza dieta şi greutatea, susţinere psihologică, implementarea unor strategii de schimbare a stilului de viață, într-o abordare individualizată, cu respectarea drepturilor copilului în fiecare caz; în privinţa tratamentului medicamentos se va avea în vedere că majoritatea preparatelor sunt încă în proces de evaluare sau în stadii experimentale. Un aspect important este interacțiunea cu părinţii: este necesară informarea, consilierea şi susţinerea părinţilor, în situaţii extreme impunîndu-se decăderea din drepturile părinteşti prin hotărâre judecătorească. Dacă nu putem interveni in aspectele genetice şi nu putem influenţa aspectele psiho-sociale sau trendurile culturale, am putea modela alţi factori de mediu a căror implicare în apariţia obezităţii a fost documentată, prin iniţierea şi susţinerea unor politici de prevenire a excesului ponderal; implicarea mass-media în programele de promovare a sănătăţii poate ajuta la educarea şi informarea populaţiei. Un alt element de luat in considerare ar fi elaborarea şi utilizarea unor ghiduri de practică medicală pentru diagnosticul şi managementul obezitătții pediatrice şi, nu în ultimul rând, necesitatea alocării de resurse pentru asistenţă medicală. [ABSTRACT FROM AUTHOR]

The congenital valves belonging to the posterior urethra, have a congenital anomaly characterized by the presence of some semicircular folds of the posterior urethral mucous membrane, which create obstacle in the evacuation of the urine with serious consequences to the superior urinary apparatus. It is in general an affection which occurs with an ethyopathogenic source : the valves of the posterior urethra, polypi, and strictures. The obstruction of the urethral lesions, generate an unusual symptomatology : disurea, an increased urinal frequency, the reduction of the urinary sprinkle, urinary incontinence, terminal hematurea, bladder globe, hydronephrosis, urinary infection, sepsis. The positive diagnosis is based on the rapid echographical discovery of this medical problem, starting from the 28th week of pregnancy, followed by a urinary cistography and retrograde urethrography. The improvement of the surgical methods of treatment in order to improve the posterior urethral valve diagnosis, are concerned with finding these medical problems as soon as possible, and the most important methods of treatment are endoscopic ablation of the valves. Material and method:The studied group comprised male children diagnosed with vesicoureteral reflux their ages ranking between 0 -18 years, admitted to the Pediatric Clinic, Tg Mures during the last 10 years. Children diagnosed and operated with posterior urethra valves at the Surgical Clinic of the M.S. Curie Hospital, Bucharest during the last 20 years. Results: Our results show that out of the total 170 children admitted to the Pediatrics Clinic II in Tg.-Mures with vesicoureteral reflux, 5 were diagnosed with posterior urethra valves (as compared to the 20 children undergoing surgery with PUV in the Marie Curie Clinic in Bucharest). The imagistic examinations indicated 4 cases of type I, and 3 cases of type III PUV. Conclusions:We can conclude that the presence of the vesicoureteral reflux is an unfavourable prognosis regarding the degree of renal failure. [ABSTRACT FROM AUTHOR]

The 3D multiplanar ultrasound is lately used for the study of the fetal face. The possibility of acquiring a volume which includes the whole fetal cephalic extremity, with further processing in various sections of nasal bone imaging, has opened new perspectives on the study of an ultrasound sign as a call for genetic syndromes. The aim of the paper is to assess the utility of acquiring of a single volume 3D, for the study of both nasal bones in the normal fetus. Material and method: A lot of 20 pregnant women, with a unique pregnancy and normal fetal echo structure, who had come at the screening of 12-14 gestational weeks, were scanned with an ultrasound machine, equipped with abdominal and vaginal 3D transducer, with a volume that included the acquisition of fetal head with the ultrasound beam direction directly to the fetus face, with an angle between the transducer and the long axis of the nose close to 45ş. Further analysis of the volume through multislice technique, to obtain an oblique transverse section of the skull along the nasal bones, could lead to simultaneous evidence of the two nasal bones, with their measurement. Results: All the fetuses had an acquire of 3D volume, satisfactory in terms of further processing of the image, obtaining optimal section comprising .top. sight of both, whole nasal bones. The average duration of volume processing, up to the oblique cross section described, was 20 minutes. Conclusions: The acquire of a single volume of the cephalic extremity, with the fetal face towards the ultrasound transducer, is a reliable method to obtain a section of the two nasal bones, at the time of the screening of 12-14 gestational weeks. [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]

Mucopolizaharidozele (MPZ) sunt un grup de boli genetice rare din marea familie de boli lizozomale. Tulburările (MPZ) sunt cauzate de o deficienţă în activitatea unei enzime lizozomale specifice necesare pentru degradarea glicozaminoglicanilor (GAG). MPZ tip II, numită şi sindromul Hunter, constă dintr-un deficit al unei enzime, iduronat-2-sulfataza. Vă prezentăm un caz rar de sindrom Hunter cu prezentare atipică. Este vorba despre un băiat de 2,7 ani, care s-a prezentat la Clinica Pediatrie I cu simptome de infecţie a tractului respirator, cu antecedente de multiple infecţii ale otice şi respiratorii. Examenul clinic e evidenţiat: statură mare, moderat supraponderal, dismorfi sm facial (caracteristici faciale grosiere, frunte proeminentă, nas lărgit şi deprimat), degete mici butucănoase, cu flexie a articulaţiilor interfalangiene distale, rigiditate articulară, abdomen proeminent cu hernie ombilicală, hepatomegalie şi splenomegalie, precum şi uşor retard mental. Aspectul clinic a fost sugestiv pentru MPZ tip I, II sau VII. Dozarea enzimelor cu rol în metabolismul mucopolizaharidelor lizozomale a relevat un nivel scăzut al iduronat-2-sulfatazei, modifi cari caracteristice pentru MPZ tip II. Diagnosticul enzimatic a fost confi rmat prin analiza ADN-ului molecular care a arătat o mutaţie a genei hemizigote iduronate-2-sulfatazei la nivelul intronului 3 (c.419-2A>G). S-a instituit terapia de substituţie enzimatică genetic recombinată de iduronat-2-sulfatază (Elaprase®). Evoluţia cazului, după aproape doi ani de tratament cu Elaprase este favorabilă, fără pierderi ale achiziţiilor neurologice. [ABSTRACT FROM AUTHOR]

Introduction: Nephroblastoma is the most frequent primary malignant renal tumor in child (90-95% of all renal malignant tumors), with a peak of incidence between 3-5 years of age. The ultrasound reveals a well delimited mass, with Doppler signal, hemorrhagic and necrotic areas, and sometimes, calcifications. The tumor may extend to the surrounding organs or within the inferior vena cava and renal vein. Material and method: We report the case of 1 year and 2-month-old male child diagnosed with left nephroblastoma to underline the major role of abdominal ultrasound in diagnosing this tumor. Results: The patient presented the onset 3 weeks before the admission with persistent fever and altered general status, whose laboratory test revealed severe hepatic cytolysis syndrome, and the abdominal ultrasound raised the suspicion of a left renal tumor, thus being transferred in our clinic. The laboratory tests showed Hgb 11.7 g/dl, ESR 35 mm/h, LDH 632 U/L, AST 337 U/L, ALT 635.3 U/L, and serum cooper 156.6 μg/dl. The urine exam pointed out microscopic hematuria. The renal parameters, bone marrow exam and urinary vanillylmandelic acid were within normal ranges, while the neuron specific enolase mildly increased (29.63 ng/ml), ruling out a neuroblastoma. The abdominal ultrasound revealed mild hepatomegaly, in the left renal lodge an echoic, inhomogeneous mass, with a diameter of 99.2/46.6, present Doppler signal, with septs within the superior pole, which does not overpass the renal capsule. The abdominal CT confirmed the ultrasound aspect. The patient benefited form left nephrectomy and chemotherapy, with favorable evolution. Conclusions: Abdominal ultrasound is the first imagistic investigation used for abdominal tumor masses. Its role is essential in most of the cases since it provides very useful details for establishing the diagnosis. Nephroblastoma is one of the tumors where abdominal ultrasound fully justifies its importance. [ABSTRACT FROM AUTHOR]

Background: Phenylketonuria is a genetic disease caused by mutations in the gene encoding phenylalanine-hydroxylase. The accumulation of phenylalanine in different tissues leads to numerous adverse consequences, particularly in the central nervous system: mental retardation, delay in neuro-psychic development, behavioral problems. Detected at birth, the disease can be controlled by a dietary regimen that is poor in phenylalanine. A National Screening Program for Phenylketonuria was started in 2009. Objectives: Evaluation of the results of the screening program for phenylketonuria in Mures county during 2009-2017. Methods: We included in the study all children born in the 7 maternities in Mures county, and starting with 2017 in Bistrita-Nasaud county as well. Levels of phenylalanine were determined by fluorimetric assay. Newborns with levels of phenylalanine greater than 3 mg / dl were retested. Results: Elevated levels of phenylalanine were detected in 12 cases of 46,728 tested newborns. In one case re-testing did not confirm the diagnosis of phenylketonuria. The cases detected are followed-up at the Pediatric I Clinic of Targu Mures and they receive periodically special dietary products. Conclusions: Phenylketonuria is a rare metabolic disorder that may have serious consequences. Dietary regimen is the only therapeutic method used in the treatment of this disease. [ABSTRACT FROM AUTHOR]

Introduction: A curricula focused on developing students communication skills is still a critical aspect and remain in many universities an individual challenge. Objective: The paper proposes as a solution for this teaching gap a strategy that explores the benefits of Problem Based Learning (PBL). Applying the ability of solving problems, using preexistent knowledge and finding new information, students could be motivated to find answers for pediatric communication cases. Material and methods: PBL could be organized in 2 sessions following the classical 7 steps method proposed by H.G. Schmidt. The first session contains: the presentation of the problem and clarifying terms, defining the main and secondary problems, brainstorming on existing knowledge followed by the structuring of information and elaborating the learning objectives. The learning objectives represents the homework for students, all being involved in collecting additional information outside the group. The second session, guided by the teacher, is dedicated for synthesisof new information reached by the group so that the problem could be solved. An important step remains also the reflection that should be done on regular basis, when the need arises. Results: Using this design for teaching communication skills, students will be able to study on authentic cases, to develop their critical thinking finding solutions, but also to focus on particular aspects as: team work, communication with peers, ethics and professionalism. Conclusions: PBL could represents a solution for teaching comunication skills for students, the main challenge for the institution remaining the design of the problems and the training of tutors. [ABSTRACT FROM AUTHOR]

Child obesity is a current reality and a public health problem, given its medical and social implications. Interleukin 6 (IL-6) is an inflammatory marker of obesity. The polymorphism of genes IL-6 572 G/C modifies the producing of protein, influencing the level of the cytokine. Our aim was to establish the correlations between IL-6 gene 572 G/C polymorphism and obesity in a children population from Romania, aspects that weren't studied before in children. Methods We assessed 222 consecutively hospitalized patients in a tertiary emergency pediatric hospital. The patients were divided according to BMI, in two groups: the control group - I, consisting of 110 patients, age and gender-matched patients with normal nutritional status and group II, 102 patients with obesity. The two groups underwent IL-6 572, G/C polymorphism evaluation, as well as anthropometric assessment (middle upper arm circumference, MUAC, tricipital skin-fold thickness, TST), and biochemical tests (protein, albumin, leptin, adiponectin and VEGF).Results: We observed that the phenotype CC of IL-6 572 Gene was more frequent in obese children (p=0.0001) than GG or GC phenotypes. When we applied a multivariate regression in which the dependent variable was leptin (the others being independent variables), we pointed that leptin was dependent of IL-6 572 gene polymorphism, while adiponectin was not; also, leptin was dependent of albumin. Anthropometric parameters (MUAC and also TST) significantly correlated with phenotypes CG and GG (p=0.0001) in obese children; the same, leptin correlated significantly for all three haplotypes, and VEGF especially for haplotypes CC. Conclusion: BMI, MUAC, TST and serum albumine levels correlate with CC allele carriers of IL-6 572 gene in children with obesity. The highest risk of developing obesity was found in children C carriers of the polymorphism of gene IL-6 572. [ABSTRACT FROM AUTHOR]

Introducere. Pneumoniile la copii determină o rată mare a morbidității și mortalității, în special la copiii mici. Evoluția și prognosticul sunt influențate de o serie de parametri clinico-biologici, în raport cu vârsta copilului și cu terapia primită. Obiective. Evaluarea statusului proinflamator la pacienții cu pneumonie. Material şi metode. Studiul a fost realizat în cadrul Clinicii Pediatrie I din cadrul Spitalului Clinic Județean de Urgență din Târgu Mureș, România, în perioada septembire 2018 - decembrie 2019, și a inclus 95 de pacienți. Rezultate. Analiza nivelului seric al proteinei C reactive, varianta înalt-senzitivă (hsCRP), a arătat o corelație pozitivă, semnificativ statistică între nivelul la internare și numărul de neutrofile la internare (p = 03169, r = 0,2801), respectiv o corelație negativă, semnificativ statistică între nivelul la externare și nivelul leucocitelor (p = 0,0253, r = -0,2911), monocitelor (p = 0,0014, r = -0,4105) și neutrofilelor (p = 0,0335, r = -0,2793) la externare. Dintre cele trei citokine monitorizate (IL-1β. IL-6 și TNF-α), au fost observate corelații semnificativ statistic pentru TNF-α. Astfel, a fost identificată o corelație pozitivă, semnificativ statistică între valorile limfocitelor (p = 0,0007, r = 0,3448), monocitelor (p = 0,00563, r = 0,2896) și ale trombocitelor (p = 0,0335, r = 0,2195) la internare cu valorile markerului seric TNF-α. De asemenea, a fost identificată o corelație negativă, semnificativ statistică între valorile hemoglobinei (p = 0,0034, r = -0,328) și ale hematocritului (p = 0,0004, r = -0,3932) la externare cu valorile markerului seric TNF-α. Au fost observate următoarele corelații: corelație negativă, semnificativ statistică între TNF-α și NLR (p = 0,0144, r = -0,2601), NPR (p = 0,0473, r = -0,2051) și PLR (p = 0,0138, r = -0,2602), corelație pozitivă, semnificativ statistică între hsCRP la internare și NLR (p = 0,0124, r = 0,3264), NPR (p = 0,0073, r = 0,3460) și corelație pozitivă, semnificativ statistică între hsCRP la externare și NLR (p = 0,0189, r = 0,3128), PLR (p = 0,0036, r = 0,3831). Concluzii. Studiul nostru a arătat că valorile neutrofilelor, limfocitelor, monocitelor și trombocitelor, NLR, PLR și TNF-α au fost semnificativ crescute în pneumonii, corelându-se și cu PCR, subliniind statusul inflamator precoce apărut în acestă afecțiune. [ABSTRACT FROM AUTHOR]

Introduction. Pneumonia in children causes a high rate of morbidity and mortality, especially in young children. The evolution and prognosis are influenced by a series of clinical-biological parameters, in relation to the child's age and the therapy received. Objectives. Assessment of proinflammatory status in patients with pneumonia. Material and methods. The study was conducted at the Pediatrics Clinic I within the Emergency County Clinical Hospital in Tg. Mures, Romania, between September 2018 and December 2019 and included 95 patients. Results. Analysis of the serum level of C-reactive protein, the high-sensitive form (hsCRP), showed a positive correlation, statistically significant between its level at admission and the number of neutrophils at admission (p = 03169, r = 0.2801), respectively a negative correlation, statistically significant between its level at discharge and the level of leukocytes (p = 0.0253, r = -0.2911), monocytes (p = 0.0014, r = -0.4105) and neutrophils (p = 0.0335, r = -0.2793) at discharge. From the three monitored cytokines (IL-1β, IL-6 and TNF-α) statistically significant correlations were observed for TNF-α. Thus, a positive, statistically significant correlation was identified between lymphocyte values (p = 0.0007, r = 0.3448), monocytes (p = 0.00563, r = 0.2896) and platelets (p = 0.0335, r = 0.2195) at admission with the values of the serum marker TNF-α. Also, a negative, statistically significant correlation was identified between hemoglobin values (p = 0.0034, r = -0.328) and hematocrit (p = 0.0004, r = -0.3932) at discharge and the TNF-α serum marker values. The following correlations were observed: negative correlation, statistically significant between TNF-α and NLR (p = 0.0144, r = -0.2601), NPR (p = 0.0473, r = -0.2051) and PLR (p = 0, 0138, r = -0.2602), positive correlation, statistically significant between hsCRP at admission and NLR (p = 0.0124, r = 0.3264), NPR (p = 0.0073, r = 0.3460) and positive correlation, statistically significant between hsCRP at discharge and NLR (p = 0.0189, r = 0.3128), PLR (p = 0.0036, r = 0.3831). Conclusions. Our study showed that the values of neutrophils, lymphocytes, monocytes and platelets, NLR, PLR and TNF-α were significantly increased in pneumonia, correlating with C-reactive protein, highlighting the early inflammatory status in this condition. [ABSTRACT FROM AUTHOR]

Introduction: In Romania, 1 of 2 children with age between 0-2 years has a nutritional deffciency, usually with a low adherence to routine medical check-ups, and national vaccination rate is under 75%. When it comes to child health, parents use mainly internet and unauthorised sources to get informations. Starting from this issues, we plan to create an online platform, an authorised source of health education to help parents throughout parenthood. Project Aim: Presentation of DaDa Baby platform. Material and methods: Implementing an eHealth instrument using pediatric guidelines. Results: Dada Baby is an eHelth instrument, through which parents can have acces to child milestones for age groups, a guide for recomended medical check-ups and is also offering the possibility to create a medical history easy to acces. Themobile application will send notifications if the child missed any medical checkup or if some milestones weren›t achieved at a proper age. Users will be just at one click distance of their pediatrician. Conclusions: Digital era marked significantly the innovation in the medical field. Dada baby is a project that aims to make parents more responsible towards a healthy growth of their children, to improve adherence to routine medical controls and vaccination, and to facilitate access and communication with their pediatrician. [ABSTRACT FROM AUTHOR]

Introduction: pGALS (Pediatric Gait, Arms, Legs and Spine) is a method of examining the gait, upper and lower limbs and spine in order to evaluate the joints. pREMS (regional examination of the musculoskeletal system) refers to the regional examination of the musculoskeletal system in children. Rheumatological disorders are sometimes difficult to identify, thus prolonging the diagnostic time. Scope: The presentation of the pGALS and pREMS examination and the study of the literature in order to assess the need to introduce the pGALS and pREMS examination methods as part of the clinical examination of the child in the current practice of family physician and pediatrician for an earlier diagnostic of rheumatological disorders. Material and method: We synthesized literature data on this topic, both for rheumatological and other aetiology. Results: We identified 14 international papers with reference to pGALS in the international database search. The pGALS application time was between 2.9 and 4.5 minutes. Up to 97% of patients did not experience discomfort during pGALS examination. The analyzed materials recommended the use of pGALS as a method of identifying rheumatologic disorders. Conclusions: pGALS and pREMS have been shown to be effective in diagnosing patients with rheumatologic conditions. Applying these methods is easily accepted by children and parents. We consider it useful to introduce pGALS and pREMS as a screening in the clinical assessment of the pediatric patient. [ABSTRACT FROM AUTHOR]

Introducere. Statusul nutriţional precar este o problemă comună în rândul copiilor cu afecţiuni oncologice. În scopul de a detecta modificările statusului nutriţional şi ale compoziţiei corporale, acest studiu investighează parametrii antropometrici şi compoziţia corporală la pacienţii pediatrici cu leucemie. Material şi metodă. Studiul de tip prospectiv a inclus 33 de pacienţi internaţi în Clinica Pediatrie I Târgu-Mureş împărţiţi în două loturi: lotul I -- lot studiu, pacienţi cu leucemie (15 copii) şi lotul II -- lot control, pacienţi cu afecţiuni pediatrice (18 copii). S-au măsurat parametrii antropometrici (greutatea -- G, înălţimea -- I, indicele de masă corporală -- BMI, perimetrul mediu al braţului -- MUAC şi pliul cutanat tricipital - TST), iar cu ajutorul Analizorului Tanita BC 420 S MAs-a determinat ţesutul gras (FM -- kg şi %), ţesutul non-gras (FFM -- kg), masa musculară (MM - kg) şi procentul de apă totală din corp (TBW -- %). Rezultate. Parametrii antropometrici la lotul de studiu a diferit semnificativ statistic faţă de lotul martor pentru MUAC şi TST (p < 0,05). La copiii din lotul de studiu, FM a fost mult mai redus (14,79 ± 7,14%) comparativ cu lotul martor (21,56 ± 9,06 %) (p = 0,01), iar TBW mai mare (61,84 ± 4,93% versus 57,45 ± 6,64%) (p = 0,02). FFM şi MM nu au diferit statistic la cele două loturi. Concluzii. BIA, alături de antropometria braţelor, este o metodă sensibilă în detectarea alterării compoziţiei corporale la copiii cu malignitate. Comparativ cu lotul de copii cu boli non-maligne, copiii cu leucemii au prezentat alterări mai marcate ale statusului nutriţional. [ABSTRACT FROM AUTHOR]

Malnutrition is a prevalent condition in hospitalized children. Our aims were to evaluate the nutritional state and to validate the STRONGkids risk assessment tool in a hospitalized paediatric population in Romania. This is a prospective single-centre study in a tertiary teaching hospital in Romania (May 2011-January 2012). We calculated the STRONGkids score and measured the children's height and weight. Standard deviation < -2 for weight-for-height and height-for-age was considered to indicate acute or chronic malnutrition respectively. Two hundred seventy-one children were included, with median age of 5.2 years and median hospital stay of 2.01 days. Prevalence of malnutrition and severe malnutrition was 37% and 15% respectively. Using the STRONGkids screening tool, 58% of the children were found at risk of malnutrition (24% were at high risk). The kappa coefficient of agreement between STRONGkids and WHO malnutrition classification was 0.61. When a low serum protein level was used in upgrading STRONGkids risk category, kappa increased significantly to 0.71 (p = 0.001). A modified STRONGkids score, incorporating total serum protein levels, performs well in predicting malnutrition in hospitalized paediatric population in Romania. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the anthropometric and biochemical status of children with nutritional deficiency. Methods: We have conducted a prospective study on 226 children admitted in Pediatric Clinic I, divided into two groups: one group of 49 children with nutritional deficiency (body-mass-index < -2SD) and one control group (177 children). We have followed demographic data, anthropometric indices evaluated as standard deviations (weight, height, middle upper-arm circumference, tricipital skinfold), biochemical proteic status (Insulin-like Growth Factor 1 IGF-1, albumin, total proteins). We also followed parameters of general nutritional biochemistry. Results: The mean age for underweight children was 5.8 years, lower than in the control group. The weight of the nutritional-deficient group was significantly lower than in the control group, unlike the height (p <0.001). We have also found significant differences in body-mass-index, middle upper-arm circumference and tricipital skinfold, all of them with low SDs in children with nutritional deficiency. Regarding the biochemical markers, we have found significantly higher values of transaminases (p <0.001) and lower IGF-1 (p = 0.02) and total proteins (p = 0.013) in nutritional-deficient group. Most IGF-1 values were in normal range in both groups, but with a higher percent of low values in nutritional deficient children (37.5% vs 14.2%, p = 0.0046). There were no significant differences in height, albumin, cholesterol, triglyceride and glucose levels between the two groups. Conclusions: The anthropometric measurements are the most precise methods in evaluating the nutritional status. Among the studied biochemical markers, IGF-1, total proteins and transaminases are correlated with nutritional deficiencies. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the serum levels of infl ammatory markers in children with alterations in nutritional status and the correlation of these markers with clinical diagnoses of infection. Methods. We conducted a prospective study on 120 children admitted to the Pediatric Clinic I Tg. Mures. We have followed the nutritional status and the presence or absence of infectious signs, the children being evaluated anthropometrically and by laboratory analysis (suggestive infection markers). Results. Underweight was found in 28.3% of children, and 24.2% were overweight. Clinically, at least one infectious syndrome has been identified in 31.7% of children, ESR being increased in these children compared to the healthy ones (p=0.034); no differences were observed in the other serological markers. We have found IL-6 and IL-8 values below the detection limit especially in underweight children with diagnosis of infection; significantly higher values of IL-6 and IL-8 were found in overweight children with a diagnosis of associated infection. Conclusions. Interleukins have significantly lower values in underweight children, even in the context of a possible infection. In order to confirm or infirm an infectious syndrome, the clinical judgment is not enough and the corroboration with complex laboratory data is necessary. [ABSTRACT FROM AUTHOR]

Scop. Evaluarea nivelurilor serice ale unor markeri inflamatori la copiii cu alterări ale statusului nutriţional şi corelarea acestor markeri cu patologii infecţioase. Material şi metodă. Am efectuat un studiu prospectiv pe 120 de copii internaţi in Clinica Pediatrie I Tg. Mureş, la care am urmărit statusul nutriţional şi prezenţa sau absenţa unor semne infecţioase, copiii fiind evaluaţi antropometric şi paraclinic prin markeri sugestivi pentru infecţii. Rezultate. 28% dintre copii au avut deficit ponderal, iar 24% exces ponderal. Clinic s-a identificat cel puţin un sindrom infecţios la 31,7% dintre copii, VSH fiind mărit la aceşti copii comparativ cei clinic sănătoşi (p = 0,034); nu s-au observat diferenţe în acest sens în cazul celorlalţi markeri serologici. S-au observat valori ale IL-6 şi IL-8 scăzute sub limita de detecţie, în special la copiii subponderali cu diagnostic de sindrom infecţios, şi valori crescute ale IL-6 si IL-8 la copiii supraponderali cu diagnostic de sindrom infecţios asociat. Concluzii. Interleukinele au valori semnificativ scăzute la copiii subponderali, chiar în contextul unei eventuale infecţii. Pentru a confirma sau infirma prezenţa unui sindrom infecţios nu este suficientă aprecierea clinică, ci este necesară coroborarea cu date complexe de laborator. [ABSTRACT FROM AUTHOR]

Cazurile de hidronefroză gigantă sunt rare şi, de obicei, nu conţin mai mult de 1-2 litri de lichid în sistemul colector. Prezentăm un caz de hidronefroză gigantă însoţită de hipertensiune arterială (HTA) tranzitorie secundară. Cu ocazia unui examen de rutină, unui pacient de 14 ani, supraponderal, i-au fost descoperite valori crescute ale teniunii arteriale. Istoricul medical a fost nesemnifi cativ. Ecografia abdominală a evidenţiat o tumoră chistică gigantă ce ocupa peste 50% din cavitatea abdominală. Deşi simptomele clinice cât şi examenul fizic au fost sărace, iar iniţial HTA părea indusă de obezitate, în cele din urmă HTA s-a dovedit a fi secundară hidronefrozei gigante. Prin urmare, diagnosticul diferenţiar al unei formaţiuni abdominale chistice, chiar şi în absenţa altor patologii evidente, ar trebui să includă o posibilă hidronefroză. [ABSTRACT FROM AUTHOR]

Introducere. Statusul nutriţional, reprezentat de compoziţia corpului, este un considerent important în tratamentul pacienţilor pediatrici oncologici deoarece influenţează evoluţia bolii. Obiectiv. Ne-am propus să evaluăm comparativ statusul de nutriţie la copiii cu boală malignă la momentul diagnosticării bolii faţă de copiii cu afecţiuni nononcologice. Material şi metodă. Am efectuat un studiu prospectiv pe un număr de 90 de copii internaţi în Clinica Pediatrie I Tg- Mureş în perioada noiembrie 2009 - iulie 2011. Copiii au fost împărţiţi în două loturi: lotul I, reprezentat de copii cu boală malignă (35 copii) şi lotul II - martor, reprezentat de copii cu diverse afecţiuni pediatrice (55 copii). Am efectuat măsurători antropometrice şi biochimice: greutatea, înălţimea, indicele de masă corporală, perimetrul mediu al braţului, pliul cutanat tricipital, proteine totale şi albumine serice, IGF-1, colesterol total, trigliceride şi sideremie. Am urmărit comparativ parametr ii antropometrici şi biochimici la cele două loturi şi am efectuat corelaţii statistice. Rezultate. Greutatea şi înălţimea copiilor din lotul I a fost mai mică faţă de lotul II, fără o diferenţă semnificativă statistic (p>0,05). Am constatat o diferenţă semnificativă statistic în rândul parametrilor antropometrici ai braţelor: perimetrul mediu al braţului - MUAC (-1,58 DS la lotul I şi -0.74DS la lotul II) cu p=0,022 şi pliul cutanat tricipital -TSF (-1,34 DS la lotul I şi -0,76 DS la lotul II) cu p=0:05. Urmărind parametrii biochimici, am observat o diferenţă semnificativă statistic (p<0,05) între cele două loturi în ceea ce priveşte valoarea proteinelor totale, albuminele serice şi IGF-1, sideremia şi trigliceridele. Concluzii. Studiul demonstrează că pacienţii diagnosticaţi cu cancer prezintă status nutriţional precar faţă de pacienţii nononcologici; parametrii antropometrici ai braţelor, coroboraţi cu parametrii biochimici reflectă cel mai bine compoziţia corporală. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to suggest a new technique for the ultrasound assessment of fetal facial bones at the end of the first trimester and the beginning of the second gestational trimester. Material and method: The study was conducted over a period of 6 months, between October 2010 and March 2011, on a number of 52 acquired fetal 3D volumes, stocked by the same operator, on fetuses with normal echo structure, from unique pregnancies. The cohort of 52 fetuses had the gestational age between 12-14 weeks. Ultrasonographies were made at 16-17 weeks and 22-24 weeks. The methodology for the evidence of primary palate and maxillary alveolar used a 3D multiplanary ultrasonography technique "Face Reverse View" with Maxi IP and Skeletal Rendering. Results: Practically, in all volumes the presence of the jaw with alveolar ridge and primarly palate as single, uninterrupted structure has been documented. Conclusions: The usage of Skeletal Rendering can provide further information at the level of the cranial bone, especially in the first half of pregnancy. [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]

Malnutrition is a prevalent condition in hospitalized children. Our aims were to evaluate the nutritional state and to validate the STRONGkids risk assessment tool in a hospitalized paediatric population in Romania. This is a prospective single-centre study in a tertiary teaching hospital in Romania (May 2011-January 2012). We calculated the STRONGkids score and measured the children's height and weight. Standard deviation < -2 for weight-for-height and height-for-age was considered to indicate acute or chronic malnutrition respectively. Two hundred seventy-one children were included, with median age of 5.2 years and median hospital stay of 2.01 days. Prevalence of malnutrition and severe malnutrition was 37% and 15% respectively. Using the STRONGkids screening tool, 58% of the children were found at risk of malnutrition (24% were at high risk). The kappa coefficient of agreement between STRONGkids and WHO malnutrition classification was 0.61. When a low serum protein level was used in upgrading STRONGkids risk category, kappa increased significantly to 0.71 (p = 0.001). A modified STRONGkids score, incorporating total serum protein levels, performs well in predicting malnutrition in hospitalized paediatric population in Romania.

Fetal face was the main concern of researchers who developed three-dimensional ultrasound. 3-D ultrasound beginnings date back to 1973. Parallel concerns of researchers from different parts of the world have led to a constantly changing the equipment and software. 3-D images of the fetal face were obtained since 1986, but those that are available on the ultrasound devices sold today dates from 1992, and the 4-D since 1996. Techniques such as volume rendering and multiplanar volume rendering, led to the development of 3-D ultrasound. Late 2000 revealed study fetal face by multiplane three-dimensional ultrasound, through the acquisition of volume and its processing. Study of fetal profile by this method provides new data on the jaw, naso-maxillo-mandibular angle, even a diagram of the fetal profile or of dimensions of the fetal face or nasal bone length. Fetal profile analyzed by 16 parameters measured by 3-D ultrasound, with the creation of a craniofacial index variable is useful in assessing normal and abnormal fetal face. Today, the bones of fetal face--nose, jaw, bone palace, those of the orbit, can be studied in dynamics, from 12-14 gestational weeks. The best ultrasound images can be obtained after 21 gestational weeks, when fetal size and its ratio with amniotic fluid are optimal for the acquisition of fetal volume.